Effectiveness of an Instructional program on patients’ knowledge about exercises to prevent coronary artery disease progression after percutaneous coronary intervention (PCI) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mosul Journal of Nursing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article 29, Volume 10, Issue 3, August 2022, Pages 199-205 PDF (1.1 M) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI: 10.33899/mjn.2022.175554 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Authors | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Halla Fadhel Abdul_Amir Alwardi1; Khalida Mohammed Khuder2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1Ministry of Health, Wasit health directorate, Iraq; | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2Department of Adult Nursing, College of Nursing, University of Baghdad, City of Baghdad, Iraq | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abstract | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pre-experimental design (one group pretest-posttest) A non-probability (purposive) sample of 35patients who have coronary artery disease and are being treated with percutaneous coronary intervention to manage coronary artery occlusions. The study started from November 2021 to May 2022.The data was collected using sociodemographic, the clinical characteristics of the client, and the Coronary Artery Disease Education Questionnaire Short Version (CADE-SV), and lifestyle compliance items after PCI: Physical activity. The collected data were statistically analyzed using SPSS software version 26. The study result revealed that the majority of CAD patients are males with age 48 and above, married, secondary school graduates, and housewives. More than half of the study sample had risk factors for coronary artery disease, except for the patient's own smoking. Patients with coronary artery disease had a low degree of knowledge about healthy lifestyles before beginning the program, and significant improvement in patients’ knowledge regarding healthy lifestyles after giving the program also presented a significant difference in all items about physical activity for patients with percutaneous coronary intervention. The finding presented that there were significant differences in post-test knowledge of all items about physical activity for patients with percutaneous coronary intervention after completing the program. There is a need to instruct patients following PCI by offeringpamphlets, books, and brochures about healthy lifestyle aspects (especially exercise). Conducting a relatively large nursing health education program for patients after PCI to see how the program affects patients' understanding of healthy lifestyles. Also, suggest that all CHD patients have a full understanding and practice of exercise. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Keywords | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exercise; coronary artery disease; percutaneous coronary intervention | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Effectiveness of an Instructional programon patients’ knowledge about exercises to prevent coronary artery disease progression after percutaneous coronary intervention(PCI) Halla fadhel Abdul-Ameer1, Khalida Mohammed Khuder2 *
Corresponding author:Halla fadhel Abdul- Ameer Email: hala.fadhel1202a@conursing.uobaghdad.edu.iq ABSTRACT Pre-experimental design (one group pretest-posttest) A non-probability (purposive) sample of 35patients who have coronary artery disease and are being treated with percutaneous coronary intervention to manage coronary artery occlusions. The study started from November 2021 to May 2022.The data was collected using sociodemographic, the clinical characteristics of the client, and the Coronary Artery Disease Education Questionnaire Short Version (CADE-SV), and lifestyle compliance items after PCI: Physical activity. The collected data were statistically analyzed using SPSS software version 26. The study result revealed that the majority of CAD patients are males with age 48 and above, married, secondary school graduates, and housewives. More than half of the study sample had risk factors for coronary artery disease, except for the patient's own smoking. Patients with coronary artery disease had a low degree of knowledge about healthy lifestyles before beginning the program, and significant improvement in patients’ knowledge regarding healthy lifestyles after giving the program also presented a significant difference in all items about physical activity for patients with percutaneous coronary intervention. The finding presented that there were significant differences in post-test knowledge of all items about physical activity for patients with percutaneous coronary intervention after completing the program. There is a need to instruct patients following PCI by offeringpamphlets, books, and brochures about healthy lifestyle aspects (especially exercise). Conducting a relatively large nursing health education program for patients after PCI to see how the program affects patients' understanding of healthy lifestyles. Also, suggest that all CHD patients have a full understanding and practice of exercise.
Keywords:Exercise, Coronary artery disease, Exercise, Coronary artery disease, percutaneous coronary intervention. Received: 13 April 2022, Accepted: 08 June 2022, Available online: 28 August 2022.
INTRODUCTION Coronary heart disease (CHD) is the greatest cause of death worldwide, with more people dying each year from it than from any other cause. Patients with CHD have a higher risk of recurrent heart attacks and mortality. People who have had a stroke have a 4-6 times greater chance of dying abruptly, according to various studies. CHD had been an issue for a long time. Controlling CHD Risk factors will lower the number of hospital admissions. Patients' quality of life will be improved, as well (WHO, 2017).
