Effect of Pre-procedural Teaching on level of knowledge and Anxiety among patients undergoing Cardiac Catheterization

 

Ms. Rincy P R¹, Dr. Angela Gnanadurai², Rev. Dr. Sr. Philoresmi³

¹MSc (N), Lecturer, Jubilee Mission College of Nursing, Thrissur.

²Proffesor cum Principal, Jubilee Mission College of Nursing, Thrissur,

³Professor cum Vice Principal, Jubilee Mission College of Nursing, Thrissur

 

ABSTRACT:

The present study was aimed at evaluating the effect of pre-procedural teaching on level of knowledge and anxiety among patients undergoing cardiac catheterization. Objectives: Assess the level of knowledge and anxiety, compare the knowledge and anxiety score, correlate the post-test knowledge and anxiety score and associate the pre-test level of knowledge and anxiety with selected socio- demographic and clinical variables among patients undergoing cardiac catheterization in interventional and control group. Methodology: True experimental pre-test post-test control group design was used with a sample size of 60 selected by random sampling method. Study was conducted in the cardiology wards of JMMCH and RI. The tools used were structured knowledge questionnaire and Zung’s modified self rating anxiety scale. Pre-test was conducted on the admission day for both groups followed by teaching on cardiac catheterization for patients in interventional group. Post-test was conducted for both groups 2hrs before cardiac catheterization. The study was based on Peplau’s theory of interpersonal relationship. Results and interpretation: There was highly significant difference in post-test knowledge and anxiety score between patients in interventional and control group at p <0.001.A significant negative correlation was found between post-test knowledge and anxiety score with correlation coefficient (r = -0.42) in both groups. A significant association was found between educational qualification (p=0.02) and occupation (p=0.000) with pre-test level of knowledge. A significant association was found between age (p=0.04) and previous knowledge on cardiac catheterization (p=0.02) with pre-test level of anxiety. Conclusion: Providing the patients with appropriate information will diminish their anxiety level and promote their knowledge.

 

 

 

 

 

 

INTRODUCTION:

Coronary artery disease has been defined as “impairment of heart function due to inadequate blood flow to the heart compared to its needs, caused by obstructive changes in the coronary circulation to the heart”.

                                                                                   (Park K)¹

 

Cardiovascular Diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.5 million people died from CVDs in 2012, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke.² According to Heart Disease and Stroke Statistics — 2015 Update, the number is expected to rise to more than 23.6 million by 2030.³

 

Among the cardiovascular diseases, coronary artery disease ranks number one, leading to mortality, morbidity and disability.⁴ In order to manage this dreadful disease, many newer diagnostic and therapeutic measures have been developed, one of such important measure is coronary angiogram. Coronary angiogram is the most common diagnostic procedure in cardiac catheterization.

 

In the current scenario, the significance of interventional cardiology is well understood. Cardiac catheterization is currently the "gold standard" for determining the presence of obstructive coronary artery disease. With more and more people requiring cardiac catheterization, meeting the educational needs of the patients becomes a major challenge.⁵

 

A great benefit of educating patients undergoing invasive procedures is obviously the reduction in anxiety levels and adoption of better coping strategies by the patients. Any invasive procedure is a major stressor for a person, and more so, with an invasive procedure directly involving the heart. Several researchers recommend the development of non-pharmacological interventions to reduce patients anxiety prior to and after cardiac catheterization procedures.

 

Interventions that provide sensory and procedural information as well as answer patients questions have led to decreased pre-procedural anxiety,^6,7 though general social support interventions (talking about patient’s life, interests, or any other topic desired and answering questions) may also help to decrease pre-procedural anxiety.

 

OBJECTIVES OF THE STUDY:

·       Assess the level of knowledge and anxiety among patients undergoing cardiac catheterization in interventional and control group

·       Compare the knowledge and anxiety score among patients undergoing cardiac catheterization in interventional and control group

·       Correlate the post-test knowledge and anxiety score among patients undergoing cardiac catheterization in interventional and control group

·       Associate the pre-test level of knowledge and anxiety among patients undergoing cardiac catheterization with selected socio- demographic and clinical data variables in interventional and control group.

 

MATERIALS AND METHODS:

The present study was conducted at selected cardiology wards of Jubilee Mission Medical College Hospital, Thrissur. Target population for the present study comprised of patients posted for elective cardiac catheterization. The sample size was 60 (30 in interventional and 30 in control group) were selected by simple random sampling method. The study was carried out in the month of January and February 2015.

 

Data collection tools were structured knowledge questionnaire and Zung’s modified self rating anxiety scale to assess the knowledge and anxiety level among patients undergoing cardiac catheterization.

