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SYNOPSIS FOR
REGISTRATION OF SUBJECT FOR
DISSERTATION
SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN MEDICAL SURGICAL NURSING
SUBMITTED BY:
Ms. ASHA ANN MATHEW
I YR M.Sc (N)
UNDER THE GUIDANCE OF:
Mrs.PRIYALATHA
H.O.D
MEDICAL SURGICAL NURSING
NARAYANA HRUDAYALAYA COLLEGE OF NURSING
NO: 258/A, BOMMASANDRA INDUSTRIAL AREA
ANEKAL TALUK, BANGALORE-99
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NAME OF THE CANDIDATE AND
Ms. ASHA ANN MATHEW
ADDRESS
FIRST YEAR M.Sc NURSING,
NARAYANA HRUDAYALAYA
COLLEGE OF NURSING,
BOMMASANDRA INDUSTRIAL
AREA, BANGALORE – 99.
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NAME OF THE INSTITUTION
NARAYANA HRUDAYALAYA
COLLEGE OF NURSING.
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COURSE OF STUDY AND SUBJECT
FIRST YEAR M.Sc NURSING
(MEDICAL SURGICAL NURSING)
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DATE OF ADMISSION TO COURSE
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TITLE OF THE TOPIC
O8-06-2009
THE EFFECTIVENESS OF VIDEO
ASSISTED TEACHING PROGRAMME
ON KNOWLEDGE REGARDING
CORONARY ANGIOPLASTY AMONG
PATIENTS UNDERGOING
CORONARY ANGIOPLASTY .
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PROBLEM STATEMENT
A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING
PROGRAMME ON KNOWLEDGE REGARDING CORONARY ANGIOPLASTY
AMONG PATIENTS UNDERGOING CORONARY ANGIOPLASTY AT NARAYANA
HRUDAYALAYA HOSPITAL,BANGALORE.
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6.BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Every heart that beats strongly and cheerfully has left a hopeful impulse behind it in the
world and bettered the tradition of mankind”
-R.L.Stevenson
From the beginning of our life until death the human heart works tirelessly ,the human
heart beats more than two and half billion times during average life time without even pausing to
rest. The heart pumps with full force and supplies blood and energy to the body to sustain life.If
it stops pumping or does not pump with sufficient force life comes to end.
Coronary artery disease is a condition in which plaque builds up in the coronary arteries.
A plaque is made up of fat, cholesterol, calcium and other substances. Its deposits narrow the
arteries and reduce blood flow to heart muscle .It also make it more likely that blood clots will
form in arteries. Blood clots can partially or completely block blood flow. When coronary
arteries are narrowed or blocked, oxygen rich blood cannot reach the heart muscle which causes
Angina or Myocardial Infarction1
Percutaneous transluminal coronary angioplasty (PTCA) is one of the invasive
interventional procedures to treat coronary artery disease(CAD). A small balloon at the tip of
specially designed catheter after placing in the affected coronary artery is inflated to compress
the fatty matter into the artery wall and stretch the artery open to increase the blood flow to the
heart2.
PTCA has been used as a treatment modality of coronary artery disease in case of 1/3 rd
of patients3.Primary angioplasty may be the preferred approach in patients with extensive
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myocardial infarction who have immediate (less than 120 min) access to cardiac catheterization
laboratory with experienced personnel. Patients who have been identified to have any
contraindication for thrombolytic therapy 2) cardiogenic shock 3) prior to CABG 4) or with
stuttering onset of pain also benefit from primary angioplasty4.
Coronary angioplasty is currently practised in high turnover requiring short stay. In
hospital environment the nurses are the personnel who are available with the patient round the
clock .They also play a vital role by establishing and meeting the educational needs of these
patients. Nurse can therefore empower the patient what to expect during and after the procedure.
NEED FOR THE STUDY
Second half of the 20th century has witnessed a global spread of coronary arteries disease
epidemic especially in developing countries like India. It account for the 16.7 million or 29% of
total global death in 20035.Earlier coronary artery disease was considered as the number one
killer disease in Western countries. But last few decades ,India has emerged as the world capital
for heart disease .There are more people with heart problem than anywhere else in the world ,
“This is the largest epidemic of heart disease in the world” says Dr. Bhimal Chattergi former
cardiac consultant at New Delhi All India Institute of Medical Science6.
