A Study to Assess the Effectiveness of Self Instructional Module on Cardiomyopathy and Its Management Among Staff Nurses at Selected Hospital, Mangalore.

 

Raiza Raju1, Gireesh G R2, Sachina B.T3,  Ann Barnes3, Raiju Panchikkil3

1M.Sc Nursing Student, Shree Devi College of Nursing, Mangalore

2Associate Professor, Department of Medical Surgical Nursing, Yenepoya Nursing College, Mangalore

3Lecturer, Department of Medical Surgical Nursing, Yenepoya Nursing College, Mangalore

*Corresponding Author Email: gireeshsachin@gmail.com

 

ABSTRACT:

An evaluative study was conducted to find out the effectiveness of self instructional module on cardiomyopathy and its management. Fifty staff nurses were selected based on non probability sampling technique and the result of the study revealed that in Anatomy and Physiology of Heart the pre-test mean knowledge score was 47.33% (1.42±0.673) where as post-test mean knowledge score was 90% (2.7 ± 0.505) with an effectiveness in the knowledge score as 44% (1.32± 0.835) where as knowledge regarding Cardiomyopathy the pre-test mean knowledge score was 31.66% (3.8± 1.246) where as post-test mean knowledge score was 81.17% (9.74± 0.922) with effectiveness in the knowledge score as 49.5% (5.94± 1.268). In Management of cardiomyopathy) the pretest mean knowledge score was 27.86% (4.18± 1.625) whereas post test mean knowledge score was 79.87%(11.98± 0.958) with an effectiveness in the knowledge score as 52%(7.8± 1.654). The study results indicate that least effectiveness in the knowledge score was found regarding to anatomy and physiology of heart and highest effectiveness in the management of cardiomyopathy.

 

KEYWORDS: Cardiomyopathy, Effectiveness, Self instructional module, Knowledge score, Mean score.

 

 


INTRODUCTION:

As marvelous as this system is, our heart is very vulnerable to damage from the things we do to it, like smoking, eating an unhealthy diet or putting it under stress. Or you may be born with a heart condition.  When our heart’s functions become compromised, this is known as cardiovascular disease, a broad term that covers any disorder to the system that has the heart at its centre. Mostly people are facing various cardiac problems in their stress filled professional lives that cause imbalances in their personal lives too. It’s high time for people to think and over check their daily activities and eating habits to keep safe on their heart. "You have a really big heart" is usually a wonderful compliment — except when it comes from a cardiologist and the term cardiomyopathy crops up in the conversation.

An oversized heart usually isn't a good sign. Among cardiovascular diseases, cardiomyopathy is the leading cause of heart transplantation and sudden cardiac death. Cardiomyopathy (CMP) is a disorder in which disease of the cardiac muscle fibers reduces myocardial contractility or dispensability. The World Health Organization has classified CMP conditions into three general types: dilated (congestive), hypertrophic and restrictive. According to the American Heart Association 2009publication on heart disease statistics, inUnited States, at least 0.7% of cardiac deaths are attributable to cardiomyopathy.Worldwide cardiomyopathy with high morbidity and mortality rate is a reason for the need of heart transplantation in persons under forty years of age. It is difficult to assess the prevalence of cardiomyopathy accurately as many patients with this condition go undiagnosed and may present with sudden cardiac death5. In Indian context, dilated cardiomyopathy has a prevalence rate of 0.04% and incidence being 5 to 8 cases per 100,000 of population per year, increasing steadily. The overall prevalence of hypertrophic cardiomyopathy is low and has been estimated to occur in 0.05-0.2% of the population whereas prevalence of restrictive cardiomyopathy is very rare. A prospective study was conducted in Hyderabad to identify the epidemiological variables in HCM among 127 hypertrophic cardiomyopathy (HCM) cases. An increased male preponderance (78.7%) was observed when compared to females (21.3%).  31% of the HCM probands had a familial history of the disease, which is in conformation with other reports. Further HOCM was found to have a higher familial status 41% compared to ASH 27%, while 66% individuals with concentric HCM had a family history. The study thus reveals the complexity of HCM and suggests that modes of inheritance other than autosomal dominant may be encountered in a subset of HCM especially in asymmetric septal hypertrophy, apical, concentric and mid cavity obstruction subsets and hence a mixed model of inheritance is the best fit for such complex disorders.