 

Section A: Socio-demographic variables include age in years, sex, educational qualification, occupation, marital status and monthly income

 

The clinical variables include history of coronary artery disease, history of hospital admission, history of surgical experience, presence of co-morbid diseases and previous knowledge on cardiac catheterization

 

Section B:

Part 1- structured knowledge questionnaire:

A self administered structured knowledge questionnaire was developed which consists of 30 questions with 4 choices to assess the patient’s knowledge on cardiac catheterization procedure and care. The questions were organized under 3 domains. General awareness on coronary artery disease and cardiac catheterization, Pre proceduraland intra procedural knowledge, Post procedural knowledge

 

Part 2- Zung’s modified self rating anxiety scale:

A four point self rating anxiety scale with 30 items with four rating like normal, mild, moderate and severe level of anxiety was used. The scale consists of 24 positive items and 6 negative items which were scored separately.

 

The tool was validated by 5 experts, of which 3 experts were from the field of medical surgical nursing and 2 were from medical field. The reliability of the tools was established by cronbach’s alpha method with a reliability score (r) of 0.80 and 0.81 for structured knowledge questionnaire and anxiety scale respectively.

 

Pilot study was conducted which did not indicate any major flaws in the feasibility and design of the study.

 

Data was collected from cardiology wards of JMMCH and RI, Thrissur. The data collection was carried after obtaining written permission from the hospital authorities for duration of four weeks from 27-01-15 to 21-02-15. Samples were selected using simple random sampling and were grouped into interventional group and control group by lottery method.

 

Day 1:

Pre-test was conducted on the admission day using self administered knowledge questionnaire and self rating anxiety scale on cardiac catheterization among patient in both interventional group and control group. The average time taken by each patient to complete the knowledge questionnaire and self rating anxiety scale was 30 minutes. Investigator assured the confidentiality of data provided by the patient. Pre-procedural teaching on cardiac catheterization was provided to patients in interventional group for an average duration of 30 minutes on individual basis along with distribution of pamphlet and routine care for control group as per hospital policy.

 

Day 2:

Post-test was done 2 hours before sending the patient to cardiac catheterization procedure using the same structured knowledge questionnaire and self rating anxiety scale among patient in both interventional group and control group. After post-test, pamphlet on cardiac the catheterization was provided to patients in control group.

 

Data was analyzed using descriptive and inferential statistics. Frequency and percentage, paired t test, independent t test, coefficient of correlation, chi-squire were used to infer the collection of data.

 

RESULTS:

Total 60 patients were enrolled in the study. 11 (36.7%) in interventional group belongs to age group of 41-50 years and 13(43.3%) in control group belongs to 51-60 years. Male and female ratio was equal in interventional group and more than half of the patient 21(70%) in control group were females. In interventional group 14 (46.6%) and in control group 11(36.7%) patients were having primary education. Nearly half of the patient 15 (50%) in interventional group and 16(53.3%) in control group were unemployed. More than half of the patient, 25 (83.3%) in interventional group and 16(53.3%) in control group had no previous knowledge on cardiac catheterization.

 

 

Comparison of knowledge and anxiety score on cardiac catheterization between patients in interventional and control group.

Table 1: Mean, standard deviation, standard error and t value of pre and post-test knowledge and anxiety score on cardiac catheterization among patients in interventional and control group  (n=60)

Variable		Group	Mean	SD	SE	df	t value	p value
Level of knowledge	Pre-test	Interventional group	11.33	2.49	0.46	58	1.64	0.11
		Control group	12.73	3.97	0.72
	Post-test	Interventional group	24.37	1.85	0.34	58	13.69	0.000***
		Control group	13.80	3.80	0.69
Level of anxiety	Pre-test	Interventional group	60.83	7.98	1.46	58	0.24	0.24
		Control group	58.10	9.73	1.78
	Post-test	Interventional group	57.90	6.84	1.25	58	3.84	0.000***
		Control group	64.20	5.83	1.06

(t₅₈=2.92, p< 0.05 level) ^*** Highly significant at p< 0.001 level

 

Table 2 Correlation between post test knowledge and anxiety score among patients in interventional and control group.                (n=60)

Group	Variable	Maximum score	Mean	SD	Correlation coefficient	p value
Interventional group	Level of knowledge	30	24.37	1.85	-0.42	0.02*
	Level of anxiety	120	57.90	6.84
Control group	Level of knowledge	30	13.80	3.80	-0.42	0.02*
	Level of anxiety	120	64.20	5.83

^* Significant at p < 0.05 level

 

 

Table 1 reveals that, the mean post-test knowledge score on cardiac catheterization among interventional and control group is (24.37±1.85) and (13.8±3.8) respectively. The calculated independent t value (13.69) is greater than the table value (t₅₈=2.92 at p< 0.05 level). Similarly the mean post-test anxiety score is (57.90±6.84) and (64.2±5.83) in interventional and control group respectively. The calculated independent t value (3.84) is greater than the table value (t₅₈=2.92 p< 0.05 level). It shows that, there is significant difference in post-test knowledge and anxiety score on cardiac catheterization among patient in interventional and control group. It means that pre-procedural teaching on cardiac catheterization improves the knowledge and reduces the anxiety among patients.

