Hasta Öğrenim Gereksinimleri Ölçeği

Transkript

KHJ-93064: ORİJİNAL ARAŞTIRMA
Açık Kalp Cerrahisinde "Hasta Öğrenim Gereksinimleri Ölçeği"
Kullanılarak Yapılan Hasta Eğitiminin Hasta Kaygı Düzeyi
Üzerine Etkisi
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Giriş: Bu çalışmanın amacı kalp cerrahisi geçirecek hastalara ameliyat öncesi “Hasta Öğrenim
Ge reksinimleri Ölçeği” kullanılarak, b ireylerin ihtiyaçlarına göre yapılan b ilgilendirmenin ameliyat sonrası
a nksiyete üzerine herhangi b ir e tkisinin olup olmadığını araştırmaktır.
Ha stalar ve Yöntem: Çalışmaya kalp ce rrahisi kliniğinde açık kalp ameliyatı p lanlanan, hastaneye ya tışı
ya p ılan ve çalışmaya katılmaya gönüllü olan hastalar (n =114) dahil edildi. Araştırmacılar tarafından
g e liştirilen demografik ve ri formu, State-Trait Anxiety Inventory (STAI) ve Hasta Öğrenim Gereksinimleri
Ö lçeği formları ameliyat öncesi ve ameliyattın 3 . günü hastalar ile yü z yü ze görüşme tekniği kullanılarak
d o lduruldu. Ameliyat ö ncesi yatışı sırasında öncelikle Durumluluk-Sürekli Anksiyete En vanteri, daha sonra
Ha sta Ö ğrenim Gereksinimleri Ö lçeği uygulandı. Hasta Öğrenim Gereksinimleri Ölçeği sonuçlarına göre
h a stalar yatışından itibaren bilgilendirildi. Ameliyatın 3 . g ünü hastalara STAI tekrar u ygulandı. Çalışma
ve rileri tanımlayıcı istatistiksel metotlar (frekans, yü zde, ortalama, standart sapma) ile ö zetlendi. No rmal
d ağılımın incelenmesi için Kolmogorov-Smirnov dağılım testi, normal dağılım gösteren parametrelerin iki
g ru p için karşılaştırmalarında eşlenik örnekler (Paired samples) t te sti, normal dağılım göstermeyen
p a rametrelerin g rup içi karşılaştırmalarında ise Wilcoxon işaret testi kullanıldı. Parametrelerin g ruplar
a ra sı karşılaştırmalarında Mann-Whitney U test kullanıldı. Sonuçlar %95 g üven a ralığında, p <0.05
a n lamlılık d üzeyinde ve p <0.01 ileri anlamlılık düzeyinde değerlendirildi.
Bu lgular: Hastaların eğitim öncesi d urumluluk kaygı (state anxiety) düzeyine göre eğitim sonrası
d u rumluluk kaygı düzeyinde meydana gelen düşüş (t=2.003; p=0.050) ile, eğitim öncesi sürekli kaygı
(tra it anxiety) d üzeyine göre eğitim sonrası sürekli kaygı düzeyinde meydana gelen düşüş istatistiksel
o larak anlamlı bulundu (t=2.984; p =0.004).
So nuç: Bu ça lışmada elde edilen bulgular, hastaların a meliyat öncesi Hasta Öğrenim Gereksinimleri Ölçeği
k u llanılarak b ireylerin ihtiyaçlarına göre yapılan b ilgilendirmenin bireylerin anksiyetesini azalttığı
g ö stermiştir.
A nahtar Kelimeler: Hasta eğitimi, hasta öğrenim gereksinimleri ö lçeği, kalp ce rrahisi; kaygı düzeyi
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Effect of Patient Education on Patient Anxiety Level Using
“Scale of Patient Education Requirements” in Open Heart
Surgery
In troduction: T he purpose o f th is study is to research wh ether education according to individuals’ needs
h a s an effect on the anxiety a fter surgery u sing a scale o f patient education requirements on the patients
wh o will u ndergo heart surgery.
P atients and Methods: The re search in cluded voluntary patients wh o wo uld have an open-heart surgery
a nd a re already hospitalized in a heart surgery clinic (n =114). Data we re co llected u sing a demographical
d a ta form (state-trait anxiety inventory; STAI) and patient education requirements scale forms, wh ich
h ad been developed by the re searchers before su rgery a nd th ree days later than the surgery b y
in dividually meeting the patients. During the hospitalization before surgery, STAI wa s performed.
Fu rther, patient requirements scale wa s applied. Acco rding to patient requirements scale re sults, the
p a tients we re informed at the beginning o f hospitalization. On the th ird day of the surgery, STAI wa s
p e rformed one more time. While e valuating the study data, in addition to descriptive statistical m ethods,
su ch as frequency, percentage, average, standard deviation, the Kolmogorov–Smirnov distribution test
wa s a pplied to re view n ormal d istribution. Fu rthermore, paired samples t te st wa s u sed to co mpare if
p a rameters had normal d istribution for 2 g roups, and Wilcoxon sign test wa s u sed to compare if
p a rameters had abnormal distribution in the g roups. Mann-Whitney U test wa s u sed for the co mparison
o f parameters in g roups. The re sults we re e valuated a t a confidence level of 9 5%, a significance level o f
p <0 .05, and an advanced significance level of p <0.01.
R esults: The decrease in the state anxiety level a fter education according to state anxiety level before
e ducation wa s significant (t=2.003; p =0.050). Moreover, the decrease in the trait anxiety level after
e ducation wa s a lso found to be statistically significant (t=2.984; p=0.004).
C onclusion: Acco rding to the findings obtained in th is study, it wa s re vealed that in forming the patients
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Journa lAge nt powe re d by LookUs
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u sing patient education requirements scale a ccording to individuals’ needs decreased individuals’ anxiety
le vels.
Key words: Patient’s education, patient learning needs scale, cardiovascular surgery; anxiety
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Ref.No: KHJ-93064 (2)
Makale Grubu: Kalp Damar Cerrahisi
Makale Türü: O RİJİNAL ARAŞTIRMA
Kayıt Tarihi: 1 0.10.2014 1 1:38:50
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Revised Files (1)
Tam Metin
Effect of Patient Education on P atient Anxiety Level Using “Scale of P atient Education
Requirements” in Open Heart Surgery
Kayıt Tarihi: 18.12.2014 10:43:25
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Effect of Patient Education on Patient Anxiety Level Using “Scale of Patient Education
Requirements ” in Open Heart Surgery
ABS TRAC T
In trodu ct ion : The p urpose of th is study is to research wh et her educat io n acco rdi ng to individuals’ needs has an effect
on t he anxiet y aft er surgery us ing a scale of pat ient educat ion requirement s on the patient s who wi ll undergo heart
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surgery.
