الفهرس 
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Abstract
SUMMARY
Esophageal varices represents a catastrophic consequence of portal hypertension due to high prevalence of schistosomiasis and viral hepatitis, with high incidence of morbidity and mortality, despite modern therapeutic modalities it considered a major health problem in Egypt (Nettina,2001).
Compliance is defined as the extent to which patients’ behavior change in term of taking medications, following diets or exercising and other life style changes. And it was defined as partnership between the health care provider and patient. The goal of this relationship being to ensure that the patient is as self sufficient in managing his or her health as possible (Walsh and Gorman etal 2002).
Discharge planning is a process by which the client is prepared for continued care outside the health care facility or for independent living at home. Clients themselves, family, or other health care workers may provide continuing care. Planning for discharge begins when a client is admitted to the health care system, aiming to establish a recovery based plan for return to the community which minimize the possibility of readmission to hospital and encourages compliance with a treatment plan. (Kyngos, (2001).
Aim of the study:
- To assess needs of patients with esophageal varices.
- To assess effect of discharge planning on patients compliance.
Research hypothesis:
The discharge plan will has appositive effect on patients’ compliance.
Research setting:
The study was conducted in medical department in the Liver Institute-Menofya University. And there are endoscopic unit, laboratory, operating room, surgical department and x ray unit .
Subjects of the study:
The subjects of the present study consisted of 100 adult patients from both genders who already diagnosed with bleeding esophageal varices. They were divided into two equal matched groups (control and study).
To collect data of the study the following tools were used:
Three tools were used for collecting the necessary data.
1- Patients’ need assessment sheet:
This sheet was developed by the researcher to assess Patients’ needs only one time before the intervention of discharge guideline booklet . It was consisted of the following parts; the sociodemographic data of the patients, health history of the patient, physical assessment for various body systems; respiratory, cardiovascular, neurological, gastro-intestinal, urinary, integumentary system, assessment of sexual disorders and hygiene.
2- Interview Questionnaire sheet:
It was developed by the researcher to assess Patients’ knowledge about the disease and therapeutic regimen, it recorded data about the following:
a- Disease and medication
b- Diet and beverage.
c- Physical exercise
3- Compliance assessment sheet:
It was developed by the researcher to assess Patients’ compliance with therapeutic regimen, it was translated in Arabic and it recorded data about the following:
a- Medication
b- Diet and beverage
c- Physical exercises
The results of this study showed that :
- All patients in the study and control group had unsatisfactory knowledge related to esophageal varices and therapeutic regimen preintervention except regarding instruction about follow up with statistically insignificant difference between two groups
- The majority of patients in the study group had satisfactory knowledge related to esophageal varices and therapeutic regimen post intervention with highly statically significant difference between two groups.
- No one of the control and study group had adequate compliance pre discharge guideline booklet intervention with statistically insignificant difference between both groups.
- The majority of patients in the study group had adequate compliance post discharge guideline booklet with statistically significant difference between both groups.
- There was a positive relationship between patients’ knowledge and compliance regarding medication, nutrition and exercises as well as total patients’ knowledge and compliance with therapeutic regimen.
- The most common factors affecting non compliance with therapeutic regimen among patients were cost and forgetfulness.
- The highest physical and psychological needs of patients in the study and control groups including; checking vital signs, endoscopic management, psychological support and pharmacological management.
Conclusion :
- This study concluded that the highest physical and psychological needs of patients with esophageal varices in the study and control groups were checking vital signs, endoscopic management, pharmacological management and psychological support.
- Discharge planning have positive effect on compliance of patients with esophageal varices to therapeutic regimen.
The following recommendations are inferred from the study:
- Discharge planning for patients with esophageal varices should start from admission to enhance their compliance with disease and therapeutic regimen.
- Simplified and comprehensive discharge planning booklet introduced to the patients with esophageal varices before discharge.
- Development of special staff who are responsible for education and discharge planning of patients with esophageal varices.
- Further researches are recommended to study the factors affecting compliance of patients with esophageal varices to therapeutic regimen to be taken into consideration in the discharge planning.