Knowledge regarding cardiac rehabilitation among staff nurses

Mr. Girish Degavi¹, Mrs. Preeti R Bhupali²

KLEU Institute of Nursing Sciences, Belgaum, Karnataka.

Corresponding Author Email: girishdegavi1984@gmail.com

ABSTRACT:

The study entitled “A study to evaluate the effectiveness of Planned teaching programme (PTP) on knowledge regarding cardiac rehabilitation among staff nurses working in ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

The objectives of the study were

1. To assess the knowledge regarding cardiac rehabilitation among staff nurses working in ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

2. To evaluate the effectiveness of PTP on knowledge regarding cardiac rehabilitation among staff nurses working in ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

3. To find the association between the pre test knowledge scores with selected socio demographic variables among staff nurses working in ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

Methods:

The conceptual framework of the present study is based on Ernestine Wiedenbach’s helping art of clinical nursing theory.

The study was conducted using one group pre test post test design. Demographic variables analyzed for the study were age, gender, years of experience, professional qualification.

The study was conducted using purposive sampling technique on a sample of 40 staff nurses. Structured questionnaire were used to collect the data regarding cardiac rehabilitation among staff nurses.

Finding of the study:

The Pre test and post test Frequency and percentage of knowledge scores of subjects regarding CR revealed pre test (47.5%) subjects had poor knowledge (47.5%) had average (5 %) had good knowledge where as in post test all the subjects (100%) had good knowledge scores.

Effectiveness of planned teaching programme (PTP) was assessed with paired‘t’ test it was revealed that there was significant gain in knowledge at 0.05 level.

In the present study the association between the pre-test level of knowledge with selected socio-demographic variables was calculated using chi-square ( χ2 ) test there was no association found between selected demographic variables and pre test knowledge scores.

Interpretation and conclusion:

The study findings were that planned teaching programme (PTP) is effective teaching strategy to improve the knowledge regarding cardiac rehabilitation among staff nurses. There is no significant association between the knowledge scores with socio demographic variables.

KEYWORDS: Planned teaching programme –PTP ; Cardiac Rehiablitation – CR.

INTRODUCTION:

“Diagnosis is not the end, but the beginning of practice”

-Martin H Fisher

Every day, the heart quietly does its business, pumping blood and oxygen to organs and sustaining human life.¹ It’s as natural as breathing, but when someone is suddenly smitten with a heart attack or faces the onset of cardiac disease, the consequences can be enormous, impacting not only the body but the person’s emotional state. Life for the person can be turned upside down or at least it can feel that way.²

Age when increases, individuals become more susceptible to diseases especially cardio vascular diseases. Coronary artery Disease is one of the leading disease, which possesses greater risk among Indians. ³

Death due to Cardio vascular disease accounts for 24 percent of total deaths. Cardio vascular disease mortality rates are higher in urban than in rural areas, and is much more prevalent among the upper and middle classes. In 1960, this represented four percent of all deaths, whereas in 1990 the proportion was greater than 50 percent. According to World Health Organization - 2002 Coronary artery disease death rates are currently about three times higher than stroke rates and cardiac efficiency is achieved when work and activities of daily livings can be performed at reduced heart rate.⁴

In the 1950s, Hellerstein presented his methodology for the comprehensive rehabilitation of patients recovering from an acute cardiac event. Cardiac rehabilitation is the restoration of a person to optimal state of function in 6 areas; physical, physiologic, Mental, Spiritual, Economic and Vocational.⁵

The purpose of cardiac rehabilitation is to provide comprehensive, multifaceted treatment, education, and secondary prevention for cardiac patients and individuals with heart disease risk factors, in order to aid recovery and prevent recurrence of heart problems. ⁶

Cardiac rehabilitation, It is an education program designed to improve the patient’s quality of life after a heart attack or another heart problem. It is important for the nurses in cardiac unit to become familiar with various types of cardiac problems.⁷

NEED FOR THE STUDY:

By 2020 heart disease will become the leading cause of both death and disability worldwide, with the number of fatalities projected to increase to more than 20 million a year and to more than 24 million a year by 2030.⁹

