A STUDY TO ASSESS THE KNOWLEDGE OF

HOMECARE MANAGEMENT OF PERMANENT

PACEMAKER IMPLANTED PATIENTS IN

SCTIMST, TRIVANDRUM.

PROJECT REPORT

Submitted in partial fulfillment of the requirements for the

Diploma in Cardiovascular and Thoracic Nursing

Submitted by

SREELEKSHMI V

Code No: 6203

SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES

AND TECHNOLOGY, TRIV ANDRUM

November 2011

CERTIFICATE FROM SUPERVISORY GUIDE

This is to certify that Mrs. Sreelekshmi V has completed the project work on "A

STUDY TO ASSESS THE KNOWLEDGE OF HOMECARE MANAGEMENT

OF PERMANENT PACEMAKER IMPLANTED PATIENTS" in SCTIMST,

Trivandrum under my direct supervision for the partial fulfillment for the

Diploma in cardiovascular and thoracic nursing in the university of SREE

CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND

TECHNOLOGY TRIV AND RUM. It is also certified that no part of this report

has been included in any other thesis for procuring any other degree by the

candidate. .~ ~-

Trivandruin,

November 2011.

ii

DR. SARAMMA. P. P, MN, PhD

SENIOR LECTURER IN NURSING

SCTIMST, TRIV ANDRUM

iii

CERTIFICATE FROM THE CANDIDATE

This is to certify that the project on “A study to assess the knowledge

of homecare management of permanent pacemaker implanted patients in

SCTIMST, Trivandrum" is a genuine work done by me, under the guidance of

Dr. Saramma P.P, PhD, Senior Lecturer in Nursing, SCTIMST, Trivandrum. It is

also certified that this work has not been presented previously to any other

University for award of degree, diploma or other recognition.

Sreelekshmi. V

Code No:6203

SCTIMST,

Trivandrum

Trivandrum,

November 2011.

iv

APPROVAL SHEET

This is to certify that Mrs. Sreelekshmi. V bearing code no: 6203 has been

admitted to the Diploma in Cardiovascular and Thoracic nursing, in January

2011 and she has undertaken the project entitled, " A STUDY TO ASSESS THE

KNOWLEDGE OF HOMECARE MANAGEMENT OF PERMANENT

PACEMAKER IMPLANTED PATIENTS”, which is approved for the Diploma

in Cardiovascular and Thoracic nursing, awarded by the Sree Chitra Tirunal

Institute for Medical Sciences and Technology, Trivandrum, and is found

satisfactory.

Place:

Date:

Examiners

(1)__________________

(2) __________________

Guide

(1) __________________

(2) __________________

v

ACKNOWLEDGEMENT

First of all let me thank God Almighty, who accompanied and directed me to

achieve success throughout this study.

The present study has been completed under the expert guidance of

Dr.Saramma.P.P, Senior Lecturer in nursing, SCTIMST, Trivandrum. I express

my sincere gratitude to Dr. Saramma P. P, for the valuable guidance, constant

support and encouragement given for the completion of the study.

I express my sincere thanks to Dr. J M Tharakan, professor and HOD of

cardiology, SCTIMST, Trivandrum, for giving this opportunity for conducting

this study.

I would like to acknowledge the contribution of all the participants who kindly

agreed to take part in the study. They generously gave their time and attention to

the research. This study would have been impossible without their generosity.

Special thanks to computer division and library staff of SCTIMST for granting

permission to utilize computer and library.

Sreelekshmi. V.

Trivandrum,

November 2011.

vi

ABSTRACT

TOPIC: A study to assess the knowledge of homecare management of patients

undergoing permanent pacemaker implantation in SCTIMST, Trivandrum.

Implanted cardiac devices, pacemakers and automatic cardioverter/defibrillators

are becoming more common in general population. There are more than one half

million persons living in North America, and approximately 20,000 patients have

received automatic implantable cardioverter/defibrillators. Through careful

assessment, intervention, and discharge planning, the nurse can reduce the risk

complications. Studies shows that patients have inadequate knowledge regarding

homecare management after PPI implantation. They raised a lot of questions

about their daily living .OBJECTIVES: -[a] To identify knowledge of PPI

patients. [b] To identify the relationship between knowledge of homecare

management of PPI patients and selected variables.

