Faculty of Nursing

Name: Malik .R .Manasrah

20710272

The topic:
Research Paper
"Nursing teaching toward cardiovascular disease patient"

Supervisor :
Dr. Hussein Jabareen
Academic year:
2011
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prepared by: Malik Manasrah
 ACKNOWLEDGMENTS
This thesis wouldn’t be completely done unless I had obtained very
unmistakable assistance from Associate my advisors, Dr. Hussein Jabareen
who have been giving me very captivating and useful ideas, concepts,
advice, and guidelines. They have also devoted their precious time to
checking and correcting the shortcomings in all phases of this research,
including giving me the encouragement and moral supports all along. I
really appreciate their sincerity, generosity, and sacrifices, so I would like
to take this opportunity to give them my heartfelt thanks.
It is not possible to credit the many who have contributed toward the
accomplishment of this research. However, I would like to give particular
recognition to those who helped and guided me through this study.
I shall never be able to express adequately my acknowledgment to all
my supportive friends, who were very co-operative and helpful.
Sincere thanks, true appreciation, and love go to all my family members,
especially to my father and mother, for their patience, encouragement, and
endless support during my graduate study.
I also wouldn’t forget to thank my friends, my senior friends and anyone
who has provided me their help, but I can’t mention all their names here.

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Index
No. Subject Page no.
1 Acknowledgement 1
2 Table of contents 2
3 Abstract 4
Chapter one
5 Introduction 6
6 Research question 9
7 Hypothesis & null hypothesis 9
8 Aims of research 9
Cardiovascular risk Factors 10
Epidemiological transition of cardiovascular 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

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20 Recommendation 58
21 Study limitation 59

22 Appendix A : Cross tabulation 60

23 Appendix B : Questionnaire 62
24 References 66

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 Abstract
Cardiovascular disease (CVD) is a critical public health issue, nationally and
internationally.
cardiovascular diseases most common causes of death worldwide
among adults in Palestine in 2005, 21 % of deaths were due to heart
diseases and 11 % to cerebrovascular diseases.
Counseling and teaching in cardiovascular disease care relating to lifestyle
changes, nonpharmacolgical treatment regarding smoking, weight, diet,
physical activity and stress, aims to reduce complications. Many patients
have several risk factors to deal with. There are few studies of nursing in
cardiovascular disease care in Palestine and this issue therefore needs to
be investigated in my study.
The aims of this study were to analyze the communication between
patients and nurses about lifestyle changes in cardiovascular disease care
at hospitals and To establish data of what kind of teaching the nurse give
to cardiovascular patient and To identify factors which limit or prevent
sufficient teaching to cardiovascular patient. In the first study.
Research question:
Is nurse give teaching to cardiovascular patient by giving them
information and instruction about variables of Specific Cardiovascular risk
factors (lifestyle behaviors )
Aims & objectives
Ø To establish data of what kind of teaching the nurse give to cardiovascular
patient.
Ø To examine which topics that nurse focus on during teaching.
Ø To identify factors which promote the successful nursing teaching.
Ø To identify factors which limit or prevent sufficient teaching to cardiovascular
patient.

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

Population:
the population consisted of Nurses working with cardiovascular patient

Location:
Ø Hebron governmental hospital
Ø Al-Ahli Hospital in Hebron
Ø Al-Mezan hospital in Hebron
Ø Al-Hussein governmental hospital

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

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

Analysis: By using the SPSS windows program.

• The response rate is 86%
• My questionnaires consist of 3 parts:
• 1. Demographic Data
• 2. question to test nursing teaching to CVD Pt
• 3. Question to test abesticles and motivations

Keywords: Nursing, cardiovascular disease, counseling, teaching, lifestyle,

health behavior, patient-centered care, stages of change model.
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 Chapter One
INTRODUCTION

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INTRODUCTION

The purpose of my research is to conduct a the role of nursing teaching among

cardiovascular disease patient and promotion and prevention in the area of
cardiovascular modifiable risk factor to identify the areas in which nursing have
Concerns than other, especially the in patient who have cardiovascular risk factor or
who have cardiovascular disease to decrease ferocity or to prevent complications.

The terms of concerns in this research include:

1. Nursing teaching to cardiovascular patient in area of:
Ø The lifestyle-related risk factors for cardiovascular disease such as “high blood
pressure, high cholesterol, diabetes, smoking, overweight/obesity, and
physical inactivity” and the role of nursing in increase knowledge about effect
on the risk of disease when they are considered together and the method in
remove or decrease these risks.
Ø Explain the diagnoses of patient and increase patient knowledge on the signs
and symptoms and how to deal with each and when to seek health care.
Ø Medications in and how to use each one, the therapeutic activity and
predictable side effect.
Ø Patients who have combination of cardiovascular disease and diabetes.
Ø The tests needed and explain of other procedures and the purpose of each
one.
Ø The method in decreasing anxiety and chest pain such as relaxation
techniques and music therapy.
Ø The actions that patient should avoid and actions that no need to avoid and
the purpose of these precautions.
Ø The role of physical activity and sport in decrease risk factors .
Ø The use of suitable words and sentences according to patient abilities and level
of knowledge.
Ø Use directional and specific teaching for each disease in

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Cardiovascular diseases

Cardiovascular disease (CVD) is a critical public health issue, nationally and

internationally. It was responsible for less than 10% of all global deaths at the
beginning of the 20th century1, but in 2005 that number was 30%.

