الفهرس 
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Abstract
Psoriasis is a major significant worldwide health problem. It is also becoming an important item on the agenda of health of the World Health Organization (WHO). It is one of the most common skin diseases that affect millions of people all over the world. Psoriasis is a chronic disease that has no cure and has a significant negative impact on the quality of life of patients. Therefore, the disease requires systematic treatment and appropriate self-care. It is worth emphasizing that psoriatic patients need health care and education, and require certain preventative activities. Such activities should lead to the understanding of the disease state from the patients’ perspective, and should include all self-care activities aimed at the maintenance of good health as well as the prevention of complications.
Psoriasis needs an important consideration from the nurse due to long-term quality of life implications, additionally to physical and psychosocial negative consequences. Nursing is a profession whose main objective is caring. So, nurses have a prominent role not only in the treatment, but also by their educational work. Therefore, it is necessary to educate the psoriatic patients in order to equip them with the knowledge essential to enable them to undertake self-care and improve their quality of life.
The present study aimed to; assess disease-related knowledge and self-care practices of patients with psoriasis. This study was conducted at the dermatology out-patient clinic of Alexandria Main University Hospital. A convenience sample of 110 adult patients was selected from the above mentioned setting according to the following criteria:
Age from 20-60 years.
Alert, able to communicate.
Confirmed diagnosis with psoriasis.
Have no other dermatological disease.
Tools for the study:
Two tools were used in data collection
Tool I: Structured Interview Schedule for assessing Psoriatic Patients’ Knowledge about the Disease.
It consisted of two parts:
Part A: Psoriatic patients’ Socio-demographic, Medical and Clinical data.
C. Socio-demographic data as Patient’s age, sex, level of education, occupation, marital status, area of residence.
D. Medical data as past medical history: onset of the disease, presence of other diseases as (cardiovascular diseases, diabetes mellitus), family history, present medical history: current symptoms of psoriasis, course of the disease and methods of treatment.
E. Clinical data: Blood pressure, BMI (body mass index) and PASI scoring (Psoriasis Area and Severity Index), it is define as an index of the severity
(thickness, redness, scaling) and extent of body surface coverage of psoriasis. The PASI combines assessment of four body areas: head and neck (H), upper limbs (U), trunk (T), and lower limbs (L). PASI < 7 as mild chronic psoriasis; PASI (7–12) as moderate chronic psoriasis; PASI > 12 as severe chronic psoriasis (67,68).
Part B: Psoriasis Knowledge Questionnaire (PKQ)
PKQ was adopted from Wahl et al )2013( (99). It was used to measure the psoriatic patient s’ knowledge about the disease; PKQ consisted of 49 statements about psoriasis, pertaining to knowledge related to basic facts of psoriasis (8 items), triggering factors (11 items), disease process (5 items), disease comorbidities (3 items) and knowledge related to treatment aspects (22 items). The study participants were requested to give “true, false or do not know” responses. One score was given for every correct answer and zero was given for every wrong answer or don’t know.
Tool II: Structured Interview Schedule for assessing psoriatic patients Self-care practices.
It was developed by the researcher based on review of the related literature (35,89,91) to elicit self-care practices of patients with psoriasis. It consisted of 31questions about how psoriasis patients take care of their skin; it includes the following items:
4. Self-care practices regarding personal hygiene (bathing).
This part included eight questions about the guidelines which the patient must follow during bathing as daily bathing, use warm water, avoid hot bath, use bath oil or emollient cleansing has a moisturizing effect, avoid using scented soap or other irritating shampoo, wash skin gently and dry skin by patting not vigorously rubbing.
5. Self-care practices regarding skin care
This part included seven questions regarding care of psoriatic lesions as keep skin moist, apply a moisturizer regularly, avoid scratching psoriatic lesions, trim nails regularly, daily short non-burning exposure to sun light, wear cotton clothes and avoid wearing clothing made of wool or synthetic fiber.
6. Self-care practices to prevent exacerbation of psoriasis (psoriasis flares)
This part included 16 questions regarding prevention of psoriasis flare, it included:-
Managing psoriasis triggers which include (emotional stress, smoking, skin injury, exposure to cold or dry weather, obesity, and exposure to streptococcal infection)
Diet modification as increase fluid intake, gluten-free diet, increase intake of fruits and vegetables , increase intake of food rich in(Omega-3 fatty acids, Zinc and vitamin D), avoid (chili, hot spices, junk foods and heavy meals).