It has been estimated that Indians are nearly four times more susceptible to heart attacks
than White Americans. According to the World Health Organization (WHO) by 2010, India will
account for about 60% of world’s heart disease. According to the International obesity task force
a medical NGO that co ordinates with WHO on obesity issues ,reports that of all Asians ,South
Asians have by far the worst problems when it comes to heart disease .Nearly 50%of CVDrelated deaths in India occur below the age of 70 ,compared with 22% in West6.
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The reasons for this are not yet clear, but it may be due to the considerable enhancement
in richness of diet that Indians have been taking over the years. This factor combined with
notorious reluctance to exercise, the increase in prevalence of diabetes, increase in jobs that are
deskbound and relative stress of modern urban living has contributed to swelling population of
Indians affected with heart problem6. One of the treatment modalities for coronary artery disease
is PTCA which helps to improve blood flow within coronary artery by cracking the atheroma.
A descriptive study was done in University hospital Turkey in 60 samples to find out
patient’s perspective of treatment benefit of PTCA. Findings reveal that 96.7% had wrong
interpretation of complete recovery from disease before and after the PTCA 7.
Another study was conducted in University of Ottawa Heart Institute to identify the
perceived learning needs of balloon angioplasty patients among 251 samples. Samples completed
PTCA Learning needs inventory (PTCALNI) and items for knowledge of results of angioplasty,
symptom management and life style modification scored highest8.
Similarly the investigator during her clinical experience identified that many patients
undergoing angioplasty had lack of knowledge regarding procedural outcome. Patient education
is important both before and after the procedure .Helping patient to set realistic expectation in
terms of procedural outcome and lifestyle modifications is an important part of patient education
and health promotion.
Hence the investigator found it imperative to develop a video assisted teaching
programme for patients undergoing coronary angioplasty, which will provide a source of
knowledge and thus these empowered patients will be more involved in self care activities
showing better response resulting in better health outcomes.
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6.2: REVIEW OF LITERATURE
Literature review obtained from various sources are organized into following
sections:
 Section A:Literature review on knowledge of patients undergoing coronary
angioplasty
 Section B: Literature review on effectiveness of video teaching among cardiac
patients.
SECTION A: Literature review on knowledge of patients undergoing angioplasty
Larobina ME, Merry CJ, Negri JC, Pick AW conducted a study in Australia among
patients undergoing percutaneous coronary intervention(PCI)and CABG to assess the patient
understanding about PCI &CABG and associated risk. Sample consisted of 90 patients (50
CABG,40 PCI)and data was collected by interview.Findings reveals patients undergoing both
CABG and PCI have a poor understanding of their disease, their intervention, and its
complications9.
Another study was done by Campell M,Torrence C to assess the coronary risk factors and
patient understanding of the severity of their condition .Two hundred and eighty four patients
was selected by convenient sampling among patients who had undergone angioplasty within a
six month period in two major metropolitan hospitals in Melbourne .Findings reveal that 42%
believed their condition has been cured. Researcher has also recommended for better health
education to be given for patients undergoing coronary artery angioploasty 10
To assess the information needs of patients treated with primary angioplasty, twenty nine
patients were selected. A qualitative methodology using semi structured interview was carried
out by Astin F,Closs S J,Mcleanachan,Hunter S, Priestley C in UK.The need for more specific
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information about risk of reoccurrence, level of heart muscle damage, discharge medications,
appropriate level of physical activity and diet were highlightened by the patient11
A study was done in Australia to evaluate whether a pre procedural education could
improve the level of knowledge on coronary risk factors in 130 patients ( 65 experimental and 65
control group) undergoing angioplasty. Data was collected after four months. Analysis shows
that knowledge and physical activity level improved for both groups from pre PTCA to follow
up. Further the experimental group showed favorable change in total cholesterol level at follow
up12.
A qualitative study was done by Gulianick M ,Bliley A, Perino B ,Keough V in USA to
assess the patient perspective of recovery patterns and life style changes after coronary
angioplasty. About 26 men and 19 women were interviewed for 2 hours and conversation was
tape recorded. Findings reveal that request of patients were for newsletter, Hotlines, Video
library for providing these informations. Author suggested that nurses have an excellent
opportunity to expand their focus and provide guidance to patient to adopt a heart healthy
lifestyle13.
