Thesis Nurs. 1995 C776e
c. 2
Cooper. Diann C.
Education's effect on
anxiety in outpatient
1995.

Education’s Effects

Education’s Effects on Anxiety
in Outpatient Cardiac Catheterization Patients

by
Diann C. Cooper, RN, BSN

Submitted in Partial Fulfillment of the Requirements

for the Master of Science in Nursing Degree

Running head: EDUCATION’S EFFECTS ON ANXIETY

Approved by:

Chairpers^h,
j^n, Thesi;
Thesis Committee
Edinboro University of Pennsylvania

Committee Member

Committee Member

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Date

Education’s Effects
ii

Abstract

Cardiac catheterizations are known to be anxiety provoking for patients.

Originally an inpatient procedure, many are now outpatient procedures. The

purpose of this study was to determine the effect that education, provided prior

to the cardiac catheterization, had on pre-cardiac catheterization anxiety in

outpatients.

This correlational study used a convenience sampling method.

Fourteen males between the ages of 30 and 65 were given the State-Trait Anxiety

Inventory prior to receiving, and at the conclusion of, their pre-cardiac
catheterization education. The results were analyzed using the Student’s t-Test.

The State Anxiety scores decreased from pretest to post test. The Trait Anxiety
scores increased from pretest to post test. These results were not statistically
significant.

Only the decrease in State Anxiety scores was supported by the

literature, indicating education had an effect on anxiety. This study should be
repeated with a larger sample size and with women.

Education’s Effects
iii
Acknowledgements
This study was completed through the patience, understanding and support

of many people. I am truly indebted to each of them. Thank you, Brad, for the

encouragement, support, reviewing , baby sitting and so much more. I love you
more than words can say.
Thanks, Dr. Keller, Ellen, and Dr. Beckman, for agreeing to be on my
committee and for the numerous reviews, suggestions and so on that are involved

with that commitment.

Thanks, Deb, for reading and commenting on this study, and to Mom and
Dad, just for being there.

Thanks, LaMar, for explaining statistics easily and helping out with the
data analysis for this study.
Thanks, Jean, for your thoughtful suggestions and encouragement during
this project. Thanks, also to Mary Beth, Al and all the others associated with

Education and Human Resources, both past and present, for your ideas and

support.
Thanks to many, many friends who gave up parties, music, and vacation
time to let me work on this study. And thanks for enforcing much needed breaks

later on!

Education’s Effects
iv
Table of Contents

ACKNOWLEDGEMENTS

iii

TABLE OF CONTENTS

iv

LIST OF TABLES

vi

CHAPTER
I.

n.

in.

INTRODUCTION

1

Background of the problem

1

Purpose of the study

2

Statement of the problem

2

Assumptions

2

Definitions

3

Limitations

4

REVIEW OF LITERATURE

5

Anxiety

6

Education and Anxiety

7

Conceptual Framework

18

METHODOLOGY

20

Education’s Effects
v

IV.

V.

Sample and Setting

20

Instrumentation

21

Collection of Data

26

Analysis of Data

28

PRESENTATION AND ANALYSIS OF DATA

29

Presentation of Data

29

Analysis of Data

30

CONCLUSION

36

Conclusions

36

Recommendations

39

APPENDICES

41

Appendix A - Letter requesting research tool

41

Appendix B - Research Tool

42

Appendix C - Consent Form for Physicians

44

Appendix D - Participant Consent Form

45

Appendix E - Patient Education Booklet

46

REFERENCES

47

Education’s Effects
vi
List of Tables

TABLE 1 - Number of Valid Observations

39

TABLE 2 - Paired Samples Student’s t-Test—State Anxiety

40

TABLE 3 - Paired Samples Student’s t-Test—Trait Anxiety

41

Education’s Effects
1

Chapter I

Introduction

Background of the Problem

Hospitalization can be a stressful experience. As Swindale (1989) says "If
unrecognized, prolonged anxiety creates stress which may subsequently harm the

patient and delay recovery" (p. 899). Helping patients cope with stressful events

is recognized as one of the nurse’s most vital and special responsibilities (WilsonBarnett, 1980 in Swindale, 1989). Nursing interventions that provide education

and information to hospitalized patients can decrease patient anxiety. Cardiac

catheterizations can be seen as stressful procedures.

