Implementation and Outcomes of Cardiac Rehabilitation Educational Package: A Tertiary Center Study

 

Shatrughan Pareek¹, Narendra Kumar Kaushik²

¹Nursing Superintendent, NWR Div. Hospital, Bikaner, Rajasthan

²Principal, Govt. College of Nursing, Bikaner, Rajasthan

 

ABSTRACT:

Introduction: Non-communicable diseases are increasing drastically all over the world. Cardiac diseases are among the main causes of morbidity and mortality. Cardiac rehabilitation program is designed for the patients suffering from heart diseases. The program is a group of activities, needed to affect favourably the underlying cause of cardiac disorders as well as provide the best possible physical, social and psychological conditions. Methodology: Research approaches adopted for the study was Evaluative approach with Pre experimental design. Non-random sampling technique was used for data collection. The study was conducted on 30 staff nurses working in SPMC and AG hospitals of Bikaner, Rajasthan from May 2015 to July 2015. Results: Most of subjects (56.67%) were female. Half of subjects were in the age group of 36-45 years. The majority of participants (63.33%) were having GNM diploma. The mean pre-test and post-test knowledge scores were 7.70 and 12.70 respectively. The calculated ‘t’ value was 9.611^*, which indicates the significant gain in knowledge, through the Educational package. The study showed significant relationship between knowledge and selected variables. Conclusion: The Educational package was effective in increasing the knowledge of staff nurses regarding cardiac rehabilitation. An educational package is needed to enhance the knowledge of staff nurses regarding Cardiac rehabilitation.  The educational package will be helpful in declining the disease burden and post complications of cardiac disorders.  

 

 

INTRODUCTION:

The burden of cardiac diseases around the world is increasing with great pace.  The mortality due to cardiac disorders is projected to increase to 23.4 million in 2030. So Cardiac  diseases are a current health issue and its impact will be increased in the future¹. Cardiac rehabilitation is a comprehensive programme that prepares the patient for a full, vital and productive life within the limitations imposed on him/her by the cardiac disease.

In other words, it is the process of restoring and maintaining the patient at his/her optimal physiological, psychological, vocational and social status. Patient moves from a stage of complete dependence to a stage of independence in /her activities of daily living (ADL). The incidence of Coronary artery disease is 2 to 4 times greater among persons who have Diabetes². One fourth of total deaths occurs due to Coronary vascular diseases. According WHO, Coronary artery disease death rates are three times higher than Coronary vascular diseases³.

 

Cardiac rehabilitation’s implementation after cardiac diseases is less than 50% in recent years. The program has positive health benefits among the coronary heart disease patients. Cardiac rehabilitation is secondary prevention, it is comprehensive and long term program involving medical evaluation, exercises, cardiac risk factor modification, education, guidance and counseling^4,5. India has a large population of Cardiac patients. This gives the scenario for effective cardiac rehabilitation program and improved health care delivery system to the patients. Cardiac Rehabilitation is widely practiced all over the world as secondary prevention, for health promotion and rehabilitation as well. But the concept has not adopted in India⁶. Cardiac rehabilitation programme led by a nurse can significantly improve the health parameters in heart disease patients. Nurses can fill treatment gaps in the risk factor management of patients with cardiac disease⁷. Cardiac Rehabilitation program has been shown to enhance the quality of life and reduce mortality among myocardial infarction patients. The activities of cardiac rehabilitation will provide a significant improvement for heart disease patient’s care that ultimately results in better health outcomes. Health care professionals should be involved in Cardiac rehabilitation program in order to increase patients’ performance in the program⁸. The purposes of cardiac rehabilitation are to improve the quality of life, increase life expectancy and Prevention of further cardiac disorders. There are 4 phases in the cardiac rehabilitation program².

 

During the clinical postings and working period, the researchers has observed that many of the patients with heart diseases are re-admitted to the hospital due to insufficient cardiac care and non-adhere to the cardiac rehabilitation programme. Therefore the investigators strongly feels that the nurses need to be well-oriented with the cardiac rehabilitation program, So that they can educate the patients properly.