Patien ts an d Methods: The research included vol un t ary pati ent s who would have an open-heart surgery and are
already hospit ali zed in a heart sur ger y clinic (n =11 4). Data were collected using a demographical dat a fo rm (st at e-trait
anxi ety inventory; STAI) and patient educat ion requirement s scale forms, which h ad been developed by t he researchers
before surgery and t hree days l at er t han t he surgery by i ndi vid ual ly meeting t he p atient s. During th e h ospit alization
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before surgery, STAI was p erfo rmed. Further, pat ient requiremen ts scale was appl ied. A ccordi ng t o patient requirement s
scale result s, the p atient s wer e informed at t he beginnin g of ho spit alizat ion. On the third day of the surgery, STAI was
performed on e mo re t ime. While evaluating the st udy data, in addit ion to descripti ve st atisti cal methods, such as
frequency, percent age , average, st andard deviat io n, the Kolmo gorov–Smirnov distr ibut ion t est was applied t o revi ew
no rmal dis tribut ion. Furt hermore, paired samples t test was used to co mpare if paramet ers had normal distribut ion f or 2
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group s, and Wil co xon sign t est was us ed to compare if paramet er s had abn ormal distr ibution in the gro ups. Man nWhitney U test was used fo r t he comparison of paramet ers in group s. The result s were evaluate d at a confidence level
of 95%, a significance level of p<0.05, and an advan ced significance lev el o f p<0.01.
Results: The decrease in the stat e anxiet y level aft er education according t o stat e anxiet y level before educat ion was
significant (t =2.003; p=0.050). Moreover, the decrease in the trait anxiety level aft er education was also found to be
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st at istically significant (t=2.984; p=0.004).
Con clusion : A cco rding t o the findings o bt ain ed in t hi s st udy, it was rev ealed t hat i nf orming t he pat ient s usi ng patient
educat ion requirement s scal e acco rding t o individuals ’ needs decreased in div iduals’ anxi et y levels.
Key Wo rds: Patient’s educat io n; patient learning n eeds scale; cardi ovascular surgery ; anxiety
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Açık Kalp Cerrahisinde "Hasta Öğ renim Gereksinimleri Ölçeğ i" Kullanılarak Yapılan Hasta
Eğitiminin Hasta Kaygı Düzeyi Üzerine Etki si
Gi riş: Bu çalışmanı n amacı kalp cerrahisi geçirecek hast alara ameliyat ön cesi “Hast a Ö ğrenim Ger eksini mleri Ölçeği”
kullanıl arak, bireyleri n iht iyaçlarına göre yapı lan bil gi lendirmenin ameli yat sonrası anks iyete üzerine herhangi bir
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et kisi nin olup ol madığını ar aşt ırmaktır.
Hastala r ve Yöntem: Çalışmaya kalp cerrahisi kliniğin de açı k kalp ameliyatı planlanan, hastaneye yatışı yapılan ve
çalış maya katılmaya gönüllü olan hastalar (n =114) dahil edildi. Araştırmacılar tarafından geliştirilen demo grafik veri
formu, State-Trait Anxiety Inventory (STAI ) ve Hasta Öğrenim Gereksi ni mleri Ölçeği formları ameliyat öncesi ve
ameli yat tı n 3 . günü hast alar ile yüz yüze görüşme tekniği kull anı larak dolduruldu. Ameli yat öncesi yat ışı sırasın da
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ön celikle Duruml uluk-Sürekli Anksi yet e Envant eri, daha sonra Hast a Öğrenim Gerek sinimleri Ölçeği uy gul andı. Has ta
Öğrenim Gereksiniml eri Öl çeği sonuçlarına göre hast alar y atışından itibaren bilgil endirildi . Ameliyatın 3. gün ü
hast alara STAI t ekrar uy gulan dı. Çalışma veril eri tanım lay ıcı ist at istiks el metot lar (frekans , yüzde, ortalama, standart
sapma) i le özet lendi. No rmal dağılımın incel en mesi için Ko lmogoro v-Smirnov dağılım testi , normal dağıl ım göst eren
parametreleri n iki grup i çin karşılaşt ırmaları nda eş len ik örn ek ler (P ai red samples) t t est i, normal dağıl ım göst ermeyen
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parametreleri n grup içi k arşılaşt ır malarında ise Wilcoxo n i şaret t esti kullanıl dı . P aramet relerin gruplar arası
karşıl aştırmaları nda M an n-Whitney U t est kullanıldı . Son uçl ar %95 güv en aralığında, p<0.05 anlamlı lık düzeyinde ve
p<0. 01 ileri anlamlılı k düzeyinde değerlendirildi .
Bulgular: Hast aların eğit im öncesi durumluluk kaygı (state anxiety) düzeyine göre eğit im sonrası durumluluk kaygı
düzeyinde meydana gelen düşüş (t =2.003; p=0.050) ile, eğit im öncesi sürekli kaygı (trait anxiety) düzeyine göre eğitim
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sonrası sürekli kaygı düzeyinde meydana gelen düşüş ist at istiksel olarak anlamlı bulundu (t =2.984; p=0.004).
Son uç: Bu çalışmada elde edilen bulgul ar, hast aların ameliyat öncesi H ast a Öğrenim Gereksinimleri Ö lçeği kullanıl arak
bireylerin iht iyaçlarına göre y apılan bi lgil endir menin bireylerin anksiyetesini azalttığı göst ermiştir.
An ahtar Kelimeler: Hast a eğitimi; hasta öğrenim gereksinimler i ölçeği; kalp cerrahisi; kaygı düzeyi
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INTRO DU C TION
Surgical interventio ns have the pot ential o f causing seri ous ps ychosocial and psychiatric pr obl ems , and surgical
op er ation can be an an xi ety so urce and affect post operat iv e morbidit y. It has been st ated t hat medical compli cat ions
increased after surgery for patient s having high anx iet y levels bef ore surgery, in creased t he dur at ion of hospitalizat ion,
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and delayed the recovery t ime (1,2 ). Educati on and preparation of patients bef ore surgery had an effect on the pat ient care
aft er surgery and at the discharge stage. The priorit y of the information required by surgical p atients v ar ies with type of
surgery and needs of i ndi vidual pat ient s. Heart surgery is percei ved by mo st p eo ple as a life-threatening event o r
crisi s(3). The surviv al rat e aft er open-heart surgery applied by car di o pulmonary bypass definit ively increased usi ng
inno vat ion s of anest hesia management and surgical t echn iques, advances in cardi opulmonary bypass t echno lo gy, and
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development of intensive care t reatment principles(4). Despite th ese development s, anxi et y and fear of deat h persist ed in
pat ients.
Symbol ic meaning of “heart operation” increases f ear o f death and t he risk of preoperat iv e anxiety (5). Th e most effecti ve
appr oach t owar d anxio us patient s has been t o reass ur e an d p rovide psy chological s up port. Patient educati on had an
important role wit hin sugge st ed methods. Educat ion before surgery is an indisp en sabl e p ar t of patient care and one of
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the most imp ort ant nurs ing att empts; education pro vided du ring t his time cont inues unt il discharge from t he hospit al
and has an import ant role for the pat ient i n terms of gai ni ng information regarding surgical int ervention an d feeling
bett er physically and psy chologically (6). It has been imp ortant t hat p atient educat io n requirement s are f ul fill ed before
and aft er s ur ger y. Because f ul filling t he educat ion requirements po si tively affected th e qual ity of patient care result s (7,8).
In this st udy, it was aimed to evaluat e t he an xiety level s of pat ient s befo re and after surgery by organizing trai ni ng and
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det erminin g p atien t requirements usi ng the patient education requirement scale.
