The psychological effects of a videotape educational intervention on cardiac catheterization patients
Sek Ying Chair
Associate Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, NT, Hong Kong, P.R. China
Mei Yi Chau
Staff Nurse, Coronary Care Unit, Queen Mary Hospital, Pokfulum, Hong Kong
Janet Wing Hung Sit
Associate Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
Eliza Mei Ling Wong
Assistant Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
Aileen Wai Kiu Chan
Professional Consultant, The Nethersole School of Nursing, The Chinese University of Hong Kong
Sha Tin, New Territories, Hong Kong
PP: 225 - 233
Abstract
Coronary artery disease (CAD) is one of the leading causes of death and morbidity worldwide, and cardiac catheterization plays an essential role in its diagnostic evaluation. This quasi-experimental study examined the effectiveness of an educational intervention with the use of videotape and pamphlet among the Chinese patient undergoing the cardiac catheterization, and explored the relationship between anxiety, uncertainty, and other psychological variables. One hundred and thirty two Chinese patients of diagnosed or suspected CAD preparing for the first-time catheterization were recruited. Anxiety level (the Chinese State-Anxiety Inventory) and uncertainty (the Chinese version of Mishel Uncertainty in Illness Scale) were measured before the intervention and within 2 hours before receiving cardiac catheterization; while patients' satisfaction and perceived knowledge gain were measured at 20-24 hours after it. The mean age of the participants was 61.3 and 64.8% of them were male. The findings indicated that the use of videotape to prepare patients for the cardiac catheterization is effective in reducing the level of anxiety (p<0.001) and the uncertainty (p<0.001), as the patients experienced higher satisfaction and knowledge level after the educational intervention. Therefore, videotape education is suggested for cardiac catheterization care on top of the usual pamphlet education.
Keywords
anxiety; uncertainty; videotape; education; cardiac catheterization
Article Text
Coronary artery disease (CAD) is the leading cause of high morbidity and mortality worldwide (Lloye-Jones, 2010). In 2010, CAD accounted for 6630 deaths (15.5% of all deaths) in Hong Kong (Centre for Health Protection, 2010). Cardiac Catheterization (CC) has been one of the essential diagnostic evaluations used for suspected or known CAD to assess the extent and severity of the disease process (Dejong & Morton, 1997). In a regional hospital in Hong Kong, the number of CC procedures had increased from 954 in 1994 to 1371 in 2008 (Cardiac Catheterization Laboratory, 2009). Patients after CC in Hong Kong are usually required to stay in hospital for two to three days (Chair & Pang, 2008; Chair, Taylor-Piliae, Lam, & Chan, 2003).
It has been reported that patients undergoing CC can experience anxiety associated with uncertainty toward the invasive procedure (Mitchell, 2003, 2009) and the level of anxiety was the same as reported in those patients undergoing major surgery (Taylor-Piliae & Molassiotis, 2001). Therefore, providing essential procedural information for the pre-CC patient is important in reducing anxiety and uncertainty towards the procedure.
Uncertainty has been defined as "the inability to determine the meaning of illness-related events" and is created by the cognitive state (Mishel, 1988, p. 225). According to Mishel (1984, 1988), uncertainty would develop if the patient does not form a cognitive schema towards illness, treatment, and hospitalization. Further, the unfamiliar hospital environment with complex and frightening routines, ambiguous communication with healthcare staff, unknown diagnosis, and low social support received are potential factors contributing to uncertainty which was found to be the major source of anxiety in patients (Koivula, Paunonen-Ilmonen, Tarkka, Tarkka, & Laippala, 2002; McCormick, McClement, & Naimark, 2005).