 

A prospective study was conducted in USA to determine the effectiveness of surgical management of hypertrophic obstructive cardiomyopathy among 178 patients. The 5-year late survival of patients undergoing valve operation plus septalmyectomy was 51%, and multivariate testing confirmed the adverse influence on late survival (p=0.008), as well as adverse influences of increasing age (p=0.016) and return to cardiopulmonary bypass for mitral valve replacement (p=0.038). At follow-up 136 patients (94%) had New York Heart Association class I or II symptoms. Thus the investigator concluded that for patients with hypertrophic obstructive cardiomyopathy, septalmyectomy alone or in combination with coronary artery bypass grafting produces effective symptom relief, excellent long-term survival, and a low risk of late cardiac death.

 

A descriptive study was conducted in Karnataka to assess the effectiveness of self instructional module on care of patients with cardiomyopathy among 30 staff nurses. The findings of the study revealed that majority of the staff nurses had an average knowledge score in the pretest. The mean percentage of knowledge score in the post test was high 84.39% when compared to pretest knowledge score 50.29%. There was significant difference between pretest and post test knowledge scores (t29= 21.99, p>0.05, tab value 2.045). Thus the investigator concluded that nurses lack knowledge in caring for patients with cardiomyopathy.

A retrospective study was conducted in Europe to determine the thromboembolic complications in patients with arrhythmogenic right ventricular cardiomyopathy among 126 patients. The result has shown that annual incidence of thromboembolic complications was 0.5/100 patients. Thus the study revealed that ARVC may be complicated by thrombosis. Annual incidence of such complications is significantly lower than reported for left ventricle failure. Anticoagulation should be used in ARVC patients with large, hypokinetic RV and slow blood flow. Patients with severe forms of ARVC, thrombus formation in the RV and/or spontaneous echocardiographic contrast are at higher risk of a poor outcome. A prospective study was conducted in USA to evaluate the prognosis and mortality associated with cardiomyopathy among 119 patients with hypertrophic obstructive cardiomyopathy, have been followed up for an average of 4·6 years. The findings of the study revealed that familial or suspected familial disease was present in 39 patients. The commonest mode of death was sudden (19 patients). Young males with familial disease tended to be more prone to die suddenly than other groups. The estimated mortality was 15% at five years and 35% at ten years. The development of atrial fibrillation may represent a natural progression in the course of the disease. Thus the investigator concluded that hypertrophic cardiomyopathy is associated with some major complications that lead to poor prognosis and increased mortality.

 

MATERIAL AND METHODS:

Research Approach:

In the present study an evaluative approach was used to assess the effectiveness of Self Instructional Module (SIM) on cardiomyopathy and its management among staff nurses in a selected hospital at Mangalore.

 

Research Design:

The research design selected for this study was pre-experimental one group pre-test - post-test design. In one group pre-test – post-test design the investigator introduce base measure before and after planned exposure, which is depicted in O1 and O2 respectively. In this study the base measure was questionnaire oncardiomyopathy and its management. The administration of SIM is depicted as ‘X’.

 

Setting of the Study:

The setting is the place or type of surroundings where something is positioned or where an event takes place. The pretesting, testing the reliability of tool and pilot study was conducted in Vinaya Hospital, Mangalore. The main study was conducted in Indiana Hospital and Heart Institute, Mangalore.

 

Population:

The term population refers to the aggregate or totality of all the objects, subjects or members that confirm to a set of specifications. In the present study the population comprised of staff nurses working in a selected hospital, Mangalore.

 

Sample:

Sample refers to the subset of a population selected to participate in a research study. In the present study, the samples were fifty staff nurses working in Indiana Hospital and Heart Institute during the time of data collection.

 

Sampling Technique:

Non probability sampling involves deliberate selection of particular units of the population for constituting a sample. Convenience sampling is a type of non probability sampling in which the population elements are selected for inclusion in the sample based on the ease of access. Convenience sampling entails using the most conveniently available people as study participants. Convenience sampling was used to collect data from the samples.

 

Sampling Size:

In this study, the sample size were 50 staff nurses working in Indiana Hospital and Heart Institute, Mangalore.

 

Selection and Development of Tool:

Tools are the procedures or instruments used by the researcher to collect data.The tool was prepared on the basis of the objectives of the study

 

RESULTS:

Percentage distribution of staff nurses according to their age in year

 

 

Percentage distribution of staff nurses according to their professional  qualification.

