INTRODUCTION:

Ischemic Heart Disease has remained the leading cause of death in India. According to the report generated by Registrar general of India, Coronary heart disease (CHD) caused 17% of total deaths and 26% of adult deaths in 2001-2003, whereas in 2010-2013 death rate has increased to 23% of total and 32% of adult deaths. Over the last 60 years in India, CHD prevalence increased from 1% to 9-10% in urban population which is relatively higher than rural population i.e. <1% to 4-6% (Gupta R, 2016).

According to government of NCT of Delhi, The major causes of deaths in Delhi are Heart Attack, pneumonia, tuberculosis, cancer and diabetes mellitus in which Heart Attack has the highest rate of death per year i.e. 10.7% of total population in Delhi died due to heart attack in 2000 and 14.12% of total population died due to heart attack in 2013. Heart attack caused 14% of total deaths in Delhi (Nanda JD, 2017).

Acute Myocardial Infarction is defined as a clinical condition involving myocardial ischemia which shows an evidence of myocardial injury. The clinical event involves increase and decrease of cardiac biomarkers, correlation with clinical symptoms supports as evidence, changes in the electrocardiogram and imaging evidence of new loss of viable myocardium (Hinkle, Brunner & Suddharth, 2014). The electrocardiogram (ECG) is a diagnostic procedure which is most frequently used in cardiac emergency. ECG helps in recording the electrical activity of heart and reveals cardiac abnormalities. It is the first or can be the only indication of cardiac disease. A nurse may be the first heath care profession to observe the electrocardiogram when the client is an acute distress. In order to prevent any complication or emergency nurses should know about the ECG interpretation because cardiac emergencies can occur suddenly and it gives little time for the staffs to take critical decision (Levine Ethan, 2017).

Instructional methodologies are new approaches in education, intervened for sharing information and learning. Best possible results can be achieved using different instructional methods as it helps to provide guidance and imparting knowledge to students. When various types of instructional methodologies introduced to the students, it will influence and improve their base of knowledge. In this study the researcher aimed to assess the effectiveness of assisted self directed learning, whether this will be helpful for the nurses to retain their knowledge (Sooper T, 2016).

MATERIALS AND METHODOLOGY:

In the present study researcher used Quasi-experimental, One group Pre-test Post-test research design. Through purposive sampling technique 60 registered nurses working in cardiology department of National Heart Institute, New Delhi was included as the subjects of this study.

Tool:

A structured knowledge questionnaire was developed to assess the effectiveness of Assisted self directed learning. The tool was consists of two sections. Section A included baseline variables of staff nurses: age, gender, professional qualification in nursing, year of experience, departments where working and in-service education programme regarding ECG. Section B includes 25 multiple choice questions regarding definition and meaning, anatomy, physiology and conduction system of heart, basic ECG and interpretation of myocardial infarction.

The ASDL was prepared for two sessions namely, Session 1: Power point illustrations which discussed the anatomy, physiology and conduction system of heart, definition of electrocardiogram and its purpose, leads and its placement, interpretation of ECG paper, analysis of ECG paper and interpretation of myocardial infarction. Session 2: Handbook and practice worksheet comprises 10 practices ECG’s which includes a handbook consists of content area in details and one worksheet consists of 10 ECG’s for practice included assessment of pulse rate, regularity, P waves, PR interval, QRS interval and ST segment changes. Each session lasted 1 hour.

Knowledge questionnaire administered to the subjects and ASDL was provided immediately after data collection. Post ASDL data same questionnaire was administered one week after the session given during ASDL to evaluate the effectiveness of ASDL. Ethics Committee clearance was obtained from All India Heart Foundation.

RESULTS:

Frequency distribution and percentage table were used to present the demographic variables. Paired ‘t’ test was calculated to compare the significant difference between pre and post test knowledge scores and to find out the association of post test knowledge scores and selected demographic variables Chi-square test was used.

