الفهرس 
Literature ReviewOnly 14 pages are availabe for public view
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Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by the production of autoantibodies, the formation of immune complexes, and immune dysregulation, resulting in damage of multiple organs, including the skin and the kidneys. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by immune cell abnormalities which lead to the production of autoantibodies and the deposition of immune complexes. The prognosis for SLE depends on the severity of the disease and the organs that are involved (Koga, et al., 2021).
There are 5 million people with systemic lupus erythematosus worldwide, 90% of whom are women between 15 and 44 years. Systemic lupus erythematosus is often more severe in people of African, Hispanic, Chinese, and Asian descent. The estimated number of SLE patients in Indonesia is between 200, 000 and 300, 000, with a male-female ratio of 1:9. The incidence of SLE is in the range of 0.001–0.01% and has a prevalence of 0.02–0.2% per 100, 000 per year (Kusnanto, et al., 2018).
Systemic lupus erythematosus is a chronic autoimmune disease that affects different body organs and causes extensive and serious complications that lead to damage to the connective tissues, blood vessels, and membranes. In addition to numerous clinical, psychosocial, social complications and economical disabilities (Mazhariazad, et al., 2020).
Assessing biopsychosocial needs of patients with SLE is very important; helping them cope with any problems and understand human health and illness. The assessment should be undertaken for the purpose of adapting the home environment to facilitate recovery and attention should be paid to the willingness and ability of familial and social networks to provide support during rehabilitation. The need for rehabilitation therapies and advice should be tailored to meet the needs of the individual patient (Chun, et al., 2019).
Aim of the study:
This study aimed to assess the biopsychosocial needs among patients with systemic lupus erythematosus through:
1. Assessment of physical needs among patients with systemic lupus erythematosus.
2. Assessment of psychological needs among patients with systemic lupus erythematosus.
3. Assessment of social needs among patients with systemic lupus erythematosus.
Research questions:
1. What are the physical needs among patients with systemic lupus erythematosus?
2. What are the psychological needs among patients with systemic lupus erythematosus?
3. What are the social needs among patients with systemic lupus erythematous?
Research design: A descriptive exploratory research design was utilized to achieve the aim of the present study.
Setting: The current study was carried out in special medicine department at EL Fayoum university hospital.
Subjects: A purposive sample of 90 adult patients with thalassemia was included in this study.
Tools for data collection:
Two tools was utilized in this study:
1-Interview questionnaire for patients with SLE:
This tool was developed by the researcher in an Arabic language based on the related literatures (Sullivan, 2016; Janice, et al., 2018; Fanouriakis etal 2019). It aimed to assess knowledge of patients suffering from systemic lupus erythematous. It consists of 56 questions in form of closed, open ended and multiple-choice questions, matching questions and true and false questions. The tool consisted of three parts:
Part I: Patients’ demographic data:
This part aimed to assess patients’ demographic data such as patients’ age, gender, marital status, number of family members, educational level, occupation, monthly income, residence and treatment costs. It contains nine questions in form of multiple-choice questions and closed ended questions.
Part II: Patients’ medical history:
This part aimed to assess patients’ medical history that includes information about present history, duration of the disease, past history, previous hospitalization and family history of systemic lupus erythematosus. It contains 14 questions in form of closed, open ended and multiple-choice questions.
Part III: Patients’ knowledge assessment regarding systemic lupus erythematosus:
This part aimed to assess patients’ knowledge regarding systemic lupus erythematosus. It consisted of 33 questions. It includes questions about definition and causes of systemic lupus erythematosus, signs and symptoms, diagnostic test, complications, treatment , diet, activity and life style and infection control measures.
2 - Biopsychosocial needs assessment tool:
This tool was designed to assess biopsychosocial needs of patients with systemic lupus erythematosus. It includes three categories of patients’ needs as follows:
A) Patients’ physical needs assessment
Part 1: Body system assessment:
This part was developed by the researcher to assess patients’ physical needs. It was written in an Arabic language. It was guided by (Dekker & Wiersinga, 2012). It includes systemic assessment of patient’s body systems which included respiratory system (4 items), cardiac system (4 items), nervous system (6 items), gastrointestinal system (7 items), musculoskeletal system (5 items), elimination (6 items), integumentary system (4 items), blood status (4 items), sleep and rest (4 items).
