Nirmal Kaur, Prem Verma, Rana, Sandip Singh


Abstract : The objective of the study was to assess the effect of planned preoperative teaching on self-care activities for patients undergoing cardiac surgery.

A quasi-experimental design was used based on convenient sampling technique. Total 40 subjects 20 each in the experimental (Group I) and control group (Group II). In each group an equal number of subjects 10 each were included undergoing two types of cardiac surgery i.e. open (Group

  1. & closed (group B) heart A checklist with 40 items was framed to assess the level of performance during preoperative period, before the implementation of teaching on self-care activities and as well as on the 4th and 7th postoperative day. The control group did not receive any preoperative teaching. Data analysis showed that statistically there was no significant (P>0.05) difference of pretest performance scores was found between the two groups. A comparison of posttest performance scores between both groups shows that experimental group had strongly statistically significant (P<0.001) increase in performance of total scores as well as each variable of self-care activities. The findings of the study reflect that the preoperative teaching is an extremely effective media to increase the level of performance and enhance the early recovery of the subjects.

Key words :

Properation case, planned teaching, self care activities

Correspondence at :

Nirmal Kaur

Guru Nanak College of Nursing, Dhahan- Kaleran, Nawanshahr, Punjab.


Each and every organ in the human body is important but the heart is the most vital one as it gives life to the body while pumping blood to the tissues.

When heart does not work efficiently, the individual’s life is threatened. The normally efficient & remarkably durable structure can develop structural defects & functional disturbances and may require surgical intervention to overcome that.

Any type of surgery is a stress to the patient. It becomes even more stressful when the heart-a vital organ is involved. Some of the patients may respond with expression of helplessness, insecurity & isolation due to discomfort, pain & fear of breaking stitches. These feelings can be minimised with the detailed preoperative education.

Education of the patients undergoing cardiac surgery is an impor tant nursing concern to prepare them for self-care before surgery. The patient who is undergoing cardiac surgery requires specific information about postoperative problems, activity progression, nutrition and medication. The operative success of cardiac surgery is limited unless the patient understands and adheres to the prescribed activities, diet, exercise & medical regimen after surgery.

Keeping in view these facts the investigator conducted the study to assess the effectiveness of planned preoperative teaching on self-care activities for patients undergoing cardiac surgery.


  1. To assess the level of performance of the patient on self-care activities from both the experimental as well as control group during preoperative
  2. To implement a planned teaching module to the experimental group
  3. To assess the level of performance on self-care activities from both the groups during postoperative
  1. To compare the pre and post test performance score between both the
  2. To find out the relationship of level of performance on self-care activities of both the groups with selected variables such as: age, sex and education

Materials and Methods

Setting & subjects : A quasi- experimental research approach was adopted. The study was conducted in cardiothoracic unit of Nehru Hospital, PGIMER, Chandigarh. The sample consisted of all eligible patients who were admitted for elective cardiac surgery (opens as well as closed) during the month of January & February 1998. Criteria for eligibility in the study were patients who were above the age of 15 years, who could converse in Hindi & English and who were free from any other medical illness/ infection pertaining to other systems. Patient who died within first seven postoperative days & who remained on endotrachial intubation / mechanical ventilation for more than three days was excluded. The sample consisted of 40 subjects, 20 subjects each in the experimental (group I) & control group (group II). In each group an equal number of subjects 10 each were included undergoing two type of cardiac surgery i.e. open (group A) & closed (group B) heart surgery.

Treatment : A teaching module on self- care activities was developed for the purpose of this study. This was developed after an exhaustive review of literature & opinion of experts in this field & also by the investigator’s personal observation. It included ten variables such as: self-care activities related to breathing exercises (coughing, deep breathing & incentive spirometry), turning positioning, extremities exercises, ambulation, eating drinking, elimination, wound care, personal hygiene chore (sponging, brushing combing & dressing), self-care measures for coping with pain, rest & sleep. The patients undergoing cardiac surgery were taught two days before surgery by using of this module as well as with various teaching aids & demonstration that could reinforce teaching. No such teaching module was prepared for control group.

Instruments : An interview schedule was developed for the collection of socio- demographic data. To systematically assess the efficacy of the planned preoperative teaching programme, a check list with 40 items related to ten variables (self-care activities) in the above mentioned teaching module were designed. Each item of the checklist for performance level was scored for correct response. A score one was given to the correct response and zero to the incorrect. The total score range was 0-40. It was reviewed for content validity by the experts in this field. Test-retest (r=0.99) and split-half (r=0.93) reliability was determined. It was found to be highly significant.

Procedure : Purposive convenient sampling technique was used. The experimental group was studied first and control group later in order to minimize the direct effect of teaching on the control group. Ethical aspects of the research were considered throughout the study. Two days

before surgery the investigator visited all the patients posted for surgery, obtained a formal consent and asked patients to provide demographic data.


Pretest : Pretest level of performance was assessed using checklist. It was helpful to obtain the baseline information by asking patient to demonstrate deep breathing, coughing, leg & arm exercises, getting out of bed, personal hygiene chores, eating, rest & sleep.

Intervention : After pretest perform- ance assessment all the 20 subjects (10 subjects for open and 10 for closed heart surgery) in the experimental group were given planned preoperative teaching on self-care activities. The investigator instructed the patients until all activities were done correctly, which took about 50-55 minutes.

Posttest : Same checklist was used for observing posttest performance of both the groups. Non-par ticipatory observation technique was adopted to collect the data. The specific self- care performance was observed between 7a.m. to 2.30 p.m. on 4th & 7th postoperative day.


Socio-demographic characteristics of study subjects. The information is summarized in table 1. There was no difference of statistical significance between the groups indicating that the purposive convenience process permits the assembling of two equivalent groups.