Though cardiac

catheterizations originally were performed in the hospital, many are now being

performed as an outpatient procedure. As the number of these out patient cardiac
catheterization programs continues to increase, it is important for the nurse to

make certain that the patients choosing this alternative receive the same quality

care as inpatients would.

By providing education about their procedure to

patients, the nurses may decrease the patient’s anxiety and prepare them for

Education’s Effects
2
discharge. The lack of this pre-procedural information may result in increased

anxiety, making it more difficult for the patient to participate in his or her care

and possibly resulting in post procedure complications.

Purpose of the Study

The purpose of this study is to determine the effect that education,
provided prior to the cardiac catheterization, has on pre-cardiac catheterization
anxiety.

Statement of the Problem

There is a positive correlation between patient anxiety levels in outpatient
cardiac catheterization patients before they receive education and their anxiety
levels after the education has been provided.

Assumptions

1.

Hospitalization is anxiety provoking in patients.

Education’s Effects
3

2.

Invasive and non-invasive diagnostic procedures cause anxiety.

3.

Pre-procedure

education

decreases

anxiety in

inpatient

cardiac

catheterization patients and should decrease anxiety in outpatients as well.

4.

Cardiac catheterizations will produce elevations in anxiety.

5.

Participants can read and speak English.

Definitions

1.

Education—information about the cardiac catheterization that is given to

patients about to undergo this procedure. This includes information about the
procedure (procedural), information about what the patient may feel during the

procedure (sensory), and information about ways to relax (coping).
2.

Anxiety—a feeling of apprehension, worry, uneasiness, ordread, especially

of the future.

3.

Outpatient- a person who is scheduled to have a procedure done in the

hospital but is not admitted to the hospital.

4.

Cardiac catheterization-an invasive procedure that involves the passage

of a tiny plastic tube into the heart through a blood vessel. Samples of blood are

withdrawn for testing; blood pressure and cardiac output are measured. Used in

Education’s Effects
4

diagnosis of heart disease and anomalies. (Taber’s Cyclopedic Medical

Dictionary, 1981, p. C-19).

Limitations

1.

This study was limited to a sample size of thirty.

2.

This study was limited to males, between the ages of 30 and 65.

3.

The study was limited to a 550 bed non-profit hospital in Northwestern

Pennsylvania, and to the Northeastern United States.
4.

Participants can read and speak English.

Education’s Effects

5
Chapter n

Review of the Literature

Current literature states that hospitalization is generally considered to be

a stressful experience for individuals. Miller (1981) reviewed the Life Events
Scales and described the Hospital Stress Rating Scale. This scale, developed by

Volicer and Bohannon (1973, 1975), allows patients to place stressful life events
in order.

The rank of the events provides the mechanism by which the

psychosocial stress experienced by patients can be measured (Miller, 1981, p.

318). Though Miller recommended further research using the scale, it is one
example of hospitalization being considered stressful. Mishel (1984) investigated

the relationship between perceived uncertainty and the perception of hospital
events as stressful.

He found that there was a strong relationship between

uncertainty and stress due to vagueness, lack of clarity, and lack of information
about events occurring to the patient while in the hospital. Mishel recommended
that the "patients age, the recency of prior hospitalization, and seriousness of

illness by disease label be evaluated upon admission. Uncertainty can be assessed
during the first few days of hospital stay and the reassessed" later (p. 170-71).

Education’s Effects
6
Mishel suggests nurses should provide information to the patient to reduce stress.

