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"Nursing teaching toward cardiovascular disease patients in palestine "malik manasrah


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"Nursing teaching toward cardiovascular disease patient"
health in Palestine
By Malik Manasrah
Dr. Hussein jabareen

Published in: Health & Medicine
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"Nursing teaching toward cardiovascular disease patients in palestine "malik manasrah

  1. 1. Faculty of NursingName: Malik Rebhi Manasrah 20710272The topic: Research Paper "Nursing teaching toward cardiovascular disease patient"Supervisor : Dr. Hussein JabareenAcademic year: 2011 J0J
  2. 2. ACKNOWLEDGMENTSThis thesis wouldn’t be completely done unless I had obtained veryunmistakable assistance from Associate my advisors, Dr. Hussein Jabareenwho have been giving me very captivating and useful ideas, concepts,advice, and guidelines. They have also devoted their precious time tochecking and correcting the shortcomings in all phases of this research,including giving me the encouragement and moral supports all along. Ireally appreciate their sincerity, generosity, and sacrifices, so I would liketo take this opportunity to give them my heartfelt thanks.It is not possible to credit the many who have contributed toward theaccomplishment of this research. However, I would like to give particularrecognition to those who helped and guided me through this study.I shall never be able to express adequately my acknowledgment to allmy 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, andendless support during my graduate study.I also wouldn’t forget to thank my friends, my senior friends and anyonewho has provided me their help, but I can’t mention all their names here. J1J
  3. 3. 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 12 risk factors BACKGROUND 13 Concepts related to the nurse effective 15 communication 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 30 design 16 Ethical consideration 31 Chapter four 17 Result & data analysis 36 Chapter five 18 Discussion 54 J2J
  4. 4. 20 Recommendation 5821 Study limitation 5922 Appendix A : Cross tabulation 6023 Appendix B : Questionnaire 6224 References 66 J3J
  5. 5. AbstractCardiovascular disease (CVD) is a critical public health issue, nationally andinternationally.cardiovascular diseases most common causes of death worldwideamong adults in Palestine in 2005, 21 % of deaths were due to heartdiseases and 11 % to cerebrovascular diseases.Counseling and teaching in cardiovascular disease care relating to lifestylechanges, nonpharmacolgical treatment regarding smoking, weight, diet,physical activity and stress, aims to reduce complications. Many patientshave several risk factors to deal with. There are few studies of nursing incardiovascular disease care in Palestine and this issue therefore needs tobe investigated in my study. The aims of this study were to analyze the communication betweenpatients and nurses about lifestyle changes in cardiovascular disease careat hospitals and To establish data of what kind of teaching the nurse giveto cardiovascular patient and To identify factors which limit or preventsufficient teaching to cardiovascular patient. In the first study.Research question: Is nurse give teaching to cardiovascular patient by giving theminformation and instruction about variables of Specific Cardiovascular riskfactors (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. J4J
  6. 6. Methodology I used Quantitative approach, cross sectional method & Questionnaires design.Population: the population consisted of Nurses working with cardiovascular patientLocation: Ø Hebron governmental hospital Ø Al-Ahli Hospital in Hebron Ø Al-Mezan hospital in Hebron Ø Al-Hussein governmental hospitalTiming: 2 weeks from 19/2/2011 -1/3/2011Subjects: 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 motivationsKeywords: Nursing, cardiovascular disease, counseling, teaching, lifestyle,health behavior, patient-centered care, stages of change model. J5J
  7. 7. Chapter OneINTRODUCTION J6J
  8. 8. INTRODUCTIONThe purpose of my research is to conduct a the role of nursing teaching amongcardiovascular disease patient and promotion and prevention in the area ofcardiovascular modifiable risk factor to identify the areas in which nursing haveConcerns than other, especially the in patient who have cardiovascular risk factor orwho 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 J7J
  9. 9. Cardiovascular diseasesCardiovascular disease (CVD) is a critical public health issue, nationally andinternationally. It was responsible for less than 10% of all global deaths at thebeginning 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 thefirst and second most common causes of death worldwide3. In developed countrieslike the United Kingdom, it was found that 39% of deaths to be related to CVD in20024.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 deathamong 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 ofdeveloping CVD. For example, there are more than 200 risk factors for CHD but themost significant risk factor is abnormal lipid values3. However, the main CVD riskfactors 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 andBethlehem hospitals nurse , in addition factor that affects teaching process. J8J
  10. 10. Research question:Is nurse take care with cardiovascular patient by giving teaching for cardiovascularpatient by test nursing teaching for these variables of Specific heart-healthy lifestylebehaviors such as physical activity, low-saturated fat and low-salt diet, cigarettesmoking abstinence or cessation, weight control or reduction, and controlled bloodpressure (hypertension), glucose (type 2 diabetes), and serum cholesterol and otherlipids . 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 givessufficient teaching for cardiovascular patient on modification there life style invariables that promote their health and prevent further complication and maketeaching about drug use and each. The null hypotheses: The null hypotheses suggest that nurse take care with cardiovascular patient don’tgives 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. J9J
  11. 11. Cardiovascular risk FactorsIn the last years, prevention and treatment of CVD risk factors have resulted inlowering CVD-related mortality. However, many patients identify these factors butthey do not have them adequately controlled8.•Physical InactivityDespite the debate about the amount, intensity, frequency and duration of activityfor optimal health, researchers concur that physical activity is necessary for themetabolic and cardiovascular benefits. Physical activity can slow the initiation anddevelopment of diabetes and the sequence of CVD through its effect on body weight,insulin sensitivity, glycemic control, blood pressure, fibrinolysis, endothelial functionand inflammatory defense systems. Moreover, physical activity can lessentriglycerides and have an effect on both low-density lipoprotein (LDL) and HDLparticle sizes9.• ObesityObesity leads to the development of Cardiovascular disease. Studies demonstratethat obesity cause endoplasmic reticulum ER stress. This stress leads to thesuppression of insulin receptor signaling.Body mass index (BMI): one of the most commonly used indicators of obesity, but itis not an ideal one as it does not take into account the body fat distribution. BMI iscalculated 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 aBMI 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 decreasein 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 lipaseactivity decrease in clearance. So rising risk of heart diseases11. J 10 J
