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Educational Video Intervention Effects On Periprocedural Anxiety Levels Among Cardiac Catheterization Patients A Randomized Clinical Trial
Educational Video Intervention Effects On Periprocedural Anxiety Levels Among Cardiac Catheterization Patients A Randomized Clinical Trial
Educational Video Intervention Effects On Periprocedural Anxiety Levels Among Cardiac Catheterization Patients A Randomized Clinical Trial
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C
ardiovascular diseases (CVDs) are the number one causes of death and loss 39
of quality of life globally (Chang, Peng, Wang, & Lai, 2011; World Health 40
Organization, 2013), and it is the number one killer in Jordan (Jordanian 41
Ministry of Health, 2012). By the year of 2030, almost 23.6 million people will die 42
from CVDs and these are projected to remain the single leading causes of death 43
44
45
© 2016 Springer Publishing Company1 46
http://dx.doi.org/10.1891/1541-6577.30.1.1
et al., 2011). Given the potentially serious consequences of untreated anxiety, the 1
assessment of anxiety is necessary, yet this assessment rarely occurs as a part of 2
routine care. 3
Preprocedural education related to CATH is generally provided by nurses (Buzatto 4
& Zanei, 2010), who have several alternatives such as verbal education, pamphlets, 5
booklets, audiotapes, and videos (Jamshidi, Abbaszadeh, Kalyani, & Fakhondeh, 6
2013). Patients’ education using an educational video before CATH shown to be 7
more effective in improving patients’ knowledge, reducing their anxiety and effec- 8
tively maximizing their outcomes than the use of educational pamphlets and oral 9
education alone (Buzatto & Zanei, 2010; Jamshidi et al., 2013). Furthermore, the 10
video method was ranked by surgical patients, particularly patients prior to elec- 11
tive cardiac surgery as the preferred way of providing preoperative information 12
over individualized methods of instruction, written materials, and Internet-based 13
instructions (Suhonen & Leino-Kilpi, 2006). Overall, the use of educational video 14
presentation regarding CATH and the CATH laboratory environment improves 15
patients’ knowledge and reduces their anxiety levels (Jamshidi et al., 2013; Trotter 16
et al., 2011). 17
A literature search was conducted using PubMed, Ovid, ProQuest, Cumulative 18
Index to Nursing and Allied Health Literature (CINAHL), Arabic Journals, Wiley 19
Online Library, EBSCOhost Research Databases, A to Z Full Text Periodicals, Science 20
Direct, and Oxford Journals (OUP Journals) databases for the period from 1990 to 21
2013 that are available to provide a full-text article. A subsequent search using 22
the same databases, as well as the Internet search engine Google scholar, explor- 23
ing the keywords nursing care, anxiety, and cardiac catheterization was conducted. 24
These words were explored independently as well as in various combinations to 25
accomplish relevant literature to this topic. Within the reviewed databases, there 26
are currently no published studies yet that involve the use of randomized clinical 27
trials to assess the effect of educational video intervention provided individu- 28
ally on periprocedural anxiety in cardiac populations, which is recommended 29
by previous literature (Chair & Thompson, 2005; Torrano, Veiga, Goldmeier, & 30
Azzolin, 2011). Also, no one has measured this periprocedural anxiety objectively 31
by comparing physiological parameters associated with anxiety and subjectively 32
by using self-reported anxiety measure to assess psychological manifestations of 33
anxiety. Literature also recommended further research to evaluate educational 34
video intervention in samples of patients undergoing CATH cross cultures (Chair 35
et al., 2012). 36
Arabs usually believe in fate and that God is the direct and eventual controller of 37
all what happens. In the Arab culture, one needs to believe in God’s will and pray to 38
bring comfort and calmness. Furthermore, social life in the Arab region is character- 39
ized by “situation-centeredness,” in which loyalty to the extended family is superior 40
over individual needs and goals (Nydell, 2005). More specifically, separation from 41
the family may lead to stress and anxiety, therefore, family contribution will help in 42
providing psychosocial care and should be considered by nurses (Lovering, 2012). 43
In Jordan, The impact of educational interventions in periprocedural anxiety among 44
CATH patients has not yet been investigated. Therefore, this study is conducted and 45
46
1
Admission for a diagnostic CATH
2
3
4
Was potentially eligible for the study
5 (N 186)
6
7
8
Collected base line data (T0; N 186)
9
10
Ineligible for
11 the study
Randomization refused
12 Randomized (N 186)
13 No further
observations
14
15
16 Allocated to experimental Allocated to control group
17 group (N 93) (N 93)
18
Educational
19 intervention
20
21 Measured preprocedural anxiety Measured preprocedural anxiety
22 and vital signs and vital signs
23
24
25 A CATH received A CATH received
26
27
Measured postprocedural Measured postprocedural
28 anxiety and vital signs (T2) anxiety and vital signs (T2)
29 (N 91) (N 91)
30
31 Figure 1. The study protocol and data collection point. CATH 5 cardiac catheterization.
32
33
34 The third part is the Arabic version of Spielberger’s State-Anxiety Inventory (SAI)
35 that is a subscale of the State Trait Anxiety Inventory (STAI) developed by Spielberger
36 AQ2 (1968, 1977; Spielberger, 1983). The SAI is a 20-item self-reported instrument used
37 to evaluate an individual’s temporal feelings of apprehension, tension, nervousness,
38 and worry, using a 4-point Likert format (1 5 not at all, 4 5 very much so). Possible
39 scores range from 20 to 80 with higher scores indicating greater anxiety. However,
40 scores on the SAI scale increase in response to physical danger and psychological
41 stress, and decrease as a result of relaxation training (Chair & Thompson, 2005).
