Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.

+,, 2 +3

www.iiste.org

Impact of a Designed Nursing Intervention protocol on Myocardial Infarction Patient's Outcome at a selected University Hospital in Egypt
+. 2. 3. 4. A-delha.eed /ahrosA-delha.eed+0, 1arda 2oussef /oha.ed2, 2ousria A-d 3l-sala. Selo.a3, Hanan 3l-sayed 4aghla4, 5linical Instructor of 5ritical 5are and 3.ergency Nursing, 6aculty of Nursing, #rof. of 5ritical care and 3.ergency Nursing, 6aculty of Nursing, 7ecturer of 5ritical 5are and 3.ergency Nursing, 6aculty of Nursing, 7ecturer of 5ritical 5are .edicine 6aculty of /edicine, 0 3-.ail of the corres$onding author8 a-delha.eed.ahros9yahoo.co.

Abstract ac!ground8 /yocardial infarction is a life threatening disease that influences the $hysical, $sychological and social di.ensions of the indi:idual. I.$ro$er lifestyle is one of the causes of this disease. ;he designing and i.$le.enting of nursing inter:ention $rotocol for /I $atients could -e one of the i.$ortant and funda.ental ste$s in i.$ro:ing /I $atients outco.es. Aim8 ;he ai. of this study was to e<a.ine the i.$act of a designed nursing inter:ention $rotocol on .yocardial infarction $atient=s outco.es as indicated -y higher $ost total .ean >nowledge scores, higher $ost total .ean $ractices scores and high le:el of co.$liance to lifelong instruction. "esearc# #ypot#eses$ H+. #atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a higher $ost total .ean >nowledge scores? H2. #atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a higher $ost total .ean $ractices scores? H3. #atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a high le:el of co.$liance to lifelong instruction. Design$ A @uasi-e<$eri.ental research design was utiliAed in this study %ample$ A con:enience sa.$le of 4 adult .ale and fe.ale /I $atients. %etting8 ;he cardiac care units at a selected 5airo Bni:ersity Hos$ital were recruited to fulfill the ai. of this study. &ools8 6our tools were for.ulatedC tested to collect data $ertinent to the study? Socio-de.ogra$hic and .edical data sheet, #reD#ost >nowledge @uestionnaire sheet, an )-ser:ational chec>list and 5o.$liance assess.ent sheet. Structured inter:iew, re:iewing .edical records and direct o-ser:ation were utiliAed for data collection. "esults$ ;he study results re:ealed that the $ost total .ean >nowledge scores of the studied su-Eects is increased significantly with :alue of tF 2 .G at $F . , higher $ost total $ractice scores a.ong the studied su-Eects with tC $ :alues "tF&.G at $F . % also, studied su-Eects had .ild to high co.$liance le:el regarding the lifelong instructions. 'onclusion$ It can -e concluded that, enrich.ent of $atientsH >nowledge and $ractices in relation to their condition and utiliAation of the effecti:e nursing inter:ention $rotocol as an a$$roach of care could ha:e a $ositi:e i.$act u$on i.$ro:e.ent of $atientsH outco.e. "ecommendations$ ;he study reco..ended 5onduction of further studies in order to assess the effecti:eness of the designed $rotocol on $atientsH outco.e regarding different cardiac disorders with re$lication of this study on a larger $ro-a-ility sa.$le fro. different geogra$hical locations at the Ara- Ie$u-lic of 3gy$t, in addition to esta-lish.ent of cardiac reha-ilitation center in the different heath care organiAations. (ey)ards: Nursing inter:ention $rotocol, /yocardial Infarction, )utco.es, 5ardiac care units. Introduction )ne of the goals of nursing care is health $ro.otion and $re:ention of disease. 5ardiac reha-ilitation achie:es these goals as it a co.$rehensi:e $rogra. that $re$ares the $atient to full, :ital and $roducti:e life in the ter.ination i.$osed on hi. -y the cardiac disease. It is a $rocess for restoring and .aintaining a $atient at his o$ti.al $hysiological, $sychological, and social status. #atient .o:es fro. co.$lete de$endence to inde$endence in his acti:ities of daily li:ing "AJ7% "Nair, 2 '%. ;he $attern of coronary care has changed, as ha:ing treat.ent $hiloso$hies, early hos$ital discharge is a .aEor force. Su$er:ised $rogra.s of e<ercise, education and lifestyle changes ha:e i.$ro:ed outco.e for client who ha:e coronary artery disease, .yocardial infarction "/I%, and other se:ere cardio:ascular conditions "Hoe.an, 2 2%. Kulanic> C /ayers "2 ++% added, ;he A.erican Heart Association and A.erican 5ollege of cardiology ha:e de:elo$ed treat.ent guidelines for $atients with unsta-le angina and Non S; seg.ent ele:ation /yocardial infarction, as well as for S; seg.ent ele:ation .yocardial infarction. 3ach guidelines addresses initial and ongoing drug thera$y, indication for fi-rinolytic and #ercutaneous coronary inter:entions, and discharge consideration. 6or $atient with /I, the thera$eutic goals are to esta-lish re$erfusion, to reduce infarct siAe, to $re:ent and treat co.$lications, and to $ro:ide e.otional su$$ort and education. Ieco:ery fro. unsta-le angina is shorter than with .yocardial infarction -ecause only ische.ic, not infracted, tissue occurs. /ore than !&L of $atients e<$eriencing *+