Aguilera and Messick (1974) also saw physical illness as a stressful event which
can precipitate a crisis. Anxiety is one of the first reactions to a stressful event.
This is supported by Aguilera and Messick in an example of a physical illness:
"Heart Disease is closely associated with death and, as a result, the patient

usually first reacts with fear and anxiety." (p. 86).

Anxiety

When under stress, the body reacts with the ’fight or flight’ response. In
brief, increased amounts of epinephrine are released from the adrenal glands
leading to increases in heart rate, respiration, blood pressure, and glucose
production. Blood is shunted away from less vital areas (peripheral areas) to vital

areas, such as the brain. The skin becomes cool, clammy, the mouth becomes
dry, the pupils dilate, and thought processes are enhanced. The individual also

feels anxious. The body continues to respond in this manner until the source of

stress is removed or until it can respond no more.
According to Taber’s Cyclopedic Medical Dictionary (1981), anxiety is

"a feeling of apprehension, worry, uneasiness, or dread, especially of the future"

Education’s Effects
7

(p. A-103). It can also be described as a response to a perceived threat to the self
(Roy, 1984, p. 355). In the context of the hospital environment, that threat can

take the form of major or minor surgery, fear of procedures, fear of pain, fear

of the unknown, and so on. Swindale (1989) quotes Wilson-Barnett (1981) as
defming anxiety as "fear of the unknown, as disproportionate to the threat

involved, related to the future" (p. 899).
Since a variety of events occur at a hospital or during a hospital stay,

there is a potential for the individual to be continually anxious. This constant

state of anxiety means the body is ’geared up’ at all times.

This can be

detrimental to the body, and could lead to longer lengths of stay, postoperative

complications, and other problems. The nurse today must be alert for the signs
of anxiety in the patient and work to decrease the amount of anxiety the patient

feels.

Education and Anxiety

Current literature supports the idea that education can have a positive

effect on anxiety. Anderson (1987) studied 60 male coronary artery bypass graft
patients to determine what type of preparation is most effective for patients

Education’s Effects
8
undergoing cardiac surgery, by what mechanisms do preparations reduce
psychological distress, and whether psychological factors influence the incidence

of acute postoperative hypertension.

He found that the group receiving

information and the group receiving information plus coping mechanisms both had
lower levels of anxiety postoperatively. These groups also recovered faster than

the control group and had lower incidences of acute postoperative hypertension.

Oberle, Wry, Paul, and Grace (1990) studied the relationships between anxiety,
environment and postoperative pain and found that there was a strong relationship
between postoperative anxiety and pain (high anxiety associated with increased

pain).

Bowman (1992) studied the relationship between anxiety and the

development of postoperative delirium.

She found that the unplanned and

unexpected surgeries were associated with higher anxiety and higher postoperative
delirium rates, especially if the surgery was orthopedic in nature.

Cochran

(1984) conducted a review of the literature with regards to psychological

preparation of patients for surgical procedures. In her introduction she indicates
that hospitalization provokes more anxiety for the surgical patient than for the

medical patient. Her research indicates that patients who are given emotional
support and information about the procedure are more cooperative and have
smoother courses of recovery.

Education’s Effects
9

Preoperative teaching has been evaluated at different times.

Cuppies

(1991) studied the effects of providing preoperative education up to 14 days

before admission to the hospital and compared this group with one that received

education after their admission to the hospital.

She looked at preoperative

knowledge of coronary artery bypass graft surgery, postoperative anxiety,

postoperative mood state and physiologic recovery.

She found that the

experimental group, who received preoperative education prior to admission, did
report less postoperative anxiety, though the difference was not statistically
significant. Also, the experimental group had more positive mood states after
surgery and more favorable physiologic recovery states than the control groups.

Felton, Huss, Payne, and Srsic (1976) randomly assigned patients to three groups
which received preoperative education.

The frequency of postoperative

complications, ventilatory function, anxiety level, and patients’ perceptions of
psychological well being were assessed after the surgery.

