The action phase encompasses the participation in health promotion behavior. The modifying factors are demographic characteristics, interpersonal influences, situational and behavioral factors.

REVIEW OF LITERATURE

· Studies related to knowledge regarding risk factors, early signs, immediate treatment and prevention of myocardial infarction.

· Studies related to myocardial infarction.

Studies related to knowledge regarding risk factors, early signs, immediate treatment and prevention of myocardial infarction:

A descriptive study was conducted in Sahid Gangalal National Heart Centre, Nepal by Asmita Adhikari and Buna Bhandari. The study was the awareness and practice of myocardial infarction among hypertensive patients. Hospital based cross sectional study was conducted among ninety-six hypertensive patients in outpatient department. Purposive sampling method was used to select calculated number of study participants. Data was collected by interview method using structured questionnaire and descriptive and inferential statistics was used to analyze the data. This study revealed that more than half of the participants (60.4%) had high level of knowledge of prevention of myocardial infarction whereas 39.6% had low level of knowledge. Similarly, 57.3% had good practice; however, 42.7%had poor practice.

A descriptive study was conducted to assess the public knowledge of the symptoms of myocardial infarction. The study was conducted as a street survey in Birmingham, England. The objectives of the study are to investigate knowledge of myocardial infarction symptoms among the general population and the relationship between age, gender and socioeconomic status with knowledge. The sample size was 302 participants and the sampling technique was questionnaire method.

They used SPSS for data analysis. The study revealed that of 7 symptoms accepted in the medical literature as typical of a myocardial infarction, central chest pain was most frequently identified in 75% of the sample. The mean number of typical symptoms identified was 2.2 [SD=1.28]. The study demonstrated a paucity of knowledge of MI symptoms among general public and such findings provide a baseline to guide public health campaigns targeting awareness of MI.

A descriptive study was conducted in northern Tanzania, where the prevalence of cardiovascular risk factor is high by Julian T Hertz, Deng B Madut. The objective of the study is known about community knowledge of myocardial; infarction symptoms and perception of self risk in sub-Saharan Africa.

Community survey was conducted in northern Tanzania. Households were selected randomly in a population. A total of 718 persons participated in the survey and their socio demographic features are summarized. The median age of participants was 48 years, 485 of respondents were female. Purposive sampling technique was used and data was collected by survey, administered to self identified household’s healthcare decision maker. Survey questions were designed using open data kit software. This study revealed that in 718 survey participants, with median age 48 years of these 115 were able to identify any conventional symptoms of heart attack including 24 respondents who sited chest pain as a possible symptom. There was no association between ability to identify a conventional symptom, gender, level of education, age, residence.⁷

A study was conducted to assess the Knowledge of Risk Factors and Prevention about the Acute Myocardial Infarction among the Patient Admitted in Rural Tertiary Care Hospital, Karad. Simple random sampling was done to enrolled patient in study. Samples were drawn from patients with both male and female in the age group of 15-70yrs, admitted in Krishna hospital, Karad. A structured knowledge questionnaire was used to assess the knowledge of AMI. They concluded that there is a deficiency of well knowledge among patients admitted with AMI.

A study of risk factors for acute myocardial infarction in patients below 35 years in eastern India. Fifty patients aged 35 years or younger diagnosed with acute MI were included. They concluded that Homocysteine and Lp(a) should be measured in young MI patients. Smoking cessation and prevention of diabetes and hypertension should be encouraged. As young patients have more discrete lesion, timely revascularization will reduce myocardial damage.

A study was conducted to assess the knowledge regarding early signs of myocardial infarction among the adults in selected urban areas of Pune city. This was a Non experimental, exploratory research design and quantitative research approach. 100 adults were selected from urban areas of Pune City by non-probability purposive sampling technique. A self - structured questionnaire was used to assess knowledge with the observational checklist. They concluded that knowledge regarding early signs of myocardial infarction was average.

A descriptive study was conducted to assess risk factors for Acute Myocardial Infarction in Central India. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India. The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire.

The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein. The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.

A study to assess the knowledge about risk factors and warning signs of acute coronary syndrome among patients admitted in cardiac medical unit at SCTIMST, Trivandrum. The study is as a descriptive survey design with sample consisted of 50 patients. 10 samples were selected for pilot study. The results conveyed that the patients had lower level of knowledge about risk factors and warning signs of ACS.

