Abstract
Heart failure patients require comprehensive care that involves drugs controlling and intentensive. Health teaching about the significance of suitable nutrition, consistent exercise, symptoms control, and fluid checking. This study aimed to assess compliance to therapeutic regimen among elderly patients with heart failure in Assiut City hospitals. Subjects and method: Descriptive research design was conducted. The total sample size was 280 elderly patients by using software EPI /Info, version 3, 3 who were selected by quota from 3 outpatients in Assiut City. Two tools were used; first, structured interview questionnaire, and heart failure compliance questionnaire scale. Results: it was found 59.3% of elderly patients were male, with a mean age as 65.10 ± 6.12, 56.1% had poor knowledge scores, 66.8% were non-compliant with measuring weight and 58.9% and 53.9% respectively of them were non-compliant with avoiding drinking excessive fluid and following a low sodium diet. Also, illustrated significant relation among all items of compliance with patients' knowledge except compliance with medication. Conclusion: More than half of studied elderly patients had poor knowledge scores and this was correlated with non-compliance to therapeutic regimen among elderly patients. Recommendations: More studies should be implemented to assess patient's compliance and health education program for elderly about importance of compliance to therapeutic regimen.
Keywords: Therapeutic, Regimen, Compliance & Elderly Patients With Heart Failure.

Background: One in 10 elderly people worldwide have kidney disease, according to the first detailed global report on care delivery for kidney disease, family caregivers of hemodialysis patients experience high levels of burden. Aim of the study to assess family caregivers' burden of hemodialysis elderly patients Subjects and method: This study included 83 family caregivers were participated in the study. Descriptive research design carried out in the present study for hemodialysis patients' family caregivers within all hemodialysis units at Assiut city. Convenient sample are used in this study by total coverage technique. An interview questionnaire designed by the researchers after reviewed the related literature; it was structured into three parts: Part (1): Care givers personal data and properties, Part (2): Caregivers knowledge about CKD, Part (3):Zarit Sh Caregiver Burden Scale that used to assess caregivers' burden.. Results: Only 1.2% of caregivers had mild burden& 71.1%had severe burden. Conclusion: it is concluded that there was a high percent of studied caregivers had severe burden, also 38.6% of them had good knowledge. Recommendations: Involving family caregivers counseling and coping mechanisms regarding hemodialysis elderly patients to decrease burden's level.
Key words: Hemodialysis, Elderly, Family Caregivers & Burden.

Background: Organs and tissue perfusion are generally affected because of intraoperative, respiratory and cardiovascular frameworks after heart surgeries. Nursing activities has crucial benefits on hemodynamic and perfusion boundary. Aim: To determine the effects of planned exercise on tissue perfusion improvement post coronary artery bypass graft. A quasi-experimental design was used within the present study. Setting: The study was carried out at the cardiothoracic intensive care unit at Assiut University Hospital. Sample: A convenience sample of 60 patients with open heart surgery from both sex assigned into two equal groups (control and study groups) from age 18 years and above. Tools: Patients assessment sheet that include, part one is concerned with the patient’s basic health data and part two involved the hemodynamic indices and tissue perfusion parameters in preoperative and 1st, ,3rd and 5th days post-operative. Results: It was revealed that there was a statistically significant difference between the two groups after the surgery as regards to capillary refill on 3rd and 5th day(p=0.002) and also as regards to mean blood pressure on the 3rd day (p=0.017). Conclusion: exercise as a part of nursing intervention had a significant impact on tissue perfusion parameter of postoperative cardiac patients. Recommendation: planned exercises for postoperative cardiac patients should be offered on a regular basis.
Keywords: Cardiac patients, Exercise & Tissue perfusion.

Background: Most asthmatic patients use their inhalers incorrectly; As a result, they are more vulnerable to poor clinical control and exacerbation. The study aim: was to evaluate the effect of different nursing educational methods (video, educational booklet, both booklet & video) about correct use of inhaler devices on the clinical improvement for asthmatic patients. Methods: Design of the study: Quiz-experimental design. Setting: chest department and chest diseases outpatient clinics at Assiut University Hospitals Sample: 80 asthmatic patients were divided into four groups, 20 patients for each. Tools: Tool I: patient assessment sheet, Tool II: Global Initiative for Asthma scale (GINA), 2019, and Tool III: nursing educational methods. Results: According to the Global Initiative for Asthma scale, in excess of half of the patients (60.0 %) in the routine nursing instructions, booklet, and video groups had partially asthma control, while the majority of patients (80.0%) in the video and booklet groups had well asthma control. Conclusions: The group of patients who received the video and the booklet had a statistically significant effect on improving the level of asthma control. Recommendation: All asthma patients should be given written and visual information about how to use inhalers devices correctly to minimize the complications arising from the incorrect use of inhalers.
Keywords: Asthmatic patients, Clinical improvement, Inhaler devices & Nursing educational methods