Anxiety has been reported as an unpleasant subjective experience associated with the perception of anticipated or imagined threat (Anderson, Keith, Novak, & Elliot, 2002). The anxiety sources associated with a CC procedure may include fear of the unknown, possible complications, tension resulting from awareness of the unfamiliar equipment, and the comments and activities of the staff during the procedure (Caldwell, Arthur, Natarajan, & Anand, 2007; Chair & Thompson, 2005). Eastwood, Doering, Roper and Hays (2008) found that patients who perceived greater uncertainty also reported greater distress. In contrast, patients with high perceptions of control to uncertainty were less likely to experience anxiety and depression (Dracup et al., 2003). Because stress is a combination of an individual's appraisal of the environment and perceived ability to cope (Tung, Hunter, & Wei, 2008), appropriate nursing interventions should be carried out to make the event more predictable which would consequently reduce patients' anxiety before an invasive procedure (Chair & Pang, 2008).
Various studies of patient education before CC have been conducted and the content commonly includes such aspects as fasting period before the procedure, length of bed rest after the procedure and potential complications (Harkness et al., 2003; Chair & Pang, 2008). Though CC environment and equipments used in the lab may be frightening to the patients, the environmental and procedural information, as well as the sensory expectations inside the catheterization laboratory was seldom explained (Chair & Pang, 2008; Chair & Thompson, 2005). Moreover, a printed pamphlet may not be helpful enough as many of the CC patients were either illiterate or had received only elementary education in Hong Kong (Chair & Thompson, 2005). Several studies have reported the effectiveness of different formats of education aimed to reduce anxiety and uncertainty provided to patients before invasive procedures. The use of pre-admission education such as videotape instruction has been proven to be effective in improving patients' knowledge and reducing their anxiety (Yeh, Chen, & Liu, 2005; Pearson, Maddern, & Hewett, 2005; Stern & Lockwood, 2005). Optimal timing for patient education was between one to 10 days prior to CC procedure (Eckert, 2004).
There have been few studies conducted to examine anxiety and uncertainty level on the Chinese population and the effects of providing procedural-sensory intervention to prepare for a CC. Traditionally, Chinese people are less inclined to express their needs and tend to play a passive role (Lui & Mackenzie, 1999). Chinese people are often reluctant to ask questions or afraid of disturbing the medical staff during their hospitalization and this can result in inadequate information received (Wong & Chan, 2008; Taylor-Piliae & Molassiotis, 2000). Thus, further research is needed to examine the effects of nursing interventions to reduce uncertainty and psychological distress among Chinese patients undergoing CC.
References
Anderson, D. M., Keith, J., Novak, P.D., & Elliot, M. A. (2002).. Mosby's medical, nursing & allied health dictionary (6th ed.). St. Louis, USA: Mosby.
Barnason, S., Zimmerman, L., & Nieveen, J. (1995). The effects of music interventions on anxiety in the patient after coronary artery bypass grafting. Heart & Lung, 24, 124-132.
Caldwell, P. H., Arthur, H. M., Natarajan, M., & Anand, S. S. (2007). Fears and beliefs of patients regarding cardiac catheterization. Social Science and Medicine, 65(5), 1038-1048.
Cardiac Catheterization Laboratory. (2009). Statistics of Procedures (2005-2008). Hong Kong: Queen Mary Hospital.
Cason, C. L., Russell, D. G., & Fincher, S. B. (1992). Preparatory sensory information for cardiac catheterization. Cardiovascular Nursing, 18, 41-45.
Centre for Health Protection, Hong Kong. (2010). Vital Statistics. Retrieved 5 September 2011 from: http://www.chp.gov.hk/tc/data/4/10/27/380.html.
Chair, S.Y., & Thompson, D. (2005). Patient teaching prior to coronary angiography in Hong Kong: A pilot study. Journal of Clinical Nursing, 14, 114-115.
Chair, S.Y., Taylor-Piliae, R.E., Lam, G., & Chan, S. (2003). Effect of positioning on back pain after coronary angiography. Journal of Advanced Nursing, 42, 470-478.
Chair, S.Y., & Pang, A.M. (2008). Patient education before undergoing percutaneous coronary intervention. British Journal of cardiac Nursing, 3(1), 32-36.