 

 

Figure 2: Bar diagram showing the percentage distribution of staff nurses according to their professional qualification.

 

 

Percentage distribution of staff nurses according to their years of experience as staff nurse.

 

 

 

Percentage distribution of staff nurses according to their current area of experience.

 

 

Figure 4: Bar diagram showing the percentage distribution of staff nurses according to their area of experience.

 

 

 

PART II: Analysis of Pre-Test and Post-test Knowledge Scores of Staff Nurses Regarding Cardiomyopathy and its Management:

In order to find out the level of the knowledge scores of the staff nurses, a five-point scale was used. Categorization of the staff nurses on the basis of the level of knowledge was done as follows, scores between 0-6 shows very poor knowledge level, scores between 7-12 shows poor knowledge level, scores between 13-18 shows average knowledge level, scores between 19-24 shows good knowledge level, scores between 25-30 shows knowledge level was very good.

 

 


Table 1: Assessment of Pre-test and Post-test level of knowledge score on cardiomyopathy and its management. n=50

Level of knowledge

Score levels

Number of respondents

Percentage (%)

Pre test

 

Post test

Pre test

Post test

Very poor

Poor

 

0-6

7– 12

5

40

 

0

0

10

80

0

0

Average

 

13 – 18

5

 

0

10

0

Good

 

19 – 24

0

 

24

0

48

Very good

 

25 – 30

0

 

26

0

52

Total

 

30

50

 

50

100

100

Maximum score = 30

 


Table 2: Pre-test and post-test Knowledge scores  Regarding cardiomyopathy and its management.  n=50 

Area

Maximum score

Respondents knowledge

Paired ‘t’ test

Mean

Mean%

SD

Pre-test(X)

30

9.4

31.33

2.595

15.63

Post-test(Y)

30

24.42

81.4

1.263

Effectiveness(Y-X)

15.02

50.07

2.653

‘t’ table value  = 1.6766 at p < 0.05, df=49

 


Area Wise Effectiveness of SIM on Cardiomyopathy and its Management.

Table 3: Area wise mean, SD and Mean percentage of pre-test and post-test knowledge scores of staff nurses regarding cardiomyopathy and its management. n = 50

Sl.no

Area

Statements

Respondents knowledge level

‘t’ value

Pre-test(X)

Post-test (Y)

Effectiveness  (Y-X)

Mean±

SD

Mean

%

Mean±

SD

Mean

%

Mean±

SD

Mean

%

 

1

Unit I (Anatomy and Physiology of Heart)

3

1.42± 0.673

47.33

2.7± 0.505

90

1.32± 0.835

44

11.8

2

Unit II (Cardiomyopathy )

12

3.8± 1.246

31.66

9.74± 0.922

81.17

5.94± 1.268

49.5

33.2

3

Unit III (Management of cardio myopathy)

15

4.18± 1.625

27.86

11.98± 0.958

79.87

7.8± 1.654

52

33.3

Total

30

9.4±2.595

31.33

24.42± 1.263

81.4

15.02± 2.653

50.07

15.6

Table value =1.6766 , P<0.05

 

 


DISCUSSION:

Part I: Description of the Demographic Characteristics of Staff Nurses:

In the present study, majority of the subjects 45 (90%) were in the age group of 21-30 years, highest percentage 36(72%) had BSc.nursing degree, most of the staff nurses 45(90%) had ≤1year of experience, majority 14(28%) were working in cardiac post operative wards and majority of the staff nurses 49(98%) were not having any previous exposure to inservice educational programmes regarding cardiomyopathy and its management. The findings were supported by a study conducted to assess the effectiveness of a teaching guide on ECG interpretation and monitoring, to find out the competency of staff nurses and to determine the factors influencing their competency as expressed by them among 30 staff nurses. Statistical analysis shows that there was a significant increase in competency scores (t29 = 8.11, p<0.05). Area-wise competency analysis shows that there was a significant increase in knowledge (t29=9.35 p<0.05) and skill (t29=4.78, p<0.05) scores which indicates that the teaching guide was effective.