The experimental

group, which received education about equipment used, various sites used for

surgery and so on, had significantly lower levels of anxiety and higher scores on
three measures of psychological well being than the other two groups. All three

groups were the same with regard to the number of postoperative complications

and measures of vital capacity. Brown (1990) measured anxiety pre and post

Education’s Effects

10
operatively in patients undergoing renal surgery and noted that the anxiety

experienced by the patients was related to the need for general anesthetic
preoperatively, and pain postoperatively.

She recommends providing more

preoperative information to decrease the anxiety patients experience.

Hathaway (1986) conducted a meta-analysis on 68 studies which examined

the effect of preoperative instruction on postoperative outcomes. The results
suggest that nurses need to assess the patients’ level of anxiety more closely and

adapt their preoperative teaching accordingly. She found that procedural content

should be provided when the patient has a lower level of fear/anxiety, and
psychological content should be provided when patients have higher levels of
fear/anxiety.

Hathaway also analyzed the way in which the teaching was

organized (structured and unstructured, individual and group), and found that
individual instruction that included aspects of both structured and unstructured
content was more favorable.

Thus, not only procedural content but also

psychological content should be included. Hathaway concludes that 67% of the

patients receiving preoperative instruction have more favorable outcomes, and
these outcomes are 20% better than those not receiving preoperative instruction.

Education decreases anxiety as demonstrated by the following journal

articles. Sheridan, Humfleet, Phair, and Lyons (1990) demonstrated that AIDS

Education’s Effects
11
education decreases anxieties of community leaders. Sigsbee and Geden (1990)

demonstrated that family members of patients who had coronary artery disease

and were hospitalized who learned CPR had decreases in their anxiety levels after
completing the CPR classes. Sirles, Brown, Hilyer (1991) found that depression,
anxiety, and perceptions of pain were decreased after patients with back injuries

attended a Back School.

Lockard (1989) found that nursing students who

participated in a death education instructional unit had reduced death anxiety as
compared to those nursing students who did not participate in the unit. This

result was maintained up to one year post study, as well. Hill and Balk (1987)
found that stress was reduced in families of the chronically mentally ill by

attending supportive education classes. Duryee (1992) conducted a literature
review dealing with inpatient education after a myocardial infarction and found

that, despite the anxiety associated with an MI, patients can learn new information
on risk factors, symptoms, home activity, and medications.

Several studies demonstrated no reduction in anxiety in the participants.
For example, Zeidner, Klingman, and Papko (1988) studied the effect of a health

education program on students’ test coping skills and found that, though the

program increased the teachers awareness of test anxiety, the students selfreported test anxiety did not decrease. This study was conducted in Israel. Peace

Education’s Effects
12

and Vincent (1988) studied death anxiety education in Hospice caregivers and

found that the level of death anxiety was no different from their non-Hospice
caregiver counterparts, even though the level of death education for the Hospice

caregivers was much higher.

Glass (1990) found that death education in

elementary schools did not affect the childrens’ death anxiety levels after the

education or two months later. Glass suggested that discussions of losses might
have interfered with the results, as death and dying education were not the only

topics covered. This study also may not be generalized due to the fact that the
study group was made up of children.
Besides preoperative education and educational classes, there are several

other forms of education which have been shown to exert an effect on anxiety.
Cassileth, Heiberger, March, and Sutton-Smith (1982) studied the effect of an

audiovisual cancer program on patients and families. They found that such a
program can increase the patients’ understanding of their disease, decrease
anxiety and improve communication between patients, families, and physicians.
Gagliano (1988) conducted a literature review of the efficacy of video in patient
education and found that video programs increase short term knowledge and

instruct as well as or better than other methods. When they are applied to "well-

defined, self-limited, stressful situations, video modeling decreases anxiety, pain

Education’s Effects
13
and sympathetic arousal while increasing knowledge, cooperation, and overall

coping ability." (p. 790). Stone, Wolraich, and Hillerbrand (1988) evaluated a
video training program for conveying distressful information. This information
related to Public Law 94-142, which deals with the education of all handicapped

children. Participants were asked to answer questions regarding self-efficacy,
anxiety and feelings toward working with parents of handicapped persons. They

were shown the videotape(s), depending upon which group the participants were

in.

