The Effect of Preparatory Information on Stress Reduction in Patients Undergoing Cardiac Catheterization = 심도자 검사에 관한 사전 간호 정보 제공이 스트레스 감소에 미치는 효과
저자
김금순 (서울대학교 의과대학 간호학과)
발행기관
학술지명
권호사항
발행연도
1991
작성언어
Korean
주제어
KDC
512.8
자료형태
학술저널
수록면
49-79(31쪽)
제공처
Cardiac catheterization, because of its similarity in procedure to that of surgery and due to the fact that a catheter is inserted into the heart during the procedure, causes great anxiety to patients awaiting cardiac catheterization, adding to the psychological stress induced by the procedure itself.
Conventionally when preparing for stress-inducing medical procedures, preparatory information has been provided to patients to reduce stress and to enhance their adaptation to the procedure. However, so far, previous research indicates that effects vary according to the content and type of the information and what methods of conveyance are most effective and to define the important variables influencing the effectiveness of the information.
The research problem was to study the effect of preparatory information provided by a booklet containing structured preparatory sensory information and instruction one day prior to cardiac catheterization on the subject's stress response by measuring their state anxiety, blood cortisor and behavioral responses further, to analyze the correlations that exist among variables such as coping style, trait anxiety and state anxiety. the purpose was to evaluate the benefits, of this nursing intervention for patients undergoing cardiac catheterization.
The theoretical framework for this study borrowed from stress theory considered relevant to the nursing domain(Lazarus and Folkman, 1984 : Scott et al, 1980) and from the theory of nursing intervention of sensory information(Johnson,1972). Within this framework, stress recognition occurs when the discrepancy between experience and expectation, after primary and secondary cognitive appraisal, exceeds the built-in stress-coping resources. As a means to cope with stress, either a problem-focused coping method of emotion-focused coping method is selected. The manifested immediate reaction is an integration of cognitive, emotional, physiological and behavioral responses. Problem-focused coping method is a problem solving process which enhances predictability and control over an unpredictable situation with the aid of structured preparatory sensory information and instruction in a stress situation, therefore contributing to the reduction of stress response. However, a negative effect of the information may manifest itself due to individual differences in coping styles and anxiety level.
Several research questions in this study were addressed. Is structured preparatory sensory information and instruction effective in stress reduction? Are state anxiety, blood cortisol and behavioral responses adequate variables to measure the effect of the information? What are some of the individual characteristics that can influence the effect of the information and is there any negative effect deriving from individual characteristics? Specific objectives for the study were 1) to analyze the effect of structured preparatory sensory information and instruction: 2) to analyze the effect of the differences in coping styles and anxiety levels due to individual characteristics : 3) to define the degree of stress before, during and after catheterization.
The experimental design used in this study was a non-equivalent control group with a pre-post test design : the independent variable was the structured preparatory sensory information and instruction provided to the subjects : the mediating variable were individual characteristics such as coping styles and anxiety level which may influence the outcome and the dependent variables were state anxiety, blood cortisol and behavioral responses.
The subjects were selected among patients scheduled for cardiac catheterization in the internal medicine ward of SNUH during March 2nd to June 30th, 1989. Of the total 90 subjects who fully understood the purpose of theis study and consented to paricipate in the experiment, 44 were assigned to the experimental group and 46 to control group according to the ward to which they were admitted.
For tools for this research, Miller's Monitor & Blunter and Spielberger's Trait Anxiety Scale were used for individual characteristics, and Spielberger's State Anxiety, blood cortisol and behavioral response scale were used for stress response.
The research method was as follows ; Miller's Monitor and Blunter Scale and Spielberger's Trait and State Anxiety Scale were applied and 3cc of blood sample was sampled for cortisol analysis to the all subjects one day prior to cardiac catheterization. The experimental group was provided with a booklet by the researcher in the afternoon of the day before the cardiac catheterization. The booklet contained structured information of the procedure, sensations that the patient would experience, and instructions that would be given during the procedure. The control group was given only basic information necessary for the procedure by other medical staff. On the morning of the procedure, state anxiety was examined, 3cc of blood sampled and subject's behavior observed. After the procedure the state anxiety was tested after the subject returned to the ward.
Concerning data analysis, t-test was used for the effect of preparatory information and the effect of the information according to individual characteristics ; paired t-test was used to measure the differences in stress at various points during the investigation ; reliability of the tools was analyzed using Chronbach's α-model.
1. The effect of the preparatory information
State anxiety prior to the cardiac catheterization was found to be lower in the experimental group than in the control group(p<0.05) ; however, no significant differences were found in blood cortisol and behavioral response between the experimental group and the control group.
For the experimental group, state anxiety was at the highest point the day before the procedure, and blood cortisol at the highest point immediately prior to the procedure ;for the control group, both state anxiety and blood cortisol were at the highest point immediately prior to the procedure. Therefore, this study concluded that preparatory information was effective in reducing the anticipatory anxiety about cardiac catheterization in the subjects and demonstrates that cardiac catheterization does, in fact, induce emotional and physiological stress.
2. The effect of coping styles and level of anxiety.
With regard to coping style, the level of state anxiety of patients adopting a monitor type of conping style was high before information;level of state anxiety and blood cortisol of this group with in the experimental groups dropped significantly(p<0.05), where as patients adopting a blunter coping style showed a low level state anxiety one day prior to the procedure : the level of state anxiety and blood cortisol of this group within the experimental group did not change, displaying little negative effect. The subjects exhibited no significant differences in their behavioral responses depending on the level of trait anxiety irrespective of whether preparatory information was provided or not.
With regard to trait anxiety, the level of state anxiety of the low trait anxiety group was low ; and that state anxiety level decreased in the experimental group(p<0.05). The level of state anxiety of the high trait anxiety group was high on the day before the procedure ; and that state anxiety level did not change within the experimental group, revealing little negative effect. The subjects exhibited no significant differences in their blood cortisol and behavioral response depending on the level of trait anxiety irrespective of whether preparatory information was provided or not.
With regard to state anxiety before information. The level of state anxiety(p<0.05) and behavioral response(p<0.05) of the low state anxiety group within the experimental group decreased significantly where as the level of state anxiety of the high state anxiety group within the experimental group did not change, showing little negative effect. The subjects exhibited no significant difference in blood cortisol of whether preparatory information was provided or not.
3. The correlations among anxiety, blood cortisol and behavioral response.
There were correlations among trait, state anxiety, and behavioral response, cortisols were correlated among themselves, and during the cardiac catheterization cortisol and the behavioral response were highly correlated. However, no significant correlations were found between anxiety and blood cortisol.
Based upon the above findings, this study concludes that structured preparatory sensory information and instruction is effective in reducing the level of state anxiety immediately prior to the procedures, is effective for patients with a monitor type of coping style, low and high trait anxiety and low state anxiety before information. The anticipatory anxiety of the patients was already higher on the day before information that the average score of state anxiety for Korean college students tested in previous studies. The preparatory information proved to be effective in reducing the state anxiety as the cardiac catheterization procedure drew near ; however, it did not help alleviate the state anxiety induced by the cardiac catheterization procedure irself. Therefore this study concludes that nursing interventions to be used simultaneously with structured preparatory information and instruction to reduce state anxiety caused by the procedure itself and to ease the state anxiety of blunter type of coping styles and patients with high state anxiety before information, is indicated.
Cardiac catheterization creates a situation of both emotional and physiological stress. The level of state anxiety and blood cortisol used in this study were valid tools of measurements for stress ; however, since cortisol rseponds not only to cognitive stimulus but also to physical stimulus, more stringent control over the experiment condition is requir
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