 

Table 2 shows that, there is significant negative correlation between post-test knowledge and anxiety score on cardiac catheterization with correlation coefficient r = -0.42 in interventional group. It means that when knowledge increases, anxiety decreases. In control group also, a significant negative correlation was found between post-test knowledge and anxiety score on cardiac catheterization with correlation coefficient          r = -0.42. It means that when knowledge decreases, anxiety increases.

 

A statistically significant association was found between educational qualification and pre-test level of knowledge on cardiac catheterization at p<0.05 level in both interventional and control group.

 

DISCUSSION:

In present study, it is evident that, Mean post-test knowledge score on cardiac catheterization among interventional and control group is (24.37) and (13.8) respectively. Similarly the mean post-test anxiety score is 57.90 and 64.2 in interventional and control group respectively. The independent t value showed, there is significant difference in post-test knowledge and anxiety score between interventional and control group at p<0.05 level. Similar findings was seen in a randomized experimental design by Chan DS et al to examine the effects of patient education on anxiety among Chinese patients with heart disease undergoing cardiac catheterization with a sample size of 62. The result revealed that, a lower level of anxiety was experienced by the experimental subjects who received the education intervention when compared with the control subjects who did not receive the education intervention before cardiac catheterization.

 

Findings further showed, there is significant negative correlation between post-test knowledge and anxiety score on cardiac catheterization with correlation coefficient r = -0.42 in interventional group. It means that when knowledge increases, anxiety decreases. In control group also, a significant negative correlation was found between post-test knowledge and anxiety score on cardiac catheterization with correlation coefficient r = -0.42. It means that when knowledge decreases, anxiety increases.

 

It is consistent with a semi experimental one-group study was conducted by Ganji T ^{et al} to know effect of teaching on the level of anxiety and knowledge of patients before cardiac catheterization. The sample size was 70 adult patients. Findings showed that a significant relation between anxiety and knowledge level of the sample group before and after teaching (P<0.001) and also found that reduction of anxiety is related to patients high knowledge level (P<0.001, r= 0/395)

 

ACKNOWLEDGEMENT:

At very outset, I would like to thank almighty for his presence. My sincere thanks go to all participants of my study. Lastly and most importantly I am grateful to everybody who has important to successful realization of thesis.

 

ETHICAL CONSIDERATION:

Ethical approval to conduct the study was obtained from institutional ethical committee of Jubilee Mission Medical College Hospital, Thrissur. Written consent was obtained from the study subjects regarding their willingness to participate in the research project.

 

FUNDING SOURCE:

Self financed.

 

REFERENCES:

1.      Park K. Park’s textbook of preventive and social medicine.23^rd ed. Jabalpur: Bhanot; 2015.

2.      WHO. Cardiovascular diseases. [Homepage on internet] [Cited at 2014 MAR 5]. Available from: http://www.who.int/mediacentre/factsheets/fs317/en.

3.      American Heart Association. American Heart Association statistical report tracks global figures for first time. [Homepage on internet] [cited 2014 MAR 12]. Available from: http://blog.heart.org/ American- heart –association- statistical- report- tracks-global figures- for first- time/.

4.      Lewis SL^{et al}. Medical Surgical Nursing: Assessment and management of clinical problem. 7^th Ed. Philadelphia: Mosby; 2007.

5.      Baim DS. Grossman’s Cardiac Catheterization, Angiography and Intervention. 7^th ed. New Delhi: Lippincott; 2005.

6.      Gallagher R^{et al}. Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions. Eur J Cardiovasc Nurs.[Internet] 2010 Mar [cited 2015 Feb 10]; 9(1): [about 6 pages].Available from: http://www.ncbi.nlm.nih.gov/pubmed/19846343.

7.      Moline LR. Patient psychologic preparation for invasive procedures: An integrative review. J Vasc Nurs [Internet] 2000 Dec [cited 2014 Nov 3]; 18(4):[about 5 pages].Available from: http://www.ncbi.nlm.nih.gov/pubmed/11995292.

 

 

 

 

 

 

Received on 31.01.2019         Modified on 21.03.2019

Accepted on 30.04.2019       ©A&V Publications All right reserved