الفهرس 
Theoretical and operational definitionsOnly 14 pages are availabe for public view
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Abstract
Endometriosis is a painful, chronic, and inflammatory disease that is characterized by the growth of endometrial-like tissue outside the uterus which causes pain and adhesions to chronic inflammatory reactions. Its incidence and symptoms can differ during the women’s menstruation process as the hormone levels fluctuate (As-Sanie et al., 2019). Endometriosis may be mistaken as a routine menstrual pain, particularly in younger women, due to a lack of awareness regarding the symptoms of endometriosis,stigma, or symptoms normalization (Riazi et al., 2018). Endometriosis has a variety of symptoms including chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, lower abdominal pain, infertility, and others such as diarrhea or constipation, chronic fatigue, nausea, and vomiting, headaches, heavy and irregular periods, and hypoglycemia-menstrual pain. The chronic painful symptoms of endometriosis and its negative consequences can also severely reduce the women‟s quality of life (Silva et al., 2018). Several studies have documented the negative impact of endometriosis on daily life including physical, mental, and social well-being; general health; interpersonal interactions; productivity, sexual relation, and self-esteem. So, endometriosis symptoms are among the main causes of morbidity and psychosocial problems in women during their reproductive ages (Facchin et al., 2019). The instructional supportive guidelines of care for endometriosis focus on the prevention of the dangers and relieving the patient’s complaint. This can be achieved through education, lifestyle modification, and medical therapy. Treatment success is determined by patient compliance, which is based on women’s knowledge of the disease. Health education is seen to be an effective health promotion technique for women with endometriosis (Price and Knibbs, 2019) Maternity nurses have an important role to promote health by providing women with endometriosis the support and knowledge needed. In addition, nurses can promote the quality of care and effectively manage therapies to enhance the quality of life, decrease the endometriosis-related pain symptoms to reduce its negative effect on the quality of life (Mao & Anastasi, 2017).The purpose of the current study was to investigate the effect of instructional supportive guidelines on the quality of life among women with endometriosis. The study was conducted at Obstetrics and Gynecology outpatient clinics affiliated to Menoufia University Hospital and Shebin El-Kom Teaching Hospital. A quasi- experimental design was used in carrying out the study.Non-probability (convenience) sample including (100) women with endometriosis were selected. The women were divided randomly into two groups (study and control). Each of the 100 women was asked to pick a piece of paper containing a number; those who selected number 1 were assigned to the study group and those who selected number 2 were assigned to the control group.1. The study group which included (50) women with endometriosis was instructed to follow the instructional supportive guidelines. 2. The control group which included (50) women with endometriosis were left on routine hospital care.Inclusion and exclusion criteria of the studied women:Both groups have the following criteria:Inclusion criteria:- All women diagnosed with endometriosis during their reproductive age including various stages of endometriosis.Exclusion criteria:- History of any chronic medical or gynecological disorders that can affect the quality of life.Throughout the course of the present study, data were collected using these instruments. These instruments were as follows:Instrument I: A structured interviewing questionnaire: Included demographic data,previous obstetrical and gynecological history, assessment of women’s knowledge regarding endometriosis, and its guidelines of care.Instrument II: Numerical rating scale (NRS): Assess the intensity of endometriosis- related pain symptoms such as dysmenorrhea, dyspareunia, dysuria, dyschezia, and pelvic pain Instrument III: Endometriosis Health Profile Questionnaire (EHP): It consisted of dimensions that are applicable to all women with endometriosis which including the following: pain (9 items), control and powerlessness (2 items),social support (3 items), emotional well-being (3 items), and self-image (2 items), work(5 items), sexual activity (3 items), infertility (2 items), and treatment (3 items). These dimensions were categorized by the researcher into physical, psychological, social, and sexual aspects of quality of life. An approval from the committee of Hearing and Ethics was obtained from the Faculty of Nursing, Menoufia University on 8/1/2020. Approaches to ensure ethics were considered in the study regarding confidentiality and informed consent. The researcher introduced herself to the women and explained the purpose of the study in order to obtain their acceptance to be recruited in the study as well as to gain their cooperation Confidentiality was achieved by the use of locked sheets with the names of the women replaced by numbers. All participants were informed that the information they provided during the study would be kept confidential and used only for statistical purposes. After finishing the study, the findings were presented as a group of data without personal participant information remaining.After explanation prior to enrollment in the study, informed consent had been obtained from all women. Each woman had informed that participation in the study was voluntary and each woman could withdraw from the study whenever decide to do so.Each woman was allowed to freely refuse the participation. They were free to ask any questions about the study details.Upon the completion of data collection, each answer was coded and scored. The researcher coded the data into a coding sheet so that data could be prepared for computer use. Data were statistically analyzed using (Statistical Package for the Social Sciences, version 22, SPSS Inc. Chicago, IL, USA).The findings of this study supported the three study hypotheses and failed to accept the null hypothesis. The women with endometriosis would exhibit a higher score of total knowledge regarding the endometriosis and the instructional supportive guidelines of care after receiving the educational sessions. Women with endometriosis had lower scores of pain intensity regarding the endometriosis-related pain symptoms and exhibit a better quality of life in the four dimensions (physical, psychological, social, and sexual) after implementation of the instructional supportive guidelines of care.The findings of the present study showed that:● There was no statistically significant difference among the studied women regarding their demographic characteristics and previous obstetrics history.● There was no statistically significant difference among the studied women regarding their level of knowledge regarding endometriosis before the intervention.● There was a highly statistically significant difference among the studied women regarding their level of knowledge regarding endometriosis within 1 month (posttest) and 2 months after the intervention (follow-up).● There was no statistically significant difference among the studied women regarding their level of knowledge about the instructional supportive guidelines of care before the intervention.● There was a highly statistically significant difference among the studied women regarding their level of knowledge regarding the instructional supportive guidelines of care at 1 month (posttest) and 2 months after the intervention (follow-up).● There was no statistically significant difference in the endometriosis-related pain symptoms (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) among the studied women before the intervention.● There was a highly statistically significant difference among the studied women regarding the endometriosis-related pain symptoms at 1 month (posttest) and 2months (follow-up) after the intervention.123● There was an impairment of all aspects of quality of life which including physical, psychological, social, and sexual aspect which means that there was no statistically significant difference among studied women before the intervention.● There was an improvement in all aspects of quality of life with a highly statistically significant difference among the studied women at 1 month (posttest) and 2 months after the intervention (follow-up).● There was a negative correlation between total knowledge score and quality of life at 1 month and at 2 months after the intervention among the study group.● There was a positive correlation between the Endometriosis Health Profile Questionnaire (EHP) score and the total pain score. According to the findings of the present study, it can be concluded that there was a higher statistically significant increase in total knowledge scores in the study group regarding endometriosis and the instructional supportive guidelines of care than before.In addition, the implementation of the instructional supportive guidelines of care was effective and there was a highly statistically significant decrease in the intensity of endometriosis related pain symptoms. Also, there is an improvement in the woman’s quality of life than before.Based on the findings of the current study, the following recommendations are proposed: providing a health educational program for women with endometriosis to improve their quality of life and increase their awareness regarding the guidelines of care to relieve the endometriosis-related pain symptoms. Also, performing regular follow up to evaluate the health-related quality of life and sexual function is essential to detect any health problems early.