الفهرس 
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Abstract
Diabetes mellitus is a public health problem and progressive disease accompanied by metabolic disorders and micro vascular complications such as retinopathy, neuropathy, and nephropathy. Diabetic retinopathy (DR) is considered one of the most common and severe complications of and a major cause of blindness worldwide. Also, it is associated with loss of productivity and quality of life (Bui, 2019). About 4.8% (1.8 million) of global blindness was due to DR. However, diabetic retinopathy (DR) affects 1 in 3 clients with diabetes and remains the principal reason for blindness in adults (Wong & Sabanayagam, 2020). Self –care practices are learned, purposeful, and continued behavior. So, the nurse should provide regular health education to DR patients to make them knowledgeable about the disease which aids them to modify their wrong self-care practices, cope with their health problems, improve their compliance with prescribed treatment, and consequently improve their life quality (Abid, 2022). Self-care practices of DR should focus on self- monitoring of glucose level in blood, regular health checkups, compliance with treatment regimen, proper intake of medications, performing eye care correctly, appropriate dietary intake, and regular physical activity (Shaban, 2018). Raising awareness about DR is an important element for early diagnosis and treatment of this blinding disease. To control or prevent vision loss, appropriate health education is necessary to encourage those at risk to seek timely and appropriate care. Also, this will require developing educational materials that are regionally and culturally appropriate with an understanding of the current knowledge, attitudes, and practices in the community.( Khalaf , 2019) Purpose of the Study This study aimed to examine the effectiveness of an educational intervention on self-care management of patients with diabetic retinopathy Study Setting The study was conducted in outpatient clinic of Kafr El-Sheikh New Ophthalmology Hospital, which is located in the capital city (Kafr El-Sheikh) of Kafr El-Sheikh Governorate that is located in the far north of Egypt, looking over the Mediterranean Sea Subjects: A convenience sample of 140 patients who attended the above-mentioned setting during the period of data collection (4 months), met the required inclusion criteria and agreed to participate in the study were recruited Inclusion criteria: The subjects were recruited based on the following criteria: - Both sexes. - Patients who are diagnosed with type 2 diabetes mellitus - Patients who are diagnosed with diabetic retinopathy at the first stage. - Patients who have no pathology diseases or chronic diseases in the eye. - Patients are not diagnosed with medical disorders that affect patient’s vision such as hypertension, hypo tension, and hepatic disorders to avoid any pathological changes. The final sample size was 140 participants as the sample size. Using confidence level with sample size of 137 participants. However, this number was approximated to 140 participants b Data Collection Instruments: In order to achieve the purpose of the study, the following instruments were used: Instrument1: A structured interviewing questionnaire: This questionnaire contained three parts, sociology demographic data, medical data about the patient and assessment of patient’s knowledge about diabetes and diabetic retinopathy Instrument two: Self-care practices and prognosis checklists This instrument was used to assess the reported self-care practices of patients and prognosis of the condition in pre and post-intervention phases, and at follow-up Scoring system The questionnaire contained, items related to the diabetic patients‟ sociology- demographic criteria, their medical history, as well as knowledge assessment items, each was three points Liker scale (0 – 2) as (0) for Don ‟t know/wrong answer (1) for incomplete correct answer, and (2) for complete correct answer. The patients „knowledge about diabetes and diabetic retinopathy were evaluated giving a score of The total score of each patient was categorized into “Poor Knowledge” when he/she achieved score of the total score, and those who had scor were considered as “Fair knowledge”, and those who had score were considered as “Good knowledge”. Concerning self-care practice for DR, practice assessment items, were used, each was four points Liker scale) as (0) for Don’t make, (1) for Rarely make, ( for make but irregular, and (3) for Regularly make. The patients „practice about diabetes and diabetic retinopathy were evaluated giving a score of The total score of each patient was categorized into “Unsafe pr.” when he/she achieved – 43 score of the total score, and those who had score were considered as “safe practice”. The nursing intervention: Nursing intervention plan was developed and implemented by the researcher to cases based on their knowledge about diabetes and diabetic retinopathy and self- care practices needs. To modify their knowledge and their incorrect practices Follow up phase A follow up was performed monthly for patients under study by telephone, and every 3 months in the outpatient clinic of Kafr El-Sheikh New Ophthalmology Hospital. In the follow up phase, the researcher could be informed by the effect of the nursing intervention for modifying the incorrect or incomplete practices. In addition, to assess the change of knowledge and answer any question raised by the patients. Evaluation phase: After implementation of the designed nursing intervention the researcher collect post intervention data by using the previous mentioned tools after one year