الفهرس 
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Abstract
Venous thromboembolic (VTE) disease is a term encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE). Deep venous thrombosis is a common vascular condition that arises from the formation of a blood clot within the deep veins of the circulatory system. Most of the literature and international guidelines on VTE emphasize that prevention is more important and cost-effective than treatment. A prior history of deep venous thrombosis, age over 60 years, obesity, immobility, thrombophilia ,venous disorders, pregnancy, the combined oral contraceptive pills and hormone replacement therapy are considered the most important risk factors that increase the probability for DVT.
Learning needs for DVT patient to increase their awareness about the risk factors, signs and symptoms, self-diagnosis, preventive measures, active involvement in management, and importance of adherence to treatment and health behaviors promote safe and high-quality patient care.
Patient teaching is accepted as an integral part of the nursing practice; the teaching process can be seen as parallel to the nursing process in that each has an assessment, diagnosis, goal, intervention, and evaluation phase. The nurse bears the primary responsibility for assisting the patient to verbalize his learning needs as he sees them and for the identification of additional information needs implied in observable behavior, since she has the most extensive contact with the patient.
The present study aimed to:
Identify learning needs of patients diagnosed with deep venous thrombosis. This study was conducted at the Inpatient Medical Departments of the Alexandria Main University Hospital and Alexandria Vascular Center (AVC). A convenience sample of 133 adult patients with deep venous thrombosis admitted to the above mentioned settings and meeting the following criteria was included:
4. Adult patients from age 21 to 60 years.
5. Patient confirmed diagnosed with deep venous thrombosis.
6. Able to communicate verbally.
Tool for the study:
Learning needs of patients with Deep vein thrombosis Structured interview schedule.
This tool was developed by the researcher based on review of relevant literature (15-30) to identify the deep venous thrombosis patient’s learning needs. It included three parts:
Part I:
This part was divided into two sections:
3. Socio demographic data:
This part was used to collect patient’s personal data such as: sex, age, educational level, occupation, marital states, area of residence and income.
4. Clinical data
It was utilized to obtain information about clinical history for patients and their families which included patient history: such as present history: current symptoms of deep venous thrombosis, associated diseases, prescribed and over the counter medications. Past history: past medical and surgical history, data related to previous hospitalization, family history: such as history of deep venous thrombosis.
Part II:
This part addressed learning needs of deep vein thrombosis patients; it constituted knowledge related to nature of the disease, line of treatment to identify patient’s knowledge related to medical, surgical management.
Part III:
This part was composed of two main items with ten questions with fixed alternatives. It was used to assess patient’s knowledge in relation to the following items:
Preferred source of knowledge as doctors, nurses, relatives, other patients, media and preferred methods of knowledge & advices as written, oral, photos.
The most important learning needs related to patients activity daily living affection regards sleeping pattern, work and their psychological status.
Development of the study tool:
The study tool was developed by the researcher after extensive reviewing of relevant literature. The content of constructed tool was revised by a jury of 5 experts in the field of Medical Surgical Nursing Department of the Faculty of Nursing at Alexandria University to test content validity, relevance, completeness, and clarity of items. Comments and suggestions of jury were considered and the tool was modified accordingly.
Data collection:
A convenience sample of 133 adult patients with DVT who met the inclusion criteria of the subject were selected from the mentioned setting, then every subject was interviewed by the researcher individually to collect the necessary data related to patients’ learning needs adopted by patients. Each interview took from 30-45 minutes.
Method of the study
The developed tool was tested for content validity by five experts in the field of medical, surgical nursing for content validity, correction and clarifying of needed items was done. A pilot study was conducted before the actual study and was done on 15 patients with deep venous thrombosis to test the clarity and applicability of the tool as well as necessary modification was done.
Statistical analysis:
After completion of data collection, statistical tests were done using the Statistical Package of Social Sciences (SPSS, version 18) for both data presentation and statistical analysis of the results.
• The numbers and percentage were used for describing and summarizing qualitative data. Mean and standard deviation were used to present the quantitative data.
The main results of the study:
• More than half of the studied patients (64.7%) were in the age group of 50-60 years.
• The majority of the studied patients (67.7%) were males.
• Illiterate patients formed 33.1% of the studied patients
• Manual workers represented 45.9% of the studied patients.
• The majority (88%) of the studied patients were married
• About two thirds (62.4%) of the studied patients lived in rural area.
• Study subjects with enough family income represented the highest percent (91.7%).
• The highest (63.2%) of the studied patients were receiving their treatment at university free hospital.
• Study subjects with hypertension represented 22.6% of the studied patients.
• More than two thirds (72.9%) of the studied patients were diagnosed with DVT when the severity of symptoms increased.
• Pain and weakness of calf muscles, limb edema, redness of limb, hotness of limb, impaired physical mobility and positive Homan’s sign were the most common signs and symptoms reported by the studied patients (100%, 97%, 82.7%,82.7%,85%, and 97% respectively).
• More than one third (40.6%) of the studied patients had one previous hospitalization.
• The majority (89.5%) of the studied patients had no history of previous DVT.
• The majority of patients (89.5%) had no family history of DVT.
• Regarding DVT disease nature the studied patients had poor knowledge level regarding meaning of DVT, causes, risk factors, the signs & symptoms , the diagnostic procedures to confirm DVT, disease complications and the health practices in the treatment (42.1%, 62.4%, 46.6%, 6.8%, 57.1%, 16.5% and 27.1% respectively).
• Majority of patients (93.2%) know action of prescribed medications.
• More than two thirds (62.4%) of the studied patients had poor knowledge level regarding knowing side effects of prescribed medications, 69.2% regarding tests that should be followed during treatment, and 78.3% regarding patient`s precautions during treatment.
• All studied patients had knowledge regarding, types of surgery, preoperative preparations but incompletely, as well as 100% of them not had knowledge regarding breathing and limb exercises
• Three quarters (75%) of the studied patients had poor knowledge level regarding complications of immobility for long periods, moreover 62.5% of them had poor knowledge level regarding preventive measures of these complications.
• The majority (80.5%) of the studied patients had poor total knowledge level.
• All studied patients considered physicians as the main source of their knowledge, while a small number (28.6%) of them referred to nurses as their knowledge source.
• Anxiety, decreased ability to work due to fatigue and ongoing concern of family members were the most psychosocial status affection reported by the studied patients with (62.4%, 60.9%, and 100% respectively).
• Statistically significant relation was found between patients’ knowledge level and age (p = 0.026), educational level (p = 0.022), nurses as a source of knowledge and advices (p = 0.002), also a nurse as preferred source of knowledge and advices (p < 0.001).
The following were the main recommendations based on the findings of the present study, the following recommendations are suggested:
3. Development and application of educational sessions for patients to improve their knowledge about DVT in order to comply with treatment method and to prevent recurrence of DVT.
4. Increase patient’s awareness about DVT through mass media. Disseminate health knowledge through posters, photos, video, and booklets as educational directed to DVT patients that help to meet learning needs for patients with DVT.
5. Nurses should receive updated educational program about the learning needs for patients with DVT.
6. Develop of a health program for DVT patients about DVT managements and prevention of disease recurrence.