Seminar paper malik

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Name:

Malik Rebhi Manasrah

The topic:

Research Paper

"Nursing teaching toward cardiovascular disease patient"

Supervisor : Dr. Hussein Jabareen

Academic year:

2011

20710272

Faculty of Nursing

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ACKNOWLEDGMENTS This thesis wouldn’t be completely done unless I had obtained very unmistakable assistance from Associate my advisors, Dr. Hussein Jabareen who have been giving me very captivating and useful ideas, concepts, advice, and guidelines. They have also devoted their precious time to checking and correcting the shortcomings in all phases of this research, including giving me the encouragement and moral supports all along. I really appreciate their sincerity, generosity, and sacrifices, so I would like to take this opportunity to give them my heartfelt thanks. It is not possible to credit the many who have contributed toward the accomplishment of this research. However, I would like to give particular recognition to those who helped and guided me through this study. I shall never be able to express adequately my acknowledgment to all my supportive friends, who were very co-operative and helpful. Sincere thanks, true appreciation, and love go to all my family members, especially to my father and mother, for their patience, encouragement, and endless support during my graduate study. I also wouldn’t forget to thank my friends, my senior friends and anyone who has provided me their help, but I can’t mention all their names here.

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Index No. Subject Page no. 1 Acknowledgement 1 2 Table of contents 2 3 Abstract 4

Chapter one 5 Introduction 6 6 Research question 9 7 Hypothesis & null hypothesis 9 8 Aims of research 9 Cardiovascular risk Factors 10 Epidemiological transition of cardiovascular

risk factors 12

BACKGROUND 13 Concepts related to the nurse effective

communication 15

Chapter two 11 Literature review 16

Chapter three 12 Methodology 28 13 Sample 29 14 Instrument of data collection 30 15 Advantage & disadvantage of quantitative

design 30

16 Ethical consideration 31 Chapter four

17 Result & data analysis 36 Chapter five

18 Discussion 54

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20 Recommendation 58 21 Study limitation 59

22 Appendix A : Cross tabulation 60 23 Appendix B : Questionnaire 62 24 References 66

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Abstract Cardiovascular disease (CVD) is a critical public health issue, nationally and internationally. cardiovascular diseases most common causes of death worldwide among adults in Palestine in 2005, 21 % of deaths were due to heart diseases and 11 % to cerebrovascular diseases. Counseling and teaching in cardiovascular disease care relating to lifestyle changes, nonpharmacolgical treatment regarding smoking, weight, diet, physical activity and stress, aims to reduce complications. Many patients have several risk factors to deal with. There are few studies of nursing in cardiovascular disease care in Palestine and this issue therefore needs to be investigated in my study.

The aims of this study were to analyze the communication between patients and nurses about lifestyle changes in cardiovascular disease care at hospitals and To establish data of what kind of teaching the nurse give to cardiovascular patient and To identify factors which limit or prevent sufficient teaching to cardiovascular patient. In the first study. Research question: Is nurse give teaching to cardiovascular patient by giving them information and instruction about variables of Specific Cardiovascular risk factors (lifestyle behaviors ) Aims & objectives

Ø To establish data of what kind of teaching the nurse give to cardiovascular patient.

Ø To examine which topics that nurse focus on during teaching.

Ø To identify factors which promote the successful nursing teaching.

Ø To identify factors which limit or prevent sufficient teaching to cardiovascular patient.

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Methodology

I used Quantitative approach, cross sectional method & Questionnaires design.

Population: the population consisted of Nurses working with cardiovascular patient

Location:

Ø Hebron governmental hospital

Ø Al-Ahli Hospital in Hebron

Ø Al-Mezan hospital in Hebron

Ø Al-Hussein governmental hospital

Timing:

2 weeks from 19/2/2011 -1/3/2011

Subjects:

I was Distributed 80 questionnaires and I included all nurses’ work with cardiovascular patients in a ward of CCU and Medical ward excluded nurses who don’t work with cardiovascular patients.

Analysis: By using the SPSS windows program.

• The response rate is 86%

• My questionnaires consist of 3 parts:

• 1. Demographic Data

• 2. question to test nursing teaching to CVD Pt

• 3. Question to test abesticles and motivations

Keywords: Nursing, cardiovascular disease, counseling, teaching, lifestyle, health behavior, patient-centered care, stages of change model.

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Chapter One INTRODUCTION

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INTRODUCTION

The purpose of my research is to conduct a the role of nursing teaching among cardiovascular disease patient and promotion and prevention in the area of cardiovascular modifiable risk factor to identify the areas in which nursing have Concerns than other, especially the in patient who have cardiovascular risk factor or who have cardiovascular disease to decrease ferocity or to prevent complications.

The terms of concerns in this research include:

1. Nursing teaching to cardiovascular patient in area of:

Ø The lifestyle-related risk factors for cardiovascular disease such as “high blood pressure, high cholesterol, diabetes, smoking, overweight/obesity, and physical inactivity” and the role of nursing in increase knowledge about effect on the risk of disease when they are considered together and the method in remove or decrease these risks.

Ø Explain the diagnoses of patient and increase patient knowledge on the signs and symptoms and how to deal with each and when to seek health care.

Ø Medications in and how to use each one, the therapeutic activity and predictable side effect.

Ø Patients who have combination of cardiovascular disease and diabetes. Ø The tests needed and explain of other procedures and the purpose of each

one. Ø The method in decreasing anxiety and chest pain such as relaxation

techniques and music therapy. Ø The actions that patient should avoid and actions that no need to avoid and

the purpose of these precautions. Ø The role of physical activity and sport in decrease risk factors . Ø The use of suitable words and sentences according to patient abilities and level

of knowledge. Ø Use directional and specific teaching for each disease in

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Cardiovascular diseases

Cardiovascular disease (CVD) is a critical public health issue, nationally and internationally. It was responsible for less than 10% of all global deaths at the beginning of the 20th century1, but in 2005 that number was 30%.

About 80% of these deaths were in low- and middle-income countries2.

Of these cardiovascular diseases coronary heart disease (CHD) and stroke are the first and second most common causes of death worldwide3. In developed countries like the United Kingdom, it was found that 39% of deaths to be related to CVD in 20024.

In Comparison, Arab countries like Jordan has mortality rate as high as 38.2% associated with CVD5. Similarly, CVD has been found to be the leading cause of death among adults in Palestine in 20056, 21 % of deaths were due to heart diseases and 11 % to cerebrovascular diseases7.

There are many risk factors for cardiovascular diseases that lead to enhanced risk of developing CVD. For example, there are more than 200 risk factors for CHD but the most significant risk factor is abnormal lipid values3. However, the main CVD risk factors are smoking, diet, obesity, hypertension, physical inactivity, dyslipidaemia, genetic influences, family history and diabetes.

Nursing teaching to these risk factors be studied in this research among Hebron and Bethlehem hospitals nurse , in addition factor that affects teaching process.

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Research question:

Is nurse take care with cardiovascular patient by giving teaching for cardiovascular patient by test nursing teaching for these variables of Specific heart-healthy lifestyle behaviors such as physical activity, low-saturated fat and low-salt diet, cigarette smoking abstinence or cessation, weight control or reduction, and controlled blood pressure (hypertension), glucose (type 2 diabetes), and serum cholesterol and other lipids .

Ø What are some things that could be done to improve the quality of teaching for cardiovascular patients.

