Abstract
Heart disease is first of the largest killer diseases in the world. According world health organization estimated 17 million people worldwide coronary vascular disease. In developing country the cost of bypass surgery and angioplasty is very high. every person cannot affordable for taking treatment. this study helps to patient about self care precaution and awareness of disease and its minimizes the further complication. This study helps to myocardial infarction patient to improve their health. This study is a experimental study. The population of this study consists of medical college attached government hospitals in Gujarat state. This study includes the 35 samples in male and female. A structured questioner tool is prepared for assessing the knowledge including six component (self care, modifications, exercise, pulse monitoring, diet, stress reduction technique) and check list, ratings scale prepared for assessing the performance of their activities(pulse monitoring, muscle starching exercise, stress reduction technique) the finding is indicated that health guideline is very effective for the MI patient to improving their health and healthy life style.
Key words: Effectiveness, Health guideline, Myocardial infarction, Performance rating scale observational check list.
Introduction
The widely accepted definition of “WHO” in 1948 in preamble to its constitution which is follows “Health” is a state of complete physical, mental and social well being and not merely absence of any disease or infirmity”. So according to W.H. O. health cannot be defined as a ‘state’ but it must been as a process of continue adjustment to the changing meaning which we give to life. This is a dynamic concept.
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Heart disease is first of the largest killer disease in the world. Cardiovascular disease are major contributors to the global burden of chronic disease with 29.3% of global deaths and 9.9% of total disease burden, in terms of disability- adjusted life years lost, being reported in 2003. Low and middle income countries accounted for 78% and 86% of the CVD deaths and daily lost, respectively, worldwide in 1998.
In India CVD is projected to be the largest cause of death and disability by 2020 with 2.6 million Indians predicted to die due to coronary heart disease, each consist 54.1% of all CVD deaths.
In resent year education has come to be considered as an integral component of health care. The modern philosophy of health care in every society take in to consideration the physical, special for diet, psychological and socio cultural environment and other thing in that stress management using many technique like mediation, relaxation etc. MI is a chronic life long illness.
The basic component of self care applies to all cardiac patients but the care must be designed to fit each person individual needs and habits.
In order to meet learning needs of the patients, prepare health guideline on self care activities for the promotion of the health, prevention of further risk or complication, early diagnosis and treatment of the disease. It aims at the modification of life style – change in diet, regular exercise, avoid smoking and avoid alcohol and stress management for preventing health crisis.
Objectives of the study
To assess the knowledge of self care on myocardial infarction before and after introducing health guideline and demonstration on self care activates to myocardial patients admitted in medical ward in medical college attached government hospitals in Gujarat state.
To assess the performance of self care on myocardial infarction before and after introducing health guideline and demonstration on self care activates to myocardial patients admitted in medical ward in medical college attached government hospitals in Gujarat state.
Literature reviewed
Important education after myocardial infarction
Duryee R, “ The efficiency of inpatient educational after myocardial infarction in that the educating the patient who has experienced a MI has long been a challenge for the professional nurse. Nurse has prepared volumes of teaching materials to enlighten the patient who has experienced an MI. the purpose of this study was to review the research literature on in- patient education after MI published between 1975 and 1983 the review of 21 studies to determine what information is most important to patients whether inpatient teaching increase patient knowledge, whether lifestyle changes are affected by education and which instructional methods were most effective. Multiple teaching methods were used across the 21 studies reviewed: individual and group session led by nurse rehabilitators, slide sound presentation, videotape sessions with a nurse. The studies demonstrated that audiovisual methods are as effective as presentations by an educator.
Important of diet for heart disease
Miss Saramma Jacob “A study of the knowledge of the patients and the relatives about the importance of salt restricted diet as a therapy in some heart disease”. This study was designed to explore the knowledge of the patients and the relatives about the importance of salt restriction and also the importance of using the prescribed amount of salt. Through this of study it was found that knowledge of this patient and the relatives about the importance of salt restricted diet as a therapy and the relatives about the importance of salt restricted diet as a therapy in some of the heart disease has increased 10% to 70% proper explanation and teaching about the important of salt restricted diet is the reason for this increase in knowledge. All patients used the prescribed amount of salt within one day when they realized the importance.