and compared the result of pre and post-test to assess the effect of nursing intervention The study revealed the following main finding sAccording to patient‟s age, the study revealed that the prevalence of DR was in patients aged between while more than one third of patients aged years (38.6%). • According to the patient’s gender, the study revealed that Approximately 65% of patients are females (63.6%) • According to residence, the study revealed that more than half of the studied patients (60%) are from rural areas while 40% from urban. • Concerning the level of patient’s education, the study revealed that % of patients had intermediate education, while them are illiterate, 6.4% of them had Primary education and them are highly educated. • Regarding to patient’s occupation, the study revealed that, slightly more than half (50.7%) of the patient’s had being employees. • Concerning smoking status, study revealed that, less than one fifth of patients are smokers (17.1%). • Regard to marital status study revealed that, only 6% are single and 67.9% are married, while 27.9% of them are widowed or divorced. • The study revealed that, approximately three quarters of studied patients (74.3%) have family history of diabetes mellitus. • Regarding to patient’s knowledge about diabetes mellitus pre-intervention, this study reported that, majority of patients showed either poor or incomplete knowledge which ranged from 0 % to 91.4% & 0 and 95.7% respectively. While unfortunately the correct and complete response was the lowest percentage which ranged from 0 to 29.3% The mean patient‟s total diabetes knowledge score was 10.2 ± 4.1. • Regarding to patient’s knowledge about diabetic retinopathy pre- intervention this study reported that, majority of patients showed either poor or incomplete knowledge which ranged from 42.9 % to 95.7 % & 4.3% to 57.1% respectively. While unfortunately, the correct and complete response was the lowest percentage which ranged from 0 to 7.9. %. The mean patients total diabetic retinopathy knowledge score was 8.2 ± 3.1. • The study revealed the efficacy of the educational intervention for the knowledge of patients with diabetic retinopathy. Post educational intervention revealed a highly significant improvement in the different categories of total knowledge about and DR. The post intervention good knowledge responses increased from zero% pre-intervention to 94.3% for post intervention. In addition, the mean total knowledge score among studied patients, increases from 13.2±3.6 pre intervention to 48.5±7.1post intervention and this difference was highly significant statistically. This result approved the first hypothesis of current study which stated” The patients with diabetic retinopathy will have improvement in their awareness and knowledge about diabetes mellitus and diabetic retinopathy after the educational intervention more than before the educational intervention • The study revealed the efficacy of the educational intervention program for the practice of patients. Post intervention revealed a highly significant improvement in the different categories of total practice about self-care practice for diabetic retinopathy. The post intervention safe practice responses increased from zero% pre-intervention to> 90% for post intervention. In addition, the mean total practice score among patients, increases from 31.1 ± 5.2 pre intervention to 76.6 ± 0.9 postint ervention and this difference is highly significant statistically. This result approved the second hypothesis of current study which stated ”The patients will have improvement in all aspects of self-care management skills after the educational intervention more than before the educational intervention”. The study revealed the efficacy of the educational intervention on blood glucose levels, BP, and eye investigation. Concerning Blood glucose levels, the post intervention good control increased from12.9 pre intervention to 87.1% post intervention and the difference is highly significant statistically . Concerning controlling of BP there is post intervention good control of BP as 99.3% of patients still normotensive (Good Control). Concerning eye investigation there is post intervention stability of ocular status as 99.3% of the patients still stable (First stage DR) and had no deterioration to any stage as the diabetic retinopathy is a progressive disorder. This study concluded that: In the light of the present study finding, it can be concluded that the implementation of the educational intervention for patients with diabetic retinopathy, emphasizing the importance and the proper technique of the deferent aspects of self- care practices lead to improvement of their knowledge and their reported self-care practices. The educational intervention for patients with diabetic retinopathy was an effective method for improvement of their knowledge and practices, and subsequently lead to high rates of good control of blood glucose levels and high stability of both, blood pressure and quality of vision of the patients The study recommended that: • Enhance health education of patients with diabetic retinopathy and their caregivers about proper self-care practices of diabetic retinopathy to reduce the risks and its subsequent complications as loss of vision Follow up program of patients with diabetic retinopathy should be applied and organized at the hospitals, for the proper management application, educating patients and caregiver the proper self-care practices, prognosis of patients with diabetic retinopathy Further researches will be needed for training nurses especially the new nurses, about the proper self-care of patients with diabetic retinopathy.