الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Asthma is chronic inflammatory disorder of the airways that causes airway hyperresponsivness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms. Asthma needs more attention to control symptoms and to prevent exacerbations. Each patient has different causes of exacerbations, and different self management plan that describe ways to achieve asthma control, reinforcing baseline medications, and quickly intensify therapy when asthma starts to worsen. The nurse can address patient and family concerns about asthma and asthma treatment; developing treatment goals; selecting medications collaboratively with the physician, patient, and family; and encouraging self monitoring.
The aim of this study was:
To determine the effect of implementing self management protocol on asthma control level and activities of daily living among patients with bronchial asthma.
Materials and method:
Research design:
Quasi experimental research design was utilized to meet the aim of the present study.
Settings:
The present study was conducted at chest inpatient and outpatient clinic of Alexandria Main University Hospital.
Subjects:
The sample of this study comprised 60 adult patients of both sexes with bronchial asthma. They assigned into two equal groups 30 patients in each group.
Tools of the study:
Six tools were used for data collection in this study:
Tool I: Biosociodemographic and Respiratory Physical Assessment.
This tool was developed by the researcher after reviewing related literature to obtain baseline data. It consisted of three parts:
Part I: Patient’s Sociodemographic characteristics.
Part II: Patients Clinical Data.
Part III: Respiratory Physical Assessment.
Tool II: Inhalers use Observational check list.
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This tool was developed by the researcher after reviewing related literature. It was used to assess how patients used their inhalers including meter dose inhalers, and dry powder inhalers.
Tool III: Assessment of Asthma Control and Severity.
This tool was developed after reviewing related literature to assess the extent to which asthmatic patients control their disease and to assess severity of asthma. It consisted of three parts:
Part I: Asthma Control Test (ACT).
Part II: Assessment of Asthma severity.
Part III: Dyspnea Assessment questionnaire.
Tool IV: Effect of dyspnea on Asthmatic patients’ Activities of daily living questionnaire.
This tool was adapted by the researcher from Manchester respiratory activities of daily living questionnaire (MRADL) developed by Yohannes et al and used to assess how dyspnea affects patient’s activities of daily living.
Tool V: Acupressure observational check list.
This tool was developed by the researcher based on a review of related literature. It was used for two purposes, the first: at the end of two weeks it was used to assess asthmatic patient competence to do acupressure alone at home, the second: at the end of the four weeks to assess asthmatic patient compliance to acupressure.
Tool VI: Asthma self management knowledge structured interview schedule.
This tool was developed by the researcher based on a review of related literature to assess asthmatic patient’s knowledge regarding bronchial asthma.
Data collection:
All available sample of 60 adult patients who followed the inclusion criteria with bronchial asthma were assigned randomly and alternatively into two equal groups 30 patients each.
group I: Study group was subjected to the self management protocol and
routine hospital care.
group II: Control group was managed according to usual hospital routine.
The study was carried out through four phases:
I. Assessment Phase:
Initial assessment was carried out for every patient in both study and control group, individually after carefully listening and documenting his / her history, in addition to assessment of patient’s asthma control level, inhalers used , activities of daily living, and patient’s knowledge related to asthma.
II. Planning phase:
Based on the data collected from the assessment phase and literature review, the self management protocol goals, priorities contents, and expected outcomes were
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developed by the researcher according to patient’s individual needs and problems. In addition, an illustrated colored booklet in Arabic language was developed by the researcher and was distributed to each patient in the implementation phase.
III. Implementation phase:
The developed self management protocol for the study group was conducted and applied individually for each patient in the inpatient chest department and was continued in chest outpatient clinic, using modified lectures, interactive discussions, demonstration-redemonstration method and colored booklet. Asthma self management protocol consisted of the following:
Patient education sessions: It provided theoretical information related to bronchial asthma through two sessions.
Correct inhalers use training: It was carried out through three sessions, one session per day for three consecutive days.
Acupressure: It was carried out twice daily for two consecutive weeks at chest inpatient unit; after two weeks each patient was asked to carry out acupressure at home.
IV. Evaluation phase:
Every Patient in the study and control group was reevaluated after four weeks using tools I, II, III, IV, V and VI to determine the effectiveness of the self management protocol.
The main results of the study were:
The majority of patients in both control and study group were among the age group (50 - 60 years).
The majority of patients in both control and study were females, illiterate, married, housewives and coming from urban areas.
The majority (80%) of the control group patients had no cats, dogs or birds at home, while the majority (60%) of the study group patients had cats, dogs or birds at their homes, with statistical significance (p = 0.001*).
The majority of patients among both control and study group had no associated diseases, hadn’t other respiratory diseases and hadn’t family history of any respiratory diseases.
More than one third (40%) of the control group patients started their disease at the age of ten to less than thirty, while more than one third (43.3%) of the study group patients started their disease at the age of less than ten years.
All patients (100%) among both groups discovered their disease as the presence of some signs and symptoms, and dyspnea was the main symptom.
More than one-third (43.3%) of the control group patients had no previous hospitalization. On the other hand, around two-thirds (60%) of the study group patients were hospitalized less than five times because of bronchial asthma.
Dry powder inhaler was the most common (56.7%) inhaler type used among control group patients, however, meter dose inhaler was the most commonly used type among the study group patients.
There was significant improvement in oxygen saturation pre and post self management protocol within the study group patients only (p=0.000*).
There was significant difference between control and study group patients post application of self management protocol in relation to inhaler technique, patient’s
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knowledge, asthma control level, asthma severity, grade of dyspnea and activities of daily living.
About half (50%) of study group patients highly complied with acupressure, followed by around one third (36.7%) who moderately complied with acupressure and a minority of patients (13.3%) poorly complied with acupressure.
The main recommendations are:
4- Patients with bronchial asthma should be instructed to follow asthma self management protocol once bronchial asthma is diagnosed.
5- Illustrated colored booklet about asthma self management should be available and distributed for all patients with bronchial asthma.
6- On-job training program should be carried out for nurses working in chest department about benefits of acupressure for patients with bronchial .asthma