PATIEN TS AND METHO DS
After receiving app roval from t he ethical committ ee and department of surgery, this comparat ive and descrip ti ve st udy
was con duct ed bet ween February 1 and May 31. Befo re surgery, (in th e course of the ap pl icat ion t o t he clin ic) st ate-trait
anxi ety inventory (STA I), p at ien t educati on r equi rement s scale, and demographi c survey were co nduct ed for patient s
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supp osed t o undergo an op en heart surgery an d h osp it alized (n=11 4) in heart surgery clinics. Patient r equirement s were
defined according to the pat ient learning requirement s s cal e; educat ion start ed befo re surgery and cont inued unt il t he
discharge of p at ien ts. On the third day aft er surgery, STA I was re-appl ied t o the p atient s.
Whi le evaluat in g t he findings in t he st udy, St at ist ical P ackage P rogram was used for st atist ical analysis. Wh il e
evaluating the st udy data , in addit ion to descripti ve st atisti cal met hods, such as frequency, per cen tage, average, standard
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deviation, Kolmogorov–Smirnov distr ibut ion test was used t o revi ew normal distributi on. Furth er mor e, paired samples t
t est was used to comp are if parameters had n ormal distri but io n for 2 groups an d Wi lcox on si gn t est was used to
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comp ar e if p aramet ers h ad an abnormal distribution in the groups. Mann-Whitney U test was used fo r compar in g t he
paramet ers bet ween th e gro up s. The result s wer e ev al uat ed at a confidence level of 95%, a significance level of p<0.05,
and an adv an ced si gni ficance level o f p<0.01.
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RES ULTS
In tot al, 11 4 patient s were invo lved in t he study; 86 (75.4%) patient s were male an d 68 of t hem were ≥61 y ear s old.
Furt her, 46 (40.5%) pat ient s weighed ≥81 kg, 106 (93% ) were married, and 110 (96. 5% ) had at l east one child. Eight y
pat ients (7 0.1%) graduat ed fro m primary school. Gen er al demograp hic p rop erties for patients are shown in Tabl e 1.
The decrease in the st ate anxiet y level after educat ion according t o the st ate anxiet y level before education was
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st atist ically significant (t =2.003; p=0.050<0.05). The decrease in t rait anxiety levels aft er educat ion was also
st atist ically significant (t =2.984; p=0.004<0.05) (Table 2). It was det ermined that the average t rait anxiet y level of
pat ients was affected by variables, such as gender, smoking, exercising before and after educat ion.
The difference bet ween before and after education trait anxiet y levels according to gender was evaluat ed. The
difference bet ween the group average before education (Mann-Whit ney U t est =193.50; p=0.046<0.05) and t he group
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average aft er educat ion (Mann-Whitney U t est =193.00; p=0.045<0.05) was found t o be st atist ically significant (Table
3). The trait anxiety level of females before and aft er educat ion (n=49.74, n=45.23, respectively) was higher than those
of males before and aft er educat ion (n=43.38, n=39.95, respectively).
The t rait anx iet y levels were significantl y differ ent with respect to t he working st at us of pat ient s ( Mann-Whit ney U
t est =11 3.00; p=0.01 4<0.05 ). T rait anxiet y level of unempl oyed pat ient s (n=46.41) was higher than those of employed
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pat ients before educat ion (n=40.02) (Table 4).
The difference in anxiety levels respect to exercising was significant before educat ion (Mann-Whit ney U t est =135.00;
p=0.004<0.05) and after educat ion (Mann-Whit ney U t est =167.00; p=0.026<0.05) (Table 3). St ate anxiety levels of
pat ients who were not exercising before and aft er educat ion (n=40.49, n=37.09, respect ively) was higher than the
pat ients who were exercising (n=31.52, n=30.48, respectively) (Table 5).
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It was observed that 26 (22.8%) patient s were regularly smoking and 28 (24.9%) were exercising (Table 6). The
difference bet ween trait anxiet y levels according to t he smoking stat us was not significant before education (MannWhitney U test =221.500; p=0.395>0.05) was not st atist ically significant. However, the difference was significant after
educat ion (Mann-Whit ney U test =155.50; p=0.030<0.05) (Table 6). St at e anxiety levels of patients (n=40.31) who were
smoking aft er educat ion was higher than those of patients (n=34.06) who quit smoking after educat ion.
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DIS C USSION
It is crucial t hat nurses determ ine education requirement s considerin g t he educat ion r equirement s of patient s and th eir
families(9,10). In the present st udy, we sho wed t hat informing th e p at ient s using pat ient educat io n requirement s scale
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acco rding t o individual s’ needs decreased individuals ’ anxi et y levels of patients un dergoing open-heart surgery.
Demographi c charact erist ics of our study population was simi lar to those of previous s tudies on pat ient s undergoing an
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op en -heart surgery (11-14).
One of the import ant t arget s of the care before surgery is t o eliminat e the anxiety of pat ient s. The common reasons of
anxiety before surgery is pain, fear of disorder, change in body image, being addict ed t o others, loss of job, and damage
of physical int egrity. Educat ion before surgery considerably decreases anxiet y levels of patient, and t he response of
pat ients to treatment become easier (7). In addit ion, it has been st at ed that the most effective method to handle
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preoperative anxiety was educat ing pat ients regarding t he disease and surgery (9).
Guo et al (15) have st at ed t hat educat ion before coronary art ery bypass surgery had a posit ive effect in decreasing t he
anxiety and stress of pat ient s; they emphasized that education should be rout inely provided t o all pat ient s. In t he st udy,
it was declared t hat educat ion had no effect on pain. ’In our st udy pain was not evaluat ed but the ot her findings t hat Guo
and his friends(15) obt ained were parallel wit h our findings. In bot h st udies, it has been concluded that education
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provided before surgery decreased anxiet y levels, and recovery became faster. In another st udy, the efficiency of
preoperative educat ion has been st udied and it has been observed t hat programmed preoperative educat ion decreased
anxiet y levels(16).
Gallagher and McKidney (17) declared that female and old patient s who would have coronary art ery bypass surgery had
more stress and anxiety in the st udy conduct ed in 2007. Furt hermore, it was concluded t hat pat ient s were st ressed while
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they were wait ing before surgery, and st ressors were the awaiting surgery, thinking of pain, being away from home,
thinking of dying from disease or surgery, changing lifestyle, requiring help, and knowing of undergoing surgery. In our
st udy, st ressors were not defined. Moreover, it was consistent wit h the st at e obt ained in the st udy t hat trait anxiety
levels of female patient s before and aft er educat ion (n=49.745, n=45.233, respectively) were higher than those of male
pat ients before and after educat ion (n=43.378, n=39.946, respectively)
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In the st udy by Asilioglu and Celik (16), 100 patient s (50 experiment, 50 control) were examined. In t he st udy,
post operative st at e and t rait anxiet y point s were found slightly higher t han pat ient s in the experiment al group. It was
concluded t hat there was no stat istical difference bet ween the point s of st ate and trait anxiety levels in groups. In st udies
conduct ed by Sidar et al(11), st atist ical significance was not found bet ween tot al point average gained by stat e anxiety
scale of pat ient s and trait anxiet y scale in post operative period (t =0.6, p>0.05; t =−1.0, p>0.05). Our st udy result s were
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consist ent with those of t he st udy conduct ed by Asilioğlu and Çelik (16) and support ed the hypothesis that education
decreased or eliminates anxiety levels.
Deyirmenjian et al. ev al uat ed t he effect of preo perat ive pat ient educat ion on anxiety level with B eck an xi ety scale in
20 06 (3). Before surgery, educati on t o the experiment al group was pro vided but the contro l group had no educat ion.
