الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Home –based- nursing guidelines after coronary artery bypass graft
surgery promotes cardiac rehabilitation and that are focused on risk factor
modifications, adequate exercise training, and coping strategies are
effective measures to reduce recurrent events. For most patients, heart
surgery is a life-saving procedure but also a major source of emotional
stress and financial burden (Heran , 2011).
Knowledge are an important method for all patients with cardiac
diseases to improve their health status and prevent complication
retaliated surgery and classified into actual knowledge positive or definite,
personal knowledge based on one’s own observation, and constructive
knowledge based on other circumstances (Temple, 2010).
Daily Living Activities (DALs) are defined as” set of activities
necessary for normal self-care. For those patients with cardiac disease.
The activities include movement in bed, transfers, locomotion, dressing,
personal hygiene, and feeding pattern. Health care providers are under
constant pressure to discharge patients quickly, but it is essential that
nurses engage early in adequate, individualized, and in-depth discharge
planning, that increasing the odds for successful recovery (West, 2012).Aim of this study:
The study aimed to assess the effectiveness of home based nursing
intervention on knowledge, daily living activities and pain for patients
after coronary artery bypass graft.
Research design:
A Quasi Experimental research design (case & control) design was
used to achieve the aim of the study.Research setting:
The present study was conducted in the out- patient clinics of Mahalla
Cardiac Center, Mahalla city, Al-Gharbia Governorate, Egypt. This is
follow (Specialized Medical Centers). This setting was selected as it is
considered the biggest and most specialized cardiology center in Al-
Gharbia governorate, Egypt.
Research sample:
A purposive sample of 140 post-coronary artery graft surgery
patients’ who were willing to participate and complete the study were
included. These patients were divided randomly into two groups.
according to their weight and education. A Study group composed of 70
patients who received home based nursing intervention (HBNI) while
control group composed of 70 patients and received the routine follow up
care.
The following power analysis equation was used to indicate the
study sample size. Prior data indicated that the prevalence of knowledge
among control group was 30 %. If the true knowledge rate for intervention
subjects was 60%, the study needed 70 experimental subjects and 70
control subject to be able to reject the null hypothesis that the knowledge
rate for experimental and control subjects were equal with probability
power 0.9. The Type 1 error probability associated with this test of this
null hypothesis was 0.05. The researcher used an uncorrected chi-squared
statistic to evaluate this null hypothesis.
Assumptions
Alpha = 0.05
Power = o.9
Knowledge prevalence among control group = 30% .Knowledge prevalence among the intervention group = 60% .
Ration of cases to controls = 1 .1
Case sample size for uncorrectrd chi- squared teset = 70 .
So total sample size was 140
The evacuation was :
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Inclusion criteria:
Patient immediately discharged from the hospital after coronary
artery bypass grafting (CABG). (the first visit hospital out-
patient follow up post surgery)
Both sexes.
Patients who more than 30 years.
Exclusion criteria:
Patient with other cardiac surgery such as valve replacement or
congenital heart diseases.
Study Tools:
The following tools were used:-
Tool I: A structured Interviewing questionnaire:
This questionnaire was designed and used by the researcher after an
extensive review of literature and discussion with the experts to collect
data about the subjects. It included the following three parts:-
Part one: Socio- demographic data such as name, age, sex, marital status
occupation, address, level of education and monthly
income.......etc.Part two: Medical data: which included patient information about present
and past history as frequency of hospital admission and regular
follow up of surgery from patients/ or ICU report..........
Tool II: Knowledge assessment questionnaire: which included
knowledge about nature of the operation, factors leading to
coronary artery disease, wound & skin care, and complications
among the study and control groups .........etc. It was used for
pre-post- test.
Tool III: Barthel Index Scale (BIS):
This scale was developed by Barthel Collin et al., (1988). It
measures a person’s daily functioning specifically the activities of daily
living and mobility. It consisted of 10 items assessing the ability to
achieve certain activities without assistance. It evaluates the ability of
feeding, moving from wheelchair to bed and returning, doing personal
toilet, getting on and off toilet, bathing self, walking on level surface,
ascending and descending stairs, dressing, controlling bowels and
controlling bladder. The scale Scoring ranges from 0 (completely
dependent) to 100 (completely independent) with intervals of 5
alternatives (00 – 20 was total dependence - 21 – 60 was Severe
Dependence - 61 – 90 was Moderate Dependence - 91 – 99 was Slight
Dependence - - 100 was Independence. This tool was used for pre-post-
test.
Tool IIII: Visual analogue Scale (VAS)
This scale was developed by Wewers & Lowe, (1990). It was a pain
measurement tool that measures characteristics and attitudes that are
believed to range a cross a continuum of values that cannot easily be
directly measured. It is a rating scale starting from 0-100. The score of 0-30 reflects mild pain. 40-60 reflects moderate pain, finally 70-100 reflects
sever pain.
There were data included about description of the pain, nature of
the pain, when the pain starts and when the pain ends, and site of the pain.
These data were collected from the patients after discharge from the
hospital post surgery. It was used for pre- post- test.
The study concluded that:
Home based nursing intervention had an effective in knowledge,
pain and daily living activities among study patients and control patients
after coronary artery bypass graft surgery.
Recommendation
Based on the results of the present study, the following
recommendation are proposed:
The rehabilitation program has to start at the preoperative phase
of patient care to reduce the risk of a new cardiac event
1. The home based nursing intervention has to be started at the
preoperative phase of patient care to reduce the risk of a new
cardiac event
2. There is a need for more home based nursing interventions for
cardiac patients to raise the awareness about common risk
factors, healthy life styles and complications reduction
modalities for coronary artery diseases.
3. A great importance for nurses to meet the home based nursing
intervention m care needs of cardiac patients through in-
service training education, support close supervision.
4. A further nursing studies are needed to cover area of cardiac
rehabilitation and coronary heart diseases.