RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) / Ms. JEENA JOSEPHIST YEAR M.Sc. NURSING
NITTE USHA INSTITUTE OF NURSING SCIENCES, MANGALORE.
2. /
Name of the institution
/ NITTE USHA INSTITUTE OF NURSING SCIENCES, COLLEGE OF NURSINGPANEER, DERALAKATTE,
MANGALORE – 574 160
KARNATAKA, INDIA.
3. /
Course of study and subject
/ Ist YEAR M.Sc. NURSINGMEDICAL SURGICAL NURSING
4. / Date of admission / 02-06-2008
5. / Title of the topic
A STUDY ON EFFECTIVENESS OF VIDEOBASED INFORMATION IN REDUCTION OF ANXIETY AMONG CLIENTS UNDERGOING CORONARY ANGIOGRAPHY IN A SELECTED HOSPITAL AT MANGALORE.
6.
7. / BRIEF RESUME OF THE INTENDED WORK:
6.1Need for the study
At the threshold of the new millennium Coronary Artery Disease is looming largely as a new epidemic afflicting Indians at a relatively younger age with severe and diffuse forms of lesions.Coronary Artery Disease remains the leading cause of death in the world responsible for close to half a million deaths each year. According to the statistics compiled in the year 2007, an estimated 2 million cases were attributed to Coronary Artery Disease in the United Statesalone. Out of this nearly 2,15,000 die each year.1Going by the trends in the incidence of Cardiovascular diseases in India, the country is likely to have 100 million heart patients,ie nearly 60% of world’s heart patients by the year 2020,according to an observation made by Dr. Anil Kumar, President of the Cardiological Society of India. In India 90 people die of heart disease every hour and 10 -15% of adult Indian population suffers from coronary artery disease according to the statistical report compiled in September 20072.
Providing educational information to the patient prior to a surgical intervention may help
them to feel more in control and better prepared for their procedure and assist in achieving positive post-intervention outcomes. The pre-intervention period for the patient awaiting a cardiac procedure is undoubtedly one of the most traumatic stages of the patient’s hospital admission. Prior to the intervention many patients feel frightened and experience a great deal of stress and anxiety. Engel (1981) reported that death has occurred during cardiac catheterization due to extreme distress alone. It has been suggested that with the provision of pre-interventioneducation, the patient was better prepared for surgery and furthermore, aiding the recovery phase. Education for patients prior to invasive cardiac intervention can encompass a number of different approaches such as designated nurse educators, telephone intervention, education groups, audio-visual (video), information pamphlets, nurse initiated information delivered in an unstructured manner, or a combination of these methods.3
Coronary Angiography plays an essential role in the diagnostic evaluation of patients with suspected or known cardiac disease and it is an important pre operative protocol for vascular surgery patient’s.Coronary Angiography remains 100% effective in diagnosing the presence or absence of Coronary Artery Disease. Coronary Angiography is done in 30% to 81% of patients after acute myocardial infarction in different settings and regions. Therate of Angiography and Revascularization after myocardial infarction seems to be increasing in the elderly.5
Studies on psychological preparation have concluded that preparatory techniques,specifically, sensory-perceptual information and modeling are beneficial in reducing patient’s anxiety in various situations, including cardiac catheterization. Studies done in the Academyof Psychosomatic Medicine at Washington in the year 2003 revealed a high rate of depression among clients undergoing coronary angiography for Coronary Artery Disease. A study done by American Psychosomatic Society at Washington in the year 2002 on 198 stable clients with Coronary Artery Disease, after elective Angiography revealed minor depression in 27% of clients ,67% with moderate depression, and 12% with severe depression.4
The Department Of Cardiac Pathology at Paris, has conducted a study which was aimed to assess the added value of video information to the standard informed consent for 200 clients undergoing coronary angiography .The outcome of the study was that ,the patients who watched video were significantly less anxious after informed consent and had a significantly lower heart rate.4
Various studies revealed that psychological preparation is beneficial in reducing patient’s anxiety before a stressful experience such as coronary angiography. Keeping in view the needs and importance of educating the patients prior to a stressful procedure, theinvestigator felt that videobased information before coronary angiography canhave a positive impact on client’s emotional status and in reduction of anxiety experienced before the procedure.
6.2 Review of literature:
The following literatures were reviewed pertaining to the study by the Researcher.
