الفهرس 
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Abstract
Summary
Liver transplantation (LT) is one of the most successful innovations in the medical field over the last 50 years. Transplantation, as a specialty requires full time professionals working with multi-disciplinary team with great emphasis on the importance of team work. Preparation of the patient is essential in the perioperative period and the role of the nursing team is determinant for treatment success (Shanmugam et al., 2019).
A liver transplant is a surgical procedure that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor. Liver Transplantation remains the most effective and often the only option for curative treatment for large numbers of patients with end-stage organ diseases, metabolic liver disease and primary liver cancer. Liver transplantation (LT) has become a common surgical procedure worldwide (Youssef & Ali, 2022).
Self-management refers to “the ability of the individual, in conjunction with family, community, and health care professionals, to manage symptoms, treatments, lifestyle changes, and psychosocial, cultural, and spiritual consequences associated with a chronic illness or condition.” LTRs require formidable self-management skills to maintain long-term health. To maximize the long-term benefits of LT, LTRs must navigate complex health systems, adhere to lifestyle changes and clinical monitoring, and take multiple medications with potential adverse effects and frequent dosing changes (Serper, et al., 2022).
Aim of the study:
This study aims to assess predictive factors affecting self-management for recipient post liver transplantation patient through the following:
1. Assess recipient patient’s related factors that affecting self-management post liver transplantation.
2. Assess nurses’ related factors affecting self-management for recipient patients post liver transplantation.
3. Assess environmental factors affecting self-management for recipient patients post liver transplantation.
Research Question:
1) What are predictive factors affecting self-management for recipient post liver transplantation?
Research design:
A descriptive exploratory research design was used in conducting this study, which was to observe, describe, and explore aspects of situation (persons, organization, setting, or phenomena).
Setting:
This study was conducted in liver transplantation outpatient clinic and ICU (A) at Ain Shams Specialized hospital.
Subjects:
A convenient sample of all available nurses working in ICU (A) at Ain Shams Specialized hospital which equal 30 nurses.
A purposive sample of 76 patients after their second visit post liver transplantation in the previously mentioned setting.
Tools for data collection:
Three tools were used in this study and classified as the following:
Tool (I) Patients related factors assessment tools:
This tool consists of four parts:
A. Socio-demographic data:
• It was developed by the investigator and was written in simple Arabic language. It included age, gender, level of education, marital status, work nature, residence, treatment method, medical income and number of family members.
B. Patients’ clinical data assessment:
• It was developed by the investigator after reviewing related recent literature. It included present medical history, past medical history, family history, medical follow up history, etc.
C. Knowledge assessment interview questionnaire:
It was developed by the investigator after reviewing related recent literature. It concerned assessment of patient knowledge about liver transplantation and self-management.
D. Self-management tool for recipient post liver transplantation:
It was adapted by the investigator after reviewing related recent literature and it will include self-management behaviors.
Tool (II) Nurses performance assessment tool:
It included two parts:
A. Nurses’ knowledge assessment structured self- administrated questionnaire:
It was be developed by the investigator after reviewing related recent literature. It was included two parts:
1- Socio-demographic data of nurses such as: age, gender, level of education, years of experience, training course in liver transplantation.
2- Nurses’ level of knowledge related to self-management for recipient post liver transplantation.
B. Nurses’ practice observational check list:
Practice checklist about self-management post liver transplantation operation. It was be developed by the investigator after reviewing related recent literature
Tool (III) Environmental related factors assessment tool:
It was be developed by the investigator after reviewing related recent literature. It was included:
1-Air quality, water, heating, housing condition, economical condition, food related myths, food, taboos and medication fades, cultural influences and religious causes.
2- Assessment of work field.
Results:
The main results of this study revealed that:
• More than two thirds of the studied patients (68.4%) were males and more than half of them (57.9%) not working.
• The majority of the studied patients (93.4%) had satisfactory level of knowledge regarding liver transplantation, and only a small percentage of them (6.6%) had unsatisfactory level of knowledge.
• A vast majority of the studied patients (96.1%) had moderate level of self-management, and only a small percentage of them (3.9%) had high level of self-management.
• Less than two thirds of the studied patients (61.8%) had unsatisfactory environmental factors, and more than one third of them (38.2%) had satisfactory environmental factors.
• The majority of the studied nurses (93.3%) were females and more than half of them (53.3%) studied at nursing institute. Moreover, only the minority of them (16.7%) attended only one training course about liver transplantation.
• Only one third of the studied nurses (33.3%) had satisfactory knowledge regarding liver transplantation and two third of them (66.7%) had unsatisfactory knowledge regarding liver transplantation.
• Near to three quarters of the studied nurses (70%) had sat satisfactory level of practice regarding liver transplantation and slightly higher than one quarters of them (30%) had unsatisfactory level of practice regarding liver transplantation.
• Less than two thirds of the studied nurses (63.3%) had satisfactory level of the work environment and the factors affecting the performance of the nursing staff and just above one third of the studied nurses (36.7%) had unsatisfactory level.
• There was highly significant correlation between total self-management behaviors of the patient with their total information and there was no significant correlation between total self-management behaviors of the patient with total nurses’ information and practice.
Conclusion
Based on the findings of the current study, the study concluded that:
The majority of the studied patients had total satisfactory level of knowledge about liver transplantation. Also a vast majority of them had moderate level of self-management behaviors and only a small percentage had high satisfactory level of self-management behaviors. Additionally less than two thirds had unsatisfactory level of environmental factors.
Also, two thirds of the studied nurses had total unsatisfactory knowledge level about liver transplantation while less than three quarters of them had total satisfactory level of practice. Additionally less than two thirds of them had satisfactory level of the work environmental factors.
Moreover, there was a statistically significant positive correlation between patients’ self-management behaviors and their total knowledge. While there was a statistically significant negative correlation between total patients’ self-management behaviors and total nurses’ knowledge and practice there was a statistically significant negative correlation between total nurses’ practice regarding liver transplantation and total their knowledge.
Recommendations
In the light of the findings of the current study the following recommendations were suggested:
In service:
1. Conducting health educational program about self-management post liver transplantation for patients to enhance their knowledge and self-management behaviors.
2. Provide health teaching about complications post liver transplantation and their effect on patients’ medical health condition.
3. Establishing courses concerned with liver transplantation and nurses’ role in caring patient post transplantation for ICU nurses to enhance their knowledge and practice.
4. Submitting of educational posters, handout, booklets and brochures about liver transplantation and factors affecting self-management post liver transplantation
In research:
1. Replication of the study on a large probability sample selected from different geographical areas in Egypt to obtain more generalizable data.
2. Conduct research studies about self- management programs post liver transplantation.
3. Developing psychological assessment sheet to evaluate psychological condition for patients post liver transplantation.