Methods
The present study was a randomized clinical trial study performed at
Farshchian Hospital in Hamadan, Iran, in January 2020. The sample size
was determined with a confidence coefficient of 95% and a test power of
90% and the basis on previous studies (13), 40 subjects being taken
into account for each group.
The inclusion criteria were include at least 18 years of age; fully
conscious and knowledgeable regarding time, place, and person; having
the ability to communicate, not having a history of heart surgery, lack
of psychiatric illness, lack of occupational health care, lack of drug
addiction, non-use of anti-anxiety and sedative drugs and Patients who
had simultaneous CABG surgery and valve replacement or repair, Patients
that unwillingness to continue the participation in the study and their
condition worsening during the study period were excluded. The study
units were selected by a convenient sampling method. Then, the samples
were randomly assigned to either of the groups (control and
intervention) by a random method of Cards or envelop shuffling (14).
Data collection tools consisted of three parts:
- Individual and demographic information that includes: Age, Sex,
marital status, Occupation, Education, Height, Weight, diabetes,
hypertention, Hyperlipidemia, hospitalization history, and history of
previous surgeries.
- Checklist of vital signs that include: Heart rate, respiration rate,
temperature, systolic, and diastolic blood pressure.
- Spielberger’s state anxiety inventory: The questionnaire was made up
of 20 multiple
questions that measure a person’s anxiety during ”response time” with
the options of “very little, little, a lot, and very much”. In this
questionnaire, the lowest score is 20 and the highest score is 80. The
Spielberg anxiety questionnaire had global validity
and reliability also in Iranian society, its validity and reliability
have already been studied. According to Mahram’s report, the
scientific reliability was also verified by α-Cronbach formula, which
was 0.9452 in the normal community and 0.9418 in the standard
community (15). In this study, its reliability by α-Cronbach formula
was 0.78.
One day before the surgery, after meeting with the patients and
obtaining consent to participate in the study, the demographic
characteristics of the patients were recorded and as a pre-test, their
vital signs were recorded and anxiety was measured. The control group
(n=40) received only routine training programs of hospital, but the
intervention group (n=40), in addition to these routine trainings,
participated in two one-hour home care training sessions. The first
session was held at 10 am and the second session was held at 5 pm in the
conference room of the ward, in these sessions, the researcher, the
patient, and the experienced nurse were present.
To empower patients in home care, an educational package was prepared
and designed based on the results of the AYDANUR AYDIN et al. study,
which undertaken to determine patients’ care needs in the first month
after CABG surgery(16), and according to clinical experts and university
professors. The educational topics of this package include: Breathing,
surgical incision care, Sternal bone care, Prevention and care of edema
of the upper and lower limbs, Surgical wound dressing training, Bathing,
Rest, Pain control, Depression control, Sleep, Diet, Medications,
Prayer, Mobility and activity, time and principles of starting work and
sports. Content validation method was used to evaluate the validity of
the training package. For this purpose, the training package was
provided to 8 faculty members of the Cardiovascular and Nursing
Department to review the content of the package and express their
dissent or agreement with the educational content. Then the content
validity ratio (CVR) was calculated that to be 0.75.
After ensuring that the training package was appropriate, the patient
was given the necessary care according to the intervention program and
the questions and concerns of the people regarding the post-discharge
period from the hospital were answered. Then, in the morning of the
surgery, as a post-test, the vital signs and anxiety of all control and
intervention groups were re-evaluated. Data analysis was performed using
descriptive statistics and inferential statistics methods in SPSS
software version 16 and at a significance level of 0.05 (Figure 1).
Results
The demographic characteristics of the two groups are presented in
(Table1), the results demonstrated that the mean age of the control and
intervention groups were 64.15 ± 11.05 years, 61.27 ± 7.92 years
respectively, and the mean of BMI of the control and intervention groups
were 25.70 ± 2.74, 26.64 ± 3.05 respectively. Most of the patients in
these two groups were male, married, self-employed, and illiterate. The
statistical tests revealed no meaningful difference between the
demographic characteristics of the two groups (p>0/05).
The results of the medical records displayed that 48/7% of the patients
had hypertention, 33/75% had diabetes, and 40% had hyperlipidemia,
73/75% hospitalized, and 43/75 surgery. According to the Chi-square
test was not a significant difference between the two groups in terms of
medical records (p>0/05) (table2).
