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:
  1. Individual and demographic information that includes: Age, Sex, marital status, Occupation, Education, Height, Weight, diabetes, hypertention, Hyperlipidemia, hospitalization history, and history of previous surgeries.
  2. Checklist of vital signs that include: Heart rate, respiration rate, temperature, systolic, and diastolic blood pressure.
  3. 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.