Studies related to myocardial infarction:

A study was conducted to assess the Quality of life in patients with acute myocardial infarction. Twelve studies were selected for analysis. The main instrument used was the generic SF-36. They concluded that it was possible to identify some important aspects in the improvement of quality of life and factors that contribute negatively to the recovery of the physical and mental wellbeing of the subjects. Future studies are needed to assess differences in coping with the disease in relation to gender, age and other demographic factors.

A study was conducted to assess the Patients' knowledge about symptoms and adequate behaviour during acute myocardial infarction and its impact on delay time. This investigation was based on 486 AMI patients who participated in the cross-sectional Munich-Examination-of-Delay-in-Patients-Experiencing-Acute-Myocardial-Infarction (MEDEA) study. They concluded that Knowledge of AMI-symptoms remains to be substandard, especially knowledge of atypical-symptoms. Knowledge is essential to reduce delay-times, but it is not a panacea, since it is not sufficient alone to optimize pre hospital delay-times.

A study was conducted to assess the Patients' knowledge and attitudes about myocardial infarction. The study targeted 50 participants diagnosed with myocardial infarction who were interviewed about their knowledge, attitudes, and perceived control related to heart disease in their home 1 month after being discharged from hospital using the Acute Coronary Syndrome Response Index and the Control Attitude Scale-Revised. The findings showed inadequate knowledge, with only 26% scoring over 70%. Moreover, only 16% reported having received education about heart disease. The participants reported confidence in recognizing symptoms and getting assistance during a myocardial infarction. Assessment of patients’ knowledge and Perception Regarding Myocardial Infarction. A descriptive research design was used to conduct this study.

A convenient sample of 90 patients who have myocardial infarction through 6 months and attended intensive care unit and outpatient clinic in Specialized Hospital and coronary care unit and outpatient clinic in El- Azhar Hospital in Damietta. They concluded that most of studied patients had highly positive perception about myocardial infarction and there no statistical significant relation between age, level of education and patient's perception.

A study was conducted to assess acute Myocardial Infarction in Pregnant Women Pregnancy-associated AMI is found to occur in pregnant women of all child-bearing ages, ranging from 19 to 44years. Yet, the highest incidence occurs in pregnant women over the age of 30, which is found to be associated with an odds ratio (OR) of 6.7.3 This is important, given the increasing number of late marriages and older childbearing ages, as well as advances in reproductive technology making conception in older women feasible. They concluded that in practice, the occurrence of AMI in pregnancy remains a rare event.

A study was conducted to assess the acute ST elevation myocardial infarction in pregnancy due to coronary vasospasm. They done about an acute myocardial infarction with anterior ST elevation in a 40-year-old woman, at 38th week of gestational period. The coronary arteriograms showed a diffuse left coronary vasospasm.

A descriptive study was conducted to assess the Quality and Completeness of Myocardial Infarction recording in clinical practice research datalink aurum in Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK.

The objective of the study. To examine data source agreement of myocardial infarction (MI) diagnoses recorded in CPRD Aurum compared with linked Hospital Episode Statistics (HES) data. Patients with MI diagnoses recorded in either data source was selected from a random sample of 50,000 patients in CPRD Aurum with HES linkage. There were 1260 patients with MI recorded in the CPRD Aurum sample. The overall correctness of the recorded MI diagnoses was 94%: 986 patients (78%) had concordant diagnoses in HES within 90 days; 123 (10%) were concordant with HES, but with an inconclusive date and another 71 (6%) had strong supporting evidence for being a true MI case. MI diagnoses recorded in CPRD Aurum were highly likely to be correct, supporting its use in clinical research studies. Completeness was lower, indicating the need for data linkage for some studies.

METHODOLOGY:

RESEARCH APPROACH:

To accomplish the objectives, quantitative approach is found to be appropriate for this study.

RESEARCH DESIGN:

Descriptive design is used for the study.

