الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 221 |  |  |
| | | from | 221 | | |
Abstract
chronic kidneydisease is an increasingly prevalent global problem; especially long-term hemodialysis therapy imposes a huge degree of burden on patients, family caregivers and the health care system. Family members of patients undergoing dialysis act as a partner in the process and are considered as the personal caregivers of patients. They are more affected by the dialysis process in hospitals compared to others, so, the caregivers of dialysis patients have a much lower quality of life. At the same time, patients‟ physical health, functional status, personal relationships, social and economic prosperity are greatly affected. Family-centered empowerment is a process through which the family acquires knowledge and skills so that it can manage family life optimally and consequently enhance the family members‟ lifestyles and QoL. Aim of the study: The aim of this study was to evaluate the effect of an education intervention based on family-centered empowerment model on the quality of life of hemodialysis patient and their caregivers. Subjects and Method Study design: A quasi-experimental research design was utilized in this study. Study settings: This study was conducted at dialysis unit at Tanta University Hospitals and Kafr El- Sheikh University Hospital. Each unit of hemodialysis at Tanta University Hospitals and Kafr El-Sheikh University Hospital consists of 10- 13 hemodialysis (HD) active stations. On average, there were 20–25 HD patients dialyze each day. (Working in a three-shift system: morning, afternoon and night). Study subjects: A random of sample of 60 patients with chronic renal failure and their caregivers (30 patients and their caregivers from Tanta university hospitals and 30 of them from Kafr El-Sheikh University Hospital). Tools of the study:- Seven tools were used in this study (three tools for patients and four tools for caregivers) by the researcher to obtain the necessary data:- Patient’s tools include: Tool I: Structured interview schedule: it included the following parts: - Part 1: Socio demographic characteristics of the hemodialysis patients: - This included data about age, gender, marital status, level of education, occupation, income and its source, and place of residence. Part 2: Health history of the hemodialysis patients: - It included data about past and current health history of the patients as : hospital admission ,number and cause of previous hospitalization, history of chronic diseases and types of medication taken for it, history of kidney disease, onset, duration of disease, affected side, types of treatment, and medication received . Tool II: chronic Kidney Disease Self-Efficacy Instrument (CKD-SE) (110) . This tool was developed by Lin (2011) and adopted by the researcher used to assess patient’s self-efficacy to deal with the disease to assess the person confidence in his /her ability to overcome barrier in order to perform disease specific self-management behavior. The chronic kidney Disease Self-Efficacy (CKD-SE) instrument included a 25-item self-reported questionnaire. It consisted of four subscales: autonomy (8 items), self-integration (7 items), problem solving (6 items) and seeking social support (4 items). Scoring each item was rated on 4 point which was ranging from one (least relevant) to 4 (most relevant). The total score ranged from 25-100. Tool III: World Health Organization Quality of life-BREF (WHOQOL-BREF) (111): WHOQOL-BREF was an abbreviated generic Quality of Life Scale developed by the World Health Organization in the year 1997. It was adopted by the researcher in this study. The WHOQOL-BREF instrument comprised 26 items. The twenty-six standard items contained two generic items (over all QOL and general health) and remaining twenty four items could be further classified into four domains: physical domain (7 items), Psychological domain (6 items), social relationship domain (3 items) and environmental domain (8 items). The score ranged from 26-130. The score 26 refers to the worst possible QOL and the score 130 referd to the best possible QOL. Caregivers’ tools include: Tool IV: A Structured interview schedule (112,113,114): It included data about socio-demographic characteristics of the patient’s family caregivers such as: age, sex, marital status, occupation, level of education kin relation with the patient, number of children, health problems, other burden on family caregivers as other patient in family and the duration that he / she offering care to the patient. Tool V: Scale of General Self-Efficacy (GSE) for measuring Caregiver Self -Efficacy(115). General self-efficacy (GSE): The SGSES (Sherer et al., 1982) was a Likert format 17-item scale (example of items include: “When I make plans, I am certain I can make them work “, “I give up easily “, “I am a self-reliant person “, “I avoid facing difficulties”). The response format was a 5-point scale (1 = strongly disagree, 5 = strongly agree). It was adopted by the researcher in this study. Total possible scores ranged from 17 to 85, with a higher score indicating a deeper belief in one‟s ability to succeed in performing one‟s duties. Tool VI: Zarit Burden Interview(ZBI) (116,117) : This tool was used to assess burden of caregivers. It was originated as 29-item questionnaire by Zarit, Reever, Bach-Peterson, 1980. Then it was revised and modified by Herbert et .al.,(2000) to contain 22 items such as (Do you feel that your relative asks for more help than he/she needs and Do you feel embarrassed over your relative’s behavior ? ) . It was adopted by the researcher in this study. Each item on the interview was a statement, which the caregiver was asked to endorse using a Likert 5-point scale. Response options ranged from 0 (never) to 4 (nearly always). ZBI total score ranged from 0 