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

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

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

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

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

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 Research question:
Is nurse take care with cardiovascular patient by giving teaching for cardiovascular
patient by test nursing teaching for these variables of Specific heart-healthy lifestyle
behaviors such as physical activity, low-saturated fat and low-salt diet, cigarette
smoking abstinence or cessation, weight control or reduction, and controlled blood
pressure (hypertension), glucose (type 2 diabetes), and serum cholesterol and other
lipids .
Ø What are some things that could be done to improve the quality of teaching
for cardiovascular patients.
Ø What are the barriers that keep you from providing teaching for cardiovascular
patients.
Hypotheses:
It is hypothesized that the nurse take care with cardiovascular patient gives
sufficient teaching for cardiovascular patient on modification there life style in
variables that promote their health and prevent further complication and make
teaching about drug use and each.
The null hypotheses:
The null hypotheses suggest that nurse take care with cardiovascular patient don’t
gives sufficient teaching for cardiovascular patient and hasn’t role in giving teaching.

Aims:
The overall aim of this research was twofold:
Ø to analyse the communication between nurses and patients about lifestyle
changes in cardiovascular disease patient care
Ø To evaluate the effects of nursing interventions.
Specific aims
Ø To establish data of what kind of teaching the nurse give to cardiovascular
patient.
Ø To examine the influence of various variables on educational policy.
Ø To examine which topics that nurse focus on in teaching.
Ø To identify factors which promote the successful nursing teaching.
Ø To identify factors which limit or prevent sufficient teaching to cardiovascular
patient.
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 Cardiovascular risk Factors
In the last years, prevention and treatment of CVD risk factors have resulted in
lowering CVD-related mortality. However, many patients identify these factors but
they do not have them adequately controlled8.

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

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

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

• Lipid profile (total cholesterol (TC), triglycerides (TG))

Quantitative changes occur due to the increase of glucose for synthesis and decrease
in lipoprotein lipase activity leading to decrease of from peripheral circulation,
increase in LDL-C levels and decrease in HDL-C levels due to increase in hepatic lipase
activity decrease in clearance. So rising risk of heart diseases11.

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

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

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

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

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

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

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

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

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

Changing lifestyle could be expressed as executing self-care. Self-care was defined in

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

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

If lifestyle changes are to be successful, the patient has to be motivated. Motivation

means mobilizing mental and behavioral effort to achieve a goal 26. A tool for the
nurse to use in counseling 27.

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

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

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

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Chapter two
Theoretical framework

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

_ The Health Belief Model (Becker, 1974)

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

_ Social Cognitive Theory (Bandura, 1977)

_ Stages of Change (Prochaska & DiClemente,1992)

_ Health Promotion models and strategies

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1. HEALTH BELIEF MODEL (BECKER, 1974)

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

The HBM has two basic components:

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

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

_ Perceived susceptibility – This refers to one’s subjective perception of the risk of

contracting a condition (the individual evaluation of the likelihood of developing the
health problem)

_ Perceived severity – This refers to feelings concerning the seriousness of the illness
if it is contracted or left untreated
_ Perceived benefits – These are the beliefs regarding the effectiveness of the
actions available in reducing the disease threat
_ Perceived barriers – These refer to the potential negative physical, psychological
and financial aspects of a particular health action (e.g., expense, side effects, pain,
time-constraint)
_ Cues to action – These are the reminders about a potential health problem (e.g.,
newspaper and magazine article, mass media campaigns, advice from others). It
should be noted that cues to action can be external (e.g., the recommendation of a
physician or mass media messages) or internal (e.g., symptoms). Another type of
external cue, social influence, has also been shown to be an important predictor of
health behavior.
According to the HBM, individuals weigh the potential benefits of the recommended
response against the barriers of the action (e.g., psychological, physical, and financial
costs) when deciding to act. For example, a woman may recognize the benefit of
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having a mammogram but may be afraid of finding cancer.The readiness to take
action for health stems from a perceived threat of disease, due to an individual’s
perception of his or her susceptibility to disease and its potential severity. The
anticipation of a negative outcome and the desire to avoid this outcome creates
motivation to take preventative actions. (See Figure 2).

Figure 1: The Health Belief Model (HBM)

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

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

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2. THEORY OF REASONED ACTION (TRA) (AJZEN & FISHBEIN,1980)
Since the development of the HBM, other researchers, notably Ajzen and Fishbein
(1980), have maintained that it is not enough for health planners to construct health
interventions based on theoretical variables.

Rather, salient beliefs and attitudes need to be incorporated.

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

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

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

3. SOCIAL COGNITIVE THEORY (BANDURA, 1977)

Albert Bandura’s Social Cognitive Theory (sometimes called Social Learning Theory)
has been used in a wide variety of interventions and evaluation efforts.The focal
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point of the theory is on perceived self-efficacy. Self-efficacy is defined as “people’s
beliefs that they can exert control over their motivation, behaviour and social
environment” 36. In other words, perceived self-efficacy is what one believes about
one’s capability to perform a certain action (perceived self-effectiveness).

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

Outcome expectations (also called response efficacy in other models) refer to an

individual’s belief that a certain behaviour will lead to a certain outcome. For
example, “I believe that if I exercise regularly I will look better” is an outcome
expectation. Outcome expectations are different from efficacy expectations in that
the latter is a person’s belief on whether he or she is able to ”successfully execute
the behavior required to produce the outcomes” 36. Bandura states that health
behaviour and health outcomes are a function of efficacy and outcome expectations.
However, an individuals’ efficacy and outcome expectations may be inconsistent, for
example, someone who smokes may perceive that smoking is harmful to his/her
health yet believes him/herself to be incapable of changing this behaviour. In
addition, a person’s efficacy expectations may vary across behaviours and situations.
For example, a person may have high self-efficacy for attending exercise classes
regularly but low perceived self-efficacy for reducing alcohol intake. Bandura (1977)
further proposes that an individual’s self-efficacy perceptions are developed from
four sources of information: performance accomplishments (e.g., learning through
personal experience), physiological states (e.g., relaxation, biofeedback, information
from providers about the consequences of health risks and the benefits of change),
verbal persuasion (e.g., information from practitioners, self-instruction), and
vicarious experience (e.g., seeing others consider and perform challenging health
behaviours successfully). The concept of self-efficacy has been used in areas such as
exercise, dietary fat intake, and smoking 38.
Figure 3: Social Cognitive Theory