Robertson d and keller C. “ Relationship among health beliefs. Self efficiency and exercise adherence in patients with coronary artery disease.” Many nursing care hours are dedicated to educating patients with coronary artery disease about their disease process and requisites life style changes in order to maximize life expectancy. New therapies may abort life threatening events, however control of the progression of coronary artery disease is ultimately dependent upon the patient’s cooperation in modifying risk factors. Too often health care recommendations go unheeded. The purpose of this study was to develop a model that would explain relationship among several variables that determined adherence to an exercise regimen. The variables were chosen from the health belief model and self efficiency theory. Study findings revealed a significant positive correlation between activity and perceived benefits and between activity and perceived self efficiency. There was significant negative relationship between activities and perceived barriers.
Hypotheses
The mean post test knowledge scores of self care of myocardial infarction patients will be significantly higher than their mean pretest scores at 0.05 level.
The mean post test of self care activities scores of self care of myocardial infarction patients will be significantly higher than their mean pretest scores at 0.05 level.
Operational definition
Effectiveness: It refers to the power of the bringing a change in the knowledge and activities of myocardial infarction patients regarding self care activities after the administration of health guide line and demonstration of exercise from the knowledge and performance scores.
Knowledge: It refers to the myocardial patients for correct responses regarding self care activities on the structured knowledge test item and evidence from knowledge score.
Activities: It refers to the myocardial infarction patient’s ability to perform activities regarding pulse monitoring muscle stretching exercise, stress reduction technique and tool as evidence from structured observational checklist and performance rating scale.
Self care: Those health generating activities that are undertaken by the person themselves.
Delimitation:
Investigator includes only medical college attached government hospitals.
Investigation take only hemodynamic stable myocardial infarction patient.
Methodology
The present study is a quai experimental study. The methodology presents the population of the study, sample of the study, tools and technique used in this study, data collection, and plan for analysis.
POPULATION: the population of this study consists of MI patient admitted in medical college attached Government hospitals in Gujarat state.
SAMPLE AND SAMPLING TECHNIQUE: patient who has a Myocardial infarction and hemodynamic stable admitted in medical ward. Researcher take the 35 sample that were use the purposive sampling method.
TOOL USED: the investigator has prepared tool for to check knowledge as well as activities of MI patients regarding self care. For to check the knowledge she prepared structured questionnaire and for observe the practices she prepared observational checklist and performance rating scale.
PROCEDURE FOR DATA ANALYSIS: for testing the hypothesis of the study the investigator analyze the data using frequency, percentage, standard deviation, ‘t’ test and correlation.
ANALYSIS AND DISCUSSION
The data were tabulated, analyzed in terms of objectives of the study.
Descriptive statically methods were employed for the analysis of tool. in that knowledge area mainly six area those are the related to self care, medicine, exercise, pulse monitoring, diet, stress reduction technique.
Through the analysis and interpretation of data, researcher has described following major findings of the study.
Findings related to knowledge and activities area:
There was maximum gain of knowledge in exercise area. In the exercise area mean percentage of pretest was 11.4% and mean percentage of post test was 78.97%. It indicates that the 67.55% gain in area. According to the table it is the highest gain.
Findings of sample related to knowledge of diet :There was minimum gain in the area ‘diet’. In this area mean percentage of pre test was 61.42%whereas mean percentage of post test was 99.28% which suggests that 37.86% gain in the area.
Findings of sample related to activates of the self care, stress reducing exercise and pulse monitoring:
There are 62.94% and 62.87% gain in area ‘ medications’ and ‘ pulse monitoring respectively. They are 2nd and 3rd in gain after the exercise. There was approximately equal gain in self care and stress reduction technique and providing information areas. It was 45.71% and 45.75% respectively.
