Background of the Study
The heart contracts rhythmically and with every contraction pumps blood into the blood vessels. The primary function of the cardio vascular system is to provide an adequate supply of blood to all cells of the body, the materials needed for their proper function and that carries away the waste products of their metabolism.1
Healthy heart can meet the needs of the entire human body and stressful conditions. When the heart does not work efficiently that persons life may be threatened. For proper pumping of the heart, cardiac muscle needs adequate blood supply through the coronary arteries. When the coronary artery is unable to supply adequate blood to the myocardium due to the narrowing or blockage, the myocardium becomes ischemic and injured may result in infarction.2
It is widely acknowledged that heart disease and stroke are the leading cause of death and disability in the developing countries. We are in the midst of a true global cardiovascular disease epidemic. Cardio vascular disease is responsible for approximately 30% of all deaths worldwide every year. Coronary artery disease is the most common type of cardio vascular disease and accounts for the majority of these deaths.3 Coronary artery disease results from the development of obliterate atherosclerotic lesions within the coronary arteries that narrow or obstruct these vessels.4
Two decades ago coronary artery disease was traditionally associated with advanced age, this association does not seem to hold true any longer and today age is no bar for heart problems. Many young men in their thirties found to have angina and even become victims of a heart attack.5
Need for the Study
Disease can occur in all organs of our body and one of the vital organ heart can also be affected by various disease. One of the important diseases which affect the heart is coronary artery disease. An Individual with cardiac illness will be disturbed physically and mentally. Majority of the patients with coronary artery disease feel a threat to their identity and self esteem and may be unable to fill their usual roles in society. Coronary artery disease can be treated with various treatments such as medications, percutaneous transluminal interventions and coronary artery bypass graft surgery.6
During the hospital stay the health care provider mainly focus on the patients physiological changes and after the discharge also the medical team mainly concentrate on the functional assessment of cardiac system. The psychological wellbeing is still a non focused aspect in hospital services. Physical and mental health is considered as both the sides of the coin, one without another is of no value. So the investigator desired to enlighten the importance of psychological support by nurses in reducing post operative anxiety and improvement in activities of daily living.7
Also, the literature review revealed that only few studies have been done regarding the psychosocial problems and studies that are focused on health related quality of life among patients who had undergone coronary artery bypass graft. The investigator has felt that a study would help the nursing practitioner to understand and provide the necessary information for promoting the emotional well being and improve their quality of life.8
Statement of the Problem
A study to assess the quality of life of patients with coronary artery disease before and after the Coronary Artery Bypass Graft in a selected hospital at Sahdol M.P.
Objectives of the Study
To assess and compare the level of quality of life of patients with coronary artery disease in different aspects of Physical, Psychological and Social well being before and after the surgery.
To assess and compare the level of overall quality of life in Physical, Psychological and Social wellbeing and Overall quality of life before and after the surgery.
To associate the selected demographic data with the level of quality of life of patients in Physical, Psychological and Social well being before and after the surgery.
Hypothesis
HO1 .There is no significant difference in the quality of life score in Physical well being (personal, household, outdoor & other activities) before and after surgery
H02. There is no significant difference in the quality of life score in Psychological well being (positive feeling about self, positive feeling about health & interest) before and after surgery
H03 There is no significant difference in the quality of life score in Social well being (Interaction with family, interaction with friends & Spiritual activities) before and after surgery.
H04 There is no significant difference in the total score of quality of life in Physical Psychological, Social wellbeing and Overall quality of life before and after surgery
Assumption
Individual differs in meeting needs of physical, psychological and social well being.
Aim of the surgery is to improve the quality of life.
Individual experience will vary after the surgery.
Quality of life may be influenced by various factors such as family support, social support and information regarding the disease condition.
Materials and Methods
Research approach
This study adopted a non experimental descriptive and comparative survey approach.
Setting of the study
The study was conducted at the cardio thoracic surgical out patient department of one of the selected hospital at Sahdol.
Population
The population comprised of all patients with coronary artery bypass graft attending the cardio thoracic surgical outpatient department of the selected hospital at Sahdol at the time of the study.
Sample size
The sample consisted of 75 patients with coronary artery bypass graft based on the criteria for sample selection.