2&

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

.yocardial infarction return to full acti:ity le:el. Ac>ley, 7adwig, Swan C;ucher "2 '% re$orted that, 5ardiac disease self-.anage.ent are $ersonal actions to .anage heart disease and $re:ent disease $rogression which are? re$ort sy.$to.s of worsening disease? $erfor.s treat.ent regi.en as $rescri-ed? li.its sodiu. inta>e? follows reco..ended diet? $artici$ates in s.o>ing cessation $rogra.? $artici$ates in reco..ended e<ercise $rogra. and uses war.ing signs to see> health care. ;rials ha:e esta-lished that se:eral ty$es of inter:ention can reduce the ris> factors for cardio:ascular disease? i.$ro:e $sychosocial well--eing, and $atient >nowledge? and reduce .or-idity and .ortality "Hanestad, Hanssen C Nordrehaug , 2 4%. Nurses should $ro:ide the $atient with an e<ercise instruction such as instructing the $atient to record his heart rate -efore and after each $hase of e<ercise and whene:er he feels anything unusual during and after each e<ercise. #atient .ay increase s$eed of wal>ing day -y day, and increase the length of wal>ing distance. At the end of G-! wee>s $atient should -e a-le to engage in -ris> wal>ing for &>.Dhr. $atient .ay -e ad:ised to a:oid static e<ercise "lifting, carrying, $ushing hea:y o-Eects%" Nair 2 '%. In 3gy$t, cardiac reha-ilitation, usually, is not a $art of the routine $atient care after acute .yocardial infarction, so ;he designing and i.$le.enting of nursing inter:ention $rotocol for /I $atients could -e one of the i.$ortant and funda.ental ste$s in i.$ro:ing /I $atients outco.es. %ignificance of t#e study 6ro. clinical o-ser:ation in the cardiac care and critical care units, it was o-ser:ed that the nu.-er of $atients with A5S has increased o:er the last years and these $atients re@uire intensi:e colla-orati:e care to sa:e their li:es and they are at ris> for se:eral conse@uences. ;hese conse@uences in turn .ay ha:e negati:e i.$act on the $atientHs $hysical and $sychological condition, and will $rolong $atientHs hos$ital stay, and increase hos$ital costs, ;hat is why there is an interest to conduct such ty$e of research which .ight safeguard this category of $atients against these serious conse@uences, In addition, scattered researches where done in this area es$ecially on the national le:el. 6urther.ore, this research could $ro:ide health $rofessionals with an in de$th understanding related to this category of $atients which could -e reflected $ositi:ely on the @uality of $atientsH life, ;he study as well could su$$ort the i.$ortant role of the nurse in the $atientsH care through assessing the $atientHs and $ro:iding the re@uired care and teaching regarding the .yocardial infarction, Also it is ho$ed that findings of this study .ight hel$ in i.$ro:ing @uality of $atient care and esta-lish e:idence -ased data that can $ro.ote nursing $ractice and research. Aim of t#e study ;he ai. of the study is to assess the i.$act of nursing inter:ention $rotocol on .yocardial infarction $atientHs outco.es at the cardiac care units- 5airo Bni:ersity hos$itals. .+ "esearc# #ypot#eses ;o fulfill the ai. of this study, the following research hy$otheses were for.ulated8 H+. #atients who will -e e<$osed to the nursing inter:ention $rotocol will ha:e a higher $ost total .ean >nowledge scores. H2. #atients who will -e e<$osed to the nursing inter:ention $rotocol will ha:e a higher $ost total .ean $ractices scores. H3. #atients who will -e e<$osed to the nursing inter:ention $rotocol $lan will ha:e a high le:el of co.$liance to .edication regi.en, diet, e<ercises, and follows u$ a$$oint.ents. /+ %ub0ects and Met#ods$ 5.1 Research Design A @uasi-e<$eri.ental research design was utiliAed in this study 5.2 Setting ;his study was carried out at the cardiac care units affiliated to 5airo Bni:ersity Hos$itals, in 5airo go:ernorate. It is one of the largest educational uni:ersity hos$itals in 3gy$t in this field. It recei:es the cardiac $atients all o:er the day. It recei:es .ore than +& /I $atients $er year. 5.3 Subjects A con:enient sa.$le of 4 adult .ale and fe.ale $atients ad.itted to cardiac care units at 5airo uni:ersity hos$itals with acute .yocardial infarction for the first ti.e and willing to $artici$ate in the study. -+ ,+