Ø What are the barriers that keep you from providing teaching for cardiovascular patients.

Hypotheses:

It is hypothesized that the nurse take care with cardiovascular patient gives sufficient teaching for cardiovascular patient on modification there life style in variables that promote their health and prevent further complication and make teaching about drug use and each.

The null hypotheses: The null hypotheses suggest that nurse take care with cardiovascular patient don’t

gives sufficient teaching for cardiovascular patient and hasn’t role in giving teaching.

Aims:

The overall aim of this research was twofold:

Ø to analyse the communication between nurses and patients about lifestyle changes in cardiovascular disease patient care

Ø To evaluate the effects of nursing interventions.

Specific aims

Ø To establish data of what kind of teaching the nurse give to cardiovascular patient.

Ø To examine the influence of various variables on educational policy. Ø To examine which topics that nurse focus on in teaching. Ø To identify factors which promote the successful nursing teaching. Ø To identify factors which limit or prevent sufficient teaching to cardiovascular

patient.

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Cardiovascular risk Factors

In the last years, prevention and treatment of CVD risk factors have resulted in lowering CVD-related mortality. However, many patients identify these factors but they do not have them adequately controlled8.

•Physical Inactivity

Despite the debate about the amount, intensity, frequency and duration of activity for optimal health, researchers concur that physical activity is necessary for the metabolic and cardiovascular benefits. Physical activity can slow the initiation and development of diabetes and the sequence of CVD through its effect on body weight, insulin sensitivity, glycemic control, blood pressure, fibrinolysis, endothelial function and inflammatory defense systems. Moreover, physical activity can lessen triglycerides and have an effect on both low-density lipoprotein (LDL) and HDL particle sizes9.

• Obesity

Obesity leads to the development of Cardiovascular disease. Studies demonstrate that obesity cause endoplasmic reticulum ER stress. This stress leads to the suppression of insulin receptor signaling.

Body mass index (BMI): one of the most commonly used indicators of obesity, but it is not an ideal one as it does not take into account the body fat distribution. BMI is calculated as weight/height2 (Kg/m2). According to the World Health Organization (WHO) definition "overweight" is a BMI equal to or more than 25, and "obesity" is a BMI equal to or more than 3010.

• Lipid profile (total cholesterol (TC), triglycerides (TG)) Quantitative changes occur due to the increase of glucose for synthesis and decrease in lipoprotein lipase activity leading to decrease of from peripheral circulation, increase in LDL-C levels and decrease in HDL-C levels due to increase in hepatic lipase activity decrease in clearance. So rising risk of heart diseases11.

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• Smoking Smoking is assumed to cause coronary thrombosis by increasing the formation of coronary plaques, destabilizing coronary plaques, promoting plaque split, increasing platelet activation and causing endothelial dysfunction. In addition, smoking causes coronary spasms by increasing catecholamine release22. In developing countries about 2.41 million premature deaths from cardiovascular causes were attributed to smoking in 200012.

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Epidemiological transition of cardiovascular risk factors According to the International Obesity Task Force, more than 1.1 billion adults worldwide are overweight 16.6%), and 312 million of them are obese (4.7%)12. In 2005, the prevalence of obesity in U.S adults (older than 18 years old) was 23.9%13. As well obesity is a growing challenge because of the high rate of obese people (about 40%) in Palestine6. A study was conducted in the urban Palestinian population to investigate the prevalence of obesity; the results indicated that 41% of urban population is obese (49% for women and 30% for men)14.

The world health organization indicated that more than 60% of global populations are physically inactive which causes 2 million deaths worldwide annually. In addition, physical inactivity causes 22% of ischemic heart disease. According to WHO, prevalence of physical inactivity in the Eastern Mediterranean Region was 77% among population above 20 years in 200515.

According to the sixty first world health assembly report the prevalence of hypertension was 35.2% among people aged 60 years or more in Palestine in 2004-20066, but the prevalence in the whole population was 3.3% in 200616. Hypertension was the eight-leading cause of deaths in Palestine (4.8%) in 200517.

According to the WHO report in 2003, there are about 1.3 billion smokers in the world. This represents about one third of the global population aged 15 and over. About 84% or 1 billion people of the world smokers live in developing countries. The smoking geography is shifting from the developed to the developing world. In 1995, more smokers lived in low and middle income countries (933 million) while in high-income countries (209 million). In China, there are about 350 million smokers (60% men and 3% women. In Palestine the prevalence rate of smoking decreased from 22.1% in 2000 to 19.8% in 2006. But there was a wide gap between male smokers (37%) and female smokers (2.2%) in 200618.

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BACKGROUND

Counseling on lifestyle changes is based on communication between patient and nurse. Interpersonal skill in nursing involves personal qualities, dispositions towards others, communication skills and disposition towards self, among other things 19

It is important to remember that the relationship between caregiver and the care-taker is not equal. The caregiver is allowed to ask the most intimate questions, while the contrary is not allowed. Counseling is designed to make a person confident enough to choose and to be able to take a particular course of action 20. To act, the patient needs to be able to identify the things he/she has to do, stop doing, continue to do and to accept. Counseling is always voluntary 19.

Applying interpersonal skills in an efficient way is not an easy task. A study based on audio-recorded consultations between cardiovascular patients and nurses at health centers and a specialist clinic showed that the nurses dominated the interaction by using more words, initiating more topics and using more discourse space than the patients 21.

In counseling, nursing actions are directed towards the goal of helping patients to accept the fact that they have high risk to cardiovascular disease. The nurse has to help the patients to understand that medications and lifestyle modifications can control but are generally unable to cure cardiovascular diseases and to persuade them to use specific strategies to achieve the necessary lifestyle changes. When a patient is confronted with the need for lifestyle change, strategies are essential to handle a situation that could be experienced as demanding. Coping comprises a person’s strategies to handle trying situations and demands that are appraised as taxing or exceeding a person’s resources 22.

Changing lifestyle could be expressed as executing self-care. Self-care was defined in 1978 as a process whereby a lay person can function effectively on his own behalf in health promotion, in disease detection and treatment at the level of primary health care 23. Counseling conducted in a patient-centered way, where chronically ill patients become more active, may lead to treatment plans that are more structured around the patient’s beliefs and are therefore more likely to produce self-care 24.

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Hypertension can be experienced as being at increased vascular risk. As this ‘at risk’ is less obvious than being ill, the nurse-led self-management has to be organized so that the patient actively participates in problem definition and realistic and personalized goal-setting 25. It is important that the interventions are guided by patients’ willingness for change and self-efficacy. Support for behavioral changes and followup visits are also necessary parts.

If lifestyle changes are to be successful, the patient has to be motivated. Motivation means mobilizing mental and behavioral effort to achieve a goal 26. A tool for the nurse to use in counseling 27.

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Concepts related to the nurse effective communication

When counseling cardiovascular disease patients, nurses make use of their professional knowledge and skills to help the patients, through performed self-care, to reach their treatment goals. The importance of health education as a part of nursing has been recognized for a long time. The nurses also need an understanding of patients’ physiological and psychosocial state to make an assessment together with the patient to determine the kind of education that is needed. This encompasses a holistic view, which is necessary in order to help a patient to decide on behavioral change. Even a well-informed and behaviorally skilled patient must generally be highly motivated and receive support to initiate and maintain preventive behavior 28. For many people, changing one’s lifestyle is equivalent to finding a new personal identity 29.