42 Cronbach’s alpha of the SAI items in this study was .88. Content validity of the
43 scale was established by a panel of experts including three nurses with more than
44 10 years experience in caring for CATH patients and three cardiologists who fre-
45 quently performed CATH procedures.
46
42
43
44
45
46
DISCUSSION 1
2
High levels of anxiety can be debilitating and may interfere with natural function- 3
ing. Besides, it is unpleasant feeling, it can induce a strong negative impact on the 4
individual’s physical health. Under the conditions of this study, the results show 5
the effectiveness of using educational video intervention about CATH in lowering 6
periprocedural anxiety associated with the procedure. Nevertheless, using this 7
educational video may not significantly affect physiological parameters associated 8
with anxiety. Although the benefits of educational videos on patients’ psychologi- 9
cal status are well recognized from the relevant literature, limited knowledge has 10
been developed on the effect of educational video on patients with cardiac dis- 11
eases. Several studies have indicated that education via video instructions about 12
invasive procedures such as CATH is more effective in reducing the level of anxiety 13
than the use of educational pamphlets and oral education alone (Chair et al., 2012; 14
Jamshidi et al., 2013). This study contributes new knowledge to literature in a large 15
sample from a newly explored setting in Jordan. The study findings may add to the 16
knowledge on promoting psychological status through addressing the educational 17
needs of cardiac patients, particularly those undergoing their first diagnostic CATH. 18
The significant difference regarding the anxiety levels between the two groups 19
supports the effectiveness of using educational video intervention before CATH, 20
which is reported in previous literature (Jamshidi et al., 2013; Köllner & Bernardy, 21
2006). This may have occurred because of the knowledge gained from the educa- 22
tional video received prior to CATH. Specifically, the knowledge gained from the 23
educational video further enabled patients in the experimental group to develop a 24
more accurate cognitive expectation about the procedure. Anxiety among patients 25
awaiting elective CATH could be alleviated if adequate factual explanations about 26
CATH were provided to them (Harkness, Morrow, Smith, Kiczula, & Arthur, 2003). 27
Similarly, a low level of anxiety was reported before and after percutaneous coronary 28
intervention (PCI) among patients because of the adequate facilities, orientation, and 29
health education provided to them by the health care members (Eng et al., 2007). 30
In this study, the content of educational video intervention includes not only 31
factual information about CATH but also contains sensory information. By factual 32
information, desirable knowledge and informational needs of the patients might 33
be met and that could help their anxiety reduction. However, sensory information 34
refers to knowledge about the environment acquired by the way of the senses and 35
includes what the patient may hear, smell, see, taste, and touch that enable him or 36
her to interpret experiences obtained from the external and internal environments 37
(Tawalbeh & Ahmad, 2013). Although the CATH environment and equipment may 38
be frightening to the patients, environmental and procedural information as well 39
as sensory expectations during CATH were seldom explained (Chair et al., 2012). 40
A combination of procedural and sensory data is proved to be the most effective 41
type of information in reducing patient anxiety (Buzatto & Zanei, 2010). Because 42
most patients in this study had received only primary education, an educational 43
video may be more appropriate than a printed brochure. Anxiety is reduced when 44
better quality information is provided. This happens when nurses are able to clear 45
46
of patients. Finally, providing the educational intervention in the day before CATH 1
was found to be effective. Future studies to evaluate the effectiveness of educational 2
video intervention that is provided as soon as patients are informed of their need 3
to undergo CATH could be considered. 4
As a limitation of the study, results should be read with caution, especially for 5
patients who were taking antihypertensive medications or beta-blockers such as 6
ACE inhibitors. The physiological parameters of anxiety such having normal BP and 7
HR could be attributed for these medications. It is possible that lack of control for 8
medications may have obscured any impact on these measures. For future studies, 9
we suggest to adopt different methodological/procedural aspects that might over- 10
come this limitation. It is noteworthy to emphasize that the hospital policy was not 11
to administer any sedatives before or during CATH procedure. There was a relatively 12
short follow-up period, and it is therefore unclear whether changes in illness repre- 13
sentations including anxiety associated with a CATH procedure remain stable over 14
an extended time, particularly those who were in need for a PCI or a CABG surgery. 15
In conclusion, an educational video intervention was found to be more effec- 16
tive in lowering periprocedural perceived anxiety associated with CATH than usual 17
cares. A key strength of this study included the use of an experimental design, 18
the assessment of the psychological and physiological aspects of anxiety, and the 19
assessment of these aspects at key times for CATH patients. The findings of this 20
study can contribute to the knowledge in promoting the psychological status of 21
cardiac patients through addressing their educational needs. 22
23
24
25
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Acknowledgments. The authors acknowledge the partial funding from the University of Jordan. 6
7
Correspondence regarding this article should be directed to Shahnaz Mohammed Ayasrah, 8
PhD, RN, Lecturer, Al-Balqa’ Applied University, Department of Applied Science/Nursing, 9
Amman, Jordan. E-mail: shahnazhamdan@yahoo.com AQ4 10
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