  12. 12. • SmokingSmoking is assumed to cause coronary thrombosis by increasing the formation ofcoronary plaques, destabilizing coronary plaques, promoting plaque split, increasingplatelet activation and causing endothelial dysfunction. In addition, smoking causescoronary spasms by increasing catecholamine release22. In developing countriesabout 2.41 million premature deaths from cardiovascular causes were attributed tosmoking in 200012. J 11 J
  13. 13. Epidemiological transition of cardiovascular risk factorsAccording to the International Obesity Task Force, more than 1.1 billion adultsworldwide are overweight 16.6%), and 312 million of them are obese (4.7%)12. In2005, 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 populationto investigate the prevalence of obesity; the results indicated that 41% of urbanpopulation is obese (49% for women and 30% for men)14.The world health organization indicated that more than 60% of global populationsare 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 ofhypertension 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. Hypertensionwas 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 theworld. 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. Thesmoking 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 from22.1% in 2000 to 19.8% in 2006. But there was a wide gap between male smokers(37%) and female smokers (2.2%) in 200618. J 12 J
  14. 14. BACKGROUNDCounseling on lifestyle changes is based on communication between patient andnurse. Interpersonal skill in nursing involves personal qualities, dispositions towardsothers, communication skills and disposition towards self, among other things 19It 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, whilethe contrary is not allowed. Counseling is designed to make a person confidentenough to choose and to be able to take a particular course of action 20. To act, thepatient needs to be able to identify the things he/she has to do, stop doing, continueto do and to accept. Counseling is always voluntary 19.Applying interpersonal skills in an efficient way is not an easy task. A study based onaudio-recorded consultations between cardiovascular patients and nurses at healthcenters and a specialist clinic showed that the nurses dominated the interaction byusing more words, initiating more topics and using more discourse space than thepatients 21.In counseling, nursing actions are directed towards the goal of helping patients toaccept the fact that they have high risk to cardiovascular disease. The nurse has tohelp the patients to understand that medications and lifestyle modifications cancontrol but are generally unable to cure cardiovascular diseases and to persuadethem to use specific strategies to achieve the necessary lifestyle changes. When apatient is confronted with the need for lifestyle change, strategies are essential tohandle a situation that could be experienced as demanding. Coping comprises aperson’s strategies to handle trying situations and demands that are appraised astaxing or exceeding a person’s resources 22.Changing lifestyle could be expressed as executing self-care. Self-care was defined in1978 as a process whereby a lay person can function effectively on his own behalf inhealth promotion, in disease detection and treatment at the level of primary healthcare 23. Counseling conducted in a patient-centered way, where chronically illpatients become more active, may lead to treatment plans that are more structuredaround the patient’s beliefs and are therefore more likely to produce self-care 24. J 13 J
  15. 15. 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 sothat the patient actively participates in problem definition and realistic andpersonalized goal-setting 25. It is important that the interventions are guided bypatients’ willingness for change and self-efficacy. Support for behavioral changes andfollowup visits are also necessary parts.If lifestyle changes are to be successful, the patient has to be motivated. Motivationmeans mobilizing mental and behavioral effort to achieve a goal 26. A tool for thenurse to use in counseling 27. J 14 J
  16. 16. Concepts related to the nurse effective communicationWhen counseling cardiovascular disease patients, nurses make use of theirprofessional knowledge and skills to help the patients, through performed self-care,to reach their treatment goals. The importance of health education as a part ofnursing has been recognized for a long time. The nurses also need an understandingof patients’ physiological and psychosocial state to make an assessment togetherwith the patient to determine the kind of education that is needed. Thisencompasses a holistic view, which is necessary in order to help a patient to decideon behavioral change. Even a well-informed and behaviorally skilled patient mustgenerally be highly motivated and receive support to initiate and maintainpreventive behavior 28. For many people, changing one’s lifestyle is equivalent tofinding a new personal identity 29.The nurse must then choose education strategies, which means instructionalmethods, behavioral strategies and educational aids 20. Educational aids as acomplement to verbal communication could include instruction sheets, pamphlets,brochures, booklets or computer-assisted instructions 30. Effective teaching is acombination of the use of good communication skills and effective educationalstrategies. Information, clear, honest and adequate, should be given to patients asrequired 31.In counseling on lifestyle changes, it is important for the nurse to show the patientrespect, irrespective of whether or not the patient is prepared to perform behavioralchange. This approach embraces being the patient’s advocate. The advocate shouldinform the patient and promote informed consent, empower the patient and protectthe rights and interests of the patient 32. The empowerment part means that thenurse should enable patients to choose to take control over and make decisionsabout their lives 33. As the nurse-patient relationship is supposed to be based uponmutual respect and equality, nurses should facilitate the empowerment of patientsrather than empower them, i.e. the patient must be active in the process. J 15 J
  17. 17. Chapter twoTheoretical framework J 16 J
  18. 18. Theoretical frameworkMany theories and models have been proposed to explain the adoption of health riskand health enhancing behaviors. This chapter reviews the major evidence-basedmodels of health behavior identified in the literature. These include psychologicalmodels aimed at modifying individual behavior as well a health promotion modelsand 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 J 17 J