Table 1: Description of demographic variables of the study subjects. N=60

Sample characteristics

Frequency

Percentage

Age (in years)

Below 25

26-30

31-35

Above 35

Gender

Male

Female

Professional Qualification

Diploma in GNM

B.sc. Nursing

Post basic B.sc. Nursing

73.3

4.7

Year of experience

<3 year

3-6 years

>6 years

13.3

6.7

Departments where working

General Ward

Intensive care unit

In-service education

Attended

Not attended

Table 1 shows that 73.3% of study subjects were below 25 years, majority of subjects were female (80%), half of the study subjects were had GNM diploma (50%). Majority of the staff nurses had less than 3 year of experience (80%) were from Intensive care unit (53%). Majority of the subject did not attended in-service education (85%).

Table 2: Effectiveness of the assisted self directed learning on knowledge of staff nurses. N=60

	Mean score	SD	MD	SE	‘t’ value
Pre-test	11.53	2.66	7.98	0.492	22.25
Post- test	19.51	2.75	7.98	0.492	22.25

In table 2 showed post-test mean score of staff nurses if higher than the pre-test mean scores indicating a statistically improvement in the knowledge of staff nurses regarding basic ECG and interpretation of MI (p=0.05)

Fig 1 showed line graph showing significant difference of the pre-test and post-test knowledge scores to assess the effectiveness of ASDL which indicates that the lowest score of pre-test was between 3-6 scored by 2% of the staff nurses and the highest score was between 15-18 obtained by 3% of staff nurses. However, during the post test the lowest score was between 9-12 scored by around 2% and highest score was between 24-27 scored by 1% of the staff nurses.

DISCUSSION:

Findings of the present study revealed a significant gain in knowledge after administration of ASDL programme on various areas of “Basic ECG and interpretation of myocardial infarction”. These findings are in line with the other studies noted. H Zhang (2013), knowledge scores calculated after 4months of learning through lecture method and one month after providing handbook on ECG for self learning were higher than the pre-test knowledge scores. Yet another study by Reshma Sabu et al. (2016) who reported post test mean score (23.8±3.08) which was higher than pre test mean score (7.93±3.12) which revealed that the Structured teaching programme was effective in increasing knowledge regarding basic ECG.

It seems that the assisted self directed learning programme was effective for all irrespective of their demographic characteristics expect departments where they were working.

The study conducted did not have a control group and size of sample was small therefore generalization of the findings were restricted. Same research could be replicated with larger sample size and generalization of findings could be done with control group. Post test data was collected after one week of the ASDL administration hence long term affects of intervention could notcalculated.

Certain areas of ASDL in this study were less effective. Hence same study can be conducted to assess the effectiveness of ASDL after modification of ASDL.

CONCLUSION:

It is important for the nurses to have adequate knowledge regarding ECG to prevent the life threatening condition in the hospital which will decrease the mortality rate of patients with cardiac diseases and providing the educational programs to the nurses. During pre-test, nurse’s knowledge regarding basic ECG and interpretation of MI was poor. Assisted self directed learning and handbook of ECG improved knowledge of staff nurses regarding basic ECG and interpretation of MI.

REFERENCES:

1. Gupta, R. (2016). Trends in coronary health disease epidemiology in India. Annuals of global health, 82(2), 307-315.

2. Nanda, JD. (2017). Delhi enjoying life but losing heart. Times of India.

3. Hinkle, JL, Brunner & Sudharth. (2014). Textbook of medical surgical nursing. Lippincott Williams and Wilkins, 8^th edition.

4. Levine, Ethan. (2017). Electrocardiology. The heart organization medscape. Available from: https://emedicine.medscape.com/article/1894014-overview

5. Soper, T. (2016). Knowledge into learning: comparing lecture, e-learning and self study take home pocket instructional methodologies with nurses. Nursing open journal, 4(2), 76-83.

6. Zhang, H. (2012). The effectiveness of an education program on nurse’s knowledge of electrocardiogram interpretation. International emergency nursing journal, 21(4), 247-51

7. Reshma, sabu, N., subhashini, K., padma, Indra Arumugam. (2017). Assess the knowledge regarding electrocardiogrma among final year b. sc. students in Narayana College of nursing, Nellore. International journal of applied research, 3(6), 88-90

Received on 21.09.2019 Modified on 18.10.2019

Int. J. Nur. Edu. and Research. 2020; 8(1):98-100.

DOI: 10.5958/2454-2660.2020.00020.4