Level of Stress and Coping Strategies of Patients undergoing Coronary Artery by pass Grafting at selected Hospitals, Guntur District with a view to Develop Instructional Module

 

Jampani Madhuri1, Korrapati Mounika2, Jonnalagadda Miryani3

1M. Sc (N) Final Year Student, NRI College of Nursing, Guntur.

2Assistant Professor, NRI College of Nursing, Guntur.

3Lecturer, NRI College of Nursing, Guntur.

*Corresponding Author E-mail: madhurijamppani07@gmail.com

 

ABSTRACT:

Background: “Stress is your body’s way of responding to any kind of demand or threat. When you feel threatened, your nervous system responds by releasing a flood of stress hormones, and including adrenaline and cortisol, which rouse the body for emergency action.” The Stress, like a virus has infected the entire population and symptoms appear everywhere. Stress; it has no age, race, gender, religion and nationality and for this purpose it is called as an "equal opportunity destroyer". When left unresolved, stress can undermine all aspect of one’s life. A research now reveals that between 70 to 80% of all illness is stress related. Most notably coronary heart disease, cancer, common cold, migraine, headaches. Some cases of female infertility, ulcer, insomnia, hypertension and the list go on1. Methodology: A descriptive study is conducted among patients undergoing Coronary Artery Bypass Grafting in a selected hospitals at Guntur district, Andhra Pradesh. Hundred patients are selected by using Convenient sampling technique. A perceived stress scale for assessing the level of stress and coping strategies inventory for assessing coping strategies are used to collect data from patients undergoing CABG. Data are analyzed by using descriptive and inferential statistics. Results: Among the 100 patients, 51(51%) had mild stress who is undergoing CABG, 44(44%) had moderate stress and only 5(5%) had severe stress. Most of the patients 52(52%) had moderate coping strategies, 48(48%) had inadequate coping strategies and none of them had adequate coping strategies. Significant association is found between the sex (χ2=7.81) and the level of stress among patients undergoing CABG. Significant association is found between coping strategies among patients undergoing CABG with their occupation (χ2=9.33) at 0.05 level of significance. Conclusion: The present study concludes that majority of patients had mild stress and moderate coping strategies of patients undergoing CABG.

 

KEYWORDS: Assess, level, Stress, Coping Strategies, CABG.

 

 


 

 

 

INTRODUCTION:

Stress is a feeling that's created when you react to certain events. It's the body's way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness. Stress becomes a problem when you become over-stressed and it starts to affect how you cope with day to day stuff. The human body responds to events that provoke stress by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. The physical changes prepare you to react quickly and effectively to handle the pressure of the moment. This natural reaction is known as the stress response. Working properly, the body's stress response improves your ability to perform well under pressure2.

 

Relaxation is one of the most effective coping strategies. By using relaxation, patient can prepare yourself for handling stressful situations. Patient become more resilient, and better able to manage anxiety and stress in general3.

 

Coronary artery bypass surgery or coronary artery bypass graft surgery, is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowing and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery4.

 

Everyone has stress in their lives. Stress can range from mild to severe. If we let the stress build up without doing anything to relax, our health can be affected. When people feel stressed by something going on around them, their bodies react by releasing chemicals into the blood. These chemicals give people more energy and strength, which can be a good thing if their stress is caused by physical danger. But this can also be a bad thing, if their stress is in response to something emotional and there is no outlet for this extra energy and strength5.

 

Coping means to invest own conscious effort, to solve personal and interpersonal problems, in order to try to master, minimize or tolerate stress and conflict. The term coping generally refers to adaptive coping strategies. That is strategies which reduces stress6.

 

According to WHO estimate by 2010, Asian Indians will represent 60% of the world cardiac patients. Asian Indians living both in India and abroad have one of the highest rates of coronary artery disease in the world, three times higher than any other population. Some report shows that the data from Karnataka picturing 91% of young individual below 40 years, who are in risk of developing coronary artery disease. It is reported that mortality from cardiovascular disease was projected to decline in developed countries from 1970 to 2015 while it was projected to all most double in the developing countries7.