The nurse must then choose education strategies, which means instructional methods, behavioral strategies and educational aids 20. Educational aids as a complement to verbal communication could include instruction sheets, pamphlets, brochures, booklets or computer-assisted instructions 30. Effective teaching is a combination of the use of good communication skills and effective educational strategies. Information, clear, honest and adequate, should be given to patients as required 31.

In counseling on lifestyle changes, it is important for the nurse to show the patient respect, irrespective of whether or not the patient is prepared to perform behavioral change. This approach embraces being the patient’s advocate. The advocate should inform the patient and promote informed consent, empower the patient and protect the rights and interests of the patient 32. The empowerment part means that the nurse should enable patients to choose to take control over and make decisions about their lives 33. As the nurse-patient relationship is supposed to be based upon mutual respect and equality, nurses should facilitate the empowerment of patients rather than empower them, i.e. the patient must be active in the process.

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Chapter two

Theoretical framework

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Theoretical framework

Many theories and models have been proposed to explain the adoption of health risk and health enhancing behaviors. This chapter reviews the major evidence-based models of health behavior identified in the literature. These include psychological models aimed at modifying individual behavior as well a health promotion models and strategies:

_ The Health Belief Model (Becker, 1974)

_ Theory of Reasoned Action (Ajzen & Fishbein,1980)

_ Social Cognitive Theory (Bandura, 1977)

_ Stages of Change (Prochaska & DiClemente,1992)

_ Health Promotion models and strategies

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1. HEALTH BELIEF MODEL (BECKER, 1974)

The health belief model (HBM) (Janz & Becker,1984; Rosenstock, 1974) is one of the most commonly-used models of health behaviour change and many have used it to guide the development of health interventions. It was developed in the early 1950’s as a framework for how to promote preventive behaviours (such as immunizations) 34.

The HBM has two basic components:

1) The perception of a threat, 2) The evaluation of a recommended behaviour 34.

In other words, people will act to protect their health if they perceive that they are personally at risk of a particular problem or illness and that a particular action will enable them to deal with that risk, without excessive personal sacrifice. Briefly, the HBM suggests that preventive health behaviours are influenced by five factors:

_ Perceived susceptibility – This refers to one’s subjective perception of the risk of contracting a condition (the individual evaluation of the likelihood of developing the health problem)

_ Perceived severity – This refers to feelings concerning the seriousness of the illness if it is contracted or left untreated _ Perceived benefits – These are the beliefs regarding the effectiveness of the actions available in reducing the disease threat _ Perceived barriers – These refer to the potential negative physical, psychological and financial aspects of a particular health action (e.g., expense, side effects, pain, time-constraint) _ Cues to action – These are the reminders about a potential health problem (e.g., newspaper and magazine article, mass media campaigns, advice from others). It should be noted that cues to action can be external (e.g., the recommendation of a physician or mass media messages) or internal (e.g., symptoms). Another type of external cue, social influence, has also been shown to be an important predictor of health behavior. According to the HBM, individuals weigh the potential benefits of the recommended response against the barriers of the action (e.g., psychological, physical, and financial costs) when deciding to act. For example, a woman may recognize the benefit of

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having a mammogram but may be afraid of finding cancer.The readiness to take action for health stems from a perceived threat of disease, due to an individual’s perception of his or her susceptibility to disease and its potential severity. The anticipation of a negative outcome and the desire to avoid this outcome creates motivation to take preventative actions. (See Figure 2).

Source: “Communication and Community Development for Health Information: Constructs and Models for Evaluation” by John E. Bowers, Review prepared for the National Network of Libraies of Medicine, Pacific Northwest Region, Seattle, December 1997. Jbowes @ uwashington.edu

In summary, HBM, with its focus on cognitive processes, may be viewed as the grandmother of most modern health education theories. As such, its variables and principles can be seen in many of the other models to be discussed in this chapter.

Figure 1: The Health Belief Model (HBM)

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2. THEORY OF REASONED ACTION (TRA) (AJZEN & FISHBEIN,1980)

Since the development of the HBM, other researchers, notably Ajzen and Fishbein (1980), have maintained that it is not enough for health planners to construct health interventions based on theoretical variables.

Rather, salient beliefs and attitudes need to be incorporated.

The Theory of Reasoned Action (TRA) was developed by Ajzen and Fishbein (1980) in an effort to understand the relationship between attitudes and behaviour. It begins with the premise that people usually consider the implications of their actions, then act consciously and deliberately. In other words, people eventually do what they intend to do, and the best single predictor of a behaviour is the intention to act in that way.

According to Fishbein and Ajzen (1980), two sets of beliefs must be altered prior to behavioural change: (1) beliefs about the consequences of performing a certain behaviour and the evaluation of those consequences (attitude); and (2) beliefs about what other people or referents think about the behavior to be performed and the motivation to comply with those referents (subjective norm). Only when a message targets the salient beliefs of these variables do attitudes and subjective norms, and subsequently, behavioural intentions and behaviour change.

Overall, TRA is one of the few theories to offer a systematic approach to the construction of the content of a health education message. It has been applied to a number of health-related behaviours including the impact of health risk messages about tap water, sexual practices and AIDS related-behaviours 35, childbearing intentions, testicular cancer prevention, exercise in schoolchildren, alcoholism, cigarette smoking, prediction of mammography use, and obtaining Pap tests for cervical cancer. This theory has also shown some promise in AIDS prevention.

3. SOCIAL COGNITIVE THEORY (BANDURA, 1977)

Albert Bandura’s Social Cognitive Theory (sometimes called Social Learning Theory) has been used in a wide variety of interventions and evaluation efforts.The focal

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point of the theory is on perceived self-efficacy. Self-efficacy is defined as “people’s beliefs that they can exert control over their motivation, behaviour and social environment” 36. In other words, perceived self-efficacy is what one believes about one’s capability to perform a certain action (perceived self-effectiveness).

Bandura (1977) views self-efficacy as the driving force of human behaviour. Another important construct in Bandura’s theory is outcome expectations.

Outcome expectations (also called response efficacy in other models) refer to an individual’s belief that a certain behaviour will lead to a certain outcome. For example, “I believe that if I exercise regularly I will look better” is an outcome expectation. Outcome expectations are different from efficacy expectations in that the latter is a person’s belief on whether he or she is able to ”successfully execute the behavior required to produce the outcomes” 36. Bandura states that health behaviour and health outcomes are a function of efficacy and outcome expectations. However, an individuals’ efficacy and outcome expectations may be inconsistent, for example, someone who smokes may perceive that smoking is harmful to his/her health yet believes him/herself to be incapable of changing this behaviour. In addition, a person’s efficacy expectations may vary across behaviours and situations. For example, a person may have high self-efficacy for attending exercise classes regularly but low perceived self-efficacy for reducing alcohol intake. Bandura (1977) further proposes that an individual’s self-efficacy perceptions are developed from four sources of information: performance accomplishments (e.g., learning through personal experience), physiological states (e.g., relaxation, biofeedback, information from providers about the consequences of health risks and the benefits of change), verbal persuasion (e.g., information from practitioners, self-instruction), and vicarious experience (e.g., seeing others consider and perform challenging health behaviours successfully). The concept of self-efficacy has been used in areas such as exercise, dietary fat intake, and smoking 38.