 

OBJECTIVES:

1)  To assess the pre-test and post-test knowledge regarding Cardiac rehabilitation among staff nurses.

2)  To find out the association between post-test knowledge regarding cardiac rehabilitation with selected demographic variables.

 

MATERIALS AND METHODS:

Present study was conducted at SPMC and AG hospitals of Bikaner, Rajasthan during May 2015 to July 2015.  A total of 30 staff nurses were selected for the present study. Sampling was performed among staff nurses working in SPMC and AG hospitals of Bikaner, Rajasthan in age group of 25-55 years. Research approaches adopted for the study was Evaluative approach with Pre- experimental design. Purposive sampling technique, which is a non-probability sampling approach was used to obtain data. Both male and female were included in the study. In this study the population consisted of staff nurses working at SPMC and AG hospitals of Bikaner, Rajasthan. In the present study, independent variable was the Educational package and dependent variable was Knowledge of the staff nurses regarding cardiac rehabilitation. Staff nurses, who were working in Cardiac units, Medical wards and Cardiac OPD, were selected from the study. The reliability and validity of the tool was established by the researchers. Pre-test was done on day 1^st by administering a structured knowledge questionnaire on cardiac rehabilitation followed by Educational package regarding cardiac rehabilitation than post-test was done by the questionnaire on day 10^th to evaluate the level of knowledge regarding cardiac rehabilitation.

 

Ethical consideration:

Ethical clearance was obtained from the concerned authority. The study participants were staff nurses working in SPMC and AG hospitals of Bikaner, Rajasthan. Written informed consent was taken from the subjects.

 

RESULTS:

Table: 1  Socio-demographic characteristics and clinical profile of the subjects.                                                                                       N=30

Demographic and clinical profile		Frequency (f)	Percentage (%)
1. Age group (In years.)	25-35 year 36-45 year 46-55 year	09 15 06	30 50 20
2. Gender	Male Female	13 17	43.33 56.67
3. Educational qualification	GNM diploma Graduate in Nursing Postgraduate and above	19 09 02	63.33 30 06.67
4. Experience	<3 years 4-7 years 8-10 years 11 years and above	03 11 09 07	10 36.67 30 23.33
5. Area of experience	Cardiac unit Medical ward Cardiac OPD	13 11 06	43.33 36.67 20

 

Table: 2  Mean, standard deviation and ‘t’ value of pre and post-test knowledge scores of staff nurses            N=30

Group	Mean		Standard deviation		‘t’ value
	Pre-test	Post-test	Pre-test	Post-test
Staff Nurses	7.70	12.70	2.168	5.875	09.611*

 (^*  - significant at 0.05 level of significance)

 

Table:-03 Association between post-test knowledge scores and the selected demographic variables                  N=30

S. No	Demographic  characteristics	Chi-square  (χ2) value	Degree of freedom	Level of significance
1.	Age (yrs.)	13.261*	2	Significant
2.	Gender	0.836	1	Non-Significant
3.	Educational qualification	11.261*	2	Significant
4.	Years of experience	5.837	2	Non-Significant
5.	Areas of experience	9.628*	2	Significant

(^*  - significant at 0.05 level of significance)

 

DISCUSSION:

Cardiac disorders are increasing in both developed and developing countries. There are many internal and external factors are responsible for heart diseases. The diseases have great role in high morbidity and mortality rate. Cardiac rehabilitation program is very crucial for the cardiac patients to prevent further complications of heart diseases. The program is a group of activities to achieve the health status after cardiac disorders. Nurses play a vital role in the compete care of cardiac patients. The investigators undertaken the present research project to assess the knowledge of staff nurses regarding cardiac rehabilitation. In the study, 50% participants were in age group of 36-45 years. The educational qualification was mainly GNM diploma. The mean post-test knowledge score was more than mean pre-test knowledge score regarding cardiac rehabilitation. The calculated ‘t’ value (t=09.611) was greater than table value, which represents the significant gain in knowledge, through the educational package. Girish et al and Valamurti et al. also conducted studies on cardiac rehabilitation, which reported that teaching programmes were effective in increasing the knowledge of nurses^3,9. Findings of the studies are also supporting the present study. 