The researchers found that the videos decreased anxiety related to

communicating distressful information to parents of handicapped persons.

Robertson, Gatchel, and Fowler (1991) used a videotape to prepare patients for
emergency oral surgery. Their groups were divided by sex into a treatment and

control groups, for a total of four groups. The results showed that men who
watched the treatment film had decreased anxiety (as measured by heart rate) than

men who watched a placebo film. The opposite effect was noted in the women;
the results showed decreased anxiety from the placebo film, not the treatment

film.

A study of 69 subjects by Friedman, Badere, and Fitzpatrick (1992)

showed that those participants who watched television prior to their surgery had
a significantly lower level of anxiety than those who did not. No particular

program was to be watched.

Education’s Effects
14
Hagopian (1991) assessed the effects of a radiation newsletter on patients.
This newsletter was used to convey information about radiation therapy to patients

receiving this type of therapy.

She found that the newsletter increased the

patients knowledge and self-care behaviors. Unfortunately, she did not assess
for its effect on anxiety, she only recommended that this be addressed in future
research.
Hartfield, Cason, and Cason (1982) conducted a quasi-experimental study

to examine the effects of sensory preparation (as opposed to procedural

information) for a threatening event (barium enema) on patient expectations and
emotional distress. They found that patients receiving sensory preparation for the

barium enema reported significantly less anxiety and expectations more congruent

with the actual experience than did those who received the procedural information
alone. In an earlier study, Hartfield and Cason (1981) looked at the effect of
information on emotional responses during a barium enema and found that the
participants who received sensation information reported less anxiety than those
who received no information or procedural information. Sime, and Libera (1985)

also evaluated sensation information with regards to dental surgery.

Subjects

were placed in one of four groups; sensation, sensation and self-instruction, selfinstruction, and control. An audiotape provided all information. The results of

Education’s Effects
15
this study showed that patients with high anxiety reported less tension and distress

during surgery after receiving sensation information, less tension after receiving

self-instruction information, and increased use of positive self-statements with a
combination of information. Low anxiety patients did not benefit from treatment.
In

another study, Fullhart (1992) compared information given before

sigmoidoscopy and anxiety and found that there was no difference in anxiety
levels of patients before and after being given procedure information when

compared with anxiety of those who received both procedure and sensation
information. These results may be related to the size of the sample, according
to the author.
Toth (1980) examined the effect of structured preparation for transfer on

patient anxiety. She compared structured with unstructured information that was
given to stable myocardial infarction patients. Though the subjects who received

teaching did not report feeling less anxious, the measurements of systolic blood
pressure and heart rate on the day of transfer and at the time of transfer were

significantly lower for the structured group.
Anderson and Masur (1989) looked at psychological preparation of patients
undergoing cardiac catheterization. Subjects were assigned to one of five groups:

sensory-procedural information, modeling, cognitive-behavioral coping skills,

Education’s Effects

16
modeling plus coping skills, or control. The results showed that modeling and
modeling plus coping skills were the most effective preparatory strategies.
Subjects in these groups reported less subjective anxiety, and greater perceived

coping skills. The information group did not differ from the control group in
these areas. Peterson (1991) studied cardiac catheterization patients as well. She
looked at anxiety before a catheterization. Subjects were placed in one of three

groups: educational intervention, social intervention, and control. Sensory and
procedural information was provided to the education group. The social group

spent the time "chatting" with the researcher. Results of this study showed no
difference between the educational and social groups. The author suggests the

patients’ anxiety level may be lessened by having a support person present and
she advocates further research in this area.

A variety of other articles exist that discuss outpatient procedures,
education, and anxiety.