According to World Health Organization (WHO) estimates, in 2003, 16.7 million people around the globe die of cardio vascular diseases each year. This is over 29 percent of all deaths globally. In India in the past five decades, rates of coronary disease among urban populations have risen from 4-11 %. The World Health Organization (WHO) estimates that 60 % of the world's cardiac patients will be Indian by 2012.¹⁰

Coronary Artery Disease (CAD) is a Global Epidemic among South Asians. This disease strikes South Asians at a four-fold rate compared to the rest of the world population. This holds true even for lifelong vegetarians who do not smoke and are not overweight.¹¹

British Heart Foundation statistics show that the death rate from coronary heart disease is 46% higher in South Asian men and 51% higher in South Asian women than the United Kingdom population as a whole. South Asian women also have one of the highest mortality rates due to coronary artery diseases.¹²

India's cardiac patients statistics alarm health department reported on Jun 05, 2009 that India is known to have the most cardiac patients in the world and a number that is expected to rise to 10 million by 2011.¹³

In 2010 Medical mission global statistics conducted a survey on reviewing the prevalence of cardiac diseases, in estimated population in selected countries. The survey revealed the results showing China with extrapolated prevalence of heart diseases of 105,053,816 and estimated population of 1,298,847,624, Pakistan had extrapolated prevalence of heart diseases of 12,876,173 and estimated population was 159,196,3362 in Indian context the extrapolated prevalence of heart diseases is 86,145,412 and population estimated is 1,065,070,607.¹⁴

As per Medical mission statistics on prognosis of cardiac rehabilitation, 2011 The percentage of prognosis of patients giving their maximum level of effort as light, moderate, heavy or very heavy before and after Cardiac rehabilitation twelve month outcomes 2009-10 and 2010-11 declared, there was a 9 % change of prognosis of patients giving their maximum level of effort as light, moderate, heavy or very heavy before and after Cardiac rehabilitation in the year 2009-10 were as there was a drastic increase to 11.4% in the year 2010-11.¹⁵

STATEMENT OF PROBLEM:

“A study to evaluate the effectiveness of planned teaching programme (PTP) on knowledge regarding cardiac rehabilitation among staff nurses working in ICCU of Heart foundation of KLE’s Prabhakar Kore Hospital and MRC Belgaum.”

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding cardiac rehabilitation among staff nurses .

2. To evaluate the effectiveness of planned teaching programme (PTP) on knowledge regarding cardiac rehabilitation among staff nurses.

3. To find the association between the pre test knowledge scores with selected socio demographic variables among staff nurses.

OPERATIONAL DEFINITIONS:

1. Effectiveness: It refers to the improvement in knowledge of staff nurses regarding cardiac rehabilitation after administration of Planned teaching programme (PTP).

2. Planned Teaching Programme (PTP): It refers to the information provided through systematically organized teaching for one hour to the staff nurses on cardiac rehabilitation which include introduction, need, phases and advantages of cardiac rehabilitation by using audio visual aids.

3. Knowledge: In this study, knowledge refers to the interpretation of correct responses made by the respondents as elicited through self administered knowledge questionnaire.

4. Staff nurses: A staff nurse refers to one who is registered nurse and qualified either ( GNM / BS.c nursing) and working in ICCU.

5. Cardiac rehabilitation (CR): Refers to the development of physical, psychological, vocational, social and educational potential consistent with physiological impairment of cardiac patients.

6. Selected Demographic variables: In this study it includes the age, gender, years of experience and educational qualification of staff nurse.

7. Intensive Coronary Care Cardiac Unit (ICCU): It is one of the department of the hospital to which the most serious cardiac cases are transferred for specialist monitoring and treatment.

Assumption

The study assumes that,

1. The staff nurses will have some knowledge on cardiac rehabilitation

2. Planned teaching programme (PTP) is one of the best teaching strategy in imparting knowledge regarding cardiac rehabilitation among staff nurses.