Figure 3: Social Cognitive Theory

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Another type of Social Learning Theory which has been widely used in adolescent population is the social influence theory. This theory proposes that adolescents are highly prone to the social influences from peers, family, media as well as internal pressure. In terms of intervention, the social competency model proposes that adolescent may engage in risky health behaviour because they lack psychosocial skills to deal with negative social influences 39.

4. TRANSTHEORETICAL MODEL (STAGES OF CHANGE) (PROCHASKA & DICLEMENTE, 1992)

One of a number of stage models of behavior change, the transtheoretical model (TTM) proposes that health interventions must first determine which stage the majority of their target population are in along a continuum of no action to consistent action 40. The transtheoretical model, also referred to as the stages of change model (SOC), is currently conceptualized in terms of several major dimensions. The core constructs, around which the other dimensions are organized, is the stages of change. These represent ordered categories along a continuum of motivational readiness to change a problem behaviour: Precontemplation, Contemplation, Preparation, Action, and Maintenance.

In the Precontemplative stage, individuals do not intend to change their behaviour because they are completely unaware of the behavioural options available to them. In other words, they may not realize they are engaging in a risky behaviour or they may deny that their behaviour puts them at risk for harm. In the second stage (Contemplation), the risk becomes apparent to the individual. At this stage individuals begin to think about the behaviour that is putting them at risk and to contemplate the need for change. In this stage, an individual recognizes the need to engage in physical activity. In the third stage, Preparation, individuals make a commitment to change and take some action towards behavioural change. It is in the Action stage that individuals perform the new behaviour consistently. In the Maintenance stage, the final stage of the SOC model, the new behaviour is continued and steps are taken to avoid lapsing into the formerly risky behaviours. Transitions between the stages of change are effected by a set of independent variables known

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as the processes of change. These are covert and overt activities and experiences that individuals engage in when they attempt to modify problem behaviours. Each process is a broad category encompassing multiple techniques, methods, and interventions traditionally associated with disparate theoretical orientations. Numerous studies have shown that successful self-changers employ different processes at each particular stage of change.The ten processes of change are consciousness raising, counterconditioning, dramatic relief, environmental reevaluation, helping relationships, reinforcement management, self-liberation, self-reevaluation, social liberation, and stimulus control.

The model also incorporates a series of intervening or outcome variables. These include decisional balance (the pros and cons of change), self-efficacy (confidence in one’s ability to change across problem situations), and situational temptations to engage in the problem behaviour, and behaviours which are specific to the problem area. Situationspecific confidence refers to the confidence one may have that he/she can cope with high-risk situations without relapsing into their previous behaviour patterns. Also included among these intermediate or dependent variables would be any other psychological, environmental, cultural, socioeconomic, physiological, biochemical, or even genetic variables specific to the problem being studied.

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5. HEALTH PROMOTION MODELS AND STRATEGIES

The World Health Organization defines health promotion as ‘the process of enabling people to increase control over and to improve their health’ 41. According to this definition, health promotion extends beyond “promoting health” to include: 1) the enhancement of health, 2) a political ideology that is concerned with the redistribution of power and control over individual and collective health issues, 3) reducing the negative impact of a broad range of health determinant associated with the socio-politico-economic environment, 4) shifting the allocation of resources “upstream” towards prevention, rather than treatment of problems, 5) viewing the domains of health beyond the physical - i.e. including mental, social, and spiritual, and 6) recognizing community development and involvement as effective strategies to promote health 42.

Two of the key concepts in health promotion are “enabling” and “empowerment”. These concepts are reflected in the action areas of the Ottawa Charter for Health Promotion [building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services] which fundamentally advocates a basic change in the way society is organized and resources are distributed 43.

Health Promotion aims to help people to live healthy lives. It encompasses many diverse strategies including: health education, behavioural change models, mass communication, social marketing, building healthy public policy, and community development.

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Various author provide working definitions of patient education. Cresia ( 1996) defines patient education as a process assisting people to learn and incorporate health-related behaviors into everyday Iife. Smith (1989) describes learning as a change in behavior and defines patient education, therefore, as a process of assisting people to change behavior. Other authors describe attitudinal and value change as also king important (Garity, 19%; Ryan, 1987). Overall, many of these definitions are developed by authors with backgrounds in nursing education, who import mainstream educational principles into patient education ( Luker and Caress, 1489).

Patient trenching is to nursing care as flour is to cake. Each is so essential in their respective processes that without them the outcome is unsatistiactory. High quality ingredients are another essential requirement for both ... the better the teaching skills of nurses, the more likely patients are to learn (Gessncr. I %!?, p. 589)

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Chapter three

Methodology

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Methodology

INTRODUCTION

A quantitative descriptive research design was used to describe the nursing teaching among cardiovascular disease patient and promotion and prevention in the area of cardiovascular modifiable risk factor. The statement of the problem and the nature of data that would be generated to address the research question influenced the choice of the quantitative design.

RESEARCH DESIGN

The design is seen as the structural frame of the study. The study’s design helps the researcher to plan and implement the study towards answering the research questions. The researcher adopted a quantitative descriptive design. This design choice was based on the fact that the data was presented numerically in percentages and frequencies. Below is a detailed explanation of the design.

Quantitative design

Quantitative implies that the study uses quantification for the measurement of data. The research design in a quantitative study explicates the strategies that the researcher plans to adopt to develop information that is accurate and interpretable 44.

3.2.2 Descriptive design

Description involves identifying and understanding the nature of nursing phenomena and, sometimes, the relationships between the phenomena 44. Descriptive study design can be used in a study when:

Ø The researcher identifies a phenomenon of interest and variables within the phenomenon;

Ø The researcher develops conceptual and operational definitions of the variables; or when

Ø The researcher describes variables.

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The description of the variables leads to an interpretation of the findings’ theoretical meaning and provides knowledge of the variables and the study population that can be used for future research in the area 44. According to Waltz and Bausell (1981), a descriptive study design is used for developing theory, identifying problems with current practice, justifying current practice, making judgment, or determining what others are doing in similar situations. A descriptive study design provides an accurate portrayal or account of characteristics of a particular individual, situation or group. In this study, a descriptive design was used to describe the nursing teaching among cardiovascular disease patient.

POPULATION AND SAMPLING

Population

Population is described as all the elements or subjects that meet the criteria 44. In this study, the population consisted of Nurse working with cardiovascular patient in Hebron and Bethlehem Hospitals.

Sample

A sample is a portion or subset of a population selected to participate in the research 44.

A purposive sample was used in this study. This sample was chosen because Nurses were selected based on preselected criteria. Typically, purposive sampling is used to study groups not well represented in the population. The sample consisted of Nurses working with cardiovascular patient in Hebron and Bethlehem Hospitals.

The inclusive criteria included:

Ø The Nurses had to have deal with cardiovascular patient in there ward. Ø The nurse still working in hospital during data collection. Ø The nurse had to working in Hebron or Bethlehem hospitals.

Location:

I will ask and give the questionnaire to nurse who work with cardiovascular patient in the ward of CCU and medical ward in the hospital of :

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Ø Hebron governmental hospital in Hebron Ø Al-Ahli Hospital in Hebron Ø Al-Mezan hospital in Hebron Ø Al-Hussein governmental hospital in Bethlehem.

Subjects:

I will give 80 questionnaires and I will include all nurses’ work with cardiovascular patients in award of CCU and Medical ward and I will exclude nurses who don’t work with cardiovascular patients.

