Appraisal of Cardiac Patients Knowledge and Use of SLGTN Paper by Fan M-I, Mitchell, and Cooke - Article Example

Critical appraisal research paper “Cardiac patients’ knowledge and use of sublingual glyceryl trinitrate (SLGTN)” written by Fan M-I, Mitchell M & Cooke M and published by Australian Journal of Advanced Nursing. Key words: Sublingual glyceryl trinitrate, medication, chest pain, angina, self administration, knowledge. Introduction The research was to examine the knowledge and use of sublingual glyceryl trinitrate by cardiac patients. This is a main concern for clinical diagnosis since a third of all hospitalisations are as a result of the cardiac condition called the coronary heart disease who risk premature deaths, and vascular events like myocardial infarction (McIntosh 2004, pp. 272). The study was also to look at the patients characteristics that influence their level of knowledge and use regarding SLGTN. This research was important for the nursing practice and cardiac rehabilitation staff in facilitating education sessions for patients in acute rehabilitation and admission situations regarding SLGTN. This way the role of nurses in providing health care and cardiac rehabilitation will be improved to promote quality of life and long term survival of patients (Warrington et al 2003, pp.124). The research most specifically targets the cardiac patients who are administered SLGTN sprays and tablets in the study hospital. The patients are supposed to have knowledge on storage, angina prevention and the status of the drug expiry. Literature Review According to AIHW (2004), the Coronary Heart Disease (CHD) is the most common heart disease in Australia having been the one with a third majority principal diagnosis for hospital admissions (ABS 2006). Angina has been found as the common symptom for CHD and can be managed by the patients using SLGTN as a pain control (Liu et al 2006, p. 1 out 2). The research shows that people with angina pain can manage their condition by self administration of SLGTN to reduce complications. The research found more people with this condition wanted to know about its treatment, control, causes, medication, and its effects on their everyday life (Weetch 2003, pp.152). This is because people didn’t have enough knowledge on the use of SLGTN in appropriation and safe administration (McGovern et al 2001, pp. 175). However this is as far as European and American research is concerned with no specific Australian research in the past that has looked at the patient’s use and knowledge of SLGTN. Other studies for other medications like nitro-glycerine for angina showed that patients had little knowledge on its use and storage (Fernandez et al 2007, pp. 56). The past researches in Australia have not been specific to the knowledge of patients on the use of SLGTN and as a result there is a research gap that needs to be filled which brings us to the aims of this research. First is to research on the patients’ level of knowledge and use of SLGTN and also the patients’ characteristics that influence the use and the level of knowledge of SLGTN. Patients might not be able to administer the drug by themselves if they lack prior knowledge on how to given the risk involved in dosage. Type of patients also differ in knowledge and use of the drug and as a result the ability to administer it on themselves. Some characteristics are likely to encourage or hinder the use of the drug either by the health personnel or self administration by the cardiac patients. Sample The research used descriptive design method on a non-experimental basis of convenience sampling strategy. This is a non probability sampling method for quantitative methodology based on choice. The inclusion criteria involved patients who were prescribed SLGTN sprays or tablets who are over 18 years of age and through assessment of the nurses in charge of wards can complete the survey. Those exclude involve those cardiac patients in the terminal phase of their illness, those experiencing pain, non-English speakers or those under alternative medication of buccal glyceryl trinitrate(GTN). This inclusion and exclusion strategy was meant to allow patients who would aid in the complete survey without any hindrances. The sample was selected from two cardiac wards of a metropolitan teaching hospital in Brisbane, Australia which has coronary care units. The sample size used was that of 41 participants of 23 males and 18 females between the ages 31 to 90 years with the 31 and 90 ages being the least participant while the 51-60 years of age being the majority participants. Men are the most likely patients of this disease which makes them account for the majority in the sample size. Most of the participants were married with majority educated to high school level. This was necessary to have the knowledge of SLGTN relate to the educational background. Most of the participants are retired which relates to the most affected age group of between 51-60 years. Most participants had previous use of the drug either as