INTRODUCTION:

By now, Non-communicable disease has become a major epidemic in the world. This is due, in part to a rapid transition in life style leading reduced physical activity, changing diets and increased to tobacco use. This trend is present in all categories of the societies rich and poor in developed and developing countries¹. The world health organization estimates that 60 percent of the world’s cardiac patients will be an India. Coronary artery disease appears a decade earlier with the age incidence in developed countries. The peak period is attained between 51-60 years. Men are more affected than women. Ischemic heart diseases contribute from one-third to one-half of all deaths due to cardiovascular diseases. 3.8 million men and 3.4 million women in the world die every year from ischemic heart diseases, and in Europe about 2 million. The highest mortality rate from ischemic heart diseases occurs in India, China and Russia. Coronary heart disease (CHD) is a major cause of mortality and morbidity all over the world. According to a report of World Health Organization (WHO) in 2005, cardiovascular disease (CVD) caused 17.5 million (30%) of the 58 million deaths that occurred worldwide. While the prevalence and mortality due to CHD is declining in the developed nations the same cannot be held true for developing countries. There has been an alarming increase over the past two decades in the prevalence of CHD and cardiovascular mortality in India and other south Asian countries^2-5. India is going through an epidemiologic transition whereby the burden of communicable diseases have declined slowly, but that of non-communicable diseases (NCD) has risen rapidly, thus leading to a dual burden. There has been a 4-fold rise of CHD prevalence in India during the past 40 years. Current estimates from epidemiologic studies from various parts of the country indicate a prevalence of CHD to be between 7% and 13% in urban and 2% and 7% in rural populations. Epidemiologic studies have shown that there are at present over 30 million cases of CHD in this country. A study by Gajalakshmi et al during 1995–1997 showed that CVD deaths are the highest (38.6%) in urban Chennai. Similar data are published by Joshi et al from Andhra Pradesh. The Global Burden of Diseases Study reported that the disability-adjusted life years lost by CHD in India during 1990 was 5.6 million in men and 4.5 million in women; the projected figures for 2020 were 14.4 million and 7.7 million in men and women respectively⁶. The prevalence of cardiovascular disease is reported to be 2-3 times higher in the urban population as compared to the rural population. The risk increases with age and is greater among women than men. In the United States, over one million cause of MI are reported annually. Incidence is greater in men than women⁷.

MATERIALS AND METHODS:

Research Approach:

An evaluative approach was adopted for this study.

Research Design:

The research design selected for this study was Pre experimental One group pretest, post test design.

Setting of the study:

The study was conducted in KMC Hospital, Trichy.

Population:

The target population selected for the study were the patients who are diagnosed as myocardial infarction admitted in KMC hospital, Trichy.

Sample:

The sample who were diagnosed as myocardial infarction and admitted in cardiology ward in KMC Hospital, Trichy.

Sample size:

The sample size consists of 60 patients with myocardial infarction.

Instrument and scoring procedure:

The Instrument consists of 4 parts.

PART – 1:

It consists of demographic variable of myocardial patients were age, sex, marital status, education, occupation, monthly income, residence, and number of myocardial infarction attack.

PART – II:

Structured interview schedule was used to assess the level of knowledge regarding cardiac rehabilitation among patients with myocardial infarction. It consists of 25 multiple choice questions with four options for each question and patients are expected to choose one correct option. Correct answer is given a score as one. Total score is 25.

KNOWLEDGE SCORE:

Level of knowledge

Score

Percentage

Adequate knowledge

Moderately Adequate knowledge

Inadequate knowledge

17-25

9 -16

1 – 8

67 – 100%

34 - 66%

0 - 33%

PART – III:

Five point likert scale was used to assess the attitude of patients regarding cardiac rehabilitation among patients with myocardial infarction. It has 10 dichotomous type of questions out of which 5 are positive statements and 5 are negative statements. Total score is 50.

For the Positive response score was measured as follows:

Strongly Agree - 5

Agree - 4

Uncertain - 3

Disagree - 2

Strongly disagree - 1

For the negative statements the score was measured as follows:

Strongly Agree - 1

Agree - 2

Uncertain - 3

Disagree - 4

Strongly disagree - 5

PART – IV:

Structured Observational check list was used to assess the practice of patient regarding cardiac rehabilitation among patients with myocardial infarction. Total score is 10. It consists of 10 items with alternative response of “yes” or “no”.

Attitude score:

Level of Attitude

Score

Percentage

Favourable attitude

Moderately favourable

unfavourable attitude

35-50

18-34

1-17

67-100%

34 -66%

1 -33%

PART – IV

Check list was used to assess the practice regarding cardiac rehabilitation among patients with myocardial infarction.

Level of Practice

Score

Percentage

Adequate practice

Moderately Adequate practice

Inadequate practice

7-10

4-6

0-3

67 – 100%

34 -66%

<33%

Validity:

The validity of the tool was established in consultation with four nursing experts in the field of medical surgical and in the field of cardiology. The tool was modified according to the suggestions and recommendations of experts and finalized.