 

 

 

Part II: Analysis of Knowledge Scores of Staff Nurses Regarding Cardiomyopathy and its Management:

The findings of this study reveals that in the pre test, majority 80% of the sample obtained scores ranging between 7 and 12 and none of the staff nurses scored above the score 18. Assessment of the level of knowledge of the staff nurses after the administration of Self Instructional Module shows that majority of the respondents 52% have very good knowledge score and 48% have good knowledge score on cardiomyopathy and its management. It shows that Self Instructional Module on cardiomyopathy and its management was very effective in improving the knowledge level of staff nurses. The findings were supported by a study conducted to evaluate the effectiveness of self instructional module on knowledge of basic life support among 40 staff nurses. Pre test and post test knowledge scores were compared and the findings were analyzed statistically. The post test knowledge scores were significantly higher than the pre test knowledge scores which indicate that the self instructional module on knowledge of basic life support was highly effective in enhancing the knowledge level of staff nurses.

 

 

Part III: Evaluation of Effectiveness of the SIM on Cardiomyopathy and its Management:

The knowledge score of staff nurses on cardiomyopathy and its management reveals that, post test mean knowledge score was higher 24.42 (81.4%) with SD of 1.263 when compared with pre test mean knowledge score which was 9.4 (31.33%) with SD of 2.595.The mean effectiveness score was 15.02 (50.07%) with SD of 2.653.Area wise comparison of effectiveness of SIM also shows significant difference between pre test and post test. Maximum effectiveness 52% was observed incardiomyopathy and its management. These findings were supported by a study conducted in Kolkata among 30 staff nurses to find out the effectiveness of Self Instructional Module on selected cardiac emergency drugs for the nursing personnel working in critical care unit. Paired ‘t’ test was computed to find out the difference between the mean pre-test and post-test knowledge score. There was significant difference between the pre-test score and post-test score (t29 =11.2, p < 0.05).The study findings reveals that the SIM was effective in increasing the knowledge of nursing personnel.

 

Part IV: Testing of Hypotheses:

a)      Testing of Hypothesis,H1:

To find out the difference between pre-test and post-test knowledge scores of staff nurses who received self instructional module on cardiomyopathy and its management, the following research hypothesis and null hypothesis was stated:

 

H1:   The mean post test knowledge score of staff nurses will be significantly higher than the mean pre test knowledge score at 0.05 level of significance.

 

H01: There will be no significant difference between mean pre-test and post-test knowledge scores of staff nurses at 0.05 level of significance.

 

The hypothesis was tested using paired ‘t’ test. The ‘t’ value was calculated and compared with table value to analyze the difference in knowledge of staff nurses regarding cardiomyopathy and its management. Results reveal that the post test mean knowledge score (81.4%) was higher than the pre test mean knowledge score (31.33%) with a mean difference of 50.07%. The calculated ‘t’ value,15.63 was greater than the table value 1.6766 at 0.05 level of significance. Therefore, the null hypothesis was rejected and research hypothesis was accepted indicating that gain in knowledge was not by chance. Hence H1 is accepted and it is concluded that there is significant gain in knowledge after implementation of self instructional module.

 

The above findings were supported by a study conducted to evaluate the effectiveness of an information booklet on knowledge regarding complications of left ventricular assistive devices for cardiomyopathy among 50 staff nurses. One group pre test post test design was used. The finding of the study has shown that their mean post test knowledge score was significantly higher than their mean pre-test knowledge score (t49=36.29; p < 0.01). The study has shown that the information booklet was effective in increasing the knowledge score of staff nurses.

 

b)      Testing of Hypothesis,H2

To evaluate the association of knowledge score with selected demographic variables, the following null hypothesis was stated:

 

H2: There will be significant association of the pre test knowledge scores of staff nurses with selected demographic variables at 0.05 level of significance.

 

H02: There will be no significant association between pre-test knowledge score of staff nurses on cardiomyopathy and its management with selected demographic variables at 0.05 level of significance.

 

The above study findings is supported by another study conducted in USA among 30 critical care nurses to describe the knowledge regarding dysrhythmias in critically ill patients and relate this knowledge level to certain demographic variables .A descriptive survey design was used. The analysis of the test results and their comparison with the demographic variables shows that there was no significant relationship between variables age, professional qualification, years of experience as staff nurse, area of experience and their perceived knowledge level.

 

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Received on 18.08.2014           Modified on 09.10.2014

Accepted on 30.10.2014           © A&V Publication all right reserved

Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 239-243