  19. 19. 1. HEALTH BELIEF MODEL (BECKER, 1974)The health belief model (HBM) (Janz & Becker,1984; Rosenstock, 1974) is one of themost commonly-used models of health behaviour change and many have used it toguide the development of health interventions. It was developed in the early 1950’sas 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 arepersonally at risk of a particular problem or illness and that a particular action willenable them to deal with that risk, without excessive personal sacrifice. Briefly, theHBM suggests that preventive health behaviours are influenced by five factors:_ Perceived susceptibility – This refers to one’s subjective perception of the risk ofcontracting a condition (the individual evaluation of the likelihood of developing thehealth problem)_ Perceived severity – This refers to feelings concerning the seriousness of the illnessif it is contracted or left untreated_ Perceived benefits – These are the beliefs regarding the effectiveness of theactions available in reducing the disease threat_ Perceived barriers – These refer to the potential negative physical, psychologicaland 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). Itshould be noted that cues to action can be external (e.g., the recommendation of aphysician or mass media messages) or internal (e.g., symptoms). Another type ofexternal cue, social influence, has also been shown to be an important predictor ofhealth behavior.According to the HBM, individuals weigh the potential benefits of the recommendedresponse against the barriers of the action (e.g., psychological, physical, and financialcosts) when deciding to act. For example, a woman may recognize the benefit of J 18 J
  20. 20. having a mammogram but may be afraid of finding cancer.The readiness to takeaction for health stems from a perceived threat of disease, due to an individual’sperception of his or her susceptibility to disease and its potential severity. Theanticipation of a negative outcome and the desire to avoid this outcome createsmotivation to take preventative actions. (See Figure 2). Figure 1: The Health Belief Model (HBM)Source: “Communication and Community Development for Health Information: Constructs and Models forEvaluation” by John E. Bowers, Review prepared for the National Network of Libraies of Medicine, PacificNorthwest Region, Seattle, December 1997.Jbowes @ In summary, HBM, with its focus on cognitive processes, may be viewed as thegrandmother of most modern health education theories. As such, its variables andprinciples can be seen in many of the other models to be discussed in this chapter. J 19 J
  21. 21. 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 healthinterventions 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) inan effort to understand the relationship between attitudes and behaviour. It beginswith the premise that people usually consider the implications of their actions, thenact consciously and deliberately. In other words, people eventually do what theyintend to do, and the best single predictor of a behaviour is the intention to act inthat way.According to Fishbein and Ajzen (1980), two sets of beliefs must be altered prior tobehavioural change: (1) beliefs about the consequences of performing a certainbehaviour and the evaluation of those consequences (attitude); and (2) beliefs aboutwhat other people or referents think about the behavior to be performed and themotivation to comply with those referents (subjective norm). Only when a messagetargets the salient beliefs of these variables do attitudes and subjective norms, andsubsequently, behavioural intentions and behaviour change.Overall, TRA is one of the few theories to offer a systematic approach to theconstruction of the content of a health education message. It has been applied to anumber of health-related behaviours including the impact of health risk messagesabout tap water, sexual practices and AIDS related-behaviours 35, childbearingintentions, testicular cancer prevention, exercise in schoolchildren, alcoholism,cigarette smoking, prediction of mammography use, and obtaining Pap tests forcervical 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 J 20 J
  22. 22. point of the theory is on perceived self-efficacy. Self-efficacy is defined as “people’sbeliefs that they can exert control over their motivation, behaviour and socialenvironment” 36. In other words, perceived self-efficacy is what one believes aboutone’s capability to perform a certain action (perceived self-effectiveness).Bandura (1977) views self-efficacy as the driving force of human behaviour. Anotherimportant construct in Bandura’s theory is outcome expectations.Outcome expectations (also called response efficacy in other models) refer to anindividual’s belief that a certain behaviour will lead to a certain outcome. Forexample, “I believe that if I exercise regularly I will look better” is an outcomeexpectation. Outcome expectations are different from efficacy expectations in thatthe latter is a person’s belief on whether he or she is able to ”successfully executethe behavior required to produce the outcomes” 36. Bandura states that healthbehaviour and health outcomes are a function of efficacy and outcome expectations.However, an individuals’ efficacy and outcome expectations may be inconsistent, forexample, someone who smokes may perceive that smoking is harmful to his/herhealth yet believes him/herself to be incapable of changing this behaviour. Inaddition, a person’s efficacy expectations may vary across behaviours and situations.For example, a person may have high self-efficacy for attending exercise classesregularly but low perceived self-efficacy for reducing alcohol intake. Bandura (1977)further proposes that an individual’s self-efficacy perceptions are developed fromfour sources of information: performance accomplishments (e.g., learning throughpersonal experience), physiological states (e.g., relaxation, biofeedback, informationfrom providers about the consequences of health risks and the benefits of change),verbal persuasion (e.g., information from practitioners, self-instruction), andvicarious experience (e.g., seeing others consider and perform challenging healthbehaviours successfully). The concept of self-efficacy has been used in areas such asexercise, dietary fat intake, and smoking 38. Figure 3: Social Cognitive Theory J 21 J
  23. 23. Another type of Social Learning Theory which has been widely used in adolescentpopulation is the social influence theory. This theory proposes that adolescents arehighly prone to the social influences from peers, family, media as well as internalpressure. In terms of intervention, the social competency model proposes thatadolescent may engage in risky health behaviour because they lack psychosocial skillsto 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 themajority of their target population are in along a continuum of no action toconsistent action 40. The transtheoretical model, also referred to as the stages ofchange model (SOC), is currently conceptualized in terms of several majordimensions. The core constructs, around which the other dimensions are organized,is the stages of change. These represent ordered categories along a continuum ofmotivational readiness to change a problem behaviour: Precontemplation,Contemplation, Preparation, Action, and Maintenance.In the Precontemplative stage, individuals do not intend to change their behaviourbecause 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 theymay deny that their behaviour puts them at risk for harm. In the second stage(Contemplation), the risk becomes apparent to the individual. At this stageindividuals begin to think about the behaviour that is putting them at risk and tocontemplate the need for change. In this stage, an individual recognizes the need toengage in physical activity. In the third stage, Preparation, individuals make acommitment to change and take some action towards behavioural change. It is in theAction stage that individuals perform the new behaviour consistently. In theMaintenance stage, the final stage of the SOC model, the new behaviour is continuedand steps are taken to avoid lapsing into the formerly risky behaviours. Transitionsbetween the stages of change are effected by a set of independent variables known J 22 J
