| BackgroundsThe coronary heart disease (CHD) is to be called "the biggest killer of human beings" because of its high incidence and mortality rate. In recent years, due to the change of lifestyle of Chinese people, CHD has become the disease which seriously does harms to public health. Percutaneous coronary intervention (PCI) is the important means which develops rapidly for diagnosis and therapy of CHD in past few years. The annual case number has increased by 30-40% every year in China. Many studies find that patients who receive PCI widely suffer from emotion disorder, mainly anxiety .Anxiety can have a great adverse impact on patients. It may impact the implement of the operation, even can result in heart attack and do harm to one's life. So, nurses should pay attention to the anxiety level of the PCI patients. Uncertainty in illness (UNC) is defined as the inability to determine the meanings of illness-related events. According to the research findings of some aborad and Taiwan scholars, UNC has relativity with emotional disorder. So, to investigate the UNC level and its impact factors of the patients during PCI will be helpful to decrease the anxiety level of patients. The generation of UNC is relate to lack of information. Efficient patients education can decrease UNC. Nurses should study what information the patients needto decrease UNC and anxiety level and improve the quality of patient education. We use Mishel uncertainty in illness scale(MUIS) in this research .MUIS was developed by Mishel ,and had been translated into different languages. Professor Xu Shulian in Taiwan translate it into Chinese, and this Chinese version had been confirmed as a scale which has a nice reliability and validity. But, it has not ever been reported in mainland China. Taiwan and mainland China have some differences in language culture and medical environment. So ,we should also test the applicability of the scale in mainland China.ObjectivesThe reliability and validity of MUIS were tested by applying the scale in this research to investigate the uncertainty level of patients who receive PCI;the anxiety and uncertainty level of 97 patients who were ever admitted in the cardiac unit betwee en July 2005 and January 2006 were assessed applying the state anxiety inventory and MUIS. And to analyse relationship between anxiety and uncertainty;to investigate the impact of patient's demographic data, clinical characteristics in-hospital on the anxiety and uncertainty level of patients. Applying self-designed information needs scale to find out the disease or PCI related information which the patients need to improve the quality of patients education.MethodsUse the Chinese version of MUIS in the study , and test its split-half reliability Cronbach's a,content validity criterion validity. A convenient sampling of 97 patients were investigated. They filled in the MUIS ^ State anxiety Inventory and Information Needs Scale at the day before operation operation day and three days after operation. The anxiety level was compared with normal criterion of Chinese . Compare the anxiety and uncertainty level at three times to find differences. Analyse the relationship between some demographic data or clinical characteristics in-hospital and anxiety or uncertainty;Analyse relationship between anxiety and uncertainty through regression analysis;find the information which patients need.ResultsMUIS showed good internal consistency (Cronbach a of total scale is more than 0.8, that of two dimension are between 0.7~0.8).the split-half reliability of total is 0.886,that of two dimension are 0.810,0.748,show that MUIS is stable. It also has satisfying content validity(0.83) and criterion validity(0.68).The anxiety level of patients on Preoperation day (44.27±8.74) was similar to that of operation day (45.45±8.87) ,and both were significantly higher than normal criterion of Chinese (P<0.05 ) .that of after-operation was significantly lower than the preoperation day and operation day (P<0.05) ,also, is similar to the normal criterion(P>0.05 ). Uncertainty level were 67.74±11.39> 65.13±8.94> 61.74±10.19, each was in an upper level. The difference only exited in preoperation and after operation. Dimension of ambiguity decrease step by step, and complexity has no statistical difference. Ambiguity and complexity of uncertainty , course of disease had impact on the anxiety level. The impact factors of uncertainty at three times were different from each other. The result of regression analysis showed that the factors relating to the result of PCI, for example, whether or not to implant a stent, and history of PCI, were important impact factors on uncertainty. Degree of education, Sex were also relate to uncertainty. Anxiety and uncertainty at three times had significantly relationship. Correlation coefficient were 0.453, 0.430, 0.680(P<0.05) . The information need of patients had a certain relationship with the source of uncertainty. The information which patients most want to acquire was relate to safety of life, for example, how to save oneself in heart attack of CHD,the success rate and danger of PCI,et al.Conclusions1. The result showed that MUIS had satisfying reliability and validity, it is applicable for mainland China.2. The anxiety level of patients on the day preoperation and the operation day were significantly higher than normal criterion of Chinese, especially ,anxiety level of the operation day was also high.Nurses should make efforts to decrease the anxiety level. The uncertainty level of patients at three times were high .3. Ambiguity and complexity of uncertainty and course of disease had impact onthe anxiety level. The impact factors of uncertainty at three times were different from each other. The factors relating to the result of PCI, for example, whether or not to implant a stent, and history of PCI, were important impact factors on uncertainty. Nurses should pay more attention to those who had implanted stents or with an history of PCI.4. Anxiety and uncertainty had a significant relationship. Nurses should pay more attention to anxiety. It dedicated that the anxiety level can be decreased by decreasing uncertainty level.5. The nurses could supply the patients with the infonnation relating to disease and PCI which they want to acquire by investigation. It will be helpful to decrease the uncertainty level of patients , so that the anxiety level of patients could be decreased,and The quality of nursing could be improved . |
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