Effectiveness of Audio-Visual Education on Physiological parameters among patients undergoing Coronary Angiography

 

G. Chitra¹, K. Kanchana², T. Nirmala³

¹M.Sc Nursing Student, College of Nursing, SRIPMS, Coimbatore.

²Associate Professor, College of Nursing, SRIPMS, Coimbatore.

³Principal, College of Nursing, SRIPMS, Coimbatore.

 

ABSTRACT:

Audio-visual education have a positive impact on stabilize the physiological parameters such as blood pressure and heart rate. The main aim of the study was to identify the effectiveness of audio-visual education on physiological parameters among patients undergoing coronary angiography. Quasi experimental posttest only control group design was adopted in the study. By using Non probability purposive sampling technique 60 study participants were selected and 30 were assigned to the experimental and control group respectively. The demographic variables, health history was collected from the patients undergoing coronary angiography. Audio- Visual Education was provided to the patients in the experimental group for 15 minutes. Routine nursing care was provided to patients in the control group. The vital signs 30 minutes before and after the intervention in both groups were measured. The experimental group showed a statistically significant decrease in the heart rate and blood pressure after the Audio-visual education compared to the control group (P < 0.05). Hence, it was concluded that using Audio-visual education before coronary angiography can effectively maximize the patients outcome. The results of this study confirms the usefulness of prior to an invasive coronary angiography procedure.

 

 

 

INTRODUCTION:

The human heart is the central organ of a body which consist of several functions for the entire body. It has the key role to maintain good health by supplying blood supply which enhances good vital oxyg life span. (AHA 2020)

 

Cardiovascular disease is the term for a variety of conditions that affect the heart and blood vessels. The most common form of heart disease is Coronary artery disease (CAD) caused by atherosclerosis (Lewis. 2007).

According to World Health Organization, Coronary artery disease affects 15.8 million individuals with CAD in 2018, which is to be expected to increase up to 23 million by 2030. It is a complex syndrome that is associated with profound disease morbidity and mortality which has an adverse impact of quality of life (Cowie, 2003).

 

Coronary angiography is the golden standard most widely used hemodynamic interventional and diagnostic technique performed worldwide more than 1,000,000 annually (22 June 2020). It is a procedure that uses contrast dye, usually containing iodine, x-ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup.

 

The patient with acute coronary syndrome has fluctuations in physiological parameters such as the heart rate, respiratory rate, blood pressure and oxygen saturation. (Atlanta, 2017). Anxiety is defined as the psychological opposite reaction of an individual to high inner energy caused by challenging situations (Kierkegaard, S. 2013). In fact it is emotional equivalent of a state of uncertainty. Individuals who experience this situation may feel restless, nervous, or anxious about what to happen next (Steffenino, G., 2007). High levels of anxiety and stress can cause change in cardiovascular function such as cardiac irritability, increased basal metabolic rate and increased blood pressure. Research studies on patients before angiography shows that more than 82% of patients who underwent coronary angiography are experiencing fear and anxiety that could change the physiological parameters stability. (Basar C., 2015) Audio- visual education is highly recommended instrument in angiogram day care unit among patients undergoing coronary angiography and it increases the level of satisfaction from the received information. (Balcı, A., 2013). Hence the researcher has chosen audio- visual education as one of the effective method on physiological parameters among patients undergoing coronary angiography.

 

REVIEW OF LITERATURE:

Gupta, A., et al., (2018) conducted a cross sectional study to assess the magnitude of CVD risk factors among adults in rural population. 5748 patients Simple random sampling technique The results showed that Physical inactivity, obesity, non-vegetarian diet, hypertension, and high low-density lipoproteins level were more prevalent among adults, and it was major risk factors for CVD.

 

Mercy George et al., (2019) conducted a quasi-experimental study to evaluate the effectiveness of video assisted interventional package for control of heart rate and blood pressure and anxiety among clients undergoing coronary angiography. The result showed that there was significant reduction in anxiety (p=0.001<0.05) and reduced heart rate, systolic and diastolic blood pressure among clients undergoing coronary angiography after video assisted interventional package.

