Effect of Teach-Back Instructional Sessions on Severity of Sheehan’s Syndrome Sequelae

Background: Sheehan's syndrome is a consequence of ischemic necrosis of pituitary gland following a significant intra and/or post-partum hemorrhage. It is a well-known cause of hypopituitarism and causes physical, psychological, and sexual problems. Aim: The aim of the current study was to examine the effect of teach-back instructional sessions on severity of Sheehan’s syndrome sequelae. Methods : A quasi-experimental design (one-group pretest-posttest) was employed. A purposive sample of 30 women was enrolled. Data were collected using five tools: Structured interviewing questionnaire schedule; The 6-item female sexual function index (FSFI-6); Hot Flushes Index (HFI); Hot Flash Related Daily Interference scale (HFRDIS); and perceived stress scale (PSS). Results : Regarding sexual function, the mean score of the total female sexual function was increased significantly from 12.2±3.29 at pre-intervention to 14.2±4.05 at post-intervention (p=0.002). Concerning the effect of hot flushes on daily living activities, there was a highly significant difference between pre-and post-intervention where the mean score was decreased from 60.3±12.8 at pre-intervention to 25.6±9.06 at post-intervention (p<0.001). In relation to stress level, 20.0% of women reported high stress level at pre-intervention which significantly decreased to 8.5% at post-intervention (p<0.001). Conclusion : Teach-back instructional sessions was effective in reducing the severity of Sheehan’s syndrome sequelae. Recommendation: Women with Sheehan’s syndrome should be equipped with adequate knowledge through teach-back instructional sessions to enhance their self-care efficacy and therefore, reduce their suffering


Aim of the study:
The current study aimed to examine the effect of teach-back instructional sessions on severity of Sheehan's syndrome sequelae

Operational definition
In this study, Sheehan's syndrome sequelae refer to sexual function, hot flushes, and stress level and were measured using the 6-item female sexual function index (FSFI-6); Hot Flushes Index (HFI); Hot Flash Related Daily Interference scale (HFRDIS); and perceived stress scale (PSS).

Main hypothesis
Women who receive teach-back instructional sessions experience less sever Sheehan's syndrome sequelae than before

Setting
The study was carried out at two health care

Sample size calculation
Based on data from earlier literature

Tools of data collection:
To collect data relevant to the current study,

Hot Flushes Index (HFI)
This instrument, which assesses the frequency and severity of hot flushes, was adopted from the Kupperman Index ( ranging from 0 (none) to 10 (extremely). The total score is than obtained by adding the scores of all items together, which ranges from 0 to 100. Higher scores indicate greater interference with daily activities. To obtain the average score for the week, the total score of each day is summing up and divided by seven. Then the average score is divided into three levels: mild interference (score 0-33), moderate interference (score 34-67), and severe interference (score 68-100).

1983)
PSS is a popular psychological tool for assessing how stressed a person is, which was first constructed question is rated using a 5-point Likert scale ranged from 0 ("never"); 1 ("almost never"); 2 ("sometimes"); 3 ("fairly often"); to 4 ("very often"). The over-all score of PSS ranging from 0 to 40. Higher PSS score indicate greater stress perceived by respondent. The over-all score was divided into three levels: low perceived stress (scores from 0 to 13), moderate perceived stress (scores from14 to 26), and high perceived stress (scores from 27 to 40).

Tools validity:
Five academic nursing experts in the field of midwifery and women's health were given the tools to test its face and content validity. The tools' contents were examined for completeness, relevance, and clarity. Based on the recommendations of the experts, the necessary modifications were carried out.  Evaluation: One month following the last instructional session, an evaluation of the three main outcomes; sexual function, hot flashes, and stress level was conducted. The three main outcomes were assessed using the data collection tools that were used for baseline data assessment.

Statistical Analysis
An IBM personal computer running the   18.50% at post-intervention and the difference between the levels of the total hot flash related daily interference was highly statistically significant (p<0.001) (Figure, 1).

Figure
(2) illustrates that, 27.0%, 53.0 %, 20.0% of women experienced low, moderate, and high stress level respectively at pre-intervention assessment compared to 67.0%, 24.5%, and 8.50% respectively at post-intervention evaluation. As well, the difference between stress levels at preintervention and post-intervention was highly statistically significant (p<0.001).

Conclusion
In conclusion, the findings of the current study declared that teach-back instructional sessions were effective in decreasing the severity of Sheehan's syndrome sequelae.

Recommendations
Based on the findings of the present study, the following recommendations are suggested: ▪ Teach-back instructional sessions should be conducted in order to empower women with Sheehan's syndrome sequelae to take an active role in self-care and therefore, reduce their suffering.