Chau, J. P.C., Chang, A. N., & Chang, A. M. Z. (1998). Relationship between premenstrual tension syndrome and anxiety in Chinese adolescents. Journal of Adolescent Health, 22, 247-249.
Cohen, J. A. (1992). Power Primer. Psychological Bullet, 112, 155-159.
Davis, T. M., Maguire, T. O., Haraphongse, M., & Schaumberger, R. (1994). Preparing adult patients for cardiac catheterization: Informational treatment and coping style interactions. Heart & Lung, 23, 130-139.
DeJong, M. J., & Morton, P.G. (1997). Research analysis: Control of vascular complications after cardiac catheterization: A research-based protocol. Dimensions of Critical Care Nursing, 16, 170-181.
Dracup, K., Westlake, C., Erickson, V. S., Moser, D. K., Caldwell, M. L., & Hamilton, M. A. (2003). Perceived control reduces emotional stress in patients with heart failure. Journal of Heart and Lung Transplantation, 22(1), 90-93.
Eastwood, J., Doering, L., Roper, J., & Hays, R. d. (2008). Uncertainty and health-related quality of life 1 year after coronary angiography. American Journal of Crirical Care, 17, 232-242.
Eckert, M. (2004). The effectiveness of different approaches to pre-intervention education for adult cardiac patients: A systematic review. Health Care Report, 1(2), 25-68.
Gysels, M., & Higginson, I. J. (2007). Interactive technologies and videotapes for patient education in cancer care: Systematic review and meta-analysis of randomised trials. Supportive Care in Cancer, 15, 7-20.
Hanseen, T. A., Nordrehaug, J. E., & Hanestad, B. R. (2005). A qualitative study of the information needs of acute myocardial infarction patients and their preferences for follow-up contact after discharge. European Journal of Cardiovascular Nursing, 4(1), 37-44.
Harkness, K., Morrow, L., Smith, K., Kiczula, M., & Arthur, H. K. (2003). The effect of early education on patient anxiety while waiting for elective cardiac catheterization. European Journal of Cardiovascular nursing, 2, 113-121.
Houston, S., Eagen, M., Freeborg, S., & Dougherty, D. (1996). A comparison of structured versus guided preheart catheterization information on mood states and coping resources. Applied Nursing Research, 9(4), 189-194.
Koivula, M., Paunonen-Ilmonen, M., Tarkka, M., Tarkka, M., & Laippala, P. (2002). Social support and its relation to fear and anxiety in patients awaiting coronary artery bypass grafting. Journal of Clinical Nursing, 11(5), 622-633.
Krouse, H. J., Fisher, J. A., & Yarandi, H. N. (2001). Utility of video modelling as an adjunct to preoperative education. Southern Online Journal of Nursing Research, 2(8), 1-38. Retrieved from http://www.snrs.org/publications/SOJNR_articles /iss08vol02.pdf.
Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., ... Wylie-Rosett, J. (2010). Heart disease and stroke statistics 2010 update: a report from the American Heart Association. Circulation, 121, e46-e215.
Lui, M. H., & Mackenzie, H. E. (1999). Chinese elderly patient's perceptions of their rehabilitation needs following a stroke. Journal of Advanced Nursing, 30, 391-400.
McCromick, K.M., McClement, S., & Naimark, B. J. (2005). A qualitative analysis of the experience of uncertainty while awaiting coronary artery bypass surgery. Canadian Journal of Cardiovascular Nursing, 15(1), 10-22.
Mishel, M. H. (1984). Perceived uncertainty and stress in illness. Research in Nursing & Health, 7, 163-171.
Mishel, M. H. (1988). Uncertainty in illness. Image: Journal of Nursing Scholarship, 20, 225-232.
Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Image: Journal of Nursing Scholarship, 22, 256-262.
Mitchell, M. J. (2009). Patient anxiety and conscious level. Journal of Perioperative Practice, 19(6), 168-173.