Percutaneous coronary intervention (PCI) is a frequent interventional procedure used to treat CHD. This procedure can widen a stenotic or occluded coronary artery, alleviate clinical symptoms, and effectively save the patient's life (Tamburino et al., 2010; Higami et al., 2015). ISR is a tough challenge in PCI-based CHD treatment, as well as a hotspot and difficult area of the current study. The etiology of ISR following PCI is not well known at this time. According to a recent study, the putative pathogenic mechanism is vascular intimal growth and infiltration of local inflammatory cells (Buccheri et al., 2016). "Neoatherosclerosis" is the name given to a novel type of atherosclerotic process. In-stent restenosis (ISR) after PCI has steadily gained clinical attention (Murata et al, 2018)5.ISR refers to plaque that is within 5 mm of the stent's edge after PCI and has stenosis of more than 50%. ISR occurs 15–30% of the time with stents (Alfonso et al., 2018). The widespread use of drug-eluting stents and anti-proliferative medications such as rapamycin, everolimus, and other anti-proliferative agents has increased the success rate of interventional therapy, but the ISR problem has not been totally cured. As a result, identifying ISR-related risk variables is critical in order to give evidence for ISR prevention. We sought to assess the qualities as well as the risk (Picard et al, 2017). Stent thrombosis (ST) is a very dangerous clinical incidence that often progresses to ST-elevation myocardial infarction in the vast majority of instances, fatality rates are high. up to 20%–40% (Schulz et al., 2009). However a, comprehensive discussion of ST care most ST databases state that thrombus extraction and balloon angiography are frequently used, with repeated stenting in 30–50% of patients (Kimura et al., 2010). Decades of research have looked at the function and efficacy of educational interventions in improving a patient's understanding of and ability to manage CAD risk factors. Patient education advocates in primary care have advocated a shift away from a basic approach to improving patient health status through information and toward "high-quality health education." With the purpose of assisting the patient in taking ownership of their personal health and welfare, a formal and well-organized mode of delivery has become the ideal design of an educational approach. Reduced healthcare costs and enhanced wellness outcomes are also desirable results of a successful teaching strategy. Previous research has looked at the effects of educational intervention on knowledge and health (Guzek et al., 2019). Weight loss and improved physical exercise are the foundations of treatment for high triglyceride levels. Regular, moderate physical exercise raises high-density lipoprotein (HDL) levels while lowering triglyceride levels, lowering the risk of coronary events and overall mortality. Most individual adults should do at least 150 minutes of moderate-intensity aerobic activity per week and 75 minutes of vigorous-intensity aerobic activity per week. They should also do muscle- strengthening activities that train all major muscle groups two or more days per week. (CDC, 2015).
METHOD
Pre-experimental design (one group pretest-posttest). The study was conducted in the cardiac catheterization unit at Al-Zahraa teaching hospital in AL-Kut City. This study started from November 2021 to May 2022 after getting approval from the hospital. A non-probability (purposive) sample of 35 patients who have coronary artery disease and are being treated with percutaneous coronary intervention to manage coronary artery occlusions. The data was collected using sociodemographic, the clinical characteristics of the client, Coronary Artery Disease Education Questionnaire Short Version (CADE-SV), and lifestyle compliance items after PCI: Physical activity A self-administered questionnaire was created, and by using structured interviews for the clients that not able to read and write. Section 1: Demographics: Section 1 Had questions regarding the socio-demographics of the participants including age, gender, marital status, level of education, and occupation. Section 2: Clinical Characteristics of the participants:It consists of five variables, which include; body mass index, hypertension history, diabetes mellitus history, hyperlipidemia history, and smoking history. Section 3: the Coronary Artery Disease Education Questionnaire Short Version (CADE-SV) which comprised 16 items. Scoring for (CADE-SV) assessed by Yes=3, not sure =2, No=1 Section 4: lifestyle compliance items after PCI: Physical activity: comprised of 5 items. Physical activity domain scored as follows: light (less than 3), neutral (3-5), strong (5-7) RESULTS Table (4.1.) presented that 77.1 percent of the study sample were within age group 48 years and more. Moreover, 62.9 percent of the study sample were males, and 85.7 percent were married. The highest percent 28.6 were secondary school graduate. In addition, 34.3 percent of the study sample were housewives as the highest percent of the study sample. Table (4.2.) presented that more than half of the study sample (54.3) percent were overweight, 60 percent of them have hypertension, 57.1 percent have diabetes mellitus, and 62.9 percent have hyperlipidemia. In relation to smoking, 85.7 percent of the study sample do not smoke, and 37.1 percent have other person smoke at home. Table (4.3.) presented that there were significant differences were happened at the knowledge of patients related to a healthy lifestyle about percutaneous coronary intervention. Table (4.4) presented that there were significant differences in all items about physical activity for patients with percutaneous coronary intervention
Results:
Table (1): Distribution of Socio-Demographic Characteristics of study sample -frec=frequency,% = percentage, = arithmetic Mean (x̄) and Standard Deviation (S.D.)
Table (2): Distribution of Clinical Characteristics of Study Sample
Freq.= frequency,% = percentage Table (3): Comparison between Patients’ Knowledge (pre-post) test toward healthy lifestyle after percutaneous coronary intervention
Ass. = Asymptomatic significant; H = High (2.34 – 3), M = Moderate (1.67 – 2.33), L = Low (1 – 1.66). Table (4): Comparison between healthy lifestyle of patients with percutaneous coronary intervention ( physical activity)
Ass. = Asymptomatic significant; S = Strong (2.34 – 3), N = Neutral (1.67 – 2.33), L = Light (1 – 1.66).