 

Najafi Kalyani M et al., (2018) conducted a Quasi- experimental study to evaluate the effect of video information on the heart rate variability, blood pressure anxiety, stress and depression of patients undergoing coronary angiography. There was a statistically significant reduction in the anxiety, stress and depression levels of experimental group after video information (P= .000) among patients undergoing coronary angiography. Video information was found to be effective in reducing anxiety and diastolic blood pressure of clients undergoing coronary angiography.

 

STATEMENT OF THE PROBLEM:

Effectiveness of Audio-Visual Education on Physiological Parameters among Patients Undergoing Coronary Angiography at Selected Hospital, Coimbatore.

 

OBJECTIVES OF THE STUDY:

·       To assess the physiological parameters among patients undergoing coronary angiography.

·       To evaluate the effectiveness of Audio-Visual Education among patients undergoing coronary angiography.

·       To find out the association between physiological parameters with their selected variables among patients undergoing coronary angiography.

 

OPERATIONAL DEFINITION:

Effectiveness:

It refers to the changes produced by audio-visual education on physiological parameters among patients undergoing coronary angiography.

 

Audio-Visual Education:

It is a method of teaching by which information on coronary angiography is provided to the patients with the help of audio- visual education for about 15 minutes before coronary angiography.

 

Physiological parameters:

It refers to the heart rate and blood pressure. Blood pressure observed by sphygmomanometer.

 

Coronary Angiography:

Coronary angiography is a procedure used to detect an occlusion in the coronary arteries of the heart, by inserting a catheter into the coronary artery, either using femoral or radial approach in order to view the patency of blood flow through the heart.

 

HYPOTHESIS:

H1 - There is a significant difference in the level of heart rate and blood pressure before and after audio-visual education in the experimental group and control group.

H2 - There is a significant difference in the level of heart rate and blood pressure after audio-visual education between the experimental group and control group.

H3 - There is a significant association between the selected demographic variables and physiological parameters among patients undergoing coronary angiography.

 

ASSUMPTION:

Audio-visual education will maintain the optimal physiological parameters among patients undergoing coronary angiography.

 

METHODOLOGY:

Research approach:

Quantitative research approach.

 

Research design:

Quasi experimental pre test post test only control group design was adopted in this study.

 

Research setting:

The study was conducted in Angiogram daycare center, of Sri Ramakrishna hospital Coimbatore.

 

Population:

All patients undergoing coronary angiography.

 

Sampling technique:

Purposive sampling technique was adopted.

 

Sample size:

60 patients were selected for this study. Purposive sampling technique is used to select 60 participants. Participants for experimental group (30) and control group (30) were allotted on alternate days. Alternate days were chosen to avoid sample contamination and a feeling of dissatisfaction among the control group.

 

TOOL USED FOR DATA COLLECTION:

Section A: Demographic data:

A questionnaire was designed to collect the demographic variables related to age, gender, educational status, occupation, marital status, type of family.

 

Section B: Health history of the sample:

Health history of the sample consist of personal habits, dietary pattern, and history of comorbid illness.

Initial assessment consists of Heart rate (beats/min), and Blood pressure (mm of Hg).

 

DATA COLLECTION PROCEDURE:

The main study was initiated after the expert guidance and acceptance after the pilot study. The validated tool was used for data collection and the main study was conducted over a period of four weeks. The study was conducted at Angiogram daycare center of Sri Ramakrishna hospital, Coimbatore. Non randomized Quasi- experimental posttest only control group design was adopted. By using Purposive sampling technique 60 study participants were selected in alternative days based on inclusion and exclusion criteria, 30 in experimental and 30 in control group. Audi-visual education consist of the following aspects, anatomy and physiology of heart, meaning, risk factors, and pathophysiology of Coronary artery disease, coronary angiography procedure followed before, during and after, complications and lifestyle modifications following coronary angiography. The heart rate and blood pressure were assessed before audio-visual education. Audio- Visual Education was provided prior to the patients undergoing coronary angiography in the experimental group for 15 minutes and routine nursing care was provided to patients in the control group. After audio-visual education, the physiological parameters were assessed.