METHODS: Thirty five patients were purposely selected from pacemaker clinic

of SCTIMST, Trivandrum. Convenient sampling technique was used for

selecting the sample. Total period of study was from August 2011 to October

2011. A self-administered questionnaire was used in the form of multiple

choices. RESULTS: The study concluded that there is no statistical relationship

between knowledge of homecare management of PPI patients and related

variables like age, educational qualifications and year of pacemaker

implantation.

vii

CONTENTS

III METHODOLOGY

3.1 Introduction 13

3.2 Research approach 13

3.3 Setting of the study 13

3.4 Sample and sampling technique 13

3.5 Inclusion criteria 14

3.6 Exclusion criteria 14

3.7 Development of tool 14

3.8 Description of the tool 14

Chapter

NO. TITLE Page No.

I INTRODUCTION

1.1 Introduction 1

1.2 Back ground of the study 2

1.3 Need and Significance of the study 4

1.4 Statement of the problem 5

1.5 Objectives of the study 5

1.6 Operational definitions 5

1.7 Methodology 6

1.8 Delimitations 6

1.9 Summary 6

II REVIEW OF LITERATURE

2.1 Introduction 7

2.2

Studies related to knowledge regarding

homecare management of patients undergone

PPI

7

viii

3.9 Pilot study 14

3.10 Data collection 15

3.11 Plan of analysis 15

3.12 Summary 15

IV ANALYSIS AND INTERPRETATION OF

DATA

4.1 Introduction 16

4.2 Distribution of sample according to

demographic data

16

4.3 Distribution of sample according to the sum

knowledge score.

21

4.4 Summary 23

IV SUMMARY, CONCLUSION, DISCUSSION

AND RECOMMENDATIONS

5.1 Summary 24

5.2 Major findings of the study 24

5.3 Limitations 25

5.4 Conclusion 25

5.5 Discussion 25

5.6 Recommendations 25

REFERENCES 26

APPENDIX 28

ix

LIST OF TABLES

TABLE TITLES

PAGE

NO

1.1 Indications of permanent pacemaker implantation 2

4.2 a Distribution of samples according to the age category. 17

4.2 b Distribution of sample according to sex 18

4.2 c Distribution of sample according to educational

qualifications.

19

4.2 d Distribution of sample according to duration of pacemaker

implantation.

20

4.3 a Distribution of sample according to the sum of knowledge

score.

21

4.3 b Mean, standard deviation and P value with the age group by

mean knowledge score.

22

4.3 c Mean, standard deviation and P value with the educational

status by the knowledge score.

22

4.3 d Mean, standard deviation and P value with duration of

pacemaker implantation by the knowledge score.

23

x

LIST OF FIGURES

Figure Title Page no

4.2 a The pie diagram showing distribution of

samples according to age

17

4.2 b The pie diagram showing distribution of

samples according to sex

18

4.2 c The pie diagram showing distribution of

samples according to educational

qualifications.

19

4.2 d The pie diagram showing distribution of

samples according to duration of pacemaker

implantation.

20

4.3 a The pie diagram showing distribution of

samples according to the sum of knowledge

score

21

xi

ABBREVIATIONS

SCTIMST

SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL

SCIENCES AND TECHNOLOGY TRIVANDRUM

PPI

PERMANENT PACEMAKER IMPLANTATION

1

Chapter - I

INTRODUCTION

I.1 Introduction

With the tremendous advances in cardiac pacing during the past four decades.

cardiac pacemaker implantation is now a common clinical procedure. This

increase in reasons for pacing and a shift in mode of pacing have been caused by

the evolution of pacemaker therapy from a life saving measure to one aimed at

improving health related quality of life. Knowledge assessment and educating

cardiac patients in how to lead anactive life after a pacemaker implantation

presents many challenges for nurses who are involved in the care. Nurses, being

independent in their management of these patients should initially assess the

clients knowledge level and start the health teaching to avoid misconcepts in the

field. Nurse- patient interaction affords key opportunities for education support

and interventions aimed at facilitating positive patient and family adjustments for

one with permanent pacemaker implantation (PPI).

The construction of high technology electronic artificial cardiac pacemaker and

its application by the medical science has changed the way and the prognosis of

the disease of the cardiac conduction system. Nursing presence is essential in the

care of patient with a cardiac pace maker. In the cardiac catheterization lab, the

nurse creates the most ideal environment and assists in the application of the

artificial pacemaker; in the ward she observes with watchful glance for

prevention of complications providing individual and holistic nursing care, and

helps the patient and the family with rehabilitation and adaptation to his new way

of life. In addition, the nurse teaches the patient how to observe the function of

his pacemaker, and emphasizes the importance of keeping the doctor’s orders

and regularly visiting the outpatients cardiac pacemaker review clinic to check

his pacemaker.