My study will not differ between nurse and every one in ward have the same chance to get and fill questionnaire.

DATA COLLECTION INSTRUMENT

A checklist developed by the researcher that contained both closed and an opened questions, was used as research instrument. It was used to determine facts about the education given by Nurse working with cardiovascular patient in Hebron and Bethlehem Hospitals.

a checklist is prepared items in which the respondents indicate their participation in a certain activity. Checklists are used to ensure that no task is left undone.

Advantages:

Ø -can be used to explore a wide variety of issues such as prevalence, characteristics of a population or views and opinions.

Ø -Provide descriptive data and generate hypotheses, guiding future research. Ø -No follow up issues. Ø -It is feasible to use random samples for the total population of interest. Ø -Relatively cheap and easy to run

The distinctive disadvantages of a checklist are:

Ø It does not supply an opportunity for respondents to classify their judgment. Ø It is a rigid method in both question and the responses. Ø Extra time must be planned for pre-testing and validating the instrument.

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Ø The respondent is required to make a forced choice response, so each item must be carefully worded and based on the research purpose.

Ø Since its inception the tool employed open-ended questions, which allowed the respondents to state their opinions. This overcame the above disadvantages.

Ø To enhance the protection against bias in this descriptive study, the following precautions, as described by Burns and Grove (2001:248), were taken:

Ø A valid and reliable instrument for data collection was used. Ø The data collection procedure achieved some environmental control. Ø Precise and replicable criteria were established before the population was

assembled.

Attention was paid to the following aspects in the development of a the checklist:

Ø The development phase. Ø The compilation of the questionnaire. Ø The refinement of the questionnaire. Ø The confirmation phase.

THE DEVELOPMENT PHASE

A thorough Introduction was conducted to assess the most important aspects that had to be included in this questionnaire.

Based on this information, a questionnaire that captures all relevant data in a consistent and organised manner was compiled.

An information leaflet accompanied the questionnaire and contained the following:

Ø A covering letter indicating the (i) purpose of this study (ii) the name of the researcher and name of researcher supervisor (iii) institution supporting this study.

Ø An informed consent letter.

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COMPILATION OF THE QUESTIONNAIRE

The questionnaire consisted of itemised questions. Space was provided for the respondents’ answers. It was important that the nurse role was not influenced by the completion of questionnaires. To ensure this, the questionnaires were handed out at 11 o’clock in the morning when doctor’s rounds were finished.

CONFIRMATION PHASE

The ethical approval for this research topic I get it from my literature Dr. Hussein Jabareen, as he tilled us that our faculty has approval from Palestine ministry of health. So our literature Dr. Hussein Jabareen has the right to decide that is ethical or not, He give me the ok on the topic.

The study is not considered to cause any harm to the nurses.

VALIDITY AND RELIABILITY

Reliability

reliability is “...the degree of consistency with which the instrument measures the attribute.” Reliablity is a matter of whether a particular technique, applied repeatedly to the same object, would yield the same result each time. Reliability does not ensure accuracy any more than precision ensure it. Even total reliability does not ensure that our measures measure what we think they measure

Reliability of the research process was ensured through the following steps:

Ø A study leader evaluated the questionnaire. Ø The researcher was present while the nurses completed the questionnaires.

No questions arose.

Validity

Validity refers to the degree to which an instrument measures what it is supposed to measure 44. Internal validity is defined as the degree to which results are a true reflection of the truth and the realties that are being researched. There are numerous yardsticks for determining validity: face validity, criterion related validity, content validity, and construct validity. Asking the nurses to be as truthful as possible when completing the questionnaires secured this.

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Validity was also promoted by the following:

Ø All questionnaires were completed under the researcher’s supervision, and therefore, no questionnaires were removed from the environment.

Ø The patients completed the questionnaires themselves.

External validity is defined as the degree to which the results of the study can be generalized to settings or samples other than the ones studied. This study was conducted in Hebron and Bethlehem hospital only, and therefore the sample is not necessarily representative of the larger population. The results of this study cannot be generalized to samples or settings other than where studied.

Construct validity is defined as the degree to which an instrument measures the construct under investigation 44. The theme of this research was education given by Nurse working with cardiovascular patient.

The researcher followed this theme throughout the study.

Content validity is concerned with the sampling adequacy of the content area being measured 44. In this study the researcher ensured content validity through a thorough literature review and the use of expert opinions in the development of a questionnaire.

DATA COLLECTION PROCEDURE

The researcher explained the purpose of the study to each patient. The hospital was consulted and written permission obtained before the study commenced.

The anonymity and confidentiality of each participant was assured, as information obtained would not be linked to their names in any way.

The questionnaires were handed out on the 2 week between 11Am and 2Pm o’clock. The researcher was present while the nurses completed the questionnaire. 80 questionnaire used in the study. Consent was obtained from the Hospital nursing supervisor before the questionnaires were handed out.

DATA ANALYSIS

The data that I collected from the surveys were coded and entered into the Statistical Package for the Social Sciences (SPSS), version 19.0 for analysis. The data were analyzed using both descriptive and correlation statistics.

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I will test each variables in questionnaire and express by descriptive and use of suitable graphs such as bar chart and pie chart.

And I will address things that improve nursing teaching to cardiovascular patient and things that limit nursing teaching to cardiovascular patient.

Also I will test the quality of nursing teaching among staff and practitioner nurse

And I will test the nursing teaching among privet and governmental hospital

Also I will test the nursing teaching among CCU and medical ward

The data analysis will be discussed in Chapter 4. The analysis was done by means of descriptive statistics and interpreted and presented in frequencies and percentages. The process of data analysis is largely a search for patterns of similarities and differences - followed by an interpretation of those patterns .

CONCLUSION

This quantitative descriptive research study aimed to establish the impact of education given by Nurse working with cardiovascular patient in. A checklist for data collection was developed based on a thorough literature review. Intensive care specialists reviewed the tool and their advice and suggestions were incorporated. The study involved nurses in Hebron and Bethlehem Hospitals, and questionnaires were completed under the researcher’s supervision. As the sample was small, special precautions such as precise and replicable inclusion criteria were established in advance to enhance the reliability and validity of the study. The data analysis will be discussed in Chapter 4.

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Chapter four: Result

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Result

The overall purpose research is to conduct a the role of nursing teaching among cardiovascular disease patient and promotion and prevention in the area of cardiovascular modifiable risk factor to identify the areas in which nursing have Concerns than other, especially the in patient who have cardiovascular risk factor or who have cardiovascular disease to decrease ferocity or to prevent complications.

So I did my questioners according to previous cardiovascular risk factor, and my question is at the aim modify these risk factors by nurse in assist people to:

Ø quit tobacco use, or reduce the amount smoked, or not start the habit Ø make healthy food choices Ø be physically active Ø reduce body mass index, waist–hip ratio/waist circumference Ø lower blood pressure Ø lower blood cholesterol and low density lipoprotein cholesterol Ø (LDL-cholesterol) Ø control glycaemia Ø Take ant platelet therapy when necessary.

The result of my research will be categorized in three parts :

1- Demographic data 2- Nursing role in cardiovascular disease patient teaching 3- The Factors that limit the extent of giving teaching and the factors that

motivate giving teaching

response rate

The response rate was 86%; the sample was 80, 69 returned back.

