Cardiovascular Nursing Journal

Comparison of the effect of education through lecture and multimedia methods on knowledge, attitude, and performance of cardiac care

Majid Haghjoo

Abstract

Aim.The aim of this study was to compare the effect of education through lecture and multimedia methods on knowledge, attitude, and performance of cardiac care nurses about temporary pacemaker care.

Background.Cardiac dysrhythmias are among the most common cardiovascular disorders. Temporary pacemaker insertion is a treatment or prevention method for cardiac dysrhythmia. Nurses are the main group to provide the care for patients with temporary pacemaker, so it is necessary to educate them in an effective and efficient way.

Method.This was an experimental study conducted in 2015 on 52 cardiac care nurses working in ShaheedRajaei cardiovascular center. All 52 nurses were randomly divided in 2 groups of education through lecture and multimedia. The level of nurses' knowledge, attitude and performance was evaluated before and three weeks after education and the effect of education was examined using Mann-Whitney and Wilcoxon Signed Ranks Test through SPSS version 22.

Findings.Before intervention, the median and interquartile range of knowledge levels for lecture and mul-timedia groups were 12.5 (10-14) and 11 (9-12), respectively, and after that, they increased to 17 (15- 19) and 17 (13- 19). The median and interquartile range of performance levels for lecture and multimedia groups changed from 29 (26- 30) and 30 (26- 31) to 34 (32- 35) and 34 (32- 35), respectively. The knowledge and performance levels increased in both methods. But there was no statistically significant difference between these two methods. Before intervention, the median and interquartile range of attitude levels for lecture and multimedia groups were 62.5 (60-64) and 64 (63-66) and after that, they changed to 64 (60-64) and 63 (61-64), showing that intervention has no effect on attitude level in any of these two groups.

Conclusion.There is no difference between the effectiveness of education through two methods of lecture and multimedia software on cardiac care nurses' knowledge, attitude and performance. In the other words, multimedia software method is as effective as lecture method. Education using multimedia software can be considered as a proper method for increasing demand in staff education. Proper infrastructure and optimal training programs are prerequisites to effectiveness of education through multimedia software method.

Comparative study of pulse pressure variation and central venous pressure in evaluation of fluid status in mechanically ventilated patients after cardiac surgery

alireza azad

Abstract

Aim.This study aimed to compare pulse pressure variation (PPV) with central venous pressure (CVP) in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery.

Background.In clinical area, assessment of body fluid and determination of the intravascular volume after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not.

Method. In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaee Heart Center, Tehran, Iran, were recruited in the study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP, systolic and diastolic pressures (for calculating pulse pressure and its variation) were recorded by bedside monitoring. Cardiac Index (CI) was measured by non invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 20, using statistical tests.

Findings. The mean changes of CVP, before and five minutes after fluid administration, were significantly different (10.10±6.01 mmHg and 12.37±6.34 mmHg, respectively, p=0.015). The mean changes in arterial pulse pressure, before and five minutes after fluid administration, were significantly different (16.94±8.32 mmHg and 12.77±4.02 mmHg, respectively, P=0.005). At the cut point 2.8 lit/min/m2 for CI, the sensitivity and specificity values for PPV>13%, were 0.71 and 0.61, respectively. Also, at the same cut point, the sensitivity and specificity values for CVP<5mmHg, were 0.11 and 0.84, respectively. These findings suggest a higher diagnostic power of PPV compared to CVP to assess fluid volume.

Conclusion.It seems that in the mechanically ventilated patients after heart surgery, PPV dynamic index is preferred to CVP static index to evaluate and maintain fluid volume.

Relationship between prodromal (warning) symptoms and referring time in patients with myocardial infarction

Sakineh Sabzevari

Abstract

Aim.The aim of the study was to determine the relationship between prodromal symptoms and referring time in patients with myocardial infarction in cardiac care unit of Rafsanjan Imam Ali-ibnAbi-Talib hospital in 2012.

Background.There is little information about how people respond to prodromal symptoms of myocardial infarction and how fast they refer to medical centers.

Method.In a cross-sectional study, 175 patients with acute myocardial infarction were recruited. For data collection, lasting about seven months, a questionnaire consisting of demographic data, risk factors for heart disease, prodromal symptoms, referring time and causesof delay was used. Questionnaires were completed by the researcher with bedside interview with patient and using medical records. Data were analyzed in SPSS version 18 using descriptive statistics (mean, standard deviation, frequency distribution and percentage) and inferential statistics (Chi-square test and Pearson coefficient).