Astudy was conducted by Nursing and Medical staffs of cardiac catheterization unit in Italy in the year 2003 on the effectiveness of videobased information for clients undergoing coronary angiography. The video based presentation was proposed to a sample of 108 patients, who had read the standard information sheet, before elective coronary angiography. Before and after watching the video Anxiety scores were assessed plus haemodynamic measurements of heart rate, systolic and diastolic BP obtained at baseline and immediately after written informed consent. Out of 108 patients 60 watched the video and 48 read only standard information sheet and were found to have high anxiety than those watched the video. Overall, the percentage of anxiety decreased from 79% to 37% after watching the video. The video had improved their knowledge and at the same time made them aware of the environment of the cathlab and technical aspects of the procedure. Those who watched the video were found to have less anxiety score and had a significantly lower heart rate. The client with higher anxiety levels benefited from video information.The study concludes that video based information is one of the effective strategy in reduction of anxiety for clients undergoing cardiac procedures.3
A study was conducted by The Department of CardiacPathology, inParisin the year 2000, which was aimed to assess the added value of video information to the standard informed consent process. Sample consisted of 200 patients undergoing coronary angiography. First 100 were assigned to conventional education conducted by the physician and the second 100 had consent obtained in the conventional manner assisted by video information. The outcome variables for this comparison consisted of a standard anxiety score( Spielberger Statement Anxiety Inventory Questionnary) plus haemodynamic measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent. Patients who watched were significantly less anxious after informed consent and had a significantly lower heart rate. The benefits of video information were especially prominent in those with higher anxiety score at baseline Tolerability were higher in the video group compared with no video group. Satisfaction of information for informed consent process was higher in video group compared with no video group. Video information decreased anxiety level after informed consent and improved satisfaction and tolerability in clients undergoing coronary angiography. To conclude video based information is most effective than common education.4
A study was conducted by Human Resources DepartmentinItalyin the year 2002, to evaluate the effectiveness of an informative video, devised for patients undergoing coronary angiography on reducing anxiety levels and satisfaction from the received information. The sample consisted of 93 clients. A two arm RCT design was chosen. The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications. The weighted mean difference between the anxiety levels of the treated and controlled groups was -8.24. The use of the informative video in Cardiology Departments proved to be highly recommended as an instrument to lower anxiety levels and increasedsignificantly the level of satisfaction derived from the received information. 3
A study was conducted in The Cardiac Rehabilitation Centre at Paris in the year 2003 to compare effectiveness of the preparatory informative (sensory and procedural data) and modeling strategies in reducing anxiety before cardiac catheterization.The 30 subjects who were participated for the study were given a combination of sensory-perceptual informational preparation and modeling preparation. A significant difference existed between the preintervention and post intervention anxiety scores. Therefore, this study validates the psychological and nursing literature that states psychologic preparation is beneficial in reducing patient’s anxiety before a stressful experience such as cardiac catheterization. The study findings also revealed an interesting trend for employing a modeling technique.4
A study was conducted in The Centenary Health Center Site and Cardiac Care Network of Ontario, Canada in the year 2004 on Anxiety and health-related quality of life in patients awaiting elective coronary angiography .The purpose of this study was to document the impact of waiting for first-time elective coronary angiography (CA) on patient’s anxiety and health-related quality of life (HRQL).Disease-specific HRQL was measured using the Seattle Angina Questionnaire at baseline (Time 1 [T1]) and 1 week before CA (Time 2 [T2]). The association between time on the waiting list and subjects' perceived anxiety was analyzed. Paired-sample t tests comparing mean anxiety levels at T1 and T2 indicated a statistically significant increase in anxiety levels at T2 that did not seem to be related to the waiting time for CA. Comparison of mean Seattle Angina Questionnaire scores at T1 and T2 indicated a trend toward deterioration in HRQL over time. Waiting for elective CA may have a negative impact on patient’s psychological status and HRQL. The study recommended nursing and clinical interventions to reduce anxiety and improve HRQL.4
6.3 Problem statementA STUDY ON EFFECTIVENESS OF VIDEOBASED INFORMATION IN REDUCTION OF ANXIETY AMONG CLIENTS UNDERGOING CORONARY ANGIOGRAPHY IN A SELECTED HOSPITAL AT MANGALORE.
6.4 Objectives of the study
To assess the anxiety level of clients undergoing coronary angiography.
To develop and validate video based information on coronary angiography.
To find out the effectiveness of video based information on anxiety level of clients undergoing Coronary Angiography in the experimental group.
To compare the anxiety level of clients undergoing coronary angiography between experimental and control group.
6.5Operational definitions
1. Effectiveness
In this study effectiveness refers to reduction in anxiety of clients undergoing coronary angiography following Videobased information.
- Videobased Information
- Anxiety
- Clients
5. Coronary Angiography
It refers to the fluoroscopic image of the coronary arteries following administration of radio opaque dye.7
6.6Assumptions
The study assumes that
- All clients who undergo Coronary Angiography experiences anxiety.
- A videobased information before Coronary Angiography is effective in reduction of anxiety.
- Delimitations
- Inpatients who are planned for Coronary Angiography
- Inpatients who are willing to participate for the study.
- Projected outcome (Hypothesis)
H2: There will be a significant difference between anxiety experienced by the experimental and control group.
MATERIALS AND METHOD:
7.1Source of Data:
The data will be collected from inpatients who are planned to undergo Coronary Angiography of a selected Hospital at Mangalore.