Allen, Knight, Falk, and Strang (1992) studied the

effectiveness of preoperative teaching for cataract patients. They found that a

home based education program was as effective as teaching done in the hospital
in preparing patients for cataract surgery. Though not statistically significant,
there was also a decrease in preoperative anxiety after the teaching program was

completed. Hill, Baker, Warner, and Taub (1988) studied the use of a videotape

Education’s Effects
17
in teaching the pre-cardiac catheterization patient. Two groups were used, one
to view the videotape and the other received the information via an interview.

The results showed that both groups had lower anxiety scores following

instruction and the scores did not differ between groups. The authors suggest
using both the video and the interview together to prepare patients for cardiac

catheterization. Warner, Peebles, Miller, Reed, Rodriquez, and Martin-Lewis
(1992) studied the effectiveness in teaching a relaxation technique to inpatients
undergoing elective cardiac catheterization. This study found that anxiety scores

decreased for both the experimental and the control groups after the cardiac

catheterization, with the decrease statistically significant only for the experimental
group. The authors believe this to be due to the relaxation technique. Finesilver

(1978) found that patients who received preparatory sensory information before
their first cardiac catheterization were significantly less distressed during the
procedure than patients who received the usual care. Verderber, Shively, and

Fitzsimmons (1992) noted in their study that modeling preparation was more
effective than an information intervention for cardiac catheterization patients.

Kendall, Williams, et al (1979) studied cognitive-behavioral and patient education
interventions in cardiac catheterization patients. The patient education and the

cognitive-behavioral groups had significantly lower state anxiety scores than the

Education’s Effects
18
control groups. These two groups had received formal training in relaxation or

procedural information related to cardiac catheterizations.

Conceptual Framework

In dealing with an individual with the potential for a crisis, Aguilera and

Messick (1974) advocate assessing the individual for his perception of the event,

his coping mechanisms, and the available situational support to determine if the
person is in crisis (p. 55-65). Roy (1984) believes in assessing the individual in

all four modes (physiological, self concept, role function, and interdependence)
to determine which is most disrupted by anxiety. Roy advocates a three-step

process of goals and interventions that will help promote adaptive behavior. The

first goal is for the individual to realize that he or she is anxious. The second

goal is for the individual to identify the source of his or her anxiety. The third
goal is for the individual to be able to cope with his or her anxiety (p. 365-66).

These two theories compliment each other in that nurses need to make sure that

the individual has a realistic perception of the event causing the anxiety, and that
the individual is able to cope with the anxiety.

Besides using open ended

questions and providing an environment of trust, the goals of both theories can

Education’s Effects
19

be reached by providing the individual with the necessary information about the
situation and about alternate coping mechanisms. Kendall, Williams, et al, (1979)

stated in their study of education interventions in cardiac catheterization patients
that "invasive medical procedures can be viewed as crises because there is often
inordinant stress and acute elevations of anxiety. Supplying the patient in crisis

with effective methods to deal with stress should also improve the patient’s
behavior and adjustment during the medical procedures themselves." (p. 49).

Education’s Effects
20
Chapter ni

Methodology

This correlational study was done to determine what effect education has
on the anxiety levels of outpatient cardiac catheterization patients. The purpose

of this study was to determine the effect that education, provided prior to the

cardiac catheterization, had on pre-cardiac catheterization anxiety.

Sample and Setting

The sample for this study was a convenience sample consisting of 16 male
outpatients who underwent their first cardiac catheterization. The setting was the
Pre-Admission Teaching and Testing area. This area was open from 7:00 am
until 9:00 pm Monday through Friday. Appointments were made by the Primary
Physician’s office staff for each patient that is to have a procedure done at this

hospital. These patients come to the Pre-Admission area on the day of thenappointment to have all pre-operative tests completed. Pre-operative teaching
takes place at this time as well.