The patient undergoing CABG surgery deserves to have confidence that the professional nurse taking care of them is knowledgeable, caring, efficient and effective in providing necessary care, education and reinforcement. From available literature reviewed, it was found that in effective post operative management and poor quality of life after CABG surgery is responsible for high morbidity and mortality among patients8. Therefore the investigator felt the need to assess the level of stress and coping strategies among patients undergoing coronary artery bypass grafting.

 

OBJECTIVES:

1.    To assess the level of stress and coping strategies among patients undergoing coronary artery bypass grafting.

2.    To find out the association between the level of stress and coping strategies with selected demographic variables.

3.    To develop an instructional module regarding stress management and coping strategies among Coronary Artery Bypass Grafting patients.

 

HYPOTHESIS:

H1-There will be a significant association between the stress and coping strategies of patients with their selected demographic variables.

 

METHODOLOGY:

The present study is conducted by using quantitative approach with descriptive survey design at selected hospitals Guntur district, Andhra Pradesh. The target Population for the present study are the patients undergoing Coronary Artery Bypass Grafting. A sample of 100 patients were selected by using convenient sampling technique.

 

The sample included the patients who are undergoing for Coronary Artery Bypass Grafting, In the age group of 25 years and above, willing to participate in the study, able to read and write Telugu and English, Available at the time of data collection. Patients who are already under went for Coronary Artery Bypass Grafting are excluded from the study.

 

The Questionnaire used for collecting the data based on study objectives, the instrument was divided into three sections.

·      Section A-Demographic Data

·        Section B-Perceived stress scale (PSS)

·        Section C-coping strategies inventory (CSI)

 

SECTION A:

This section consists of 6 items on personal demographic characteristics of the participant’s relation to Age, Sex, Religion, Education, Family income, Occupation.

 

 

SECTION B:

This section consists of 10 items, the questions in the perceived stress scale ask about feelings and thoughts during the last month. Each item is selected on a scale of 0 (never) to 4(very often), with a total scale range of 0-40.

 

SECTION C:

This section consists of 72 items of coping strategies. Each phrase consists of -Not at all, A little, Somewhat, much and very much. The scale consists of Questionnaire related to 9 ways of coping strategies such as Problem solving, Cognitive Restructuring, Express Emotions, Social Support, Problem Avoidance, Wishful Thinking, Self Criticism, Social Withdrawal.

 

DEVELOPMENT OF THE TOOL:

Researcher wants to assess the level of stress and coping strategies of patients undergoing CABG by using Perceived stress Scale (PSS) developed by Sheldon Cohen (1988) and coping strategies inventory (1984). For the present study researcher has taken permission from original author for perceived stress scale and coping strategies inventory was of public domain.

 

PILOT STUDY:

After obtaining prior permission from the authorities and oral consent from the subjects, the pilot study was conducted on 10 patients who were undergoing CABG. Participants have shown intrest to complete the tool. It took approximately 30 minutes for them to complete the entire tool and no difficulties are expressed by them. These subjects are not included in the main study.

 

ETHICAL CONSIDERATION:

Ethical clearance is taken from the institutional ethical committee.

 

PERIOD OF DATA COLLECTION:

The researcher collected the details of selected hospitals and the patients. Patients were selected to participate in the study applying inclusion and exclusion criteria. Data collection was done from 100 patients through administering standard tools in Telugu and English. The investigator personally administered questionnaire to the subjects in the time permitted by the hospital authorities during the period of data collection. Time taken to fill questionnaire was about 30 min and have collected back after they are filled in by the subjects. The completeness of the filling of the questionnaires was checked before collecting them back.

 

PLAN FOR ANALYSIS:

The data is planned, analyzed and interpreted based on objectives and Hypothesis by using descriptive and inferential statistics.