2G

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

5.4 Tools 6our tools were de:elo$ed to collect data $ertinent to the study. ;hese tools are8 +-Sociode.ogra$hic and .edical data sheet "A$$endi< A%8it is a sheet co:ering two .ain sections8 the first section is related to sociode.ogra$hic data which includes age, gender, occu$ation, .arital status, le:el of education, socioecono.ic le:el, nutritional ha-its, s.o>ing ha-its etc. and ;he second section co:ers .edical data such as date of ad.ission and discharge, diagnosis, :ital signs, $ast .edical historyC co-.or-idities such as dia-etes, hy$ertension%, routine .edications, fa.ily history, and -ody .ass inde< 2- #reD#ost >nowledge @uestionnaire sheet "A$$endi< B%8 ;his sheet was for.ulated to assess $atientsH >nowledge a-out ris> factors, .anifestations, treat.ent, co.$lications of acute .yocardial infarction, warning signs of recurrent attac>s, acti:ities, and life style .odificationsM.etc. 3- )-ser:ational chec>list "A$$endi< 5%8 ;his sheet was de:elo$ed to assess $atientHs $ractices regarding $atientsH a-ility to $ractice $eri$heral $ulse counting, rela<ation techni@ue? dee$ -reathing techni@ue and filling a diet record. 4- 5o.$liance assess.ent sheet "A$$endi< J%8;his sheet was designed to e:aluate su-EectsH adherence to the $rescri-ed regi.en. It includes si< .ain areas including a% adherence to the life-long $ost discharge instructions? -% adherence to $rescri-ed follow u$ syste.? c% adherence to $rescri-ed .edications regi.en? d% adherence to $rescri-ed diet regi.en? e% adherence to $rescri-ed e<ercise regi.en and f% adherence to stress .anage.ent techni@ues. It is a rating scale which is co.$osed of 4 $oints "always, so.eti.es, rarely and ne:er%. Ethical consideration An official $er.ission to conduct the study was o-tained fro. the ethical co..ittee of research and *ice Jean for Higher 3ducation and Iesearch- 6aculty of Nursing and directors of 5ritical 5are Bnits. *er-al consents were o-tained fro. head nurses of these units. In addition, $atientsH agree.ents to -e included in the study were o-tained for.ally after e<$lanation of the nature and $ur$ose of the study. 3ach $atient was free to either $artici$ate or not in this study and ha:e the right to withdraw fro. the study at any ti.e without any rational? also, $atients were infor.ed that data will not -e included in any further researches without another new consent if they do not .ind. 5onfidentiality and anony.ity of each su-Eect were assured through coding of all data. 5.6 Techniques or data collections Structured inter:iew, re:iewing .edical Dnursing records ,direct $atients o-ser:ation and follow u$ -y $hone calls were utiliAed to fill out the study tools. 5.! "rocedure ;he current study was carried out on two $hases, designation and i.$le.entation $hases which are8 5.!.1 Designing #hase: It was concerned with the construction and $re$aration of the different data collection tools and instructional -oo>let in addition to o-taining .anagerial arrange.ent to carry out the study. 5.!.2 $%#le%entation #hase: ;he researchers :isited the cardiac care units on daily -ases once they find the $atient who .et the criteria of selection? socio-de.ogra$hic and .edical data sheet "tool +% was fulfilled. As well the >nowledge assess.ent sheet "tool 2% and o-ser:ational chec>list sheet "tool 3% were filled out for the whole grou$ as a control grou$. ;he whole grou$ was e<$osed to the routine hos$ital care. ;hen the whole grou$ was su-Eected to the designed nursing inter:ention $rotocol on a daily -ase till discharge as a study grou$. ;hen all su-Eects were su$$lied with the $redeter.ined instructional -oo>let. ;he co.$liance assess.ent sheet "tool 4% was filled out for all su-Eects during the first .onth after discharge. /ainly follow u$ was done through the o$en channel of co..unication with the in:estigator through the tele$hone call to answer their @uestions, reinforce infor.ation, correct .isunderstanding and .onitor the $atientHs adherence to the gi:en instructions. 5.& Statistical data anal'sis Jata o-tained fro. the study tools were categoriAed, ta-ulated, analyAed and data entry was $erfor.ed using the S#SS software "statistical $ac>age for social sciences :ersion2 . %. Jescri$ti:e statistics were a$$lied "e.g. .ean, standard de:iation, fre@uency and $ercentage%. ;ests of significance were $erfor.ed to test the study hy$otheses "i.e. $aired and un$aired t- test, chi s@uare test and AN)*A test%. #earsonHs correlation coefficient was a$$lied -etween @uantitati:e :aria-les. A significant le:el :alue was considered when $N . &.;he s.aller the #- :alue o-tained, the .ore significant is the result. ;he #- :alue is -eing the $ro-a-ility of error of the conclusion. 1+ "esults 6indings of the current study are $resented in three .ain sections? section "+% related to sociode.ogra$hic data, .edical data "ta-le+ and figures+,2,3,4,&,G,,C!%, section "2% is concerned with testing the research hy$othesis "figure ',+ C++% and section "3% is concerned with the additional findings"ta-le2C3%

2,

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