Part 2: Assess activities of daily living using the Barthel Index Scale:
This scale was used to assess the patient’s ability to perform activities of daily living independently. It was adopted from (Mahoneyand, & Barthel, 1965). It was translated into an Arabic language and back translated into English. It consists of 10- items (feeding, bathing, grooming, dressing, bowels (stool elimination), bladder (urination), toilet use, transferring, mobility and stairs climbing). The response for each question was by choosing the correct statement that correspond with the patient status and the ability to perform each activity.
B): Assess of psychological needs of patients with SLE using Depression, Anxiety Stress Scale (DASS):
This scale was used to assess negative emotional states (depression, anxiety, stress) of the patient’s with systemic lupus erythematosus. It was adopted from (Gomez, 2012). It was translated into an Arabic language and back translated into English. It consists of 42- statements.
C) Assess of social needs of patients with SLE using the Social Dysfunction Rating Scale:
This scale was used to measures the dysfunction aspects of social adjustment of the patients with systemic lupus erythematosus. It was adopted from (Linn, 1969). It was translated into an Arabic language and back translated into English. It consists of 21- items classified under three main categories which includes, self-confidence (4 items), interpersonal system (6 items) and performance system (11 items).
Results of the study:
This study revealed the following results:
- Regarding patient’s age, the result showed that the mean age of the studied patients was (35.2±10.8) years, and ranged from19-56 years old.
- In relation to gender, it was revealed that 88.9% of patients, were females and 11.1% were males.
- In relation to treatment cost coverage, 75.6% of patients are treated at expenses of the state.
- Concering history of present illness, the result demonstrated that 95.6% of patients were discoverd the disease through appearance of symptoms.
- Regarding past medical history, the result illustrated that 17.8% of patients had hypertension, 8.9% of them had allergy from dust and chemicals.
- As regard to past history of hospitalization, it was found that 68.9% of patients had previous history of hospitalization.
- As regard to family history, it was found that 15.6% of patients under study had a positive family history of systemic lupus erythematosus.
- Concering total score of patients’ knowledge, the results showed that 84.4% of patients had satisfactory level of knowledge regarding SLE, while 15.6% of patients had unsatisfactory level of knowledge.
- As regard to physical needs assessment, the current study illustrated that the higher mean score of patients’ physical needs was 12.5 ±1.6 for GIT system and the lowest scores was for respiratory and dermatological systems with mean score of (6.8±0.93) and (6.7±1.1) respectively.
- As regards to activities of daily living, the current study illustrated that 22.2% of patient’s had a moderate level of dependency, 20% showed a mild level of dependency during performance activities of daily living.
- In relation to psychological needs assessment, the current study illustrated that 48.8% of patients had extremely severe level of depression, 55.6% of patient had extremely severe level of anxiety and 33.3% suffer from extremely severe level stress.
- Concerning social needs assessment, the result of the current study showed hat 73.3% of patients under study had no social dysfunction, 11.1% showed a moderate level and 13.3% had a mild level of social dysfunction.
Conclusion
Based on the findings of this study it can be concluded that:
- The physical needs assessment illustrated that the GIT system assessment got the higher mean score among patients with SLE , followed by elimination needs.While the lowest mean score of physical needs among patients with SLE was concerned with integumantory and respiratory system.
- The activity of daily living assessment revealed that less than one quarter of patients had able to perform activity of daily living with mild and moderate dependency level respectively.
- The assessment of psychological needs showed that nearly half of patients under study had extremely severe depression and more than half of them had extremely severe anxiety. While one third of patients had extremely severe stress.
- The social needs assessment reported that there was approximately three quarters of patients under study had no social dysfunction. While, few of the studied patients had mild and moderate social dysfunction respectively.
- The present study showed that more than three quarter of patients had satisfactory level of knowledge regarding SLE.
Recommendations
Based on the findings of the present study, the following recommendations are suggested:
1. Regular follow up for all patients with SLE to evaluate their different health needs and to detect complications early.
2. Simple booklet written in an Arabic language should be developed for patients with SLE and includes all needed information.
3. Supportive care services in the hospital should be directed towards meeting all needs for patients with SLE.