  24. 24. as the processes of change. These are covert and overt activities and experiencesthat individuals engage in when they attempt to modify problem behaviours. Eachprocess is a broad category encompassing multiple techniques, methods, andinterventions traditionally associated with disparate theoretical orientations.Numerous studies have shown that successful self-changers employ differentprocesses at each particular stage of change.The ten processes of change areconsciousness raising, counterconditioning, dramatic relief, environmentalreevaluation, helping relationships, reinforcement management, self-liberation,self-reevaluation, social liberation, and stimulus control.The model also incorporates a series of intervening or outcome variables. Theseinclude decisional balance (the pros and cons of change), self-efficacy (confidence inone’s ability to change across problem situations), and situational temptations toengage in the problem behaviour, and behaviours which are specific to the problemarea. Situationspecific confidence refers to the confidence one may have that he/shecan cope with high-risk situations without relapsing into their previous behaviourpatterns. Also included among these intermediate or dependent variables would beany other psychological, environmental, cultural, socioeconomic, physiological,biochemical, or even genetic variables specific to the problem being studied. J 23 J
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  26. 26. 5. HEALTH PROMOTION MODELS AND STRATEGIESThe World Health Organization defines health promotion as ‘the process of enablingpeople to increase control over and to improve their health’ 41. According to thisdefinition, health promotion extends beyond “promoting health” to include: 1) theenhancement of health, 2) a political ideology that is concerned with theredistribution of power and control over individual and collective health issues, 3)reducing the negative impact of a broad range of health determinant associated withthe socio-politico-economic environment, 4) shifting the allocation of resources“upstream” towards prevention, rather than treatment of problems, 5) viewing thedomains of health beyond the physical - i.e. including mental, social, and spiritual,and 6) recognizing community development and involvement as effective strategiesto 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 HealthPromotion [building healthy public policy, creating supportive environments,strengthening community action, developing personal skills, and reorienting healthservices] which fundamentally advocates a basic change in the way society isorganized and resources are distributed 43.Health Promotion aims to help people to live healthy lives. It encompasses manydiverse strategies including: health education, behavioural change models, masscommunication, social marketing, building healthy public policy, and communitydevelopment. J 25 J
  27. 27. Various author provide working definitions of patient education. Cresia ( 1996)defines patient education as a process assisting people to learn and incorporatehealth-related behaviors into everyday Iife. Smith (1989) describes learning as achange in behavior and defines patient education, therefore, as a process of assistingpeople to change behavior. Other authors describe attitudinal and value change asalso king important (Garity, 19%; Ryan, 1987). Overall, many of these definitions aredeveloped by authors with backgrounds in nursing education, who importmainstream 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 theirrespective processes that without them the outcome is unsatistiactory. High qualityingredients are another essential requirement for both ... the better the teachingskills of nurses, the more likely patients are to learn (Gessncr. I %!?, p. 589) J 26 J
  28. 28. Chapter three Methodology J 27 J
  29. 29. MethodologyINTRODUCTIONA quantitative descriptive research design was used to describe the nursing teachingamong cardiovascular disease patient and promotion and prevention in the area ofcardiovascular modifiable risk factor. The statement of the problem and the natureof data that would be generated to address the research question influenced thechoice of the quantitative design.RESEARCH DESIGNThe design is seen as the structural frame of the study. The study’s design helps theresearcher to plan and implement the study towards answering the researchquestions. The researcher adopted a quantitative descriptive design. This designchoice was based on the fact that the data was presented numerically in percentagesand frequencies. Below is a detailed explanation of the design.Quantitative designQuantitative implies that the study uses quantification for the measurement of data.The research design in a quantitative study explicates the strategies that theresearcher plans to adopt to develop information that is accurate and interpretable44 .3.2.2 Descriptive designDescription involves identifying and understanding the nature of nursing phenomenaand, sometimes, the relationships between the phenomena 44. Descriptive studydesign 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. J 28 J
  30. 30. The description of the variables leads to an interpretation of the findings’ theoreticalmeaning and provides knowledge of the variables and the study population that canbe used for future research in the area 44. According to Waltz and Bausell (1981), adescriptive study design is used for developing theory, identifying problems withcurrent practice, justifying current practice, making judgment, or determining whatothers are doing in similar situations. A descriptive study design provides an accurateportrayal or account of characteristics of a particular individual, situation or group. Inthis study, a descriptive design was used to describe the nursing teaching amongcardiovascular disease patient.POPULATION AND SAMPLINGPopulationPopulation is described as all the elements or subjects that meet the criteria 44. Inthis study, the population consisted of Nurse working with cardiovascular patient inHebron and Bethlehem Hospitals.SampleA sample is a portion or subset of a population selected to participate in the research44 .A purposive sample was used in this study. This sample was chosen because Nurseswere selected based on preselected criteria. Typically, purposive sampling is used tostudy groups not well represented in the population. The sample consisted of Nursesworking 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 inthe ward of CCU and medical ward in the hospital of : J 29 J
