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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 4  |  Page : 123-128

Effectiveness of planned teaching program on knowledge regarding early sign and symptoms of myocardial infarction among hypertensive patients


Medical Surgical Nursing Department, Swami Premanand College of Nursing, Mukerian, Punjab, India

Date of Web Publication20-Dec-2016

Correspondence Address:
Mandeep Kaur
Medical Surgical Nursing Department, Swami Premanand College of Nursing, GT Road, Mukerian, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.196288

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  Abstract 

Introduction: Hypertension is a major public health problem and an established major risk factor for developing myocardial infarction (MI). However, majority of the population with hypertension does not have sufficient knowledge regarding early sign and symptoms of MI as the sign and symptoms appear in a confusing way hence causes delay in seeking treatment.
Aim of the Study: Assess the effectiveness of planned teaching program (PTP) on knowledge regarding early sign and symptoms of MI among hypertensive patients.
Materials and Methods: A quasi-experimental research approach with nonrandomized control group design was used. Through purposive sampling, sixty patients were selected (thirty in each experimental and control groups). Data were collected with interview method by using self-structured knowledge questionnaire. Pretest was taken, and PTP was administered to experimental group only. After 7 days, posttest was taken from both groups. Collected data were analyzed using descriptive and inferential statistics.
Results: In experimental group, mean pretest knowledge score was 13.87 and posttest mean knowledge score was 23.57. In control group, mean pretest knowledge score was 13.97 and posttest mean knowledge score 13.83. As per t-test, difference between mean posttest knowledge score (23.57, 13.83) of both groups was found statistically significant (t = 15.767
***, P< 0.001).
Conclusion: PTP significantly improved the knowledge of patients. This emphasized that providing education to patients at risk for MI can greatly reduce the morbidity and mortality associated with it.

Keywords: Early sign and symptoms of myocardial infarction, myocardial infarction, planned teaching program


How to cite this article:
Kaur M, Cheema PK. Effectiveness of planned teaching program on knowledge regarding early sign and symptoms of myocardial infarction among hypertensive patients. Heart India 2016;4:123-8

How to cite this URL:
Kaur M, Cheema PK. Effectiveness of planned teaching program on knowledge regarding early sign and symptoms of myocardial infarction among hypertensive patients. Heart India [serial online] 2016 [cited 2021 Dec 2];4:123-8. Available from: https://www.heartindia.net/text.asp?2016/4/4/123/196288


  Introduction and Background of the Study Top


High blood pressure is a well-established risk factor for acute myocardial infarction (AMI). It has been observed that risk of myocardial infarction (MI) doubles with every 20 mmHg increase in systolic blood pressure and 10 mmHg increase in diastolic blood pressure.[1] In India, 32% deaths occur due to MI in 2011, and more than 25% of all cardiac patients in the world are Indian.[2]

AMI remains unrecognized most of the time because the sign and symptoms appear in a confusing way. The first type of AMI symptoms are typical which are associated with cardiac problems, for example, numbness and chest pain which may radiate to the neck, jaw, shoulder, back, or left arm and unconsciousness.[3] The other type of symptoms are atypical which might be associated with cardiac problems, but the public is rarely educated about them, for example, nausea and vomiting, cough, palpitations, lightheadedness, epigastric pain, indigestion, shortness of breath, sweating which may be very heavy, fever and even fainting.[4]

Many studies suggest women experience a greater diversity of MI symptoms compared with men. Nonchest-pain symptoms occur frequently in women and may be falsely identified as musculoskeletal, gastrointestinal, or emotional in origin and considered inconsistent with cardiac symptoms.[5] Most of the patients are not aware of the different types of symptoms indicating the presence of AMI, and this leads to delay in seeking medical advice and hence worsening the situation.[4]

Objectives of the study

  1. To assess the pretest knowledge regarding early sign and symptoms of MI in patients with hypertension in both experimental group and control group.
  2. To assess the posttest knowledge regarding early sign and symptoms of MI in patients with hypertension in both experimental group and control group.
  3. To assess the effectiveness of planned teaching program (PTP) on early sign and symptoms of MI in patients with hypertension.
  4. To determine association between knowledge regarding early sign and symptoms of MI with selected demographic variables.


Hypothesis

H1-there is a significant difference of knowledge in the experimental and control group regarding early sign and symptoms of MI after giving PTP.


  Materials and Methods Top


Research approach and design

A quasi-experimental research approach and nonrandomized control group design were used for fulfilling the objectives of the study.