 

The Analysis and interpretation of data are presented under the following

Frequency and percentage Distribution patients by their Demographic Variable, Item wise analysis of questions on level of Stress and coping strategies, Mean and Standard deviation of level of stress and coping strategies of patients undergoing Coronary Artery Bypass Grafting.

 

Chi–square values will be computed to find out the association between level of stress and coping strategies among patients undergoing Coronary Artery Bypass Grafting.

 

RESULTS:

Section–1: Characteristics of the Study Sample

 

Figure 1: Percentage Distribution of Sample According to their Age

 

 

Figure 2: Percentage Distribution of Sample According to their Sex

 

 

Figure 3: Percentage Distribution of Sample According to their Religion

 

 

Figure 4: Percentage Distribution of Sample According to their Education

 

 

Figure 5: Percentage Distribution of Sample According to their Income

 

 

Figure 6: Percentage Distribution of Sample According to their Occupation

 

Section 2: Item wise analysis on level of Stress and coping strategies:

For the phrase “the past month, often have you been upset because of something that happens unexpectedly” 31(31%) patients said it was sometimes, 30(30%) said it was never, 17(17%) said it was very often followed by 14 (14%) said it was fairly often and only 8(8%) said it was almost never.

 

Regarding the phrases “In the past month, how often have you felt unable to control the important things in your life” 29(29%) said it was sometimes, 24(24%) said fairly often, 17(17%) said it is never, 16(16%) said it was almost never, 14(14%) said it was very often.

 

With the phrase “In the past month, how often have you felt nervous or stressed” 39(39%) said it was sometimes, 21(21%) said it was very often, 18(18%) said it was fairly often, 17(17%) said it was never, only 5(5%) said it was almost never.

 

Concerned with the phrase “In the past month, how often have you felt confident about your ability to handle personal Problems” 37(37%) patients said it was sometimes, 28(28%) said it was never, 13(13%) said it was fairly often and 11(11%) said it was almost never.

 

Thirty three (33%) patients said it was sometimes for the phrase “In the past month, how often have you felt that things were going your way” followed by 27(27%) said it was almost never, 18(18%) said it was never, 11(11%) said it was fairly often and only 11(11%) said it is very often.

 

As for as the phrase “In the past month, how often have you found that you could not cope with all the things you had to do?” 27(27%) patients said it was sometimes, 22(22%) said it was very often, 21 (21%) said it was never, 17(17%) said it was fairly often and 13(13%) said it was almost never.

 

With the phrase “In the past month, how often have you been able to control irritations in your life” 43(43%) patients said it was sometimes, 21(21%) said it was almost never, 19(19%) said it was fairly often, 12 (12%) said it is very often and 5(5%) said it was never.

 

 “In the past month, how often have you felt that you were on top of things” for this phrase 30(30%) said it was very often, 21(21%) patients said it was sometimes, 20(20%) said it was fairly often, and 18 (18%) said it was almost never and 11(11%) said it was never.

 

Concerned with the phrase “In the past month, how often have you been angry because of things that happened that were Outside of your control” 26(26%) patients said it was sometimes, 20(20%) said it was never, 19(19%) said it was very often. 18(18%) said it was fairly often and 17(17%) said it was almost never.

 

Out of 100 patients 33(33%) patients said it was sometimes, 22 (22%) said it was never, 18(18%) said it was fairly often and 14 (14%) said it was almost never, 13(13%) said it was very often. For the phrase “In the past month, how often have you felt that difficulties were Piling up so high that you could not Overcome them”

 

Table-1 Frequency and percentage distribution of stress among patients undergoing Coronary Artery Bypass Grafting in selected hospitals.

S. No.

Level of stress

Frequency (f)

Percentage (%)

1

Mild Stress

51

51

2.

Moderate Stress

44

44

3.

