الفهرس 
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Abstract
Preeclampsia is a multi-system disorder of pregnancy associated with the development of hypertension which appears most commonly after 20 weeks of pregnancy. It is a rapidly progressive condition marked by high blood pressure and protein in urine.
The continuous care model is a regular process for efficient, interactive and continuous communication between woman and nurse for identifying women needs and concerns and sensitizing women to accept continuous health behaviors and assisting women in sustaining health promotion and improvement. The continuous care model is intended to provide a plan for accepting and improving women’s insight and responsibility for continuing care and controlling illness and potential complications.
The nurse’s role in the care of a woman with preeclampsia focuses on close monitoring of blood pressure and ongoing evaluation for signs of preeclampsia progression. Fetal monitoring is necessary during a pregnancy. The woman is required to monitor blood pressure on a regular basis and report any elevated readings, also tested the amount of protein contained in urine and checked weight daily. A woman should take daily fetal movement counts, a well-balanced diet with sodium restriction is advised. Besides, woman is advised to drink six to eight glasses of water per day.
Aim: The study aimed to evaluate effect of continuous care model on self-care and quality of life among women with preeclampsia. Study hypotheses: H1: There would be a significant improvement in knowledge among preeclamptic women after implementation of continuous care model than before implementation. H2: There would be a significant improvement in self- care practices among preeclamptic women after implementation of continuous care model than before implementation. H3: There would be a significant improvement in quality of life among preeclamptic women after implementation of continuous care model than before implementation. Setting: Obstetrics and Gynecological out -patient clinic at Benha University hospital in Benha city. Sample: A purposive sample of 75 women with preeclampsia was recruited according to inclusion and exclusion criteria. Inclusion criteria: All women were diagnosed with mild preeclampsia (systolic blood pressure < 160 mmHg and diastolic blood pressure < 110 mmHg with proteinuria ± 2 in urine test strip), gestational age 20 to 24 weeks, can read and write and exclusion criteria: Women with obstetrical complications as gestational diabetes and eclampsia, women with psychiatric disorders affect quality of life, reluctance to continue cooperation.
Tools of data collection: Four tools were used for data collection which were designed, adjusted and prepared in Arabic language by the researcher after reviewing all related literatures.
Tool I: A self-administered questionnaire encompassed two parts: Part I: General characteristics included (age, residence, level of education, occupation, monthly income). Part II: Previous and current obstetric history included (gestational age, gravidity, parity, previous abortions, number of antenatal care visits during the current pregnancy).
Tool II: Women’s knowledge questionnaire regarding preeclampsia: It was used to assess women’s knowledge regarding preeclampsia through questions written in Arabic language in the form of multiple-choice questions.
Tool III: Self-care reported practices questionnaire: It was used to assess self-care practices that women practiced to control and manage preeclampsia.
Tool IV: World Health Organization Quality of Life - BREF (WHOQOL-BREF): It was used to assess the perception of the quality of life among women with preeclampsia in the previous two weeks. The pilot study was carried out on 10% of total sample (8women) before starting the data collection. The pilot study subjects were included in the study sample.
Fieldwork: The study was carried out from the beginning of February 2022 and completed at the beginning of March, 2023 covering 13 months. The researcher visited the previously mentioned setting three days/week (Sunday, Tuesday and Thursday) from 9.00 Am to 1.00 Pm. Continuous care model was implemented in four stages: Orientation, sensitization, control and evaluation. The program was conducted to studied women through four sessions over a period of (20) weeks. Women were classified to (10) subgroups, each group consisted of (7-8) women. At the beginning of the first session the women were oriented with the program contents. Each subgroup was informed about the time of the next sessions at the end of session. The subsequent session started with feedback about the previous session and the objectives of the new session by using simple Arabic language to suit women’s level of understanding. Motivation and reinforcement during sessions were used to enhance motivation for sharing in the study. At the end of each session the researcher gave five minutes to participant women for asking any questions for correcting any misunderstanding. Various educational methods were used (lecture, discussion, role model, demonstration and re-demonstration) materials were included (power point presentation, video and designed booklet) were used.
