Effect of Nursing Guidelines on the Severity of Frozen Shoulder among Patient with Artificial Implanted Pacemaker

Abstract

Background: Cardiac implanted pacemaker technique and therapies play an essential role in the treatment of some clinical heart disease. These disorders include bradyarrhythmias resulting from dysfunction of the sinus node or the atrioventricular node; implantable pacemakers consider as a life-sustaining devices that can return patients to a normal quality of life. Shoulder pain and disability in the first year after implant one of the complications can occur with implanted pacemaker. Aim: The aim of the study was to assess the effect of nursing guidelines on the severity of frozen shoulder among patient with artificial implanted pacemaker, through measuring: 1.The knowledge of patient with artificial implanted pacemaker pre and post implant. 2. The visual analog scale for pain before and after the implant. 3. The disabilities of arm shoulder and hand before and after the implant. Design: A quasi-experimental research design with two groups (control and study) was used to conduct this study. Setting: The study was conducted at outpatient of coronary care unit at EL-Hussein University Hospital. Subject: A purposive sample: The sample size calculated by using Open Ebi version 3. It indicated the sample size was 60 adults patients based on comparing 2 means- 30 for control group and 30 for study group. Tools: Four tools were utilized to collect data in the current study. 1. Patient demographic characteristics 2. Interview questionnaire to assess patients' knowledge (pre-post) 3. A visual analog scale for pain assessment and 4. DASH (disabilities of the arm, shoulder and hand) tool) it was standardizes. Results: high significant positive difference between pre and post test which reveals improvement in both groups knowledge regarding pacemaker implantation, indication, complication, and follow up at p-value  0.000**. Also study indicates that, an improvement in the measurements of all visual analog scale in both groups but there is a significant improvement in study group which return to mild level of pain at 6 month measurement while the control group still in high moderate level of pain and an improvement in the measurements of all DASH scale in both groups but there is a significant improvement in study group at 6 month measurement with a maximum score 8 /30 which indicate minimum disability. Conclusion: The findings of this study concluded that, there is the frozen shoulder and arm discomfort was improved after implementing arm exercise, so practicing simple educational technique can prevent many of complications can occur to patient with implanted pacemaker. Recommendations Based on the results of the current study the following recommendations are suggested; 1. Designing educational guidelines for nurses, patient and their family about arm exercise and 2. Recommended continuous education for such patient in outpatient clinic