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1- Demographic data

الدرجة العلمیة

Frequency Percent %29 20 دبلوم متوسط

%59.4 41 بكالوریوس %7.2 5 دبلوم عالي متخصص

%4.3 3 ماجستیر فأعلىThe nurse participate on my study according to education level are 59% bachelor degree , diploma 29% , master and high diploma are 11.5 %

الوظیفي المسمى

Frequency Percent قسمرئیس 4 5.8%

%11.6 8 نائب رئیس قسم %56.5 39 ممرض قانوني %26.1 18 ممرض مؤھل

The nurse participate on my study according to job title are 56.5% staff nurse and 26% practical nurse , head nurse and vice head nurse are 17%.

القسم الذي تعمل بھ

Frequency Percent %20.3 14 الباطني

%34.8 24 العنایة القلبیة المكثفة %26.1 18 طوارئ

%18.8 13 اقسام اخرىThe nurse participate on my study according to ward 35% CCU, 20% medical ward, 26% ER and other is 19%.

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الجنس

The nurse participate on my study according to sex there are 56.5% male and 43.5% female

عدد سنوات الخبرة

The nurse participate on my study according to Years of Experience are 41% from 5-10 years , 38% from 10-15 years, 14.5% less than 5 years and 7% more than 15years.

نوع المستشفى

The nurse participate on my study according to hospital type there is 55% none governmental , 39% governmental and 6% private

Frequency Percent %56.5 39 ذكر %43.5 30 أنثى

Frequency Percent سنوات 5أقل من 10 14.5%

سنوات 5-10 28 40.6% سنة 10-15 26 37.7%

سنة 15أكثر من 5 7.2%

Frequency Percent %39 27 حكومي

%55 38 غیر حكومي %6 4 خاص

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ھل حصلت على دورات بخصوص امراض القلب والشرایین

The courses and training increase the awareness and knowledge,

also attitude in nursing here about half of nurses work with

cardiovascular disease say that they got course in cardiovascular

disease.

Frequency Percent 50.7 35 نعم 49.3 34 ال

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2- Nursing role in cardiovascular disease patient teaching

أقوم بتوضیح التشخیص للمریض )1

The patient has the right to know and understand the actual problem that

he have, and the nurse has responsibility in clarify the diagnoses.

Here the result of this question show that about 91 % say always and

some time and about 9 % say rarely .

أقوم بتوضیح االعراض المرضیة المتوقعة )2

The patient should know what sign and symptom that may appear and

what is normal and what is abnormal and when he should seek health

care here the result show that 61 say some time which mean not all nurse

work with cardiovascular disease patient clarify for patient this topic.

Frequency Percent %40.6 28 دائمًا

%50.7 35 احیانًا %8.7 6 نادرًا


%60.9 42 احیانًا %10.1 7 نادرًا 2.9 2 مطلقًا

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أوضح للمریض كیفیة استخدام االدویة وما الفائدة العالجیة لكل دواء وتاثیره حتى بدون )3 ان یسأل المریض

The medication is the one of the most important steps in treatment and

care plan for the patient, and medication one of the major duties for

nursing. The result here show that about 90% say always and some time.

أقوم بتوعیة المرضى حول اضرار التدخین والفوائد الصحیة لتركھ )4

The smoking is one of the major risk factor of cardiovascular disease and

the nurse has role in clarify the smoking risk and benefits of get smoking

out the result show that about 85% of nurses give instruction always and

some time.


%47.8 33 احیانًا

%8.7 6 نادرًا

%2.9 2 مطلقًا


%36.2 25 احیانًا %13 9 نادرًا %2.9 2 مطلقًا

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أقوم بتوعیة المریض حول اھمیة الغذاء المتوازن )5

One of the factor for cardiovascular disease is food component and the

nurse should increase patient awareness about balanced food. Here

about 95% say always and some time and 15% say rarely and never.

أقوم بتوضیح نوعیات الغذاء المناسب الذي یساعد في تحسین صحة المریض )6

There is kind food that promote health for cardiovascular disease and there is food should be avoided, the nurse has responsibility in give these instruction, here about 88% give instruction about these topics and about 12% rarely or never give these instructions.


%39.1 27 احیانًا %13 9 نادرًا %1.4 1 مطلقًا


%40.6 28 احیانًا %10.1 7 نادرًا %1.4 1 مطلقًا

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أقوم بمساعدة المریض بعمل برنامج غذائي مناسب یخفف من مضاعفات المرض

Each patient need nutritional program differ to become appropriate to his health status, and nurse has responsibility in help patient to put this program. The result here show that always and sometime 75% and 25% to rarely and never.

لریاضة المنتظمة وما ھي الریاضة المناسبة حسب حالة المریضأقوم بتوضیح اھمیة ا

The exercise is one of lifestyle that promote health of cardiovascular disease patient and each one differ from other because of health status. The result show that 74% say always and some time and 26% say rarely and never.

Frequency Percent %29 20 دائمًا




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أقوم بتحدید االعمال التي یجب اوال یجب عى المریض القیام بھا وفقا لحالتھ الصحیة

Each patient according to health able to do kind of work and un able to other kind, the nurse here has responsibility in determine works that appropriate to patient. The result show here that 90% say always and some time and 10% say rarely.

أقوم بتوعیة المریض حول اھمیة الوزن الطبیعي وطرق التخلص من الُسمنة

The obesity is one of the major risk factor of cardiovascular disease, and cardiovascular patient with obesity should become around normal weight, the nurse should give the patient instruction how to be in normal weight. The result here show 77% say always and some time and 33% say rarely and never.




%37.7 26 احیانًا %23.2 16 نادرًا %39.1 27 دائمًا

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أقوم بتعلیم المریض كیفیة التعامل مع حاالت الذبحة الصدریة واعراضھا

Angina is one of cardiovascular disease and high number of cardiovascular patient have angina, so the nurse should give the patient instruction how to deal with it and when he need to seek health care. The result show that nurses say always and some time are 87% and 13% say rarely.

أقوم بتوعیة المریض حول المخاطر الصحیة الرتفاع ضغط الدم وضرورة االلتزام بالعالج

Hypertension is one of cardiovascular disease and can cause other cardiovascular disease, the nurse should give patient instruction to take his responsibility by talk to him about risks of hypertension. The result here show that nurses say always and some time are 89% and 11% say rarely and never.


%47.8 33 احیانًا %13 9 نادرًا



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أقوم بتوعیة المریض حول وسائل العالج باالسترخاء والموسیقى لتخفیف االلم

The music and relaxation has direct effect in decrease pain and

stress, so the nurse should tell this to patient. The result here

show that nurse say always and some time are 55% and 45% say

rarely and never.

طبیعي من السكر في الدم اذا كان أقوم بتوعیة المریض حول اھمیة المحافظة على مستوى المرض مقترننا بداء السكري

Diabetes mellitus is one of chronic disease and consider as one of major

factor for cardiovascular disease, the nurse responsibility is to increase

patent awareness to maintain normal blood sugar. The result of this

question show that 93% say always and some time and 7% say rarely.





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أقوم بتوعیة المریض حول طرق التشخیص والفحوصات الدوریة التي علیھ القیام بھا

The patient has right to know about what will done for him, and he should

know about the procedures he needed, the nurse responsibility here is to

clarify each procedure and the goal of it. The result here show that 84% of

nurses say always and 16% say rarely and never

.عند تقدیم التثقیف الصحي استخدم كلمات وعبارات تراعي القدرات العلمیة للمریض

Each patient has education lever differ from other, the nurse here should

adapt to patient level of education to maintain our goal to maximum

information to be understand by patient. The result here show that 92% of

nurses say always and some time and 8% say rarely and never.





