[논문]Effects of a Personalized Nurse-Led Educational Program for New Patients Receiving Oral Anticoagulant Therapy after Mechanical Heart Valve Prosthesis Implantation on Adherence to Treatment

Eltheni, Rokeia; Schizas, Nikolaos; Michopanou, Nektaria; Fildissis, Georgios

doi:10.5090/kjtcs.20.106

Abstract ▼ AI-Helper

Background: Life-long anticoagulant therapy is mandatory for patients who undergo heart valve replacement with implantation of a mechanical prosthesis. The aim of this study was to investigate the effects of a nurse-led patient educational program concerning oral anticoagulant therapy intake after h...

Background: Life-long anticoagulant therapy is mandatory for patients who undergo heart valve replacement with implantation of a mechanical prosthesis. The aim of this study was to investigate the effects of a nurse-led patient educational program concerning oral anticoagulant therapy intake after heart valve replacement surgery on patients' knowledge of important parameters of anticoagulant administration. Methods: In this single-center study, 200 patients who underwent surgical implantation of a mechanical prosthesis were divided into 2 groups. The control group received the basic education concerning oral anticoagulants, while the intervention group received a personalized educational program. Results: Personalized education was correlated with a better regulation of therapeutic international normalized ratio (INR) levels and adequate knowledge among patients. Therapeutic levels of INR were achieved in 45% of the patients during the first month, 71% in the third month, and 89% in the sixth month after discharge in the intervention group, compared to 25%, 47%, and 76% in the control group, respectively. Patients' satisfaction with the information was higher in the intervention group than in the control group. The percentage of satisfaction reached 80% for the intervention group versus 37% for the patients of the control group. Conclusion: The implementation of the nurse-led educational programs was associated with improved clinical results and increased adherence to oral anticoagulant treatment.

주제어

표/그림 (6)

표 Table 1. Satisfaction of the participants in the study and reasons for lack of satisfaction
표 Table 2. The socio-demographic and preoperative clinical characteristics of the participants
표 Table 3. INR measurements at FU examinations
표 Table 4. Variation in INR levels at FU examinations: comparison between the control and intervention group
표 Table 5. Percentage of patients who responded to more than 21 questions correctly
표 Table 6. Three-month incidence of hemorrhagic and thromboembolic episodes in each patient group

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

The aim of this study was to investigate the effects of a nurse-led patient educational program about oral anticoagulant therapy intake after heart val.,e replacement surgery on patients’ knowledge of important parameters of anticoagulant administration.
The basic goal of this research was to evaluate the impact of a nurse-led educational program for patients who require lifelong anticoagulant therapy after heart val.,e replacement surgery.
,e replacement surgery on patients’ knowledge of important parameters of anticoagulant administration. The data from this study will contribute to understanding the impact of postoperative personalized education on patients who need life-long anticoagulant treatment.
During the course, the patient was alone with the instructor, who was the same for the whole intervention group. The title of the booklet, which was created for the purpose of this study, was “What you should know about anticoagulant therapy following heart val.,e replacement surgery&rdquo;. The content of this booklet was based on commonly accepted medical practice in this field, reliable sources from the literature, and 2 experts’ opinions on this subject.

제안 방법

According to the follow-up protocol of the study, pa- tients’ level of knowledge about oral anticoagulant treatment was assessed with a questionnaire 1, 3, and 6 months after discharge from the hospital, while their adherence to the treatment was checked through measurements of INR at the same time points. The results of the INR measurements are depicted in Table 3, in which the participants are categorized into 3 groups according to the achievement of their therapeutic goals (Table 3).
monitoring. Both groups were evaluated using the questionnaire on the level of knowledge and INR measurements 1, 3, and 6 months after discharge from the hospital.
Data collection was performed using a specifically designed form for the collection of patients’ demographic and clinical data, an information and instruction form for proper receipt of oral anticoagulants, and a questionnaire concerning patients’ level of knowledge on oral anticoagu- lants, which was given on the first, third, and sixth month of monitoring. Both groups were evaluated using the questionnaire on the level of knowledge and INR measurements 1, 3, and 6 months after discharge from the hospital.
In the intervention group, a nurse-led educational program for oral anticoagulant treatment after implantation of a mechanical prosthesis through surgery and an educational booklet for such patients were added. The nursing educational program included a verbal 20-minute course on this subject on the fourth, fifth, and sixth postoperative days, during which patients were encouraged to ask questions and express their specific needs. During the course, the patient was alone with the instructor, who was the same for the whole intervention group.
patients in both groups. The questionnaire consisted of 29 questions, with only 1 right answer for each question, and its Greek-language version was previously validated by other researchers with an estimation of internal consistency through the Cronbach α (with values more than 0.7 being considered acceptable). After statistical analysis, the cutoff point indicating a good knowledge of oral anticoag-ulant therapy was defined at 21 right answers.

대상 데이터

These patients were divided into 2 groups: the control group, which included 100 patients, and the intervention group, which also contained 100 patients. The control group received the standard information about the benefits of the anticoagulant drug and medication administration.

데이터처리

The patients’ personal data and rights were protected according to the law. The statistical analysis was performed with IBM SPSS ver. 19.0 (IBM Corp., Armonk, NY, USA), and for the comparison of proportions, the chi square and Fisher exact tests were used. All reported p-val- ues are 2-tailed and the cutoff for statistical significance was set at p≤0.

이론/모형

Data were collected through a globally accepted questionnaire (the Anticoagulation Knowledge Assessment Questionnaire) used to evaluate the level of knowledge of the patients in both groups. The questionnaire consisted of 29 questions, with only 1 right answer for each question, and its Greek-language version was previously validated by other researchers with an estimation of internal consistency through the Cronbach α (with values more than 0.