Similar study was conducted by Guilanick M,Nailo in Chicago to examine the patient
concern and risk factor modification behavior during early recovery from angioplasty. Self report
of recovery and profile of mood states were mailed to 54 patients .Results revealed that majority
of patients did not expect any complication to occur14
A descriptive study was conducted in university of Kuopio, Finland to describe CABG
and PTCA patients need for nursing informational support in health related matters before and
after coronary artery procedures. Study sample consisted of 625 patients who are treated with
elective CABG or PTCA .Data was collected by structured interview before and after coronary
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artery procedures and mailed questionnaires six and twelve months after. Findings reveal that
majority of patients reported the need for information about recovery15.
A study was done in US to examine patient’s perception of side effects and treatment
benefits of PTCA in the early recovery period .Convenient sample of 62 patients were selected
Seventy nine percentage had knowledge regarding treatment benefits while five percentage
believed PTCA made thing worse16.
An integrated review on literature on perceived learning needs of patients undergoing
coronary angioplasty. Nineteen studies involving clients who had undergone coronary
angioplasty were identified using CINHAL and MEDLINE. Findings reveal that informational
knowledge such as risk factor education and survival management were considered of high
importance17.
To assess the expressed preference for health education of patients after percutaneous
coronary intervention a study was carried out in Royal Melbourne hospital, Australia .Two
hundred and eighteen patients were selected randomly from three metropolitan hospitals in
Melbourne and structured telephone interviews were conducted. Findings reveal that cardiac
rehabilitation programme staff were most frequently nominated preferred source of information
delivery18.
To identify factors affecting learning during a structured education programme for
patients undergoing angioplasty was undertaken. Knowledge ,coping style, social support, health
locus of control ,IQ ,medical and demographic factors were assessed before procedure and
educational programme was administered .Risk factor, knowledge, anxiety and medical status
were assessed before discharge and at 6 months & 2 years after angioplasty. Results indicate that
structured educational approach have beneficial effects on immediate knowledge gain19.
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Section B: Literature review on effectiveness of video teaching among cardiac patients.
A study was done in Italy to assess the effectiveness of video-based patient information
before percutaneous cardiac interventions among 108 patients. Effectiveness was compared with
the standard information sheet.Results of the study reveals that the percentage of correct answers
in the post test increased from 39% to 77% after watching the video, with a reduction in 'don't
know' answers from 53% to 10% .Study findings suggested that video shown improved the
knowledge of patients about percutaneous coronary interventions, and was welcomed, especially
because it made patients more familiar with both the environment of the cathlab and the
technical aspects of the procedures20
To evaluate the effects of video information on anxiety among patients undergoing
angiography study was conducted among two hundred patients.The first one hundred were
assigned to conventional education and other by assisted by video. State Anxiety score was
measured by Speilberger statement anxiety inventory questionnaire. Analysis reveals that patient
who watched the video found to have significantly less anxious21.
Similar study was done to assess the effects of informational preparation and coping style
on patient anxiety during cardiac catheterization. Sample consisted of 145 patients(107 men &38
women).Coping was measured by Miller Behavioral style scale ,anxiety by a self report measure,
subjective unit of distress scale ,a behavioral measure & cardiac catheterization adjustment scale
were used .Physiological parameters like heart rate ,systolic and diastolic blood pressures were
measured .After coping and anxiety was assessed the patients were randomly assigned to one
among three preparatory informational treatments 1)videotaped procedural modelling
information 2) videotaped procedural sensory modeling information and 3) procedural sensory
information booklet. Analysis reveals that subjects who received videotaped modelling treatment
demonstrated greater behavioural adjustment than patients who received information booklet22.
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Herrmann KS, Kreuzer H carried out a prospective randomized study in Germany to
compare the effectiveness of preparatory information with and without a video film show about a
planned heart catheterization. Sixty patients took part in the study in which one group (n = 34)
received preparatory disclosure from a standard pamphlet and a personal interview; the other
group additionally watched a 14 min video (n = 26). Analysis reveals that patients received better
information from the film than from the pamphlet and concluded that viewing the video may
improve patient compliance23.
A study was conducted in New Delhi to assess effects of health educational video
intervention in MI patients. Two hundred patients participated in the study and were randomly
divided into experimental and control group. Each group took a standard survey of thirty-seven
questions to assess baseline knowledge pertaining to MI .Results reveal that the intervention
group had a statistically significant improvement in the mean number of correct responses , and a
significant decline in the mean number of unsure responses compared to the post test responses
of the control group24.