VARIABLES:

Baseline variables: Age, sex

Study variables: Knowledge of the patient

SETTING OF THE STUDY:

Setting is a physical location and condition in which data collection takes place in the study. Setting for the present study is the General medicine OPD and endocrinology OPD of Pushpagiri Medical College Hospital, Thiruvalla. The criterion for selecting this setting was the availability of subjects and feasibility of conducting the study.

POPULATION:

The population of the present study includes all the risk patients attending the general medicine and endocrinology outpatient clinics of Pushpagiri medical college hospital, Thiruvalla.

SAMPLE SIZE:

For the present study, sample size is 80 risk patients attending the general medicine and endocrinology outpatient clinics of Pushpagiri medical college hospital, Thiruvalla.

SAMPLING TECHNIQUE:

Sampling technique of the present study is non probability purposive sampling.

SAMPLING CRITERIA:

Inclusion Criteria:

· People who are willing to participate.

· Available at the time of data collection.

· Patients who are able to follow instructions.

· Risk patients with Hypertension, Diabetes mellitus and Hyperlipidemia.

Exclusion Criteria:

· Patients who are mentally ill.

· Patients who have hearing or visual impairment.

· Patients who are not able to read or write Malayalam.

DATA COLLECTION INSTRUMENTS:

Tools used for this study are baseline proforma and structured knowledge questionnaire.

· Tool 1: Baseline proforma:

Baseline proforma for the study includes age, gender, education status, height, weight, family history of cardiovascular diseases, food preferences, history of smoking, history of alcoholism and exercise pattern.

· Tool 2: Structured knowledge questionnaire:

Structured knowledge questionnaire includes questions related to general facts of MI, modifiable and non modifiable risk factors, signs and symptoms, diagnostic methods, management and importance of early detection and prevention.

PILOT STUDY:

The pilot study was conducted in outpatient Department of General Medicine andEndocrinology OPD at Pushpagiri Medical college Hospital after getting a formal approval for the study. The investigators explained the purpose of the study and assured the clients that the data will be confidential. After getting informed consent, the investigators conducted the study among 8 samples, selected by means of non-probability purposive sampling. Samples that fulfill the inclusion criteria were selected. The Investigators administered the questionnaires to samples and gathered information.

DATA COLLECTION PROCESS:

· The formal written permission was obtained from the institution for conducting the study.

· The data collection was carried out among high-risk patients attending the general medicine and endocrinology outpatient clinics of Pushpagiri medical college hospital, Thiruvalla.

· The researcher explained the purpose of the study and a good rapport was established with the subjects of study.

· The sample size of the present study is 80 samples. The samples were selected by non probability purposive sampling technique.

· The data collection was done on 21\09\2021. Informed consent was taken from every sample prior to the study. The tool was administered and confidentiality of the responses were assured to all subjects to get co-operation.

· After obtaining the data from the samples, an information pamphlet was given to the patients.

ANALYSIS AND INTERPRETATION:

The data collected were organized and tabulated, analyzed and interpreted by using descriptive and inferential statistics. The collected data were presented under the following sections :

Section I: Description of subjects according to demographic variables.

Section II: Assessment of the knowledge regarding early signs and immediate treatment of myocardial infarction among high risk patients.

Section III: Association between pretest level of knowledge and selected baseline variables.

SECTION I:

DESCRIPTION OF SUBJECTS ACCORDING TO DEMOGRAPHIC VARIABLES:

Majority of the high risk patients i.e., 38.7% belong to the age group of 50 to 60 years. Majority of the high risk patients are men, i.e., 65%. Majority of the high risk patients i.e., 46.25% have higher secondary education. Majority of high risk patients i.e., 51.25% have family history of cardiovascular disease. Majority of the high risk patients i.e., 66.25% have previous knowledge regarding myocardial infarction.

SECTION II:

ASSESSMENT OF KNOWLEDGE AMONG HIGH RISK PATIENTS REGARDING EARLY SIGNS AND IMMEDIATE TREATMENT OF MYOCARDIAL INFARCTION.

Variable	Frequency	Percentage
Poor	18	22.5%
Average	23	28.75%
Good	34	42.5%
Excellent	5	6.25%

SECTION - III

ASSOCIATION OF PRETEST LEVEL OF KNOWLEDGE WITH SELECTED BASELINE VARIABLES:

There is significant association between socio demographic variables (age, education, family history of CVD and previous knowledge) and knowledge of high-risk patients regarding early signs and immediate treatment of myocardial infarction.

