الفهرس 
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Abstract
Chronic Rheumatoid arthritis( RA) is a chronic autoimmune disease. RA primarily
affects the synovial joints, resulting in pain, deformity and eventual functional limitation,
causing substantial morbidity and accelerated mortality. It also has widespread extra
articular manifestations. Therefore, RA has a significant negative impact on the ability to
perform daily activities, including work and household tasks, and health related quality of
life.
Patients with chronic rheumatoid arthritis have many questions about the nature of
the disease process, prognosis, as well as, follow up, and therapeutic maneuver. They
require educational materials that are customized to individual circumstances and level of
understanding. Key topics that should be covered in patient materials include disease
information, coping strategies, lifestyle advice, medication information, alternative
treatment options, and support services. However, it is important to determine the
understanding of the patient and family concerning the diagnostic tests, the diagnosis or
potential diagnosis, the treatment options, and the prognosis.
Self care program is a primary care intervention that has become a popular
component of management in a number of chronic conditions, including rheumatoid
arthritis, self care programs aims to achieve more than the provision of information to
increase knowledge, to improve outcomes for patients by supporting, not replacing, medical
care. Arthritis self care programs have been reported to improve pain and disability and
reduce health care costs.
The aim of the study was to:
Determine the effect of self care program on health practices among patients with
chronic rheumatoid arthritis.
Materials and method:
The study was carried out in the Rheumatology and Rehabilitation outpatient clinics
& inpatient unit of the Alexandria Main University Hospital and Rheumatology and
Rehabilitation outpatient clinics of El Hadara Orthopedic and Traumatology University
Hospital . A convenience sample of 60 patients was selected .They were included and
assigned randomly and alternatively into two equal groups 30 patients in each group.
Tools of the study:
Five tools were used for data collection in this study:
Tool I: chronic Rheumatoid Arthritis Patients Health History and
Clinical Data.
This tool was developed by the researcher after review of relevant literature to collect
information about sociodemographic, present and past patient medical history, surgical
history and medication regimen, family history, previous hospitalization, nutritional status
including Anthropometric measurement as weight, height, body mass index. Data obtained
were compared against normal findings.
Tool II: chronic Rheumatoid Arthritis Patients Health Assessment
Questionnaire.
This tool used to measure problems and disability for patients with chronic
rheumatoid arthritis It was comprised of the following 3domains:
•Physical health domain.
•Psychological health domain.
•Social domain.
Tool III:Chronic Rheumatoid Arthritis Patients Pain Assessment Scale.
It was divided into two main parts.
A-The first part was the chronic rheumatoid arthritis patients pain intensity
assessment using Numerical Pain Rating Scale (NPR).
B-The second part was developed by the researcher and included questions related
to pain characteristics.
Tool IV: chronic Rheumatoid Arthritis Patients Knowledge and Coping
Strategies Structured Interview Schedule
This tool used to measure patients’ basic knowledge related to rheumatoid arthritis
and patients’ coping strategiesand adaptation with disease related problems.
Tool V: chronic Rheumatoid Arthritis Patient Self Care Scale
This tool was used to evaluate the self care program; this scale is composed of 40
questions divided into eight domains included ; active engagement in life ,health directed
behavior ,skill and technique acquisition, constructive attitudes and approaches ,self
monitoring and insight health service navigation ,social integration and support and
emotional wellbeing .
Data collection:
A convenience sample of 60 adult patients with chronic rheumatoid arthritis who
followed the inclusions criteria were divided into two equal groups 30 patients each:
group (I) control group:30 patients were exposed to routine hospital treatment regimen.
group (II) study group:30 patients were exposed to proposed self care program on
health practices.
•Data collection started with the control group before the application of the self care
program to the study group patients to avoid data contamination .
•Data collection was started, and continued for a period of 12 months from May 2017 to
April 2018.
The study was carried out in four phases:
I. Assessment phase:
Assessment was carried out for both groups (study & control) immediately on
admission whether to in patient or outpatient clinics using the five tools to collect base
line data .