Another study was done by Fidela S. J. Blank & Howard A to evaluate the effectiveness
of educational video in delaying prehospital delays among cardiac patients. Among 500 samples
patients who received standard discharge instructions served as the control group, whereas those
who received the new patient teaching in addition to standard discharge instructions served as the
intervention group. Nineteen patients were rehospitalized within 1 year. Analysis of
rehospitalised patients showed there was a significant increase in the use of ambulances for the
intervention group who watched the video but not for the control group25.
A study was done in Italy to assess the effectiveness of informative video devised for
patients undergoing coronary angiography on reducing anxiety levels and getting more
satisfaction from the received information. Ninety-three patients took part in the study. The
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Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as
to the received information was measured using a scale with semantic indications. Findings
suggests the use of the informative video in Cardiology Departments proves to be highly
recommended as an instrument to lower anxiety levels and increase significantly the level of
satisfaction deriving from the received information26.
A pilot study was study was done in University of Kansas to assess the effectiveness
videotape intervention designed to improve patient self management of heart failure. Participants
were 10 newly diagnosed Heart Failure patients. Data indicated participants had a clinically
relevant improvement in knowledge, and improved or maintained health status. None were
rehospitalized during the 60-day follow-up period. One patient contacted his physician to report
weight gain, as prompted by the videotapes27.
Similarly a study was done in US to assess the effect of video education on heart failure
healthcare utilization, symptoms, and self-care behaviours. One hundred and twelve hospitalized
patients were randomly selected .Fifty three received standard education and 57 received video
education. Analysis reveals that
patients who received video education had greater
sign/symptom reduction ; especially related to edema and fatigue and initiated more actions for
edema and dyspnoea (with exercise or rest). Overall patients had a higher mean self-care
behaviour score reflecting greater self-care adherence. Researcher concluded that video
education is a useful adjunct to in-person education28.
The effects of a preparatory videotape among cardiac surgical patients was studied in
Germany. One hundred and one male patients prior to elective cardiac surgery were enrolled
into the study. On the second postoperative day, patients filled in a questionnaire concerning
their experiences of having preoperatively watched the video.Analysis revealed that cardiac
surgical patients prefer preoperatively an adjunct surgery-related video preparation 29.
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An experimental pilot study to examine the impact of an interactive video program on
the decision making of patients with ischemic heart disease was carried at a tertiary care centre
in US. The patients (n = 80) who had undergone diagnostic cardiac catheterization and who
were found to have significant coronary artery disease (> or = 75% stenosis in at least one
vessel)participated in the study.They watched the Shared Decision-Making Program
for
Ischemic Heart Disease designed to provide information necessary to participate actively in
decision making. Before and after viewing the video, patients completed surveys containing
multiple choice questions and Likert scales. They rated the program as more helpful than all
other decision aids, and expressed increased confidence in their treatment choice30.
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6.3: OBJECTIVES OF THE STUDY
 To assess the knowledge on coronary angioplasty and its after care among patients
undergoing coronary angioplasty.
 To determine the effectiveness of video assisted teaching programme on coronary
angioplasty in terms of gain in knowledge score and acceptability score.
 To find the association between levels of knowledge of coronary angioplasty with their
selected socio demographic variables.
6.4: OPERATIONAL DEFINITIONS
 Assess-It refers to appraisal of knowledge of patients undergoing coronary angioplasty.
 Effectiveness-It refers to improvement in knowledge score after video assisted teaching
programme.
 Video assisted teaching programme- It refers to systematically organized individual
teaching strategy using video images on coronary angioplasty and its after care.
 Knowledge –It refers to awareness of patients regarding coronary angioplasty and its
after care as measured by the questionnaire.
 Patients- It refers to clients undergoing coronary angioplasty admitted at Narayana
Hrudayalaya.
 Angioplasty-It refers to the technique in which a balloon tipped catheter is passed into
narrowed coronary arteries and is inflated to widen the stenosed area and increase the
blood flow.
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6.5: ASSUMPTIONS
 Patients will have some knowledge regarding coronary angioplasty.
 Video assisted teaching is an accepted method for providing information and guides
action to improve knowledge level of patients.
6.6: HYPOTHESIS
 H1- The mean post test knowledge score of patients in the experimental group will be
higher than mean post-test knowledge score of patients in control group after video
assisted teaching programme on coronary angioplasty at 0.05 level of significance.
 H2- The mean post test knowledge score will be higher than mean pre-test knowledge
score of patients in experimental group at 0.05 level of significance.
 H3-There will be a significant association between knowledge score and selected socio
demographic variables such as age, gender, education and chronicity of illness.