DISCUSSION The result in the table (4-1) concerning socio-demographic characteristics presented that more than half of the study sample were within the age group 48 years and more, male, married, had a primary school education, and housewife. This finding was supported by (Mousa, 2020) who illustrated in his study in Iraq at Baghdad city to Evaluate the “Effectiveness of an Instructional Program on Patients' Knowledge and Attitudes concerning Healthy Lifestyle after Percutaneous Coronary Intervention at Cardiac Centers in Baghdad City” that majority of samples in study and control groups were male, with the mean age (56-63) married, primary school graduate Table (4-2) presented that more than half of the study sample were overweight, suffer from hypertension, have diabetes mellitus,have hyperlipidemia, and most of the study participants do not smoke but had other person smoke at home. Hamid (2016)find that HT&DM have the highest incidence in our patients but smoking is less prevalent in our study. This is consistent with the current study. Table (4.3) there was a big difference in the knowledge of patients about some areas such as (Heart disease only happens in older people who smoke or have high cholesterol, Stop taking anticoagulant medications when you feel better, Increase more than the prescribed dose when your health condition worsens, Resistance training (lifting weights or using elastic bands) can strengthen your muscles and help lower your blood sugar, Increase the speed while walking when feeling chest pain to see if it will disappear or not, Eating more meat and milk products is a good way to add more fiber to your diet). This result comes into agreement with the finding of (Kittan & Hamza, 2020),who stated that after using an Instructional Programs on Patient's Knowledge Regarding Self-Care Management after Ischemic Heart Disease, there was a highly significant link between (Pre & Post-test case groups) at (p-value = 0.000). Tables (4-4), presented that there were significant differences in post-test knowledge of all items about physical activity for patients with percutaneous coronary intervention after completing the instructional program. The results demonstrated that in some areas of exercise an acceptable level respectively pre-implementation program. This encompasses the following questions which are (riding a bicycle for 20 minutes, working in the garden of the house for 20 minutes). While the percentage of these answers increased after the application of the program and became a high level. This means that the patients benefited from the educational lectures given to them. The researcher agrees with the recommendations in the guidelines. Exercise is a very important measure that everyone should do on a regular basis, especially people with IHD because evidence and guidance show that it has a significant physiological benefit. This finding is backed up by (Al - Tamimi et al, 2017), who conducted a descriptive pilot study in Oman to assess the amount of knowledge about lifestyle habits in thirty patients with CAD. According to the findings, only about a third of the overall sample exercises less than twice per week, and only about half of the sample exercises more than five times per week. CONCLUSIONS The majority of CAD patients are males with age 48 and above, male, married, secondary school graduates, and housewives, more than half of the study sample had risk factors for coronary artery disease, except for the patient's own smoking, Patients with coronary artery disease had a low degree of knowledge about healthy lifestyles before beginning the instructional program.A significant improvement in patient’s knowledge regarding healthy lifestyles after giving them the instructional program ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES This study was completed following obtaining consent from the University of Baghdad. FUNDING This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. Study concept, Writing, Reviewing the final edition by all authors. DISCLOSURESTATEMENT: DISCLOSURE STATEMENT: The authors report no conflict of interest. ACKNOWLEDGEMENTS I extend my sincere thanks to everyone who provided or contributed to providing me with scientific and moral support REFERENCES World Health Organization (2017, May 17). Cardiovascular diseases (CVDs). Retrieved from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases- (cvds) Tamburino, C., Angiolillo, D. J., Capranzano, P., Di Salvo, M., Ussia, G., La Manna, A., ... & Bass, T. A. (2009). Long‐term clinical outcomes after drug‐eluting stent implantation in unprotected left main coronary artery disease. Catheterization and Cardiovascular Interventions, 73(3), 291-298. Higami H, Shiomi H, Niki S, et al: Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease. Cardiovasc Interv Ther, 2015; 30: 189–97 Buccheri, D., Piraino, D., Andolina, G., & Cortese, B. (2016). Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. 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Retrieved on 10/18/2015 at: www.cdc.gov/physicalactivity/basics/adults/index.htm Mousa, A. M., & Mansour, K. (2020). Effectiveness of an Instructional Program Concerning Healthy Lifestyle on Patients’ Attitudes after Percutaneous Coronary Intervention at Cardiac Centers in Baghdad City. Iraqi National Journal of Nursing Specialties, 33(1), 1-11. Hamid, M. B. (2016). Clinical Characteristics and Outcomes of Acute Coronary Syndromes in a Group of Iraqi Patients. Iraqi Journal of Medical Sciences, 14(4). Kittan, A. A. H., & Hamza, R. A. H. (2020). Effectiveness of an Instructional Programs on Patient’s Knowledge Regarding Self-Care Management after Ischemic Heart Disease. Indian Journal of Forensic Medicine & Toxicology, 14(1), 1107. Al-Tamimi, T. R., Ba-Omar, H. A., & Nadar, S. (2017). Knowledge regarding secondary prevention lifestyle practices among patients with ischaemic heart disease in Oman: pilot study. 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Al-Tamimi, T. R., Ba-Omar, H. A., & Nadar, S. (2017). Knowledge regarding secondary prevention lifestyle practices among patients with ischaemic heart disease in Oman: pilot study. Sultan Qaboos University Medical Journal, 17(1), e88. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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