الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 268 |  |  |
| | | from | 268 | | |
Abstract
Bone marrow (BM), considered 5th largest organ of the
human body, the chief function is hematopoietic, providing the
optimal supply of circulating platelets, white and red blood cells
to meet the body’s requirements for coagulation, immunity, and
oxygenation Bowden, etal.,(2015) Allogeneic(Allo) is the type of
transplantation involves uses of donor stem cells which donated
from a related or unrelated donor siblings have the potential to
match the CL’s tissue type most closely, because both the have
received the genes from the same parents, however, siblings do
not always have closely matched tissue types Vanel, etal., (2016)
Regarding Rehabilitation Steiner, (2016) mention that
rehabilitation may be summarized as meaning to integrate or reintegrate
physically, sensorially, mentally and/or psychologically
impaired people into as full and as normal life roles as is possible,
in additionally, rehabilitation implies an understanding of the life
role expectations of the particular individuals had been fully ablebodied.
Rehabilitation includes all measures aimed at reducing the
impact of disability for an individual, enabling him or her to
achieve independence, social integration, a better quality of life
and self actualization.
Aim of the study:
The Study Aims to:
Evaluate the effect of rehabilitation for adult clients
discharged post BMT. This aim was achieved through
fulfillment of the following objectives.
Summary
Page 121
1) Assessing knowledge, problem and needs of the client
post receiving bone marrow.
2) Assessing the degree of client’s adjustment on fulfillment
of their needs.
3) Designing and implementing rehabilitation program for
client post receiving of bone marrow.
4) Evaluating degree of rehabilitation after implementation
the program.
Research Hypothesis:
Rehabilitation program will affect client’s knowledge and
practices through activity of daily living.
Rehabilitation will improve degree of adjustment for discharged
client post BMT.
Subject and methods:
Design:
A Quasi-experimental study design was be used to evaluate
the effect of rehabilitation for discharged adult clients post BMT.
Settings:
The selected health setting was at Out- patient clinic for post
BMT CL which affiliated to Oncology Center at Naser Instituted
Hospital.
Summary
Page 122
Sampling:
A purposive sample was being selected, medical record study
showed that number of cases over the past five years was 842
subscribes CLs received Allo transplanted were recorded from
2008-2013, a proportion of 10% was be selected randomly to
represent the sample subjects. Estimated number is equal to 85
clients. Data collection started from the beginning of February
2015 till the end of May 2016 from the previously mentioned
setting, with the inclusion criterion of being adult CLs over 18
years, received Allo BMT, regardless of disease origin and CLs
already discharged from the hospital. The CLs were selected
according to their agreement to participate and complete the
program.
Sample Technique:
The techniques of selection had be carried out as follows: all
CLs who meet the set of inclusive criteria had only be involved in
the study sample; the first case selected after the researcher’s
arrival at morning during the clinic working day, and then select
each third CL; if one doesn’t meet the criteria, and next CL had
chosen; Approximately 5 CLs had be interviewed in each of the
working days. This process had be continued by the researcher
until the sample size is achieved.
Tools of Data Collection:
The data for this study were collected by using two main tools:
1. The First Tool Structure Interview Questionnaire Forms
Summary
Page 123
A Structured Interview Questionnaire for Post Transplant Client: It
was developed by the investigator based on the review of literatures
and expert opinions; it is composed of five main parts to collect the
following:
Part I. The Socio-demographic characteristics of the client.
Part II. Knowledge about BMT
Part III. Adjustment to Anxiety and Distress Scale
Part IV: Assessment of Client Activities of Daily Living:
Activities of daily living
Part V. Checklist to Assess Home Safety Environment: as report
by client.
2. Second Tool:
Part I: Medical record to study items indicating CL prognosis
Part II: Checklist to assess Problem and need checklist.
Result:
The result of the study revealed the following:
o Around two third of post BMT CLs (75.3%) knowledge
had satisfactory choices regarding meaning of BM,
o The majority of post BMT CL s (87.1%) state correct
choice for the meaning of transplant.