Reliability:

The reliability of the structured interview schedule on knowledge questionnaire was assessed by testing the stability and internal consistency. The value was found to be reliable(r=0.9). The spearman’s brown prophecy formula was used to assess the internal consistency by using split half technique. The value was found to be reliable (R = 0.94).The reliability of the Five point likert scale on attitude regarding cardiac rehabilitation was computed by test retest method and was found to be reliable (r=0.93).

The test retest method was used to assess the stability of practice questionnaire. The value was found to be reliable (r=0.87). The spearman’s brown prophecy formula was used to assess the internal consistency by using split half technique. The value was found to be reliable (R = 0.80).

PROTECTION OF HUMAN SUBJECTS:

The research proposal was approved by the dissertation committee prior to conducting the pilot study and the main study. The written permission obtained from chief medical officer and medical superintendent of KMC Hospital. Oral consent was obtained from each participant before data collection.

DATA COLLECTION PROCEDURE:

The main study was conducted in KMC specialty hospital, at Trichy, in the month of August 2009. The data collection period was five weeks. The investigator obtained written permission from the chief medical officer and medical superintendent and oral consent from each participant prior to the study. Data were collected from 60 patients who fulfilled the criteria. Demographic data was collected and the pretest was conducted to assess the knowledge by using the structured interview schedule, five point likert scale was used to assess attitude and observational check list was used to assess practice for 45 -50 minutes. On the same day after the pretest, structured teaching programme was given regarding cardiac rehabilitation by using Compact disc and laptop for 45 minutes. The structured teaching programme was given for 2-4 patients individually per day. The post test was conducted on seventh day by using the same structured interview schedule, five point likert scale and observational check list.

RESULTS AND DISCUSSION:

Percentage distribution of patients with according to their age group depicts that the highest percentage 25(41%) of patients belonged to the age group of 50-60. 18(30%) were between the age group of 40-49 years. 10(17%) patients were between the age group of 31-39 and 7(12%) patients were between the age group of 20-30. Regarding sex the higher percentage 32(53%) were male when compared to the females 28(47%). Regarding marital status 45(75%) were married, 9(15%) were unmarried, and 6 were widow respectively. According to their education 21 (35%) were studied up to primary school, 17(28%) were studied up to higher secondary, 10(17%) were studied up to high school, and 2(3%) were graduates, 10(17%) were no formal education. The distribution showed that 20 (34%) were self employed, 17(28%) were private employee, 11(18%) were coolie workers, 9 (15%) were government employee and 3 (5%) were unemployed. With regard to religion 36(60%) were Hindus, 15(25%) were Christians and 9(15%) were Muslims. According to their monthly income 37(61%) had income less than Rs. 2000, 22(37%) had income between Rs. 2001-Rs. 5000, one (2%) had income between Rs. 5001-10000. According to their area of residence reveals that 38(63%) were from rural areas and 22(37%) were from urban areas. According to the distribution of patients with myocardial infarction on basis of the number of MI attack 37(62%) had first attack, 23 (38%) had second attack of myocardial infarction respectively.

Table:1 Comparison of Mean, SD and ‘t’ value of pre test and posttest knowledge scores regarding cardiac rehabilitation among patients with myocardial infarction . n=60

S. No	Variables	Mean	SD	‘t’	Table value
1.	Pre test	10	3.46	12.074	1.671
2.	Post test	16.2	3.54	12.074	1.671

df (59) (P<0.05)

The table 1 deplicts that the mean score of pre and post test of knowledge regarding rehabilitation among patients with myocardial infarction patients were Mean 10, SD 3.46 and Mean 16.2 , SD 3.54 respectively.Post test mean score regarding cardiac rehabilitation among patient with myocardial infarction is higher than the pretest mean score. From the t’ value is 12.074 which is significant at 0.05 level.

Table – 2 : Comparison of mean, SD and ‘t’ value in pretest and post test attitude scores regarding cardiac rehabilitation among patients with myocardial infarction. n= 60

Sl.no	Test	Mean	SD	‘t’	Table value
1.	Pre test	19.8	7.05	10.836	1.671
2.	Post test	28	9.80	10.836	1.671

df (59) (P<0.05)

The table 2 deplicts that the mean score of pre and post test of the regarding rehabilitation among patients with myocardial infarction were Mean19.8, SD 7.05 and Mean 28, SD 9.80 respectively.Post test mean score regarding cardiac rehabilitation among patient with myocardial infarction is higher than the pretest mean score. From the table ‘t’ value is 10.836 which is significant at 0.05 level.

Table - 3 : Comparison of mean, SD and ‘t’ value in pretest and posttest practice scores regarding cardiac rehabilitation among patients with myocardial infarction . n=60

S. No	Test	Mean	SD	‘t’	Table value
1.	Pre test	4.2	1.08	11.455	1.671
2.	Post test	6.3	1.38	11.455	1.671

df (59) (P<0.05)

The table 3 deplicts that the mean score for pretest and posttest of the patients with myocardial infarction practice regarding cardiac rehabilitation were Mean 4.2, SD 1.08 and Mean 6.3, SD 1.38 respectively.

