Renee Madeline Sheena, S (2016) Effectiveness of selected noetic therapies upon clinical outcome of patients with unstable angina undergoing percutaneous coronary intervention. Masters thesis, Apollo College of Nursing, Chennai.
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Abstract
An Experimental Study to assess the Effectiveness of selected Noetic Therapies upon the clinical outcome of patients with Unstable Angina undergoing Percutaneous Coronary Intervention at Apollo Hospitals, Chennai. The Objectives of the Study were, 1. To assess the clinical outcome among the control and the experimental groups of patients with unstable angina undergoing percutaneous coronary intervention before and after selected noetic therapies. 2. To assess the effectiveness of selected noetic therapies by comparing the clinical outcome before and after noetic therapies among the control and the experimental groups of patients with unstable angina undergoing percutaneous coronary intervention. 3. To assess the level of satisfaction of patients regarding selected noetic therapies in the experimental group of Patients with unstable angina undergoing percutaneous coronary intervention. 4. To find out the association between the selected demographic variables and the clinical outcome among the control and the experimental groups of patients with unstable angina undergoing percutaneous coronary intervention. 5. To find out the association between the selected clinical variables and the clinical outcome among the control and the experimental groups of patients with unstable angina undergoing percutaneous coronary intervention. The conceptual framework for the study was developed on the basis of King’s Goal Attainment Theory (Martha 2013), which has been modified for the present study. The study variables were Noetic therapies on satisfactory clinical outcome among unstable angina patients undergoing percutaneous coronary intervention. A quasi experimental research design was adopted for the study. The present study was conducted at Apollo Main Hospital, Greams road, Chennai. The study samples were selected using purposive sampling technique. The sample size for the present study was 60 among which, 30 patients were assigned to the control group and 30 to the experimental group who satisfied the inclusion criteria. An extensive review of literature and guidance by experts laid the foundation for the investigator in developing demographic variable proforma, clinical variable proforma to obtain the baseline data by interview method. The researcher also used the universal pain assessment tool to assess the level of pain, hospital anxiety and depression scale to assess the level of anxiety and depression, observational check list to measure blood pressure and heart rate for patients with unstable angina undergoing percutaneous coronary intervention and rating scale to assess the patient’s satisfaction. The data collection tools were validated and reliability was established. After confirming the feasibility and research ability through pilot study, data for the main study was conducted for a period of 6 weeks. The collected data was tabulated and analyzed by using appropriate descriptive and inferential statistics. The Major Findings of the Study were 1. More than two thirds of the patients with unstable angina undergoing percutaneous coronary intervention were employed (66.66%, 70%), around half of them were graduates (46%, 43.33%), live as a nuclear family (46.66% 63.33%) most of them were non-vegetarian (83.33%, 86.66%), and all of them were married (100% 100%) in the control and the experimental groups respectively. 2. Around half of the patients were overweight (20%,53.3%), and had slight limitation of physical activity (20%, 43.3%), diagnosed to have two vessel disease (43.3%,30%) with ejection fraction below normal (53.3%, 50%), with more than fifty percentage of stenosis (43.3,76.6%), majority of them had no history of coronary artery disease (83.3%,56.6%), history of smoking (60%,80%), had history of co-morbid illness (70%,53.3%) and no history of getting treatment for illness (83.3%,53.3%), with pre medication before procedure (70%,86.6%) and pain medication after procedure (100%,100%) in the control and the experimental groups respectively. 3. Unstable angina patients undergoing percutaneous coronary intervention in the control group had moderate hypertension (16.6%, 50 %) in pre-test and post-test. On the other hand, one third of the patients undergoing percutaneous coronary intervention (30%, 43.33%) in the experimental group had mild hypertension before therapy and normal blood pressure after therapy respectively. 4. Around half of the patients (36.6%, 50%) in the control group had normal heart rate and tachycardia in pre-test and post-test whereas, around half of the patients (43.3%, 56.6%) in the experimental group had tachycardia and normal heart rate after the therapy. 5. A majority of the patients (66.6%, 66.6%) in the control group had mild pain in pre-test and post-test whereas, around half of the patients (80%, 50%) in the experimental group had mild pain after the therapy. 6. Half of the patients in the control group had anxiety (56.6%, 50 %) in pre-test and post-test. On the other hand, in the experimental group, around half of the patients undergoing percutaneous coronary intervention (46.6%, 60%) had anxiety before therapy and borderline anxiety after the therapy respectively. 7. More than half of the patients (60%, 66.6%) in the control group had depression in pre-test and post-test whereas around half of the patients (50%, 36.66%) in the experimental group had depression and borderline depression after the therapy. 8. Pre-test score of systolic blood pressure (M=136.56, S.D=16.20) in the control group and (M=136.36, SD=18.40) in the experimental group with the ‘t’ value 0.26 which was not statistically significant at p<0.05 whereas, after noetic therapies, there was a difference in the systolic blood pressure (M= 136.6, SD=14.09) in control group and (M= 120.3, SD= 6.08) in the experimental group with ‘t’ value of 5.81 which was statistically significant at p<0.01. Comparison of pre-test post-test systolic blood pressure score of patients in experimental group shows ‘t’ value 7.20*** at p<0.001 and shows the effectiveness of noetic therapies. 