 

DATA ANALYSIS AND INTERPRETATION:

SECTION-I:

Table1: Demographic variables of the sample                         (n=60)

 

SECTION-II:

Health history of the sample:

Health history of the sample includes personal habits, dietary pattern, and history of comorbid illness. Results of the study shows that majority of them had habit of smoking and alcohol in both experimental group 12 (40%) and control group 9 (30%). Likewise in the diet pattern majority of them were consuming non-vegetarian in the experimental group 24 (80%) and control group 25 (83%). In view of comorbid illness majority patients had hypertension and diabetic mellitus in both experimental group 13 (43%) and control group 15 (50%).

 

 

Section III:

Table 2: Assessment of systolic blood pressure of patients undergoing coronary angiography in experimental and control group before and after intervention

Table 3: Assessment of diastolic blood pressure of patients undergoing coronary angiography in experimental and control group before and after intervention

 

Table 4:  Assessment of heart rate of patients undergoing coronary angiography in experimental and control group before and after intervention

 

The table 2. Shows that the systolic blood pressure of patients undergoing coronary angiography in experimental and control group before and after intervention. The level of systolic blood pressure before intervention in the experimental group, result reveals that 17(56.6%) patients had systolic blood pressure between 140- 159, 12(40%) patients had systolic blood pressure between 121-139, 1(3.3%) patients had systolic blood pressure between >160, and after intervention it was identified that 19(63.3%) patients had systolic blood pressure between 121-139, 7(23.3%) patients had systolic blood pressure between <120, 4(13.3%) patients had systolic blood pressure between 140-159.

 

The level of systolic blood pressure before intervention in the control group, result reveals that 21(70%) patients had systolic blood pressure between 140- 159, 7(23%) patients had systolic blood pressure between 121-139, 2(6.6%) patients had systolic blood pressure between > 160, whereas after intervention it was identified that 16 (53.3%) patients had systolic blood pressure between 121-139, 14(46.6%) patients had systolic blood pressure between 140-159.

 

The above table 3. shows that the diastolic blood pressure of patients undergoing coronary angiography in experimental and control group before and after intervention. The level of diastolic blood pressure before intervention in the experimental group, result reveals that 19(63.3%) patients had diastolic blood pressure between 81-90, 6(20%) patients had diastolic blood pressure between 91-100, 4(13.3%) patients had diastolic blood pressure between 60-70, 1(3.3%) patient had diastolic blood pressure between 71-80  and after intervention, it was identified that 14(46.6%) patients had diastolic blood pressure between 60-70, 8(26.6%) patients had diastolic blood pressure between 71-80, 8(26.6%) patients had diastolic blood pressure between 60-70.

 

The level of diastolic blood pressure before intervention in the control group, result reveals that 20(66.6%) patients had diastolic blood pressure between 81-90, 7 (23.3%) patients had diastolic blood pressure between 60-70, 6(20%) patients had diastolic blood pressure between 91-100, 3(10%) patients had diastolic blood pressure between 71-80 whereas after intervention it was identified that 16(53.3%) patients had diastolic blood pressure between 71-80, 11(36.6%) patients had diastolic blood pressure between 81-90, 3(10%) had diastolic blood pressure between 60-70.

 

The above table 4 shows that the heart rate of patients undergoing coronary angiography in experimental and control group before and after intervention. The level of heart rate before intervention in the experimental group, result reveals that 13(43%) patients had heart rate between 91-100, 9(30%) patients had heart rate between 8-90, 6(20%) patients had heart rate between 101-110 and 2(7%) patients had heart rate between 111-120 and after intervention it was identified that 19(67%) patients had heart rate between 80-90, 9(30%) patients had heart rate between 91-100, and 2(6%) patients had heart rate between 101-110.

