الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Balloon valvuloplasty is an alternative to valve replacement in patients with critical stenosis although the treatment of choice for valvular heart disease is surgery, This technique enlarges the orifice of a heart valve that has been narrowed by a congenital defect, calcification, rheumatic fever, or aging (Allen, et al., 2013). Balloon valvotomy is a procedure that may relieve many of the symptoms of valve disease, but it will not cure valve disease. Some patients may continue to need medications, even after a successful procedure. Patients will need to continue seeing their doctors regularly after the procedure to make sure that cardiac valves are working properly. Lifestyle factors that can worsen valve disease may also need to be changed. An exercise program may be prescribed to improve health after the procedure (Sheila, 2011). Therefore, this study was conducted for the purpose of suggesting discharge guidelines to improve both the quality and value of care for patients undergoing percutaneous balloon mitral valvotomy.
Aim of the study:
This study aimed to suggest discharge guidelines for patients undergoing Percutaneous Balloon Mitral Valvotomy through the following:
- Assessing health needs of patients undergoing Percutaneous Balloon Mitral Valvotomy (physical, social, psychological, educational and spiritual needs).
- Suggesting discharge guidelines based on patients’ health needs.
Research questions:
The research questions formulated to be answered during this study were;
- What are the health needs of patients undergoing percutaneous balloon mitral valvotomy?
- Is there a relation between health needs of the studied patients and the suggested guidelines?
Methodology
Design
A descriptive explorative design was utilized for the conduction of this study.
Setting
The study was conducted at the Cardiology Departments and out patients Clinics in Cardio Vascular Hospital, affiliated to Ain Shams University Hospitals.
Subjects
A Purposive sample of 60 adult patients of both gender undergoing percutaneous balloon mitral valvotomy were involved in this study.
Tools for data collection
Data were collected using the following tools:
I. A structured interviewing questionnaire form
Developed by the researcher to assess the needs of patients undergoing percutaneous balloon mitral valvotomy in a simple Arabic language including the following parts:
A- Socio-demographic data sheet which included: (age, gender, level of education, marital status, occupation, income, and residence
B - Patient’s needs assessment sheets included:
- Physical needs as (resuming activities of daily living, follow prescribed diet, perform exercises, maintain Hygienic measures, sufficient sleeping hours, and relive fatigue)
- Psychological needs such as (reducing anxiety, sense of safety, coping, fear of complications and fear of loneliness)
- Social needs as (patients’ social support, recreation activities, sexual change, work adjustment, need for assistance, financial burden and feeling of usefulness).
- Educational needs such as (definition / causes of mitral stenosis, signs and symptoms of mitral stenosis, management, advantages of balloon valvuplasty, health education and discharge instructions)
- Spiritual needs as (increase satisfaction, inner peace, positive vision of future, and improving spiritual practices).
Scoring system:
Patients’ answers were recorded as yes or no.
• Positive items scored as one mark, while negative items scored as zero mark. Positive item means there is a need for the patient to be covered, negative item means there is no needs for such point.
• More than 20%of positive responses for any items should be considered as identified needs for such group of patients.
• For questions used to assess educational needs of the patients, each item one mark for yes means right and acceptable heath information, and zero mark for no means wrong or un-known heath information which is in need to be covered. The satisfactory level = 60 % & more. Meanwhile, unsatisfactory level = less than 60%.
II- Patients’ medical records: used in identifying, patient physical examination, related past and present history, manifestations, investigations and treatment
III- Psychometric assessment: It was completed by interviewing of the studied patients to determine their anxiety level and pain level through the following:
A- Hamilton’s anxiety rating scale It was developed by Hamilton (1959) and modified by the researchers. This scale formed of fourteen variables: anxious mood, tension, insomnia,, cognitive changes, depression, somatic(sensory), cardiovascular, respiration, gastrointestinal, genitourinary, autonomic symptoms, somatic (muscular) and the behavior at the interview.
The total score ranged from 0-42 and according to patients’ responses the following classifications were adapted: no anxiety (zero), mild anxiety (0 - less than 25), moderate anxiety (25 - less than 31.5) and severe anxiety (31.5 - 42).
B- Numerical pain scale it was developed by Compbell (1995) in Mohasseb et al. (2004), to measure pain severity. It was consisted of a line divided by numbered points from (0-10). Patients’ responses were categorized and adapted as follows: no pain (zero), mild pain (0 - less than 4), moderate pain (4-less than 7) and severe pain (7 - 10).
Results:
The important findings that were obtained from the study can be summarized as follows:
• Socio-demographic characteristics revealed that the mean age of the study sample was 36.5 ± 6.54 ranged from 18 to 55 years, mean weight was 62 ±7.95 ranged from 45 to 80kg and the mean height was 172.5 ±15.03. The majority of the study sample was married and females, nearly one third (35.0%) of them had secondary school education, half of them were not working. one fifth of them (20.0%) didn’t have enough income and (60.0%) were from urban areas.
• All of study subjects (100 %) had palpitation, shortening of breath, lower limb edema and fatigue. While the majority had cough, orthopnea and chest pain (95.0%, 90.0% & 90.0% respectively.
• All of study subjects (100 %) expressed resuming their physical activity and maintaining hygienic measures as a physical demand. While the majority had reliving fatigue
• The majority of the studied population nearly two thirds (65%) had fear of complications, more than half of them had fear of loneliness
• The majority nearly two thirds of the studied population had sexual activity change and feeling of usefulness (70% & 65% respectively), more than half of them (55.0%) had need of assistance.
• All of patients (100 %) did not have knowledge about related life style changes, the majority did not have knowledge about wound care after the procedure, follow up, laboratory test monitoring and signs & symptoms of infection and infection control precautions. Most of them did not have knowledge about drugs needed in their medical plan, diet adjustment, and about self-care & hygiene related to their disease. Nearly two thirds of them (65 %) did not have knowledge about probable complications of their illness.
• The majority of the studied (80%) population had unmet educational needs, most of them (75%) had unmet psychological needs, and more than half of them had unmet social needs
• There was highly statistically significant difference between patient’s age and patient’s psychological and social needs, also there was statistically significant difference in physical, spiritual and educational needs, statistically significant difference between patient’s gender according psychological and social needs, statistically significant difference between patient’s income according physical and educational needs, statistically significant difference between education level according patient’s needs.
Conclusion
Overall the study has indicated that, the majority of the studied patients had Physical, Psychological, Social, Spiritual and educational needs before the procedure. In addition, the highest needs before the procedure were, physical followed by, educational spiritual and social and then later psychological. Meanwhile, there was a statistical significance relation between patients’ needs and their characteristics as regards: age, gender, income, marital status and educational level.
Recommendations
The following recommendations were inferred from the study:
• An orientation program should be prepared for patients undergoing percutaneous balloon mitral valvuplasty (PBMV).
• Patients are in need to a simplified illustrated and comprehensive Arabic booklet including information about percutaneous balloon mitral valvuplasty (PBMV).
• Continuous assessment of the needs of the patients undergoing percutaneous balloon mitral valvuplasty (PBMV) is highly recommended.
• Further research studies are needed to focus on the assessment of the quality of life of such group of patients