RESULTS:

The results based on the objectives and assumption which are tested and described under the following sections

Section I: Description of subjects according to demographic variables

Section II: Assessment of the knowledge among high-risk patients regarding early signs and immediate treatment of myocardial infarction

Section III: Association of pretest level of knowledge with selected baseline variables.

SECTION I: DESCRIPTION OF SUBJECTS ACCORDING TO DEMOGRAPHIC VARIABLES:

Baseline variables of participants were computed using descriptive statistics such as frequency and percentage.

· The majority of samples who participated were in the age group of 50-60 years (38.75%, frequency – 31), 40-50 years (25%, frequency -20), >60 years (25%, frequency- 20).

· Majority of samples belongs to the gender males (65%, frequency- 52) and females (35%, frequency-28).

· Majority of samples who has primary education (2.5%, frequency-2), secondary education (26.25%, frequency-21), higher secondary education (46.25%, frequency-37), degree or diploma (23.75%, frequency-19), masters degree (1.25%, frequency-1).

· Majority of samples have family history of cardiovascular diseases (51.25%, frequency-41) and 48.75%, frequency-39 have no family history of cardiovascular diseases.

· Majority of samples have previous knowledge regarding the early signs and immediate treatment of myocardial infarction (66.25%, frequency-53) and 33.75%, frequency-27)

SECTION II: ASSESSMENT OF KNOWLEDGE AMONG HIGHRISK PATIENTS REGARDING EARLY SIGNS AND IMMEDIATE TREATMENT OF MYOCARDIAL INFARCTION:

6.25% Of high-risk patients (frequency- 5) have excellent knowledge regarding the early signs and immediate treatment of myocardial infarction, 42.5% of high-risk patients (frequency -34) have good knowledge, 28.75% of high-risk patients (frequency -23) have average knowledge and 22.5% of high-risk patients (frequency – 18) have poor knowledge.

SECTION III: ASSOCIATION OF PRETEST LEVEL OF KNOWLEDGE OF HIGH-RISK PATIENTS WITH SELECTED BASELINE VARIABLES:

Association between pretest level of knowledge of high-risk patients regarding the early signs and immediate treatment of myocardial infarction with selected baseline variables were computed using chi-square test. There was significant association between pretest knowledge and baseline variable i.e., course (χ2 =46.3550 and p=<0.00001).

DISCUSSION:

The study was conducted to assess the knowledge regarding early signs and immediate treatment of myocardial infarction among high-risk patients who attending the OPD with a view to develop an information pamphlet in a selected hospital at Pathanamthitta district.

The conceptual frame work used for the study was Pender’s health promotion model. The approach used was quantitative and research design was descriptive research design. The sample size was 80 and non probability purposive sampling technique was used. Knowledge regarding early signs and immediate treatment of myocardial infarction were measured by using structured knowledge questionnaire and baseline proforma were used to collect the baseline variables. Pilot study was conducted among 8 high risk patients in a selected hospital at Pathanamthitta district to check the feasibility of the study. The main study was conducted on among 80 high risk patients who attending the general medicine and endocrinology OPD in a selected hospital at Pathanamthitta district.

The data collected from the participants were analysed using descriptive and inferential statistics based on the objectives and assumption of the study .The baseline variable were described in terms of frequency and percentage .The score obtained from the structured knowledge questionnaire was interpreted under poor (0-8), average (9-16), good(17-24) and excellent (25-30).The the pretest score were analyzed using frequency and percentage .Chi-square test is used to find the association between knowledge and selected demographic variables.

FINDINGS OF THE STUDY BASED ON OBJECTIVES:

After the study, the investigators identified that 6.25% of high-risk patients have excellent knowledge regarding the early signs and immediate treatment of myocardial infarction, 42.5% of high-risk patients have good knowledge, 28.75% of high-risk patients have average knowledge and 22.5% of high-risk patients have poor knowledge. While checking the results we find that there is significant association between pretest level of knowledge regarding the early signs and immediate treatment of myocardial infarction and selected baseline variables. We also found that there is no significant association between gender and pretest level of knowledge regarding the early signs and immediate treatment of myocardial infarction.

