INTRODUCTION:

Heart beats represent the life and lack of it pronounces death. As we enter the twenty first century heart attack technically named myocardial infarction, threaten to occur more frequently as the disease has reached alarming proportions in the developed countries. Cardiovascular Diseases are the World’s largest killers, claiming 17.1 million lives a year. Over 80% of Cardiovascular Disease (CVD) deaths take place in low and middle income countries. ¹ An estimates of the year 2003, 16.7 million people around the globe die of cardiovascular diseases each year. This is over 29% of all deaths globally.² In 2006, CVD caused 831,000 deaths i.e. 34 percent of all deaths. Heart disease is the leading cause of death; the main form, CHD, caused 425,000 deaths in 2006. The annual number of deaths from CVD increased substantially from 1900 to 1970 and remains high. In 2006, an estimated 81.1 million persons in the United States had some form of CVD, 74.5 million had hypertension, and 17.6 million had CHD.³

Cardiovascular diseases are the leading cause of death globally; contributing to around 17.5 million deaths worldwide in 2005, 80% of those deaths occur in lower and middle income countries. Once a disease of the affluent, cardiovascular disease has now emerged as the number one killer in India. The prevalence of cardiovascular disease in individuals over 35 years currently stands at 10%. The WHO has warned that cardiovascular disease related mortality in India will increase to epidemic proportion by 2020.⁴

Ischemic Heart Diseases or Coronary Heart Diseases are spreading like an epidemic and have been appropriately designed as the number one killer. According to the statistical estimates about cardiovascular diseases provided by the American Heart Association for the year 2004; 79,400,000 Americans have one or more forms of cardiovascular disease for example, High blood pressure- 72,000,000; Coronary Heart Disease- 15,800,000; Myocardial infarction- 7,900,000; Angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)- 8,900,000 and stroke- 5,700,000. Cardiovascular diseases claimed 871,500 lives in 2004 (36.3 percents of all deaths or 1 of every 2.8 deaths).⁵

Ischaemic Heart Disease (IHD), otherwise known as Coronary Artery Disease, is a condition that affects blood supply to the heart. The blood vessels are narrowed or blocked due to the deposition of cholesterol plaques on their walls. This reduces the supply of oxygen and nutrients to the heart musculature, which is essential for proper functioning of the heart. This eventually results in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack or sudden death. As the heart is the pump that supplies oxygenated blood to the various vital organs, any defect in the heart immediately affects the supply of oxygen to the vital organs like the brain, kidneys etc. This leads to the death of tissue within these organs and their eventual failure or death.⁶

Once the heart ceases to function, a healthy human brain may survive without oxygen for up to 4 minutes without suffering any permanent damage. Unfortunately, a typical EMS (Emergency Medical Service) response may take 6, 8 or even 10 minutes. For effective reperfusion of myocardium, the victim must receive timely Basic Life Support (BLS).

RM. Norris did a study on circumstances of out of hospital cardiac arrest in patients with Ischaemic Heart Disease. Objectives: To discover the circumstances of out of hospital cardiac death irrespective of resuscitation attempts. Design: Prospective community study over the two years 1994 and 1995. Setting: The health districts of Brighton, South Glamorgan, and York, UK. Subjects: 1290 victims of sudden death or cardiac arrest caused by coronary heart disease who were under 76 years of age. Interventions: Basic and advanced life support for witnessed cardiac arrests. Main outcome measures: Survival to reach hospital and for 30 days after the arrest. Results: 35 (35%) of 101 patients (mean age 64) whose arrest was witnessed by a doctor or paramedic survived for 30 days compared with 9 of 464 (2%) whose arrest was witnessed by a relative or bystander at home (mean age 66) and 15 of 200 (8%) whose arrest was witnessed in a public place (mean age 61). None of the 525 victims of an unwitnessed arrest survived but the majority of those whose arrest was witnessed had complained of new symptoms before the arrest. Victims who were given basic life support by relatives or bystanders had better survival (14 of 183 (8%)) than those who were not (10 of 481 (2%), p < 0.001). Of the 20% of arrests that occurred in public places, few were in places where public access defibrillators would now be available. Conclusions: The burden of out of hospital cardiac arrest is mainly in the home but most victims have premonitory symptoms. Public education to seek help urgently for new or prolonged chest pain seems the most promising method to address the problem.⁷

Rachael T. Donohoe, Karen Haefeli did a study on public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London. Introduction: The lay public has limited knowledge of the symptoms of myocardial infarction (“heart attack”), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low. Aims: To explore public perceptions of myocardial infarction and cardiac arrest; investigate perceptions of cardiac arrest survival rates; assess levels of training and attitudes towards CPR, and explore the types of interventions considered useful for increasing rates of bystander CPR among Greater London residents. Methods: A quantitative interview survey was conducted with 1011 Greater London residents. Eight focus groups were also conducted to explore a range of issues in greater depth and validate trends that emerged in the initial survey. Results: Chest pain was the most commonly recognized symptom of “heart attack”. Around half of the respondents were aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain this difference was limited. The majority overestimated that at least a quarter of cardiac arrest patients in London survive to hospital discharge. Few participants had received CPR training, and most were hesitant about performing the procedure on a stranger. Conclusions: Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency. ⁸

