A Study to Assess The Effectiveness of Structured Teaching Programme on Knowledge of Early Signs, Symptoms and Immediate Management of Myocardial Infarction among Hypertension and Diabetes Mellitus patients in selected hospital at Kolar

 

Puneeth J.V.

M.Sc. Nursing Student, Medical Surgical Nursing (Cardiothoracic), Sri Channegowda College of Nursing, Kolar

*Corresponding Author E-mail:

 

ABSTRACT:

MI is often caused by coronary artery disease (CAD). It is the leading cause of mortality and morbidity in many countries worldwide. It is estimated that it will be the single largest cause of disease burden globally by the year 2020. It is a condition where plaque buildup in the heart's arteries blocking blood flow. Symptoms can appear suddenly and require urgent medical attention. Calling emergency services and, consuming aspirin if they are conscious. Deep breathing followed by a strong cough can temporarily raise blood pressure and help stabilize the heart's rhythm. A researcher conducted a study to evaluate the impact of a Structured Teaching Programme on the understanding of early signs, symptoms, and immediate management of myocardial infarction in patients with hypertension and diabetes mellitus. The objective of a study was to assess the effectiveness of this educational intervention in enhancing the knowledge of these patients regarding critical aspects of myocardial infarction. The methodology involved an evaluative study with a sample of 60 patients suffering from hypertension and diabetes mellitus, where pre-test and post-test knowledge scores were compared following the implementation of the Structured Teaching Programme. The research employed a pre-experimental one-group pre-test post-test design with a control group to facilitate the assessment of knowledge improvement. The results indicated a significant enhancement in knowledge levels among the participants, with the mean pre-test score recorded at 8.85 and the post-test score at 20.67, resulting in a mean difference of -11.817. The calculated 't' value of -27.945 was found to be statistically significant at the p<0.001 level, leading to the acceptance of the stated hypothesis (H1). This finding suggests that the post-test knowledge scores were markedly higher than the pre-test scores, demonstrating a highly significant difference in knowledge regarding the early signs, symptoms, and immediate management of myocardial infarction among patients with hypertension and diabetes mellitus. Consequently, it can be concluded that the Structured Teaching Programme effectively enhanced the participants' knowledge in this critical area of health. In conclusion, the study affirms that the Structured Teaching Programme significantly improved the knowledge levels concerning the early signs, symptoms, and immediate management of myocardial infarction among patients with hypertension and diabetes mellitus. This underscores the importance of educational interventions in promoting better health outcomes in this vulnerable patient population.

 

KEYWORDS: CVD, Left bundle branch block, Dyslipidemia, Nitroglycerin, CPR

 

 

INTRODUCTION:

Coronary heart disease is the most common type of heart disease, killing 382,820 people in 2020.1 Although the incidence of Myocardial Infarction is decreased in the industrialized nations partly because of improved health systems and implementation of effective public health strategies, nevertheless the rates are surging in the developing countries such as South Asia, parts of Latin America, and Eastern Europe.2 According to the projection by the WHO and the Indian Council for Medical Research, India will not only be the heart attack capital but also the capital of diabetes and hypertension by 2020.3 And according to the International Obesity Task Force, a medical NGO that coordinates with the WHO on obesity issues, of all Asians, South Asians have the worst problems when it comes to heart DISEASE  With the turn of the century, CVDs have become the leading cause of mortality in India.4 It is considered to be a coronary heart disease equivalent Acute myocardial infarction is one of the leading cause of death in the developed world. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery. This leads to necrosis of the area of myocardium subtended by the affected artery and is labeled as Myocardial Infarction.5 An MI results in irreversible damage to the heart muscle due to a lack of oxygen. These could be signs of a heart attack: Discomfort in the chest, especially the center that lasts more than a few minutes or comes and goes.6 A defibrillator is the kind of device EMS workers use to revive people who are experiencing heart attacks. Defibrillators come with easy-to-use instructions, so it’s possible for a non-EMS worker to revive you if the heart attack strikes. Taking aspirin when you’re still conscious, take a normal dose of aspirin (325 milligrams) if you have one on hand. Aspirin works by slowing the blood’s ability to clot. During a heart attack, aspirin slows blood clotting and minimizes the size of the blood clots that might have formed. Once the EMS arrive, they will transport you to the hospital, where you receive care for the specific type of heart attack you had. What should you do if you think you’re having a heart attack when you’re alone?7

 

If you’re alone and experience any of the above heart attack symptoms, call 911 right away. Take aspirin if you have it on hand. Then, unlock your front door and lie down near it, so EMS workers can easily find you. Cough CPR One type of treatment found online is called cough CPR. Some online sources claim that breathing deeply, and then coughing deeply, can raise your blood pressure for a second or two. Sources say this can deliver more blood to your brain. The claim also says that if your heart is beating normally, a deep cough may be able to set it back to normal. Water and cayenne pepper, Another online recommendation that’s not effective is to drink a glass of water with a spoonful of cayenne pepper in it. Some people say cayenne pepper is a stimulant capable of increasing the heart rate and carrying blood all over the body, balancing circulation. Some claim that cayenne pepper can stop bleeding instantly.