Mitchell, M. (2003). Patient anxiety and modern elective surgery: a literature review Journal of Clinical Nursing 2003, 12, 806-815.
Pearson, S., Maddern, G. J., & Hewett, P. (2005). Interacting effects of preoperative information and patient choice in adaptation to colonoscopy. Disease of the Colon & Rectum, 48, 2047-2054.
Pernilla, L., Mike, T.J., Krister, N., & Thomas, L. (2009). Reliability and validity of the orofacial esthetic scale in prosthodontic patients. International Journal of Prosthodontology, 23(3), 257-262.
Peterson, M. (1991). Patient anxiety before cardiac catheterization: An intervention study. Heart & Lung, 20, 643-647.
Schapira, M. M., Meade, C., & Nattinger, A. B. (1997). Enhanced decision-marking: The use of videotape decision-aids for patients with prostate cancer. Patient Education and Counselling, 30, 119-127.
Seymour, R. A. (1982). The use of pain scales in assessing the efficiency of analgesics in post operative dental pain. Pain, 2, 1775-184.
Sharpley, C. F. (2002). Heart rate reactivity and variability as psycho physiological links between stress, anxiety, depression, and cardiovascular disease: Implications for health psychology interventions. Australian Psychologist, 37(1), 50-62.
Shek, D. T. L. (1993). The Chinese Version of the state-trait anxiety inventory: Its relationship to different measures of psychological well-being. Journal of Clinical Psychology, 49, 349-358.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jocobs, G. A. (1983). Manual for the State Trait Anxiety Inventory for Adult Form Y. USA: Mind Garden, Inc.
Stern, C., & Lockwood, C. (2005). Systematic review: Knowledge retention from preoperative patient information. International Journal of Evidence-based Health Care, 3, 45-63.
Taylor-Piliae, R. E., & Molassiotis, A. (2001). An exploration of the relationships between uncertainty, psychological distress and type of coping strategy among Chinese men after cardiac catheterization. Journal of Advanced Nursing, 33, 79-88.
Taylor-Piliae, R. E., & Molassiotis, A. (2000). Psychometric evaluation of the Chinese version of Mishel's Uncertainty in Illness Scale. The Hong Kong Journal, 36, 14-21.
Teasdale, K. (1993). Information and anxiety: A critical reappraisal. Journal of Advanced Nursing, 18, 1123-1132.
Timmins, F. (2006). Exploring the concept of 'information need'. International Journal of nursing Practice, 12(6), 375-381.
Tooth, L., McKenna, K., Maas, F. & McEniery, P. (1997). The effects of pre-coronary angioplasty education and counselling on patients and their spouses: A preliminary report. Patient Education and Counselling, 32, 185-196.
Tung, H. H., Hunter, A., & Wei J. (2008). Coping, anxiety and quality of life after coronary artery bypass graft surgery. Journal of Advanced Nursing, 61(6), 651-663.
Twinn, S., & Lee, D. (1997). The practice of health education in acute care settings in Hong Kong: An exploratory study of the contribution of registered nurses. Journal of Advanced Nursing, 25, 178-185.
Wewers, M. E., & Lowe, N. K. (1990). A critical review of VAS in the measurement of clinical phenomena. Research in Nursing & Health, 13, 227-236.
Wong, E., & Chan, S. (2008). The pain experience and beliefs of Chinese patients who have sustained a traumatic limb fracture. International Emergency Nursing, 16, 80-87.
Yeh, M., Chen, H., & Liu, P. (2005). Effects of multimedia with printed nursing guide in education on self-efficacy and functional activity and hospitalization in patients with hip replacement. Patient Education and Counselling, 57(2), 217-224.
Yiu, H.Y.M., Chien, W.T., Lui, M.H.L., & Bai, Q. (2011). Information needs of Chinese surgical patients on discharge: A comparison of patients' and nurses' perceptions. Journal of Advanced Nursing, 67(5), 1041-1052.
eContent Home
