RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE-
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. / Name of the candidate and address (in Block letters) / MR. PRINCE MATHEW PHILIP1 YEAR M.SC. NURSING
SHREE DEVI COLLEGE OF NURSING, MAINA TOWERS, BALLALBAGH MANGALORE -575003.
2. / Name of institution / SHREE DEVI COLLEGE OF NURSING, BALLALBAGH,
MANGALORE.
3. / Course of study and subject / M.Sc. NURSING
MEDICAL – SURGICAL NURSING
4. / Date of admission to course / 15.11.2008
5. / TITLE OF THE TOPIC:
“A STUDY to assess the effectiveness of individual planned teaching programme regarding modifiable risk factors of coronary artery disease among patients who have undergone percutaneous coronary interventions in A selected hospital at Mangalore”.
6. / Brief Resume of the Intended Work
6.1 Need for the study:
Coronary artery disease is the most common cardiovascular disorder in adults It is an accepted fact that the incidence of CAD has reached endemic proportions in many countries. CABG, PTCA & insertion of stent are major therapeutic approaches to the treatment of CAD but in themselves do nothing to correct the underlying disease process. A careful CAD risk profile assessment and lifestyle adaptation of the modifiable risk factors should always accompany such dramatic and expensive interventions.1
The high risk and wide prevalence of CAD among the general Indian Population is well established. CAD remains the highest cause of mortality in India and the majority of cases are due to risk factors that include hypertension, smoking,DM and elevated serum cholesterol level. The gravity of this situation is emphasized by a recent projection from the WHO and the Indian Council of Medical Research (ICMR) which predicts that India will be the MI capital of the world by 2020.2
A study was conducted to assess the prevalence of cardio vascular risk factors in patients with CAD in India. They enrolled 1000 consecutive patients who were undergoing CABG in Escorts heart institute between June 2004 – Sep 2004. 1.8% patients has all the five major modifiable risk factors 11.6% patients had four risk factors. 33.6% had three and 32.4% had two 16.2% patients had one risk factor. Only 4.4% patients were free of all five major risk factors. 3
A descriptive survey was conducted to explore self report changes in coronary risk factors among 234 patients following coronary artery angioplasty. Patients were self selected from a convenience sample of all patients undergoing angioplasty. Forty percentage of subjects reported the recurrence of chest pain and eighty five percentage of respondents reported making at least one modification to their risk factors and stress was the most common risk factors identified. Diet modification, increased exercise and stress reduction were the top three changes in life style reported. The findings suggest, there is a major need for better health education and follow up for patients after coronary artery angioplasty. 4
From the above studies it is clear that there is a urgent need to educate the patients with CAD. Educational interventions can be effectively targeted and implemented as primary and secondary prevention strategies to reduce the burden of CAD. Hence the investigator planned to conduct teaching program on modifiable risk factors of CAD among the patients who have undergone percutaneous coronary intervention.
6.2 Review of literature
A study was conducted to identify the patients view, as their learning needs when undergoing PTCA and to compare the patients view to the perception of cardiac nurses about the learning needs of PTCA. Two hundred and fifty one patients and thirty three nurses completed PTCA learning needs inventory. The items were mainly on result of angioplasty and life style change needs to prevent future build up in artery. Both the patients and nurses scored all items “Moderately” to “very important” to learn. 5
A study was conducted to determine the effectiveness of a comprehensive life style intervention programme among patients with coronary heart disease. A total 19% patients with proven coronary heart disease were included and randomized for the programmme. Patients in the lifestyle intervention group reduced the intake of saturated fat, sugar and cholesterol (p<0.001) increased their exercise level (p<0.01 ) and stopped smoking (p<0.05) when compared with the usual care group. The study result suggests that secondary cardiovascular disease prevention is possible through a favourable diet, exercise and smoking cessation.6
A study was conducted to examine the ability of a secondary preventions programme to improve the life style in myocardial infarction patients aged 50-70 years. The intervention group was educated about the effects of smoking cessation, dietary management and regular physical activity. The results indicates the secondary prevention programme was successful in improving food habits in patients with acute myocardial infarction.7
A qualitative study was conducted to examine patient’s reaction to suggested life style changes, to identify the barriers and facilitators to risk reduction. Forty five patients who had undergone PTCA were recruited for the study. Using a constant comparative method for data analysis specific barriers and facilitators for risk reduction were readily identified. Patients were making at least some of their necessary lifestyle changes. Nurses have excellent opportunity to expand their focus and provide guidance and support to patients as they adopt a healthy lifestyle. 8
A study was conducted to assess effectiveness of patient education about the risk factor of cardiovascular diseases. Fifty six patients who were discharged from the cardiology unit constituted the population. The result showed that less patients were not informed by physicians about smoking (p<0.03) and diet (p=0.0001 ), less patients claimed unaware of their blood pressure (p=0.01 ) ,cholesterol level ( p=0.00001 ) and the necessity to correct them (p=0.00001). Implementation of the patient education about cardiovascular risk factor by physicians into the daily routine of the cardiology unit was successful. 9
A hospital based cross sectional study was conducted at AIMS in New Delhi to assess the knowledge of modifiable risk factors of CAD among patients. Participants (n=217) recruited from patient waiting areas in emergency room. Forty one percentage of the sample surveyed has a good level of knowledge 65%, 72%, 85% of the population identified smoking, obesity, hypertension and high cholesterol respectively. A trend towards a good knowledge level was associated with higher levels of education.2
6.3 Statement of the problem
“A study to assess the effectiveness of individual planned teaching programme regarding modifiable risk factors of coronary disease among patients who have undergone percutaneous coronary interventions in a selected hospital at Mangalore”.