Finding of sample related to muscle starching exercise:
There was maximum mean percentage of post test in muscle starching exercise
All over the knowledge score of MI patients before exposing the health guideline and demonstration, mean score of the sample was 3.14 after exposing the health guideline and demonstration, mean score of the sample was 8.11 the difference in knowledge and act score suggesting the knowledge gain by sample.
Interpretation through comparing the mean percentage of pre and post performance test in each task. The data suggest that there was maximum gain in pulse monitoring it was 68.93%gain. There was 57.66 % gain in stress reduction technique and 59.61% gain in muscle starching exercise.
It indicate the mean 8.6 score obtained by sample before demonstrate the activities and 34.2 score obtained after demonstrating the activities. to the myocardial infarction patients.
Conclusion
Knowledge deficit existed in all area of self care among samples admitted in medical ward in medical college attached government hospital in Gujarat state.
The study in terms of health guideline and demonstration was found to be effective in enhancing the knowledge and skill of the samples regarding self care activities.
IMPLICATIONS AND UTILIZATIONS
The findings of the study have several implications in the nursing practice, nursing education, nursing administration and nursing research.
Nursing practice: the study is relevant for nursing professional working in the area of cardiac center in the Indian setting. Nursing personal should plan teaching programmes and provide adequate information and guidance to such client who have myocardial infarction disease and they enhance their self care ability.
Nursing education: skill development is an essential component of professional life. The responsibility of instructor is in meeting learner’s need in acquiring relevant knowledge to underpin the development skills. Attempts should be made to ensure that the learner is taught in such a way that it allows them to construct learning in a simulated context and then apply it into real situation. The focus should be on the learner under standing the process of acquisition rather than performance.
They should develop health guideline, self instructional module , audio- visual materials, booklet, pamphlet i.e. video, tap, slides etc. on cardiac self care for utilize them for teaching learning activities.
Nursing administration: the expressed learning need of client can be considered as indicator for planning structured health programmes. nursing administration should promote and support preparation of such instructional material by nursing personnel and they should be educationally prepared at different levels to undertake such endeavors in order to assist clients, and the community in developing their self care potentials.
Nursing research: self care is a fundamental therapy for cardiac patients. Many questions remain to be answered about it. Research is needed to identify the optima ways to teach self care activities to cardiac patients. Nurses are available at all the time ti the patients in hospital. Research should be directed to exploring the nurses knowledge regarding self care of myocardial infarction patients or other cardiac diseases. There should be research studies conducted in different setting and on large sample.
RECOMMENDATIONS
The following recommendations are made on the basis of the findings of the present study.
A study can be replicated on a large sample, their findings can be generalized for a large population.
Similar study can be conducted on nursing student.
A study can be conducted develop and evaluate a self guideline n the form of pictorial booklet/ pamphlet for the illiterate group.
A comparative study can be conducted for the two groups. One group gives the treatment and other group is control group.
A study can be conducted to identify life style of the cardiac patients.
References
Websites
www.Cardiac home care.org
www.Self care of myocardial patient.org
www.diet for cardiac patients.com
www.excercise for cardiac patient.com
www.guideline for cardiac patient.com
Journals
Bennet sj, Savue MJ “ cognitive deficits among patients with heart failure”. A review of literature J. cardiovascular nurse2003.
Cardiac nurse preparedness to use self help groups as a support strategy. Journal of America nursing 1995, vol 22 p 921- 928
Heart facts dallas TX; American heart association;2005
Books
Alexander R.W. and schant, Textbook of heart.8th edition, health professional division, new York: 1998
Black J.M. Medical Surgical Nursing. 5th edition W.B. Saunders company, Philadelphia: 1999
Dossey B.G. Guzzetta C.E. “ Critical care nursing Body- mind- Spirit ,3rd edition, J.B. Lippincott: Philadelphia ; 1996
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