Delimitation

This study is limited to the staff nurses working in ICCU of heart foundation of KLE’s Dr. Prabhakar Kore Hospital and MRC, Belgaum.

REVIEW OF LITERATURE:

Literature related to knowledge regarding cardiac rehabilitation:

A retrospective study was conducted by University of Newcastle to assess the Staff nurses knowledge on cardiac rehabilitation .Five non-randomly selected nursing homes in north east England with total of 157 cardiovascular nurses were included in the study. The results found that overall mean score for the knowledge scale was 9.6 (SD 1.9) for Staff nurses, which was significantly higher (t=7.5, p<0.001) the nurses score was not significantly associated with experience or place of work. For the misconception scale the mean score for nurses was 6.8 (SD 1.5), which was significantly higher (t=6.85, p<0.001) nurses working in specialized cardiac wards and well experienced nurses had significantly higher scores.. The study concluded that Advanced training personnel should recognize the need to enhance Staff nurses skills in patient education and rehabilitation. The importance of these skills also should be recognized in first-level training. Staff nurses should be provided with sound knowledge on cardiac rehabilitation and risks so that they can educate patients accordingly and in particular, can correct misconceptions about the condition, prognosis, and appropriate lifestyle changes.¹⁶

An observational study conducted between The University of Western Sydney, School of Nursing and Midwifery, Sydney, Australia in the year June 2005 and March 2009, to determine the implications for the nurses role in chronic heart failure management involving the learning experience of 150 Staff nurses on cardiac rehabilitation. Data were collected using a 10-point scale questionnaire. The electronic databases, Web of Knowledge and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), was introduced using keywords including; "heart failure", "management", “nursing” .The Results of the study revealed full marks (10/10) were awarded to 46% of respondents, while almost 90% of total responses were graded as 8/10 . This study concluded that this was a unique study of its kind in terms of analyzing exercise tutorial on cardiac rehabilitation a unique teaching method and also emphasizing cardiac rehabilitation as an essential part of the curriculum since majority of staff has an average score.¹⁷

Literature related to effectiveness of cardiac rehabilitation programme:

An descriptive study carried out in Jabalpur, India to evaluate the effectiveness of planned cardiac rehabilitation program in an institutional set up involving 74 patients who underwent coronary artery bypass surgery (CABG). The patients were evaluated prior to surgery and were initiated into lifestyle changes based on Diet, Relaxation, Exercise, Attitude and Motivation (DREAM) concept on discharge post operatively. Patients were advised unsupervised walking exercise based on target heart rate of 60 –75% based on age. Follow up was made in every 15 days. The outcomes were functional capacity as measured by treadmill test 3 months postoperatively, lipid and glucose profiles and anthropometric indices like body mass index (BMI) and waist to hip ratio (WHR). Results showed that there was a favorable change in functional capacity, resting rate ,pressure, fasting blood sugar, total cholesterol, triglycerides and anthropometric indices. The study concluded that an encouraging pattern for effective cardiac rehabilitation program that can also be used for secondary prevention of Coronary Artery Disease in India.¹⁸

A cohort Study was conducted by researchers at the Peter Munk Cardiac Centre, USA to know the effectiveness of cardiac rehabilitation Programme in reduction of risk of death among patients with heart disease in 2006, Study included a total of 105 patients were Patients received an individualized, multidisciplinary 12-week cardiac rehabilitation program which included awareness of risk factors measured by using the Knowledge Questionnaire on consecutive participants of post percutaneous coronary intervention. Study indicated that participating in cardiac rehabilitation after a cardiac illness, such as a heart attack, can reduce the risk of death by approximately 25%, a reduction similar to that of other standard therapies such as cholesterol-lowering medications (Statins) and aspirin. The results showed that cardiac rehabilitation programs reduced the risk of death in patients with heart disease and improved their quality of life. Study concluded that every patient discharged from the hospital with a heart condition should be referred to a cardiac rehabilitation program.¹⁹

METHODOLOGY:

Research Design:

A One group pre-test post-test pre-experimental research design was adopted to carry out the present study.

