Cardiovascular Journal of Africa: Vol 25 No 6 (November/December 2014)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014 AFRICA 259
Cardiovascular Topics
Effect of standard versus patient-targeted in-patient
education on patients’ anxiety about self-care after
discharge from cardiovascular surgery clinics
Tülin Yıldız, Selami Gürkan, Özcan Gür, Cüneyt Ünsal, Sonay Baltacı Göktaş, Yücel Özen
Abstract
We compared standard and patient-targeted in-patient educa-
tion in terms of their effect on patients’ anxiety. One hundred
and ninety-eight patients who were hospitalised for coronary
artery bypass surgery were given standard education (group
1) or individualised education (group 2) on the management
of their healthcare after discharge. Patients in group 2 were
assessed on the patient learning needs scale and were given
education according to their individual needs. The level of
anxiety was measured by the state–trait anxiety inventory.
Anxiety scores were significantly lower in group 2 than group
1 after education (p < 0.001). While state anxiety did not
change after education in group 1 (p = 0272), it decreased
significantly in group 2 (p < 0.001). For cardiovascular surgery
patients, patient-targeted in-patient education was more effec-
tive than standard education in decreasing anxiety levels,
therefore the content of the education should be individual-
ised according to the patient’s particular needs.
Keywords: cardiovascular surgery, anxiety, patient’s education,
coronary artery bypass surgery
Submitted 6/6/14, accepted 16/8/14
Published online 29/10/14
Cardiovasc J Afr 2014; 25: 259–264
DOI: 10.5830/CVJA-2014-048
Coronary artery bypass surgery is the absolute treatment for
severe coronary artery disease, which is the leading cause of
mortality globally. 1 The surgery relieves angina symptoms,
improves quality of life, and reduces cardiac-related mortality.2
To achive the desired benefits of coronary artery bypass surgery,
it is important to decrease the risk factors for atherosclerosis and
change the lifestyle of patients. For this reason, clinical practice
guidelines published by several organisations have recognised the
importance of patient self-care measures, and agree that patient
education is an important element in the care of patients for
whom cardiac surgery is planned. 3-5
To this end, pre- and postoperative in-patient and discharge
education have been shown to demonstrate benefits for patients
in cardiovascular surgery clinics.6,7 Comprehensive in-patient
education before discharge improved health outcomes such as
survival and quality of life. 8
For coronary artery bypass surgery, the duration of
hospitalisation of patients ranges from four to seven days. During
the hospital stay, patients usually feel anxious about surgery and
about finding solutions to likely problems they may encounter
after discharge. Lack of knowledge and skills necessary for
home care and for the new lifestyle after discharge may slow the
healing process by causing physical and psychological stress on
the patient.9,10 In-patient and discharge education aims to give
patients the necessary information and to decrease their anxiety
levels.
Although specific elements of information and standards of
patient education have been defined, 11 there are no guidelines or
standards for the education of cardiovascular surgery patients
for discharge. Cardiovascular surgery clinics usually create
patient education content, which focuses on postoperative care,
diet, rest and exercise, and implement it via nurses who play a
key role in education of hospitalised patients.12 Furthermore,
although the advantages of in-patient education on anxiety,
depression and post-discharge health outcomes were described
for cardiovascular surgery patients,13,14 the effectiveness of
standardised educational tools in comparison with individualised
education has not been studied.
We hypothesised that in-patient education individualised
according to the patient’s needs would be more targeted and
effective than standardised education for patients hospitalised for
coronary artery bypass surgery. On the basis of this hypothesis,
Department of Surgical Nursing, School of Health, Namık
Kemal University, Tekirdağ, Turkey
Tülin Yıldız, MsN, PhD,
Selami Gürkan, MD
Özcan Gür, MD
Department of Psychiatry, Faculty of Medicine, School of
Health, Namık Kemal University, Tekirdağ, Turkey
Cüneyt Ünsal, MD
Department of Surgical Nursing, School of Nursing,
Maltepe University, Istanbul, Turkey
Sonay Baltacı Göktaş, MsN, PhD
Department of Cardiovascular Surgery, Kartal Koşuyolu
Education and Research Hospital, Istanbul, Turkey
Yücel Özen, MD