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.عند تقدیم التثقیف الصحي لمرضى القلب اعتمد على مرجعیة علمیة مؤكدة ومعتمدة

When give instruction to patient, all information should be true and nurse

take it from reliable references, the result here show that nurse say

always and sometime 97% and 3% say rarely.

اعتقد انھ من الضروري اعداد دورات لزیادة الخبرة التمریضیة في التثقیف الصحي لمرضى القلب

The courses and training increase the awareness and knowledge,

also attitude in nursing. The result here show that 96% say always

and some time and 4 % say rarely.

یقوم جمیع الممرضین في القسم بتقدیم التثقیف الصحي للمرضى تلقائیا







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3- The Factors that limit the extent of giving teaching and the factors that motivate giving teaching

من العوامل التي تحد من اعطاء قدر كافي من التوعیة للمرضى ضغط العملھل تعتبر

94% of nurses consider work overload is one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 6 % disagree.

العوامل التي تحد من اعطاء قدر كافي من عدم المعرفة بالتعلیمات الواجب اتباعھاھل تعتبر من التوعیة للمرضى

54% of nurses consider Don't know about teaching to is one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 46 % disagree

من العوامل التي تحد من اعطاء قدر كافي من التوعیة للمرضى عدم تعاون المریضھل تعتبر

75 % of nurses consider Non-cooperation of the patient as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 25% disagree.

Frequency Percent %94.2 65 أوافق

%5.8 4 أعارض


%46.4 32 أعارض


%24.6 17 أعارض

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من العوامل التي تحد من اعطاء قدر كافي من التوعیة للمرضى قلة الوقت ھل تعتبر

88 % of nurses consider lake of time as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 12% disagree.

من عدم وجود قوانین في المستشفى تجبر الممرض على تقدیم التثقیف الصحيھل تعتبر العوامل التي تحد من اعطاء قدر كافي من التوعیة للمرضى

64 % of nurses consider The absence of laws forcing the nurse at the hospital to provide health education as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 36% disagree.

من وجود ارشادات ثابتة او مطبوعة من قبل المستشفى حول التثقیف الصحيعدم ھل تعتبر العوامل التي تحد من اعطاء قدر كافي من التوعیة للمرضى

74 % of nurses consider The absence of printed instructions in the hospital about health education as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 26% disagree.


%11.6 8 أعارض


%36.2 25 أعارض


%26.1 18 أعارض

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من العوامل التي تحد من اعطاء قدر كافي من في التواصل مع المرضى كمھارات قلةھل تعتبر التوعیة للمرضى

33 % of nurses consider Lack of communicating skills with patients as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 67% disagree.

للمریض جزء من البرنامج العالجي للمریضال اعتبر التثقیف الصحي

26% of nurses don't consider giving teaching to cardiovascular disease patients as part of care plan for patients, and 74% disagree.

من العوامل التي تحد د من قبل المستشفى على ھذا المجھو د حوافز كافیةووجعدم ھل تعتبر من اعطاء قدر كافي من التوعیة للمرضى

80 % of nurses consider The absence of adequate incentives by the hospital on this effort as one of factor that limit the extent of giving teaching to cardiovascular disease patients, and 20% disagree.


%66.7 46 أعارض


%73.9 51 أعارض


%20.3 14 أعارض

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ال أعتبر التثقیف الصحي من وظائف التمریض في المستشفى

26% of nurses don't consider giving teaching to cardiovascular disease patients as part of nursing curricula in care for patients, and 74% disagree.

یقوم رئیس القسم بمتابعة التثقیف الصحي ویعتبره جزء اساسي من وظیفة الممرض

72.5% of nurses consider that head nurse follow teaching to cardiovascular disease patients and consider is part of nursing curricula in care for patients, and 27.5% disagree.

یوجد في القسم ارشادات مطبوعة لتثقیف المرضى

62% of nurses agree with There are printed instructions in the section to educate patients, and 38% disagree.


%73.9 51 أعارض


%27.5 19 أعارض


%37.7 26 أعارض

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مرضین الملتزمین بالتثقیف الصحيمیوجد في القسم حوافز اضافیة لل

56.5% of nurses agree with There are additional incentives in the section of the nurses who are committed to health education, and 43.5% disagree.


%43.5 30 أعارض

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Chapter Five :

Discussion

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Discussion

Introduction

The purpose of this chapter is to discuss four main issues: the significance of the findings of the study and how these relate to the research question are discussed. Consideration is then given to how these findings relate to the literature, especially the literature on patients’ perspectives on CHD that was discussed in chapter two; Finally, issues concerned with the practical application of reflexivity in the study are considered.

Discussion

As discussed in Chapter one, the overall aim of the study was to explore nursing teaching toward cardiovascular disease patients’

perspectives lifestyle modification using a quantitative approach (the rationale for which is discussed in chapter three.

Nurses take a central role in working with clients to promote the best outcomes.

The evidence from this study lends support for the research hypothesis that there are significant interrelationships between the cardiovascular health/risk behaviors and nursing role in teaching, the nursing role here clarify from high percent in answers of questions related to issue in cardiovascular teaching by nurse participate.

The result in part tow of questionnaire support that nursing give teaching in major sector of cardiovascular disease for healthy life style, clarify of procedures and care plan.

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According to result There isn't topic nurse focus on than another, the nurse focus on medical treatment and care plan as medical diagnoses, medication, procedures and life style teaching as healthy food, exercise.

According of the nurse participate the half of them take training and courses in cardiovascular nursing, the course give nurse information and awareness to health related issue for cardiovascular disease patient, and teaching become more helpfully because it's depend on valid database

When they have confidence, the teaching process will go on smoothly, rapidly, and procedurally because there is a complete and preliminary teaching arrangement and direction to control the teaching to go on in the same guideline. this broad based clinical skills that can be extended and expanded with appropriate training.

one of the most important factors is to deal with patient use information according to patient level of education to assess the patient’s self-efficacy beliefs for behavioural change to make health practices easier.

collaboration with the nurses. Team-work is valuable for the patients and gives confidence to both the health-care and the patient, as the patient receives the same information and meets the same attitude from nurses.

Recurrent consultation training can give structure to the consultation and increase individually adapted communication in assessing lifestyle behaviour.

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The nurse identify many obstacles the main one is work pressure and overload.

54% of nurses says that they haven't information as one obstacles to give cardiovascular teaching.

75% of nurses says that Non-cooperation of the patient as one obstacles to give cardiovascular teaching.

89% of nurses says that no time as one obstacles to give cardiovascular teaching.

64% of nurses says that The absence of laws forcing the nurse at the hospital to provide education as one obstacles to give cardiovascular teaching.

74% of nurses says that The absence of printed instructions by the hospital as one obstacles to give cardiovascular teaching.

There is many motivation factor : follow up of nursing teaching by head nurse and motivation from team.

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Recommendation

Health polices maker may utilize this provided information to assist them in helping nurse to identify obstacles and inhibitors and to develop strategies to initiate health behavioral changes.

Hospitals must offer teaching framework for supporting the nurse to perform relevant nursing actions and interventions.