  31. 31. 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 cardiovascularpatients in award of CCU and Medical ward and I will exclude nurses who don’t workwith cardiovascular patients.My study will not differ between nurse and every one in ward have the same chanceto get and fill questionnaire.DATA COLLECTION INSTRUMENTA checklist developed by the researcher that contained both closed and an openedquestions, was used as research instrument. It was used to determine facts aboutthe education given by Nurse working with cardiovascular patient in Hebron andBethlehem Hospitals.a checklist is prepared items in which the respondents indicate their participation ina 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 runThe 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. J 30 J
  32. 32. 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 PHASEA thorough Introduction was conducted to assess the most important aspects thathad to be included in this questionnaire.Based on this information, a questionnaire that captures all relevant data in aconsistent 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. J 31 J
  33. 33. COMPILATION OF THE QUESTIONNAIREThe questionnaire consisted of itemised questions. Space was provided for therespondents’ answers. It was important that the nurse role was not influenced by thecompletion of questionnaires. To ensure this, the questionnaires were handed out at11 o’clock in the morning when doctor’s rounds were finished.CONFIRMATION PHASEThe ethical approval for this research topic I get it from my literature Dr. HusseinJabareen, as he tilled us that our faculty has approval from Palestine ministry ofhealth. So our literature Dr. Hussein Jabareen has the right to decide that is ethical ornot, He give me the ok on the topic.The study is not considered to cause any harm to the nurses.VALIDITY AND RELIABILITYReliabilityreliability is “...the degree of consistency with which the instrument measures theattribute.” Reliablity is a matter of whether a particular technique, appliedrepeatedly to the same object, would yield the same result each time. Reliabilitydoes not ensure accuracy any more than precision ensure it. Even total reliabilitydoes not ensure that our measures measure what we think they measureReliability 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.ValidityValidity refers to the degree to which an instrument measures what it is supposed tomeasure 44. Internal validity is defined as the degree to which results are a truereflection of the truth and the realties that are being researched. There arenumerous yardsticks for determining validity: face validity, criterion related validity,content validity, and construct validity. Asking the nurses to be as truthful as possiblewhen completing the questionnaires secured this. J 32 J
  34. 34. 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 begeneralized to settings or samples other than the ones studied. This study wasconducted in Hebron and Bethlehem hospital only, and therefore the sample is notnecessarily representative of the larger population. The results of this study cannotbe generalized to samples or settings other than where studied.Construct validity is defined as the degree to which an instrument measures theconstruct under investigation 44. The theme of this research was education given byNurse working with cardiovascular patient.The researcher followed this theme throughout the study.Content validity is concerned with the sampling adequacy of the content area beingmeasured 44. In this study the researcher ensured content validity through athorough literature review and the use of expert opinions in the development of aquestionnaire.DATA COLLECTION PROCEDUREThe researcher explained the purpose of the study to each patient. The hospital wasconsulted and written permission obtained before the study commenced.The anonymity and confidentiality of each participant was assured, as informationobtained 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. 80questionnaire used in the study. Consent was obtained from the Hospital nursingsupervisor before the questionnaires were handed out.DATA ANALYSISThe data that I collected from the surveys were coded and entered into theStatistical Package for the Social Sciences (SPSS), version 19.0 for analysis. The datawere analyzed using both descriptive and correlation statistics. J 33 J
  35. 35. I will test each variables in questionnaire and express by descriptive and use ofsuitable graphs such as bar chart and pie chart.And I will address things that improve nursing teaching to cardiovascular patient andthings that limit nursing teaching to cardiovascular patient.Also I will test the quality of nursing teaching among staff and practitioner nurseAnd I will test the nursing teaching among privet and governmental hospitalAlso I will test the nursing teaching among CCU and medical wardThe data analysis will be discussed in Chapter 4. The analysis was done by means ofdescriptive statistics and interpreted and presented in frequencies and percentages.The process of data analysis is largely a search for patterns of similarities anddifferences - followed by an interpretation of those patterns .CONCLUSIONThis quantitative descriptive research study aimed to establish the impact ofeducation given by Nurse working with cardiovascular patient in. A checklist for datacollection was developed based on a thorough literature review. Intensive carespecialists reviewed the tool and their advice and suggestions were incorporated.The study involved nurses in Hebron and Bethlehem Hospitals, and questionnaireswere completed under the researcher’s supervision. As the sample was small, specialprecautions such as precise and replicable inclusion criteria were established inadvance to enhance the reliability and validity of the study. The data analysis will bediscussed in Chapter 4. J 34 J
  36. 36. Chapter four: Result J 35 J
  37. 37. ResultThe overall purpose research is to conduct a the role of nursing teaching amongcardiovascular disease patient and promotion and prevention in the area ofcardiovascular modifiable risk factor to identify the areas in which nursing haveConcerns than other, especially the in patient who have cardiovascular risk factor orwho have cardiovascular disease to decrease ferocity or to prevent complications.So I did my questioners according to previous cardiovascular risk factor, and myquestion 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 teachingresponse rateThe response rate was 86%; the sample was 80, 69 returned back. J 36 J
  38. 38. 1- Demographic data ‫اﻟﺪرﺟﺔ اﻟﻌﻠﻤﯿﺔ‬ Frequency Percent ‫دﺑﻠﻮم ﻣﺘﻮﺳﻂ‬ 20 29% ‫ﺑﻜﺎﻟﻮرﯾﻮس‬ 41 59.4% ‫دﺑﻠﻮم ﻋﺎﻟﻲ ﻣﺘﺨﺼﺺ‬ 5 7.2% ‫ﻣﺎﺟﺴﺘﯿﺮ ﻓﺄﻋﻠﻰ‬ 3 4.3% The nurse participate on my study according to education level are 59% bachelor degree , diploma 29% , master and high diploma are 11.5 % ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﯿﻔﻲ‬ Frequency Percent ‫رﺋﯿﺲ ﻗﺴﻢ‬ 4 5.8% ‫ﻧﺎﺋﺐ رﺋﯿﺲ ﻗﺴﻢ‬ 8 11.6% ‫ﻣﻤﺮض ﻗﺎﻧﻮﻧﻲ‬ 39 56.5% ‫ﻣﻤﺮض ﻣﺆھﻞ‬ 18 26.1% 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 ‫اﻟﺒﺎﻃﻨﻲ‬ 14 20.3% ‫اﻟﻌﻨﺎﯾﺔ اﻟﻘﻠﺒﯿﺔ اﻟﻤﻜﺜﻔﺔ‬ 24 34.8% ‫ﻃﻮارئ‬ 18 26.1% ‫اﻗﺴﺎم اﺧﺮى‬ 13 18.8% The nurse participate on my study according to ward 35% CCU, 20% medical ward, 26% ER and other is 19%. J 37 J
  39. 39. ‫اﻟﺠﻨﺲ‬ Frequency Percent ‫ذﻛﺮ‬ 39 56.5% ‫أﻧﺜﻰ‬ 30 43.5%The nurse participate on my study according to sex there are 56.5% maleand 43.5% female ‫ﻋﺪد ﺳﻨﻮات اﻟﺨﺒﺮة‬ Frequency Percent ‫أﻗﻞ ﻣﻦ 5 ﺳﻨﻮات‬ 10 14.5% ‫5-01 ﺳﻨﻮات‬ 28 40.6% ‫01-51 ﺳﻨﺔ‬ 26 37.7% ‫أﻛﺜﺮ ﻣﻦ 51 ﺳﻨﺔ‬ 5 7.2%The nurse participate on my study according to Years of Experience are41% from 5-10 years , 38% from 10-15 years, 14.5% less than 5 years and7% more than 15years. ‫ﻧﻮع اﻟﻤﺴﺘﺸﻔﻰ‬ Frequency Percent ‫ﺣﻜﻮﻣﻲ‬ 27 39% ‫ﻏﯿﺮ ﺣﻜﻮﻣﻲ‬ 38 55% ‫ﺧﺎص‬ 4 6%The nurse participate on my study according to hospital type there is 55%none governmental , 39% governmental and 6% private J 38 J