 

While you can’t control all your heart attack risk factors, such as aging, gender (men are at higher risk), and heredity, there are some that you can control. To prevent your risk of a heart attack:

·       Stop smoking and minimize your exposure to secondhand smoke.

·       Get your high blood cholesterol and high blood pressure under control by modifying your diet, losing weight, taking medication, or doing a combination of these things.

·       Stay physically active daily.

·       Control your weight if you’re overweight or obese.

·       If you have diabetes, take care by sticking to your treatment plan and managing your blood sugar.

·       Get a handle on the stress in your life by practicing relaxation techniques like deep breathing or yoga, or try talk therapy.

·       Limit your alcohol consumption.8

 

NEED FOR THE STUDY:

Cardiovascular disease is the leading cause of death worldwide. The prevalence of coronary artery disease, a major contributor to CVD, is related 7 to the increasing prevalence of modifiable risk factors,9 Previous studies identified diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity and sedentary lifestyle as risk factors. Smoking is the main determinant of ischemic heart disease amongst the East Indians of Bangalore, India and populations of certain Arab countries.

 

Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) is an institute of national importance by an act of the Indian parliament. It is an autonomous institute under the administrative control of the Department of Science and Technology, Government of India, and is situated at Trivandrum, the capital city of Kerala. It has a 239-beded tertiary referral hospital with major specialties like Cardiology, Cardiac surgery, Neurology and Neurosurgery. About 12,000 patients get registered per month. An average of 30- 40 patients attends cardiac new OPD every day. An average of 15-20 patients with CHD gets admitted electively every day. Number of patients attending new OPD is increasing day by day. A total of 434 PTCAs and 1184 CAGs have been performed from January 2009 to October 2009. Knowledge about risk factors of coronary heart disease and warning signs of ACS is important for patients to prevent recurrence of the disease as a modality for secondary prevention. It was felt that there is a need to assess the knowledge level and their relationship with variables in the patients admitted in Cardiology medical unit. The present study was supported by the study aimed to compare the association of selected CAD risk factors with acute myocardial infarction patients and non-AMI patients using a case control study design in which patients were matched on the basis of age and sex. Diabetes increases the risk of coronary events twofold in men and fourfold in women. Part of this increase is due to the frequency of associated cardio vascular risk factors such as hypertension, dyslipidaemia, and clotting abnormalities.10 The present study was supported by the article undertaken to find out the prevalence of Coronary Heart Disease in the age group of 20 years and above among the rural population of Bagalkot, Karnataka. 58% with the prevalence of symptomatic CHD was higher compared to asymptomatic cases. Higher prevalence of CHD was found among individuals, married people, illiterate and also among the individuals belonging to lower socio economic class.

 

Hence the researchers felt that structured teaching program will be an effective teaching strategy to impart knowledge of hypertension and diabetes mellitus patient regarding Early signs, symptoms and immediate management of myocardial infarction.

 

MATERIALS AND METHOD:

A quantitative evaluative research methodology is deemed suitable for the current investigation. This study will employ a pre-experimental one-group pre-test post-test design to evaluate the effectiveness of a Structured Teaching Programme on the knowledge of early signs, symptoms, and immediate management of myocardial infarction among patients with hypertension and diabetes mellitus. The independent variable in this research is the Structured Teaching Programme aimed at enhancing knowledge regarding the early signs, symptoms, and immediate management of myocardial infarction. Conversely, the dependent variable is the level of knowledge concerning these aspects. Data collection will take place at Vamshodaya Hospital, a tertiary-level multi-specialty facility, with a sample size of 60 participants drawn from the population of patients suffering from hypertension and diabetes mellitus. The non-probability purposive sampling technique will be utilized for subject selection. To gather data, the researcher has chosen a structured knowledge questionnaire aligned with the study's objectives. Each correct response will be awarded one mark, with a total possible score of 30 and a minimum score of 0. In this study, 60 patients with hypertension and diabetes mellitus will be selected using the non-probability purposive sampling method. On the first day, prior to administering the structured multiple-choice questionnaire, the purpose of the study will be explained to the participants. The pre-test questionnaire will be distributed, requiring approximately 20-30 minutes for completion. Following this, a structured teaching programme will be delivered over 45 minutes using PowerPoint and charts. On the seventh day, the same questionnaire will be re-administered to the participants, who will again take 20-30 minutes to complete it. The data collected will be analyzed in accordance with the study's objectives, utilizing both descriptive and inferential statistic.