Based on the results of the independent t-test before home care
training, the mean anxiety score of the control and intervention groups
was 51.65 ± 5.23 and 49.60 ± 7.01, respectively, which were not
significantly different between the two groups (p=0/143). The results of
the Paired t- test showed that after home care training, the mean of
anxiety of the intervention group decreased significantly (p=0/001), but
the mean of the anxiety of the control group increased, although it was
not significant (p=0/107), This difference between the mean of the
post-test of the two groups was significant (p=p=/001) (Table 3).
Based on the results of the independent t-test before home care
training, there was no significant difference between the pre-test score
of the heart rate, Respiration rate, temperature, systolic blood
pressure, and diastolic blood pressure (p>0/05). Based on
the t-test, it was found that after training, the mean of the number of
pulses, the respiration rate, systolic and diastolic blood pressure of
the intervention group decreased significantly (p <0.05).
However, no significant difference was observed between the mean of the
pre-test and post-test of the number of pulses, the respiration rate,
systolic and diastolic blood pressure of the control group
(p>0.05), that this difference between the two groups is
statistically significant(p<005). Moreover, the results of the
comparison between group and intragroup of the pre-test and the
post-test temperature did not show a significant difference
(p>0/05) (Table 3).
Discussion
This study aimed to investigate the effect of home care training on
anxiety and vital signs level in coronary artery bypass grafting
patients. The results of this study showed that the two groups were
homogeneous in terms of demographic characteristics. Furthermore, before
the intervention, the two groups were homogeneous in terms of the
variables studied, therefore, it can be concluded with more confidence
that the changes in the studied variables can be affected by the
training of home care to patients.
Despite the searches, a similar and comparable study that investigates
the effect of home care training on anxiety and vital signs level in
coronary artery bypass grafting patients was not found, therefore, to
discuss these results, studies that have used different educational
approaches to reduce patients’ anxiety were examined.
The results of this study indicate a significant reduction in the
anxiety of the intervention group after training at home to this group,
but in the control group, although it was not significant, but the level
of anxiety has increased, This finding indicates a positive effect of
home care training on reducing anxiety in patients with coronary artery
bypass grafting, which indicates the importance of this educational
approach. The results of this study are consistent with the findings of
Aghakhani et al., Who in their study examined the effect of self-care
training package and concluded that self-care training can reduce
patients’ anxiety (17). Garbossa et al. (2009) concluded in a study that
there was a significant difference in the anxiety of the trained group
compared to the control group in patients undergoing coronary artery
bypass graft surgery (18), which is consistent with the present study.
One of the benefits of reducing anxiety and calming down before surgery
is balancing the level of vital signs. Moreover, the results of this
study showed that after the training of home care, the rate of heart
rate, respiratory rate, and systolic and diastolic blood pressure of the
intervention group decreased significantly, this finding indicates a
positive effect of home care training on heart rate, respiratory rate
and systolic and diastolic blood pressure in patients with coronary
artery disease. This finding is consistent with the results of a study
by Farsi et al. (2015) that showed the effectiveness of peer education
and orientation tour on patients’ the hemodinamic indices(19). The study
of Orujlu et al. (2014) has also shown that nurses’ educational
interventions have been effective in reducing the vital signs of
endoscopic candidate patients (20), which is consistent with the
findings of this study, But this finding contradicts the results of a
study by Maguire et al. (21) and García Sierra et al. (22), This
difference may be due to differences in the study population. In the
present study, patients were considered that candidates for coronary
artery bypass grafting, but in Maguire’s (2004) study, endoscopic
patients and in the Sanchez (2013) study, Gastroscopy patients have been
studied.
One of the limitations of the present study was all patients’
hospitalizations in one ward, which could exchange information between
the two control and intervention groups units that to control this
restriction, sampling was performed as a weekly block. Another
limitation of this study is the lack of follow-up of patients to
evaluate the effectiveness of the home care training programs on other
aspects of patients’ lives, for this reason, it is suggested that
further studies be conducted on the effectiveness of home care education
on different aspects of these patients’ lives.
Conclusions
Based on the results of the present study, it can be concluded that
providing information about home care to patients who are candidates for
coronary artery bypass graft surgery can reduce anxiety and mutually
affect the rate of vital signs. Therefore, health care systems should
provide the necessary facilities to provide home care training
information.
Acknowledgments
This study is the result of a research project approved by Hamadan
University of Medical Sciences with a code of ethics
IR.UMSHA.REC.1397.684. Hereby, the vice-chancellor for Research and
Technology of Hamadan University of Medical Sciences, the management and
staff of Farshchian Cardiovascular Hospital are thanked and appreciated.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
This study is funded by Hamadan University of Medical Sciences.