Section +8 6igure "+% shows that, &2.& L of study sa.$leHs age ranged fro.O& toG& years, and 3,.&L of the. were aged -etween 3&to& years. 6igure "2% shows that, .ore than three fourths of the studied su-Eects ",! L% were .ales. 6igure "3% shows that, !&L of studied su-Eects ca.e fro. ur-an areas and figure "4% shows that "4 L% of the studied su-Eects were o:erweight and 3 L were .oderate o-ese. 6igures "&%C "G% shows that, ",2.&L% of the studied su-Eects were s.o>ers and "3,.'L% of the. were s.o>ing + to 2 cigarettes $er day. In addition that, figure ",% shows that .ore than half "&&L % of the studied su-Eects were diagnosed as S;3/I while "44L %of the. diagnosed NS;3/ and figure"!% shows that "3,.&L% of the. ha:e not any co-.or-idity diseases. ;a-le "+% re:ealed that .ore than one third "3,.&L% of the studied su-Eects were a-le to read and write and "! L% of the. were ha:ing a wor>. In addition that, "4,.&L% of the studied su-Eects were used to eat foundry and fatty diet and ",2.&L% dose not drin> coffee."',.&L% of the studied su-Eects does not $ractice any s$orts. 6inally only "+&L% of the studied su-Eects has $ositi:e fa.ily history for the cardiac disease. Section "2%8 6igure "'% indicating higher total >nowledge scores a.ong the studied su-Eects, ran>ed as satisfactory to good le:els. Howe:er, all of the studied su-Eects "+ L% re.ained with an unsatisfactory >nowledge le:el -efore recei:ing the designed $rotocol which is su$$orting the first hy$othesis which stated P#atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a higher $ost total .ean >nowledge scoresP. 6igure "+ % shows that "+ L% were ha:ing unsatisfactory le:el of $ractice -efore recei:ing the designed $rotocol, this $ercentage decreased to -e "4&L%after recei:ing the designed $rotocol, the other "&&L% of the studied su-Eects were ha:ing satisfactory "2&L% and good "3 L%le:el of $ractice and this is su$$orting the second hy$othesis which stated P#atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a higher $ost total .ean $ractices scoresP. finally, it a$$ears fro. figure"++%that, "& L% of the studied su-Eects has .ediu. total co.$liance le:el to the lifelong instructions, while "4,.&L% of the. has low le:el of total co.$liance, and shows also the different su-total co.$liance scores ran>ing fro. low to high le:el of co.$liance which could $artially su$$ort the third hy$othesis which stated P#atients who will -e e<$osed to a designed nursing inter:ention $rotocol will ha:e a high le:el of co.$liance to lifelong instructionP. Section "3% ;a-le "2% re:ealed that, there is a significant $ositi:e statistical correlations -etween total >nowledge scores and total $ractice scores, total $ractice scores and total co.$liance scores and total co.$liance scores and total >nowledge scores "r F .&G', $ F . %, "r F .& ', $ F . +% and "rF .33! ,$F . 33% res$ecti:ely. ;a-le "3% Je.onstrates that, there is a highly significant statistical difference was found -etween educational le:el and total .ean >nowledge, $ractice and co.$liance scores of the studied su-Eects. 2+ Discussion ;he $resent study delineated that .ore than three fourths of the cases are .ale and .ore than half of the study sa.$leHs age ranged -etween O& -G& years old. ;his agreed with Bare, 5hee:er, Hin>le C S.eltAer "2 + % who .entioned that ris> factors for the de:elo$.ent of coronary artery diseases Q5AJR increases with age and .ale gender. In accordance with these results, Bos-Schea$, Haut:ast, Heester.ans, 1it CB.ans "2 ++% re$orted in a $u-lished study entitled as PNursing role to i.$ro:e care to infarct $atients and $atients undergoing heart surgeryP that ",&L% were .ale. ;his study results is si.ilar to the study of Angerud ,Brulin , 3liasson C Naslund "2 +3% in an analysis of 42GG /I $atient which re:ealed that a-out two third of the studied su-Eects were .ale with .ean age of G+.! years, and Haw-oldt, #earce C 2oung "2 + % in a study on 34G /I $atients found that, their .ean age was G&.3 years and G&.&L of the. were .ale. /oreo:er, Ahrens, Slin$ell C #rentice "2 + % found that A5S is .ore $re:alent in older $ersons than in younger $ersons, the condition de:elo$s earlier in .en than in wo.en. Holle, Sirch-erger, Such, /eisinger, SeidlC 1ende "2 + % also confir.ed that aged $atients ha:e a high $re:alence of /I. ;he study results also su$$orted -y the results of Haw-oldt, #earceC 2oung "2 + % which studied 34G /I $atients, showed that the .ean age of $atients was G&.4 years and al.ost two-thirds were .ale. Another study done -y 3liasson, Isa>sson ,Jansson , 7und-lad , NaslundC 4ing.ar> "2 ++% studied !G3 with a first /I and showed that a-out three fourths of the studied su-Eects were .ale with .ean age of &&.& years. In contrast with our study, the study of Aurige..a, 5hiri-oga, 6ornasini, Kold-erg, Kore, 7essard, S$encerC 2arAe-s>i "2 '% that studied G334 /I $atients showed that the .ean age of the studied su-Eects was ,+ years and &GL were .en. ;he de.ogra$hic data of $resent study also delineated that the .aEority of the studied su-Eects ca.e fro. ur-an areas. As 5airo Bni:ersity hos$itals is one of the largest educational uni:ersity hos$itals in 3gy$t in this field which recei:es the cardiac $atients fro. all o:er the country. ;his .ay -e due to the unhealthy lifestyle which the ur-an $eo$le ha:e co.$aring to the rural $eo$le lifestyle. ;his study results is si.ilar to the