Sampling technique
Non probability convenient sampling technique was adopted for the selection of sample.
Pilot study
A pilot study was conducted in a hospital in Sahdol. A formal permission was obtained from the Medical Supritendent and Cardiac Surgeon for pilot study and main study.
Ten patients came to the outpatient department for review, who met the inclusion criteria were selected for data collection. After a self introduction the samples were made to sit comfortably in the interview room. The investigator explained the purpose of the study to the samples individually and after obtaining their rapport and willingness, the data was collected using the questionnaire and rating scale. The duration of pilot study was one week.
The result of the pilot study showed that the tool and the technique adopted were adequate.
Table 1
Demographic characteristics of the sample frequency and percentage distribution of samples according to personal characteristics N = 75
Table 2
Frequency and percentage distribution of samples according to surgery and medication N= 75
Table 3
Frequency and percentage distribution of sample in different aspects of physical well being, in two levels of quality of life before and after surgery N = 75
Result
CAD – coronary artery disease
Frequency and percentage distribution of sample with regard to different aspects of physical well being, in two levels of quality of life before and after surgery.
All the samples (100%) were able to carryout personal activities such as taking bath, dressing, combing the hair, eating, shaving and moving in and out of bed or chair very well before and after surgery. 64 samples (85.3%) were able to carry out the household activities such as cooking, washing the cloth, sweeping, grinding, ironing, gardening, minor repairing work at home moderately well and 11(14.7%) were able to perform these activities very well before surgery. However after the surgery the percentage of samples who performed the household activities very well increased by 5.3%. 74 samples (98.7%) were able to perform outdoor activities such as going to bank, family shopping and going to places of worship before surgery. However after the surgery those who were able to perform the outdoor activities very well reduced by 9.4%. Other activities such as walking more than a mile, traveling by bus, climbing the flight of stairs, running and lifting heavy objects were moderately performed by 38.7% and very well by 61.3% before surgery but after surgery the number of sample who could do, these activities very well increased from 46 to 61, an increase of 20%.
From this table it could be concluded that all samples were very good at performing the personal activities before and after surgery. Ability to perform the household and other activities slightly improved after surgery. However no further improvement was seen in outdoor activities after surgery. As far as the quality of physical well being is concerned the sample shows a moderate to good quality of life after surgery.
Table 4
Frequency and percentage distribution of sample in different aspects of psycological well being in two levels of quality of life before and after surgery. N = 75
Table 5
Frequency and percentage distribution of sample in different aspects of social well being in two levels of quality of life before and after surgery. N = 75
Table 6
Frequency and percentage distribution of samples in the three areas of overall well being before and after surgery in two levels quality of life n = 75
Table 7
Frequency and percentage distribution of samples in two levels of overall quality of life before and after surgery n = 75
|
S.No |
Area |
Level of Quality of life |
|||||||||
|
Moderate |
Good |
Moderate |
Good |
||||||||
|
Before Surgery |
After Surgery |
||||||||||
|
1 |
Overall Quality of life |
F |
% |
F |
% |
F |
% |
F |
% |
||
|
1 |
1.3 |
74 |
98.7 |
8 |
10.7 |
67 |
89.3 |
||||
Table 8
Mean score and standard deviation of various aspects of physical well being before and after surgey and its significance.
Table 9
Mean score and standard deviation of various aspects of pyschological well being before and after surgery and its significance.
Table 10
Association between demographic variables and quality of life in physical well being before surgery N=7
Table 11
Association between demographic variables and physical well being after surgery N=75
Table 12
Association between demographic variables and psychological well being after surgery N=75
Table 13
Association between demographic variables and social well being after surgery n=75
Presents frequency and percentage distribution of sample with regard to different aspects of psychological well being in two levels of quality of life before and after surgery. Majority of the samples 74(98.7%) had good positive feeling about self such as feeling of independency, no feeling of loneliness and helplessness, no feeling of nervousness, anxiety and guilt and had confidence to do work alone. 73 samples (97.3%) had good positive feeling about health such as not worrying about health, had good sleep and took responsibility in family before surgery.
However after surgery there was a reduction in the number of samples (9.4%) in positive feeling about self and 31.4% in positive feeling about health. Before surgery 59 samples (78.7%) showed good interest in reading newspaper and watching TV. However after surgery this number reduced to 51, a reduction of 10.7%.