Background: Chronic low back pain is a full disorder that considers an important health problem. Aim: To evaluate the effectiveness of structured teaching program on outcomes of chronic low back pain patients undergoing radiofrequency ablation. Methods: A quasi-experimental research design has been utilized. Setting: Anesthesia and pain management department at the main Assiut University Hospital. Sample: Sixty low back pain patients undergoing radiofrequency ablation. They were randomly assigned in two groups of 30 patients each. Tools:  three tools were utilized: Tool I: Structured interview patients' questionnaire. Tool II: Visual analogue pain scale and Tool III: "Modified Oswestry low back pain disability questionnaire" in addition, structured nursing teaching program. Results: More than half (53.3%) of the case group their age was from 18 to < 55 years, and the rest of them (46.7%) were older adults aged 55 years and more. 80% of the case group had good knowledge post implementation of the program. (100%) of the case group had worst pain intensity level which decrease to (46.7%) post program. 40% of case group had sever disability, which decreased to 30% post implementation of the program. there were significant relation between pain analogue scale and Oswestry low back pain disability scale in pre and post structured nursing teaching program regarding to occupation Conclusion: Structured nursing teaching program had an effective strategy to improve the patients’ outcomes through increasing patients' knowledge, and decreasing both pain intensity and physical disability in the case group versus the control group. Recommendation: Supervised structured teaching program should be carried out for all patients undergoing radiofrequency ablation about pre-and post-procedure instructions and helpful hints for a healthy back when standing, walking, sitting, sleeping, and lifting.

Key words: Chronic low back pain, Radiofrequency ablation, structured nursing teaching program.

Background Nowadays faculties of nursing and all higher educational institutions should develop and enhance their student's soft skills to be sure that its products meets or exceeds market requirements Aim: this study was conducted with the aim to determine the relationship between soft skills and academic achievement among 4th year nursing students. Subject and method: this study was conducted at Nursing Faculty Assiut University, about 170 students from the fourth year were examined using soft skill questionnaire and students achievement sheet. Results: The present study results revealed that; the majority of 4th year nursing students were female (79.4%), and (58.2%) of them are lived in urban areas, and they had satisfactory soft skills regarding truth with achieved point (81.7%), followed by emotional expression with achieved point (79.5%), and managerial skill with achieved point (76%). Conclusions: The present study concluded that there were positive correlation between 4th year nursing students' academic achievement in practical grades including (semester work and objective structure clinical exam "OSCE") and all soft skills dimensions. Meanwhile regarding students' academic achievement in theoretical grades including (written and oral exams) there were positive correlation with truth, team work, and leadership, also there were statistical significant difference between student's achievements in both practical grades and theoretical grades p. value <0.005. Recommendations: The findings of the present study recommended that; Encourage academic teaching staff at Nursing Faculty to enhance soft skills developments and measurements for both undergraduates and post graduates students, evaluate student's soft skill levels when interviewing them before admitting them to the faculty, and new researches should be done to test the effect of soft skills training program on nurses performance.
Key Words: Nursing, Students, Soft Skill, Academic Achievement.

Background: Anemia is common in older adults aged 65 years and older, associated with morbidity, mortality, and increases the risk for cognitive decline [1]. The aim of the study was to evaluate the association between anemia and risk factors for poor cognitive function in elderly patients. Patients and tools: This study included one hundred elderly patients at internal medicine department in Assiut University hospital, which chosen randomly for three months from the first of January 2018 to the end of March 2018. Each elderly patient were assessed through socio-demographic data, hemoglobin level, activities of daily living (ADL), Mini-Mental State Examination (MMSE), Body mass index (BMI) and Charlson Comorbidity Index (CCI). Results: Anemia was shown in 78 % of patients, in comparison to patients without anemia, anemic patients showed significantly poor MMSE score (19±3.4 vs. 24±2.5; p<0.001), high CCI (3.7±1.2 vs. 2.8±0.85; p=0.001) and associated with severe functional impairment (38.5%vs 13.8%; p<0.001). A significant negative correlation between MMSE scores with age (r= -0.357, p<0.001) and CCI (r= -0.508, p<0.001) were detected. Conclusion: Older age, low education level, anemia, and comorbidity are predictive for impaired cognitive function. Increased BMI and full daily activities are protective against cognitive function impairment. Recommendation: Health education program for elderly regarding the causes, risk factors and treatment of anemia.
Keywords: anemia; elderly, cognitive capacity; comorbidity; activities of daily living