Debra K. Moser, Kathleen Dracup, Lynn V. Doering did a study on effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden. Objectives: Study objectives: (1) To compare the effects of 3 methods of cardiopulmonary resuscitation (CPR) training for parents of infants at risk for cardiac or respiratory arrest on anxiety, perception of control, and sense of burden; and (2) to identify parents’ attitudes about CPR training and willingness to perform CPR if needed. Methods: A longitudinal, controlled trial was conducted with parents and other caretakers of high-risk infants. Subjects were recruited from 5 level III neonatal intensive care units. We enrolled each of 578 subjects in 1 of 4 groups: (1) CPR-Video; (2) CPR-Didactic; (3) CPR-Social Support; or (4) control (no CPR training). Of these, 335 completed the entire study. Data were collected at baseline, and 2 weeks and 6 months after CPR training. The main outcomes measured were perceived anxiety, control, and burden related to caring for a high-risk infant and attitudes about responding to an emergency. Results: Subjects reported moderately high anxiety, sense of burden, and feelings of loss of control before CPR training. Within groups, subjects in all 3 treatment groups reported improvement in perceptions of anxiety, control, and burden 2 weeks after CPR training, with continued improvement evident 6 months after CPR training (P = .001). In contrast, perceptions were unchanged in the control group. Among groups, at 2 weeks there were significant differences in means between control and CPR-Didactic groups (P = .01), and at 6 months there were significant differences in means between control and CPR-Didactic groups (P = .01) and between control and CPR-Social Support groups (P = .01). Conclusion: CPR training is an important intervention for promoting a sense of control and reducing the anxiety and sense of burden experienced by parents of neonates at risk for cardiopulmonary arrest.⁹About 75% to 80% of all out of hospital cardiac arrests happen at home, so being trained to perform cardiopulmonary resuscitation can mean the difference between life and death for a loved one. Effective bystanders CPR, if provided immediately after cardiac arrest, can double a victim’s chance of survival. Death from sudden cardiac arrest is not inevitable. If more people knew CPR, more lives could be saved. If CPR and defibrillation is not provided to someone who experiences cardiac arrest, brain death starts to occur in 4 to 6 minutes. If bystanders CPR is not provided, a sudden cardiac arrest victim’s chance of survival fall 7% to 10% for every minute of delay until defibrillation. Few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of collapse. ¹⁰

Taylor S, Dracup K, conducted a study to determine the attitude towards CPR training and subsequent CPR use of 172 CPR trained family members of cardiac patients. Results: Only 14 (8.1%) reported feeling too responsible for their family member. 141 (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR and CPR training should be recommended to families of patients at risk for sudden cardiac death.¹¹

Moser DK (2000) conducted a study on ‘impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients’. Objectives: The objectives of this study were to determine whether there are differences in emotional distress among spouses of recovering cardiac patients based on level of perceived control, and to determine whether perceived control can be enhanced by cardiopulmonary resuscitation (CPR) training. A total of 219 spouses of cardiac patients recovering from an acute cardiac event were enrolled and 196 completed the study. Spouses were assigned to either a no-treatment control group or one of two CPR training groups. Perceived control and emotional adjustment were measured at baseline and again 1 month after subjects received CPR training. Spouses with high perceived control were less anxious, less depressed, and less hostile at baseline. Perceived control increased significantly in spouses after both CPR training groups, but was unchanged in the control group. After a partner's cardiac event, perceived control is important for psychological recovery in spouses and can be increased by CPR training.¹²

STATEMENT OF THE PROBLEM:

“Effect of Basic Life Support training on knowledge, skills and perceived control of immediate relatives of patients diagnosed with Ischaemic Heart Disease admitted in selected hospitals of Pune city.”

OBJECTIVES OF THE STUDY:

1. To assess the baseline knowledge, skills and perceived control of immediate relatives of patients diagnosed with ischaemic heart disease regarding basic life support.

2. To evaluate the knowledge, skills and perceived control of immediate relatives after training of basic life support.

3. To correlate between the knowledge, skills and perceived control of immediate relatives regarding basic life support.

4. To assess the relation between the knowledge, skills and perceived control of immediate relatives with selected background variables.

ASSUMPTIONS:

1. Ischaemic heart disease patients are at risk of developing cardiac arrest.

2. Basic Life Support training will improve the knowledge, skills and perceived control of immediate relatives of patients diagnosed with ischaemic heart disease to handle an emergency.