Summary
Page 124
o The majority of post BMT CLs (80.0%) had correct
choices regarding the most serious complication post
transplant chronic Graft versa host disease.
o The majority (82.4%) of post BMT CLs had adherent to
recommend nutritional.
o The majority (87.1) of post BMT following immune
suppression medication.
o The majority (85.8%) of Post BMT use prescribed
medication,
o less than two thirds (62.4%) of CLs post BMT had skin
change as a common problem post transplant.
o less than half (47.1%) of post BMT CLs expresses fatigue
as a common problem post program.
o less than two quarters (78.8%) of post BMT CL s had Pets
and birds inside the home.
o Around majority (87.1%) BMT CLs had night light,
o The majority (90.6%) of post BMTCLs using mask as
protective measure.
o The majority (80.0%) of post BMT had used liquid hand
soap and changed weekly.
o Around one third (37.7%) of Post BMT CLs were
completely dependent in perform bathing.
Summary
Page 125
o Around one third (38.8%) of post BMT CL s had
performed exercise partially dependent.
o Around one third (32.9%) had partially dependant in
adherent of medication,
o Around one quarter (21.1%) of post BMT CL s perform
shopping dependently.
o Around one third (38.8%) always using religious
counseling.
o Less than two thirds (60.1%) of post BMT CL s had never
sharing the problem with another had same situation.
o Less than two thirds (62.3%) of post BMT CLs sometimes
find negative alternative solutions to the problem.
o Around half (49.4%) of post BMTCL s always behave
nervously,
o There was statistically insignificant different relation
between knowledge score level of post BMT CL and
dependency level through activity of daily living score level
(X2 =.015 @ p< 0.005).
o There was statistically insignificant different relation
between score level of positive adjustment and score level of
dependency level through activity of daily living of post
BMTCL (X2 =.008 @ p<0.005).
o There was statistically insignificant different relation
between score level of negative adjustment and score level
Summary
Page 126
of dependency level through activity of daily living of post
BMTCL (X2 =.694 @ p< 0.005).
o There was statistically insignificant different relation
between knowledge score level of post BMTCL and Score
level of positive adjustment (X2 =.147 @ p< 0.005).
o There was statistically insignificant different relation
between knowledge score level of post BMTCL and score
level of negative adjustment (X2 =1.620 @ p< 0.005).
o There was statistically insignificant different relation
between knowledge score level of post BMTCL and Score
level of home environment (X2 =.926 @ p<0.005).
Conclusion and Recombination
Conclusion
In the light of the present study findings and research
hypothesis, it could be concluded that less than half of post BMT
CL represented age group range from 20-<30years, less than two
thirds were male, one third of them were secondary school or
equal, two third of post BMT CLs were resident in rural area, less
than half transplanted duo to Acute Myeloid leukemia, more than
half diagnosed since 1-<3 years as well, around half were
nonsmoker.
Regarding past medical history and family, less than one
thirds had hepatitis C positive, for post BMT CL’s knowledge
majority had correct choices regarding most serious complication
acute GVHD post program, yet the difference were statistically
Summary
Page 127
significant different =x2
28.79 at p>0.000as well as, S&S of GVHD
more than half pre program in relation to majority post program,
yet the difference were statistically significant different =x2
24.11
at p>0.000.
On the other hand, majority of CLs had carried out properly
their needs in adherent to follow body weight one tenth
preprogram to the majority post program the difference were
statistically significant different =x2
52.09 at p>0.000, while for
counseling for travelling one third follow instruction properly pre
program and around two thirds post program the difference were
statistically significant different =x2
32.66 at p>0.000.
Concerning adjustment which common always adopted
between post BMT CLs, more than one third of sample subject
practice exercise as positive approach to released stress the
difference were statistically significant different =x2
40.92 at
p>0.000, also, for find meaning or reasoning the difference were
statistically significant different =x2
43.67 at p>0.000. But for
common negative pattern , find alternative solution less than one
tenth always practices post program comparing to less almost
half per program the difference were statistically significant
different =x2
54.58 at p>0.000 type of CLs try to get rid the
problem from mind.
Regarding first research hypothesis: rehabilitation program
hadn’t affect CL’s knowledge, but for practices through ADLs,
there were statistically significant difference in some practices
such as changing position,moveing from bed and travelling
between per&post program implementation, yet the statistically
difference between knowledge and practices were not significant
Summary
Page 128
=x2
015 at p> 0.005.Additionally, for second research hypothesis,
Rehabilitation hadn’t affect degree of adjustment for discharged
CL post BMT, were not significant =x2
015 at p> 0.005