Focus on the concepts related to the nurse as tools to communicate in a more structured and interactive way with the aim of assisting patients’ development of self-care agency to change lifestyle so more training in communication skills needed.

education about non-pharmacological treatment and also on how to perform counseling in a stage-directed, patient-centered way. Lectures on how to perform counseling are not enough. Training is also needed.

More attention should be given by hospitals to the needs of those caring for people with CVD.

More research need to collect the most important factors relating to the patient, the nurse and their communication process concerning lifestyle changes in hypertension care.

they must offer The printed guidance for each Patient acording to patient case.

They must decrease work overload by increase number of nurses in wards.

Cooperative efforts to promote the education of patients may be encouraged through joint staff conferences of several agencies, inservice training, case conferences of several agencies, and other means for

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exchange of ideas and make Course to raise the level of awareness' in nursing working with cardiovascular patients.

Study Limitations

Even with such diligence to validate all methods and data, this study has some limitations, one limitation is the Lack of sources and studies on the same subject, It's the first time where scientific research work, Time constraints and pressure study, Lack of cooperation by some nurses to answer the questions,Also, this study has a small sample size.

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Appendix A

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Appendix B

ال دكتور اش راف تح ت دراس ة بعم ل اق وم الخلی ل جامع ة – التم ریض كلی ة . مناص رة ربح ي مال ك: الطال ب ان ا

."والشرایین القلب لمرضى الصحیة والتوعیة التثقیف في التمریض دور" موضوع الجبارین حسین

، ول ن یك ون فق ط العلمی ھ الدراس ة لغ رض ستس تخدم ه الدراس ة ھ ذ نت ائج , بدق ھ االستبیان ھذا تعبئة أرجو ولذلك

.باالمكان التعرف على ھویة المشاركین في تعبئة ھذا االستبیان

تعاونكم حسن لكم شاكرًا

ن.امام الخیار الذي یناسبك) X(الرجاء االجابة على ھذه االسئلة بوضع اشارة

دبلوم عالي متخصص ماجستیر فاعلى بكالوریوس دبلوم متوسط :الدرجة العلمیة

.......حدد/غیر ذلك رئیس قسم ممرض قانوني ممرض مؤھلرئیس قسم نائب : المسمى الوظیفي

سنة فأكثر 15سنة 15- 10سنوات 10- 5سنوات 5اقل من : عدد سنوات الخبرة

ذكر انثى: الجنس

................حدد / طوارئ اقسام اخرى العنایة القلبیة المكثفة القسم الذي تعمل بھ الباطني

المستشفى مستشفى حكومي مستشفى غیر حكومي مستشفى خاص

وظیفة جزئیة وظیفة كاملة المؤسسة بداوم االلتزام

...................االسبوع في العمل عاتسا عدد

ھل حصلت على دورات بخصوص امراض القلب والشرایین نعم ال

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اذا كان الجواب نعم فكم عدد ھذه الدورات .................................................................................

.بجانب الخیار الذي یناسبك) X(االجابة على ھذه االسئلة بوضع اشارة الرجاء

اوافق السؤال رقم بشدة

اعارض اعارض اوافق بشدة

ان بدون حتى للمریض التشخیص بتوضیح دائما أقوم 1 المریض یسأل

المتوقعة المرضیة االعراض بتوضیح دائما أقوم 2 المریض یسأل ان بدون حتى

وما االدویة استخدام كیفیة للمریض دائما أوضح 3 یسأل ان بدون حتى وتاثیره دواء لكل العالجیة الفائدة

المریض

التدخین اضرار حول المرضى بتوعیة دائما أقوم 4 لتركھ الصحیة والفوائد

الغذاء اھمیة حول المریض بتوعیة دائما أقوم 5 المتوازن

الذي المناسب الغذاء نوعیات بتوضیح دائما أقوم 6 المریض صحة تحسین في یساعد

غذائي برنامج بعمل المریض بمساعدة دائما أقوم 7 المرض مضاعفات من یخفف مناسب

ھي وما المنتظمة الریاضة اھمیة بتوضیح دائما أقوم 8 المریض حالة حسب المناسبة الریاضة

عى یجب اوال یجب التي االعمال بتحدید دائما أقوم 9 الصحیة لحالتھ وفقا بھا القیام المریض

الوزن اھمیة حول المریض بتوعیة دائما أقوم 10 الُسمنة من التخلص وطرق الطبیعي

حاالت مع التعامل كیفیة المریض بتعلیم دائما أقوم 11 یسأل ان بدون حتى واعراضھا الصدریة الذبحة

المریض

الصحیة المخاطر حول المریض بتوعیة دائما أقوم 12 بالعالج االلتزام وضرورة الدم ضغط الرتفاع

العالج وسائل حول المریض بتوعیة دائما أقوم 13 االلم لتخفیف والموسیقى باالسترخاء

المحافظة اھمیة حول المریض بتوعیة دائما أقوم 14 كان اذا الدم في السكر من طبیعي مستوى على

السكري بداء مقترننا المرض

التشخیص طرق حول المریض بتوعیة دائما أقوم 15 بھا القیام علیھ التي الدوریة والفحوصات

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كلمات استخدم دائما الصحي التثقیف تقدیم عند 16 .للمریض العلمیة القدرات تراعي وعبارات

اعتمد لمرضى القلب دائما الصحي التثقیف تقدیم عند 17 .ومعتمدة مؤكدة علمیة مرجعیة على

الخبرة لزیادة دورات اعداد الضروري من انھ اعتقد 18 لمرضى القلب الصحي التثقیف في التمریضیة

یقوم جمیع الممرضین في القسم دائما بتقدیم التثقیف 19 الصحي للمرضى تلقائیا دون ان یسأل المریض

للمرضى التعلیم من كافي قدر اعطاء من یحد عامل تعبره التالیة العوامل من اي اوافق العامل رقم

بشدة اعارض اعارض اوافق

بشدة العمل ضغط 1 اتباعھا الواجب بالتعلیمات المعرفة عدم 2 المریض تعاون عدم 3 الوقت قلة 5 تجبر المستشفى في قوانین وجود عدم 6

الصحي التثقیف تقدیم على الممرض

من مطبوعة او ثابتة ارشادات وجود عدم 7 الصحي التثقیف حول المستشفى قبل

المرضى مع التواصل في مھارات املك ال 8 من جزء للمریض الصحي التثقیف اعتبر ال 9

للمریض العالجي البرنامج

المستشفى قبل من كافیة حوافز یوجد ال 10 المجھود ھذا على

وظائف من الصحي التثقیف أعتبر ال 11 المستشفى في التمریض

:عوامل اخرى

..........................................................................................................................

القلب لمرضى التعلیم من كافي قدر عطاءال محفزًا عامل تعبره التالیة العوامل من اي اوافق العامل رقم

بشدة اعارض اعارض اوافق

بشدةتابعة التثقیف الصحي میقوم رئیس القسم ب 1

ویعتبره جزء اساسي من وظیفة الممرض

یوجد في القسم ارشادات مطبوعة لتثقیف 2

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المرضىیوجد في القسم حوافز اضافیة للمرضین 3

بالتثقیف الصحيالملتزمین

:عوامل اخرى

..........................................................................................................................

....................................................................................................................................................................................................................................................

........................

:مالحظات اخرى تود اضافتھا

....................................................................................................................................................................................................................................................

وشكرا جزیال لتعاونكم

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