Table 1: Socio-demographic characteristics of study subjects between both the groups


Sr. .


Particulars                Experimental           Control             Total (N=40)                  group I (N=20)     group II (N=20)                            (N=40)
1 Sex
Male 10 10 20
Female 10 10 20
2 Age
16-35 years 10 14 24
36-55 years 08 06 14
56 & above 01 01 02
3 Education
Upto Middle 12 14 26
Upto Graduation 08 16 14
4 Occupation
Housewife/unemployed 12 12 24
Unskilled 06 05 11
Skilled 01 02 03
Professional 01 01 02
5 Marital Status
Married 16 15 31
Unmarried 04 05 09
6 Dietary Habits
Vegetarian 05 09 14
Non-Vegetarian 15 11 26


The results showed that the level of performance of subjects about self-care activities before the teaching was satisfactory.Some of them showed good and very few unsatisfactory level of performance.During Ist and IInd posttest, the experimental group subjects showed excellent level of performance but control group showed unsatisfactory performance except very few who showed satisfactory level of performance in Ist posttest. During IInd posttest, most of the subjects showed satisfactory or unsatisfactory, while very few showed good level of performance.

Results of the present study revealed that there was no significant difference in the performance scores of both the groups during pretest. All interaction effects were also non significant.

During Ist and IInd posttest, there was statistically significant difference found in the experimental group in performance scores of total as well as each variable of self-care activities as compared to the control group except that of eating /drinking (Ist and IInd posttest) positioning (IInd posttest and elimination (IInd post test group IB and group IIB) (Table-2).

Table – 2 : Comparison of the posttest performance scores between both the groups


Variables Test P-Value Direction
Total score of self-care activities ‘t’ <0.001 E>C
Breathing exercises ‘t’ <0.001 E>C
Positioning ‘t’ <0.001 (Ist posttest)

N.S. (IInd posttest)

Extremities exercises ‘t’ <0.001 E>C
Ambulation ‘t’ <0.001 E>C
Eating/drinking ‘t’ N.S.  
Elimination ‘t’ <0.001 N.S.

(IInd posttest in group IB & IIB)

Wound Care ‘t’ <0.001 E>C
Personal hygiene ‘t’ <0.001 E>C
Self-care measures for coping with pain ‘t’ <0.001 E>C
Rest & Sleep ‘t’ <0.001 E>C


N.S.- Non-satisfactory E – Experimental (Group I)
Ist- 4th postoperative day performance C – Control (Group)
IInd – 7th postoperative day performance B – Closed heart surgery


The major findings of the study revealed that statistically there was no significant relationship between the performance of the subjects & demographic variables such as age, sex, & education.

A study conducted by Lamb5 reported that age was unrelated with knowledge or performance gain. He further indicated that teaching on cardiac catheterization was equally effective regardless of subjects’ level of education.

A non significant difference of pretest performance scores was found between the two groups (P>0.05) when analysed by analysis of variance. All interaction effects were also non significant. The net change in scores in each group was also not different when analysed by unpaired ‘t’test. This indicated that both the groups were showing same performance before the implementation of planned preoperative teaching on self-care activities.

Finding of the present study show that there was statistically significant difference (P<0.001) between posttest performance scores of experimental (groupI) and control (groupII) when analysed by analysis of variance as well as unpaired ‘t’ test.

This indicates that planned preoperative teaching regarding self-care activities was effective in increasing the total performance scores of experimental group.

The findings reported by Wong & Wong and Rice VH et al6 in studies to assess the effect of preoperative teaching on patient compliance and postoperative exercises were similar to the findings of the present study. These studies have reported that there was a statistically significant (P<0.001) increase in the patients’ performance of the postoperative activities after preoperative teaching and patients who received preoperative teaching were found to be more satisfied than the patients who did not.

The pretest and posttest performance scores of different variables were also compared separately by using unpaired’t’ test between both the groups. Unpaired ‘t’ test reflected that there was a highly significant difference (P<0.001) between posttest performance scores against each variable of self- care activities of the experimental and control groups except in that of eating/ drinking (in both the posttest), positioning IInd posttest and elimination (IInd posttest in Group IB and GroupIIB). This indicated that subjects of control group may have unsystematic information regarding eating/ drinking, positioning and elimination because of more emphasizes by hospital staff and relatives.

It can, therefore, be concluded that the planned preoperative teaching regarding self- care activities did increase the performance of postoperative self-care activities of the experimental group not only in the total score, but also in each component of self-care activities.


The findings of the study reflect that the preoperative teaching is an extremely effective media to increase the level of performance of the subjects as information about self-care activities is a pre-requisite to compliance. It also strengthens the self-care abilities and leads to uneventful postoperative recovery.

The concept of self-care education in the management of health has gained increasing popularity as hospital costs have risen dramatically. Therefore the role of the nurse as a patient educator is of key importance. It is hoped that the findings will stimulate interest among nurses in the existing patient teaching programmes and in developing new plan for promoting patient adherence to prescribed activities.


Based on the findings, the following implications have been drawn which are of vital concern for the field of nursing practices, administration, education and research:

  1. There should be an established system of imparting planned preoperative instructions by the nurses/doctors to all patients posted for cardiac
  2. The nurses posted in the cardiothoracic unit should be trained through in- service education to posses the required knowledge, skill and attitude on preoperative teaching on self-care
  3. Opportunity should be given to the patients and their relatives to clear doubts and misconceptions regarding postoperative activities.
  1. Planned preoperative teaching on self – care activities should be made available to the patients and their families to improve their compliance and self-care abilities with active
  2. A follow-up study needs to be designed to assess the effect of patients’ compliance on self-care activities during the post-hospital


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