الفهرس 
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Abstract
Summary
chronic obstructive pulmonary disease (COPD) is a debilitating and progressive disease that primarily affects the respiratory system. In many patients, it also has detrimental extra-pulmonary effects, such as weight loss and skeletal muscle dysfunction/wasting. The pulmonary and skeletal muscle abnormalities limit the pulmonary ventilation and enhance the ventilatory requirements during exercise resulting in exercise-associated symptoms such as dyspnea and fatigue. These symptoms make exercise an unpleasant experience, which many patients try to avoid, and along with a depressive mood status (in up to 30% of patients), further accelerates the process, leading to an inactive life-style. Muscle deconditioning, associated with reduced physical activity, contributes to further inactivity and as a result patients get trapped in a vicious cycle of declining physical activity levels and increasing symptoms with exercise (Trooster et al., 2013).
Patient education is a major component of pulmonary rehabilitation and includes a variety of topics. Depending on the length and setting of the educational program, topics may include anatomy and physiology of the lung, pathophysiology and changes with COPD, medications and home oxygen therapy, nutrition, respiratory therapy treatments, symptoms alleviation, smoking cessation, sexuality and COPD, coping with chronic disease, communicating with the health care team and planning for the future (Smeltzer, et al., 2010).
Aim of the study:
This study aimed to evaluate the effect of care protocol on knowledge, practice and clinical outcomes of patients with COPD through the following:
1- Assessment of knowledge, practice and clinical outcomes of patients with COPD.
2- Developing and implementing care protocol.
3- Evaluating the effect of care protocol on knowledge, practice and clinical outcomes of patients with COPD.
Research hypothesis:
This study hypothesized that
The implementation of care protocol will affect the knowledge, practice and clinical outcomes of patients with chronic obstructive pulmonary disease positively.
Study design:
A quasi experimental design was utilized to meet the aim of the study.
Setting:
The study was conducted at chest department and outpatient clinic at Ain Shams University Hospitals.
Subjects: A purposive sample of 50 patients with chronic obstructive pulmonary disease were selected based on power analysis according to certain inclusion criteria as follow: adult patients, from both genders with different educational levels, free from other chronic diseases, who didn’t receive any educational program and agree to participate in the study.
Study tools:
I- Patients’ assessment sheet: (Appendix II)
This sheet was developed by the researcher in an Arabic language. It includes the following parts:
a- Patients’ socio-demographic characteristics (age, gender, residence, level of education, occupation…….etc).
b- Clinical data: including patients’ medical history (duration of illness, number of previous hospitalization, exposure to irritant/pollutant etc...).
II- Patients’ knowledge assessment questionnaire regarding COPD: (Appendix III)
This questionnaire was developed by the researcher in an Arabic language after reviewing the recent related literatures “White, Walker, Roberts, Kalisky & White (2006)” to assess patients’ level of knowledge.
III- Observational checklists tools: (Appendix IV)
These checklist were developed by the researcher in an Arabic language after reviewing related literatures “COPD Foundation (2014), Web MD (2014), Nall, R. (2014), Medline Plus (2014), Leader, D. (2014) and Bottrell, J., (2014)” to assess patient’s practices related to (breathing exercise, coughing exercise, using of inhaler and using of spirometry)
IV- Clinical outcomes assessment tools (Appendix V): it included the following tools:
(A) Medical Research Council Dyspnea Scale (MRC):
This scale was adopted from Fletcher (1959) to assess the level of activity that produce dyspnea for patients.
(B) Iowa fatigue scale (IFS):
This scale was adopted from Watson, Bentler & Hartz (2003) to assess the severity of patient’s fatigue.
(C) Short Form of the Profile of Mood States (POMS):
POMS-SF is an adaptation to the original 65-item POMS. This scale was adopted from Shelly, Michael & Jamie (1995)
(D (Pittsburgh Sleep Quality Index (PSQI):
This scale adopted from Buysse, Reynolds, Berman & Kupfer (1989) to assess the severity of sleep-onset and sleep maintenance difficulties.
Results of this study showed that:
- Concerning patients’ characteristics, approximately one third of the studied subjects (32%) felt at age group between 40-50 years old, also (32%) of them, their ages between 50-60 years. As regard to patients’ gender, most of them (88%) were males. Regarding educational level of the studied subjects, two fifths of them (40%) were able to read and write. Moreover, more than three quarter of the subjects (78%) were married.
- There were highly statistically significant differences between mean scores of the pre and post knowledge questionnaire regarding COPD definition, causes, clinical manifestation, complication, and treatment, knowledge related to physical exercise, energy conservation, smoking cessation, dyspnea control, relaxation techniques, nutrition and total knowledge.
- Concerning patients’ practice, there were highly statistically significant differences between mean scores of the pre and post tests as regard to diaphragmatic breathing, pursed lip breathing, using of spirometer, coughing exercise, use of inhaler , and total performance.
- Regarding assessment of patients’ mood, there were highly statistically significant differences between mean scores of the pre and post test as regard to anger, tension, fatigue, vigor subscales and total of mood disturbance pre and post implementation of COPD care protocol.
- Regarding patients’ sleep quality, there was highly statistically significant difference between mean scores of sleep quality for patients with COPD pre and post implementation of COPD care protocol, with significant decrease in mean score.
- Regarding levels of dyspnea for COPD patients pre and post implementation of COPD care protocol, there was statistically significant difference between levels of dyspnea for COPD patients pre and post implementation of COPD care protocol
- Regarding fatigue level, there was highly statistically significant difference between mean scores of fatigue for patients with COPD pre and post implementation of COPD care protocol.
- Concerning patients’ respiratory characteristics, there were highly statistically significant differences between patients with COPD pre and post implementation of COPD care protocol regarding respiratory rate, rhythm, and depth.
The results of this study concluded that:
Application of care protocol for patients with COPD has positive effect on improving their knowledge about COPD and its management (physical exercise, energy conservation, smoking cessation, dyspnea control, relaxation techniques, and nutrition); practice related to breathing exercise, coughing exercise, inhaler use, and spirometer use; and clinical outcomes regarding dyspnea, fatigue, sleep quality, mood and respiratory characteristics.
The study recommended that
Care protocol program for patients with chronic obstructive pulmonary disease should be applied in all chest units and should be up-dated periodically in order to improve knowledge, practice and clinical outcomes for those patients.
Further researches are recommended on new approaches in the area of management of patients with chronic obstructive pulmonary disease and evaluate its effect on patients’ clinical outcomes.