Basic Informations

C.V

Master Title

PSYCHOLOGICAL ALTERATIONS POST MYOCARDIAL INFARCTION Thesis Submitted for partial fulfillment of the requirement of master degree in psychiatric Nursing By Enteisar Mohamed Abou Salem Clinical demonstrator in Nasr City Insurance Hospital Supervisors Prof Dr. Zeinab Loutfi Prof. of Psychiatric Nursing Dean of Faculty of Nursing Ain Shams University Dr. Nevein Mostafa El-Ashry Lecturer of Psychiatric Nursing Ain Shams University Ain Shams University 2002

Master Abstract

Summary Coronary artery disease is the leading cause of death in the United States, Canada and Egypt among both men and women. Coronary artery diseases are a group of related pathophysiological processes including atherosclerosis, cardiac ischaemia, angina pectoris that result from an insufficient supply of blood to the heart. Because traditional medical risk factors such as hypertension, elevated serum cholesterol, habitual cigarette smoking and obesity have been unable to explain nearly 50% of coronary artery diseases cases, there has been considerable interest in examining the potential influence of psychological factors in the course and outcome of coronary artery diseases. Cardiovascular disease frequently coexists with psychiatric disorders in three ways; the occurrence of two independent illnesses, the development of cardiac disease as a complication of emotional or psychiatric problems and the development of psychiatric disorder as complications of cardiovascular disease. The aim of this study was to answer the following question: What way dose myocardial infarction: Load to the psychological alteration. Affect the patient’s self-esteem and self-concept. Affect the patient’s life style and alteration of his mood towards. Families, work and activities. This study was conducted on 50 patients who were admitted to the out-patients cardiac clinic of Ain Shams University hospital and the out patients cardiac clinic in Nasr City insurance hospital with a diagnosis of myocardial infarction. The sample’s from all available age. From both sex and 50 patients in the same age and sex will be chosen randomly free of cardiac diseases or any chronic illness. The data were collected through the use of the following tools: 1. General Health Questionnaire. a. It consists of 30 questions assessing the presence of psychiatric morbidity. Scores over 7 denotes the presence of psychiatric morbidity subjects who gave a score over 7 were subjected to the following: i. Beck Depression Inventory: using Arabic version. It assesses the intensity of depressive symptoms and measures cognitive affective, somatic and performance related symptoms of depression in a 21 item self-report format. It was carried out as an interview questionnaire this scale take 25 mintes pre- examination of the patient . ii. Taylor Manifest Anxiety Scale: it measures a generalized tendency to experience anxiety in the face of stress or one’s tendency to feel somewhat anxious all the time this scale take another 25 mintes pre- examination of the patient . 2- Interviewing questionnaires to assess the self esteem and self-concept: iii. Tensy manifest self-concept and self-esteem scale it measures self-concept and self esteem during six month period prior to the diagnosis of acute myocardial infarction this scale take 25 mintes post- examination of the patient. The data were collected for a period of 6 months. A pilot study was carried out on a sample of 10% of patients with acute myocardial infarction who were available in out patients cardiac clinic to test the tools. Based on these findings the necessary changes were done. The important findings that were obtained from the study can be summarized as follows: • There was no significant statistical difference between the two groups in any of the other socio-demographic characteristics. • 36% of patients post-myocardial infarction developed mild to moderate depression level compared to only 6% of the control group • From the results of the present study it can be concluded that persons with myocardial infarction experience numerous psychosocial stressors. Anxiety and depression and alteration of self concept and self-esteem are common among myocardial infarction survivors. • According to this result, psychosocial assessment and management should be an integral component of care of patients with myocardial infarction.

PHD Title

Emotional and Physical Rehabilitation Protocol for Patients Undergoing Permanent Cardiac Pacemaker Implantation Entisar Mohammed Mahmud Abu-Salem, Dr. Sorayia Ramadan Abdel El-Fatah, Dr. NamatAllaGomaa Ahmed, Dr. Amal Elias Abdel-Aziz Faculty of Nursing - Ain Shams University

PHD Abstract

Summary C ardiovascular disease is the leading cause of morbidity and mortality worldwide, with economic effects at the levels of both the individual and society. Cardiac pacing is an established treatment for the prevention of asystole, while recently it has been used as an adjunctive therapy in non-bradycardia diseases. Although for almost 45 years, cardiac pacing has offered an improvement in the quality of life and/or prolonged survival in patients with complete heart block, sick sinus syndrome, although, congestive heart failure and ventricular conduction disturbances. Cardiac pacing is associated with a range of unintended negative physical, psychological and social health changes. Patients waiting cardiac pacing can experience physical and psychological stress, including anxiety and depression due to fears, worries about depending on a mechanical device for support and uncertainties about surgery. These symptoms can adversely affect physiological parameters before, after and during procedure, and can result in prolonged recovery from surgery. Emotional and physical rehabilitation as a nursing intervention can reduce anxiety, depression and improve procedure outcomes in various cardiac pacing patients. This study supposed that the rehabilitation protocol will have a positive effect on patients undergoing permanent cardiac pacemaker implantation. The aim of the study was to investigate the effect of emotional and physical rehabilitation protocol for patients undergoing permanent cardiac pacemaker implantation. A quasi-experimental research design was used in this study. All available random patients along 6 months period undergoing permanent cardiac pacemaker implantation at the inpatient and outpatient cardiac clinic, in Nasr City Health Insurance Hospital consisted the target of this study. The number of patients along 6 months period were 70 patients, classified into two groups, study group (35 patients) and control group (35 patients). All patients were subjected to three data collection tools including; 1) Beck Depression Inventory Scale to measure the degree of depression 2) Taylor Manifest Anxiety Scale to measure the degree of anxiety 3) Questionnaire to assess patients’ physical needs. The Statistical Package for Social Sciences (SPSS ver. 11.5) was used for data analysis. The numbers, percentage, mean + SD, T. test, ANOVA &Chi Square tests were used to test the research hypotheses. The main findings of the present study were as follows: Regarding to socio-demographic and medical data results: • There are no statistically significant differences between control and study groups during regarding anxiety. Inconsistent, the present study findings revealed that there are highly statistically significant differences between pre and post tests in both groups regarding post test. • There are no statistically significant differences between the control and study groups during pretest and in the control group between pre and post tests of the patients undergoing permanent cardiac pacemaker implantation regarding depression. Importantly, the depression changed of the patients as the present study findings revealed that there are highly statistically significant differences between pre and post tests in the study group and between both groups regarding post test. • There are no statistically significant differences between the control and study groups during pretest and in the control group between pre and post tests of the patients undergoing permanent cardiac pacemaker implantation regarding assessing the physical needs. However, the present study findings revealed that there are highly statistically significant differences between pre and post tests in the study group and between both groups regarding post test. Rehabilitation protocol intervention comprising an information leaflet and verbal advice was relatively simple to design and administer, and offered substantial gains for patients undergoing permanent cardiac pacemaker implantation. Despite patients increasing demands for emotional rehabilitation, nurses focused on medical tasks and collecting factual information and often failed to address the patients’ fears and emotional issues, especially when those nurses were facing heavy workloads with a limited time. Thus, it is recommended that this area of care should receive attention. The training of nurses is important for delivering emotional and physical rehabilitation which is a key recommendation to be incorporated into routine practice. Liaison psychiatric nurses should have a role in, or responsibility for, giving general information and supporting patients and their families in relation to the reduction of pre and post operative anxiety and depression. Improving emotional and physical needs in the future can be achieved through changing in nurses' attitudes, values, knowledge and skills. Improving also requires time and commitment, as well as support on individual, professional and organizational levels.