Findings.The majority of patients were male (76.6%) and middle-aged (53.1). Of 175 patients, 132 (75.4%) had experienced warning sign, two weeks before the cardiac event and 43 (24.6%) had experienced no symptoms. Also, 51 patients (38.6%) had referred the physician office, clinic or hospital after experiencing warning signs. The time duration of patients arrival to hospital ranged from 15 minutes to 1500 minutes. There was a statistically significant correlations between prodromal symptoms and referring time in patients with myocardial infarction (p=0.007). Findings showed that the average total referring time was 206.94 minutes.

Conclusion. Recognizing prodromal symptoms leads to earlier seeking treatment in patients with myocardial infarction. Education for increasing public awareness of warning symptoms, especially for those with family history and risk of cardiovascular disease seems to be an appropriate strategy.

The effect of education by video self-assessment on nurses’ knowledge and performance in cardiopulmonary resuscitation

Zahra Daram

Abstract

Aim. This study aimed to examine the effect of education by video self-assessment on nurses’ knowledge and performance about cardiopulmonary resuscitation (CPR).

Background.Cardiopulmonary arrest is one of the main medical emergencies and one of the major causes of death around the world. Cardiopulmonary resuscitation is the critical components of basic life support in response tocardiopulmonary arrest. The success ofcardiopulmonary resuscitationrequiresproficiencyandperformance of resuscitation group.

Method. This was a clinical trial study conducted on 80 nurses that were randomly divided into experimental and control group. Participants in control group received traditional training and experimental group experienced video self-assessment after traditional training. Knowledge on CPR was evaluated with a valid questionnaire including multiple choice questions. Psycho-motor skills were measured through a visual checklist observing CPR performance of the participants on a manikin. Outcome variables were measured three times (before, immediately after, and two months after training). Data were analyzed by the SPSS through repeated measures analysis.

Findings. Comparing the mean score of knowledge between the groups at before, immediately after, and 2 months after training did not show any statistical significant difference. Immediately, and two months after intervention, the mean score of performance of the experimental group was significantly higher than that of control group.

Conclusion.Education by Video self-assessment is an effective method to improve nurses’ performance in CPR.

The effect of supportive educational intervention on sleep before coronary artery bypass graft surgery

nesa Mousavi malek

Abstract

Aim. The purpose of the present study was to examine the effect of supportive educational intervention on quality of sleep before coronary artery bypass grafting surgery.

Background. Patients who are waiting for surgery, experience high levels of stress and anxiety due to invasive nature of the procedure. This experience may influence their sleep quality. Disturbed sleep could lead to worsening the disease condition and reduces the process of recovery. Using non-pharmacological methods such as Benson muscle relaxation, deep breathing and guided imagery could be safe and useful for solving patients’ sleep problems before surgery.

Method. The present study was a quasi-experimental clinical trial in which 160 patients undergoing coronary artery bypass grafting surgery who hospitalized in cardiac surgery wards and cardiac intensive care units of selected hospitals of Tehran University of Medical Science were recruited and divided into two experimental (n=80) and control (n=80) group. Demographic data questionnaire was given to the patients at the first day of hospital admission. The control group received routine care. The intervention group received routine care and supportive educational intervention for at least two days between 4 and 6 p.m. All of the patients filled Groningen sleep quality scale in the day of surgery. Data analyzed by SPSS version 16.

Findings. Before surgery, the mean score of sleep quality was 4.6±5.50 in intervention group and 10.76±1.27 in control group. There was a statistically significant difference between the experimental and control group in terms of sleep quality as the experimental group reported higher quality sleep than control group (P<0.0001).

Conclusion. Implementation of non-pharmacological methods such as relaxation, deep breathing, and guided imagery could be a good alternative method for hypnotic and sedative drugs. This could be one of the nursing interventions before coronary artery bypass grafting surgery as a safe, available and useful method.

Factors influencing the time interval from the onset of clinical symptoms to thrombolytic infusion in patients with acute myocardial infarction

Mohammad taghi Moghaddamnia

Abstract

Aim. The purpose of this study was to determine factors influencing the time interval from the onset of clinical symptoms to thrombolytic infusion in patients with acute myocardial infarction

Background.Acute myocardial infarction is one of the most common causes of death and disability all over the world including Iran. The major cause of myocardial infarction, is the clot of blood in the coronary atherosclerotic plaques. Immediate administration of thrombolytic therapy in these patients can be life-saving.

Method. This study was a cross-sectional descriptive-analytical study in which 98 patients with acute myocardial infarction hospitalized in selected Rasht therapeutic centers were recruited by convenience sampling in 2014.Data collection instrument included demographic information form and researcher-made questionnaire to obtain patients' clinical, situational and cognitive factors. Data were collected through patients medical records and interview. Data were analyzed in SPSS version 21 using non-parametric Mann-Whitney and Kruskal Wallis tests and P<0.05 was considered as significant.