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

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

1992)

One of a number of stage models of behavior change, the transtheoretical model

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

In the Precontemplative stage, individuals do not intend to change their behaviour

because they are completely unaware of the behavioural options available to them.
In other words, they may not realize they are engaging in a risky behaviour or they
may deny that their behaviour puts them at risk for harm. In the second stage
(Contemplation), the risk becomes apparent to the individual. At this stage
individuals begin to think about the behaviour that is putting them at risk and to
contemplate the need for change. In this stage, an individual recognizes the need to
engage in physical activity. In the third stage, Preparation, individuals make a
commitment to change and take some action towards behavioural change. It is in the
Action stage that individuals perform the new behaviour consistently. In the
Maintenance stage, the final stage of the SOC model, the new behaviour is continued
and steps are taken to avoid lapsing into the formerly risky behaviours. Transitions
between the stages of change are effected by a set of independent variables known
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as the processes of change. These are covert and overt activities and experiences
that individuals engage in when they attempt to modify problem behaviours. Each
process is a broad category encompassing multiple techniques, methods, and
interventions traditionally associated with disparate theoretical orientations.
Numerous studies have shown that successful self-changers employ different
processes at each particular stage of change.The ten processes of change are
consciousness raising, counterconditioning, dramatic relief, environmental
reevaluation, helping relationships, reinforcement management, self-liberation,
self-reevaluation, social liberation, and stimulus control.

The model also incorporates a series of intervening or outcome variables. These

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

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5. HEALTH PROMOTION MODELS AND STRATEGIES

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

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

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

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

Patient trenching is to nursing care as flour is to cake. Each is so essential in their

respective processes that without them the outcome is unsatistiactory. High quality
ingredients are another essential requirement for both ... the better the teaching
skills of nurses, the more likely patients are to learn (Gessncr. I %!?, p. 589)

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Chapter three
Methodology

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 Methodology
INTRODUCTION

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

RESEARCH DESIGN

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

Quantitative design

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

3.2.2 Descriptive design

Description involves identifying and understanding the nature of nursing phenomena

and, sometimes, the relationships between the phenomena 44. Descriptive study
design can be used in a study when:

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

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

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

POPULATION AND SAMPLING

Population

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

Sample

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

44
.

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

The inclusive criteria included:

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

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

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 Ø Hebron governmental hospital in Hebron
Ø Al-Ahli Hospital in Hebron
Ø Al-Mezan hospital in Hebron
Ø Al-Hussein governmental hospital in Bethlehem.
Subjects:
I will give 80 questionnaires and I will include all nurses’ work with cardiovascular
patients in award of CCU and Medical ward and I will exclude nurses who don’t work
with cardiovascular patients.
My study will not differ between nurse and every one in ward have the same chance
to get and fill questionnaire.
DATA COLLECTION INSTRUMENT

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

a checklist is prepared items in which the respondents indicate their participation in

a certain activity. Checklists are used to ensure that no task is left undone.

Advantages:

Ø -can be used to explore a wide variety of issues such as prevalence,

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

The distinctive disadvantages of a checklist are:

Ø It does not supply an opportunity for respondents to classify their judgment.

Ø It is a rigid method in both question and the responses.
Ø Extra time must be planned for pre-testing and validating the instrument.

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 Ø The respondent is required to make a forced choice response, so each item
must be carefully worded and based on the research purpose.
Ø Since its inception the tool employed open-ended questions, which allowed
the respondents to state their opinions. This overcame the above
disadvantages.
Ø To enhance the protection against bias in this descriptive study, the following
precautions, as described by Burns and Grove (2001:248), were taken:
Ø A valid and reliable instrument for data collection was used.
Ø The data collection procedure achieved some environmental control.
Ø Precise and replicable criteria were established before the population was
assembled.

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

Ø The development phase.

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

THE DEVELOPMENT PHASE

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

Based on this information, a questionnaire that captures all relevant data in a

consistent and organised manner was compiled.

An information leaflet accompanied the questionnaire and contained the following:

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

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COMPILATION OF THE QUESTIONNAIRE

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

CONFIRMATION PHASE

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

VALIDITY AND RELIABILITY

Reliability
reliability is “...the degree of consistency with which the instrument measures the
attribute.” Reliablity is a matter of whether a particular technique, applied
repeatedly to the same object, would yield the same result each time. Reliability
does not ensure accuracy any more than precision ensure it. Even total reliability
does not ensure that our measures measure what we think they measure
Reliability of the research process was ensured through the following steps:
Ø A study leader evaluated the questionnaire.
Ø The researcher was present while the nurses completed the questionnaires.
No questions arose.
Validity
Validity refers to the degree to which an instrument measures what it is supposed to
measure 44. Internal validity is defined as the degree to which results are a true
reflection of the truth and the realties that are being researched. There are
numerous yardsticks for determining validity: face validity, criterion related validity,
content validity, and construct validity. Asking the nurses to be as truthful as possible
when completing the questionnaires secured this.
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Validity was also promoted by the following:
Ø All questionnaires were completed under the researcher’s supervision, and
therefore, no questionnaires were removed from the environment.
Ø The patients completed the questionnaires themselves.
External validity is defined as the degree to which the results of the study can be
generalized to settings or samples other than the ones studied. This study was
conducted in Hebron and Bethlehem hospital only, and therefore the sample is not
necessarily representative of the larger population. The results of this study cannot
be generalized to samples or settings other than where studied.
Construct validity is defined as the degree to which an instrument measures the
construct under investigation 44. The theme of this research was education given by
Nurse working with cardiovascular patient.
The researcher followed this theme throughout the study.
Content validity is concerned with the sampling adequacy of the content area being
measured 44. In this study the researcher ensured content validity through a
thorough literature review and the use of expert opinions in the development of a
questionnaire.