RESULTS:

Section I: Demographic variables of hypertension and diabetes mellitus patient The majority of patients with hypertension and diabetes mellitus (41.70%) are aged between 41 and 50 years. Among these individuals, 55% are female, and 23.3% have completed primary education. Additionally, 36.7% are classified as moderate workers, while 45.0% have a monthly income ranging from Rs. 10,000 to Rs. 15,000. A significant 98.3% of these patients are married, and 58.3% do not engage in alcohol consumption, tobacco chewing, or smoking. Furthermore, 36.7% have a weight that falls between 56 and 70 kg, 70% belong to nuclear families, and 93.3% follow a mixed diet. Notably, 60% have not been exposed to any health information regarding myocardial infarction

 

Section II: Assessment of level of knowledge among hypertension and diabetes mellitus patient.

 

Table 1: Pre-Test and Post Test Knowledge Level of Hypertension and Diabetes Mellitus Patient N=60

Knowledge Level

Pre Test

POST TEST

Frequency

Percent

Frequency

Percent

Inadequate knowledge

60

100%

2

3.3%

Moderate knowledge

0

0

43

71.6%

Adequate knowledge

0

0

15

25%

Total

60

100%

60

100%

 

From the above table it is evident that majority (100%) hypertension and diabetes mellitus patient had inadequate knowledge of early sign and symptoms and immediate management of myocardial infarction

 

Section III: Effectiveness of structures teaching programme on level of knowledge of early Signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus Patients

 

Table 2: Mean, Mean Percentage and Standard Deviation for the Pre Test Knowledge of Hypertension and Diabetes Mellitus Patient N=60

Variables

Mean

N

Std. Deviation

Std. Error Mean

Pre test Knowledge Score

8.85

60

2.622

.339

Post Test Knowledge Score

20.67

60

2.549

.329

 

The above table-2 depicts that the mean pre-knowledge score of the study subject was 8.85 and The mean post-knowledge score of the study subject has increased to 20.67

Section IV: Association between the post-test level of knowledge among hypertension and diabetes mellitus Patients with their selected demographic variables

 

Table 3:

Variables

Mean

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

t

Df

P-value

Lower

Upper

Pre test

11.817

3.275

0.423

-12.663

-10.971

27.945

59

<0.001

Post test

 

Table: 3 Association of the pre test knowledge score with their selected Demographic variables. N=60

Demographic Variables

Pre-test median

Chi-square

Value

DF

P

Value

< 9 (Median Score)

> 9 (Median Score)

No.

No.

Age

31-40 Yrs

16

5

 

5.920

 

2

 

0.052*

41-50 Yrs

16

9

50 Yrs Above

5

9

Gender

F

19

8

1.573

1

0.210

M

18

15

Education

G

6

5

 

 

1.601

 

 

1

 

 

0.809

H

7

6

I

7

2

P

9

5

S

8

5

Occupation

HEA

13

4

 

2.230

 

2

 

0.328

MW

12

10

SE

12

9

Socio Economic Status

10K to 15K

17

10

 

0.082

 

2

 

0.960

15K to 20K

10

7

25 K Above

10

6

Marital Status

MAR

37

22

1.636

1

0.201

W

0

1

Alcohol

Yes

4

2

0.070

1

0.790

No

33

21

Beetle Nut Chewing

Yes

05

01

1.234

1

0.251

N0

32

22

Smoking

Yes

09

04

0.402

1

0.526

N0

28

19

Weight

35 - 45 Kg

1

1

1.361

4

0.851

35-40 Kg

1

1

46-55 Kg

10

4

56-70 Kg

12

10

70 kg above

13

7

Type of family

J

12

6

0.272

1

0.602

N

25

17

Diet

MD

35

21

0.247

1

0.619

V

2

2

 

 

 

The above table-3 depicts The difference in Pre means knowledge Score and Post knowledge Score regarding early signs, symptoms and immediate management of myocardial infarction in among hypertension and diabetes mellitus patients was very highly statistically significant. This indicates that the intervention given in the form of structured teaching programme was effective in increasing their knowledge. (t=27. 945. DF=59, p<0.001**)

 

The above table-4 reveals that Age is significantly associated with pre- knowledge (Chi-square-value=0.052,  df=2.P=0.052) None of the other variables are associated with Pre-knowledge regarding early signs, symptoms and immediate management of Myocardial infarction.

 

 

DISCUSSION:

The aim of present study was “To assess the effectiveness of structured teaching programme on knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patient in selected hospital, Kolar. Structured knowledge questionnaires were used to evaluate the structured teaching programme on knowledge regarding early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus.