LIMITATIONS:

1. Sample is limited to immediate relatives of patients diagnosed with ischemic heart disease.

2. Immediate relatives who are willing to participate in the study.

MATERIALS AND METHODS:

Research approach:

This study uses the quantitative research approach. A pre-experimental approach was considered best suited to the study, which aims to find out the effect of Basic Life Support training on knowledge, skills and perceived control of immediate relatives of patients diagnosed with Ischaemic Heart Disease.

Research design:

This study uses pre-experimental one group pretest and post test design.

Group	Pre intervention	Treatment	Post intervention
One group	O₁	X	O₂

O₁: Baseline observation

X: Intervention

O₂: Post intervention observation

Variables:

Independent Variable: Training of Basic Life Support

Dependent variable: The knowledge, skills and perceived control of immediate relatives

Research setting:

The study was conducted in selected hospitals of Pune city.

Population:

The accessible population consisted of the male and female immediate relatives of patients diagnosed with Ischaemic Heart Disease admitted in the selected hospitals of Pune city.

Sample:

The sample consisted of 40 immediate relatives of the patients diagnosed with Ischaemic Heart Disease admitted in selected hospitals of Pune city.

Sampling technique:

The technique used was non-probability convenient sampling to select the sample for the study.

Development of the tools:

The tools used in this study for data collection are:

A baseline proforma, knowledge based questionnaire, observational checklist and perceived control scale was prepared with the help of review of literature, personal experience and discussion with experts.

Description of the tool:

Section I: Structured questionnaire

a) Demographic profile

b) Knowledge based questionnaire

Section II: An Observational Checklist

Section III: Perceived Control Scale

Section I: A Structured Questionnaire

The objectives of the questionnaire were as follows:

1. To collect the personal demographic data of the immediate relatives.

2. To assess the knowledge of the immediate relatives regarding Heart Attack and Basic Life Support.

The researcher used multiple choice questionnaire to assess the knowledge of the immediate relatives. It consists of 15 items based on knowledge of immediate relatives regarding Heart Attack and Basic Life Support.

Section II: An Observation Checklist

The purpose of the observation checklist was to record the skills of the immediate relatives regarding Basic Life Support. This consists of 12 items. Test answered on the basis of 1-4 point scale. Score ranges from 12-48 and higher the score the greater the level of skills.

Section III: Perceived Control Scale

The purpose of the perceived control scale was to record the perceived control of immediate relatives in performing Basic Life Support in an emergency situation. It consists of 4 items, 2 positive and 2 negative statements. This test was conducted on the basis of 1-5 point rating scale. Score ranges from 4-20. In this tool the negative items scored reversibly.

Data Gathering Process:

The written permission was obtained from selected multispecialty hospitals of Pune having cardiac care unit set up prior to the data collection. The data collection was done in the period of one month in August 2010.

The study was explained in detail to the samples and the investigator obtained their consent for participating in the study. The data collection was done from 9.00 a.m. to 6.00 p.m. The training was given individually or in group as per the availability of the samples. Pre-test questionnaire and Perceived Control Scale was administered in the presence of investigator to avoid interaction between samples and after 20 minutes the completed questionnaire was taken back. Then the samples were asked to demonstrate the skills in performing Basic Life Support. The investigator taught them definition of Heart Attack, recognition of Heart Attack and demonstrated them the steps in performing Basic Life Support on manikin. After training, the samples were given an opportunity to clear the doubts and practice the procedure of Basic Life Support. Then post-test questionnaire and perceived control scale was administered to them and after 20 minutes it was taken back. Then the samples were asked to redemonstrate the steps of Basic Life Support and the investigator observed their skills. This pattern of data gathering process was continued till the desired sample size was achieved.

Plan for Data Analysis:

The investigator planned to analyze data from the questionnaire, observation checklist and perceived control scale using frequency and percentage and paired ‘t’ test. Relationship between knowledge, skills and perceived control before and after training was found using chi-square method.

RESULTS:

Significant findings of the study were:

I. Description of the Participants According to Demographic Variables:

It was observed that maximum participants i.e. 40% were sons, and minimum 2.5% were granddaughters in relationship with the patients. Majority of the participants i.e. 45% were in age group of 30-45 years, and minimum 10 % were above 60 years. Majority of the participants i.e. 55% were males and 45% were females. Majority of the participants i.e. 62.5% were graduate and above, and minimum 2.5% were illiterate. Maximum 57.5% participants were in the category of others, and minimum 12.5% were doing business. Majority of the participants i.e. 95% had not received and 5% had received information related to emergency/ Basic Life Support. Majority of the participant i.e. 95% had not seen and 5% had seen Basic Life Support being given to unresponsive patient. Majority of the participants i.e. 52.5% had not heard on radio or read in newspapers, magazines about Basic Life Support and 47.5% had heard or read about Basic Life Support.