2!

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

study of Angerud ,Brulin, 3liasson C Naslund "2 +3% in an analysis of 42GG /I $atient which re:ealed that a-out two thirds of the studied su-Eects ca.e fro. ur-an areas. ;he $resent study re:ealed that a-out three fourths of the study su-Eects were s.o>ers, that is why, s.o>ing .ay -e the .ost $ro-a-le ris> factor for the .aEority of /I e:ents. ;his is agreed with Kulanic> C /ayers "2 ++% who re$orted that s.o>ing causes :asoconstriction and reduces .yocardial o<ygen su$$ly , ris> for de:elo$ing 5AJ is 2 to G ti.es greater in cigarette s.o>ers and ris> is $ro$ortional to nu.-er of cigarettes s.o>ed. Howe:er the study carried out -y Angerud , Brulin , 3liasson C Naslund "2 +3% showed that a-out one third only of the study su-Eects which was 42GG /I $atients were s.o>ers.In accordance to this study, the study of 3liasson, Isa>sson , Jansson , 7und-lad , NTslund C 4ing.ar> "2 ++% which studied !G3 with a first /I and showed that 3'.GL of the study su-Eects were s.o>ers./oreo:er, Haw-oldt, #earce C 2oung "2 + % found that .ore than one third of the studied su-Eects "34G /I $atients % were current s.o>ers. ;he re:iewed .edical data sheet of current study su-Eects showed that .ore than half of the. were diagnosed S;3/I. ;his result is si.ilar to the results of Aurige..a, 5hiri-oga, 6ornasini, Kold-erg, Kore, 7essard, S$encerC 2arAe-s>i "2 '% study titled Q5onte.$orary trends in e:idence--ased treat.ent for acute .yocardial infarctionR which showed that the .aEority of the studied su-Eects were S;3/I. In contrast with this study the study of 2oung, Haw-oldt C #earce "2 + % which studied 34G /I $atients found that, the .aEority of the study su-Eects diagnosed NS;3/I. Iegarding B/I the current study showed that .ore than one third of the studied su-Eects were o:erweight and .ore than one forth of the. were o-ese, ;hat=s why, the o-esity .ay -e one of the ris> factors for /I. In this regards, Bru-a>er, Sa.insyC 1haley "2 2% re$orted that o-esity is docu.ented in a$$ro<i.ately 4 L of $eo$le with 5AJ $atients. In accordance with these results, BucholA, 5han, Jone, Iathore, Sru.holA, Ieid, IichC S$ertus "2 +2% in a study titled QBody .ass inde< and .ortality in acute .yocardial infarction $atientsR done on study sa.$le G3&' /I $atients re$orted that one third of the studied su-Eects were o-ese. Iegarding the co-.or-idities the current study re:ealed that co-.or-idities was a-sent in one third of the study su-Eects, while al.ost one fourths of the studied su-Eects had hy$ertension $lus dia-etes .ellitus and one fifth of the studied su-Eects had dia-etes .ellitus only. Kulanic> C /ayers "2 ++% also .entioned that eighty $ercent of dia-etic $atients ha:e cardio:ascular disease. In addition that High -lood $ressure is .aEor ris> factor for 5AJ as Nair "2 '% re$orted that the stress of constantly ele:ated -lood $ressure can increase the rate of atherosclerosis de:elo$.ent. In this regard, Aurige..a, 5hiri-oga, 6ornasini, Kold-erg, Kore, 7essard, S$encerC 2arAe-s>i "2 '% re$orted that a-out one third of the study sa.$le ha:en=t any co-.or-idities, while .ore than one fourth of the study sa.$le had had +-2 co-.or-idities and a-out one third of the. had 3-4 co.or-idities. Also BucholA et al. "2 +2% re$orted in a study done on G3&' /I $atients that around two- thirds of the sa.$le had hy$ertension, and .ore than one third of the. had dia-etes .ellitus. /oreo:er, Haw-oldt, #earce C 2oung "2 + % found that .ore than one fourth of their study su-Eects had had dia-etes .ellitus, while .ore than half of the. had hy$ertension. As regards to the #atientHs Snowledge, the current study results delineated, a higher statistically significant difference -etween $atient=s >nowledge score $re and $ost e<$osure to the designed $rotocol, indicating higher total and su-total .ean $ost >nowledge scores a.ong the studied su-Eects, ran>ed as satisfactory to good le:els. Howe:er, all of the studied su-Eects were ha:ing an unsatisfactory >nowledge le:el -efore recei:ing the designed $rotocol. ;he rational for >nowledge i.$ro:e.ent .ight -e related to the $ro:ision of educational -oo>let and D or :er-al instructional infor.ation. Also, the curiosity of the studied su-Eects as this is the first heart attac> for the. and .any concerns are $resent. Iesults of $resent study showed that there was a significant difference -efore and after the inter:ention in the studied su-Eects. ;herefore, a$$lying discharge $lan could ha:e $ositi:e effects on the lifestyle of $atients with /I. Si.ilar to the results of this research, another study -y Jiang, SitC 1ong "2 ,% indicated that, a nurseled cardiac reha-ilitation $rogra. can significantly i.$ro:e the health -eha:iors and cardiac $hysiological ris> factors in coronary heart disease $atients. Based on these findings, it is necessary to consider the role of nurses in a cardiac reha-ilitation $rogra.. Jallec>, 7ue>erC Sch.idt "2 ++% re$orted that, $artici$ation in cardiac reha-ilitation $rogra.s had $ositi:e changes in :arious ris> factors li>e -lood $ressure, cholesterol, triglyceride, HJ7 and 7J7 cholesterol +,,+! energy e<$enditure, fat, and stress. 6ollowing u$ the client=s -eha:ior at ho.e hel$ed -etter controlling the heart disease. ;his reduced the fre@uency of their re-hos$italiAation, cost of hos$italiAation and .ortality rate. 6ran>lin, Kordon 7eightonC Sal.on "2 2% also showed a reduction in ris> factors of $atients with /I, 5ABK, #ercutaneous coronary inter:ention, or angina after $artici$ating in traditional cardiac reha-ilitation, cardiac reha-ilitation with $hysician su$er:ision, and a co..unity--ased e<ercise $rogra. run -y e<ercise $hysiologists. In addition, A-edi, Ah.adi, Arefi ,6aghihi-AadehC Khofrani$our "2 &% re$orted that, continuous care .odel has $ositi:e effects on the @uality of life of $atients after 5ABK and heart failure, in all $hysical,

2'