NURSING IMPLICATIONS:

The findings of the study have certain important implications for the nursing profession in the field of nursing practice, nursing education and nursing research.

NURSING PRACTICE:

The nurse plays an important role in making awareness among the people regarding the early signs and immediate treatment of myocardial infarction.

· Nurse can provide information regarding early signs and immediate treatment of myocardial infarction among high-risk patients.

· Nurse can reduce the incidence rate of myocardial infarction with a view to develop information pamphlet.

· Nurse can avoid misinterpretation about the early signs and immediate treatment of myocardial infarction with a view to develop information pamphlet.

NURSING EDUCATION:

This study also emphasis on the improvement in the high-risk patient’s knowledge regarding early signs and immediate treatment myocardial infarction. It is essential that high risk patients are informed about the early signs and immediate treatment of myocardial infarction, so the incidence rate of myocardial infarction among the high-risk patients can reduce and the people diagnosed with myocardial infarction can avoid complications by using proper management.

· Nursing students can educate the high-risk patients about the definition, etiology, clinical manifestation, diagnostic studies, management and complications of myocardial infarction.

· Nursing students can encourage people to avoid the causative factors that lead to myocardial infarction.

· Nursing students can emphasis regarding the importance of maintaining a healthy lifestyle pattern.

NURSING RESEARCH:

The present study may inspire other researchers for conducting the studies in the same area. Researchers can do studies related to various aspects of myocardial infarction, so that there could be active participation from the high-risk patients and they may utilize the knowledge regarding myocardial infarction for reducing the incidence rate for the proper management of diagnosed cases.

LIMITATIONS:

· It is limited to 80 samples only.

· Study was limited to 2 weeks.

· The study was limited only to high-risk patients.

· The study was limited to knowledge assessment and did not focus on attitude and practices of sample.

RECOMMENDATIONS:

· The study was conducted in a large sample to generalize findings.

· A similar study can be conducted in different settings.

REFERENCES:

1. World Health Organization. Cardiovascular diseases fact sheet. WHO (Internet).2017[cited 21 February 2018]? Availablefrom: http://www.who.int/mediacentre/factsheets/fs317/en/

2. Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India. Circulation [Internet].2016 [cited 19February2018];133(16):1605-1620.Availablefrom: https://www.ncbi.nlm.nih.gov/pubmed/27142605

3. Rajiv G. Heart disease top cause of death in Kerala: Study. The Times of India [Internet]. 2018 [cited 5 March2018]; Available from: http://timesofindia.indiatimes.com/city/kochi/heart-disease-affectingyoung-Indians-ahead-of-Western-counterparts/article15007685.ece.

4. Alaska heart beatb log [Internet]. The importance of the early detection of cardiovascular disease .2018 [cited 5 March 2018]. Available from: https://www.alaskaheart.com/the-importance Of-the-early-detection-of-cardiovascular-disease/

5. Nag T, Ghosh A Cardiovascular diseases risk factors in Asian Indian population: Asystematic review. Journal of Cardiovascular Diseases Research [Internet] .2014[cited20 February 2018]; 4(4): 222-228.Available from https://www.sciencedirect.com/science/article/pii/S0975358314000059?via%

6. World Health Organization. Prevention of Cardiovascular Disease Guidelines for assessment and management of cardiovascular risk. Geneva: WHO [Internet].2007[cited 20 February 2018]. Availablefrom: https://www.who.int/cardiovascular_diaseases/guidelines/full%20text.pdf

7. American Heart Association 9AHA0.What is cardiovascular disease? May2015.Availablefrom: https://www.heart.org/

8. Simranjeet Kaur. Quality of life of post MI patients attending the cardiac outpatient department of selected hospitals, Punjab. Journal of Nursing Science and Practice. 2013; 3(3). Available from: https://stmajournal.com/

9. Nursing theories- a companion to nursing theories and models. General systems theory. September 2014.Available from: http://currentnursing.com/nursing_theory/systems_theory_in_nursing.html.