II. Comparison of knowledge score in pre test and post test by paired ‘t’ test:

It was found that the ‘t’ value was 44.52 was greater than the table value at 0.05 level of significance. ‘p’ value was highly significant. Therefore Basic Life Support has increased the knowledge score of the samples with regard to Heart Attack and Basic Life Support.

III. Comparison of skills score in pre test and post test by paired ‘t’ test:

It was found that ‘t’ value was 121.75 was greater than the table value at 0.05 level of significance. ‘p’ value was highly significant. Therefore Basic Life Support has increased the skills score of the samples with regard to Basic Life Support.

IV. Comparison of perceived control score in pre test and post test by paired ‘t’ test:

It was found that the ‘t’ value 68.53 was greater than the table value at 0.05 level of significance. The ‘p’ value was highly significant. Therefore Basic Life Support has increased the perceived control score of the samples with regard to Basic Life Support.

V. Correlation between knowledge, skills and perceived control:

It was found that the correlation value between knowledge and perceived control was 0.95, between knowledge and skills was 0.94 and between skills and perceived control was 0.97. It shows that knowledge, skills and perceived control were highly correlated at 0.05 level of significance. N=40

Sr. No.	Correlation Among	Corr. Value	p value
1	Knowledge and Perceived Control	0.95	0.000**
2	Knowledge and skills	0.94	0.000**
3	Skills and Perceived control	0.97	0.000**

VI. Association of knowledge, skills and perceived control with selected background variables:

It was found that the knowledge is not associated with the selected background variables. As participants were not having knowledge, their skills and perceived control also very poor. Thus knowledge, skills and perceived control were not associated with selected background variables.

CONCLUSION:

· The findings show that the participants were having poor knowledge about Heart Attack and Basic Life Support; they were having poor skills about Basic Life Support and were having poor perceived control in handling emergency situation (cardiac arrest) in pre test.

· The finding shows that there is an increase in knowledge, skills and perceived control after Basic Life Support training in post test.

· The finding shows the knowledge, skills and perceived control are highly correlated with each other and they are not at all associated with selected background variables.

· These results suggest that providing Basic Life Support training to immediate relatives of patients diagnosed with Ischaemic Heart Disease improves the knowledge and skills of relatives regarding Basic Life Support. And also improves the perceived control of immediate relatives to handle the emergency situation if it occurs with their patient and save the life of the patient.

RECOMMENDATIONS:

· A similar study can be replicated on larger population for generalizations of findings.

· A similar study may be replicated with randomization in selected participants.

· A similar study may be replicated on other cardiac high risk patients and relatives.

· A study can be carried out to see the effect of videotape information.

· An exploratory study can be conducted to find out the factors that hinder the nurses in providing Basic Life Support to high risk patients and their relatives.

· A study can be replicated on any lay persons in community setting.

REFERENCES:

1. World Health Organization. Cardiovascular Diseases. Available from: URL: http://www.who.int/cardiovascular_diseases.

2. World Health Organization. Burden of cardiovascular disease. Geneva: WHO report; 2003.

3. National Heart Lung and Blood institute. NHLBI overview and planning documents 2009 factbook, chap4, Disease statistics.

4. Kuppuswamy V, Choo W, Gupta S. Epidemic of cardiovascular diseases. Asian Journal of Cardiovascular Nursing 2004; 12(2):25-27.

5. American Heart Association. Current in Emergency Cardiovascular Care. Winter. 2005-2006;16(4): 202-220

6. Black JM, Hawks JH. Medical-Surgical Nursing: Clinical Management for positive outcomes. 7^th ed. St. Louis: Saunders; 2004.

7. RM Norris. Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease. Journal of acute and critical care. Resuscitation [serial online] 2002 Nov ; 55( 2):[p.157-165]. Available from: URL: http:// www.heartand lung.org.

8. Rachael T. Donohoe, Karen Haefeliand Fionna Moore. Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London. Resuscitation 2006 Oct;71(1): [p.70-79].

9. Debra K Moser, Kathleen Dracup, Lynn V. Doering. Effect of cardiopulmonary resuscitation training for parents of high risk neonates on perceived anxiety, control and burdon. [cited Sept. 1999]: 28(5): (p.326-333).

10. American Heart Association. Currents in Emergency Cardiovascular Care. Winter. 2005-2006; 16(4): 202-220.

11. Taylor S, Dracup K, Guzy P, Moser D. Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients? Am J Emerg Med. 2005 Mar; 3(2): 114-9.

12. Moser DK, Dracup K Res. Nurse Health. Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients. The Ohio State University, College of Nursing, Columbus, OH 43210, USA. Pubmed, 2000 Aug;23(4):270-8.

Received on 23.02.2015 Modified on 18.03.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 143-148