الفهرس 
Frequency distribution of the studied patients according to their demographic characteristicsOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis is a chronic, progressive disease of the liver characterized by degeneration and destruction of the liver cells. Fibrotic bands of connective tissues impair the flow of blood and lymph and distort the normal liver structure. Patients with liver cirrhosis experienced a variety of clinical manifestations depending on the duration and severity of the liver disease rather than under diagnosis (Yoshiji & Kaji, 2019). Liver cirrhosis is slow and gradual in its development. It is usually well advanced before its symptoms are noticeable enough to cause alarm. Weakness and loss of weight may be early symptoms of liver cirrhosis (Tyerman et al., 2022).
There is no specific cure for cirrhosis however the aim of treatment is to minimize or reduce the progression of the disease and to prevent the development of serious complications. Assessment of patient’s knowledge about disease process is necessary. Planning short and simple self-care protocols has a significant effect on the patient’s control of their disease and its side effects; and can improve their quality of life and life satisfaction ( Janani et al, 2018).
Aim of the study:
This study aimed to evaluate the effect of self -management program on outcomes of patients with liver cirrhosis.
Research hypotheses:
The study hypothesized the following:
H1- The level of Patients’ knowledge will be improved significantly after the implementation of self-management program for patients with liver cirrhosis
H2- The level of patient’s self-management behavior will be improved significantly after the implementation of self-management program.
H3- The Patients’ health outcomes as HRQL and symptoms experience will be significantly improved after the implementation of self-management program.
Research design
Quasi-experimental research design was used to conduct this study.
Study setting
This study was conducted in hepatology department affiliated to Benha University Hospital, Qalyubia Governorate, Egypt.
Sample
A purposive sample of (58) patients from both sexes diagnosed with liver cirrhosis (third stage) over a period of nine months from the beginning of October 2021 to the end of June 2022 , participated in the current study according to the following criteria:
- Adult conscious patients
- Suffering from liver cirrhosis for a period not less than one year
- Patients with third stage of liver cirrhosis (that characterized by ascites with or without esophageal varices with absent of bleeding).
Tools for data collection
The tool was used to collect data to achieve the study’s aim as follows:
Tool I: Structured interview questionnaire:
It was developed by the researcher after reviewing related recent literature. It covered items related to different aspects of patient’ history, knowledge and self management and included the following five parts: -
Part I: Patient’s demographic data: This part concerned with the assessment of patients’ personal data related to their age, gender, educational level, marital status, occupation and residence.
Part II: Patient’s medical history: It aimed to assess past medical history included previous hospitalization and its causes, causes of current hospitalization, detection of disease, causes of liver cirrhosis, previous blood transfusion and its amount, associated chronic diseases, history of medication, as well as, quality of life included questions about smoking, duration and number of cigarettes intake/ day.
Part III: Patient’s knowledge questionnaire (pre/post program implementation):
It was adapted from ( Mohammed, 2019). It aimed to assess patient’s knowledge regarding liver cirrhosis and self management, it included 23 questions as following: (anatomy, definition of cirrhosis, risk factors, causes, signs, symptoms and diagnosis, treatment, complications, methods of prevention of cirrhosis, precautions to relieve symptoms and dietary instructions .
Part IV: Self-management behavior questionnaire (pre and post test):
It was adapted from (Wang et al., 2015) aimed to assess patient’s level of self-management behavior with liver cirrhosis. The questionnaire included 30 items within four dimensions as follow:
Diet management (ten questions).
Daily life style (eleven questions).
Medication intake (four questions).
Illness monitoring (five questions).
Tool II: Patients’ Health Outcomes Assessment: (pre and post program): It included two sections:
Section I: Health Related Quality of Life (HRQL)
It was adapted from (Ware et al. , 2000) , aimed to evaluate the patients’ health outcome regarding daily life and health wellbeing for patients with liver diseases pre and post self-care management program. It included eight domains as follow:- general health, limitation of activities, physical health problems, emotional health problems , social activities, pain, energy and emotions and general health.
Section II: Patient’s Symptoms experience.
It was adapted from (Abdel Rehaim & Mohamed, 2017) and modified by the researcher. It aimed to assess and understand the experience of patients with their symptoms which influence their daily life. It included nine questions about: gastrointestinal symptoms, fatigue, joint pain, weakness, dyspnea, peripheral edema, weight loss and memory problem or psychosocial symptoms as depression and anxiety.
Results:
The main results obtained from the present study were as follow:
• Regarding to patients demographic characteristics, near half of studied patients’ aged between forty to less than fifty years with mean age (51.84 ± 5.77) years. Nearly three quarters of them were males. In addition, less than half of studied patient were read and writes and three quarter of them were married were married. More than half of the studied patients worked manual work. Moreover, the majority of them were lived in rural areas.
• In relation to patients’ knowledge about liver cirrhosis the finding of the study showed that there was statistically significant increase of the total mean score of patients’ knowledge immediately post and after one month of self-management program implementation compared to erp self-management program implementation.
• Pertaining to patients’ behavior about liver cirrhosis the finding of the study showed that there was statistically significant difference between patients’ behavior pre and average post program implementation with p value (<0.001).
• Regarding patients’ experience of symptoms the present study revealed that there was a significant decrease in experience of symptoms and discomfort first and second month post self-management program implementation compared to pre-implementation. The mean and standard deviation of degree of patients’ experience of symptoms was (5.26 ± 1.55) pre program implementation while became (11.72 ± 2.10) and (10.03 ± 1.65) on first and second month post program implementation.
• Concerning to relations, there was statistical significant difference of between patients’ HRQOL pre and post self-care program implementation with p value (<0.05) .
• There was statistically significant relation between patients’ total behavior regarding self-management management and their sex in average post self-management program implementation and marital status in average post self-management program implementation.
• Concerning correlation, there was statistically negative correlation between total patients’ knowledge and their symptoms in average post self-management program implementation. Also, there was statistically significant negative correlation between patients’ behavior and their HRQOL in average post self-management program implementation.
Conclusion:
Based on the findings of the current study, it can be included that:
The mean knowledge scores of patients with liver cirrhosis who were exposed to self-management program were higher than before on. The mean scores were increased immediate and 1st month post educational program implementation follow up with a statistical significant difference with p- value (<0.001*).
Also, the highest mean behavior scores of patients with liver cirrhosis post self-management program were higher than before regarding medication intake but, the lowest mean score was regarding the daily life style.
The mean scores of health-related quality of life were higher post program implementation than before. There was statistically negative correlation between total patients’ knowledge and their symptoms in average post self-managementa program implementation and between patients’ behavior and their HRQOL
Recommendations
Based on results of the present study the following recommendations can be suggested:
For further researcher:-
-Make further research on effect of self-care protocol on liver cirrhosis patients self-efficacy.
- Development self-care program to liver cirrhotic patients in hepatology units through the specialist responsible nurses.
-Replication of the study in different hospital settings for generalization of the results
For patients:-
-Providing liver cirrhotic patients in hepatology units with continuous education about self-care to manage their symptoms and complications of the disease which reflect on improve their quality of life.