성능/효과

worth mentioning (Table 4). Although the average variation was similar in both groups in the first and sixth months, and a statistically significant difference was only found for the third-month evaluation, the variation in the INR levels in the control group was higher. Based on this observation, we may speculate that the time in the therapeutic range based on variation in INR levels was worse for the control group than the intervention group.
The implementation of educational programs was correlated with improved clinical results and increased adherence to oral anticoagulant treatment. A personalized, in- formative, and educational program could contribute on many levels, such as enhancing patients’ motivation and self-control, and promoting an understanding of the need for changes in one’s attitude and an early recognition of side effects.

참고문헌 (14)

1 Emery RW Emery AM Raikar GV Shake JG 2008 Anticoagulation for mechanical heart valves: a role for patient based therapy J Thromb Thrombolysis 25 18 25 10.1007/s11239-007-0105-x 18060537

상세보기
2 Hu A Chow CM Dao D Errett L Keith M 2006 Factors influencing patient knowledge of warfarin therapy after mechanical heart valve replacement J Cardiovasc Nurs 21 169 75 10.1097/00005082-200605000-00003 16699355

상세보기
3 Johnson VD 2007 Promoting behavior change: making healthy choices in wellness and healing choices in illness: use of self-determination theory in nursing practice Nurs Clin North Am 42 229 41 10.1016/j.cnur.2007.02.003 17544680

상세보기
4 Ryan P 2009 Integrated theory of health behavior change: background and intervention development Clin Nurse Spec 23 161 70 10.1097/NUR.0b013e3181a42373 19395894

상세보기
5 Cevik C Izgi C Dechyapirom W Nugent K 2010 Treatment of prosthetic valve thrombosis: rationale for a prospective randomized clinical trial J Heart Valve Dis 19 161 70 20369498
6 Bagnasco A Paola F Angela C 2010 Therapeutic education as a safety promotion tool for patiens on oral anticoagulation therapy Hell J Nurs Sci 3 11 7
7 Leiria TL Lopes RD Williams JB Katz JN Kalil RA Alexander JH 2011 Antithrombotic therapies in patients with prosthetic heart valves: guidelines translated for the clinician J Thromb Thrombolysis 31 514 22 10.1007/s11239-011-0574-9 21327503

상세보기
8 Cheah GM Martens KH 2003 Coumadin knowledge deficits: do recently hospitalized patients know how to safely manage the medication? Home Healthc Nurse 21 94 100 10.1097/00004045-200302000-00006 12574677

상세보기
9 Shrestha S Sapkota B Kumpakha A Acharya U Sharma R 2015 Evaluation of patients' knowledge on warfarin in outpatient pharmacy of a tertiary care cardiac center BMC Res Notes 8 429 10.1186/s13104-015-1416-1 26358332

상세보기
10 Tang EO Lai CS Lee KK Wong RS Cheng G Chan TY 2003 Relationship between patients' warfarin knowledge and anticoagulation control Ann Pharmacother 37 34 9 10.1345/aph.1A198 12503930

상세보기
11 Wang Y Kong MC Lee LH Ng HJ Ko Y 2014 Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control Thromb Res 133 550 4 10.1016/j.thromres.2014.01.002 24448058

상세보기
12 White HD Gruber M Feyzi J 2007 Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V Arch Intern Med 167 239 45 10.1001/archinte.167.3.239 17296878

상세보기
13 Cook-Campbell J Sefton M 2010 Discharge teaching about warfarin: patient retention of knowledge Home Healthc Nurse 28 366 74 10.1097/NHH.0b013e3181df5e87 20539139

상세보기
14 Hull RD Garcia DA 2016 Therapeutic use of warfarin and other vitamin K antagonists [Internet] UpToDate Waltham (MA) Available from: http://www.uptodate.com/contents/therapeutic-use-of-warfarin-and-othervitamin-k-antagonists? cited 2019 May 5

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증

[국내논문] Effects of a Personalized Nurse-Led Educational Program for New Patients Receiving Oral Anticoagulant Therapy after Mechanical Heart Valve Prosthesis Implantation on Adherence to Treatment 원문보기

Abstract ▼ AI-Helper

주제어

표/그림 (6)

표/그림 (6)

AI 본문요약
AI-Helper

문제 정의

제안 방법

대상 데이터

데이터처리

이론/모형

성능/효과

참고문헌 (14)

이 논문을 인용한 문헌

관련 콘텐츠

원문 보기

원문 URL 링크

오픈액세스(OA) 유형

이 논문과 함께 이용한 콘텐츠

AI-Helper ※ AI-Helper는 오픈소스 모델을 사용합니다.

선택된 텍스트

연합인증

[국내논문] Effects of a Personalized Nurse-Led Educational Program for New Patients Receiving Oral Anticoagulant Therapy after Mechanical Heart Valve Prosthesis Implantation on Adherence to Treatment 원문보기

Abstract ▼ AI-Helper

주제어

표/그림 (6) 모든 표/그림 보기

표/그림 (6) 슬라이드로 보기

AI 본문요약 엑셀 다운로드 AI-Helper

문제 정의

제안 방법

대상 데이터

데이터처리

이론/모형

성능/효과

참고문헌 (14)

이 논문을 인용한 문헌

관련 콘텐츠

원문 보기

원문 URL 링크

오픈액세스(OA) 유형

이 논문과 함께 이용한 콘텐츠

AI-Helper ※ AI-Helper는 오픈소스 모델을 사용합니다.

선택된 텍스트

표/그림 (6)

표/그림 (6)

AI 본문요약
AI-Helper