DATA COLLECTION PROCEDURE

The researcher explained the purpose of the study to each patient. The hospital was
consulted and written permission obtained before the study commenced.
The anonymity and confidentiality of each participant was assured, as information
obtained would not be linked to their names in any way.
The questionnaires were handed out on the 2 week between 11Am and 2Pm o’clock.
The researcher was present while the nurses completed the questionnaire. 80
questionnaire used in the study. Consent was obtained from the Hospital nursing
supervisor before the questionnaires were handed out.
DATA ANALYSIS
The data that I collected from the surveys were coded and entered into the
Statistical Package for the Social Sciences (SPSS), version 19.0 for analysis. The data
were analyzed using both descriptive and correlation statistics.
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I will test each variables in questionnaire and express by descriptive and use of
suitable graphs such as bar chart and pie chart.
And I will address things that improve nursing teaching to cardiovascular patient and
things that limit nursing teaching to cardiovascular patient.
Also I will test the quality of nursing teaching among staff and practitioner nurse
And I will test the nursing teaching among privet and governmental hospital
Also I will test the nursing teaching among CCU and medical ward
The data analysis will be discussed in Chapter 4. The analysis was done by means of
descriptive statistics and interpreted and presented in frequencies and percentages.
The process of data analysis is largely a search for patterns of similarities and
differences - followed by an interpretation of those patterns .

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

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Chapter four:
Result

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

So I did my questioners according to previous cardiovascular risk factor, and my

question is at the aim modify these risk factors by nurse in assist people to:

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

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

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

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

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1- Demographic data
‫اﻟﺪرﺟﺔ اﻟﻌﻠﻤﯿﺔ‬
Frequency Percent
‫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%.

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 ‫اﻟﺠﻨﺲ‬
Frequency Percent
‫ذﻛﺮ‬ 39 56.5%
‫أﻧﺜﻰ‬ 30 43.5%
The nurse participate on my study according to sex there are 56.5% male
and 43.5% female

‫ﻋﺪد ﺳﻨﻮات اﻟﺨﺒﺮة‬

Frequency Percent
‫ ﺳﻨﻮات‬5 ‫أﻗﻞ ﻣﻦ‬ 10 14.5%
‫ ﺳﻨﻮات‬10-5 28 40.6%
‫ ﺳﻨﺔ‬15-10 26 37.7%
‫ ﺳﻨﺔ‬15 ‫أﻛﺜﺮ ﻣﻦ‬ 5 7.2%

The nurse participate on my study according to Years of Experience are

41% from 5-10 years , 38% from 10-15 years, 14.5% less than 5 years and
7% more than 15years.
‫ﻧﻮع اﻟﻤﺴﺘﺸﻔﻰ‬

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

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 ‫ھﻞ ﺣﺼﻠﺖ ﻋﻠﻰ دورات ﺑﺨﺼﻮص اﻣﺮاض اﻟﻘﻠﺐ واﻟﺸﺮاﯾﯿﻦ‬

Frequency Percent
‫ﻧﻌﻢ‬ 35 50.7
‫ﻻ‬ 34 49.3
The courses and training increase the awareness and knowledge,
also attitude in nursing here about half of nurses work with
cardiovascular disease say that they got course in cardiovascular
disease.

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2- Nursing role in cardiovascular disease patient teaching

‫( أﻗﻮم ﺑﺘﻮﺿﯿﺢ اﻟﺘﺸﺨﯿﺺ ﻟﻠﻤﺮﯾﺾ‬1

Frequency Percent
‫داﺋﻤ ًﺎ‬ 28 40.6%
ً‫اﺣﯿﺎﻧﺎ‬ 35 50.7%
ً‫ﻧﺎدرا‬ 6 8.7%

The patient has the right to know and understand the actual problem that
he have, and the nurse has responsibility in clarify the diagnoses.

Here the result of this question show that about 91 % say always and
some time and about 9 % say rarely .

‫( أﻗﻮم ﺑﺘﻮﺿﯿﺢ اﻻﻋﺮاض اﻟﻤﺮﺿﯿﺔ اﻟﻤﺘﻮﻗﻌﺔ‬2

Frequency Percent
‫داﺋﻤ ًﺎ‬ 18 26.1%
ً‫اﺣﯿﺎﻧﺎ‬ 42 60.9%
ً‫ﻧﺎدرا‬ 7 10.1%
ً‫ﻣﻄﻠﻘﺎ‬ 2 2.9

The patient should know what sign and symptom that may appear and
what is normal and what is abnormal and when he should seek health
care here the result show that 61 say some time which mean not all nurse
work with cardiovascular disease patient clarify for patient this topic.

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‫( أوﺿﺢ ﻟﻠﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﺳﺘﺨﺪام اﻻدوﯾﺔ وﻣﺎ اﻟﻔﺎﺋﺪة اﻟﻌﻼﺟﯿﺔ ﻟﻜﻞ دواء وﺗﺎﺛﯿﺮه ﺣﺘﻰ ﺑﺪون‬3
‫ان ﯾﺴﺄل اﻟﻤﺮﯾﺾ‬

Frequency Percent
ً‫داﺋﻤﺎ‬ 28 40.6%
ً‫اﺣﯿﺎﻧﺎ‬ 33 47.8%
ً‫ﻧﺎدرا‬ 6 8.7%
ً‫ﻣﻄﻠﻘﺎ‬ 2 2.9%
The medication is the one of the most important steps in treatment and
care plan for the patient, and medication one of the major duties for
nursing. The result here show that about 90% say always and some time.