Research setting

The study was conducted in Civil Hospital, Dasuya and Civil Hospital, Mukerian, Punjab.

Target population

The target population comprised sixty hypertensive patients from medical ward and outpatient Department in Civil Hospital, Dasuya and Civil Hospital, Mukerian, Punjab.

Sample and sampling technique

Using purposive sampling technique, sixty hypertensive patients were selected as sample, i.e., thirty in each experimental and control groups.

Description of tool

It is divided into two sections:

  • Part 1: Sociodemographic data of hypertensive patients, i.e., gender, age, level of education, occupation, habits, and lifestyle
  • Part 2: This part consists of thirty self-structured knowledge questionnaires on early sign and symptoms of MI. Each item contains one correct answer among the four choices, and each correct answer carries 1 mark and wrong answer carries 0 mark.


Criterion measures

Knowledge score on early sign and symptoms of MI.



Data collection procedure

Data collection was done in the month of March, 2015. Written permission was also obtained from Civil Surgeon, Hoshiarpur for conducting research study in Civil Hospital, Dasuya and Civil Hospital, Mukerian. The control group was studied first and experimental group later to minimize the direct effect of teaching on the control group. Written consent was taken from the each patient. The data were collected with interview method using self-structured knowledge questionnaire. The pretest of patients in control group was taken and after 7 days posttest was taken. After completing the control group, pretest of experimental group was taken and PTP on early sign and symptoms of MI was given. After 7 days, posttest was using same self-structured knowledge questionnaire with interview method to assess the effectiveness of PTP.

Plan of data analysis

Analysis and interpretation of data were done according to the objectives of the study using descriptive and inferential statistics such as percentage, mean, mean percentage, standard deviation, correlation coefficient, Spearman–Brown prophecy, Chi-square, “t” test, and ANOVA.

Ethical considerations

After taking clearance from Institutional Research and Ethical Committee, written permission was obtained from Civil Surgeon, Hoshiarpur for conducting research study in Civil Hospital, Dasuya and Civil Hospital, Mukerian. Informed written consent was taken from the study patient.

[Table 1] depicts frequency and percentage distribution of hypertensive patients according to sample characteristics. Both the groups were homogenous as Chi-square value was found statistically nonsignificant (P < 0.05).
Table 1: Frequency and percentage distribution of sample characteristics (n=60)

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[Figure 1] depicts that maximum (90%) number of patients had below average pretest knowledge and 10% had average knowledge. In posttest, again maximum (90%) number of patients had below average knowledge, 6.7% had average, and 3.3% had good knowledge regarding early sign and symptoms of MI.
Figure1: Percentage distribution of hypertensive patients according to knowledge score regarding early sign and symptoms of myocardial infarction in control group

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[Figure 2] revealed that in experimental group majority (83.3%) of patients had below average pretest knowledge and in posttest maximum (66.7%) number of patients had excellent knowledge and 30% had good knowledge and 3.3% had average knowledge.
Figure2: Percentage distribution of hypertensive patients according to knowledge score regarding early sign and symptoms of myocardial infarction in experimental group

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[Table 2] reveals the effectiveness of PTP by comparing pretest and posttest mean knowledge score of both groups. The difference between pretest mean knowledge score of control and experimental group (13.97, 13.87) was found statistically nonsignificant whereas difference between posttest mean knowledge score of control and experimental group (13.83, 23.57) was found statistically significant (“t” =15.767***, P < 0.001).
Table 2: Comparison of pre- and post-test mean knowledge score on early sign and symptoms of myocardial infarction among hypertensive patients between control and experimental groups (n=60)

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[Table 3] depicts that the level of education had shown statistically significant relationship with the posttest knowledge score (F = 3.205* at df = 4/25, P < 0.05) which means that level of education has an impact on the knowledge score of patients regarding early sign and symptoms of MI.
Table 3: Relationship between pre- and post-test knowledge scores with selected demographic variables in control group (n=30)

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[Table 4] depicts that age (F = 3.758* at df = 3/26, P < 0.05), level of education (F = 3.199* at df = 4/25, P < 0.05), and occupation (F = 4.062* at df = 4/25, P < 0.05) had shown statistically significant relationship with the mean knowledge score regarding early sign and symptoms of MI which means that level of education, age, and occupation has an impact on the knowledge score of respondents regarding early sign and symptoms of MI.
Table 4: Relationship between pre- and post-test knowledge scores with selected demographic variables in experimental group (n=30)

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  Discussion Top


The present study revealed that in pretest maximum (90%, 83.3%) number of patients in control and experimental group, respectively had below average knowledge regarding early sign and symptoms of MI. Whitaker et al.[6] reported similar results in the study conducted to assess the public knowledge regarding symptoms of MI in the UK.