This table concludes that majority of the samples (78.7 – 98.7%) expressed good psychological well being before surgery. However after surgery the percentage of sample that expressed good psychological well being ranged from 66.7% - 89.3%, a reduction of 10.7% to 33.3%.
On the whole the feeling of good psychological well being is seen more before surgery than after surgery. Frequency and percentage distribution of sample in different aspects of social well being in two levels of quality of life before and after surgery.
Majority of the samples 71 (94.7%) showed good interaction with family such as attending family function and visiting relatives before surgery. However after surgery majority of the samples 72(96%) had only moderate interaction with family.
Majority of the samples 63 (84%) had good interaction with friends such as talking with friends and taking part in group gathering before surgery. But after surgery the number reduced to 23 a reduction of 54% in interaction with friends. 71 samples (94.7%) had good involvement in spiritual activities before surgery. However after surgery the number of samples involvement in spiritual activities reduced to 26, a reduction of 60%.
This table concludes that majority of the samples (84-94.7%) had good social well being before surgery. However after surgery the samples showed moderate quality of life in social wellbeing.
The frequency and percentage distribution of samples in three areas of over all well being before and after surgery in two levels quality of life. For majority of the samples 60 (80%) the quality of physical well being was good and for 15 (20%) the quality of physical well being was moderate before and after surgery.
All the samples (100%) had good quality of psychological well being before surgery, but after surgery the number of sample reduced to 68, a reduction of 7 samples ( 9.33%) to moderate quality of psychological well being.
All the samples (100%) had good quality of social well being before surgery but after surgery the number of sample reduced to 27, a reduction of 48 (64%) to moderate quality of social well being.
This table concludes that the overall quality of physical wellbeing was moderate to good before and after surgery. The quality of the psychological and social. Wellbeing was good before surgery for all patients. However after surgery there was a slight reduction in the number of patients who had quality of psychological well being and a great reduction in the quality of social well being.
Highlights the percentage of level of quality of life in physical, psychological and social well being. Presents the frequency and percentage distribution of samples in two levels of overall quality of life before and after surgery.
Majority of the samples 74(98.7%) had good quality of life before surgery. However after surgery the number of samples in good quality of life reduced to 67, a reduction of 10.7%. From this table it could be concluded that patients with coronary heart diseases experienced good quality of life before surgery. But after surgery while majority of patients 67(89.3%) experienced good quality of life,8 patients(10.7%) experienced only a moderate quality of life. .
Highlights the percentage of overall quality of life before and after surgery. The mean score and standard deviation of different aspects of physical well being before and after surgery and its significance.
Personal and outdoor activities scored very high mean score of 96.15 and 98.96% respectively before surgery. Other activities scored a mean score of 72% household activities comparatively scored a low mean score of 42.78% before surgery.
After surgery the mean score of all the physical activities ranged from 46.72% to 96%,the highest score in personal activities and the lowest score in household activities.
Statistically there was no significant difference between the mean score of personal and household activities ( t-0.239 and 0.054,df=74,p<0.0 ) before and after surgery and there was significant difference between the mean score of outdoor and other activities (t-3.17and3.8,df=74,p<0.01 ) before and after surgery. So the hypothesis Ho1(Pg- ) “There is no significant difference in the quality of life score in physical well being (personal ,household ,outdoor and other activities) before and after surgery” was accepted with regard to personal and household activities and rejected with regard to outdoor and other activities.
Outdoor activities were performed better before surgery than after surgery. Other activities were performed better after surgery than before surgery. The association between demographic variables and physical wellbeing after surgery.
The table shows that there is an association between occupation and physical wellbeing after surgery. Those who belonged to other categories of occupation(Labourers, Officeworkers, Business) had good quality of life than professionals and unemployed.
There is no association between age, income, duration after surgery and physical wellbeing after surgery. Presents the association between demographic variables and psychological wellbeing after surgery.
The table shows that there is no association between age, occupation and income, duration after surgery and psychological well being after surgery. Presents association between demographic variables and social well being after surgery. The table shows that there is no association between age, occupation and income, duration after surgery and social well being after surgery