2

1.2 Background of the study

An artificial pace maker is a device that electronically stimulates the pulse

initiation within the heart. The pace maker system consists of a battery powered

energy source and a wire or catheter that delivers the electronic stimulus to a

point of contact in the atrial or ventricular myocardium. There are two types of

pacemakers

1. Temporary pacemakers and

2. Permanent pacemakers

The indications for permanent pacemaker implantation are given in Table1.1

Symptomatic Brady arrythmias, sinoatrial arrest, sick sinus syndrome.

Symptomatic heart block and complete heart block.

As prophylaxis following acute Myocardial infarction

Tachyarrythmias to break rapid rhythm disturbances

There are one electrode for a single chamber system or two electrodes for a dual

chamber system. This leads monitor and deliver electrical stimulation to the right

atrium or right ventricle for a ingle chamber system or both the right atrium and

right ventricle for a dual chamber system. A device used to pace in only one

chamber will be represented by either the letter A (atrial) or V (ventricular),

devices that are capable of pacing in both chambers are represented by the letter

D (dual). Some pacemakers allow pacing to be turned OFF for diagnostic

purposes, and, while turned off, the position 1 coding is O (off). There is a code

letter S that identifies the pacemaker as a single chamber device. This is only

used as a manufacturers designation and is not valid once the pacemaker is

attached to a lead. Pacemaker using the manufacturers designation "S" in the first

position may be attached to a lead that has been placed either in the atrium or

ventricle.

3

I II III IV V

Chamber

(s) Paced

Chamber(s)

Sensed

Mode(s) of

Response

Programmable

Functions

Antitachycardia

Functions

V=

Ventricle

V=

Ventricle T=Triggered R=Rate Modulated O=None

A=

Atrium A=Atrium I=Inhibited C=Communicating P=Paced

D=Dual

(A&V)

D=Dual

(A&V)

D=Dual

Triggered/

Inhibited

M=Multiprogrammable S=Shocks

O=None O=None O=None P=Simple

Programmable D=Dual (P&S)

O=None

Rassin, et al.,(2007) conducted a study about classification of questions asked by

pacemaker patients as a basis for intervention. Study was conducted in Asaf

Harofe Medical Centre, Zrifinn, Bear Yaakov, Israel. The aim of the research

was to identify the information of patients following pacemaker implantation. A

convenience sample of participants was taken from the entire population of

patients who attended the cardiology clinic between January-June 2007; 274

individual meetings were held with 123 pacemaker patients in three periods,

reflecting different stages of recovery. Eight categories representing common

issues and content were raised. In the meeting, patients were invoked to ask any

question they may have regarding pacemaker implantation. Findings showed that

the common factor for most of the questions was the loss of confidence in the

various aspects of life. The largest relative question proportion was in the motion

and effort (27%) (e.g. may I swim? how many kg may I lift?) and environmental

influences (26%) (e.g may I use a cellular phone ?may I use a shaving

4

machine?).The author concluded that coherent, continuous pattern was found,

characterizing the different points of measurement where, at the first point,

questions were characterized as more existential, related to daily routine

activities and as time passed and patients were exposed to non-daily activities

and conditions, other questions were raised.

Malm, et al.,(2006)conducted a study on patient’s experiences of daily living

with a pacemaker. A total of 13 patients were considered for the study out of

which 7 were women. There age was 22-82 with a mean age of 59.2. The

informants had pacemaker from 0.5-33 (mean 13.1) years. The grounded theory

based on semi structured interviews, showed that variations in perceived social

participation and emotional state.

Torrington, et al.,(1985) interviewed 94 patients with permanent pacemaker to

assess their knowledge and understanding of their disease and treatment, as well

as to determine their self-assessment of the quality of life before and after

pacemaker implantation. Many patients knew little about their illness, the reason

for having a pacemaker, or their prognosis.

1.3 Need and significance of the study

Implanted cardiac devices, pacemakers and automatic cardioverter/defibrillators

are becoming more common in general population. There are more than one half

million persons living in North America, and approximately 20,000 patients have

received automatic implantable cardioverter/defibrillators. Through careful

assessment, intervention, and discharge planning, the nurse can reduce the risks

and complications. Studies showed that patients have inadequate knowledge

regarding homecare management after PPI implantation. They raised a lot of

questions about their daily living.

