Self-management is a primary goal for multiple chronic diseases and particularly for Congestive Heart Failure (CHF). Currently, treatment for CHF emphasizes relieving symptoms through teaching patients how to better care for themselves. Patients who take an active role in self-care are more independent; feel more able to manage their disease and experience better psychological outcomes. However, the research focused on self care-management intervention in heart failure patients in Egypt is very inadequate. Thus, this study aims to first explore the self-care management learning needs among patients with CHF, then secondly assess the effects of a self-care-management tool on self-care adequacy and quality of life (QOL) among this group of patients and thirdly identify patient opinions regarding the instructional developed tool. The research design encompasses the two designs of descriptive and quasi-experimental pretest-posttest study. A convenient sample of 256 patients with congestive heart disease was employed for the survey group in the assessment phase of the study. From this sample, 30% were then randomly assigned to use the developed instructional tool as the experimental group. Two tools were used for data collection. The first was the Heart Failure Self-Care Management Questionnaire (HFSCMQ) which included two parts: the Self-Care Heart Failure Index which was developed by Riegel et al., in 2009, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) that was developed by Rector T, in 1986. The second tool was a patient feedback opinionnaire which was developed by the researchers to determine patient's feedback after using the developed tool. Results for the survey group revealed observed inadequate self-care management as perceived by patients with CHF involving self-care maintenance, self-care management and self-care confidence elements, as well as poor QOL detection. Results for the experimental group showed that the CHF patient's perceptions about self-care management with its components were improved before and after use of the developed instructional tool in the second and third assessments. As well, the QOL was slightly improved as perceived by them. This proves that the self-care management tool may be effective as a self-learning reference among Egyptian CHF patients. In conclusion, instructional health education materials, particularly for patients with chronic illnesses such as CHF, are essential nursing interventions to improve patient self-care management literacy and the QOL. Furthermore, the planning, developing, and implementing of different health instructional materials for patient teaching has become a necessary scheme for nurses to improve their practice in exploring innovative roles in the health education field and activate these roles in different health specialties.

Although nurses have accepted health education as an important role, they are not practicing it in a consistent and structured manner. Several factors have been proposed as an explanation for the discrepancy between expectation and practice of nurses in health education, with ineffective communication being the first. The nurse as a health educator should have appropriate interviewing and communication skills to convey health messages. Nurse should be able to communicate information that helps patients to discover: future or present health problems; more satisfying personal meaning; description about growth and development stages; how to accept or resolve conflict feeling, how to be more creative and become more oriented by self and circumstances. Therefore, this is an exploratory descriptive study, aimed at identifying the perception of patients on nurses' communication during health education. A convenient sample was obtained comprised of 238 patients in medical sections: 100 from Gamal Abd El Naser Hospital and 138 from El Amery University Hospital; both in Alexandria, Egypt. The Health Communication Feedback questionnaire (HCFQ) was used to collect the necessary data. The study revealed that patients at medical section who with chronic medical diseases; generally have a significantly positive perception regarding nurses' communication during health education. Such as: they detected some problems that nurses encountered in this communication; these problems may be in patient him/herself as 46.2% of subjects having pain and can't mutually interact with nurse in health education, or unable to understand nurse's information. In relation to the problems that detected in nurses as perceived by study subjects, lacking of nurse' time and limitation in communication skills. In health settings, the most apparent problems were insufficient facilities or materials for patient teaching and excessive interruptions and crowding. For the perceived problems in relation to health messages, about 45% of patients found jargons in nurses' health messages and 27% of them reported that messages were not attractive or interesting enough. Furthermore, results showed that there is no specific relation between the nature of patients' chronic disease and their perception regarding nurse communication during health education. Conclusion: This study highlighted the importance of patients' views for modifying and improving health professionals' performance, which are utilized to provide guidelines and directions to develop better nurses' communication outcomes in health education. Observing, examining and identifying these perceptions will provide recognition and vision for future effective nurse-patient interactions in the health education paradigm.

Health education is considered the backbone of health care management predominantly with diabetic patients. In order to minimize oral health problems within this group, especially those complaining of gingivitis, nurses must be well trained in assessing the educational needs of patients regarding their oral health status. Health education about oral hygiene with pharmacological and non pharmacological agents or herbal products is considered a total management in several cases. Green tea has several benefits for oral health. It limits enzymatic changes and acts as an antimicrobial, anti-inflammatory and deodorant agent. As an herbal product, green tea is accessible, effective and safe for diabetics with gingivitis. This is a quasi-experimental study aimed at determining the effect of health education about oral care with green tea powder on diabetics' oral health knowledge, skills and gingivitis' status. The study was conducted at the three medical sections of Gamal Abd El Nasser Hospital in Alexandria, Egypt. The sample was comprised of sixty adult diabetics who were selected by convenient sampling technique according to specific inclusion criteria. Patients were randomly divided into study and control groups, thirty in each. The Oral Health Education Assessment Questionnaire (OHEAQ) was used to determine the knowledge and skills of adult diabetics regarding oral health care and associated green tea benefits. The Gingival Evaluation Interview Sheet (GEIS) was used to assess gingivitis severity and its manifestations. Results revealed that there was a statistically significant difference between the study and control groups after the first and second assessments of educational intervention with green tea powder, in relation to perceived oral health care knowledge and practices with green tea, gingival inflammation severity scores, and gingivitis manifestation scores. All of these variables were improved in favor of the study group. In conclusion, oral health education with herbs and particularly green tea is an admirable nursing intervention to improve patients' oral health literacy and oral self-care practices for adult diabetic patients with gingivitis.

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