to 88. Tool VI: The Adult Carer Quality of Life Questionnaire (118) . The Adult Carer Quality of Life Questionnaire (AC-QoL) developed by Elwick et al., (2010) and it was adopted by the researcher. the AC-QoL Questionnaire was a simple instrument for use with adult carers that measures the overall quality of life for adult carers, and subscale scores for eight domains of quality of life: support for caring; caring choice; caring stress; money matters; personal growth; sense of value; ability to care; and carer satisfaction. Each domain consisted of five items. The AC-QoL Questionnaire consists of 40 items that had a four-point Likert format that ranged from 0 (never), 1 (sometimes of the time), 2 (A lot of the time), and 3 (always) for the following questionnaire items: (1- 5), (17- 18), (20-36),( 39, 40) and 3 (never), 2 (sometimes of the time), 1 (A lot of the time), and 0 (always) for the following questionnaire items: (6- 16), 19, 37 & 38. Scoring system of the Adult Carer Quality of Life Questionnaire: - The total score was obtained by summing responses to each item of the questionnaire. Scores on the overall questionnaire had a possible range of 0 to 120 with higher scores were indicating greater quality of life. The implementation of the program was as follows: The field work of this study started from junurary 2020 to novmber 2020, about 11 months. The program was explained throughout five consecutive sessions with the duration of 45- 60 minutes for each session. The researcher was meeting the studied hemodialysis patients and their caregivers at the selected hemodialysis units, two days per week. Three assessments were done to the studied hemodialysis patients and their caregivers to test their quality of life. The first time, before implementation of the intervention program, second time, immediately after implementation of the intervention program and the third time, three months after implementation of the education intervention program. Results:- The results of the current study can be summarized as follows: The age of the studied hemodialysis patients, were ≥ 50 year with a mean of 51.3 ± 6.15. More than two-thirds of them (68.3% and 70% respectively) were male and married. Three- quarters (75%) of the studied patients were not working / housewife, and more than half of them, (56.7%) had secondary / technical education, half of them (50%) mentioned that their monthly income was not enough and brow, slightly less than two third (63.3%) of them were living in rural areas. More than one -third (45%) of the studied hemodialysis patients their first hemodialysis session were from 1-< 3 year, the majority (80%) of the studied hemodialysis patients were hospitalized as a result of sudden rise in blood pressure, slightly less than two -thirds (63.3%) of the studied patients suffered from hypertension and used antihypertensive drugs. One-third (45%) of them suffered from renal failure from one to three years, the majority (83.4%) of them reported that, they were performed hemodialysis session three times per week, more than two third (63.3%) of the studied hemodialysis patients received antihypertensive drugs. There was a significant improvement in autonomy, self-integration, problem solving and seeking social support of the studied hemodialysis patients post implementation of educational intervention program with a highly statistically significant difference at (P= < 0.01) between pre, immediate and three months post educational intervention program. There was a significant improvement in the mean score of total self-efficacy of the studied hemodialysis patients post implementation of an educational intervention program and three months post from(63.52±15.15 to (85.93±3.84, 77.45±4.52 respectively )with highly statistically significant difference at (P= < 0.01) between pre, immediate and three months post of an educational intervention program. More than half (56.7%)of the studied hemodialysis patients had mild a self-efficacy at pre- implementation of an educational intervention program. while, half of them (51.7% and 50% respectively) had a complete self-efficacy and mild self-efficacy at immediate and three months post implementation of an educational intervention program. There was a significant improvement in physical health, psychological health,
social relationship and environmental of the studied patients post implementation of an educational intervention program with a highly statistically significant difference at (P= < 0.01) between pre, immediate and three months post implementation of an educational intervention program. There was a significant improvement in total quality of life of the studied patients post implementation of intervention program with highly statistically significant difference at (P= < 0.01) between pre, immediate and three months post of intervention program. Social relation improved from5.67±3.72 pre intervention program to 13.47±0.98 immediate post intervention program and11.95±1.01 three months post intervention program. Also ,environmental domain improved from 15.36±4.04 pre educational intervention program to 34.69±0.99 immediate post intervention program and 33.93±1.09 three months post intervention program There was improvement of the total score of physical activity during pre, immediate and three months post program intervention. As, the mean scores of physical activity of the studied women increased from 48.69±6.95 in pre-program intervention to 67.13+11.79 immediate post-program intervention, and 60.28±12.73 three months post-program intervention. More than three- quarters, (76.7%) of the studied patients had a poor quality of life at pre implementation of intervention program. While, the majority (80% and 75% respectively) of them had a good quality of life at immediate and three months post implementation of intervention program. Regarding studied caregiver age, slightly more than half (51.7%) of them their age