5

Table1.2 Pacemaker implantation in SCTIMST Trivandrum.

YEAR PPI PG change Lead change

2008 120 48 3

2009 118 45 2

2010 128 52 2

1.4 Problem statement

A study to assess the knowledge of homecare management of permanent

pacemaker implanted patients in SCTIMST, Trivandrum.

1.5 Objectives

1. To assess the knowledge of the patients regarding homecare management

after permanent pacemaker implantation in SCTIMST, Trivandrum.

2. To assess the relationship of knowledge with selected variables.

1.6 Operational definition

Homecare is the health care provided for the pacemaker patients by the family

and he himself.

Knowledge

Knowledge refers to the response made of the post PPI patients, measured as

scores obtained in the test on homecare management of pacemaker patients.

6

1.7 Methodology

Settings - : Pacemaker clinics in Sree Chitra Tirunal institute for

Medical Sciences and Technology, Trivandrum.

Study design -: Descriptive survey

Sampling technique -: Purposive sampling

Tool -: The investigator assess the knowledge level of the

patient regarding home care after permanent pacemaker

implantation using a self administered questionnaire.

1.8 Delimitations

Only those patients who had undergone PPI in SCTIMST Trivandrum and

attending pacemaker clinic.

1.9 Summary.

This chapter deals with the introduction, background of the study, review of

literature, need and significance of the study, objectives and methodology.

7

Chapter - II

REVIEW OF LITERATURE

2.1 Introduction

A review of literature is a body of text that aims to review the critical points of

current knowledge including substantive findings as well as theoretical and

methodological contributions to a particular topic. Literature reviews are

secondary sources, and as such, do not report any new or original experimental

work.

Most often associated with academic-oriented literature, such as these, a

literature review usually precedes a research proposal and results section. Its

ultimate goal is to bring the reader up to date with current literature on a topic

and forms the basis for another goal, such as future research that may be needed

in the area.

A well-structured literature review is characterised by a logical flow of ideas;

current and relevant references with consistent, appropriate referencing style; and

unbiased and comprehensive view of the previous research on the topic.

The literature relevant to this study is presented as

2.2 Studies on knowledge regarding homecare management of patients

undergone PPI

Aqeel,et al.,(2008)conducted a survey about Pacemaker patients' perception of

unsafe activities. A descriptive cross sectional survey was carried out on

consecutive patients at the pacemaker clinic at a public hospital in Karachi,

Pakistan. A 47-question tool was developed and tested. Patients' perceptions of

safety of performing various routine activities, along with socio-demographic

8

data were recorded. The final sample included 93 adult patients (45% males).

41% were illiterate. 77.4% recalled receiving counseling at implantation,

predominantly from the implanting physician and house staff. A considerable

proportion of patients considered many routine activities unsafe including

driving automobiles (28%), passing through metal detectors (31%), bending over

(37%), and sleeping on the side of the pacemaker (30%). Also considered unsafe

were operations of household appliances. Television/video cassette recorders

(53%), irons (55%)) and electrical wall switches (56%). For nearly all variables

neither literacy nor history of counseling improved incorrect perceptions. The

researchers concluded that their pacemaker patients perceived many routine

activities as unsafe, potentially leading to disabling life style modifications.

Russell et al.,(2007)conducted a study on pacemaker. Responses of 30 cardiac

pacemaker recipients showed that 90 per cent were aware of warning signs and

symptoms prior to pacemaker implantation, but only 37 per cent sought medical

attention when the initial warning signs were evident. The group, which sought

care, experienced more symptoms per patient than the other groups, which did

not seek early treatment. Patients took inventory after implantation, and 60 per

cent reported that they were fortunate to have received a pacemaker. During the

inventory and long-term recovery stages, patients who thought they had

experienced few life-style changes after receiving a cardiac pacemaker reported

positive feelings about living with a cardiac pacemaker. Many of the patients'

problems in adjusting to a permanently implanted cardiac pacemaker and

participating in its maintenance were related to a lack of accurate information

about what to expect or how to assure normal functioning of the pacemaker.