Severe Stress

05

05

 

Total

100

100

Table-2 Frequency and Percentage Distribution of Coping strategies among patients undergoing Coronary Artery Bypass Grafting in Selected Hospitals.

S. No.

Coping Strategies

Frequency (f)

Percentage (%)

1

Inadequate coping strategies

48

48

2

Moderate

52

52

 

Total

100

100

 

Table-3 Mean and Standard Deviation of Stress And Coping Strategies Among Patients Undergoing Coronary Artery Bypass Grafting

S. No.

Item

Mean (x)

Standard Deviation (S.D)

1.

Stress

19.84

6.09

2.

Coping strategies

145.68

23.32

 

Section-3

Chi-Square showing association between levels of stress and coping strategies among patients undergoing CABG with selected variables

·      Significant association is found only between level of stress among patients and Sex (χ2=7.81) which was higher than the table value (5.99).

·      Significant association is found only between coping strategies among patients and Occupation (χ2=9.33) which was higher than the table value (7.82).

 

DISCUSSION:

This study is carried out to assess the level of stress and coping strategies. Finding of the study revealed that:

 

level of stress among patients undergoing CABG:

In the present study more than half (51%) of the patients had mild stress, (44%) had moderate stress and very less (5%) had severe stress.

 

Similar to this study, which is conducted by Medisetty Bhagya lakshmi, majority of patients had moderate level of stress (43%) followed by mild stress in (57%) patients and none of them had the increased level of stress.

 

level of coping strategies among patients undergoing CABG:

In the current study out of 100 samples (48%) of the patients has inadequate coping strategies, (52%) of the patients has moderate coping strategies. None of them has adequate coping strategies.

 

Similar to this study, which is conducted by Medisetty Bhagya lakshmi, majority of patients had moderate level (91%), followed by (5%) has adequate coping strategies and (4%) of the patients has inadequate coping strategies.

 

Association of level of stress and coping strategies of patients undergoing CABG with their selected demographic variables:

The chi square values for level of stress among patients undergoing CABG, Sex (χ2=7.81) was higher than the table value. It indicates that there was significant association between level of stress among patients undergoing CABG with their sex.

 

Similar study was conducted Medisetty Bhagya lakshmi in which there was significant association between sex (χ2=3.96), Occupation(χ2=20.76) and Family Income(χ2=9.99) and level of stress among patients undergoing CABG.

 

The chi square values for coping strategies among patients undergoing CABG Occupation (χ2=9.33) was higher than the table value. It indicates that there was significant association between for coping strategies among patients undergoing CABG with their occupation. Contrary to this , a study which is conducted by Medisetty Bhagya lakshmi in which there was significant association between sex (χ2=6.85) and Residence (χ2=12.39) and coping strategies among patients undergoing CABG.

 

CONCLUSIONS:

·      Of the total level of stress among patients (51%) had mild stress with a mean 19.84 and the standard deviation was 6.09.

·      With regard coping strategies most of the patients (52%) had moderate coping strategies with a mean of 145.68 and the standard deviation was 23.3.

·      The chi square values for level of stress among patients and Sex (χ2=7.81) was higher than the table value (5.99). It indicates that there was significant association between level of stress among patients with their sex.

·      The chi square values for coping strategies among patients and Occupation (χ2=9.33) was higher than the table value (7.82). It indicates that there was significant association between coping strategies among patients with their Occupation.

 

REFERENCES:

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3.       Williams & Wilkins, Lippincott's Manual of Psychiatric Nursing Care Plans, Lippincott publications, Penisuala, 8th Edition, 2006, pp 245-51.

4.       Julia Brooking, A Textbook of Psychiatric and Mental Health Nursing, Bethlem Royal Publications, New York, APR-1992, pp156-61.

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Received on 20.11.2018       Modified on 10.12.2018

Accepted on 30.12.2018       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2019; 7(1):69-73.

DOI: 10.5958/2454-2652.2019.00017.9