Investigating the effect of Benson's relaxation method on anxiety and homeodynamic indices of patients undergoing electrophysiological interventions hospitalized in Dr. Heshmat Shahr's research training center in Rasht in the year

(dissertation)

To receive a master's degree in nursing education

(Internal-surgical orientation)

Abstract:

Context and purpose: electrophysiological interventions, including new methods in the diagnosis and treatment of dysrhythmias and like any other invasive intervention, it has side effects such as anxiety. Considering the effects of anxiety on hemodynamic indicators and discomfort of patients, there is a need to use safe and low-cost methods to control this psychological problem. Therefore, the present study was conducted with the aim of determining the effect of Benson's muscle relaxation on the level of anxiety and hemodynamic indicators (blood movement study) of patients awaiting electrophysiological diagnostic and therapeutic interventions.

Research method: This clinical trial study was conducted on 72 patients awaiting electrophysiological interventions admitted to Dr. Heshmat's educational and therapeutic center in Rasht. The study samples were randomly selected and randomly selected in terms of individual-clinical information, anxiety, blood pressure and pulse, at a time interval of 3-5 hours before the intervention, in two test groups (under usual care and muscle relaxation) and control (only usual care). The research data were collected using a 3-part instrument including the personal-clinical information questionnaire, the anxiety section of the hospital anxiety and depression instrument, and the hemodynamic index registration sheet by interviewing, observing the findings recorded in the file, and measuring by the researcher. Data related to clinical-individual information in the time range of 3-5 hours before the electrophysiology intervention and the anxiety level and hemodynamic indicators of the samples were collected in two stages of 3-5 hours and 5-60 minutes before the electrophysiology intervention. The test group was encouraged to listen to the audio file of Benson's muscle relaxation instructions for 7 minutes using headphones, and practice it at least 3 times during this time interval. The average data were compared and analyzed using SPSS software version 21 and under paired t, independent t, Wilcoxon, analysis of covariance and chi-square statistical tests in two groups.

Findings: The results of the research showed that based on the results of the paired t test, the mean and standard deviation of the anxiety score of the test group in the post-intervention phase compared to before (7.91±6.70 in comparison) with 3.11±3.43 and P<0.0001). While the mean and standard deviation of the score of this variable in the control group in the pre-intervention phase (6.55±6.21) in the second phase of the study, there was a significant increase (8.55±7.27) with (P<0.0001). The independent t-test also showed a significant difference in the mean and standard deviation of the anxiety score of the two groups in the second stage of the investigation (P<0.0001). In the examination of the hemodynamic variables, the paired t-test showed that in the test group, the variables of systolic blood pressure, diastolic and respiration had a significant decrease after the intervention compared to this variable in the first stage of the investigation (P<0.0001). In this group, although the number of pulses also decreased, this difference was not statistically significant (P=0.372). On the other hand, the paired t-test in the control group indicated a significant increase in all variables in the second stage; In this way, all the variables of systolic and diastolic blood pressure, breathing (P<0.0001) and pulse (P<0.001) were significantly increased in the second stage of the investigation compared to the first stage. Finally, the independent t-test showed a statistically significant difference between the mean and standard deviation of all hemodynamic variables, i.e., systolic blood pressure, diastolic blood pressure, respiration (P<0.0001) and pulse (P<0.001) in the second stage in the two study groups.

Conclusion: The results of this study show the positive and reducing effect of Benson's muscle relaxation on the level of anxiety and hemodynamic indicators of the test group samples. Therefore, the use of sedation by nurses can be useful in reducing anxiety and improving hemodynamic conditions of patients.

Key words: electrophysiological techniques of the heart, relaxation, anxiety, hemodynamic indicators

Field of research:

Human life will be possible through maintaining a dynamic and complex balance called homeostasis[1], which is necessary It is compatible with stressors (2). On the other hand, incompatibility can lead to crisis, exhaustion and psychological disorders such as anxiety and depression (3). Meanwhile, anxiety is one of the common symptoms that people experience during most of their lives, especially before important life experiences (4), so that according to estimates, 16.6 - 28.8 percent of people in the world suffer from anxiety disorders during their lifetime (5).

Anxiety is also the most common mental problem seen in medical centers (6). For example, anxiety is prevalent in more than 55% of patients undergoing invasive cardiac procedures (7), which can be accompanied by cognitive (such as confusion, reduced concentration, or inability to focus on recent concerns), emotional (such as worry, fear) and physiological (such as shallow breathing, insomnia, heart palpitations, and fatigue) manifestations in patients (6). This condition, which is a mental experience and indicates the presence of a feeling of threat in a person, can trigger the stress response and in severe cases cause significant mental and physical suffering along with its specific social and economic consequences(6). This condition requires special attention in heart patients; Because studies have shown that increased levels of anxiety in cardiac patients hospitalized in medical centers, regardless of individual variables or medical history, are associated with more early and late complications (7).

Among the invasive methods of cardiac diagnosis and treatment, electrophysiological studies [2] of the heart with the practical purpose of analyzing the components of the conduction system, identifying places of aberrant stimulation, evaluating the effectiveness of treatments and also as a therapeutic intervention in various types of dis Rhythms [3] are of particular importance (8); Because dysrhythmias are one of the common heart disorders and also one of the usual events in the stages before and after heart surgery (9). The prevalence of dysrhythmia in America has been reported as 5.3%, equivalent to 14.4 million people (10), among which atrial fibrillation [4] with a prevalence of 0.4 to 1% is the most common dysrhythmia in clinical settings in all societies (11). It occurs in the heart, it is one of the common causes of hospital visits (12) and the occurrence of anxiety caused by it in the patient (13); Because this condition is usually accompanied by complaints of dizziness, palpitations and syncope (14) as well as acute symptoms and complications such as chest pain, shortness of breath, pallor and low blood pressure (15). In addition, the increased risk of stroke, transient ischemic attacks of the brain, as well as complications such as heart failure and adverse quality of life are associated with the occurrence of dysrhythmias (16). The duration of hospitalization of patients with an average of 6.7 days(17) and the heavy economic burden caused by dysrhythmias on the individual and the health care system are also the reasons(18). All of the above mentioned dysrhythmias as a serious medical and social problem(11) and indicate the importance of timely diagnosis and treatment(18).

Today, the use of cardiac electrophysiological processes, including diagnostic studies and therapeutic interventions with catheter ablation[5] to determine the type and treatment of dysrhythmias have become common(19). These interventions have become one of the most successful interventions in medicine today with a success rate of more than 95% and the occurrence of serious complications at a rate of less than 1% (20). In such a way that the statistics of performing more than 20,000 ablations annually in America have been recorded (7). The statistics obtained by the researcher from the angiography department of Dr. Heshmat Hospital in Rasht city also showed that electrophysiological and ablation procedures were performed in approximately 242 cases in 1389, 258 cases in 1390 and 350 cases in 1391. This survey indicates that approximately 180 electrophysiological and ablation studies were conducted in the first ten months (until the end of January) of 2012. These statistics, which show a relatively large number of electrophysiological interventions and the exposure of dysrhythmia sufferers to them, are important from two aspects. First, many people benefit from its benefits; and from another point of view, despite all the confirmed benefits, these methods are associated with some risks like other invasive interventions (12). Pain, drug reaction to narcotics and anesthetics, infection, thrombophlebitis [6] and bleeding. Vascular access site is one of the complications related to catheter ablation (21).