‫( أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﺿﻰ ﺣﻮل اﺿﺮار اﻟﺘﺪﺧﯿﻦ واﻟﻔﻮاﺋﺪ اﻟﺼﺤﯿﺔ ﻟﺘﺮﻛﮫ‬4

Frequency Percent
‫داﺋﻤ ًﺎ‬ 33 47.8%
ً‫اﺣﯿﺎﻧﺎ‬ 25 36.2%
ً‫ﻧﺎدرا‬ 9 13%
ً‫ﻣﻄﻠﻘﺎ‬ 2 2.9%

The smoking is one of the major risk factor of cardiovascular disease and
the nurse has role in clarify the smoking risk and benefits of get smoking
out the result show that about 85% of nurses give instruction always and
some time.

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 ‫( أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻐﺬاء اﻟﻤﺘﻮازن‬5

Frequency Percent
‫داﺋﻤ ًﺎ‬ 32 46.4%
ً‫اﺣﯿﺎﻧﺎ‬ 27 39.1%
ً‫ﻧﺎدرا‬ 9 13%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

One of the factor for cardiovascular disease is food component and the
nurse should increase patient awareness about balanced food. Here
about 95% say always and some time and 15% say rarely and never.

‫( أﻗﻮم ﺑﺘﻮﺿﯿﺢ ﻧﻮﻋﯿﺎت اﻟﻐﺬاء اﻟﻤﻨﺎﺳﺐ اﻟﺬي ﯾﺴﺎﻋﺪ ﻓﻲ ﺗﺤﺴﯿﻦ ﺻﺤﺔ اﻟﻤﺮﯾﺾ‬6
Frequency Percent
‫داﺋﻤ ًﺎ‬ 33 47.8%
ً‫اﺣﯿﺎﻧﺎ‬ 28 40.6%
ً‫ﻧﺎدرا‬ 7 10.1%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

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

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 ‫أﻗﻮم ﺑﻤﺴﺎﻋﺪة اﻟﻤﺮﯾﺾ ﺑﻌﻤﻞ ﺑﺮﻧﺎﻣﺞ ﻏﺬاﺋﻲ ﻣﻨﺎﺳﺐ ﯾﺨﻔﻒ ﻣﻦ ﻣﻀﺎﻋﻔﺎت اﻟﻤﺮض‬

Frequency Percent
‫داﺋﻤ ًﺎ‬ 20 29%
ً‫اﺣﯿﺎﻧﺎ‬ 32 46.4%
ً‫ﻧﺎدرا‬ 12 17.4%
ً‫ﻣﻄﻠﻘﺎ‬ 5 7.2%

Each patient need nutritional program differ to become appropriate to his

health status, and nurse has responsibility in help patient to put this
program. The result here show that always and sometime 75% and 25% to
rarely and never.

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

Frequency Percent
‫داﺋﻤ ًﺎ‬ 24 34.8%
ً‫اﺣﯿﺎﻧﺎ‬ 27 39.1%
ً‫ﻧﺎدرا‬ 17 24.6%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

The exercise is one of lifestyle that promote health of cardiovascular

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

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 ‫أﻗﻮم ﺑﺘﺤﺪﯾﺪ اﻻﻋﻤﺎل اﻟﺘﻲ ﯾﺠﺐ اوﻻ ﯾﺠﺐ ﻋﻰ اﻟﻤﺮﯾﺾ اﻟﻘﯿﺎم ﺑﮭﺎ وﻓﻘﺎ ﻟﺤﺎﻟﺘﮫ اﻟﺼﺤﯿﺔ‬

Frequency Percent
‫داﺋﻤ ًﺎ‬ 30 43.5%
ً‫اﺣﯿﺎﻧﺎ‬ 32 46.4%
ً‫ﻧﺎدرا‬ 7 10.1%

Each patient according to health able to do kind of work and un able to

other kind, the nurse here has responsibility in determine works that
appropriate to patient. The result show here that 90% say always and some
time and 10% say rarely.
‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻮزن اﻟﻄﺒﯿﻌﻲ وﻃﺮق اﻟﺘﺨﻠﺺ ﻣﻦ اﻟﺴُﻤﻨﺔ‬

Frequency Percent
‫داﺋﻤ ًﺎ‬ 27 39.1%
ً‫اﺣﯿﺎﻧﺎ‬ 26 37.7%
ً‫ﻧﺎدرا‬ 16 23.2%
ً‫داﺋﻤﺎ‬ 27 39.1%

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

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 ‫أﻗﻮم ﺑﺘﻌﻠﯿﻢ اﻟﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ ﺣﺎﻻت اﻟﺬﺑﺤﺔ اﻟﺼﺪرﯾﺔ واﻋﺮاﺿﮭﺎ‬

Frequency Percent
ً‫داﺋﻤﺎ‬ 27 39.1%
ً‫اﺣﯿﺎﻧﺎ‬ 33 47.8%
ً‫ﻧﺎدرا‬ 9 13%

Angina is one of cardiovascular disease and high number of cardiovascular

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

‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اﻟﻤﺨﺎﻃﺮ اﻟﺼﺤﯿﺔ ﻻرﺗﻔﺎع ﺿﻐﻂ اﻟﺪم وﺿﺮورة اﻻﻟﺘﺰام ﺑﺎﻟﻌﻼج‬

Frequency Percent
‫داﺋﻤ ًﺎ‬ 35 50.7%
ً‫اﺣﯿﺎﻧﺎ‬ 26 37.7%
ً‫ﻧﺎدرا‬ 7 10.1%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