 

PART A: Demographic variables like age, sex, education, occupation, family income, marital status, personal habits, weight, family type, personal habits.

PART B: Each question has 3-4 options, the correct answers corresponding 1 mark and the incorrect answer corresponding 0 mark, the total score for the structured knowledge questionnaires was 30. The response was analyzed through descriptive statistics (mean standard deviation) and inferential Statistics (“t”test and chi-square) discussion findings was arranged based on the objectives of the study

 

The First objective of this study was to assess the knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patients before and after structured teaching programme. The study shows that, the samples 30 (100%) had inadequate knowledge. The result revealed that after stuructured teaching programme the level knowledge was increased which is evidenced by improved post test level of knowledge. (t=27. 945. DF=59, p , 0.001**)

 

The present study is supported by the effectiveness of a structured teaching program to improve knowledge about coronary artery disease prevention in diabetes patients at selected hospitals. Using a one-group pre-test and post-test design, 60 patients were sampled through non-probability convenience sampling. Results showed that 75% had poor knowledge pre-test, while 53.33% had good knowledge post-test. The post-test mean score (23.98) significantly exceeded the pre-test mean (11.56), with a mean difference of 12.42 and a z-test value of 14.27 (p < 0.05). Chi-square analysis indicated no significant association between post-test scores and demographic factors. The study concluded that the structured teaching program effectively enhanced knowledge about coronary artery disease prevention among diabetes patient

 

The second objective of the study was to assess the effectiveness of structured teaching programme on knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patients in selected hospital, Kolar.  The study revealed that regarding knowledge the pre-test mean were (8.85) and standard deviation of the samples were (2.622) and respectively post - test mean was (20.67) and with the standard deviation of (2.549). and the “t” = 27.945.  Hence the stated hypothesis was accepted and it was inferred that the structured teaching programme was effective in improving the knowledge of signs, symptoms and immediate management of myocardial infarction

 

The third objective of this study was to find out the association between pretest level of knowledge score with their selected demographic variables. The study revealed that there was significant association between the pre test level of knowledge score with the demographic variable Age is significantly associated with pre- knowledge (Chi-square-value=0.052, df=2. P=0.052) None of the other variables are associated with Pre-knowledge regarding early signs, symptoms and immediate management of Myocardial infarction.

 

CONCLUSION:

The focus of this study was "To assess the effectiveness of structured teaching programme on knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patient in selected hospital; In this study A quantitative evaluative approach was used 60 samples were drawn from population using Non probability purposive sampling technique. The study was based on Conceptual Framework based on Modified Ludwig Von Bertanlaffy's Open system theory Major Findings of the study Majority of Hypertension and Diabetic mellitus patient belongs to 41-50 Years of age and belongs to 31-40 years and only belongs to 50 years above. Majority of Hypertension and Diabetic mellitus patient income was Rs. 20,000 Above Majority of Hypertension and Diabetic mellitus patient were married and only patient was widow. Majority of Hypertension and Diabetic mellitus patient belong to Nuclear Family and only belongs to Joint Family. Structured teaching programme on knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patient. The nursing personnel can be able to develop specific knowledge and skill in providing health education regarding knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patient. In Nursing Education the Structured teaching programme can be taught to all the nursing students to upgrade their knowledge of early signs, symptoms and immediate management of myocardial infarction among hypertension and diabetes mellitus patient. Nursing Research Findings of the study can be added to the research review regarding the structured teaching programme regarding early signs, symptoms and immediate management of myocardial infarction to increase the knowledge among hypertension and diabetes mellitus patient. Nursing curriculum should be updated to include comprehensive information about Myocardial infarction to improve the awareness in the hypertension and diabetes mellitus patient.

 

ACKNOWLEDGEMENT:

I would like to express my heartfelt thanks and deep sense of respect to my guide and mentor Associate Prof.  Banubi Head of the Department, Medical Surgical Nursing for her untiring effort, unwavering faith and cooperation have continuously motivated me for the successful completion of this dissertation. Ravi Shankar Prof of biostatics’ S.D.U Medical College Kolar,­­­­­­­­ Mrs. Evangelene. G Associate professor and HOD medical surgical nursing, Sambhram College of Nurisng, Mrs. Ashwini Assistant Professor Sambhram College of Nursing, Mrs. Lavanya Kumari, Professor Pavan College of Nursing, Mrs. Annie Becinda Assistant professor Pavan College of Nursing, Mrs. Sunitha KC, assistant professor SMG Vishnu College Kolar spending their valuable time in validating my tool and giving their valuable suggestions

 

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Received on 24.12.2024         Revised on 11.01.2025

Accepted on 27.01.2025         Published on 18.02.2025

Available online from March 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(1):61-66.

DOI: 10.52711/2454-2652.2025.00013

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