This study was conducted using the following steps:
9. Official approval to carry out the study was obtained from the hospital responsible authorities at the previously mentioned research settings after explanation of the study objective.
10. Two tools were used to collect data. Tool I part II was adopted and Tool II was constructed by the researcher depending on the related literature.
11. Both Tool I and Tool II were translated into Arabic language and the content validity of the tools was tested by five experts in the field of Medical-Surgical nursing and Dermatology to test validity, correction, completeness, and clarity of items. Comments and suggestions of the jury were considered and the tools were modified accordingly.
12. The pilot study was applied on 10% patients to test the clarity and applicability of the tool, and necessary modification was done accordingly.
13. The reliability of tools was tested by using Cronbach’s Alpha test. Reliability coefficient value for tool I was 0. 87and for tool II was 0.75
14. Ethical considerations: Patients’ consent was obtained after explanation of the aim of the study, confidentiality and privacy were assured, and patients’ right to withdraw from the study was respected.
15. Each patient was interviewed individually by the researcher in the morning shift for 30 - 45 minutes for each session. Data was collected in a period of 6 months started from January 2017 to end of June 2017.
16. Statistical analysis: data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp). Qualitative data were described using number and percent. Quantitative data were described using range mean, standard deviation. Significance of the obtained results was judged at the 5% level.
The main result of the study:
• One third of the studied patients 33.6% were in the middle age (40-49) years, while 18.2% of the total sample was in the age group of (20-29) years old.
• More than one half of the studied patients (56.4%) were males.
• Illiterate patients represented more than one half of the studied patients (53.6%).
• Married patients represented more than one half of the sample (61.8%).
• Housewife represented more than one third (38.2%) of the sample.
• The majority of patients (74.5%) were from urban areas.
• More than half of the studied patients (58.2%) reported enough family income.
• The majority of the studied patients (88.2%) had plaque psoriasis.
• More than half of the studied patients (58.2%) complain of psoriasis since more than 10 years.
• More than one third of the studied patients (34.5%) reported positive family history with psoriasis.
• More than two fifth of the studied patients (43.6%) reported that they complain of other health problems. The majority of patients who had associated diseases (83.3%) had cardiovascular diseases, while 72.9% had arthritis, and 50% of them had diabetes.
• The vast majority of the studied patients (92.7%) complained of scaling and 90% of the sample complained of itching. Redness of the lesions was observed among 82.7% of the sample. Also, more than three quarter (79.1%) of the patients mentioned that they suffering from burning pain.
• More than half of the studied patients (53.6%) complain of insomnia, nearly half of the sample (47.3) reported fatigue.
• The vast majority of the studied patients (89.1%) mentioned that they were suffering from psychological problems due to psoriasis.
• More than one half of the studied patients (51.8%) reported that psoriasis negatively affect their sexual relation.
• More than one half of the studied patients (52.7%) mentioned that they did not comply with current treatments.
• More than three quarter of the studied patients (76.4%) had poor knowledge level.
• More than two third of the studied patients (68.2%) had poor self-care practices.
• There was highly statistically significant correlation between patients’ level of knowledge and their education (p= <0.001).
• There was highly statistically significant correlation between patients’ self-care practices scores and their educational level (p= <0.001).
• There was highly statistically significant indicated positive correlation between knowledge and self-care practices scores of the psoriatic patients (p= <0.001).
The main recommendations are:
• An educational program should be implemented to each psoriatic patient regarding disease knowledge as (basic facts of psoriasis, triggering factors, disease process, complications and treatment).
• A colored illustrated booklet should be available and distributed to each patient about psoriasis self-care as (guidelines of hygienic care, Skin care, avoiding psoriasis triggers, psoriasis diet).
• Nurses should receive updated educational program about self-care practices of psoriasis.
• Study the effect of recommended self-care program on the patients’ health related quality of life.
• Assessment of health care needs of patients with psoriasis.
• Assessment of factors affecting psoriatic patients’ compliance with treatments.