INTRODUCTION:

Cardiopulmonary function is the interrelationship between the workings of the heart and lungs. The most important function of the cardiopulmonary function is with respect to the flow and regulation of the blood between the heart and the lungs, a process that centers upon the connection between the heart and the lungs made through the pulmonary artery following coronary artery bypass graft (CABG), the main causes of the postoperative morbidity and mortality are postoperative pulmonary complications, respiratory dysfunction and arterial hypoxemia. CABG interferes with the lungs, causing sections of it to collapse which may lead to pneumonia. Re-inflating areas of collapsed lung may be done by a device-an incentive spirometer-that reinforces a pattern of breathing which prevents and reverses the process. An incentive spirometer is a medical device that helps patients to improve the functions of their lungs. The incentive spirometer also minimizes the chance of fluid build-up in patients recovering from rib damage. Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient’s outcome. Instructions about expected activities can also increase compliance and help prevent complications. This includes the opportunity for the patient to practice coughing and deep breathing exercises, use of an incentive spirometer. Additionally patient should be informed about the early ambulation which decreases the risk of blood clots.

STATEMENT OF PROBLEM:

A study to assess the effectiveness of structured teaching programme on knowledge regarding use of spirometer in post operative compliance in patients with cardiac surgery in selected hospitals of Surat.

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge on use of spirometer in postoperative compliance in patients with cardiac surgery in selected hospitals of Surat.

2. To evaluate the effectiveness structured teaching programme in postoperative compliance in patients with cardiac surgery in selected hospitals of Surat.

3. To find out the association between selected socio-demographic variables and knowledge on use of spirometer in postoperative compliance in patients with cardiac surgery in selected hospitals of Surat.

HYPOTHESIS:

1. H1: There will be significant difference between pre test & post test knowledge score regarding spirometer in patients with cardiac surgery.

2. H2: There will be significant association between pretest knowledge scoresregarding spirometer in post operative cardiac patients with their socio-demographic variables.

RESEARCH METHODOLOGY:

· Research approach – An evaluative research approach

· Research design- Pre experimental one group pretest – posttest design

· Variables of the study

· Independent variable: Structured Teaching Programme

· Dependent variable: Knowledge regarding spirometer

· Research setting – Selected Hospitals, Surat Gujarat

· Population –Patients with cardiac surgerywho were admitted in hospitals

· Sample size – 30

· Sampling technique – Non-probability convenient sampling technique

Tool for data collection:

Tool was divided into 3 parts:

Part –A Socio demographical variables – This part consisted of items for obtaining information about demographic variables such as age, gender, religion, marital status, educational status, occupation, income of family per month, residence.

Part – B Structured questionnaires on knowledge of spirometer

RESULTS:

Table1: Frequency and percentage distribution of socio-demographic variables.

Sr. No.

Variable

Frequency(f)

Percentage (%)

Age

· 31-40 years

· 41-50 years

· 51-60 years

· 61-70 years

6.67

33.33

Gender

· Male

· Female

76.67

23.33

Religion

· Hindu

· Muslim

· Christian

· Other

16.67

6.67

16.67

Marital Status

· Married

· Unmarried

· Divorcee

· Widow/Widower

6.67

3.33

Educational Status

· Illiterate

· Primary

· Secondary and higher secondary

· Graduation and above

13.33

3.33

33.34

Occupation

· Household

· Labour worker

· Business

· Office

Income

· Below Rs 5000/month

· Rs 5001 to Rs 10000/ month

· Rs 10001 to Rs 15,000/ month

· Above Rs 15001/month

6.67

26.66

66.67

Residence

· Urban

· Rural

76.67

23.33

Figure 1: Mean difference between pre-test and post-test knowledge score

Table 3: Range, Mean, Median and Standard Deviation of pre-test and post-test knowledge score of cardiac patients.

Knowledge

Range

Mean

Median

Standard

Deviation

Pre-test

22.46

1.72

Post-test

24.66

24.5

1.75

Testing of hypothesis

H1: There will be significant difference between pre test & post test knowledge score regarding spirometer in patients with cardiac surgery.