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According t o th e study, signif icant differences were not foun d bet ween p osto perative anxiety, int ubat ion time, duration
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of hosp italizatio n, and syst olic blood pressure values o f t wo groups. H owev er , st atist ical difference was found fo r
number of patients who required sedati ves in the 2 groups. While in our st udy, st at e and trait anxi et y po ints were
defined only before and aft er education; it was i nconsist ent wit h the s tudy by Dey irmenjian et al(3), li kel y because of t he
differ en t compar ison and evaluation crit eria.
C on clusion
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Therefore, it is believed that t he educat ion provided to pati ent s of open-heart surgery consideri ng learn ing requirement s
for i ndi vidual s decreases anxiet y lev els of patients and i mproves their qualit y o f life by maki ng them feel safe.
Li mi tations
The result s of th e study were l imit ed wit h th e univ ersity h osp it al where the st udy was conduct ed. I t could not be
generalized wit h ot her patients who had open-heart surgery.
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Decl arati on of Conflict of Interest
T he aut hors declare that t here were no co nflict of interest s in the s tage o f draft ing and publishi n g t his arti cle.
Fi n ancial Support
T he aut hors declare that t hey did not t ake any financial support in t he process of researching and wr it ing t his art icle.
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Cimilli C. Cerrahide anksiyete. Klinik Psikiyatri 2001;4:182-6.
10. Gürlek O, Yavuz M. Cerrrahi kliniklerde çalışan hemşirelerin ameliyat öncesi hast a eğitimi uygulama
durumları. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2013;16:8-15.
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11. Si dar A, Dedeli Ö, İşkesen Aİ. Açık kalp cerrahisi öncesi ve sonrası hast aların kaygı ve ağrı dist resi: Ağrı
düzeyi ile ilişkisinin incelenmesi. Yoğun Bakım Dergisi 2013;4:1-8.
12. Özer N, Köçkar Ç, Yurtt aş A. Kalp damar cerrahisi kliniğinde yatan hastaların hemşirelik hizmet lerinden
memnuniyet i. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2009;12:12-9.
13. Aydın ÇF. Koroner arter bypass greft ameliyat ı geçiren hast aların taburculuk sonrası iki aylık dönemde
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yaşadıkları güçlükler (T ez). Ankara: Hacettepe Üniv Sağlık Bilimleri Enstitüsü; 2000.
14. Özcan H. Açık kalp ameliyatı sonrası hemşireler tarafından verilen t aburculuk eğit iminin hast alar tarafından
kullanılma oranları (Tez). Edirne: Trakya Üniversitesi Sağlık Bilimleri Enstitüsü; 2008.
15. Guo P, East L, Art hur A. The preoperative educat ion intervention to reduce anxiet y and improve recovery
among Chinese cardiac pat ients: a randomized controlled t rial. Int J Nurs St ud 2012;49:129-37.
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16. Asilioglu K, Celik SS. The effect of preoperat ive education on anxiety of open cardiac surgery patient s. Patient
Educ Couns 2004;53:65-70.
17. Gallagher R, McKinley S. St ressors and anxiety in patient s undergoingcoronary art ery bypass surgery. Am J
Cri Care 2007;16:248-57.
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Tam Metin
revizyon metni
Kayıt Tarihi: 18.12.2014 10:50:58
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AFFECTEffect Of of Pat ient Educati on On on Patient Anxiety Level BY Using "“Scale Of of
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Patient Education Requirements"” In in Open Heart S urgery
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ABS TRAC T
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In trodu ct ion Purpose: The p urpose o f th is study is to research wh et her informingeducat ion accor din g t o
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individuals 'individuals ’ needs has an affect effect o n the anxiet y after surgery by using a scale of patient educati on
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requirement s on th e p atient s who will haveundergo heart surgery.
Pl an of th e Stu dyP ati ents an d Metho ds: The research included vol un t ary pati ent s who would have an open-heart
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surgery and are already hospitalized in a heart surgery cli ni c ( n= = =11 4). The datasDat a were collected by using a
demograph ical dat a form (st at e-trait an xiety inv entory; STAI) an d P atient Educat io n Requi rements Scale Formspatient
280
educat ion requirement s scal e forms, which had been developed by the researchers before the surgery and three days
lat er than the surgery by means of the technic of face t o faceindividuall y meet ing with the patients. Wit hDuri ng the
ho spit alization before the surgery, st at e-trait inventorySTAI was performed. After that Furt her, pat ient requi remen ts
scale was applied. According to patient requirements scale r esult s, t he pat ient s were informed at th e beginn in g from of
ho spit alization. InOn t he t hi rd day o f t he surgery, st ate-trait an xiety inv entory; STAI was performed on e mo re t ime.
285
Whi le evaluat in g t he st udy dat as, besides , in addit ion to descripti ve stat istical methods, such as Frequency, Percent age,
Average, St an dart Deviat ion, frequency, percent age , average , st andard deviat io n, the Kolmo gorov- –Smirnov
distr ibut ion test was applied t o revi ew normal dist ributio n. Furth er mor e, Pairedpaired samples t test was us ed t o
comp ar e if p aramet ers had no rmal distr ibut ion for 2 groups, and Wil co xon sign t est was performed used t o compare if
paramet ers had not abnormal dist ribut ion in-group . the gro ups. Man n -Whitney U test was used fo r the comp arison of
290
paramet ers in groups. The result s were evaluat e d inat a confidence l ev el o f 95 %,%, a significance level of p< < <0.05,
and an adv an ced si gni ficance level o f p< < <0.01 .
Fin dingsResults: The decrease of in t he st at e anxiety level aft er educat ion according t o st at e anxiet y level before
educat ion was found meaningfulsignificant (t = = =2.003; p= = =0.050<0.05). In addit ionMoreover, t he decrease ofin
the trait anxiety level aft er education was foundalso found t o be st at istically meaningful as wellsignificant (t = = =2.984;
295
p= = =0.004<0.05).
Result Conclusion: A cco rding t o the findings o bt ain ed in t hi s st udy, it was showedrevealed that inf ormin g to t he
pat ients by using pat ient education r equirement s scale accordin g t o individuals’ needs madedecreased individual s’
anxi et y decrease.levels.
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300
Key words;Key Words: Patient’s educat io n, ; patient learn ing needs scale;, cardi ovascular surgery ;, anxiety
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Pa ge 12 / 27
Açık Kalp Cerrahisinde "Hasta Öğ renim Gereksinimleri Ölçeğ i" Kullanılarak Yapılan Hasta
Eğitiminin Hasta Kaygı Düzeyi Üzerine Etki si
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AmaçGiriş: Bu çalışmanı n amacı kalp cerrahisi geçirecek hast alara ameliyat ön cesi “hast a Hasta öğrenim Öğrenim
Ggereksi ni mleri Öö lçeği” kullanıl arak, bireyleri n ihtiyaçları na göre yapı lan bil gi lendirmenin ameli yat sonrası anks iyete
üzerine herhangi bir etki sinin olup olmadığın ı araştırmaktır.