Background: Social support provides the older adults with the opportunity to proper
physical function which help preserve their functional abilities. Aim: To examine the
relationship between social support of older adults with IADL and its associated factors as
personal characteristics and presence of comorbidities. Setting and Subjects: The study
conducted in the three geriatric clubs which present in Assiut City and outpatient clinics of chronic
diseases at the Main Assuit University Hospital, subjects of 178 older adults selected from the
previous areas (a convenient sample of 68 older adults from outpatient clinics and 110 from
the three geriatric clubs). Tools: Three tools were utilized for data collection: Tool I: Part
(I): personal data, Part (II): Social support scale, Tool (II): Charlson Comorbidity Index
(CCI) and Tool (III): The Lawton Instrumental Activities of Daily Living (IADL) Scale.
Results: half of the outpatient sample had moderate social support and the other half had
poor social support level, More than one quarter of both groups (29%) had moderate level of
comorbidity, some of geriatric clubs sample (5.5%) were dependent in IADL and that percent
raised to (20.6%) in outpatient clinics sample. Conclusion: Older adults who attended
geriatric clubs that they participate routinely in social contacts and activities had a strong
social support and decreased level of IADL dependency. Increased IADL dependency among
outpatient clinics sample. There was statistical significant correlation regarding social
support of both groups and IADL and with comorbidity level in geriatric clubs group.
Recommendation: Development of policies to address the point of social relations and
activities for older adults from formal, informal and institutional network.
Keywords: Social support, instrumental activities of daily living, comorbidity.

Background: The extreme heat can cause heat stress or heat stroke and poses dangerous
effects on the brain and can end in death among elderly. Aim: To implement nursing
intervention guidelines for the elderly's about protection from heat wave and evaluate its
effect on elderly knowledge. Subjects and method: Quasi experimental research design
was used. This study was conducted at chronic diseases outpatient clinics (diabetic clinic,
internal medicine clinics, chest and cardiology clinics,) at the main Assiut University
hospital. Results: Showed that (75.6%) and (78%) were illiterate and from rural areas
respectively, (92.1%) of them did not know the health hazards of heat wave on elderly's
health and (55%) of them did not know the measures to cool the body during heat stress
before application of nursing guidelines and these percent reached zero after
implementation of the nursing guidelines. Conclusion: There is improvement of the
elderly's knowledge about protection from heat wave after application of nursing
intervention guidelines regardless of the demographic data. Recommendation:
Publication and dissemination of counseling program in all rural health units and primary
health care centers to raise awareness of the elderly and their families regarding signs of
heat stress, measures of protection from heat wave, health hazards of heat wave among
elderly especially during summer months.

Background: Quality of life (QOL) is the over-all well-being of persons and societies, outlining negative
and positive structures of life. Heart failure is accompanied by bad quality of life, frequent entry to hospitals, high health costs and quick death. Study aim: Evaluate the quality of life for heart failure old age patients attending cardiac outpatient clinics in Assiut city Hospitals. Patients and methods: A descriptive research design was conducted. The total sample size was 280 old age patients who were taken by quota sample from 3 hospitals at Assiut City- Egypt. Two tools were used: the first tool was an interview questionnaire and the second tool were older people’s quality of life scale (OPQOL). Results: it was found that 59.3% of elderly patients were male with mean age ± SD was 65.10 ± 6.12, the highest mean scores were leisure and activities20.71±2.28, followed by social relationship, home and neighborhood, life overall, financial circumstance, psychological and emotional well-being and independence while the lowest mean scores were general health domains 8.36±2.07. Conclusion: Heart failure has a significant effect on the QOL of old age patients; poor QOL is associated with poor knowledge about disease of heart failure. Recommendations: Health educational programs for old age patients about how to improve QOL through maintain of optimal health, physical activity, healthy dietary habits, independency, stress management techniques, healthy sleep behavior, recreation, improve social relation, and life style.