Hypertension is one of cardiovascular disease and can cause other

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

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 ‫أﻗﻮم ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل وﺳﺎﺋﻞ اﻟﻌﻼج ﺑﺎﻻﺳﺘﺮﺧﺎء واﻟﻤﻮﺳﯿﻘﻰ ﻟﺘﺨﻔﯿﻒ اﻻﻟﻢ‬

Frequency Percent
‫داﺋﻤ ًﺎ‬ 17 24.6%
ً‫اﺣﯿﺎﻧﺎ‬ 22 31.9%
ً‫ﻧﺎدرا‬ 19 27.5%
ً‫ﻣﻄﻠﻘﺎ‬ 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
‫داﺋﻤ ًﺎ‬ 38 55.1%
ً‫اﺣﯿﺎﻧﺎ‬ 26 37.7%
ً‫ﻧﺎدرا‬ 5 7.2%

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

factor for cardiovascular disease, the nurse responsibility is to increase
patent awareness to maintain normal blood sugar. The result of this
question show that 93% say always and some time and 7% say rarely.

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

Frequency Percent
‫داﺋﻤ ًﺎ‬ 32 46.4%
ً‫اﺣﯿﺎﻧﺎ‬ 26 37.7%
ً‫ﻧﺎدرا‬ 10 14.5%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

The patient has right to know about what will done for him, and he should
know about the procedures he needed, the nurse responsibility here is to
clarify each procedure and the goal of it. The result here show that 84% of
nurses say always and 16% say rarely and never

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

Frequency Percent
‫داﺋﻤ ًﺎ‬ 43 62.3%
ً‫اﺣﯿﺎﻧﺎ‬ 21 30.4%
ً‫ﻧﺎدرا‬ 4 5.8%
ً‫ﻣﻄﻠﻘﺎ‬ 1 1.4%

Each patient has education lever differ from other, the nurse here should
adapt to patient level of education to maintain our goal to maximum
information to be understand by patient. The result here show that 92% of
nurses say always and some time and 8% say rarely and never.

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

Frequency Percent
‫داﺋﻤ ًﺎ‬ 45 65.2%
ً‫اﺣﯿﺎﻧﺎ‬ 22 31.9%
ً‫ﻧﺎدرا‬ 2 2.9%

When give instruction to patient, all information should be true and nurse
take it from reliable references, the result here show that nurse say
always and sometime 97% and 3% say rarely.

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

Frequency Percent
‫داﺋﻤ ًﺎ‬ 47 68.1%
ً‫اﺣﯿﺎﻧﺎ‬ 19 27.5%
ً‫ﻧﺎدرا‬ 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
‫داﺋﻤ ًﺎ‬ 16 23.2%
ً‫اﺣﯿﺎﻧﺎ‬ 39 56.5%
ً‫ﻧﺎدرا‬ 12 17.4%
ً‫ﻣﻄﻠﻘﺎ‬ 2 2.9%

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

that limit the extent of giving teaching to cardiovascular disease patients,
and 25% disagree.
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‫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 extent
of 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 the

hospital to provide health education as one of factor that limit the extent
of 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 hospital

about health education as one of factor that limit the extent of giving
teaching to cardiovascular disease patients, and 26% disagree.

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‫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 one

of factor that limit the extent of giving teaching to cardiovascular disease
patients, 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 don't consider giving teaching to cardiovascular disease

patients 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 the

hospital on this effort as one of factor that limit the extent of giving
teaching to cardiovascular disease patients, and 20% disagree.

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 ‫ﻻ أﻋﺘﺒﺮ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻣﻦ وﻇﺎﺋﻒ اﻟﺘﻤﺮﯾﺾ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ‬

Frequency Percent
‫أواﻓﻖ‬ 18 26.1%
‫أﻋﺎرض‬ 51 73.9%

26% of nurses don't consider giving teaching to cardiovascular disease

patients as part of nursing curricula in care for patients, and 74%
disagree.

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

Frequency Percent
‫أواﻓﻖ‬ 50 72.5%
‫أﻋﺎرض‬ 19 27.5%

72.5% of nurses consider that head nurse follow teaching to

cardiovascular disease patients and consider is part of nursing curricula in
care for patients, and 27.5% disagree.
‫ﯾﻮﺟﺪ ﻓﻲ اﻟﻘﺴﻢ ارﺷﺎدات ﻣﻄﺒﻮﻋﺔ ﻟﺘﺜﻘﯿﻒ اﻟﻤﺮﺿﻰ‬

Frequency Percent
‫أواﻓﻖ‬ 43 62.3%
‫أﻋﺎرض‬ 26 37.7%

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

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 ‫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 section
of the nurses who are committed to health education, and 43.5%
disagree.

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Chapter Five :
Discussion

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

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

perspectives lifestyle modification using a quantitative approach (the

rationale for which is discussed in chapter three.

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

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

The result in part tow of questionnaire support that nursing give teaching
in major sector of cardiovascular disease for healthy life style, clarify of
procedures and care plan.
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According to result There isn't topic nurse focus on than another, the
nurse focus on medical treatment and care plan as medical diagnoses,
medication, procedures and life style teaching as healthy food, exercise.

According of the nurse participate the half of them take training and
courses in cardiovascular nursing, the course give nurse information and
awareness to health related issue for cardiovascular disease patient, and
teaching become more helpfully because it's depend on valid database
When they have confidence, the teaching process will go on smoothly,
rapidly, and procedurally because there is a complete and preliminary
teaching arrangement and direction to control the teaching to go on in the
same guideline. this broad based clinical skills that can be extended and
expanded with appropriate training.