Rassin et al.,(2007) conducted a study about classification of questions asked by

pacemaker patients as a basis for intervention. Study conducted in Israel. The

aim of the research was to identify the information of patients find necessary,

following pacemaker implantation. A convenience sample of participants was

taken from the entire population of patients who attended the cardiology clinic

9

between January-June 2007; 274 individual meetings were held with 123

pacemaker patients in three periods, reflecting different stages of recovery. In the

meeting, patients were invoked to ask any question they may have regarding

pacemaker implantation. The questions were collected from the patients and

categorized chronologically, in accordance with their frequency in three periods,

reflecting different stages of recovery. Eight categories representing common

issues and content were raised: motion and effort, environmental influences,

personal hygiene, knowledge concerning the pacemaker operation, medical

treatment, eating and drinking, clothing and general questions. Findings show

that the common factor for most of the questions was the loss of confidence in

the various aspects of life. The largest relative question proportion was in the

motion and effort (27%) (e.g. may I swim? how many kg may I lift?) and

environmental influences (26%) (e.g. may I use a cellular phone? may I use a

shaving machine?).The author concluded that a coherent, continuous pattern was

found, characterizing the different points of measurement where, at the first

point, questions were characterized as more existential, related to daily routine

activities and as time passed and patients were exposed to non-daily activities

and conditions, other questions were raised.

Malm, et al., (2006) conducted a study on ‘Patients' experiences of daily living

with a pacemaker: a grounded theory study ’. The purpose of this study was to

examine patients' experiences of daily living with a pacemaker. A total of 13

pacemaker patients (seven women) aged 22-82 (mean = 59.2) years were

interviewed. The informants had had a pacemaker from 0.5 to 33 (mean 13.1)

years. The grounded theory method was the basis for collection and analysis of

the data. The results of the analysis of the semi-structured interviews showed that

variations in 'perceived social participation' and 'emotional state', the two core

categories, were related to four qualitatively different ways of experiencing daily

living after pacemaker implantation.

10

Van Eck et al.,(2006) conducted a study to quantify the incidence of

complications and the quality of life 1 year after pacemaker implantation, to

quantify which baseline characteristics measured during implantation are

predictors of the occurrence of complications and quality of life after 1 year and

to determine the added predictive value of follow-up measurements to improve

the efficiency of follow-up and to demonstrate which follow-up measurements

are redundant. FOLLOWPACE is a prospective, observational, prognostic cohort

study. About 40 pacemaker centers in the Netherlands will participate to include

about 2,500 patients. Each patient aged >or=18 receiving a pacemaker for the

first time is eligible. At baseline, i.e. time of implantation, all potential predictors

of complications and quality of life after 1 year are documented. After

implantation, follow-up visits will be carried out conforming with routine care,

usually three in the first year. At these visits, other potential prognostic predictors

will be documented. Primary outcome is the incidence of PM- or cardiac

complications at 1 year. Secondary outcome parameters are quality of life and

costs after 1 year. This study will lead to definition of a more efficient routine

follow-up schedule for patients with a PM, aiming to reduce time and energy

while preserving the safety of pacing therapy and the prognosis of the patient.

The study will ultimately provide evidence-based guidelines for PM follow-up

including knowledge of the responsibilities of cardiologists, technicians, and

representatives of PM manufacturers.

Jimenez et al.,(2006).Prospectively examined 398 patients from the Pacemaker

Selection in the elderly study, in which patients were randomized to either VVIR

or DDDR mode. Health values were estimated with the time tradeoff method

before implantation and at 3, 9, and 18 months after implantation. The mean age

of patients was 76 +/- 6 years; 234 patients (59%) were male. At baseline,

patients were, on average, willing to exchange 5 years of current health for

approximately 4 years in perfect health (value 0.76 +/- 0.06). There was no

difference in baseline health values with implant diagnosis (sinus node

dysfunction n = 172, 0.72, atrioventricular block n = 227, 0.75, other diagnoses n

11

= 39, 0.78, P = not significant). The overall improvement in health values at 3

months after pacemaker implantation was 0.165 +/- 0.4 (P =. 0001). The

improvement in health values was independent of pacing mode (P =. 6). The time

tradeoff score was modestly correlated with other measurements of health-related

quality of life. The change in time tradeoff score with time was not influenced by

demographic characteristics such as age and sex, diagnoses, pacing mode,

employment status, or history of angina. Patients with a lower functional class at

enrollment (III or IV on the Specific Activity Scale) demonstrated an absolute

improvement of 23% in their health values, whereas patients in class I or II

improved only by 12%, (P =. 03).

Permanent pacemaker implantation for standard indications improved health

values and descriptive health status measures. The values reported here may be

used as a means of calculating the cost-effectiveness of different pacing

modalities.