was 20-<30 year with a mean of 32.9 ± 0.95 year, the majority (80%) of them were male, half (53.3%) of them were married, slightly more than two - third (71.7%) of them were working the majority (86.7%, 80% respectively) of them didn‟t suffer from any health problems There was a significant improvement in caregivers` self-efficacy as when they set important goals for themselves, they achieve them and they didn‟t give up on things before completing them there was a marked improvement in caregivers` self-efficacy as when they expected problem to occur, they handle them well and they didn‟t give up easily post implementation of an educational program post implementation of intervention program with a highly statistically significant difference at (P=<0.01) between pre, immediate and three months post implementation of intervention program. More than half (56.6%) of the studied caregivers had complete self-efficacy immediate implementation of an educational intervention program and more than one- third ( 36.7% and 38.3% respectively ) had a mild self-efficacy immediate and three months post intervention program. There was a significant improvement in the levels of self-efficacy of the studied caregiver post implementation of an educational intervention program with highly statistically significant difference at (p=< 0.01) between pre, immediate and three months post intervention program. The mean score of caregivers‟ burden as feeling stressed between caring for their relative and trying to meet other responsibilities for family or work from 3.45±0.43 in pre intervention program to 1.46±1.78 immediate post intervention program and 1.61±0.75 Three months post intervention program, there was a marked decreased in the mean score of feeling that social life has suffered because caregivers are caring for their relative from 3.62±0.23 in pre intervention program to 1.51±0.97 immediate post intervention program and 1.71±1.08 three months post intervention program. There was a significant decreased in caregiver` burden as decrease feeling that their social life has suffered because they are caring for their relative and decrease feeling of uncertain about what to do about their relative post implementation of intervention program with a highly statistically significant difference at (P=<0.01) between pre, immediate and three months post intervention program. Half of the studied caregiver (50%) had moderate burden at pre implementation of intervention program. While , more than half (55%) and about more than one- third (48.4%) of them had a mild burden in immediate post and after three months post intervention program , There was improvement in overall quality of life of the studied caregivers as support of caring percentage (18.3%,56.7%&50% respectively) in pre, immediate post and three months post intervention program. Also, percentage of the ability of care improved (26.7%,55%&50 respectively) in pre, immediate post and three months post intervention program. The mean score of overall quality of life improved from 78.34±7.10 in pre intervention program to 101.04±0.97 immediate post and 92.55±3.23 three months post intervention program. There was a significant improvement in overall quality of life of the studied caregivers post intervention program with a highly statistically significant difference in pre, immediate post and three months post intervention program (P= < 0.01). More than half (56.7%) of the studied caregiver had low quality of life in pre intervention program, more than one- third (48.3%, 43.3%respectively) of them had high quality of life in immediate post and after three months post an educational intervention program. There was a positive correlation between total score self-efficacy of the studied caregiver and their total score of burden and overall quality of life for adult carers at post intervention program at(P= < 0.000). Conclusion: Based on the findings of the present study; it can be concluded that, the educational intervention program based on family centered empowerment model was effective and quality of life of the studied hemodialysis patients and their caregivers were improved after implementation of the program . Furthermore a significant improvement was observed in overall quality of life among the studied hemodialysis patients and their caregivers throughout the study phases. Moreover ,there was a marked decreased in caregivers` burden and marked improvement in the levels of self-efficacy of the studied caregiver post implementation of intervention program than the preprogram. Recommendations Based on the results of the present study, the following recommendations were suggested: 1. Educational intervention programs based on family centered empowerment model should be established in all hemodialysis units to all hemodialysis patients and their caregivers regarding to improve their quality of life and reduce complications. 2. Written instructions about hemodialysis in the form of booklet or brochures should be provided to each patient and their family caregivers at all hemodialysis units. 3. Public health sectors should establish awareness campaigns directed to high risk group for hemodialysis to improve their knowledge regarding ESRD. 4. Mass media programs are needed to help in disseminating information about renal failure, hemodialysis and its complications to a large sector of community. 5. Self-care management of ESRD geriatric patients to be included in the geriatric nursing course. 6. In service heath education programs to be planned by the faculty staff members of nursing department and offered o regular basis to the nurses at all hemodialysis units. The program should include knowledge and practices of the personal case management of ESRD patients recommended for hemodialysis.