6.7: DELIMITATIONS
 The study is delimited to patients who are willing to participate in the study.
 Generalization of the findings will be delimited to the population studied.
 The study duration is for 6 weeks.
 The findings are delimited to patients undergoing elective coronary angioplasty
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7. MATERIALS & METHODS
7.1 Sources of data
Patients undergoing coronary angioplasty at Narayana Hrudayalaya Hospital, Bangalore.
7.2 Methodology
7.2.1 Type of study
: Evaluative study
7.2.2 Research Design
: Pretest-Posttest design with control group
7.2.3 Sample size
: 60 (30 interventional and 30 control)
7.2.4 Sampling technique
: Simple random sampling
7.2.5 Sampling Criteria
Inclusion criteria:

Patients undergoing coronary angioplasty

Patients who are willing to participate in the study
Exclusion criteria:

Patients who are illiterate.

Patients undergoing emergency coronary angioplasty
7.2.6 Variables

Dependent variable
: knowledge

Independent variable
: video assisted teaching programme.
7.2.7 Setting: CCU and Cardiology ward at Narayana Hrudayalaya hospital.
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7.2.8 Data collection technique
Data will be collected by administering a questionnaire for collecting information
regarding demographic profile, knowledge on coronary angioplasty & opinionnaire to obtain
opinion on acceptability of video assisted teaching on coronary angioplasty.
Description of tool
Structured questionnaire (SAQ) constructed into three sections as follows:
Section A : Demographic profile. Items on age, sex, education, chronicity of illness.
Section B: Researcher prepared Questionnaire (SAQ) to assess knowledge on coronary
angioplasty
Section C: Opinionnaire (SAQ) to assess acceptability of video assisted teaching on coronary
angioplasty
The validity & reliability of the tool will be ensured through content validity by experts and pilot
study.
Data collection procedure
Data will be collected after obtaining prior permission from the authorities. Patients
falling under the inclusion criteria will be selected .They will be randomly allocated to
interventional and control group .Consent will be obtained from each patient. Pre test using
structured knowledge questionnaire will be administered to both control and interventional group
before the patients undergo coronary angioplasty. Video assisted teaching will be given to
interventional group. Post-test will be administered 24 hours after patients undergo coronary
angioplasty. An opinionnaire regarding acceptability of video teaching on coronary angioplasty
will be also collected.
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7.2.9 Data Analysis
Data obtained will be analyzed in terms of objectives. Plan of data analysis include,
descriptive & inferential statistics
Data analysis will be as follows:
 The levels of knowledge of patients in interventional group on coronary angioplasty
before and after video assisted teaching will be calculated using range, frequency, mean
and standard deviation.
 The levels of knowledge of patients in control group on coronary angioplasty will be
calculated using range, frequency, mean and standard deviation.
 The significant difference between mean pre and post test knowledge score will be
calculated using paired ‘t’test for both groups.
 The significant difference between mean posttest knowledge score of interventional
group and posttest knowledge score of control group will be calculated using independent
‘t’test
 The association between selected demographic variables and pre-test knowledge scores
for both the groups will be determined using Chi-square test .
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7.3. Does the study require any investigation or interventions to be conducted on patients
or other humans or animals? If so, please describe briefly.
Yes, the study requires intervention among patients undergoing coronary angioplasty in
the form of video assisted teaching on coronary angioplasty.
INTERVENTION PROTOCOL:
Patients allocated to the interventional group and control group will be met individually by the
researcher and pretest will be administered to assess the knowledge on coronary angioplasty.
Video assisted teaching will be given regarding coronary angioplasty and its after care to
interventional group.Control group patients will go through the routine protocol/procedure of the
hospital before coronary angioplasty. Post test will be conducted in both the groups, 24 hours
after undergoing coronary angioplasty.
7.4 Has ethical clearance been obtained from your institution?
Ethical clearance is obtained from the institution.
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9.
Signature of Candidate
10.
Remarks of the Guide
11.
Name & Designation of
a.
Guide
: Mrs. Priyalatha
H.O.D
Medical Surgical Nursing
Narayana Hrudayalaya College of Nursing.
b. Signature
:
c.
:
Co-Guide (if any)
d. Signature
:
e.
: Mrs. Priyalatha
Head of Department
H.O.D
Medical Surgical Nursing
Narayana Hrudayalaya College of Nursing.
f.
12.
Signature
:
12.1 Remarks of the Chairman & Principal
12.2 Signature