  40. 40. ‫ھﻞ ﺣﺼﻠﺖ ﻋﻠﻰ دورات ﺑﺨﺼﻮص اﻣﺮاض اﻟﻘﻠﺐ واﻟﺸﺮاﯾﯿﻦ‬ Frequency Percent ‫ﻧﻌﻢ‬ 35 50.7 ‫ﻻ‬ 34 49.3The courses and training increase the awareness and knowledge,also attitude in nursing here about half of nurses work withcardiovascular disease say that they got course in cardiovasculardisease. J 39 J
  41. 41. 2- Nursing role in cardiovascular disease patient teaching ‫1( أﻗﻮم ﺑﺘﻮﺿﯿﺢ اﻟﺘﺸﺨﯿﺺ ﻟﻠﻤﺮﯾﺾ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 28 40.6% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 35 50.7% ‫ا‬ ً ‫ﻧﺎدر‬ 6 8.7%The patient has the right to know and understand the actual problem thathe have, and the nurse has responsibility in clarify the diagnoses.Here the result of this question show that about 91 % say always andsome time and about 9 % say rarely . ‫2( أﻗﻮم ﺑﺘﻮﺿﯿﺢ اﻻﻋﺮاض اﻟﻤﺮﺿﯿﺔ اﻟﻤﺘﻮﻗﻌﺔ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 18 26.1% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 42 60.9% ‫ا‬ ً ‫ﻧﺎدر‬ 7 10.1% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 2 2.9The patient should know what sign and symptom that may appear andwhat is normal and what is abnormal and when he should seek healthcare here the result show that 61 say some time which mean not all nursework with cardiovascular disease patient clarify for patient this topic. J 40 J
  42. 42. ‫3( أوﺿﺢ ﻟﻠﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﺳﺘﺨﺪام اﻻدوﯾﺔ وﻣﺎ اﻟﻔﺎﺋﺪة اﻟﻌﻼﺟﯿﺔ ﻟﻜﻞ دواء وﺗﺎﺛﯿﺮه ﺣﺘﻰ ﺑﺪون‬ ‫ان ﯾﺴﺄل اﻟﻤﺮﯾﺾ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 28 40.6% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 33 47.8% ‫ا‬ ً ‫ﻧﺎدر‬ 6 8.7% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 2 2.9%The medication is the one of the most important steps in treatment andcare plan for the patient, and medication one of the major duties fornursing. The result here show that about 90% say always and some time. ‫4( أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﺿﻰ ﺣﻮل اﺿﺮار اﻟﺘﺪﺧﯿﻦ واﻟﻔﻮاﺋﺪ اﻟﺼﺤﯿﺔ ﻟﺘﺮﻛﮫ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 33 47.8% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 25 36.2% ‫ا‬ ً ‫ﻧﺎدر‬ 9 13% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 2 2.9%The smoking is one of the major risk factor of cardiovascular disease andthe nurse has role in clarify the smoking risk and benefits of get smokingout the result show that about 85% of nurses give instruction always andsome time. J 41 J
  43. 43. ‫5( أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻐﺬاء اﻟﻤﺘﻮازن‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 32 46.4% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 27 39.1% ‫ا‬ ً ‫ﻧﺎدر‬ 9 13% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%One of the factor for cardiovascular disease is food component and thenurse should increase patient awareness about balanced food. Hereabout 95% say always and some time and 15% say rarely and never. ‫6( أﻗﻮم ﺑﺘﻮﺿﯿﺢ ﻧﻮﻋﯿﺎت اﻟﻐﺬاء اﻟﻤﻨﺎﺳﺐ اﻟﺬي ﯾﺴﺎﻋﺪ ﻓﻲ ﺗﺤﺴﯿﻦ ﺻﺤﺔ اﻟﻤﺮﯾﺾ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 33 47.8% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 28 40.6% ‫ا‬ ً ‫ﻧﺎدر‬ 7 10.1% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%There is kind food that promote health for cardiovascular disease andthere is food should be avoided, the nurse has responsibility in give theseinstruction, here about 88% give instruction about these topics and about12% rarely or never give these instructions. J 42 J
  44. 44. ‫أﻗﻮم ﺑﻤﺴﺎﻋﺪة اﻟﻤﺮﯾﺾ ﺑﻌﻤﻞ ﺑﺮﻧﺎﻣﺞ ﻏﺬاﺋﻲ ﻣﻨﺎﺳﺐ ﯾﺨﻔﻒ ﻣﻦ ﻣﻀﺎﻋﻔﺎت اﻟﻤﺮض‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 20 29% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 32 46.4% ‫ا‬ ً ‫ﻧﺎدر‬ 12 17.4% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 5 7.2%Each patient need nutritional program differ to become appropriate to hishealth status, and nurse has responsibility in help patient to put thisprogram. The result here show that always and sometime 75% and 25% torarely and never. ‫أﻗﻮم ﺑﺘﻮﺿﯿﺢ اھﻤﯿﺔ اﻟﺮﯾﺎﺿﺔ اﻟﻤﻨﺘﻈﻤﺔ وﻣﺎ ھﻲ اﻟﺮﯾﺎﺿﺔ اﻟﻤﻨﺎﺳﺒﺔ ﺣﺴﺐ ﺣﺎﻟﺔ اﻟﻤﺮﯾﺾ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 24 34.8% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 27 39.1% ‫ا‬ ً ‫ﻧﺎدر‬ 17 24.6% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%The exercise is one of lifestyle that promote health of cardiovasculardisease patient and each one differ from other because of health status.The result show that 74% say always and some time and 26% say rarelyand never. J 43 J
  45. 45. ‫أﻗﻮم ﺑﺘﺤﺪﯾﺪ اﻻﻋﻤﺎل اﻟﺘﻲ ﯾﺠﺐ اوﻻ ﯾﺠﺐ ﻋﻰ اﻟﻤﺮﯾﺾ اﻟﻘﯿﺎم ﺑﮭﺎ وﻓﻘﺎ ﻟﺤﺎﻟﺘﮫ اﻟﺼﺤﯿﺔ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 30 43.5% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 32 46.4% ‫ا‬ ً ‫ﻧﺎدر‬ 7 10.1%Each patient according to health able to do kind of work and un able toother kind, the nurse here has responsibility in determine works thatappropriate to patient. The result show here that 90% say always and sometime and 10% say rarely. ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻮزن اﻟﻄﺒﯿﻌﻲ وﻃﺮق اﻟﺘﺨﻠﺺ ﻣﻦ اﻟ ُﻤﻨﺔ‬ ‫ﺴ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 27 39.1% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 26 37.7% ‫ا‬ ً ‫ﻧﺎدر‬ 16 23.2% ‫ﺎ‬ ً ‫داﺋﻤ‬ 27 39.1%The obesity is one of the major risk factor of cardiovascular disease, andcardiovascular 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 rarelyand never. J 44 J
  46. 46. ‫أﻗﻮم ﺑﺘﻌﻠﯿﻢ اﻟﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ ﺣﺎﻻت اﻟﺬﺑﺤﺔ اﻟﺼﺪرﯾﺔ واﻋﺮاﺿﮭﺎ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 27 39.1% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 33 47.8% ‫ا‬ ً ‫ﻧﺎدر‬ 9 13%Angina is one of cardiovascular disease and high number of cardiovascularpatient have angina, so the nurse should give the patient instruction howto deal with it and when he need to seek health care. The result show thatnurses say always and some time are 87% and 13% say rarely. ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اﻟﻤﺨﺎﻃﺮ اﻟﺼﺤﯿﺔ ﻻرﺗﻔﺎع ﺿﻐﻂ اﻟﺪم وﺿﺮورة اﻻﻟﺘﺰام ﺑﺎﻟﻌﻼج‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 35 50.7% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 26 37.7% ‫ا‬ ً ‫ﻧﺎدر‬ 7 10.1% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%Hypertension is one of cardiovascular disease and can cause othercardiovascular disease, the nurse should give patient instruction to takehis responsibility by talk to him about risks of hypertension. The resulthere show that nurses say always and some time are 89% and 11% sayrarely and never. J 45 J
  47. 47. ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل وﺳﺎﺋﻞ اﻟﻌﻼج ﺑﺎﻻﺳﺘﺮﺧﺎء واﻟﻤﻮﺳﯿﻘﻰ ﻟﺘﺨﻔﯿﻒ اﻻﻟﻢ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 17 24.6% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 22 31.9% ‫ا‬ ً ‫ﻧﺎدر‬ 19 27.5% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 11 15.9% 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. ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻤﺤﺎﻓﻈﺔ ﻋﻠﻰ ﻣﺴﺘﻮى ﻃﺒﯿﻌﻲ ﻣﻦ اﻟﺴﻜﺮ ﻓﻲ اﻟﺪم اذا ﻛﺎن‬ ‫اﻟﻤﺮض ﻣﻘﺘﺮﻧﻨﺎ ﺑﺪاء اﻟﺴﻜﺮي‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 38 55.1% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 26 37.7% ‫ا‬ ً ‫ﻧﺎدر‬ 5 7.2%Diabetes mellitus is one of chronic disease and consider as one of majorfactor for cardiovascular disease, the nurse responsibility is to increasepatent awareness to maintain normal blood sugar. The result of thisquestion show that 93% say always and some time and 7% say rarely. J 46 J