Research Setting:

Based on the geographic proximity, feasibility to conduct the study and familiarity with the setting, the investigator selected ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hoapital, Belgaum.

Population:

The target population for the study consisted of staff nurses of ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hoapital, Belgaum

Variable:

Independent variable: Planned teaching programme (PTP) on cardiac rehabilitation.

Dependent variable: Knowledge score regarding cardiac rehabilitation.

Socio-demographic variable:

The socio-demographic variables considered for this study were age, gender, years of experience , educational qualification.

Sample:

The sample size consists of 40 Staff nurses working in ICCU of Heart foundation of KLE’s Dr. Prabhakar Kore Hoapital, Belgaum

Sampling Technique

The investigator selected the Staff nurses by using purposive sampling technique.

Description of the Tool

Part I: 4 items of demographic variables age, gender, years of experience, educational qualification

Part II: It consists of 40 items of various areas of Cardiac rehabilitation

Ethical clearance

Ethical clearance was obtained.

Reliability

The reliability of the tool is computed by using Spearman Brown’s prophecy formula, where ‘r’ value obtained was 0.737 which showed that the tool was reliable.

Graph 1: Pie graph showing percentage distribution of subjects according to ‘Age’.

Graph 2 : Column graph showing percentage distribution of subjects according to ‘Gender’.

Graph 4: Pie graph showing percentage distribution of Staff nurses according to ‘Educational Qualification’

RESULT:

· Majority of the Staff nurses 20(50%) were between the age group of 26 to 30 years.

· Majority of staff nurses were female 21(52.5 %) and 19(47.5 %) were male.

· Majority of staff nurses 32 (80%) had experience between 01 to 05 years.

· Majority of staff nurses 23 (57.5 %) Staff nurses had completed G.N.M.

Table no – 1 reveals In pre test 19 (47.5%) subjects had poor knowledge, 19 (47.5%) had average and 2(5 %) had good knowledge, where as in post test all the subjects 40(100%) had good knowledge scores.

Table No – 2:- Mean difference (d) , standard error of Difference ( SEd) and paired ‘t’ test values of knowledge scores of subject. n = 40

Mean

Difference

( d¯ )

Standard

Error of

Difference

(SEd)

Paired ‘t’ Test

Inference

Calculated

39 df

16.6

1.89

8.78

2.021

df = 39, * - Significant at 0.05 level of significance

Table - 2 reveals that calculated paired ‘ t ‘ value (t _calculated = 8.78) is greater than tabulated value (t _tabulated = 2.021 . Hence H₁ is accepted. This indicates that the gain in knowledge score is statistically significant at p < 0.05 levels. Therefore, planned teaching programme (PTP) on cardiac rehabilitation is effective to improve the knowledge of staff nurses.

Table 3 reveals χ² value computed between the pre-test levels of knowledge with selected socio-demographic variables

· The χ²_calculated value (3.216) is less than χ²_tabulatedvalue ( 9.49). Hence H₂.₁ is rejected. There is no significant association between knowledge scores and Age.

· The χ²_calculated value (0.412) is less than χ²_tabulated value ( 5.99). Hence H₂.₂ is rejected. There is no significant association between knowledge scores and Gender.

· The χ²_calculated value (3.252) is less than χ²_tabulated value ( 9.49). Hence H₂.₄ is rejected. There is no significant association between knowledge scores and years of experience.

· The χ²_calculated value ( 1.831) is less than χ²_tabulated value ( 9.49). Hence H₂.₃ is rejected. There is no significant association between knowledge scores and Educational qualification.

NURSING IMPLICATION:

Nursing administration:

Nursing services are necessary for virtually every client seeking care of any type, including health promotion, diagnosis and treatment. The nurse needs to conduct education through the mass media on Cardiac Rehabilitation, its Definition , importance , goal indications, contra indications, key elements, types, team members, areas, phases, benefits and nurses responsibility. Organizing of such programme requires efficient teamwork, planning for men, money, and material for successful education programmes. The nurse administrators should explore their potentials and encourage innovative ideas in the preparation of appropriate teaching material.