Stofmeel, et al.,(2001) conducted a study to assess the sensitivity to change in

health of Aquarel. A cohort of 51 patients was assessed at baseline and at 4-6

weeks after pacemaker implantation. The authors compared the sensitivity to

change over time on the Aquarel scores to the scores on the SF- 36 using various

techniques (t-test value, effect size, standard error of measurement). Using the 1-

standard error of measurement (SEM) criterion for clinically relevant change,

Aquarel seemed to provide better classification of patients compared to the SF-

36 alone. This study supports the value of Aquarel as a disease-specific measure

of QOL in pacemaker patients.

Chen, et al.,(2002) conducted a study to investigate the quality of life (QOL) in

patients before and after permanent pacemaker implantation. A follow-up study

design was adopted and purposive sampling was applied to recruit subjects from

two medical centers in Taipei City. Subjects were interviewed before pacemaker

implantation. Follow-up interviews were conducted at second, fourth, and sixth

12

month after pacemaker implantation. There were 42 subjects enrolled in this

study. These subjects had moderate QOL (62.4 +/- 15.9 on a scale of 97) before

pacemaker implantation and the QOL improved significantly after implantation

(p<. 05). The QOL improvement reached a peak at the end of the fourth month

and the scores decreased at the end of the sixth month vs. the fourth month (p <.

05). The Patients had significant improvement in general well-being, sleeping,

appetite, physical activity, and physical symptoms (p <. 05), but not in cognitive

function, social participation, work capability and sexual function (p >.05).

Subjects with spouses as their main caregivers had significantly better

improvement in QOL after pacemaker implantation. Subject’s perceptions of

distress from arrhythmia were the most significant determinant in their QOL pre

and post pacemaker implantation. The findings suggested that aggressively

resolving arrhythmia distress was important for improving QOL.

Torrington, et al.,(1985) conducted a study to assess knowledge of pacemaker

implanted patients. Interviews conducted with 94 pacemaker recipients were

analyzed to assess their knowledge and understanding of their disease and

treatment, as well as to determine their self-assessment of the quality of life

before and after implantation. Many patients knew little about their illness, the

reason for having a pacemaker, or their prognosis. Eighteen patients claimed still

to be in bad physical condition; 47 patients claimed to be physically

handicapped, in 32 of whom the handicaps could be related to their cardiac

condition. Fifty patients said that they were less active after implantation than

before it. These findings suggested a lack of meaningful patient-doctor/doctor-

patient communication. It is suggested that a team approach involving a social

worker would improve continuity of care and communication, as well as the

quality of patients' lives.

13

Chapter - III

METHODOLOGY

3.1 Introduction

This chapter deals with the research approach, setting, the sample and sampling

technique, development of tool, description of tool ,pilot study, data collection

procedure and plan for analysis.

3.2 Research Approach

Descriptive survey study approach is used.

The objective of the study is: -

1. To assess the knowledge of the patients regarding homecare management

after permanent pacemaker implantation in SCTIMST, Trivandrum.

2. To assess the relationship of knowledge with selected variables.

3.3 Settings

This study was conducted in Pacemaker clinic, Sree Chitra Tirunal Institute for

Medical Sciences and Technology, Trivandrum, an institute of national

importance established by an Act of the Indian Parliament. It is an autonomous

institute under the administrative control of the Department of Sciences and

Technology, Government of India.

3.4 Sample and Sampling technique

The sample was selected from pacemaker clinic, Sree Chitra Tirunal Institute for

Medical Sciences and Technology, Trivandrum. Pacemaker clinic usually in

every Tuesdays.3 pacemaker clinic were attended and selected patients. The size

of the sample was thirty five. The purposive sampling technique was used to

14

collect the samples. The duration of the study period was from August 2011 to

October 2011.

3.5 Inclusion Criteria

*Patients who can understand and read Malayalam.

*Patients who are willing to participate

3.6 Exclusion Criteria

Patients who cannot understand or read Malayalam.

3.7 Development of tool

An extensive study and review of literature helped in preparation of the tool. A

self prepared validated tool is used as the tool for this study.

3.8 Description of the tool

Part I :- This part contains items such as demographic data which include

name, age, sex, place, educational qualifications, profession, year

of pacemaker implantation.

Part II:- Questionnaire to assess the knowledge of homecare management

of PPI patients.