9. Pre-test score of diastolic blood pressure (M=82.66, S.D=8.24) in the control group and (M=87.9, SD=10.32) in the experimental group with the ‘t’ value 1.76 which was not statistically significant at p<0.05 whereas after noetic therapies there was a difference in the diastolic blood pressure and heart rate (M= 82.03, SD=7.87) in the control group and (M= 72.7, SD= 6.90) in the experimental group with ‘t’ value of 4.88 which was statistically significant at p<0.01. Comparison of pre-test post-test diastolic blood pressure score of patients in the experimental group shows ‘t’ value 9.68*** (df=29) at p<0.001 and shows the effectiveness of noetic therapies. 10. Pre-test score of heart rate (M=92.9, S.D=14.43) in the control group and (M=98.2, SD=13.20) in the experimental group with the ‘t’ value 1.48 which was not statistically significant at p < 0.05 whereas, after noetic therapies, there was a difference in the heart rate (M=93.1, SD=14.9) in control group and (M=75.7, SD= 8.74) in the experimental group with ‘t’ value of 5.51 which was statistically significant at p < 0.01. Comparison of pre-test post-test heart rate score of patients in the experimental group shows ‘t’ value 11.25*** at p < 0.001 and shows the effectiveness of noetic therapies. 11. Pre-test score of pain (M=2.06, S.D=1.14) in the control group and (M=3.06, SD=1.36) in the experimental group with the t value 1.80 which was not statistically significant at p < 0.05 whereas, after noetic therapies, there was a difference in the pain (M=2.13, SD=0.86) in the control group and (M= 0.93, SD= 0.73) in the experimental group with‘t’ value of 5.79 which was statistically significant at p<0.01. Comparison of pre-test post-test pain score of patients in the experimental group shows‘t’ value 11.21*** at p<0.001 and shows the effectiveness of noetic therapies. 12. Pre-test score of anxiety (M=11.76, S.D=4.01) in the control group and (M=12.5, SD=3.8) in the experimental group with the‘t’ value 0.73 which was not statistically significant at p < 0.05 whereas, after noetic therapies, there was a difference in the anxiety (M= 11.0, SD=4.29) in the control group and (M= 7.2, SD= 1.3) in the experimental group with‘t’ value of 4.69 which was statistically significant at p<0.01. Comparison of pre-test post-test anxiety score of patients in the experimental group shows‘t’ value 11.52*** (df=29) at p < 0.001 showing the effectiveness of noetic therapies. 13. Pre-test score of depression (M=11.9, S.D=4.77) in the control group and (M=12.46, SD=3.21) in the experimental group with the t value 0.53 which was not statistically significant at p < 0.05 whereas, after noetic therapies, there was a difference in the depression (M= 11.8, SD=3.94) in the control group and (M=7.73, SD= 1.74) in the experimental group with‘t’ value of 5.17 which was statistically significant at p < 0.01. Comparison of pre-test post-test depression score of patients in the experimental group shows‘t’ value 10.51*** at p < 0.001 and shows the effectiveness of noetic therapies. 14. Majority of the patients undergoing percutaneous coronary intervention in the experimental group was highly satisfied (93.3%) with the researcher’s approach, (96.6%) and method of application of noetic therapies (93.3%). 15. There was no significant association between demographic variables like age, gender and type of food and clinical outcome(non-invasive hemodynamic parameters like Blood pressure and Heart Rate). In this regard, the null hypothesis Ho2was retained. 16. There was no significant association between selected demographic variables like age, gender, type of food and clinical outcome (Anxiety, Depression). In this regard, the null hypothesis Ho2 was retained. 17. There was no significant association between selected demographic variables like age, gender, type of food and clinical outcome (Anxiety, Depression). In this regard, the null hypothesis Ho2 was retained. 18. There was no significant association between the clinical variables and clinical outcomes (non-invasive hemodynamic parameters like blood pressure). Hence the null hypothesis Ho3 was retained. 19. There was significant association between selected clinical variables namely BMI (χ2=8.26,df=1), ejection fraction (χ2=13.09, df=1), history of coronary artery disease (χ2=4.88, df=1) and clinical outcome (heart rate and pain) at p < 0.01 level. However there was no significant association between other clinical variables like smoking, extent of coronary artery disease, percentage of stenosis and clinical outcome (heart rate, pain).hence the null hypothesis Ho3was rejected with regard to BMI, ejection fraction and history of coronary artery disease. 20. There is significant association between the BMI (χ2 = 4.21, df=1), smoking (χ2=6.16,df=1), extent of coronary artery disease (χ2=3.90,df=1)and selected clinical outcomes (Anxiety, Depression) at p < 0.05 level. However there was no significant association between other clinical variables like history of coronary artery disease, percentage of stenosis, ejection fraction and clinical outcome (Anxiety, Depression). Hence the null hypothesis Ho3 was rejected with regard to smoking and extent of coronary artery disease. RECOMMENDATIONS: 1. The present study could be replicated in different settings. 2. A similar study could be undertaken on a larger scale for more valid generalization. 3. This method may be implemented in all the settings like cath lab, cath day-care, pre-op holding area, endoscopy and can be made as a standard intervention as routine procedure. 4. A study on noetic therapies could be done for haemodialysis patients, percutaneous valvular correction patients, arthroscopy patients, endoscopy patients where patients remain awake. 5. A similar study on various therapies like touch therapy, reflexology, divertional therapies like music, guided imagery can be separately done for patients undergoing PCI, CABG, C-clamp procedures.
| Item Type: | Thesis (Masters) |
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| Additional Information: | (Reg.No.301410955) |
| Uncontrolled Keywords: | Effectiveness ; selected noetic therapies ; clinical outcome ; patients ; unstable angina ; undergoing percutaneous coronary intervention. |
| Subjects: | NURSING > Medical Surgical Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 06 Nov 2018 18:51 |
| Last Modified: | 06 Nov 2018 18:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/10100 |
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