الفهرس 
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Abstract
Summary
Diabetes is a major health care problem with an estimated incidence of 422 million people worldwide. Besides blindness, kidney failure, heart attacks, and strokes, a major burden of diabetes is the occurrence of diabetic foot ulcers (World Health Organization, 2018).
Diabetic Foot Ulcers (DFUs) are one of the more dangerous complications of diabetes, contributing to morbidity, mortality, and major financial strain, potentially affecting patients’ quality of life. Therefore, an effective DFU treatment is needed to both heal and reduce severe consequences, such as amputation. Studies into effective multiple therapeutic interventions for DFUs indicate that Hyperbaric Oxygen Therapy (HBOT) may be a current alternative for treating patients presenting with DFUs (Alshmimry, et al., 2021).
Nurses can facilitate and positively influence wound healing by promoting collaboration and participating in assessment, treatment and provide educational guide lines to these patients with professional health care team. The nurse duties involve ensuring safe conditions are meet and keeping patient comfortable due to high flammability of oxygen. Nurses remain in constant with patient helping them to remain relaxed and instructing them through breathing exercise to reduce risk of seizure from oxygen toxicity(Yisak & Kiwanuka, 2019).
The study aimed
To assess factors affecting compliance of patients with diabetic foot ulcer undergoing hyper baric oxygen therapy through assessing:
• Bio psychosocial factors that effect on compliance of patient with diabetic foot ulcer undergoing hyper baric oxygen therapy.
• Compliance of patients with diabetic foot ulcer undergoing hyper baric oxygen therapy.
Study questions
• What are bio psychosocial factors that effect on compliance of patient with diabetic foot ulcer undergoing hyper baric oxygen therapy?
• What are factors affecting Compliance of patients with diabetic foot ulcer undergoing hyper baric oxygen therapy?
Subject and methods
Study design
Descriptive exploratory design was utilized to meet the aim of the study.
Setting:
The study was conducted at Nasser Institute Hospital (NIH) in hyper baric center.
Subjects:
Purposive sample of 30 Patients with diabetic foot ulcer on hyper baric oxygen therapy.
Tools of data collection:
Four tools were used to collected data of the current study as the following:
Tool (I) patients interview questionnaire: it was written in simple Arabic language and divided into three parts:-
a- The first part : Socio –demographic data of patient. This part was used to assess socio demographic characteristics of the patient with diabetic foot ulcer patient including age, sex, marital status, residence, level of education, occupation, income, cost of treatment and sufficient of income per month from patients of point of view.
b- The second part: it was used to assess the patient clinical data (past and present history of the disease onset, duration and manifestation of the disease.
c- The third part: it was used to assess pt knowledge.
Tool (II): patient related factors: It was used to assess patient related factors of patient with diabetic foot ulcer undergoing hyper baric oxygen therapy through assessing physical, economic, social and environment factors.
Tool (III): Social dysfunction rating scale: It was used to assess social needs.it include three main items self-confidence, internal psychological system and performance.
Tool (IV): Hamiliton anxiety scale: it used to assess psychological factors of patient with diabetic foot ulcer patient.
Tool (V) Compliance assessment tool: it used to assess compliance through assessing patient compliance toward medication (, patient compliance toward self-care precautions and preventing complication, patient compliance toward dietary system, patient compliance toward daily activity, patient compliance toward preventive precautions of bleeding and bacterial infection and patient compliance toward hyper baric oxygen.
Results :
The results of this study revealed that:
- Regarding Socio-demographic characteristics, 70.0% of the studied patients their age ranged between 45 to less than 55,63.3% were males, 46.7% had university education and 56.7 % occupied. 86.7% of them had Insufficient Monthly income.
- In relation to health history 33.3% of the studied` Patients had relatives suffer from diabetes or chronic diseases, 70.0% their father suffering from diabetes.
- Related to patient knowledge about diabetes mellitus, diabetic foot ulcers and hyper baric oxygen therapy.50% of the studied patients had satisfactory knowledge about diabetes mellitus, 40% of the studied patients had satisfactory knowledge around diabetic foot ulcer and 70% of them had unsatisfactory knowledge about hyper baric oxygen therapy.
- Related to the finding there were factors that had negative effect on patient compliance physical, economic, and environment factors and social dysfunction scale more than 50% of studied patient had severe social dysfunction and hamlition anxiety scale more than 40% of studied patient had severe anxiety.
- Related to pt compliance to taking the medications 60% of them had no compliance toward medication, more 50% of them had no compliance to diet, Compliance to the necessary precautions for diabetic foot care and prevention of complications less than 40% of patients had compliance with diabetic foot care, compliance to Performing the motor activity in this study 60% of patients had no compliance to the necessary precautions to Prevent Complications and early detection more than 60% of studied patients had no compliance, finally compliance during the Hyperbaric Oxygen Therapy.
- Also, there was statistically significant relation between educational level & residence and total Knowledge. Also, there was statistically significant relation between age & gender and total Knowledge.
- The present study showed that there was statistical insignificant relation between other socio-demographic characteristics.
- The present study showed that there was statistical insignificant relation between other socio-demographic characteristics.
- Finally, there were highly significant positive correlation among total knowledge & total compliance.
Conclusion
The results of this study concluded that:
Half of the studied patients had satisfactory knowledge about diabetes mellitus. Also two fifth of them had satisfactory knowledge about diabetic foot ulcers. More ever less than three quarter had unsatisfactory knowledge about hyper baric oxygen therapy. Factors had a crucial role in patients compliance as physical, economic, and environmental factors and psychological factors that affected on patient compliance. There was highly statistically significant relation between educational level & residence and total Knowledge. Also, there was statistically significant relation between age & gender and total Knowledge while that was statistical insignificant relation between other socio-demographic characteristics, more ever there was highly significant positive correlation among total knowledge & total compliance. There were highly statistically significant relation between total compliance and total social and monthly income, also statistically significant relation between total compliance and anxiety and total knowledge.
Recommendations
Based on findings of the present study, the followings are recommended:
1- Action plan to educate patients newly diagnosed with diabetes about this disease and its complication.
2- Educate patients with diabetic foot ulcers self-foot examination.
3- Educate patients the important of follow up instructions to facilitate improvement.
4- Providing a written instructions booklet about diabetic foot and hyperbaric oxygen therapy is of great importance for the patients.
5- Organize regular counseling sessions for meeting the patient’s information needs about diabetic foot and hyperbaric oxygen therapy and solving their problems by providing them with clear, full and accurate information
6- The nurses should educate the patient on use of products that may produce harmful vapors in the chamber such as body oils, perfumes, lotions, nail polish and deodorants. Other materials that should be avoided during an HBOT session include hearing aids, metal framed eyeglasses, contact lenses, jewelry, watches, dentures and other devices.
7- Provide nursing management plan that involves preparation of the session, intra-session monitoring, and evaluation of evolution of the wound.
8- Replication of the study on large numbers of such group of patients.