Table No 3 Association between the pre-test level of knowledge scores and selected socio demographic variables:

Chi- square (χ²) test to determine the association. n = 40

Demographic Variables	Category Sample		Respondents Knowledge						χ ²value Cal df
			Poor		Average		Good
			F	(%)	f	(%)	f	(%)
Age Group (years)	20-25	17	8	20.0	7	17.5	2	5.0	3.216	NS
	26-30	20	10	25.0	10	25 .0	0	0.0
	31 – 35	3	1	2.5	2	5.0	0	0.0
Gender	Male	19	10	25.0	8	20	1	2.5	0.412	NS
Gender	Female	6	9	22.5	1	25.0	1	2.5	0.412	NS
Years of experience	1-5	32	16	40.0	14	35.0	2	5.0	3.252	NS
	6-10	7	2	5.0	5	12.5	0	0.0
	11-15	1	1	2.5	0	0.0	0	0.0
Educational qualification	G.N.M	23	12	30.0	10	25.0	1	2.5	1.831	NS
	BS.c	8	3	7.5	5	12.5	0	0.0
	PCBS.c	9	4	80.0	4	80.0	1	2.0

* - Significant at 0.05 level of significance, NS - Non significant

Nursing education:

The nurse educators have responsibility to update the knowledge of the nursing personnel regarding Cardiac Rehabilitation through the media. The findings of the study can serve guidelines for the nurse educators for planning and conducting educational programmes for the Staff nurses and people. The curriculum should lay emphasis on Cardiac Rehabilitation in providing information on health, which includes introduction, definition, indications, importance, goals, contra indications, key elements, types, team members, areas, phases, benefits and nurses responsibility, So that the Staff nurses when posted to hospital and community set-up will be able to give an education regarding Cardiac Rehabilitation and its importance.

Nursing practice:

The nurse plays an important role in the health care delivery system. The nurses can visit to hospital and community to recognize any problems of the people. Even young people in the community are prone to develop cardiac diseases; the nurse should utilize the opportunity by giving prompt and adequate information regarding cardiac rehabilitation. Measure should be taken by the nurse to motivate health personnel to maintain healthy environment in and around the community assessment of knowledge serves as a base to provide counseling service to the Staff nurses. The study findings imply that there is a need for educational programme to create awareness among the Staff nurses regarding Cardiac Rehabilitation.

Nursing Research:

The findings of the study show that the majority of the subjects had good knowledge regarding Cardiac Rehabilitation after Planned teaching programme. The study will motivate the beginning researchers to conduct the same study with the different variables on a large scale.The findings emphasis an extensive need to assess the effectiveness of planned teaching regarding Cardiac Rehabilitation. The nurse’s could conduct research study on Cardiac Rehabilitation. An experimental study could be conducted to find out the effectiveness of Cardiac Rehabilitation should be done on different aspects among the different samples in different settings.

RECOMMENDATIONS:

Based on the findings of the study, the following recommendations have been made for study:

A similar study can be done to assess the attitude and practice of Staff nurses regarding Cardiac Rehabilitation.

The study can be replicated on larger samples for a better generalization.

Video assisted teaching programme can be conducted among the Student nurses regarding Cardiac Rehabilitation.

Planned teaching can be conducted among the other groups regarding Cardiac Rehabilitation.

CONCLUSIONS:

On the basis of the findings, the investigator concluded that the staff nurses have inadequate knowledge regarding cardiac rehabilitation. The study strongly suggest that it is very important to enhance the knowledge of the staff nurses regarding cardiac rehabilitation to improve the quality of life of cardiac patients.

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Knowledge Level	Pre test		Post test
Knowledge Level	Frequency(F)	Percentage (%)	Frequency(f)	Percentage (%)
Poor < 37.5% score [ 1-15]	19	47.5	-	0.0
Average 38.5-45 % score [16-18]	19	47.5	-	0.0
Good> 46 % score [ 19- 40]	2	5.0	40	100.0
Total	40	100.0	40	100.0