The above hypothesis was tested using paired ‘t’ test.

Table 4: The significance of mean difference between pre-test and post-test knowledge score of primi mothers regarding antenatal care

Group

Knowledge

Mean

t-value

P-value

Result

Cardiac patients

Pre test

Post test

22.46

24.66

17.75

2.02

p<0.05 Sig

Maximum score: = 30, n=30, df=t29 = 2.05, p<0.05

The calculated ‘t’ value (17.75) was significantly higher than the table value (t29=2.05) at 0.05 level of significance which indicates that the structured teaching programme was effective improving the knowledge of patients with cardiac surgeryregarding spirometer. Hence the null hypothesis is rejected and research hypothesis is accepted. It can be inferred that the structured teaching programme was effective improving a knowledge score of patients with cardiac surgery regarding spirometer.

Association between the pre-test score and the selected demographic variables:

It was found that there were no significant association between the pre-test score and the selected demographic variables such as age, gender, religion, marital status, educational status, occupation, income of the family, residence at 0.05 level of significance.

CONCLUSIONS:

It can be inferred that the structured teaching programme was effective improving a knowledge score of patients with cardiac surgery regarding spirometer.

RECOMMENDATIONS:

Keeping in view the findings of the present study, the following recommendations have been made for the study:

1. Similar study can be replicated on a large sample.

2. A study can be conducted with control group.

REFERENCES:

1. Freitas ER, Soares BG, Cardoso JR. Atallah AN. Incentive spirometry or preventing pulmonary complications after coronary artery bypass graft Cochrane Database Syst Rev2007 Jul18:(3).

2. Ponsky, Jetfrey, Rosen M, Brodsky J, Brody F, Ponsky JL. The Cleveland Clinic Guide to Surgical Patient Management, 1st ed. Philadelphia, PA: Mosby. 2002.

3. Christie, Armstrong, Post-op incentive spirometry. Nursing, 47(6), 2017, 54–57.

4. Soumya D, Dasgupta A. A Study on Risk Factors of Cardiovascular Diseases in an Urban Health Center of Kolkata Indian J Community Med. 2008 October; 33(4):P:271-275.

5. Johnson RG, Arozullah AM, Neumayer L. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the Patient Safety in Surgery Study. J Am CollSurg 2007; 204: P: 1188-1198.

6. Dimick JB, Chen SL, Taheri PA. Hospital costs associated with surgical complications: a reportfrom the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 2004; 199: P:531-537

7. Hulzebos EH, Helders PJ, Favie NJ. Preoperative intensive inspiratory muscle training to preventcomplications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. Oct 18 2006; 296(15):P:1851-7.

8. Ferreyra G. Long Y.Ranieri V M. Respiratory complications after major surgery. Curr Opin Cit 2009 Aug:15(4)P:342-8

9. Johnson D, Kelm C, Thompson D. The effect of physical therapy on respiratory complications following cardiac valve surgery. Chest 1996;109:P;638-44

10. Renault JA, Costa-Val R, Rossetti MB. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Rev Bras Cir Cardiovasc. 2008:23(4):p:562-9.

11. Romanini W, Muller AP, Carvalho KA, Olandoski M, Faria-Neto JR, Mendes FL. The effects ofintermittent positive pressure and incentive spirometry in the postoperative of myocardial revascularization. Arq Bras Cardiol. 2007:89(2): p:94-9.

12. Ferreira GM, Haeffner MP, Barreto SSM, Dall'Ago P. Incentive spirometry with expiratory positiveairway pressure brings benefits after myocardial revascularization. Arq Bras Cardiol. 2010:94(2): p: 230-5

13. Braun SR, Smith FR, McCarthy TM, Minsloff M. Evaluating the Changing Role of Respiratory Therapy Services at Two Hospitals. JAMA. 1981;245(20):p:2033-2037.

14. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabates, Mazo V, Briones Z, Sanchis J.Prediction of Postoperative Pulmonary Complications in a Population-Based Surgical Cohort. Anesthesiology 2010; 340: P: 937-44.