  48. 48. ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل ﻃﺮق اﻟﺘﺸﺨﯿﺺ واﻟﻔﺤﻮﺻﺎت اﻟﺪورﯾﺔ اﻟﺘﻲ ﻋﻠﯿﮫ اﻟﻘﯿﺎم ﺑﮭﺎ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 32 46.4% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 26 37.7% ‫ا‬ ً ‫ﻧﺎدر‬ 10 14.5% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%The patient has right to know about what will done for him, and he shouldknow about the procedures he needed, the nurse responsibility here is toclarify each procedure and the goal of it. The result here show that 84% ofnurses say always and 16% say rarely and never .‫ﻋﻨﺪ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ اﺳﺘﺨﺪم ﻛﻠﻤﺎت وﻋﺒﺎرات ﺗﺮاﻋﻲ اﻟﻘﺪرات اﻟﻌﻠﻤﯿﺔ ﻟﻠﻤﺮﯾﺾ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 43 62.3% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 21 30.4% ‫ا‬ ً ‫ﻧﺎدر‬ 4 5.8% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 1 1.4%Each patient has education lever differ from other, the nurse here shouldadapt to patient level of education to maintain our goal to maximuminformation to be understand by patient. The result here show that 92% ofnurses say always and some time and 8% say rarely and never. J 47 J
  49. 49. .‫ﻋﻨﺪ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ اﻋﺘﻤﺪ ﻋﻠﻰ ﻣﺮﺟﻌﯿﺔ ﻋﻠﻤﯿﺔ ﻣﺆﻛﺪة وﻣﻌﺘﻤﺪة‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 45 65.2% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 22 31.9% ‫ا‬ ً ‫ﻧﺎدر‬ 2 2.9%When give instruction to patient, all information should be true and nursetake it from reliable references, the result here show that nurse sayalways and sometime 97% and 3% say rarely. ‫اﻋﺘﻘﺪ اﻧﮫ ﻣﻦ اﻟﻀﺮوري اﻋﺪاد دورات ﻟﺰﯾﺎدة اﻟﺨﺒﺮة اﻟﺘﻤﺮﯾﻀﯿﺔ ﻓﻲ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ‬ Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 47 68.1% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 19 27.5% ‫ا‬ ً ‫ﻧﺎدر‬ 3 4.3% 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 Frequency Percent ‫ﺎ‬ ً ‫داﺋﻤ‬ 16 23.2% ‫ﺎ‬ ً ‫اﺣﯿﺎﻧ‬ 39 56.5% ‫ا‬ ً ‫ﻧﺎدر‬ 12 17.4% ‫ﺎ‬ ً ‫ﻣﻄﻠﻘ‬ 2 2.9% J 48 J
  50. 50. 3- The Factors that limit the extent of giving teaching and the factors that motivate giving teaching ‫ھﻞ ﺗﻌﺘﺒﺮ ﺿﻐﻂ اﻟﻌﻤﻞ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 65 94.2% ‫أﻋﺎرض‬ 4 5.8%94% of nurses consider work overload is one of factor that limit the extentof giving teaching to cardiovascular disease patients, and 6 % disagree. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻋﺪم اﻟﻤﻌﺮﻓﺔ ﺑﺎﻟﺘﻌﻠﯿﻤﺎت اﻟﻮاﺟﺐ اﺗﺒﺎﻋﮭﺎ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ‬ ‫ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 37 53.6% ‫أﻋﺎرض‬ 32 46.4%54% of nurses consider Dont know about teaching to is one of factor thatlimit the extent of giving teaching to cardiovascular disease patients, and46 % disagree‫ھﻞ ﺗﻌﺘﺒﺮ ﻋﺪم ﺗﻌﺎون اﻟﻤﺮﯾﺾ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 52 75.4% ‫أﻋﺎرض‬ 17 24.6%75 % of nurses consider Non-cooperation of the patient as one of factorthat limit the extent of giving teaching to cardiovascular disease patients,and 25% disagree. J 49 J
  51. 51. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻗﻠﺔ اﻟﻮﻗﺖ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 61 88.4% ‫أﻋﺎرض‬ 8 11.6%88 % of nurses consider lake of time as one of factor that limit the extentof giving teaching to cardiovascular disease patients, and 12% disagree. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻋﺪم وﺟﻮد ﻗﻮاﻧﯿﻦ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ ﺗﺠﺒﺮ اﻟﻤﻤﺮض ﻋﻠﻰ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻣﻦ‬ ‫اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 44 63.8% ‫أﻋﺎرض‬ 25 36.2%64 % of nurses consider The absence of laws forcing the nurse at thehospital to provide health education as one of factor that limit the extentof giving teaching to cardiovascular disease patients, and 36% disagree. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻋﺪم وﺟﻮد ارﺷﺎدات ﺛﺎﺑﺘﺔ او ﻣﻄﺒﻮﻋﺔ ﻣﻦ ﻗﺒﻞ اﻟﻤﺴﺘﺸﻔﻰ ﺣﻮل اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻣﻦ‬ ‫اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 51 73.9% ‫أﻋﺎرض‬ 18 26.1%74 % of nurses consider The absence of printed instructions in the hospitalabout health education as one of factor that limit the extent of givingteaching to cardiovascular disease patients, and 26% disagree. J 50 J
  52. 52. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻗﻠﺔ ﻣﮭﺎراﺗﻚ ﻓﻲ اﻟﺘﻮاﺻﻞ ﻣﻊ اﻟﻤﺮﺿﻰ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ‬ ‫اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 23 33.3% ‫أﻋﺎرض‬ 46 66.7%33 % of nurses consider Lack of communicating skills with patients as oneof factor that limit the extent of giving teaching to cardiovascular diseasepatients, and 67% disagree. ‫ﻻ اﻋﺘﺒﺮ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻠﻤﺮﯾﺾ ﺟﺰء ﻣﻦ اﻟﺒﺮﻧﺎﻣﺞ اﻟﻌﻼﺟﻲ ﻟﻠﻤﺮﯾﺾ‬ Frequency Percent ‫أواﻓﻖ‬ 18 26.1% ‫أﻋﺎرض‬ 51 73.9%26% of nurses dont consider giving teaching to cardiovascular diseasepatients as part of care plan for patients, and 74% disagree. ‫ھﻞ ﺗﻌﺘﺒﺮ ﻋﺪم وﺟﻮد ﺣﻮاﻓﺰ ﻛﺎﻓﯿﺔ ﻣﻦ ﻗﺒﻞ اﻟﻤﺴﺘﺸﻔﻰ ﻋﻠﻰ ھﺬا اﻟﻤﺠﮭﻮد ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺤﺪ‬ ‫ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻮﻋﯿﺔ ﻟﻠﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 55 79.7% ‫أﻋﺎرض‬ 14 20.3%80 % of nurses consider The absence of adequate incentives by thehospital on this effort as one of factor that limit the extent of givingteaching to cardiovascular disease patients, and 20% disagree. J 51 J
  53. 53. ‫ﻻ أﻋﺘﺒﺮ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻣﻦ وﻇﺎﺋﻒ اﻟﺘﻤﺮﯾﺾ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 18 26.1% ‫أﻋﺎرض‬ 51 73.9%26% of nurses dont consider giving teaching to cardiovascular diseasepatients as part of nursing curricula in care for patients, and 74%disagree. ‫ﯾﻘﻮم رﺋﯿﺲ اﻟﻘﺴﻢ ﺑﻤﺘﺎﺑﻌﺔ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ وﯾﻌﺘﺒﺮه ﺟﺰء اﺳﺎﺳﻲ ﻣﻦ وﻇﯿﻔﺔ اﻟﻤﻤﺮض‬ Frequency Percent ‫أواﻓﻖ‬ 50 72.5% ‫أﻋﺎرض‬ 19 27.5%72.5% of nurses consider that head nurse follow teaching tocardiovascular disease patients and consider is part of nursing curricula incare for patients, and 27.5% disagree. ‫ﯾﻮﺟﺪ ﻓﻲ اﻟﻘﺴﻢ ارﺷﺎدات ﻣﻄﺒﻮﻋﺔ ﻟﺘﺜﻘﯿﻒ اﻟﻤﺮﺿﻰ‬ Frequency Percent ‫أواﻓﻖ‬ 43 62.3% ‫أﻋﺎرض‬ 26 37.7%62% of nurses agree with There are printed instructions in the section toeducate patients, and 38% disagree. J 52 J
  54. 54. ‫ﯾﻮﺟﺪ ﻓﻲ اﻟﻘﺴﻢ ﺣﻮاﻓﺰ اﺿﺎﻓﯿﺔ ﻟﻠﻤﻤﺮﺿﯿﻦ اﻟﻤﻠﺘﺰﻣﯿﻦ ﺑﺎﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ‬ Frequency Percent ‫أواﻓﻖ‬ 39 56.5% ‫أﻋﺎرض‬ 30 43.5%56.5% of nurses agree with There are additional incentives in the sectionof the nurses who are committed to health education, and 43.5%disagree. J 53 J
  55. 55. Chapter Five :Discussion J 54 J