a tablet or spray but the survey didn’t reveal whether the self administered it or were assisted. The sample size does not answer the question of the knowledge and use SLGTN appropriately since the level of educational knowledge does not equate to the knowledge of the use of the drug. However the patients’ characteristics are brought out as per the aims of the research question on the patients, characteristics that influence the use and knowledge of SLGTN. This is because the survey questions categorize the patients in the various demographic characteristics that are general such as age, gender, marital status, education, employment status, and the more specific such as the previous use of SLGTN and on which form. A number of 65 questions were used in the survey but the seven demographic questions are able to describe and create significance with regard to knowledge and use of SLGTN. The study hospital and university approved the recruitment of participants on ethical grounds while the participants gave informed consent to be interviewed and participate in the study. Such ethical considerations include, free participation of by patients and not under duress, patients could only disclose information that they feel comfortable giving, and also the reassurance of binding confidentiality of the information given to the surveyors. Data collection and findings In a span of one month, study details were introduced to potential participants before introducing the researcher. The survey per participant would take 20 to 30 minutes after informed content by the participant. The Sublingual Nitro-glycerine Interview Schedule (SNIS) was used in the survey whose face validity and content has been established as developed by Kimble and Kunik (2000). This interview tool was modified to fit the aims of the research and the target group in an Australian setting. The tool is valid for research survey and therefore could be relied upon for this particular research. The research data was analysed using the Statistical package for Social Sciences where demographic variables were analysed using descriptive statistics, Pearson product-moment correlation analysis and one way analysis of variance. The total mean score on knowledge and use of SLGTN was 3.98 with men having a lower knowledge score than women despite being the most cardiac patients in the study. On average there were no great gender differences on the knowledgeable items. Only a quarter of the participants, majority females, knew that SLGTN can be used to prevent chest pain where males were likely to transport SLGTN incorrectly to their bodies. All participants knew how to check the expiry dates of drugs for SLGTN spray while only half of them could check the expiration dates for the tablets. 30% of participants revealed that they experienced reduced side effects after change of the form of the SLGTN. Results reveal that any SLGTN instruction happened in a span of one year or more where doctors were the most frequent health professionals to provide instruction. Twenty eight out of the total participants had previous experience in use of SLGTN as first timers while one participant felt no chest upon prescribing. The survey showed a positive relationship between the knowledge about SLGTN and use of the drug. Conclusions/ Recommendations There were deficits in the management of cardiac conditions as revealed by the study especially in the pain conditions of angina (Adams et al 2005). In further support of healthcare of the cardiac condition, there is need to improve the knowledge and use of SLGTN and its management. Due to lack of knowledge in the administration of the SLGTN, there’s probability of overdosing of the drug and decrease their self skills of drug administration in their chronic conditions. The patient education should therefore focus on ways to take medication by having clear time sequencing and appropriately storing medication after use protected from heat and light (Timmins & Kaliszer 2003, pp.58). Ongoing SLGTN education and maintenance programs are necessary to patients by healthcare professionals and increased recall for advice for patients hence more research is required to improve the patients’ quality of life (Braden 1993, pp. 40). This research however restricts generalizations since it is limited to one study site. There is need to increase knowledge on the self administration of SLGTN and management of angina. Bibliography Adams, M., Josephson, D. and Holland, L.Jr, 2005. Pharmacology for nurses: a pathophysiologic approach. Pearson Education: Upper Saddle River, New Jersey, USA. Braden, C. 1993. Research program on learned response to chronic illness experience: self‑help model. Holistic Nursing Practice, 8(1):38‑44. Fernandez, R., Davidson, P., Griffiths, R., Juergens, C. and Salamonson, Y. 2007. What do we know about the long term medication adherence in patients following percutaneous coronary intervention? Australian Journal of Advanced Nursing, 25(2):53‑61. 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