 

Various studies have been done on Nurses regarding increasing the knowledge through structured teaching program. The studies were effective in updating the knowledge of staff nurses, which is similar to the present study^10-16. The knowledge reading cardiac rehabilitation is an independent variable. Valamurti et al reported that there was significant relationship between selected variables and the knowledge, which is supporting the present study⁹. The study was effective enough to increase the knowledge of staff nurse regarding cardiac rehabilitation.

 

CONCLUSION:

Cardiac disease remain a chronic condition, and complications may develop in the future. So it is a moral responsibility of health personnel to make the community aware of the modifiable risk factors like physical inactivity, stressful life style and obesity. Life style changes and modifications in routine exercises may reduce the cardiac diseases and its possible complications. The researchers communicate that staff nurses have limited knowledge regarding cardiac rehabilitation. The educational package was significantly effective in enhancing the knowledge of staff nurses. There is need of special training, instructional modules and teaching program for nurses to increase their knowledge and practice regarding cardiac rehabilitation. It will be a effective strategy in minimizing the heart diseases and its complications. Treatment cost and disease burden may be reduced by implementation of cardiac rehabilitation program. In addition, further study  should be done with  differences groups and ways to develop better program to provide maximum benefits of cardiac rehabilitation in all patient groups.

 

CONFLICT OF INTEREST:

Nil.

 

FUNDING:

Self funded.

 

REFERENCES:

1.     www.wikipedia//cardiac rehabilitation

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5.     Hasnain M Dalal, Patrick Doherty, Rod ST, Cardiac rehabilitation.BMJ. 2015;351

6.     Rajendran, A., Manoj, S., Karthikeyan, D. & Davis, S. Cardiac rehabilitation for CABG patients in South Indian setup: a prospective study. Indian J. Physical Med. Rehabil.2004;15:23–33.

7.     Jiang X, Sit JW, Wong TK. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. J Clin Nurs. 2007 Oct;16(10):1886-97.

8.     Ahyana, S.K., Charuwan Kritpracha, and Ploenpit T. Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: a literature review. Nurs Media J Nurs. 2013;3(1):541-556

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10.   Pareek Shatrughan, Mehta Santosh, Goyal Harindarjeet. A structured teaching programme to assess the knowledge and practices of cancer patients regarding Radiotherapy induced skin reactions: A Quasi Experimental study. Int. J. Nur. Edu. Research. 2017; 5(2): 198-202.

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13.   J. Lissa, Saraswathi K.N., Munirathanama K. Effectiveness of Structured Teaching Programme on Knowledge regarding Management of Pressure sore among the nurses in selected Hospital at Mysore. Asian J. Nur. Edu. Res. 2014; 4(1): 119-122.

14.   Mangesh Jabade, Sangeetha Moreshwar. A Study to Evaluate the Effectiveness of Planned Teaching Programme on Obesity and its Consequences among Adolescents in Selected Private High Schools. Int. J. Nur. Edu. Res. 2014; 2(1): 43-49.

15.   Summayya Abareen. A study to assess the effectiveness of structured teaching programme on knowledge & prevention of Heat Stroke among the adolescent studying in selected high schools at Gulbarga. Int. J. Adv. Nur. Management. 2014; 2(1): 28-30.

16.   Kamaljit Kaur, Vadivukkarassi P, Kiran Bala. A Pre-Experimental Study to Assess the Effectiveness of Planned Teaching Programme on Knowledge Regarding Menstrual Hygiene Among Adolescent Girls in Selected Schools of Mohali, Punjab. Int. J. Nur. Edu. Res. 2014; 2(4): 362-368.

 

 

 

Received on 10.08.2018           Modified on 11.09.2018

Accepted on 17.10.2018     © A&V Publications all right reserved