7.1.1Research design
True Experimental Design. Will be used.5
Test Area Time Period -1 Time Period -2
Level of anxiety before videobased Level of anxiety after
giving videobased information videobased information
information provided
Control Area
Levelof anxiety without Levelof anxiety without
Videobased information Videobased information
7.1.2Setting
This study will be conducted in a selected Hospital at Mangalore
7.1.2Population
In this study, population consists of clients who are planned for Coronary Angiography of a selected Hospital at Mangalore.
7.2METHOD OF DATA COLLECTION
7.2.1Sampling procedure
The subjects will be selected by usingPurposive Sampling method.
Simple Random Sampling method will be used to assign subjects for Control and Experimental group.
7.2.2Sampling size
The sample consists of 40subjects out of which, 20 subjects in experimental and 20 subjects in control group.
7.2.3Inclusion criteria for sampling
- Clients who are planned to undergo Coronary Angiography
- Clients who are able to follow Kannada and Malayalam
- Clients who are present during the study period
- Clients who are willing to participate for the study.
- Exclusion criteria for sampling
2.Clients who are unable to follow Kannada and Malayalam.
3.Clients who are unwilling to participate for the study.
7.2.5Instrument used
* Spielberger State Anxiety Inventory including Demographic Proforma
* Video based information on Coronary Angiography
7.2.6Data Collection method
The Researcher will obtain a written permission from the hospital authority and Informed consent will be taken from the samples prior to the study.
Purposive Sampling Method will be used to select 40 inpatients for the study. Simple Random Sampling will be used to select 20 subjects in both experimental and control group.
To the control group `Spielberger State Anxiety Inventory`will be administered to assess the anxiety level before undergoing Coronary Angiographyand to the Experimental group, anxiety levels will be assessed initially using Spielberger StateAnxiety Inventory. Followed by this Videobased information will be provided to the experimental group and routine care for the control group will be provided as per the hospital policy. After 2 hours the anxiety level is reassessed using the same scale both for the experimental and control group. Anxiety levels of both the Experimental and Control group will be analyzed, to determine the effectiveness of Videobased information.
7.2.7Data Analysis Plan
The data will be analyzed using descriptive and inferential statistics.
Data on anxiety levels will be analyzed by descriptive statistics (frequency,percentage, diagrams)
Anxiety levels of experimental and control group will be compared using Independent Sample T Test.
Effectiveness of Videobased information on anxiety level of clients will be analyzed using PairedT test.
7.3Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so describe briefly.
Yes. The study requires introduction ofvideobased information for clients planned for Coronary Angiography.
7.4Has the ethical clearance been obtained?
Ethical clearance isobtained.
LIST OF REFERENCES
- F Babbs C .Health Care Management Express. News Paper for the Health Care Business.Mumbai.2007October18;Sect.A:4(col.6).
- Catherine Tina. Cardiac Catheterization Angiography and Intervention. The Nursing Journal of India 2002June; 6: 132-3.
- Sabrina Paterniti. Coronary Artery Disease and Vascular Biology. American Heart Association 2001 March; 21:136. available from:URL: /1 access date -10/09/2008
- Ruffinengo C, Renga G. Effectiveness of an informative video on reducing anxiety levels Pub med discoverypanel.American Heart Association2006 July;13:122-24 .availablefrom :URL: angiogram.html access date -18/09/2008
- Eastwood JA, Doering L, Roper J, Uncertainty and health-related quality of life after coronary angiography. American Journal of Nursing critical care.2008 May 17(3):232-34.available from access date -18/09/2008
- Kothari R C .Research Methodology and Techniques .2ndedition. Newage International Publishers: New Delhi; 2003.
- Lewis SM ,Heitkemper MM,et al. Text Book of Medical Surgical Nursing .5th Edition.NewYork :Mosby publishers;2005
8. / Signature of the Candidate / JEENA JOSEPH
9. / Remarks of the Guide
10. / Name and Designation of :
(in block letters)
10.1 Guide / Mrs. MOLLY PINTO
PROFESSOR
MEDICAL SURGICAL NURSING
NITTE USHA INSTITUTE OF
NURSING SCIENCES,
MANGALORE.
10.2Signature
10.3 Co-guide (if any ) / Mrs. LATHA.S
LECTURER
MEDICAL SURGICAL NURSING
NITTE USHA INSTITUTE OF
NURSING SCIENCES,
MANGALORE.
10.3Signature
11. / 11.1 Head of Department
11.2Signature / Mrs. FATIMA D`SILVA
PROFESSOR AND HOD
DEPARTMENT OF MEDICAL
SURGICAL NURSING.
NITTE USHA INSTITUTE OF
NURSING SCIENCES,
MANGALORE.
12. / 12.1 Remarks of the Chairman and
Principal
12.2Signature
1