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

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

Recurrent consultation training can give structure to the consultation and

increase individually adapted communication in assessing lifestyle
behaviour.

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

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

75% of nurses says that Non-cooperation of the patient as one obstacles

to give cardiovascular teaching.

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

teaching.

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

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

There is many motivation factor : follow up of nursing teaching by head

nurse and motivation from team.

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

Hospitals must offer teaching framework for supporting the nurse to

perform relevant nursing actions and interventions.

Focus on the concepts related to the nurse as tools to communicate in a

more structured and interactive way with the aim of assisting patients’
development of self-care agency to change lifestyle so more training in
communication skills needed.

education about non-pharmacological treatment and also on how to

perform counseling in a stage-directed, patient-centered way. Lectures on
how to perform counseling are not enough. Training is also needed.

More attention should be given by hospitals to the needs of those caring

for people with CVD.

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

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

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

Cooperative efforts to promote the education of patients may be

encouraged through joint staff conferences of several agencies, inservice
training, case conferences of several agencies, and other means for

J 58 J
 exchange of ideas and make Course to raise the level of awareness' in
nursing working with cardiovascular patients.

Study Limitations

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

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Appendix A

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J 61 J
 ‫‪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.‬‬
‫ﺷﺎﻛﺮاً ﻟﻜﻢ ﺣﺴﻦ ﺗﻌﺎوﻧﻜﻢ‬
‫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:‬‬
‫‪ 15‬ﺳﻨﺔ ﻓﺄﻛﺜﺮ‬ ‫‪15-10‬ﺳﻨﺔ‬ ‫‪ 10-5‬ﺳﻨﻮات‬ ‫اﻗﻞ ﻣﻦ ‪ 5‬ﺳﻨﻮات‬ ‫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
 ‫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 ‫‪10‬‬
‫اﻟﻄﺒﯿﻌﻲ وﻃﺮق اﻟﺘﺨﻠﺺ ﻣﻦ اﻟﺴُﻤﻨﺔ‬
‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻌﻠﯿﻢ اﻟﻤﺮﯾﺾ ﻛﯿﻔﯿﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ ﺣﺎﻻت‬ ‫‪11‬‬
‫اﻟﺬﺑﺤﺔ اﻟﺼﺪرﯾﺔ واﻋﺮاﺿﮭﺎ ﺣﺘﻰ ﺑﺪون ان ﯾﺴﺄل‬
‫اﻟﻤﺮﯾﺾ‬
‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اﻟﻤﺨﺎﻃﺮ اﻟﺼﺤﯿﺔ‬ ‫‪12‬‬
‫ﻻرﺗﻔﺎع ﺿﻐﻂ اﻟﺪم وﺿﺮورة اﻻﻟﺘﺰام ﺑﺎﻟﻌﻼج‬
‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل وﺳﺎﺋﻞ اﻟﻌﻼج‬ ‫‪13‬‬
‫ﺑﺎﻻﺳﺘﺮﺧﺎء واﻟﻤﻮﺳﯿﻘﻰ ﻟﺘﺨﻔﯿﻒ اﻻﻟﻢ‬
‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل اھﻤﯿﺔ اﻟﻤﺤﺎﻓﻈﺔ‬ ‫‪14‬‬
‫ﻋﻠﻰ ﻣﺴﺘﻮى ﻃﺒﯿﻌﻲ ﻣﻦ اﻟﺴﻜﺮ ﻓﻲ اﻟﺪم اذا ﻛﺎن‬
‫اﻟﻤﺮض ﻣﻘﺘﺮﻧﻨﺎ ﺑﺪاء اﻟﺴﻜﺮي‬
‫أﻗﻮم داﺋﻤﺎ ﺑﺘﻮﻋﯿﺔ اﻟﻤﺮﯾﺾ ﺣﻮل ﻃﺮق اﻟﺘﺸﺨﯿﺺ‬ ‫‪15‬‬
‫واﻟﻔﺤﻮﺻﺎت اﻟﺪورﯾﺔ اﻟﺘﻲ ﻋﻠﯿﮫ اﻟﻘﯿﺎم ﺑﮭﺎ‬
‫‪J 63 J‬‬
 ‫ﻋﻨﺪ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ داﺋﻤﺎ اﺳﺘﺨﺪم ﻛﻠﻤﺎت‬ ‫‪16‬‬
‫وﻋﺒﺎرات ﺗﺮاﻋﻲ اﻟﻘﺪرات اﻟﻌﻠﻤﯿﺔ ﻟﻠﻤﺮﯾﺾ‪.‬‬
‫ﻋﻨﺪ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ داﺋﻤﺎ اﻋﺘﻤﺪ‬ ‫‪17‬‬
‫ﻋﻠﻰ ﻣﺮﺟﻌﯿﺔ ﻋﻠﻤﯿﺔ ﻣﺆﻛﺪة وﻣﻌﺘﻤﺪة‪.‬‬
‫اﻋﺘﻘﺪ اﻧﮫ ﻣﻦ اﻟﻀﺮوري اﻋﺪاد دورات ﻟﺰﯾﺎدة اﻟﺨﺒﺮة‬ ‫‪18‬‬
‫اﻟﺘﻤﺮﯾﻀﯿﺔ ﻓﻲ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ‬
‫ﯾﻘﻮم ﺟﻤﯿﻊ اﻟﻤﻤﺮﺿﯿﻦ ﻓﻲ اﻟﻘﺴﻢ داﺋﻤﺎ ﺑﺘﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ‬ ‫‪19‬‬
‫اﻟﺼﺤﻲ ﻟﻠﻤﺮﺿﻰ ﺗﻠﻘﺎﺋﯿﺎ دون ان ﯾﺴﺄل اﻟﻤﺮﯾﺾ‬