Çalışmanın pl anıHastal ar ve Yöntem: Çalışmaya kalp cerrahisi kliniğin de açı k kalp ameliyatı planlanan, ve
hast aneye yatışı yapılan ve çal ışmaya kat ılmaya gönüllü ol an hastal ar (n=114) dahil edildi. Veri ler, aAraşt ırmacılar
310
t arafı ndan gelişt iri len demo grafik veri f ormu, (st at eSt ate-Ttrait an xi etyinventoryAnxiety Inventory; (STAI) ve Hasta
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Öğrenim Gereksiniml eri ölçeği Ölçeği for mları aracı lığı ile ameliyat öncesi ve ameliyattın 3. günü hast alar ile yüz yüze
görüşme t ekniği kul lan ılarak dolduruldu. Ameli yat öncesi yatışı it ibarı ile sır asında önceli kle Duruml uluk-Sürekli
Anksiyet e envant eri Envant eri, daha son ra Hast a Ö ğrenim Ger ek sinimleri Ölçeği hast a gereks inimleri ölçeği uygulandı.
Hast a Öğrenim Gereksin imleri Ölçeği Hast a gereksinimleri öl çeğiso nuçlar ın a gör e hast alar yat ış ından it ibaren
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bil gi lendirildi. AAemeliy atı n 3. günü hast alara (st ate-trait anxiet yin vento ry; STAI) t ekrar uygulandı. Çalışma veril eri
değerlendiril irken t anımlayıcı istati st iksel metotların (Frek ansf rekans, Yüzdeyüzd e, Ortalamaort alama, St andart standart
sapma) i le özet lendi. yanı sıra nNormal dağılım ın incelenmesi i çin Kolmogorov - Smirnov dağılım t esti, normal dağıl ım
göst eren parametreleri n iki grup i çin k arşılaştı rmaları nda eşlenik örnekler (Pai red samples) t test i, normal dağıl ım
göst ermeyen par am et relerin grup içi karşılaşt ırmal ar ında ise W il cox on işaret test i kullanıldı. Paramet relerin gruplar
320
arası kar şılaşt ırmalarında Mann- Whitney U test kullanıldı . Son uçl ar % 95 güven aral ığında, p <0.05 an lamlılık
düzey in de ve p<0.01 ileri anlamlılık düzeyinde değerlendiri ldi.
Bulgular: Hast aların eğit im öncesi durumluluk kaygı (state anxiety) düzeyine göre eğit im sonrası durumluluk kaygı
düzeyinde meydana gelen düşüş (t =2.003; p=0.050<0.05) ile, eğit im öncesi sürekli kaygı (trait anxiety) düzeyine göre
eğit im sonrası sürekli kaygı düzeyinde meydana gelen düşüş ist atist iksel olarak anlamlı bulundu (t =2.984;
325
p=0.004<0.05).
Son uç: Bu çalışmada elde edilen bulgul ara gö re, hast aların ameliyat öncesi Hast a Öğrenim Gereksinimleri Öl çeği hast a
öğren im gereksinimleri ölçeği kul lanılarak bi reylerin ihti yaçların a gör e y apı lan bilgilen dirmenin bireylerin
anks iyetesini azalt tığı gö steri lmiştirgöstermişt ir.
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An ahtar Kelimeler:; Hast a eğiti mi;, hasta ö ğrenim ger eksini mleri öl çeği;, kalp cerrahisi;, kaygı düzeyi
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INTRO DU C TION
Surgical interventio ns have th e pot ent ial o f causing seri ous ps ychosocial and psychiatric pr obl ems . Sur gical operait on,
and surgical operatio n can be an anxiety source and af fect po sto perative mor bidity. It washas been st at ed t hat more
335
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medical comp licat ion developed comp lications increased aft er the surgery for t he pat ient s hadhavin g h igh anxi et y
levellevels before the surgery, incr eased t he duration of hospit alization, and delayed t he recovery t ime (1,2 ). Education
and prep ar at ion of patients before t he surgery had an effect on the pat ient care af ter surgery and at the discharge stage.
Educati on of pat ients an d their family is all healt h team’s resp onsibil ity as well as nurses have primary
respons ibilit y.The priori ty of t he informat ion requir ed by surgical pat ient s varies bywith typ e of surgery and needs of
340
individual pat ients. Heart surgery is percei ved by mo st p eo ple as a life -t hreat ening event or crisis(3). Pati ent s are
concern ed th at t hey could not co ntrol their body and life in t erms of pcychology. On t he other hand, they live in the
F ield C ode C hanged
ho pe of gaining their health back. Surv iv alThe surviv al rat e aft er open-heart surgery applied by car di o pulmonary bypass i ncreased defi nitively with t he help of increased using inno vat ion s of anest hesia managementnarco sis and surgical
t echn ics, advancetechn iques, advances in cardiopulmonary by-pass t echnolo gy and developing , and development o f
345
int ensive care t reatment principles(4).However, althou gh Despite th ese development s, it was a fact that anxi ety an d fear
of deat h exist for t he persisted in patients.
Symbol ic meaning of “heart operation” increases f ear o f death and t he risk of preoperat iv e anxiety (5). Th e most effecti ve
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appr oach t o t he patient h ad anxiety wast oward anxio us patient s has been t o reass ur e an d p rovide psy chological s up port.
Pati ent education h ad an impo rt ant role wit hin suggest ed m et hods. The education Educati on before the surgery i s an
350
indispensable part of p at ien t care and one of t he most imp ort ant nurs ing attempt. The p atient educat ion which
performed before surgi cal oper at ions an d goes o ns; educat ion pro vided during t his time continues until discharge from
the hosp it al and has an imp ort ant ro le onfor the pat ient in t erms of gaining informat ion regardin g s urgical inter vention
and feeli ng bett er phy sically and psycholo gically fort the p at ient ((6). It ishas been important t hat pat ient s education
requirement s are fulfi lled before and aft er the surgery. Because, fulfilling t he educat ion requirements posit iv ely affect ed
355
t he quali ty of patient care results positively((7,8).
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In t hethis st udy, it was aimed to evaluat e th e anxiety levellevels of p at ient s before and after surgery by organizing
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t rain ing an d det erminedet erminin g p atien t requirements by using th e p atien t educati o n requi rement scale.
PATIEN TS AND METHO DS
After receiving app roval from t he et hical committee and depart ment of surgery, the t his comparat ive and descri pt ive
360
st udy was conduct ed between the dat es of February 1 an d May 31 as comparati ve-descripti ve.. Befo re t he surgery ( , (in
the course of th e appli cat io n t o the clinic) st at e-trait an xiety inv ent ory (STA I), p at ien t educati on r equi rement s scale, and
demograph ic survey were conduct ed t o t he for patient s were pl ann ed to havesupp osed t o undergo an op en heart surgery
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and hos pit alized (n = = =11 4) in heart surgery clinics. Requirement s of the pati ent s Patient requirement s were defined
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Whi le evaluat in g t he findings in t he st udy, St atistics PackagedSt atistical Package Program was used for statist ical
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analysis. Whi le evaluating t he st udy dat as, besides , in addit ion to descripti ve st atisti cal met hods, such as Frequency,
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acco rding t o t he patient learni ng requirement s scal e, the; education start ed befo re the surgery and cont inued until the
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discharge of the patient.Inpat ient s. O n the th ird day after the surgery, St ate-Trait anxi ety inventorySTAI was re-appl ied
t o t he patients again.. Patient s who do not speak Turkish (6 pat ients) were not involved in t he study.
