A STUDY TO ASSESS THE EFFECTIVENESS OF TRANSITIONAL CARE NURSING PACKAGE ON HEALTH RELATED QUALITY OF LIFE AMONG CLIENTS WITH CORONARY ARTERY DISEASE

1. Ph.D Scholar, Meenakshi Academy of Higher Education and Research, Chennai. 2. Guide – Principal,Annai Veilankanni College of Nursing , Chennai. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 July 2020 Final Accepted: 14 August 2020 Published: September 2020


ISSN: 2320-5407
Int. J. Adv. Res. 8(09), 531-538 532 Introduction:-Coronary artery disease is the leading cause of death in developed and developing countries accounting for over 40% of CVD deaths and 15% of all deaths in the world (WHO, 2017). India is experiencing epidemiologic transition with sharp increase in coronary artery disease which is alarmingly high leading to the most common cause of premature mortality in 2016. There is a growing burden of coronary risk factors owing to rapid urbanization and changes in lifestyle, including diabetes mellitus (DM), hypertension, dyslipidemia, smoking, alcohol consumption, dietary patterns, central obesity, physical inactivity and psychological factors. These risk factors attribute 90% of CAD in population.
In addition to mortality, CAD is also responsible for morbidity and loss of quality of life (QOL). CAD has significant physical, emotional, and social impact for patients; so, evaluating their QOL is necessary for assessing the success of treatment and it may be used for modifying or improving the treatment given, or for providing treatment alternatives. Recovering from a cardiac event is a complex procedure that presents psychological and physical needs that continue after discharge from hospital. As the patient becomes anxious, scared, and depressed it has a significant impact on patient quality of life (QOL). These emotional complications can limit the patient's activities of daily living, work performance, and relationships. The transition from hospital to home or other care settings can be a challenging and confusing journey for patients and their families that is fought with challenges. Preventing avoidable readmission has the potential to profoundly improve both QOL for patients and the financial wellbeing of health care system.
Thus, an improvement in health-related quality of life (HRQOL) is considered to be important as a primary outcome and in the determination of therapeutic benefits of CAD patients by adapting positive health behavior. The nurse-led transitional care programme is helpful for coronary artery disease patients to supporting their effective transfer from hospital to community after a cardiac event by enhancing patients' knowledge of their illness and awareness of behavioral changes to prevent a new event or readmission to hospital thereby improve quality of life. Masoumeh Akbari, Sevilay Senol Celik (2020) study aimed to investigate the effects of discharge training and post discharge counseling on QOL after CABG sample of 100 patients who underwent CABG surgery. Six weeks after hospital discharge, the mean score of QOL in the intervention group was significantly greater than the control group (93.19 ± 4.45 vs. 47.00 ± 13.43; P < 0.001). A study showed that discharge training was effective in alleviating post discharge problems and improving patient outcomes such as health related knowledge and self-care ability. Objectives:-

Materials and Methods:-
Quantitative evaluative approach was used. A quasi-experimental design was chosen for this study. Sample of 290 coronary artery disease clients (study group-146, control group -144) were selected by using non probability convenience sampling technique.

Data collection procedure:-
After obtaining the formal permission from the head of the institution the investigator introduced self to the samples and explained the purpose of the study. Written informed consent was obtained and demographic variables was assessed followed by pre-test level of HRQOL was assessed by SF-36 Health survey questionnaire. Transitional care nursing package was administered to study group and the samples were encouraged to follow the recommended instructions on regular basis and to maintain the dairy of events. Post test was conducted at the end of 4 weeks, 12 weeks & 24 weeks. Reinforcement of transitional care nursing package and individual need based guidance was given as required after each post test. Similarly the pre test and post test data was collected from the samples in the control group except the administration of transitional care nursing package. The researcher maintained confidentiality throughout the study. The data collection was completed from all samples & data was prepared and analyzed.

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Results And Discussion:-Description of sample characteristics: Table 1 shows that the description of demographic variables in study and control group. In both the group majority of the clients 71.9% in study group & 65.3% in control group were in the age group 51 to 60 years. In the study group 74% were male, 32.9% had elementary school education and 80.8% were married whereas in control group 65.3% were male 38.9% had elementary school education and 79.2% were married. In both the groups majority of them belongs to Hindu religion and living in nuclear family.
In the aspect of family history of hypertension 29.5% in study group and 28.5% in control group had family history of hypertension with the degree of relationship as paternal. For diabetes mellitus 20.5% in study group and 16.7% had family history of diabetes mellitus with the degree of relationship as maternal. Only 13.7% in study group and 11.8% in control group had family history of coronary artery disease with the degree of relationship as paternal.
With regard to history of diabetes mellitus 43.2% in study group and 45.8% in control group had history of diabetes mellitus with chronicity as more than 10 years in both groups. In view of hypertension majority of them 88.4% in study group and 91% in control group had significant history of hypertension with 7 to 10 years as chronicity of disease. The above figure shows the comparison of mean and standard deviation of pre test and post test scores related to level of HRQOL among study and control groups. Results proved that there was a significant difference found between the pre test and post test level of HRQOL among study group at p<0.001. There was no significant difference found within control group.

Assessment of Pre-test post &-test level of HRQOL among study and control group
Effectiveness of Transitional care nursing package on HRQOL gain score within the study group and control group. Table 3 revealed the findings of the study that the pretest mean score of the study group was 351.12 and that of control group was 348.51 and it showed that before implementing transitional care package both of the group were having equal level of HRQOL. The post test mean score of experimental group was 506.84 and that of control group was 359.12 with the mean difference among the study group was 155.71 but in control group it was about 10.61. Hence the transitional care nursing package was effective in promoting the level of HRQOL.
Association between HRQOL of clients with coronary artery disease and demographic variables among study group. Table 4 describes the association between the level of HRQOL and demographic variables among study group. There was a significant association found with the selected demographic variables such as age, gender, education , family history of diabetes mellitus , history of diabetes mellitus at p<0.05 level and income at p<0.01 level.

Conclusion:-
The study findings demonstrates that the transition care nursing package was very effective in improving the HRQOL for CAD clients before getting discharge from the hospital. The pretest and post test level of HRQOL were compared by paired t test which showed highly significant at p<0.001 level and the gained score was 19.46% in study group whereas in control group there was no significant difference between pre test and post test level. Nurses play a vital role in treatment as they are close to the patients and their families during all the process of hospitalization.