3.9 Pilot study

Pilot study was done on October 2011.Ten patients were taken for the pilot

study. The pilot study was conducted to find out the feasibility of the study. The

questionnaire was used for this study

15

3.10 Data collection

The data was collected from PPI clinic of Sree Chitra Tirunal Institute for

Medical Sciences and Technology.3 PPI clinic were attended. Initially 10

patients were selected for Pilot study. After that remaining samples were

collected. The sample size was 35.The period of data collection was from August

2011 to October 2011.

3.11 Plan for analysis

The investigator developed a plan of analysis after data collection. The data

were coded, entered in excel sheet and analyzed using Epi info Version.

3.12 Summary

This chapter includes research approach, settings, sample and sample technique,

selection criteria, description of the tool, pilot study, data collection, and plan for

analysis.

16

Chapter - IV

ANALYSIS AND INTERPRETATION OF DATA

4.1 Introduction

Analysis is categorizing, ordering, manipulating and summarizing the data to an

intelligible and interpretable form, so that research problem can be studied and

tested.

Interpretation refers to the process of making sense of the results and examining

the implications of the findings with in a broad context. The data in this study

was arranged and analyzed under the following sections.

4.2 Distribution of sample by demographic data

The findings of the study were arranged and analyzed under the following

sections:

Distribution of samples according to the socio demographic data

Distribution of samples according to knowledge score

17

Table 4.2 a Distribution of samples according to the age category

Age Frequency Percentage

<35 2 6%

36-50 7 20%

51-65 19 54%

>65 7 20%

Total 35 100%

The age of the sample is ranged from 15 to 80 years.

Table 4.2 a shows that majority of the patients were in the age group of 51-

65years.

FIG 4.2 a Distribution of samples according to age category

7%

25%

68%

Distribution of samples according to the age group

<35 36-50 51-65

18

Table 4.2 b Distribution of samples according to sex category

Sex Frequency Percentage

Female 11 31%

Male 24 69%

Total 35 100%

Table 4.2 shows 69% of the samples were male and 31% of the samples were

female.

FIG4.2 b distribution of samples according to the sex category

31%

69%

distribution of samples according to sex

Female Male

19

Table 4.2 C Distribution of samples according to educational qualifications

Educational Qualifications Frequency Percentage

School 24 69%

Plus two 7 20%

Graduate 4 11%

Post graduate 0 0%

Total 35 100%

Table4.2 c shows 68% of the study samples had school education only.

FIG 4.2 c Distribution of samples according to the educational qualifications.

69% 20%

11%

Distribution of samples according to educational qualifications

School Plus two

20

4 Distribution of samples according to duration of pacemaker implantation.

Table4.2 d distribution of samples according to duration of Pacemaker

implantation

Year Frequency Percentage

<1Year 12 34%

1-3Year 10 29%

4-6Year 6 17%

7-9Year 5 14%

>9Year 2 6%

Total 35 100%

Table 4.2 d shows 34% samples were recently pacemaker implanted.

Fig4.2 d Distribution of samples according to the duration of pacemaker

implantation

34%

29% 17%

14% 6%

Distribution of samples according to the duration of pacemaker implantation

<1Year 1-3Year 4-6Year 7-9Year >9Year

21

Table 4.3 a Distribution of samples according to the sum of knowledge score

Table4.2 e shows most of the patients scores more than average mark.

FIG4.3 a Distribution of samples according to the sum of knowledge score

Analysis and interpretation

17%

83%

Distribution of samples according to the sum of knowledge score

<5marks 5-8 marks

Marks Frequency Percentage

<5marks 6 17%

5-8marks 29 83%

Total 35 100%

22

Table 4.3 b f Mean, standard deviation and p value with the age group by

the knowledge score.

Age group Mean Standard deviation P value

<58 6.33 1.14

0.09 >58 5.47 1.70

The knowledge of younger age group ranged from 4 to 8with a mean of

6.331.14 and that of older age group ranged from 2 to 8 with a mean of

5.471.70.(P 0.09).

Table 4.3 c Mean, Standard deviation and P value with the educational

status by the knowledge score.

Educational Qualification Mean Standard deviation P Value

School 5.79 1.53

0.48 Higher education 6.18 1.40

Knowledge of patients with school education ranged from 2 to 8 and knowledge

of patients with higher education ranged from 4 to 8.There is no significant

statistical relationship between mean knowledge of patients with school

education and higher education.( p 0.48)

23

Table 4.3 d Mean, Standard deviation and P value with the year of

pacemaker implantation by the knowledge score.