15. Varela G, Ballesteros E, Jimenez MF, Novoa N, Aranda JL. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in thoracic surgery. Eur J Cardiothorac Surg 2006:29:P; 216-220

16. Vishwanath S. Biradar &Anuradha Mhaske:the effectiveness of awareness program on the practices of biomedical waste management among nurses: A review article :International journal of Current Medical and Applied Sciences;2015,8(3), 81-87

17. Punita R Maurya, Yadunath M Joshi, Vilasrao J Kadam. A Review on Bronchial asthma. Research J. Pharmacology and Pharmacodynamics. 2013; 5(4). 257-265.

18. SK Dwivedi, Kiran Patel, Somashekar Uday, Adile SL. An Assessment of Balloon Spirometer as an Aid in Chest Physiotherapy. Research Journal of Pharmacology and Pharmacodynamics. 2015; 7(1): 27-28.

19. S. Beulah Angeline. A study to assess the effectiveness of structured teaching programme on perceived body image, self efficacy and knowledge on stoma care among patients with stoma in the selected areas of Christian Medical College (CMC), Vellore. Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 155-157.

20. K. Thilagavathi, Rajeswari Vaidyanathan. A Pilot Study to Evaluate the Effectiveness of Preoperative Teaching Protocol on Selected Postoperative Outcomes in Terms of Anxiety and Depression Status Among Women undergone Hysterectomy. Asian J. Nur. Edu. and Research 4(4): Oct.- Dec., 2014; Page 412-416.

21. Aditi Prakash. A Quasi Experimental Study to Assess the Effectiveness of Selected Nursing Interventions on the Level of Pain and Activity Tolerance among Abdominal Surgery Patients in Selected Hospital of Dehradun, Uttrakhand. Int. J. Adv. Nur. Management 2(3): July-Sept.,2014; Page 147-151.

22. Raiza Raju, Gireesh G R, Sachina B.T, Ann Barnes, Raiju Panchikkil. A Study to Assess the Effectiveness of Self Instructional Module on Cardiomyopathy and Its Management Among Staff Nurses at Selected Hospital, Mangalore.. Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 239-243

23. Vishakantamurthy, Muruli Mohan, Manasa M. Effectiveness of Self Instructional Module on Knowledge Regarding Dysrhythmias and its Management among Staff Nurses at selected Government Hospitals, Mysore. Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 244-247.

24. R. Sathiya Priya, S. Lavanya. A Study to Evaluate the Effectiveness of Sensory Stimulation to Improve the Level of Consciousness among Traumatic Brain Injury Patients With GCS 7 – 10 at Thanthai Perriyar Government Head Quarters Hospital, Erode. Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 216-220.

25. G. Dhanapriya, Jaya Thangaselvi. A Study to Evaluate the Effectiveness of Aromatherapy on Selected Adverse Effects among Patients Undergoing Chemotherapy at Cancer Centre in Madurai. Int. J. Adv. Nur. Management 3(2): April- June, 2015; Page 109-112.

26. Shiji Samuel, A. Sheeba, Rachel P George. Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Primordial Prevention of Cardiac Diseases among High School Teachers in Selected Schools, Bangalore. Int. J. Adv. Nur. Management. 2017; 5(1): 37-44.

27. Reema Mathew, G. Hemavati, Sreemini Pillai, Abhilekha Biswal. A Study to Assess the Effectiveness of Structured Teaching Programme Regarding Arterial Blood Gas Analysis and Interpretation in Terms of Knowledge among Nurses Working in ICU in Selected Hospitals of Indore (M.P.). Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 286-289.

Received on 16.04.2020 Modified on 11.05.2020

Int. J. Nur. Edu. and Research. 2020; 8(4):450-453.

DOI: 10.5958/2454-2660.2020.00100.3

Score	Grade	Pre-test		Post-test
Score	Grade	Frequency(F)	Percentage (%)	Frequency(F)	Percentage (%)
<12	Poor	00	00	00	00
13-18	Average	22	73.33	00	00
19-24	Good	08	26.67	27	90
>25	Excellent	00	00	03	10