Post test mean score regarding cardiac rehabilitation among patient with myocardial infarction is higher than the pretest mean score. From the table t’ value is 11.455 which is significant at 0.05 levels.

Table 4: Correlation between the mean post test knowledge and practice scores regarding cardiac rehabilitation among patients myocardial infarction . n=60

S. No	Variables	Mean	SD	Co –efficient of correlation	Table value
1.	Knowledge scores	16.2	3.54	0.91	0.2108
2.	Practice scores	6.3	1.38	0.91	0.2108

df (58) P<0.05)

The table 4 deplicts that there is a positive correlation (r=0.9) between mean post test knowledge and practice regarding cardiac rehabilitation among patients with myocardial infarction.

CONCLUSION:

The present study was conducted to evaluate the effectiveness of structured teaching programme regarding cardiac rehabilitation in terms of knowledge, attitude and practice among patients with myocardial infarction. The study findings revealed that there was a significant improvement in the knowledge regarding cardiac rehabilitation among patients with myocardial infarction followed by structured teaching programme. Based on the statistical findings it is evident that provision of such kind of structured teaching programme will motivate the myocardial infarction patients and help them to acquire knowledge, develop positive attitude and correct practice regarding cardiac rehabilitation among patients with myocardial infarction.

NURSING IMPLICATIONS:

v Nurse as educator, leader, counsellor, motivator, supervisor and team member in various situation of work.

v Health education may be given to myocardial infarction patients regarding meaning, phases, progressive physical activity, exercises, walking programme, counting pulse rate, safety measures to take medication, diet and resume normal activity.

v Health promotion is a vital function of the nurse and nurse can use this structured teaching programme on three levels of prevention (ie. Primary, Secondary and Tertiary)

v The result of the study will help the nurses to enlighten their knowledge on importance of health education.

Nursing education

v Students can utilize the structured teaching programme to give health education regarding cardiac rehabilitation among patients with myocardial infarction.

v The result can be used as an example by the tutor in the class rooms for giving importance to health education.

v Both the teacher and students can involve themselves in giving health education to patients and their relatives in the practical areas of nursing.

Nursing administration

v Nursing administrator can formulate policies that will includes all nursing staff to be actively involved in health education programme in their respective hospital and colleges.

v Nursing administrators can utilize the structured teaching programme while conducting in-service education programme for directing and motivating staff towards regarding cardiac rehabilitation among patients with myocardial infarction.

v Nurse administrators have more responsibility as supervisor on creating awareness regarding cardiac rehabilitation among patients with myocardial infarction by facilitating free distribution of booklets, handouts, charts regularly to patients in and outpatient department of hospitals, health clinics in urban and rural.

Nursing research

v This study can be effectively utilized by the emerging researchers for their reference purpose.

v A similar study could be replicated by taking larger samples.

RECOMMENDATIONS:

v An information booklet can be prepared as a teaching aid in the hospitals and out patient clinics.

v A similar study can be done with control group.

v A longitudinal study can be done using post test after one month, six months and one year to see retention of knowledge.

v A similar study can be done in urban and rural areas so findings can be compared.

v Similar study can be replicated on a large sample.

v Similar study can be replicated in outpatient department.

v A study can be done by involving all the cardiac patients, because the cardiac rehabilitation programme also helpful in cardiac surgery patients.

v A Comparative study can be conducted between two different teaching methods.

v A follow-up study can be conducted to evaluate the effective of planned rehabilitation among the myocardial infarction patient observing their practices at home.

LIMITATION:

v It was more time consuming to interview the sample . It took 40-60 minutes for the investigator.

REFERENCES:

1. Barber, K., (2009). “Cardiac rehabilitation for community- based patients with myocardial infarction factors predicting discharge recommendation”, Journal of clinical epidemiology, 54, 1025 -1030.

2. Dubach, P et. al., (1998).”Optimal timing of phase II rehabilitation after myocardial infarction”, European heart Journal, 35-37.

3. Park, K., (2005). “Text book of Preventive and Social Medicine”, (18^th ed.). Jabalpur: bandarsidan bhanot publisher, 93 -94.

4. David, R et.al.,(1997). “Cardiac rehabilitation services in England and Wales a national survey”, International journal of cardiology, : 59, 299-304.

5. http://:www Articles from Indian Heart Journal Jul; 64(4): 364–367. doi: 10.1016/j.ihj.2012.07.001

6. http://:www.cardiovascularnurse.com

7. http://:www.heartststs.org

Received on 13.06.2017 Modified on 18.09.2017

Int. J. of Advances in Nur. Management. 2018; 6(1): 10-14.

DOI: 10.5958/2454-2652.2018.00003.3