  56. 56. DiscussionIntroductionThe purpose of this chapter is to discuss four main issues: the significanceof the findings of the study and how these relate to the research questionare discussed. Consideration is then given to how these findings relate tothe literature, especially the literature on patients’ perspectives on CHDthat was discussed in chapter two; Finally, issues concerned with thepractical application of reflexivity in the study are considered.DiscussionAs discussed in Chapter one, the overall aim of the study was to explorenursing teaching toward cardiovascular disease patients’perspectives lifestyle modification using a quantitative approach (therationale for which is discussed in chapter three.Nurses take a central role in working with clients to promote the bestoutcomes.The evidence from this study lends support for the research hypothesisthat there are significant interrelationships between the cardiovascularhealth/risk behaviors and nursing role in teaching, the nursing role hereclarify from high percent in answers of questions related to issue incardiovascular teaching by nurse participate.The result in part tow of questionnaire support that nursing give teachingin major sector of cardiovascular disease for healthy life style, clarify ofprocedures and care plan. J 55 J
  57. 57. According to result There isnt topic nurse focus on than another, thenurse 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 andcourses in cardiovascular nursing, the course give nurse information andawareness to health related issue for cardiovascular disease patient, andteaching become more helpfully because its depend on valid databaseWhen they have confidence, the teaching process will go on smoothly,rapidly, and procedurally because there is a complete and preliminaryteaching arrangement and direction to control the teaching to go on in thesame guideline. this broad based clinical skills that can be extended andexpanded with appropriate of the most important factors is to deal with patient use informationaccording to patient level of education to assess the patient’s self-efficacybeliefs for behavioural change to make health practices easier.collaboration with the nurses. Team-work is valuable for the patients andgives confidence to both the health-care and the patient, as the patientreceives the same information and meets the same attitude from nurses.Recurrent consultation training can give structure to the consultation andincrease individually adapted communication in assessing lifestylebehaviour. J 56 J
  58. 58. The nurse identify many obstacles the main one is work pressure andoverload.54% of nurses says that they havent information as one obstacles to givecardiovascular teaching.75% of nurses says that Non-cooperation of the patient as one obstaclesto give cardiovascular teaching.89% of nurses says that no time as one obstacles to give cardiovascularteaching.64% of nurses says that The absence of laws forcing the nurse at thehospital to provide education as one obstacles to give cardiovascularteaching.74% of nurses says that The absence of printed instructions by the hospitalas one obstacles to give cardiovascular teaching.There is many motivation factor : follow up of nursing teaching by headnurse and motivation from team. J 57 J
  59. 59. RecommendationHealth polices maker may utilize this provided information to assist themin helping nurse to identify obstacles and inhibitors and to developstrategies to initiate health behavioral changes.Hospitals must offer teaching framework for supporting the nurse toperform relevant nursing actions and interventions.Focus on the concepts related to the nurse as tools to communicate in amore structured and interactive way with the aim of assisting patients’development of self-care agency to change lifestyle so more training incommunication skills about non-pharmacological treatment and also on how toperform counseling in a stage-directed, patient-centered way. Lectures onhow to perform counseling are not enough. Training is also needed.More attention should be given by hospitals to the needs of those caringfor people with CVD.More research need to collect the most important factors relating to thepatient, the nurse and their communication process concerning lifestylechanges in hypertension care.they must offer The printed guidance for each Patient acording to patientcase.They must decrease work overload by increase number of nurses in wards.Cooperative efforts to promote the education of patients may beencouraged through joint staff conferences of several agencies, inservicetraining, case conferences of several agencies, and other means for J 58 J
  60. 60. 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, Its 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. J 59 J
  61. 61. Appendix A J 60 J
  62. 62. J 61 J
  63. 63. ‫‪Appendix B‬‬ ‫اﻧ ﺎ اﻟﻄﺎﻟ ﺐ : ﻣﺎﻟ ﻚ رﺑﺤ ﻲ ﻣﻨﺎﺻ ﺮة . ﻛﻠﯿ ﺔ اﻟﺘﻤ ﺮﯾﺾ – ﺟﺎﻣﻌ ﺔ اﻟﺨﻠﯿ ﻞ اﻗ ﻮم ﺑﻌﻤ ﻞ دراﺳ ﺔ ﺗﺤ ﺖ اﺷ ﺮاف اﻟ ﺪﻛﺘﻮر‬ ‫ﺣﺴﯿﻦ اﻟﺠﺒﺎرﯾﻦ ﻣﻮﺿﻮع "دور اﻟﺘﻤﺮﯾﺾ ﻓﻲ اﻟﺘﺜﻘﯿﻒ واﻟﺘﻮﻋﯿﺔ اﻟﺼﺤﯿﺔ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ واﻟﺸﺮاﯾﯿﻦ".‬ ‫وﻟﺬﻟﻚ أرﺟﻮ ﺗﻌﺒﺌﺔ ھﺬا اﻻﺳﺘﺒﯿﺎن ﺑﺪﻗ ﮫ ,ﻧﺘ ﺎﺋﺞ ھ ﺬه اﻟﺪراﺳ ﺔ ﺳﺘﺴ ﺘﺨﺪم ﻟﻐ ﺮض اﻟﺪراﺳ ﺔ اﻟﻌﻠﻤﯿ ﮫ ﻓﻘ ﻂ ، وﻟ ﻦ ﯾﻜ ﻮن‬ ‫ﺑﺎﻻﻣﻜﺎن اﻟﺘﻌﺮف ﻋﻠﻰ ھﻮﯾﺔ اﻟﻤﺸﺎرﻛﯿﻦ ﻓﻲ ﺗﻌﺒﺌﺔ ھﺬا اﻻﺳﺘﺒﯿﺎن.‬ ‫ﺷﺎﻛﺮً ﻟﻜﻢ ﺣﺴﻦ ﺗﻌﺎوﻧﻜﻢ‬ ‫ا‬ ‫اﻟﺮﺟﺎء اﻻﺟﺎﺑﺔ ﻋﻠﻰ ھﺬه اﻻﺳﺌﻠﺔ ﺑﻮﺿﻊ اﺷﺎرة )‪ (X‬اﻣﺎم اﻟﺨﯿﺎر اﻟﺬي ﯾﻨﺎﺳﺒﻚ.ن‬ ‫ﻣﺎﺟﺴﺘﯿﺮ ﻓﺎﻋﻠﻰ‬ ‫دﺑﻠﻮم ﻋﺎﻟﻲ ﻣﺘﺨﺼﺺ‬ ‫ﺑﻜﺎﻟﻮرﯾﻮس‬ ‫دﺑﻠﻮم ﻣﺘﻮﺳﻂ‬ ‫اﻟﺪرﺟﺔ اﻟﻌﻠﻤﯿﺔ:‬‫ﻏﯿﺮ ذﻟﻚ/ﺣﺪد.......‬ ‫ﻣﻤﺮض ﻣﺆھﻞ‬ ‫ﻣﻤﺮض ﻗﺎﻧﻮﻧﻲ‬ ‫ﻧﺎﺋﺐ رﺋﯿﺲ ﻗﺴﻢ‬ ‫رﺋﯿﺲ ﻗﺴﻢ‬ ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﯿﻔﻲ:‬ ‫51 ﺳﻨﺔ ﻓﺄﻛﺜﺮ‬ ‫01-51ﺳﻨﺔ‬ ‫5-01 ﺳﻨﻮات‬ ‫اﻗﻞ ﻣﻦ 5 ﺳﻨﻮات‬ ‫ﻋﺪد ﺳﻨﻮات اﻟﺨﺒﺮة:‬ ‫اﻧﺜﻰ‬ ‫ذﻛﺮ‬ ‫اﻟﺠﻨﺲ:‬ ‫اﻗﺴﺎم اﺧﺮى/ ﺣﺪد ................‬ ‫ﻃﻮارئ‬ ‫اﻟﻌﻨﺎﯾﺔ اﻟﻘﻠﺒﯿﺔ اﻟﻤﻜﺜﻔﺔ‬ ‫اﻟﺒﺎﻃﻨﻲ‬ ‫اﻟﻘﺴﻢ اﻟﺬي ﺗﻌﻤﻞ ﺑﮫ‬ ‫ﻣﺴﺘﺸﻔﻰ ﺧﺎص‬ ‫ﻣﺴﺘﺸﻔﻰ ﻏﯿﺮ ﺣﻜﻮﻣﻲ‬ ‫ﻣﺴﺘﺸﻔﻰ ﺣﻜﻮﻣﻲ‬ ‫اﻟﻤﺴﺘﺸﻔﻰ‬ ‫وﻇﯿﻔﺔ ﺟﺰﺋﯿﺔ‬ ‫وﻇﯿﻔﺔ ﻛﺎﻣﻠﺔ‬ ‫اﻻﻟﺘﺰام ﺑﺪاوم اﻟﻤﺆﺳﺴﺔ‬ ‫ﻋﺪد ﺳﺎﻋﺎت اﻟﻌﻤﻞ ﻓﻲ اﻻﺳﺒﻮع...................‬ ‫ﻻ‬ ‫ﻧﻌﻢ‬ ‫ھﻞ ﺣﺼﻠﺖ ﻋﻠﻰ دورات ﺑﺨﺼﻮص اﻣﺮاض اﻟﻘﻠﺐ واﻟﺸﺮاﯾﯿﻦ‬ ‫‪J 62 J‬‬
  64. 64. ‫اذا ﻛﺎن اﻟﺠﻮاب ﻧﻌﻢ ﻓﻜﻢ ﻋﺪد ھﺬه اﻟﺪورات‬ ‫.................................................................................‬ ‫اﻟﺮﺟﺎء اﻻﺟﺎﺑﺔ ﻋﻠﻰ ھﺬه اﻻﺳﺌﻠﺔ ﺑﻮﺿﻊ اﺷﺎرة )‪ (X‬ﺑﺠﺎﻧﺐ اﻟﺨﯿﺎر اﻟﺬي ﯾﻨﺎﺳﺒﻚ.‬‫اﻋﺎرض‬ ‫اﻋﺎرض‬ ‫اواﻓﻖ‬ ‫اواﻓﻖ‬ ‫اﻟﺴﺆال‬ ‫رﻗﻢ‬ ‫ﺑﺸﺪة‬ ‫ﺑﺸﺪة‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﺿﯿﺢ اﻟﺘﺸﺨﯿﺺ ﻟﻠﻤﺮﯾﺾ ﺣﺘﻰ ﺑﺪون ان‬ ‫1‬ ‫ﯾﺴﺄل اﻟﻤﺮﯾﺾ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﺿﯿﺢ اﻻﻋﺮاض اﻟﻤﺮﺿﯿﺔ اﻟﻤﺘﻮﻗﻌﺔ‬ ‫2‬ ‫ﺣﺘﻰ ﺑﺪون ان ﯾﺴﺄل اﻟﻤﺮﯾﺾ‬ ‫أوﺿﺢ داﺋﻤﺎ ﻟﻠﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﺳﺘﺨﺪام اﻻدوﯾﺔ وﻣﺎ‬ ‫3‬ ‫اﻟﻔﺎﺋﺪة اﻟﻌﻼﺟﯿﺔ ﻟﻜﻞ دواء وﺗﺎﺛﯿﺮه ﺣﺘﻰ ﺑﺪون ان ﯾﺴﺄل‬ ‫اﻟﻤﺮﯾﺾ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﺿﻰ ﺣﻮل اﺿﺮار اﻟﺘﺪﺧﯿﻦ‬ ‫4‬ ‫واﻟﻔﻮاﺋﺪ اﻟﺼﺤﯿﺔ ﻟﺘﺮﻛﮫ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻐﺬاء‬ ‫5‬ ‫اﻟﻤﺘﻮازن‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﺿﯿﺢ ﻧﻮﻋﯿﺎت اﻟﻐﺬاء اﻟﻤﻨﺎﺳﺐ اﻟﺬي‬ ‫6‬ ‫ﯾﺴﺎﻋﺪ ﻓﻲ ﺗﺤﺴﯿﻦ ﺻﺤﺔ اﻟﻤﺮﯾﺾ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﻤﺴﺎﻋﺪة اﻟﻤﺮﯾﺾ ﺑﻌﻤﻞ ﺑﺮﻧﺎﻣﺞ ﻏﺬاﺋﻲ‬ ‫7‬ ‫ﻣﻨﺎﺳﺐ ﯾﺨﻔﻒ ﻣﻦ ﻣﻀﺎﻋﻔﺎت اﻟﻤﺮض‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﺿﯿﺢ اھﻤﯿﺔ اﻟﺮﯾﺎﺿﺔ اﻟﻤﻨﺘﻈﻤﺔ وﻣﺎ ھﻲ‬ ‫8‬ ‫اﻟﺮﯾﺎﺿﺔ اﻟﻤﻨﺎﺳﺒﺔ ﺣﺴﺐ ﺣﺎﻟﺔ اﻟﻤﺮﯾﺾ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﺤﺪﯾﺪ اﻻﻋﻤﺎل اﻟﺘﻲ ﯾﺠﺐ اوﻻ ﯾﺠﺐ ﻋﻰ‬ ‫9‬ ‫اﻟﻤﺮﯾﺾ اﻟﻘﯿﺎم ﺑﮭﺎ وﻓﻘﺎ ﻟﺤﺎﻟﺘﮫ اﻟﺼﺤﯿﺔ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻮزن‬ ‫01‬ ‫اﻟﻄﺒﯿﻌﻲ وﻃﺮق اﻟﺘﺨﻠﺺ ﻣﻦ اﻟ ُﻤﻨﺔ‬ ‫ﺴ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻌﻠﯿﻢ اﻟﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ ﺣﺎﻻت‬ ‫11‬ ‫اﻟﺬﺑﺤﺔ اﻟﺼﺪرﯾﺔ واﻋﺮاﺿﮭﺎ ﺣﺘﻰ ﺑﺪون ان ﯾﺴﺄل‬ ‫اﻟﻤﺮﯾﺾ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اﻟﻤﺨﺎﻃﺮ اﻟﺼﺤﯿﺔ‬ ‫21‬ ‫ﻻرﺗﻔﺎع ﺿﻐﻂ اﻟﺪم وﺿﺮورة اﻻﻟﺘﺰام ﺑﺎﻟﻌﻼج‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل وﺳﺎﺋﻞ اﻟﻌﻼج‬ ‫31‬ ‫ﺑﺎﻻﺳﺘﺮﺧﺎء واﻟﻤﻮﺳﯿﻘﻰ ﻟﺘﺨﻔﯿﻒ اﻻﻟﻢ‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻤﺤﺎﻓﻈﺔ‬ ‫41‬ ‫ﻋﻠﻰ ﻣﺴﺘﻮى ﻃﺒﯿﻌﻲ ﻣﻦ اﻟﺴﻜﺮ ﻓﻲ اﻟﺪم اذا ﻛﺎن‬ ‫اﻟﻤﺮض ﻣﻘﺘﺮﻧﻨﺎ ﺑﺪاء اﻟﺴﻜﺮي‬ ‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل ﻃﺮق اﻟﺘﺸﺨﯿﺺ‬ ‫51‬ ‫واﻟﻔﺤﻮﺻﺎت اﻟﺪورﯾﺔ اﻟﺘﻲ ﻋﻠﯿﮫ اﻟﻘﯿﺎم ﺑﮭﺎ‬ ‫‪J 63 J‬‬