Percent age, Average, Standart Deviationfrequency, percent age, average, st an dard deviati on , Kolmogor ov- –Smirnov
370
distr ibut ion t est was appl iedused t o r ev iew normal di st ribut ion. Furt hermore, P airedpaired samples t test was used t o
comp ar e if p aramet ers h ad normal distr ibut ion for 2 groups and Wilcoxo n sign test was performedused t o compare if
paramet ers had no t an abnormal dist ribut ion in-group . t he gro ups. Mann -Whitney U t est was used fo r comp ar ison o f
comp ar ing t he paramet ers bet ween th e gro up s. The result s wer e ev al uat ed inat a confidence level of 95 %,%, a
signif icance level of p< < <0.05 , andand an adv an ced si gni ficance level o f p< < <0.01 .
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FINDIN GS RES ULTS
In t otal, 114 patients were involv ed in the st udy.; 86 of t he cases (75.4%) patients were male an d 6 8 of t hem were 61
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and abo ve ≥61 year s old. Furt her, 46 of the cases (40.5 %) h ad %) patient s weighed ≥81 and abo ve 81 kil os kg, 106 of
them (93%) wer e married, and 110 of them (96.5%) had at l east one ch ild. 80 o f themEight y patient s (70.1%) gr aduat ed
from primar y scho ol. General demo graphic properties f or p at ients were showedare shown in Table 1 .
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The decrease of in the st ate anxiet y level aft er educat ion according to t he st ate anxiet y level before education was
found st at istically meaningfulsignificant (t = = =2.003; p= = =0.050< < <0.05). In addit ion, the The decrease ofin trait
anxiety level levels after educat ion was foundalso st at istically meaningful as wellsignificant (t = = =2.984; p= = =0.004<
< <0.05) (T able 2). It was det ermined that the average of trait anxiet y level of t he caseslevel of pat ient s was affected by
t he variables, such as gender, smoking, doing exerciseexercising before and after educat ion.
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Mann -Whit ney–U t est was applied for the purpose of defining if there was a meaningfulThe difference bet ween before
and after educat ion trait anxiety levels according to gender was evaluat ed variable.. The difference bet ween the group
average before educat ion (Mann -Whitney U= test = =193.50; p= = =0.046< < <0.05) and t he group average after
educat ion (Mann -Whit ney U= t est = =193.00; p= = =0.045< < <0.05) was found st at istically meaningful after
according to t he test .(Table3)to be st atist ically significant (Table 3). The trait anxiety levellevel of females before and
390
aft er educat ion (x=n = =49.74, x=n = =45.23, respect ively) was found higher t han t he trait anxiety levelt hose of males
before and aft er educat ion (x=n = =43.38, x=n = =39.95, respectively).
The dif ference bet ween average of groups was foun d st ati sticall y meaningful wit h t he help ofMann -Whitney- U t est
conduct ed bef ore educatio n oThen the purpose of whet her trait anxiet y level di ffered bylevels cons iderably wer e
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signif icant ly differ ent with respect according t o the variable of work ing st at us o f the casespat ient s (M ann -Whitney U=
395
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t est = =11 3. 00; p= = =0.01 4< < <0.05 ). T rait anxiety level of no n-working caseslevel of unemployed pat ient s (x=n =
=46 .4 1) was foun d higher t han trait an xiety level of wo rki ng casest hose of employed patient s before educat ion(x= (n =
=40 .0 2) (TableTable 4).
Mann Whitney–U test was applied for the purpose of defining if there was a meaningful difference bet ween before and
aft er educat ion t rait anxiety levels according to variable doing exercise .-tThe difference in in anxiety levels respect to
400
exercising was significant before education The difference bet ween group average before educat ion (Mann -Whitney
U= t est = =135.00; p= = =0.004< < <0.05) and group average aft er educat ion (Mann -Whitney U= test = =167.00; p= =
=0.026< < <0.05) was found st at istically meaningful after according t o the t est.(Table3). It was found that before and
aft er educat ion t he st ate (Table 3). St ate anxiet y levellevels of cases that patient s who were not doing exercise
(x=exercising before and aft er educat ion (n = =40.49, x=n = =37.09, respect ively) was higher than the st at e anxiety
405
level cases thatpat ient s who were doing exercise(x=exercising (n = =31.52, x=n = =30.48, respectively)(Table) (Table
5).
It was seenobserved that 26of the cases (22.8%) pat ient s were regularly smoking and 28 of t hem (24.9%) were doing
exercise regularly exercising (T able 6). T Mann Whitney –U t est was applied for the purpose of defining if there was a
meaningful difference bet ween trait anxiety levels before and aft er educat ion trait anxiet y levels according t o variable
410
ofthe smoking st at us . was not significant before The difference bet ween group average before educat ion (Mann Whitney U= t est = =221.500; p= = =0.395> > >0.05) was not found st atist ically meaningful.significant. However , the
difference was significant bet ween group average aft er educat ion (Mann -Whitney U= t est = =155.50; p= = =0.030< <
<0.05) was found st atist ically meaningful aft er according to the t est.(T able6)(Table 6). St ate anxiet y levellevels of t he
cases (x=pat ient s (n = =40.31) that is who were smoking after educat ion was seen higher than the st ate anxiety level of
415
cases (x=t hose of patients (n = =34.06) that is non-who quit smoking after educat ion.
DIS C USSION
Surgical int erventio ns are kind of interventi ons which have the p otenti al of causin g s er ious psychosocial and psychiat ri c
problems.Heart surgery is p er ceiv ed as life -threatening event and
(3)
crisi s for many peopl e . Moreover, s ymbolic
meaning of “heart ” increases f ear o f death and the risk of p reoperat iv e anxiet y (9). It was seen t hat the anxi ety level of t he
420
pat ients decreased with planned nursing education and cons ult ancy(7).Fo r this reason, it i s necessary to collect various
dat as i n th e p rocess o f pat ient educat ion. Pat ient educati ons should be planned in considerati on of the collected dat as
belong t o t he patient.
Real izing of t ermi nal behavioural change and det ermining of educat ion requirements depend on co llecting relat ed dat as
about every fact ors aff ect t each ing-learning process systemati cally and cont inuous ly. It is crucial that nurses determ ine
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educat ion requirement s of educat ion fromcons idering t he po int of educat ion requirement s of the patient and patient
familypat ient s and t heir famili es
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(9,10)
. In t he present st udy, we sho wed t hat informing th e p at ient s using patient educat io n
requirement s scale according to in dividual s’ needs decreased individuals ’ anxi et y levels of patients un dergoing openheart surgery.
Demographi c characterist ics of our study populat ion was simi lar t o those of previous s tudies on Most ly, male patient s
430
(75.4%) were included in the st udy about pat ient s had undergoing an op en-heart surgery conducted by Sidar and his
fri en ds(11-14). It was een th at when evaluated t he gender st atus o f patient s 93 % of them were married and when
examining educat ion st at us 70 .1 % of t hem graduat ed from p ri mary sch ool.In an ot her st udy conduct ed by Ozer and his
fri en ds(12) i n in cardiovascular surgery cl inic, it was seen that 74.5 %of t he patient s were mal e, the most of the patient s
were bet ween th e age of 41 an d 5 3 (42.1%), marri ed patient s had the percent age of 8 5.3% and It was det ermined th at
435
49 %of the pat ient s grad uat ed from primary school. In another study of o ur research, similar results were obt ained; when
cons idered demographi cal dat as, male patient s had t he percentage of 75.4%, marri ed pat ient s had t he percent age of 93%
and 70% of t he patients graduat ed f rom p rimary school. In addit on to t he st udy con duct ed by Ozer and his f riends
(12)
when considered age propert ies, the patient s who were 61 years ol d and olders had th e propo rtion of 59 .6% in our s tudy
.According t o fin din gs of demographi c dat as in st udies there was a r isk of cardiovascular diseases for males and old
440
peop l e i n lit erature.