The study also showed that in control group in posttest 90% of patients had below average knowledge. While in experimental group, 66.7% of patients had excellent knowledge, 30% had good knowledge, and 3.3% had average knowledge after the administration of PTP. Pradeep [7] also reported similar results, in which after giving planned teaching there was marked improvement in the knowledge regarding sign and symptoms of MI from 70% to 80%.

After PTP, statistically significant improvement was seen in posttest mean knowledge score in experimental group. Calculated “t” value was 15.767 which found statistically significant (P < 0.001). Gallagher et al.[8] also reported similar statistically significant improvements in the reporting of 14 warning signs of heart attack, patients reported 2.56 more warning signs (P < 0.0001) after education program.

Age, level of education, and occupation had shown statistically significant relationship with the knowledge score (P < 0.05) in both groups. Findings of the study are consistent with the results of study conducted by Gallagher et al.,[8] which found that patients can report more heart attack warning signs if they had completed high school education and statistically significant association had seen between the level of education and knowledge score. This was further supported by the study conducted by Zhang et al.,[9] which reported statistically significant relationship between age and knowledge score on heart attack symptoms. Whitaker et al.,[6] in his study, found that respondents working in professional occupations identified significantly more typical symptoms than those in skilled trades.


  Conclusion Top


This study revealed that there was a significant difference in the knowledge regarding early signs and symptoms of MI before and after PTP. This emphasized that planned teaching plays an important and beneficial role in reducing the risk of the disease. Hence, nurses must make an attempt to provide health education to patients at risk for MI, which would then reduce its incidence and complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chatterjee K, Anderson M, Heistad D, Kerber RE. Cardiology an Illustrated Book: Hypertension. 1st ed., Vol. 1. New Delhi: Jaypee Brothers Medical Publisher; 2013.  Back to cited text no. 1
    
2.
Mahajan H, Kazi Y, Shrama B, Velhal GD. Assessment of KAP, risk factors and associated co-morbidities in hypertensive patients. IOSR J Dent Med Sci 2012;1:6-14. Available from: http://www.iosrjournals.org. [Last accessed on 2015 Feb 15].  Back to cited text no. 2
    
3.
Horne R, James D, Petrie K, Weinman J, Vincent R. Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart 2000;83:388-93.  Back to cited text no. 3
    
4.
Chen MA. The New York Times: The Heart Attack. Available from: http://www.nytimes.com/health/guides/disease/heart-attack/overview.html. [Last accessed on 2015 Mar 08].  Back to cited text no. 4
    
5.
Samantha J, Eischeid Z, Loeb SJ. Recognizing Myocardial Infarction in Women; June, 2010. p. 1-7. Available from: http://www.nursingcenter.com/_pdf_.aspx?an=00152193-201003001-00001. [Last accessed on 2015 Feb 22].  Back to cited text no. 5
    
6.
Whitaker S, Baldwin T, Tahir M, Choudhry O, Senior A, Greenfield S. Public knowledge of the symptoms of myocardial infarction: A street survey in Birmingham, England. Fam Pract 2012;29:168-73.  Back to cited text no. 6
    
7.
Pradeep LP. Effectiveness of planned teaching on early signs and symptoms and immediate treatment of myocardial infarction in among patients. Int J Sci Res 2014;3:712-9. Available from: http://www.ijsr.net/archive/v3i6/MDIwMTMxOTMz.pdf. [Last accessed on 2015 Feb 22].  Back to cited text no. 7
    
8.
Gallagher R, Roach K, Belshaw J, Kirkness A, Sadler L, Warrington D. A pre-test post-test study of a brief educational intervention demonstrates improved knowledge of potential acute myocardial infarction symptoms and appropriate responses in cardiac rehabilitation patients. Aust Crit Care 2013;26:49-54.  Back to cited text no. 8
    
9.
Zhang QT, Hu DY, Yang JG, Zhang SY, Zhang XQ, Liu SS. Public knowledge of heart attack symptoms in Beijing residents. Chin Med J (Engl) 2007;120:1587-91.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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