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 263
for each individual patient according to the results of the PLNS,
and applied this modified and individualised education to the
patients in group 2.
We showed that state anxiety decreased significantly only
after patient-targeted education but not after standard education
given during the hospitalisation period. On the other hand, trait
anxiety, which represents the personal anxiety level of the subject
independent of the event, decreased in both groups, being
significantly lower on discharge in the individualised-education
group than in the standard-education group. Therefore, patient-
individualised education was more effective than standard
education in decreasing both state and trait anxiety levels in
cardiovascular surgery patients.
Additionally, we evaluated the effect of socio-demographic
factors, and found that these variables had a limited effect on the
change in STAI scores. This suggests that the change in anxiety
was mainly attributable to the effect of in-patient education.
Our findings are in line with previous studies reporting the
advantage and necessity of in-patient education for patients
hospitalised for cardiovascular surgery,7,8,13 but we are the first to
demonstrate the superiority of patient-targeted education above
standard education in decreasing anxiety levels of patients. Since
present evidence in the literature suggests that the psychological
stability of patients is associated with better physiological
parameters after the procedure and early surgical recovery,21-23
we propose that decreased anxiety provided by patient-
targeted education is related to better clinical outcomes after
cardiovascular surgery. However, the effect of decreased anxiety
levels produced by patient-targeted education on morbidity and
mortality rates after cardiovascular surgery should be evaluated
in further clinical studies.
Individual instruction of patients is important to accelerate
healing after surgery and to enable the patient’s return to social
and business life in the shortest possible time. In this context,
although gender, marital status, having children, working
status, smoking, alcohol consumption, being on diet, and
hospitalisation duration showed similarities between the study
groups, decreased anxiety levels in patients who received patient-
targeted in-patient education resulted in increased levels of self-
care and self-confidence.
The main limitations of this study are that we did not
follow up on the patients after discharge, and did not evaluate
the outcomes of standard versus patient-targeted in-patient
education on patients’ work and health outcomes after discharge.
Nevertheless, it is the first study comparing patient-targeted and
standard in-patient education in a cardiovascular surgery clinic,
where patients have high levels of anxiety about the period
after discharge. The advantage of patient-targeted education
over standard education in lowering patients’ anxiety levels may
decrease patients’ physical and psychological stress levels and
therefore provide better outcomes after surgery.
Conclusion
Education of cardiovascular surgery patients during
hospitalisation about subsequent home care and the new
lifestyle after discharge is necessary to decrease patients’ anxiety
levels, and should be implemented as part of the surgical and
pharmacological treatment of patients. Since patient-targeted
in-patient education was more effective than standard education
in decreasing patients’ anxiety, the content of the education
should be individualised according to the patient’s particular
needs. In this way, in-patient education will be more beneficial in
decreasing anxiety levels of patients and provide more effective
use of resources. Studies on the effect of patient-targeted
in-patient education on post-discharge health outcomes are
needed to test the further advantages of this type of education.
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