Year Mean Standard deviation P value

<20 months 6.06 1.60 0.58

>20 months 5.78 1.40

The sample was divided into two using median duration after pacemaker

implantation. Knowledge of patients with PPI less than twenty months ranged

from2to 8 with a mean of 6.06.The patients with longer duration after PPI ranged

from 3 to 8 with a mean of 1.40.There is no statistical difference between mean

knowledge of patients and duration of pacemaker implantation.

4.4 Summary

This chapter contains distribution of samples according to the demographic data

and the knowledge score, analysis and interpretation of data collected.

24

Chapter - V

SUMMARY, CONCLUTION, DISCUSSION AND

RECOMMENDATIONS

5.1 Summary

The study is to assess the knowledge of homecare management of permanent

pacemaker implanted patients.

The objectives of the study was:

1. To assess the knowledge of homecare management of PPI patients In

SCTIMST, TVM

2. To assess the relationship of knowledge with related variables

The study was conducted in SCTIMST, TVM with the permission from

authorities. A self-administered questionnaire approved by the experts of

SCTIMST used for assessing the knowledge PPI patients. Pilot study was

conducted on September 2011 in ten patients from PPI Clinic. The sample

collection was started after making necessary corrections in the questionnaire.

The period of study was from September to October 2011.Thirty five samples

were collected and their knowledge regarding homecare management were

analysed.

5.2 Major findings of the study

The sample size was limited to 35 patients even though the maximum percentage

of patients has average level of knowledge regarding the homecare management

after PPI. The study revealed that there is no significant statistical relationship

between the educational status and mean knowledge score of younger and older

age groups. Also there is no statistical relationship between educational

25

qualification and mean knowledge score and year of pacemaker implantation and

mean knowledge of PPI patients.

5.3 Limitations of the study

The study to assess the knowledge of homecare management of PPI patients is

limited to SCTIMST, TVM. The period of study was only one month. The

sample size was only thirty-five. The samples were collected from PPI clinic

conducted on Tuesdays.

5.4 Conclusion

The study concluded that there is no statistical relationship between knowledge

of homecare management of PPI patients and related variables like age,

educational qualifications and year of pacemaker implantation.

5.5 Discussion

The study was aimed to assess the knowledge regarding homecare management

of PPI patients. The study concluded that there is no statistical relationship

between knowledge of homecare management of PPI patients and related

variables like age, educational qualifications and year of pacemaker

implantation.

5.6 Recommendations

The study can be repeated in other hospitals.

The study can be repeated with a large sample size.

26

REFERENCES

Aqeel M, Shafquat A, Salahuddin N. Pacemaker patients’ perception of

unsafe activities: a survey. BMC cardiovascular Disorders.2008;8: 1471-

2261.

BeeryT A, Sommers MS,Hall J. Focused life stories of women with

cardiac pacemakers. West J Nurs Res,2002;1: 23–27.

Chen,Mei H,Chao,Fen Y.Change in quality of life in Patients With

Permanent Cardiac Pacemakers A Six month Follow up Study.2002;

Jimenz L F, Goldman L et al., Health values before and after pacemaker

Implantation. Am Heart J.2002;4:687-92.

Malm D, Hallberg LR. Patients’ experiences of daily living with a

pacemaker: a grounded theory study. Jernel of Health Psychol 2006;

11:787-798.

Malm D,Karlsson JF, Fridlund B. Effects of a self-care programme on the

health-related quality of life of pacemaker patients: a nursing intervention

study. Canadian Journal of CardiovascularNurse.2007 17, 3–4.

Rassin M,Zilcha L Goss D.A pacemaker in my heart Classification of

questions asked as a basis for intervention. J Clin Nurs.2007;1:56-62.

Russell C L,Alyn I B. Living with a permanent cardiac pacemaker. Heart

Lung .2007;2:273-279.

27

Stoffmeel M A, Post M W,KelderJC,GrobbeeD E, vanHeme N M.

Changes in quality of life after pacemaker implantation. Pacing Clin

Electrophysiol.2001;3:288-95.

Torrington M, Both JL, Weymar HW. What do pacemaker recipients

think of their implantations? An exploratory study. S Afr Med J 1985;

68:163-166.

Verderber A, FitzsmmonsL, Shively M. Physiologic and psychological

responses to cardiac pacemakers. J Cardivasc Nurs.1991;3:77-79.

Wood MA, Ellenbogen KA. Cardiac Pacemakers from the patient’s

perspective. Circulation. 2002; 105:2136-2138.

28

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