Findings. The mean time interval from the onset of symptoms to the beginning of thrombolytic infusion was 247.2±182.4 minutes.In this study, the most pre-hospital delay was related to making decision for care seeking and in-hospital delay time was the least one. The patients had delay in referring to the hospital mainly due to the following: negative history of previous heart disease) p=0.001), lack of awareness about the signs and symptoms of the disease )p<0.0001), female gender) p=0.026 ,(an underlying diabetes )p= 0.001),low levels of education (p=0.003), low income )p=0.044),mild pain )p=0.001), and self-medication )p=0.003).The main cause for delay was related to the lack of awareness of the symptoms and ignorance of their importance.

Conclusion. The time interval from the onset of symptoms to thrombolytic infusion in patients with acute myocardial infarction was not satisfactory. It is necessary to provide required training programs for increasing the individuals’ awareness about the symptoms of the disease and the importance of treatment with thrombolytic drugs, as soon as possible, in order to minimize the time delay, thereby, increasing the efficiency of treatment, and ultimately reducing the mortality and disability of patients.

Adherence to sodium restriction and adherence to it in patients with heart failure: A review literature

Kazem Akhondzadeh

Abstract

Aim. The aim of this paper is to review studies related to sodium restriction and adherence to this restriction in patients with heart failure.

Background. In the last decade, there has been a dramatic increase in the prevalence and incidence of chronic heart failure. Non-pharmacological and non-surgical therapies in the management of chronic heart failure play an important role, and low sodium intake, by reducing fluid retention, improves symptoms and prevents worsening of the disease, but adherence to nutritional regimes is often less than adherence to medications.

Method. We reviewed studies published over the recent 15 years regarding sodium restriction in patients with heart failure. These were searched out through scientific databases, including PubMed and Science Direct by the keywords adherence, chronic heart failure, low-sodium diet, sodium restriction, low salt diet and their Persian equivalents.

Findings. In the reviewed studies, sodium intake assay and patient's adherence to sodium restriction were different. Although sodium restriction is known as the basic management of heart failure, butthere are not consensus about its usefulness. It was also found that there is no specific guidelines for sodium restriction in heart failure, and that a small percentage of patients follow sodium restriction. Few studies have been conducted regarding related factors of adherence to the sodium restriction diet in patients with heart failure. Also, non-pharmacological methods including education and counseling have not been successful in improving patients’ adherence.

Conclusion. Further research with higher methodological quality, larger sample size and the use of appropriate and accurate approach to measure sodium intake is needed. To achieve a sodium restriction diet is possible, but difficult. Although, there is no consensus on the exact amount of the reduction of daily sodium intake, but seems that reduction in sodium intake can improve symptoms and quality of life in patients with heart failure. Theory-based and family-based interventions may be able to help improving patients’ adherence to sodium restriction diet, although more studies are essential to be conducted.

Cardiopulmonary resuscitation for pregnant women: A brief review of medical staff knowledge

Esmael Shariat

Abstract

Aim.The aim of this literature review was to study medical staff knowledge about cardiopulmonary resuscitation for pregnant women.

Background.Cardiopulmonary resuscitation (CPR) in pregnancy is a rare event. Although rare, CPR during pregnancy is very important, because saves the life of the mother and fetus. Knowledge of medical staff and their formal training on CPR in pregnancy are such factors affecting the maternal and fetal outcomes. Knowing the state of medical staff knowledge in this area will help recognize the existing gaps and plan for improvement.

Method.In this narrative review, databases such as Medline, Science direct, Ovid, Scopus, SID, Magiran and Barakat Knowledge Network System was used to data collection. Articles published between 2000-2016, were searched out by the keywords "cardiopulmonary resuscitation", "pregnancy", "knowledge","medical Staff", both inPersian and English. Inclusion criteria was content similarity to subject under study.

Findings. Out of 20 retrieved papers, 4 cross- sectional analytical articles published between 2008-2012 was selected and reviewed for describing the state of medical staff knowledge on CPR in pregnancy. The knowledge of medical staff was in poor level in different areas such as proper pregnant patient positioning during CPR, sequence of bag- mask ventilation and intubation, defibrillation (application during pregnancy, paddle placement location, energy and considerations), the use of drugs and therapeutic doses and cesarean section in within 4-5 minutes following CPR failure.

Conclusion.The knowledge of medical staff about CPR in pregnancy is poor. Establishing continuous educational course to improve their knowledge is recommended.