The main findings of the present study can be summarized as follows:
- Less than two-thirds of studied sample were in age group ˂ 30 years with a mean age of 23.02±7.57 years. As regards the residence, less than three-quarters of studied women lived in rural areas. Furthermore, more than two-thirds of studied sample were housewives. In relation to the educational level, less than half of studied women had secondary education. Moreover, less than three-quarters of studied sample did not have enough monthly income.
- There was a marked improvement in knowledge of studied sample regarding preeclampsia after implementation of the continuous care model with a highly statistically significant difference (p<0.001) at pre, immediately post and one month post-intervention phases.
- More than one quarter and more than two thirds of studied sample had good knowledge regarding preeclampsia at pre, immediately post and one month post-intervention phases respectively. While, (less than three quarters and less than one third) of them had poor knowledge regarding preeclampsia at pre, immediately post and one month post-intervention phases respectively.
- There was a marked improvement in self-care reported practices of studied sample regarding preeclampsia after implementation of the continuous care model with highly statistically significant difference (p<0.001) at pre, immediately post and one month post-intervention phases.
- There was a marked improvement in total self-care reported practices after implementation of continuous care model (more than one quarter and more than two thirds) of studied sample had satisfactory level of self-care reported practices regarding preeclampsia at pre, immediately post and one month post-intervention phases respectively. While, less than three quarters, one third and more than one third) of them had unsatisfactory level of self-care reported practices regarding preeclampsia at pre, immediately post and one month post-intervention phases respectively.
- Total score for quality of life of the sample was higher than the score before implementation with highly statistically significant difference (p ≤ 0.001) at pre, immediately post and one month post-intervention phases.
- Less than two fifths and less than two thirds of studied sample had high QOL at pre, immediately and one month post-intervention phases respectively. While, more than half and more than one third of them had low QOL at pre, immediately and one month post-intervention phases respectively.
- At pre intervention phase, there was highly statistically significant relation between total knowledge score, total self-care reported practices and total quality of life score regarding preeclampsia and the educational level of the studied sample (p ≤ 0.001). Also, there was highly statistically significant relation between total self-care reported practices score regarding preeclampsia and age of the studied sample (p ≤ 0.001). While, there was highly statistically significant relation between total quality of life score regarding preeclampsia and (residence and income) of the studied sample (p ≤ 0.001).
- There was highly statistically significant positive correlation between total knowledge and (total self- care reported practices & total QOL) regarding preeclampsia at pre-intervention and post-intervention phase (P≤ 0.001).
- There was highly statistically significant positive correlation between total self- care reported practices and total QOL regarding preeclampsia at pre-intervention and post-intervention phase (P≤ 0.001).
Conclusion:
Based on the results of the present study, it was concluded that; continuous care model had a positive effect on knowledge, self-care practices and quality of life among women with preeclampsia. There was a marked improvement in knowledge, self-care reported practices and all dimensions of quality of life of studied sample regarding preeclampsia after implementation of the continuous care model with a highly statistically significant difference at pre, immediately post and one month post-intervention phases. Moreover, there was a highly statistically significant positive correlation between total knowledge and (total self-care reported practices & total QOL) regarding preeclampsia at pre-intervention and post-intervention phase. While there was positive correlation between total self-care reported practices and total QOL regarding pre-eclampsia at pre-intervention and post-intervention phase. Therefore, the study aim was achieved and study hypotheses were supported.
Recommendations:
- The continuous care model should be integrated as a nursing intervention for promoting women’s self-care practices and improving quality of life within preeclampsia care.
- Development of health promotion strategies program and evidence-based interventions to provide better services to the women with preeclampsia.
- Applying instructional package and counselling tips for women with pregnancy induced hypertension about discharge teaching plan to maintain healthy lifestyle.
Recommendations for further studies:
- Examining the effect of the continuous care model on quality of life in other complications of pregnancy.
- Replication of the current study on a larger probability sample is recommended to achieve generalizability.
- Educational program for pregnant women to raise the level of knowledge and preventive health behaviors of high-risk during pregnancy.
- Screening program to discover high risk groups of preeclampsia with family history of hypertension for early management and follow up.
- Training courses and workshops about management of preeclampsia for health care providers at antenatal clinics should be conducted at regular intervals period.