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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014
260
AFRICA
we aimed in this study to compare standard and patient-targeted
in-patient education in terms of their effect on patients’ anxiety
about self-care after discharge.
Methods
One hundred and ninety-eight patients who were hospitalised
in the cardiovascular surgery clinic between February and
August 2013 for coronary artery bypass surgery were included
in the study. The study was approved by the institutional ethics
committee, and all patients gave consent to participate in the
study.
Patients were randomised into two groups based on the
content of education: standard education (group 1,
n
=
100) and
individualised education (group 2,
n
=
100) on the management
of patients’ healthcare at home after discharge. Patients in group
2 were assessed with the patient learning needs scale (PLNS)
to define their perception of learning needs to manage their
healthcare after discharge. These patients were given education
that was specified according to their individual needs.
Education was given at the same time daily from the first day
of hospitalisation until the day the patient was discharged from
the clinic. The duration of hospitalisation was four to five days
for all patients.
The level of anxiety of patients was measured by the
state–trait anxiety inventory (STAI) before education and on
discharge. The STAI scores were compared between the groups
and before and after education. Additionally, the effects of socio-
demographic variables on the change of anxiety scores in each
group were evaluated.
The education was given by one investigator to all patients
in both groups. The STAIs were given to patients by another
investigator who was blinded to the patients’ study groups. Only
patients’ initials (not full names) and a code for education group
were marked on the STAIs; thus the data entry and analysis were
blinded to the study groups.
The education and outcomes were evaluated during the
patients’ hospitalisation, in which time no serious complications
were recorded.
The education given to in-patients by nurses in cardiovascular
surgery clinics aims to help patients to meet their home-care
needs before and after surgery, to facilitate getting help from the
healthcare team, to accelerate the healing process, and to ensure
the transition to a normal life as soon as possible. On the basis
of these aims, a standard education that was developed by Ozcan
et al
.,
15
which includes topics on drug use, coping with pain,
surgical wound care, prevention of adverse effects, diet, exercise,
rest, hygiene maintenance, constipation, alcohol and tobacco
use, sexual activity, mood changes, emergencies, occupations and
time of control visits was given face to face to group 1 patients
for about 30 to 40 minutes daily. During this time, topics were
repeated as necessary, taking into account individual differences.
An education booklet including details on all topics was used
during the education sessions. Patients in group 2 were given
education that was individualised according to their specific
need, which were determined by the PLNS.
Study questionnaires
The PLNS was developed to measure patients’ learning needs in
order to manage their healthcare at home after discharge from
hospital.
16
It is completed in less than 20 minutes. It has 50 items
scored from 0 to 5, and seven subscales (medication, activities
of living, feelings related to condition, community and follow
up, treatment and complications, enhancing quality of life, and
skin care), yielding a total score of 40 to 200, with higher scores
indicating more importance being placed on having information
at discharge. The reliability and validity of the PLNS were shown
by Bubela
et al
.,
17
and the Turkish version was also shown to be
reliable and valid.
18
The STAI is a commonly used self-report measure of anxiety,
which is a four-point Likert scale and consists of 40 questions.
19
The STAI measures two types of anxiety: state anxiety, or
anxiety about an event, and trait anxiety, or anxiety level as a
personal characteristic. Higher scores are positively correlated
with higher levels of anxiety. It can be used to diagnose anxiety
and distinguish it from depressive syndromes, and also as an
indicator of caregiver distress. Its reliability and validity were
demonstrated.
19,20
It is offered in 12 languages, including Turkish.
Statistical analysis
Descriptive statistical methods (frequency, percentage, mean,
standard deviation) were used to summarise data, and the
Kolmogorov–Smirnov test was used to determine whether
data were distributed normally or not. For the comparison of
quantitative data between groups, the independent samples
t
-test
and Mann–Whitney
U
-test were applied for parameters with and
without normal distribution, respectively.
To compare quantitative data of more than two groups
with normal distribution, Kruskal–Wallis and Mann–Whitney
U
-tests were used. For in-group comparisons the paired-sample
t
-test was used. Pearson’s correlation analysis was performed to
define the correlation between quantitative variables, and the
outcome was expressed as correlation coefficient (
r
) and level of
significance (
p
).
The level of statistical significance was set at
p
<
0.05.
Statistical analyses were performed using computer software
(Statistical Package for Social Sciences, Version 19.0, SPSS Inc,
Chicago, Illinois, USA).
Results
The mean ages of the patients in group 1 (
n
=
98) and group
2 (
n
=
100) were 62.1
±
10.2 and 59.1
±
9.8 years, respectively,
and the number of male/female patients were 73/25 and 72/28,
respectively. Other socio-demographic and clinical characteristics
of the study patients are summarised in Table 1.
The study groups were homogeneous in terms of gender,
marital status, having children, working status, smoking, alcohol
consumption, and being on a diet (
p
>
0.05). There was no
significant difference between group 1 and group 2 in terms of
age, weight, education, income and frequency of exercise (
p
<
0.05) (Table 1).
The STAI scores showed no statistical difference between
the study groups before education (
p
=
0.168 and
p
=
0.583,
respectively). However, both anxiety scores were significantly
lower in group 2 than in group 1 after education (
p
<
0.001 for
STAI scores). Furthermore, while state anxiety did not change in
group 1 after education (
p
=
0272), it decreased significantly in