II. Planning phase:
Based on the data collected from the assessment phase and literature review, the
program goals, contents , priorities, and expected outcomes were developed by the
researcher according to a patient’s individual needs and problems. Also illustrated
colored booklet was developed by the researcher.
III. Implementation phase:
A handout in a form of an illustrated colored educational booklet for patients with
chronic rheumatoid arthritis was developed in Arabic language by the researcher to suit
the Egyptian patients and given to each patient in the study group to attract patients’
attention, motivates patients, and helps patients and his family in reviewing and support
teaching at home and know what is the disease, how to manage and coping with it; and
to reinforce the knowledge taught. The self care program was implemented in eight
sessions each session took approximately 90 min.
IV. Evaluation Phase:
Patients were evaluated two times ; immediately and two months post program
implementation using tools II, III, IV, and V.
The main results of the study were:
1. The highest percentage of the both groups ,their age ranged from 40-50 years old ,were
females , married , read and write, living in urban areas and housewife.
2. The majority of both studied groups had RA since 3 to 5 years, also had no family
history of RA and didn’t receive any health teaching about rheumatoid.
3. Pre program implementation the majority of both studied groups had poor knowledge
regarding definition, manifestation, risk factors, risk personal and management modalities
for rheumatoid arthritis . While immediately and 2months post program implementation a
significant improvement in study group knowledge was noted compared to their control
(p=0.000).
4. The majority of study group reported both upper limbs as pain site compared to their
control reported both shoulders with a statistically significant difference between them
(P=0.002).
5.More than half (53.3%) of the study group reported sudden onset of pain compared to
(53.3%)of their control reported gradually onset .
6.Around one third (33.3%, 46.7%) respectively of the study and control groups had
burning pain.
7. Regarding pain aggravating factors more than one quarter (36.7 %)of the study group
reported movement of the pain site compared to (46.7%)of their control reported both
movement and cold weather. On the other hand ,in relation to alleviating factors (63.3%,
60%) respectively ,of both study and control groups reported medication.
8.The majority of both studied patients had severe pain with physical activities pre
program .while immediately and 2months post program implementation there were
significance improvement in the pain level (p=0.000) in the study group.on the other hand
the control group remained experienced severe pain through the three phases of
assessment.
9. The majority of both studied groups had higher disabilities in relation to physical and
psychological and social disabilities pre program while immediately and 2months post
program implementation a significance improvement in the abilities of study group only
(p=0.000).
10. Pre program application the majority of both studied patients had poor adaptation and
coping strategies regarding articular manifestation ,extra articular manifestation, GIT
problems and psychological problems, with no statistical significant difference between
both groups (P=1.000). While immediately and 2months post program implementation a
significant improvement in study group had good adaptation compared to their control
had poor adaptation with a statistical significant difference between them (P=0.000).
11. Pre program implementation the majority of both studied patients had low self care
health practices regarding active engagement in life, health directed behavior , skill and
technique acquisition, constructive attitudes and approaches , self monitoring and insight ,
health services navigation, skill and technique acquisition, social integration and support
and emotional wellbeing . While immediately and 2months post program implementation a
significant improvement in study group noted ,they had high self care health practices
(P=0.000),compared to their controls had low self care health practices through the three
phases of assessment.
Conclusion:
•In conclusion, applying the self care program had statistically significant improvement
in the level of knowledge, pain intensity during physical activities, improvement in the
abilities level during physical, psychological and social activities, and self care health
practices immediately and two months post program implementation for the study group
only.
The main recommendations are:
1. Nursing care should be based on physical ,psychological, social and spiritual
assessment of the patients immediately on admission and at different interval to assess
response of care.
2. Development and application of educational program for patients to improve his
understanding about the disease and how to be active engaged in self care health
practices.
3. The health education program should be available for every patient’s with rheumatoid
arthritis based on the patient’s physical ,psychological, social and spiritual needs.
4. The developed booklet about self care health practices should be available and
distributed to each patient with chronic rheumatoid arthritis.
5. Planning sessions of group discussion should be done for newly and previously
diagnosed rheumatoid arthritis patients to exchange their knowledg ,health practices
about the disease process to help them to cope with the disease.