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

e.otional and general di.ensions. ;his .odel was effecti:e in the reduction of the hos$italiAation $eriod and chest $ain in $atients with coronary :ascular diseases. Howe:er, the study carried out -y Hosseini, /oha..adi, IahgoAarC ;aherian "2 G% ai.ing to deter.ine the effect of a$$lying cardiac reha-ilitation at ho.e on the @uality of life of $atients with /I showed that the reha-ilitation $rogra. consisting of training sessions regarding /I disease and its co.$lications, dietary and .edicinal regi.e, ris> factors of the disease, etc. at ho.e had no $articular effect on :arious di.ensions of the @uality of life of this grou$ of $atients and there was no significant difference -etween grou$s. Khahra.anian, KolchinC Iosta.i "2 ++% showed that, education $rogra.s and follow-u$ -y tele$hone ha:e $ositi:e effects on >nowledge, self-care -eha:iors, a disease sy.$to.s of $atients with cardiac failure. #atients forget the thera$eutic reco..endations gradually after discharge fro. the hos$ital? therefore, it is necessary to $ro:ide such infor.ation. )n the other hand, the nu.-er of healthy undesira-le -eha:iors of $atients with /I increases if it is not followed-u$ at ho.e. Since the $atients= $artici$ation in cardiac reha-ilitation $rogra.s after an acute /I is low, they re@uire education and follow-u$ regarding the control of sy.$to.s, .edicinal infor.ation, and i.$ro:e.ent of lifestyle. 5hris C5harlie "2 4% agreed with this findings as they studied the PInfluence of written infor.ation on $atientHs >nowledge of their diagnosisP on G4 $atients in )<ford Bni:ersity found that $atients recei:ing an infor.ation sheet were twice as li>ely to -e correct with their .ain diagnosis "&'L :s 3+L% co.$ared with the control grou$. ;here was a tendency for $atients recei:ing a sheet to ha:e increased >nowledge of $re:ious .edical $ro-le.s. 6inally, $atients recei:ing a sheet were significantly .ore satisfied with the infor.ation gi:en a-out their diagnosis in hos$ital co.$ared with the control grou$. As regards to the relationshi$ -etween >nowledge and educational le:el, the current study re:ealed that there was significant statistical correlation -etween educational le:el and .ean >nowledge scores a.ong studied su-Eects. In this regard, Alghani. C Alnaif "2 '% agreed with our findings in a $u-lished research article entitled as P$atients= >nowledge and attitudes towards health education8 i.$lications for $ri.ary health care ser:icesP in Saudi Ara-ia in which they found, res$ondents with a higher le:el of education had a significantly higher .ean score "3.G3% of >nowledge a-out dia-etes than those with a lower le:el of education "3.2!% "t-test F 3.GG&, $N . +%. 5ontradicting this, Selo.a "2 + % re$orted in an un$u-lished doctorate thesis entitled asR I.$act of utiliAation of a designed nursing clinical $athway guidelines on the $atientsH outco.es with cardiac $acing at the critical care units, 3l-/anial Bni:ersity Hos$italR that there was no significant statistical correlation -etween educational le:el and .ean >nowledge scores a.ong study and control grou$ su-Eects throughout the different assess.ent $eriods e<ce$t during assess.ent $eriod -efore $ace.a>er insertion. As regards to $atient=s $ractice, the current study results re$orted that there was a significant statistical difference -etween $atient=s $ractice .ean scores $re and $ost e<$osure to the designed $rotocol, the .aEority of study su-Eects had higher $ost total and su-total .ean $ractice scores, ran>ed as satisfactory to good le:els. Howe:er, all of the studied su-Eects had an unsatisfactory $ractice scores -efore recei:ing the designed $rotocol .;hese findings .ay -e as a result of continuous de.onstration, rede.onestration, follow u$ and $ractical content of the instructional -oo>let which was gi:en to the studied su-Eects with the continuous e<$lanations, reinforce.ent and feed-ac>. In the $resent study, there was a significant statistical correlation -etween $atients .ean $ractices scores and their le:el of education in different assess.ent $eriods a.ong studied su-Eects -efore and after the inter:ention. In addition to, there was a significant statistical $ositi:e correlation -etween total >nowledge and total $ractices scores a.ong the studied su-Eects. 5ontradicting this, Selo.a "2 + % re$orted that there was no significant statistical correlation -etween $atients .ean $ractices scores and their le:el of education in different assess.ent $eriods a.ong study and control grou$ su-Eects. Howe:er, there was a significant statistical $ositi:e correlation -etween total >nowledge and total $ractices scores a.ong the study and control grou$ su-Eects throughout the different assess.ent $eriods. In accordance with the study findings, Iefaii "2 + % in an un$u-lished doctorate thesis entitled as Pthe i.$act of a designed nursing clinical $athway guidelines on acute .yocardial infarction $atientsH outco.esP on G $atients "3 study and 3 control% at Benha Bni:ersity Hos$itals in 3gy$t found that, an incre.ent of study grou$ $ost .ean $ractices scores as co.$ared to control grou$ after i.$le.entation of a designed nursing clinical $athway with a highly significant statistical differences -etween the two grou$s during the two follow u$ assess.ent "i..ediately $ost and three .onths later% with the following (2 C$ :alues"(2 F2+.,2 at $F . + C (2 F 4.+&! at $ F . + res$ecti:ely%. As well, 3l Hadary "2 '% in an un$u-lished doctorate found that there was a higher statistically significant difference -etween the study and control grou$ su-Eects in different assess.ent $eriods, indicating higher .ean :alues of a:oiding cardiac stress acti:ities, cli.-ing stairs as ad:ised and arranging acti:ityDrest ti.e throughout the follow u$ :isits a.ong the study grou$ as co.$ared to the control grou$ ones, with high significant statistical differences -etween the. "6F 2&.+4 at $F . +, 6F&3.3' at $F . +C6F3 ., at $F . +%./oreo:er, /oha.ed "2 G% in a study entitled asP effect of counseling on

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

$atientHs co.$liance with thera$eutic regi.en after artificial :al:ular heart re$lace.ent surgeryP on + $atients at the cardiothoracic surgery de$art.ent at Ain Sha.s Bni:ersity hos$ital in 3gy$t, in an un$u-lished doctorate thesis found that, none of the $atients in the study and control grou$s were $erfor.ing radial $ulse .easuring, nec>, shoulder and el-ow e<ercises $re-$rogra. i.$le.entation. Howe:er $ost $rogra. i.$le.entation? a$$ro<i.ately one third had satisfactory $erfor.ance, with a highly significant statistical difference -etween study and control grou$ su-Eects As regards to $atient=s co.$liance, the current study indicated a statistically significant difference -etween the studied su-Eects regarding to total and su-total co.$liance scores $ost discharge and during follow u$ :isits. ;he studied su-Eects showed different le:els of co.$liance ranging -etween -eing low, .ediu. and high co.$liance le:els. ;his .ay -e due to continuous contact with the studied su-Eects through o$en channel of tele$hone co..unication -etween the researcher and the studied su-Eects. 1al, Jaars.a, /oserC*eeger "2 G% .entioned that in order to i.$ro:e co.$liance, an incre.ent of >nowledge and a change of $atientHs -eliefs -y education and counseling are reco..ended. 3<tra attention should -e $aid to $atients with de$ressi:e sy.$to.s. In this regard, 3l Hadary "2 '% su$$orted these result when re$orting that study grou$ su-Eects showed a higher .ean co.$liance scores regarding following $rescri-ed .edications and following $rescri-ed acti:ity regi.en as co.$ared to control grou$ su-Eects with significant statistical differences -etween the two studied grou$s "6F2&.G at $F . +C 6F G'. 2 at $F . +%.Also, 1al, Jaars.a, /oserC*eeger "2 G% in a $u-lished research article entitled as P5o.$liance in heart failure $atients8 the i.$ortance of >nowledge and -eliefP in Bni:ersity of Kroningen, data were collected in a cohort of & + heart failure $atients. ;hey found that o:erall co.$liance was ,2L in this older heart failure $o$ulation. 5o.$liance with .edication and a$$oint.ent >ee$ing was high "O' L%. In contrast, co.$liance with diet "!3L%, fluid restriction ",3L%, e<ercise "3'L%, and weighing "3&L% was .ar>edly lower. 5o.$liance was related to >nowledge ")IF&.G,? 5I 2.!,-++.+'%, -eliefs ")IF+.,!? 5I +.+!-2.G'%, and de$ressi:e sy.$to.s ")IF .&3? 5I .3&- .,!%. Adding to that, 4erwic "2 ,% stated that, the co.$liance to the thera$eutic regi.en was $ro.oted -y nursing clarification and e<$lanation. ;herefore, the infor.ation $ro:ided through nursing inter:ention .ust -e sufficient to increase $atientHs desire and encourage the. to co.$ly with $rescri-ed thera$eutic regi.en after discharge. ;he $atient who are oriented with e:ery-thing a-out their disease are .ore li>ely to engage in acti:ities that $ro.ote changing their -eha:iors, $ro.ote $hysical well--eing and enhancing the co.$liance with thera$eutic regi.en than those who are not oriented. 3+ 'onclusion 5onsidering the results of the $resent study and the a:aila-le e:idence, it can -e concluded that, $atients who were e<$osed to the designed nursing $rotocol for the .yocardial infarction $atients showed a relati:e i.$ro:e.ent in their conditions than those who were e<$osed to the routine hos$ital care only. ;his i.$ro:e.ent was .anifested in the incre.ent in the $ost total .ean >nowledge scores, $ost total .ean $ractice scores and the .ean co.$liance scores as regards to the i..ediate, life-long and follow u$ instructions. Ieha-ilitation centers also could a$$ly this .odel to follow the $atients after /I.