10. Burns N, Grove SK. Understanding nursing research -building an evidenced based practice. USA: W.B Saunders:2005.

11. Coronary Artery Disease among Asian Indians (CADI). India overview. Available from: http\\www.cardiresearch.org/topic/asian-indian-heart-disease/cadi-india.

12. T Shekari, RS Wilfred, P Chugh, M Chhillar, R Aggarval YK Sharma. Prevelance of risk factors for coronary artery disease in an urban Indian population epidemology

13. Polit DF, Beck CT. Nursing Research Principles and Methods. Philabelphia: Lippincott Publishers:2000.

14. Denise F. Politt, Bernabettedette P. Hungler. Nursing Research Principles and Methods. Lippincotte:1999.

15. Gopinath N, Chadha SL, Jain P, Shekhawat S, Tandon R. An epidemiological study on coronary heart disease in different ethinic groups in Delhi urban population. J Assoc Physician India. 1995 Jan: 43 (1):30-3. Available from http://www.ncbi.nlm.nih.gov/pubmed.

16. Vaishali Paswan. To assess the effectiveness of Self-Instructional Module (SIM) on knowledge regarding life style modification among Myocardial Infarction patients admitted in selected hospitals in Vidarbha Region. Asian J. Nursing Education and Research. 2018; 8(2): 247-267.

17. Parvaneh Asgari, Mahmoud Shiri, Fatemeh Bahramnezhad. Family-Centered Education and Clinical Outcomes of Patients after Acute Myocardial Infarction. Asian J. Nursing Education and Research. 2018; 8(2): 189-195.

18. Jency Jose, Asha Liz Mani, Joseena. Relationship between coping Strategies and the Development of Post-Traumatic stress Disorder among Patients after an acute Myocardial Infarction. Asian J. Nursing Education and Research. 2021; 11(2): 271-278.

19. Isha M. Aboobacker. Stress and coping among family caregivers of patients with Myocardial Infarction- Descriptive cross-sectional study. Asian Journal of Nursing Education and Research. 2022; 12(4): 402-4.

20. A. Valarmathi, Vijayarani Prince. Effectiveness of Structured Teaching Programme Regarding Cardiac Rehabilitation in terms of Knowledge, attitude and Practice among Patients with Myocardial Infarction at KMC Hospital, Trichy.Int. J. of Advances in Nur. Management. 2018; 6(1): 10-14.

21. Manjunath H, Jince Thomos, Shivappa Maranabasari, Shrikant Desai. A Study to Evaluate the effectiveness of Structured Teaching Programme (STP) on Knowledge regarding door to balloon care of patients with Myocardial Infarction among staff nurses at selected Hospitals, Bangalore. Int. J. of Advances in Nur. Management. 2020; 8(1):57-62.

22. Anita Kose Peter, Larisa Martha Sams. Assessment of the quality of life and coping strategies among male and female patients attending OPD with myocardial infarction in selected hospitals at Mangaluru. Int. J. Nur. Edu. and Research. 2016; 4(1): 1-6.

23. Jigishapatel, Jeenathjustin Doss. K, Suneesh. A Study to assess the effectiveness of Planned Teaching Programme on knowledge regarding selected life style modification for the Prevention of Myocardial Infarction among adults (30-45 years) in a Selected Institute at Rajkot. Int. J. Nur. Edu. and Research. 2018; 6(3): 239-241.

24. S. Renuka, Gowri Sethu. Regeneration after Myocardial Infarction. Research J. Pharm. and Tech. 2015; 8(6): 738-741.

25. Gulnara Bedelbayeva, Zhannat Nurmakhanova, Murat Almukhambetov, Nazima Zarubekova, Ainur Nuftieva. Factors of the Complicated Course of the Myocardial Infarction in Men and Women. Research J. Pharm. and Tech. 2018; 11(5): 1737-1744.

26. Julius, S. Raghavendra Jayesh, V. Ankayarkanni, S. Bennita, Binandita Nath. Role of Exercises in Restoring and in Maintenance of Cardiac Health. Research J. Pharm. and Tech. 2018; 11(6): 2235-2237.

Received on 06.02.2024 Modified on 16.03.2024

Int. J. of Advances in Nur. Management. 2024; 12(2):60-68.

DOI: 10.52711/2454-2652.2024.00014