‫اي ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﺎﻟﯿﺔ ﺗﻌﺒﺮه ﻋﺎﻣﻞ ﯾﺤﺪ ﻣﻦ اﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻌﻠﯿﻢ ﻟﻠﻤﺮﺿﻰ‬
‫اﻋﺎرض‬ ‫اﻋﺎرض‬ ‫اواﻓﻖ‬ ‫اواﻓﻖ‬ ‫اﻟﻌﺎﻣﻞ‬ ‫رﻗﻢ‬
‫ﺑﺸﺪة‬ ‫ﺑﺸﺪة‬
‫ﺿﻐﻂ اﻟﻌﻤﻞ‬ ‫‪1‬‬
‫ﻋﺪم اﻟﻤﻌﺮﻓﺔ ﺑﺎﻟﺘﻌﻠﯿﻤﺎت اﻟﻮاﺟﺐ اﺗﺒﺎﻋﮭﺎ‬ ‫‪2‬‬
‫ﻋﺪم ﺗﻌﺎون اﻟﻤﺮﯾﺾ‬ ‫‪3‬‬
‫ﻗﻠﺔ اﻟﻮﻗﺖ‬ ‫‪5‬‬
‫ﻋﺪم وﺟﻮد ﻗﻮاﻧﯿﻦ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ ﺗﺠﺒﺮ‬ ‫‪6‬‬
‫اﻟﻤﻤﺮض ﻋﻠﻰ ﺗﻘﺪﯾﻢ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ‬
‫ﻋﺪم وﺟﻮد ارﺷﺎدات ﺛﺎﺑﺘﺔ او ﻣﻄﺒﻮﻋﺔ ﻣﻦ‬ ‫‪7‬‬
‫ﻗﺒﻞ اﻟﻤﺴﺘﺸﻔﻰ ﺣﻮل اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ‬
‫ﻻ اﻣﻠﻚ ﻣﮭﺎرات ﻓﻲ اﻟﺘﻮاﺻﻞ ﻣﻊ اﻟﻤﺮﺿﻰ‬ ‫‪8‬‬
‫ﻻ اﻋﺘﺒﺮ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻟﻠﻤﺮﯾﺾ ﺟﺰء ﻣﻦ‬ ‫‪9‬‬
‫اﻟﺒﺮﻧﺎﻣﺞ اﻟﻌﻼﺟﻲ ﻟﻠﻤﺮﯾﺾ‬
‫ﻻ ﯾﻮﺟﺪ ﺣﻮاﻓﺰ ﻛﺎﻓﯿﺔ ﻣﻦ ﻗﺒﻞ اﻟﻤﺴﺘﺸﻔﻰ‬ ‫‪10‬‬
‫ﻋﻠﻰ ھﺬا اﻟﻤﺠﮭﻮد‬
‫ﻻ أﻋﺘﺒﺮ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ ﻣﻦ وﻇﺎﺋﻒ‬ ‫‪11‬‬
‫اﻟﺘﻤﺮﯾﺾ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ‬
‫ﻋﻮاﻣﻞ اﺧﺮى‪:‬‬
‫‪..........................................................................................................................‬‬
‫اي ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﺘﺎﻟﯿﺔ ﺗﻌﺒﺮه ﻋﺎﻣﻞ ﻣﺤﻔﺰاً ﻻﻋﻄﺎء ﻗﺪر ﻛﺎﻓﻲ ﻣﻦ اﻟﺘﻌﻠﯿﻢ ﻟﻤﺮﺿﻰ اﻟﻘﻠﺐ‬
‫اﻋﺎرض‬ ‫اﻋﺎرض‬ ‫اواﻓﻖ‬ ‫اواﻓﻖ‬ ‫اﻟﻌﺎﻣﻞ‬ ‫رﻗﻢ‬
‫ﺑﺸﺪة‬ ‫ﺑﺸﺪة‬
‫ﯾﻘﻮم رﺋﯿﺲ اﻟﻘﺴﻢ ﺑﻤﺘﺎﺑﻌﺔ اﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ‬ ‫‪1‬‬
‫وﯾﻌﺘﺒﺮه ﺟﺰء اﺳﺎﺳﻲ ﻣﻦ وﻇﯿﻔﺔ اﻟﻤﻤﺮض‬
‫ﯾﻮﺟﺪ ﻓﻲ اﻟﻘﺴﻢ ارﺷﺎدات ﻣﻄﺒﻮﻋﺔ ﻟﺘﺜﻘﯿﻒ‬ ‫‪2‬‬

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 ‫اﻟﻤﺮﺿﻰ‬
‫ﯾﻮﺟﺪ ﻓﻲ اﻟﻘﺴﻢ ﺣﻮاﻓﺰ اﺿﺎﻓﯿﺔ ﻟﻠﻤﺮﺿﯿﻦ‬ ‫‪3‬‬
‫اﻟﻤﻠﺘﺰﻣﯿﻦ ﺑﺎﻟﺘﺜﻘﯿﻒ اﻟﺼﺤﻲ‬
‫ﻋﻮاﻣﻞ اﺧﺮى‪:‬‬
‫‪..........................................................................................................................‬‬
‫‪..........................................................................................................................‬‬
‫‪..........................................................................................................................‬‬
‫‪........................‬‬
‫ﻣﻼﺣﻈﺎت اﺧﺮى ﺗﻮد اﺿﺎﻓﺘﮭﺎ ‪:‬‬
‫‪..........................................................................................................................‬‬
‫‪..........................................................................................................................‬‬
‫وﺷﻜﺮا ﺟﺰﯾﻼ ﻟﺘﻌﺎوﻧﻜﻢ‬

‫‪J 65 J‬‬
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