4+ "ecommendations Based on the findings of the $resent study, the following reco..endations are suggested8 Ieco..endations related to $atients8 - 3sta-lish.ent of $atientsH educational centers in hos$itals e@ui$$ed -y suita-le related .aterials, .edias and audio-:isual aids for teaching all .yocardial infarction $atientsH how to li:e with their .edical condition. - 5ardiac reha-ilitation centers can -e esta-lished and encouraged. - Iegular follow u$ for all $atients with .yocardial infarction to e:aluate their health conditions and to detect co.$lications early. Ieco..endations for furthers researches8 - Ie$lication of the study on a larger $ro-a-ility sa.$le selected fro. different geogra$hical areas in 3gy$t is reco..ended to o-tain .ore generaliAa-le data. - 6urther studies ha:e to -e carried out in order to assess the effecti:eness of nursing inter:ention $rotocol a$$lications on $atientsH outco.es regarding different cardiac disorders. - 6urther studies ha:e to -e carried out in order to assess nursesH >nowledge and $ractices regarding $ro:iding a nursing inter:ention $rotocol for .yocardial infarction $atients. Ac!no)ledgment ;his research article would not ha:e -een $ossi-le without the su$$ort of .any $eo$le. ;he authors wish to e<$ress their gratitude to all $eo$le who share or hel$ in this research.

3+

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

"eferences Ac>ley, B. J., 7adwig, K. B., Swan, B. A. C ;ucher, S. J. "2 '%. 3:idence-Based nursing care guidelines. 5anada, 3lse:ier /os-y, $.$. +4 -+4!. A-edi, H.A., Arefi, S.H., Ah.adi, 6., 6aghihi-Aadeh, S. C Khofrani$our, 6. "2 &%. 3ffect of continuous consultation care .odel on re hos$italiAation and chest $ain in $atients with coronary artery disease. J UaA:in Bni: /ed Sci? 3&"'%8 ''-+ 3. Ahrens, ;. S., Slein$ell, I. /. C #rentice, J., "2 + %. 5ritical care nursing certification, Singa$ore, /cKrewHill, $.$ G&-,&. Alghani., S.A., Alnaif, /.S. "2 '%. #atientsH >nowledge and attitudes towards health education8 I.$lications for $ri.ary health care ser:ices in Saudi Ara-ia. #u-lished thesis? *olu.e 8 +G, Issue 8 +, $.$. 8 2,-3 Angerud, S.H., Brulin, 5., 3liasson /. C Naslund, B. "2 +3%.7onger $re-hos$ital delay in first .yocardial infarction a.ong $atients with dia-etes8 B/5 cardio:ascular disorders2 +3,+38 G. Aurige..a, #., 5hiri-oga, J., 6ornasini, /., Kold-erg, I.J., Kore, J./., 7essard,J., S$encer, 6.A C2arAe-s>i, J."2 '%. 5onte.$orary trends in e:idence- -ased treat.ent for acute .yocardial infarction. A/ J /ed.2 + ?+23"2%8 +GG. Bru-a>er, #. H., Sa.ins>y, 7.A., C1haley, /.H., "2 2%. 5oronary artery diseases, essentials of $re:ention and reha-ilitation $rogra.s. Bnited states of A.erica, -y Hu.an >inetics, $.$. 2'+-32G. BucholA, 3./., 5han, #.S., Jones, #.K., Sru.holA, H./., Iathore, S.S., Iich, /.1.C S$ertus, J.A."2 +2%. Body .ass inde< and .ortality in acute .yocardial infarction Jallec>, 7.5., 7ue>er, I. C Sch.idt, 7.S."2 ++%. 5ardiac reha-ilitation outco.es in a con:entional :ersus tele.edicine--ased $rogra. ? +,"&%8 2+,-2+. 3l Hadary, S. "2 '%8 I.$act of BtiliAation of a Nursing 5linical #athway Kuidelines on the Heart 6ailure #atientsH )utco.es at the 5ritical 5are Bnits, 3l-/anial Bni:ersity Hos$ital8 Joctorate thesis. 3lison, /., Isa>sson, I./., Jansson, J.H., 7und-ald, J., Naslund, B.C 4ing.ar>, S. "2 ++%. 6ran>lin B.A., Kordon N.6., 7eighton, I.6. C Sal.on, I..J. "2 2%. 3ffecti:eness of three .odels for co.$rehensi:e cardio:ascular disease ris> reduction. A. J 5ardiol? !'"++%8 +2G3-!. Khahra.anian, A., Kolchin, /. C Iosta.i, H. "2 ++%3ducational needs of .yocardial infarction $atients. J Br.ia Nurs /idwifery 6ac 2 ++? '"3%8 +&,-G3. Kulanic>, /. and /yers, J.7. "2 ++%. Nursing care $lans",th ed.%. Bnited states of A.erica,3lse:ier /os-y, $.$ 2 '-2+ . Haw-oldt, J.J., #earce, N.J. C 2oung, S.1. "2 + %. Bse of e:idence -ased thera$y at discharge for $atients with A/I.5J#H-*)7 G3"3%82 ,-2++. Hoe.an, S. #. "2 2%. Ieha-ilitation nursing "3rd ed.%. Bnited states of A.erica, /os-y, $.$. ,23-,3&. Holle, I., Sitch-erger, I., Such, B., /eisinger, 5., Seidi, H. C 1ende, I."2 + %. Nurse -ased case .anage.ent for aged $atients with /I8 study $rotocol of a rando.iAed controlled trial. B/5 Keriatrics 2 + , + 82'. Hosseini, /.A., /oha..adi, 6., IahgoAar, /. C ;aherian, A."2 G%. 3ffect of ho.e--ased cardiac reha-ilitation on @uality of life in the $atients with .yocardial infarction. Iran Ieha-il J 2 G? ,"3%8 ++-'. Jiang, (., Sit, J.1.C 1ong, ;.S. "2 ,%. A nurse-led cardiac reha-ilitation $rogra..e i.$ro:es health -eha:iours and cardiac $hysiological ris> $ara.eters8 e:idence fro. 5hengdu, 5hina. J 5lin Nurse 2 ,? +G"+ %. Nair, B.I. "2 '%. ;e<t-oo> of .edical surgical nursing "+st ed.%. India, Jay$ee Brothers .edical #u-lishers, $.$ 4&-43 . Selo.a, 2.3. "2 + %. I.$act of utiliAation of a designed nursing clinical $athway guidelines on the $atientsH outco.es with cardiac $acing at the critical care units, 3l-/anial Bni:ersity Hos$ital8 Joctorate thesis.