6.4 Objective of the study :
1. To assess the knowledge regarding modifiable risk factors of coronary artery disease among patients who have undergone percutaneous coronary intervention using knowledge questionnaire.
2. To prepare and implement the individual teaching programmes regarding modifiable risk factors of coronary artery disease among patients who have undergone percutaneous coronary intervention.
3. To evaluate the effectiveness of IPTP regarding modifiable risk factors of coronary artery disease among patients who have undergone percutaneous coronary intervention.
6.5 Operational Definitions
1. Effectiveness :
Effectiveness refers to the extent to which the IPTP has achieved the desired result in
terms of gain in knowledge scores using structured knowledge questionnaire.
2. Individual planned teaching programme:-
It refers to a systematically developed instructional programme designed for the
patients.
3. Modifiable risk factors of CAD :-
In this study modifiable risk factors refers to smoking, hypertension, elevated serum cholesterol level and physical inactivity.
4. Patients :-
In this study it refers to those patients who are diagnosed as coronary artery disease
and have undergone percutaneous coronary intervention.
5. Percutaneous coronary intervention :-
In this study percutaneous coronary intervention refers to various technique that have been developed to open the vessel and restore the blood flow to the coronary artery. This includes coronary angioplasty, intra coronary stent placement and laser artherectomy.
6.6 Assumptions
Ø Patients with CAD have minimum knowledge regarding modifiable risk factors of coronary artery disease
Ø IPTP will improve the knowledge of patients regarding modifiable risk factors of coronary artery disease
6.7 Delimitation
The study is limited to patients
- With coronary artery disease
- Who have undergone percutaneous coronary intervention
- Admitted in a selected hospital
- Are attending the OPD for follow up.
6.8 Hypothesis (projected outcome)
H1. The mean post test knowledge score will be significantly higher than mean pre-test knowledge score on modifiable risk factors of CAD.
MATERIAL AND METHODS
7.1 Source of data
Data will be collected from the patients who have undergone percutaneous coronary intervention in selected hospital at Mangalore.
7.1.1 Research Design
In this study pre experimental one group pre test – post test design will be used.
Pretest / Teaching / Post test
O1 / X / O2
7.1.2 Setting
The study will be conducted in a selected hospital at Mangalore.
7.1.3 Population:
In this study population consists of patients who have undergone percutaneous coronary intervention.
7.2 Methods of Data Collection.
7.2.1 Sampling Procedure
Purposive sampling technique used to select a total of 30 patients.
7.2.2 Sampling size
Sample size consists of 30 patients who have undergone percutaneous coronary intervention in a selected hospital, Mangalore.
7.2.3 Inclusion criteria for sampling
1. Patients who have undergone percutaneous coronary intervention in a selected hospital at
Mangalore.
2. Patients who are willing to participate in the study.
3. Patients who are coming for followup care in the cardiac OPD after percutaneous coronary
intervention.
7.2.4 Exclusion criteria for sampling
1. Patients who are not willing to participate in the study .
2. Patients who have not undergone percutaneous coronary intervention .
7.2.5 Instruments intended to be used.
Structured knowledge questionnaire.
7.2.6 Data collection Method
Ø Data will be collected after obtaining permission from the hospital authority for a period of one month.
Ø Pre test will be conducted
Ø Individual planned teaching programme will be conducted
Ø Post test will be conducted
7.2.7 Data Analysis plan
Data will be analysed using descriptive and inferential statistics.
7.3 Does the study require any investigations/ interventions to be conducted on patients or the human or animals. If so please describe briefly.
Yes, individual planned teaching programme will be conducted.
7.4 Has ethical clearance been obtained from your institution in case of 7.3
Yes, permission will be obtained from the concerned authority.
List Of References
Karin E, Cur M, Wande J, Elzabe.N. Patients with coronary artery disease- maintaining planned life style adaptation. HealthSA.2008 Dec; 13(4).
Qmar S, Vineet G, Naveen D, Leanno S, et al Knowledge of modifiable risk factors of CAD among a sample in India. Preventive Medicine , 2005 Aug; 41(2): 570- 574.
Kasliwal RR, Kalshreshtha, Agarwal.S, Bansal M. Prevalence of conventional cardiovascular risk factors in Patients with CAD in India. JAPI 2006 May ; 54: 371-5.
Campbell M, Torrance C. Coronary angioplasty impact on risk factors and patients understanding. Aust.J.Adv Nurs. 2005 Jun – Aug ; 22(4) : 26-31
Bren zynkie H, Pendon E, Lindsay P, Adam M. Identification of the perceived learning needs of balloon angioplasty patients. Cardiovasc Nurs 1998 ; 9(2):8-14.
Vest fold heart care study group. Influenze on life style measures, Dis Mon, 1999, Dec ; 45(12): 497- 571.
Carsson R, Lindberg G, Westin L, Isralsson. Influenze on coronary nursing management follow up on life style after acute MI. Heart 1997 Mar ; 77(8): 256-9.
Gulasick M, Billey A, Perino.B, Keoughv. Recovery patterns and life style changes after coronary angioplasty. Heart Lung 1998 Jul- Aug; 27(4): 253- 62.
Albins N, Laima J, Egle K, Vidas P. ,Implementation of the patient education about cardio vascular risk factors into a daily routine of the cardiology unit. Preventive medicine 2005 Aug; 41(2): 570 – 574.
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