In our research, as far as working stat us of patient s was concerned it was seen t hat 70.2% of them were not working. In
anot her st udy it was det ermined t hat 56% of similar pat ient s were in the group of retired and non-working patient s.
(13)
It
was t hought t hat non-working was more common among old people who had higher prevalence of heart diseases.
In st udy conduct ed by Özcan (14), when analyzed the alcohol and smoking st at us of patients, it was det ermined 64% them
445
did not use alcohol, 58% of them did not smoke. It showed paralellism wit h the datas of our study.
One of t he import ant t arget s of t he care before surgery is to remove eliminate the anxiety of patients. The common
reasons of the anxiety before surgery is pain, fear of disorder, change in body image, being addict ed to others, job loss
of job, and damage of physical integrit y. Education before surgery makes anxiety level of patient decrease considerably
decreases anxiet y levels of pat ient, and the accordresponse of patient s t o treatment become easier (7). In addition, in a
450
st udy, it wasit has been stat ed that t he most effective method to handle preoperative anxiet y was t he education of patient
educat ing pat ients regarding t he disease and t he surgery (9).
Guo and his friends et al (15) have stat ed t hat education before coronary art ery by-pass surgery had a positive effect on in
decreasing t he anxiet y and st ress of t he pat ient s and; t hey emphasized t hat the education should be implemented to all
pat ients rout inely. provided t o all patient s. In the st udy, it was declared that educat ion had not any effect on the pain. ’In
455
our st udy pain was not evaluated but t he ot her findings t hat Guo and his friends (15) obt ained were parallel wit h our
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findingsIn our st udy pain was not evaluat ed but t he findings that Guo and his friends (15) obt ained showed parallelism
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wit hour findings. In both st udies, it washas been concluded that educat ion implement edprovided before surgery
madedecreased anxiety level decreaselevels, and in this way recovery became fast er. In another st udy, it was researched
the efficiency of preoperative educat ion has been st udied and it was seenhas been observed t hat programmed
460
preoperative educat ion madedecreased anxiet y level decrease as a resultlevels(16).
Gallagher and McKidney (17) declared t hat female and old patient s who would have coronary artery by-pass surgery had
more st ress and anxiety in t he st udy conduct ed in 2007. Furt hermore, it was concluded that pat ient s had st resswere
stressed while they were waiting before the surgery, and stressors were of t he await ing surgery, t hinking of having pain,
being away from home, thinking of dying from disease or surgery, changing life st yle, being in need oflifest yle,
465
requiring help, and knowing of havingundergoing surgery. In our st udy, stressors were not defined. Moreover, it
showed parallelismwas consist ent wit h t he st at e obt ained in the st udy t hat trait anxiety levels of female casespatients
before and aft er education (x=n = =49.745, x=n = =45.233, respectively) were found higher than t rait anxiety
levelst hose of male casespatients before and after educat ion (x=n = =43.378, x=n = =39.946, respectively)
In the st udy by Asilioglu and Celik (16), 100 patients (50 experiment, 50 control) were examined.
470
In the st udy,
post operative st at e and trait anxiety point s were found slight ly higher than the pat ient s had in the experimental group. It
was concluded t hat there was no st at istically meaningful difference bet ween the point s of st ate and t rait anxiet y levels in
groups. In the st udies conduct ed by Sidar and his friendset al (11), it st atist ical significance was not found st atist ically
meaningful bet ween t otal point average gained by stat e anxiety scale of patient s and trait anxiet y scale in post operative
period (t = = =0.6, p> > >0.05; t =- = =−1.0, p> > >0.05). Our st udy showed paralellism with the result s were consistent
475
wit h t hose of t he st udy conduct ed by Asilioğlu and Çelik (16) and supported t he hypothesis in the litert at ure that
educat ion makes anxiety level removedecreased or decrease.eliminates anxiety levels.
Deyirmenjian and his friendset al. evaluat ed th e ef fect of preoperat ive p atient educat ion on anx iet y lev el with Bezk
Anxiety ScaleBeck anxiety scale in 20 06
((3)
. Before t he surgery, educati on t o t he exp erim en tal group was p ro vided but
the con tro l group had not t he educat ion. A cco rding t o t he st udy i t was n ot fo un d m eanin gful, signif icant differences
480
were not foun d bet ween p ostoperative anxiety, int ubation time, duration of hospitalizati on , and systolic blood pressure
F or matted
...
F or matted
...
values of t wo group s. Ho wever, meaningfulst ati st ical di fference was fo un d f or n um ber o f pat ient s who needed sedat ive
medicin es in t worequired se dat ives in the 2 gro ups. While, i n our st udy, st at e and t rait an xiety p oint s were defin ed only
before and aft er educat ion; it did n ot show par al leli smwas inco nsist ent with the st udy conducted by D eyi rmenjian and
his f riendset al (3). It was though t t hat ), li kel y because of t he reason was th at crit erion s ofdiffer ent comp ar ison and
485
evaluat ion were different.criteria.
C on clusion
F or matted: F ont: Bold
Pa ge 18 / 27
In our st udy i t was found high t hat the st ate an xiety level of smoking pat ient s after educat ion. It was thought that it was
because of mentioning in the e ducat ion that smoki ng had an affect on cardivascil ar di seases. As a resultTherefore, it is
thought believed that the educatio n which i s givenprovided t o the patient s of o pen-heart surgery consideri ng learn ing
490
requirement s for individuals makesdecreases anxiet y levellevels of p at ient s decrease and increaseimproves their q ualit y
of li fe by making t hem feel safe.
Result sLi mi tations
The result s of th e study waswere limit ed wit h the un iversit y hospit al where t he st udy was conduct ed. It could not be
generalized wit h ot her patients who had open-heart surgery.
Decl arati on of Conflict of Interest
Aut hors declaredThe authors declare th at there was n ot were no co nflict of int erest on t he interests in th e stage o f
prep aringdrafting an d p ublish in g of t his art icle.
Fi n ancing
500
Restrictions
495
Aut hors declaredFi n ancial Support
T he aut hors declare that t hey did not t ake any financial support in t he process of researching and wr it ing of this art icle.
505
510
F or matted: Line spacing: D ouble
Pa ge 19 / 27
REFERENC ES
18. Milano MR, Kornfield DS. P sychiatry and surgery, Review of Psychiatry. In: L Grinspan L ((Eed).), Review
of psychiat ry. 3. Cilt, Washingt on DC:.: American Psychiatric Press Inc., ;1984:. P. 256-277.
515
19. Bekaroğlu M, Uluut ku N, Alp K, Lüleci N ve ark. Ameliyat öncesi kaygı ve depresyon durumunun ameliyat
komplikasyonlarına ve yatış süresine etkisi üzerine bir çalışma. Türk Psikiyatri Dergisi 1991;2 (4):285-288.
20. Deyirmenjian MN, Karam N, Salameh P. Preoperative patient educat ion for open-heart pat ient s: A source of
anxiet y?. Patient Educ CounsP atient Educat ion and Counseling 2006; 62: 111-117.
21. Rot henhausler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and
520
psychosocial out come of cardiac surgery wit h cardiopulmonary bypass: a prospective 12-month follow-up
st udy. Gen Hosp P sychiatry 2005;27:18-28.