32

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

"A% 6igures

33

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

5igure 6**7$ Differences in total and subtotal compliance score levels of t#e studied sub0ects8 post receiving t#e designed protocol 6n9.:7$

Compliance scores
low compliance medium compliance high compliance
95% 87.5% 70% 50% 47.5% 66% 55% 45% 22.5% 10% 2.5% 12.5% 0% 7.5% 5% 2.5% 2.5%

20%

total compliance

Patient's Patient's Patient's compliance to compliance to compliance to life-long regular follow up me ication instructions regimen

Patient's ! Patient's compliance to compliance to iet regimen e"ercise regimen

34

Journal of Biology, Agriculture and Healthcare ISSN 2224-32 ! "#a$er% ISSN 222&- '3( ")nline% *ol.3, No.+,, 2 +3

www.iiste.org

"B% ;a-les8 &able 6*7$ Distribution of t#e educational level; Occupation; Diet nature; 'offee inta!e; practicing sports and family #istory for cardiac diseases for t#e studied sub0ects 6n9.:7+ Ite.s - Illiterate - 5an read and write - Secondary education - High education - JoesnHt wor> - 1or>erD 3.$loyer - 7ow salt - 7ow fat - 6oundry and fatty - Not s$ecificP usualP - No - 2es - No - 2es - No - 2es No , +& +2 G ! 32 2 + +' +' 2' ++ 3' + 34 G L +,.& 3,.& 3 . +&. 2 . ! . & 2.& 4,.& 4& ,2.& 2,.& ',.& 2.& !&. +&.

3ducational le:el

)ccu$ation

Jiet nature

5offee inta>e #ractice s$orts 6a.ily history

&able 6,7$ 'orrelation 'oefficient et)een total !no)ledge scores; total practice scores; and total compliance scores of t#e studied sub0ects 6n9.:7+ ;he Ite.s +-;otal >nowledge scores and total $ractice scores 2- ;otal $ractice scores and total co.$liance scores 3- ;otal co.$liance scores and total >nowledge scores 0Significant at the $ N . & $ro-a-ility le:el rD:alue .&G' .& ' .33! NSF not statistically significant "D:alue . 0 . +0 . 330

&able 6-7$ One )ay ANO<A test for comparison of total mean !no)ledge scores; total mean practice score and total mean compliance scores in relation to educational =evel of t#e %tudied %ub0ects 6n9.:7+ *aria-le f $ . 0 . &0 . ++0

3ducational le:el + .+ o 3ducational le:elD total .ean >nowledge scores &.3 o 3ducational le:elD total .ean $ractice scores 4.2 o 3ducational le:elD total .ean co.$liance scores 0Significant at the #N . & $ro-a-ility le:el 0NSF not statistically significant

3&

This academic article was published by The International Institute for Science, Technology and Education (IISTE). The IISTE is a pioneer in the Open Access Publishing service based in the U.S. and Europe. The aim of the institute is Accelerating Global Knowledge Sharing. More information about the publisher can be found in the IISTEs homepage: http://www.iiste.org CALL FOR JOURNAL PAPERS The IISTE is currently hosting more than 30 peer-reviewed academic journals and collaborating with academic institutions around the world. Theres no deadline for submission. Prospective authors of IISTE journals can find the submission instruction on the following page: http://www.iiste.org/journals/ The IISTE editorial team promises to the review and publish all the qualified submissions in a fast manner. All the journals articles are available online to the readers all over the world without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. Printed version of the journals is also available upon request of readers and authors. MORE RESOURCES Book publication information: http://www.iiste.org/book/ Recent conferences: http://www.iiste.org/conference/ IISTE Knowledge Sharing Partners EBSCO, Index Copernicus, Ulrich's Periodicals Directory, JournalTOCS, PKP Open Archives Harvester, Bielefeld Academic Search Engine, Elektronische Zeitschriftenbibliothek EZB, Open J-Gate, OCLC WorldCat, Universe Digtial Library , NewJour, Google Scholar