The level of heart rate before intervention in the control group, result reveals that 12 (40%) patients had heart rate between 91-100, 8 (27%) patients had heart rate between 101-110, 7 (23%) patients had heart rate between 80-90, 3 (10%) patients had heart rate between 111-120 whereas after intervention it was identified that 19 (63%) patients had heart rate between 91-100, 6 (20%) patients had heart rate between 111-120 and 5 (17%) patients had heart rate between 101-110.

 

Effectiveness of audio-visual education on physiological parameters among patients undergoing coronary angiography in the experimental group before and after intervention.

 

Effectiveness of audio-visual education on physiological parameters among patients undergoing coronary angiography in the control group before and after intervention.

 

RESULTS AND DISCUSSION:

*Significant at 0.05 level

 

Unpaired ‘t’ test was used to compare the posttest level of heart rate among experimental and control group. It was identified that the mean level of heart rate among patients in experimental group and control group was 89.9 and 101.6 respectively with a mean difference of 11.7. Likewise the standard deviation of the experimental and control group was 7.92 and 8.86 respectively. The calculated ‘t’ value 5.40 was greater than the table value 2.57 at 0.05 level of significance. Hence the research hypothesis, H2: “There is a significant difference in the level of heart rate between experimental and control group among coronary angiography patients after audio-visual education” was accepted.

 

Unpaired ‘t’ test was used to compare the posttest level of systolic blood pressure among experimental and control group. It was identified that the mean level of systolic blood pressure among patients in experimental group and control group was 124.5 and 137 respectively with a mean difference of 12.5. Likewise the standard deviation of the experimental and control group was 14.5 and 10.39 respectively. The calculated ‘t’ value 3.54 was greater than the table value 2.57 at 0.05 level of significance. Hence the research hypothesis, H2: “There is a significant difference in the level of systolic blood pressure between experimental and control group among coronary angiography patients after audio-visual education” was accepted.

 

MAJOR FINDINDS:

·       Comparison between the heart rate of experimental and control group showed a significant difference after the audiovisual education the calculated ‘t’ value 5.40 at 0.05 level of significance.

·       Comparison between the systolic blood pressure of experimental and control group showed a significant difference after the audiovisual education the calculated  ‘t’ value 3.54 at 0.05 level of significance.

·       Comparison between the diastolic blood pressure of experimental and control group showed a significant difference after the audiovisual education the calculated ‘t’ value 3.96 at  0.05 level of significance.

·       However there was no association between physiological parameters and variables such as age (χ2=0.100), gender (χ2=0.232), educational status (χ2=0.201), occupational status (χ2= 0.617) marital status (χ2=0.734), type of family (χ2=0.3), personal habits (χ2=3.76), and dietary pattern (χ2=0.556).

 

CONCLUSION:

Cardiovascular diseases are main causes of death in developed countries, and their incidence has been increasing epidemically. The audio-visual (video) education about coronary angiography given before the procedure showed a positive effect on the physiological parameters after the procedure and it will help to achieve optimal results regarding heart rate and lowers blood pressure by stimulating cardiovascular reflexes. Hence, the researcher concludes that audiovisual education can be one of the methods to reduce physiological parameters among patients undergoing coronary angiography.

 

REFERENCES:

1.      American Heart Association, (2020). American Heart Association Recommendation of health facts retrieved from http://www.heart.og/en/health-topics/heart-importance on 29.12.2020

2.      Atlanta. (2017).  The heart disorders and diseases –Coronary artery disease. A Journal of the American College of Cardiology. 1975-2013

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7.      Kierkegaard, S. (2013). The concept of anxiety (pp. 1-6). Princeton University Press. https://doi.org/10.1515/9781400846979-002

8.      Lewis. (2007). Textbook of Medical Surgical Nursing. (6th edition), Mosby Publications.

9.      Najafi Kalyani M, Jamshidi N. (2010). Oral effects of video information on the heart rate variability, blood pressure anxiety, stress and depression of patients undergoing coronary angiography. European Journal of Cardiovascular Nursing, 25 (6): 901-905. http://doi.org/10.1016/S1474-5151 (10)60023-0.

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Received on 10.03.2022         Modified on 15.04.2022

Accepted on 05.05.2022       ©A&V Publications All right reserved