22. Pasnau RO, Fawzy FI, Skot zko CE ve ark. Surgery and surgical subspecialties, . In: Rundell JR, Wise MG
(eds). The American Psychiatric Press Text book t ext book of Consult ationconsult ation-Liaison liaison
P sychiat rypsychiatry. JR Rundell, MG Wise (Ed), Washingt on DC.,: American Psychiatric Press Inc.,
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1996.:p.608-639.
23. Yavuz M. Ameliyat Öncesi öncesi Bakımbakım. In: Karadakovan A, Eti AF, (edit öreds). Dahili ve Cerrahi
cerrahi Hast alıklarda hastalıklarda Bakımbakım. 2. Baskı. Adana:: Nobel Kitapevi; , 2010. p.:293-307.
24. Uzun O. Ameliyat öncesi hasta eğit imi. Anadolu Üniversitesi Hemşirelik Yüksekokulu Dergisi 2000; 3: 36-45.
25. Walker JA. What is the effect of preoperative ınformation on patient satisfaction? Br J Nurs. 2007;16:27-32.
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26. Cimilli C. Cerrahide Anksiyeteanksiyete. Klinik Psikiyatri 2001; 4: 182-186.
27. Gürlek O, Yavuz M. Cerrrahi kliniklerde çalışan hemşirelerin ameliyat öncesi hast a eğitimi uygulama
durumları. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2013; 16: 8-15.
28. Si dar A, Dedeli Ö, İşkesen Aİ. Açık kalp cerrahisi öncesi ve sonrası hast aların kaygı ve ağrı dist resi: Ağrı
düzeyi ile ilişkisinin incelenmesi. Yoğun Bakım Dergisi 2013; 4: 1-8.
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29. Özer N, Köçkar Ç, Yurtt aş A. Kalp damar cerrahisi kliniğinde yatan hastaların hemşirelik hizmet lerinden
memnuniyet i. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2009; 12: 12-19.
30. Aydın ÇF. Koroner arter bypass greft ameliyat ı geçiren hast aların taburculuk sonrası iki aylık dönemde
yaşadıkları güçlükler (T ez). Ankara: : Hacettepe Üniv Sağlık Bilimleri Enstitüsü; ; 2000.
31. Özcan H. Açık kalp ameliyatı sonrası hemşireler tarafından verilen t aburculuk eğit iminin hast alar tarafından
540
kullanılma oranları (Tez). Edirne: : Trakya Üniversitesi Sağlık Bilimleri Enstitüsü; ; 2008.
Pa ge 20 / 27
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N ew Roman, 10 pt, T urkish
32. Guo P, East L, Art hur A. The preoperative educat ion intervention to reduce anxiet y and improve recovery
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among Chinese cardiac patient s: A a randomized controlled trial. Int ernational Int Journal of Nursing St udies
2012; 49: 129-137.
33. Asilioglu K, Celik SS. The effect of preoperat ive education on anxiety of open cardiac surgery patient s. Patient
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Educ CounsP at ient Educat ion and Counseling 2004; 53: 65-70.
F or matted: F ont: (D efault) T imes
N ew Roman, 10 pt, T urkish, D o not
check spelling or grammar
34. Gallagher R, McKinley S. Stressors and anxiety in patient s undergoingcoronary arter y bypass surgery.
American Journal of Critical Care 2007; 16: 248-–257.
550
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555
Tablolar
table 1
Kayıt Tarihi: 18.12.2014 10:43:52
Table 1. Socio-demographic and medical characteristics of patients
n=114
%
Male
Female
≤50
51-60
≥61
86
28
18
28
68
75.4
24.6
15.8
24.6
59.6
Weight (kg )
≤70
71-80
≥81
36
32
46
31.5
28.0
40.5
Marital status
Married
Sing le
106
8
93.0
7.0
Yes
No
Primary s chool
Secondary school
High s chool
University
110
4
80
10
8
16
96.5
3.5
70.1
8.7
7.1
14.1
Yes
No
34
80
29.8
70.2
<1000
≥1000
Yes
No
Yes
No
Yes
No
72
42
26
88
10
104
28
86
63.2
26.8
22.8
77.2
8.8
91.2
24.6
75.4
Exercise frequ ency in one week
4
7
10
18
35.7
64.3
Diet
Yes
No
28
86
24.6
75.4
Gender
Age (y ears )
Children
Educatio n
Working status
In come (Tu rkish Lira)
Smo king
Use of alco hol
Exercise
560
Pa ge 22 / 27
Tablolar
table 2
Kayıt Tarihi: 18.12.2014 10:44:04
565
Table 2. Anxiety level before and after education
State anxiety
Trait anxiety
Before education
(n =114 )
Mean
SD
37.99
9.43
44.94
8.04
After education
(n =114 )
Mean
SD
35.23
9.84
41.24
8.32
570
Pa ge 23 / 27
t
p
2.01
2.98
0.05
0.00 4
Tablolar
table 3
Kayıt Tarihi: 18.12.2014 10:44:17
575
Table 3. Anxiety level according to gender before and after educat ion
State anxiety
Trait anxiety
Mal e (n =86 )
Mean
SD
Female (n =28 )
Mean
SD
MW
p
Before education
36.91
8.51
41.31
11.55
228.5
0.178
After education
33.68
9.21
39.99
10.51
200.0
0.061
Before education
43.38
6.22
49.74
10.98
193.5
0.04 6
After education
39.95
8.00
45.23
8.28
193.0
0.04 5
Pa ge 24 / 27
580
Tablolar
table 4
Kayıt Tarihi: 18.12.2014 10:44:32
585
Table 4. Anxiety level according to working status before and after educat ion
State anxiety
Trait anxiety
Working
(n = 34)
Mean
SD
Nonworking
(n =80 )
Mean
SD
MW
p
Before education
33.98
5.46
39.42
10.57
151.0
0.114
After education
32.72
7.59
35.49
10.29
193.5
0.543
Before education
40.02
5.67
46.41
8.41
113.0
0.01 4
After education
39.50
6.22
41.51
9.11
179.5
0.353
Pa ge 25 / 27
590
Tablolar
table 5
Kayıt Tarihi: 18.12.2014 10:44:45
Table 5. Anxiety levels according to status of doing exercise before and after education
Exercising
Not Exercising
(n=28 )
(n=86 )
MW
p
Mean
SD
Mean
SD
Before education
31.52
6.34
40.49
9.34
135.0
0.004
After education
30.48
7.48
37.09
10.30
167.0
0.026
Before education
40.84
5.47
46.65
8.41
148.0
0.009
After education
37.33
7.51
43.01
8.24
170.5
0.031
State anxiety
Trait anxiety
595
Pa ge 26 / 27
600
Tablolar
table 6
Kayıt Tarihi: 18.12.2014 10:44:59
Table 6. Anxiety level according to smoking status before and after educat ion
State An xiety
Trait anxiety
Befo re ed ucation
After edu cation
Befo re ed ucation
After edu cation
Smo king
(n =26 )
Mean
SD
40.69 10.63
40.31 10.65
48.27 11.89
45.31
7.06
Non -smoking
(n =88 )
Mean
SD
37.33
9.18
34.06
9.30
44.06
6.65
40.25
8.43
605
Pa ge 27 / 27
MW
p
221.5
155.5
215.0
179.5
0.395
0.030
0.327
0.091

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