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Percutaneous coronary intervention (PCI) with implantation of drug-eluting or bare-metal stents has become one of the most frequently performed therapeutic procedures in medicine. Each year, millions of patients are treated worldwide. The use of drug-eluting stents has been shown to be more effective in the prevention of restenosis than the use of bare-metal stentsand the use of newer-generation drug-eluting stents, as compared with first-generation devices, may also reduce the rate of stent thrombosis. It has been suggested that the benefits associated with the use of newer-generation drug-eluting stents may translate into reduced rates of death and myocardial infarction. Stefanini & Holmes (2013).
Home heath care is that component of acontinum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining or restoring health, or of maximizing the level of independence while minimizing illness Stanhope & Lancaster (2009).
Aim of the study:
This study aimed to evaluate the effect of nursing intervention program at home care to prevent recurrence of cardiac stent.
Aquasi-experimental study design was used to evaluate the effect of nursing intervention at home to prevent recurrence of cardiac stent.
Setting: Study was conducted at outpatient of cardiovascular hospital of Ain Shams University Hospital which include two clinics (heart clinic and heart surgery clinic) the total number of attending cliens during the years 2014 was 670cardiac stent clients with the average daily number of 25 clients daily the cardiac outpatient clinics provide the follow up services to clients :blood pressure measurement ,physical examination by doctor to check on clients condition or to listen to the clients complaint, medication follow up ,blood tests as HDL,LDL ,triglyceride prothorombine time, PT&PTT.
A purposive sample was used in the study. All clients after cardiac stent come to follow up until sample size was achieved.
One hundred and thirty (134) clients have been selected for the study regardless of their age, educational level, and occupation.
Tools of data colletion
Three tools were used for data collection.
First tool: Structured interviewing questionnaire,it was developed to assess clients knowledge and practices (Appendix1): It was composed of 3 parts,part one:socio-demographicdata,part two: Assessclients’ knowledge regarding cardiac stent.Part three:client practice related to behavioral habits, nutrition and physical activities …..etc. (Atlantic Path, 2009).(Appendix 11)
Second tool:Environmental for home assessment (ventilation, cleanleness……..etc). (Appendix 111)
Third tool: Medical records will be checked to collect data about client diagnosis and history background, vital signs, weight, (Appendix V)
The results of the present study could be summarized as follows:
The study sample age ranged between (40-60) with mean age of cardiac stent clients was (53.2+7.0years) old, most of them were married,more than one thirdhadsecondary school and less than one third got faculty degree while less than one tenth were illiterate . More than half of them were working. Regarding to working hours,the majority of themworking 6 hours daily.
Considering family residence, more than two third lived in the city (urban area),
Regarding Smoking and complication of smoking ,more than two third of clients were smoking in preprogram compared to one third in post program .Clients who are exposed to passive smoking represent more than two third compared to more than onepost program.
Consideringphysical exercise practiceless than one third of clients were adherence to physical exercise practicing in preprogram and raised to more than two third post program .
Regarding consumption of diet and fluids more than two third of clients using large amount of fat in diet in preprogram and decreased to one third in post program . As regarding salty diet more than two third were taken large amount of salts preprogram and decreased to one third post program as regarding caffeine consumption /day Two third of clients were drinking tea and coffee daily in preprogramed compared to one third post program.
In relation to stress exposure related to cardiac stent more than two third of clients exposed to stress related to cardiac disease before stent and decline to more than one third in post program in relation to duration of sleep less than one quarter of clients preprogram increase to two third postprogram.
Obesity lead to heart disease preprogram and raised to more than two third post programin relation to factors lead to heart disease one quarter agree preprogram raised to two third post program.
Regarding knowledge about cardiac Stent more than two third of clients know type of cardiac stent preprogram compared to more than three quarter post program less than one quarter know causes of cardiac stent preprogram compared totwo third postprogramone quarer know complication after cardiac stent compared with more than two third post program less than one quarter know problems during cardiac stent insertion preprogram compared with more than half post program.
Regarding knowledge about cardiac stent more than half of client take drugs after cardiac Stent insertionpreprogram compared to more than two third after programless than one quarter know the drug namepreprogram becomeone halfafter the programless than one quarter of clients had side effect from the drug used and become less than one quarterafter the program.
Regarding home environment characteristicsone third had good homelighting less than one third had good ventilation less than one third had good home cleanness and one third had good furniture organization.
Regarding physical measure, highly statistical significance between clients pulse before and after program. And highly statistical significance difference between blood pressure measures before and post program and highly statistical significance difference between bodymass index before and post program.
Regarding medical record (follow up card), highly statistical significance differences between pre&post program in relation to cholesterol and triglyceride measurement.
The findings of this study suggested the following recommendations:
1-Building up a national strategy for home care for enhancement knowledge and help in change lifestyle for cardiac stent clients to prevent recurrence cardiac stent.
2- Continuity of nursing intervention to raise the health awareness and knowledge of family about risk factors for cardiac stent and encourage them to adopt a healthy dieter behavior ,promote physical exercise and smoking session.
3-Raising community awareness through educational campaigns by home care nurse to prevent recurrence of cardiac stent.
4- Providing cardiac outpatient clinics in governmental hospital with rehabilitation centers to follow –up lifestyle promoting for cardiac stent clients.