For the out patient cardiac catheterization

Education’s Effects
21

patients, this teaching includes information about the One Day Stay unit, as well
as the procedure. The One Day Stay unit of this medium sized not for profit

hospital located in the Northeastern United States has 48 beds and operates five
days a week, Monday through Friday, from 5:00 am to 9:00 pm. Patients were

admitted the morning of their procedure and discharged the same day, several
hours after the procedure was completed.

The Cardiac Catheterization

Laboratory was located in the same hospital, one floor below the One Day Stay

unit.

Instrumentation

The instrument used for this study was the State-Trait Anxiety Inventory

(STAI) Form Y by Spielberger and Gorsuch (1983) (Appendix B). The first form
was developed in 1964, when the authors set out to create "a single set of items
that could be administered with different instructions to provide objective

measures of state and trait anxiety.” (Spielberger, 1983, p. 12) The questions on
both the state and trait anxiety forms were obtained from an item pool. Each of
these items was related to other measures of anxiety, most commonly trait

anxiety.

In order to measure state anxiety, the items in the item pool were

Education’s Effects

22
rewritten by the authors. The result was Form A. While studying the validity

of the form, the authors discovered that some items measured both state and trait
anxiety without distinguishing between them, some items were not clearly

understood, and some items could not be used when the instructions were altered.
In the next format, Form X, the authors chose items with the "best psychometric

properties" (Spielberger, 1983, p. 12).

Standardization and validity testing

involved approximately 6800 people, including high school and college students,

neuropsychiatric and medical and surgical patients, and prison inmates.

The STAI is a 40 item self evaluation questionnaire made up of two
twenty item sub scales, the State Anxiety and Trait Anxiety scales. Spielberger

(1983) defines them in the following manner: "The Trait Anxiety scale refers to

the differences between people in the tendency to perceive stressful situations as
dangerous or threatening and to respond to such situations with increases in the

intensity of their State Anxiety reactions." (p. 1) The items in each scale assess
anxiety as being either present or absent within the individual. In Form X, the

State Anxiety scale had equal numbers of the anxiety present and absent items.
The Trait Anxiety scale did not (thirteen anxiety present and 7 anxiety absent

items).

In 1980, Spielberger administered Form X with twelve potential

replacement items to high school students. The results led to the replacement of

Education’s Effects
23

six items in each scale with items of "equal or better psychometric properties and

content that was more consistent with our concepts of state and trait anxiety"
(Spielberger, 1983, p. 13). This became Form Y, which is the present form.

Reliability and internal consistency tests for Form Y are based on two

groups of high school students. The results as reported by Spielberger (1983) are

as follows:
stability, as measured by test-retest coefficients, is relatively high

for the STAI T-Anxiety scale and low for the S-Anxiety scale, as

would be expected for a measure assessing changes in anxiety

resulting from situational stress. The internal consistency for both
the S-Anxiety and T-Anxiety scales are quite high as measured by
alpha coefficients and item-remainder correlations. The internal
consistency for Form Y is slightly higher than for Form X, which
has resulted from replacement of the items in the earlier form.” (p.

14).

The overall median alpha coefficients for the two scales in Form Y in the
normative samples are higher than those for Form X, as well.

Validity testing of the STAI occurred on two levels. The validity of the
individual items was determined by administering the test to undergraduate

Education’s Effects
24

college students in four settings: regular classroom, after relaxation training,
following a difficult IQ exam, and after viewing a stressful movie. The item­
remainder correlation coefficients for each of the State-Anxiety (S-Anxiety) items

were higher for the more stressful conditions than the relaxed conditions. As

they relate to the Trait-Anxiety (T-Anxiety) items, the correlations for the SAnxiety items were slightly higher.

Concurrent, convergent, divergent, and construct validity research was
reported in six areas: contrasted groups, correlations between S-Anxiety and T-

Anxiety scales, correlation of the T-Anxiety with other measures of trait anxiety,
correlation of the STAI scales with other common measures of personality and

adjustment, correlations of the STAI scales with measures of aptitude and
achievement, and investigations of the effects of different amounts and types of

stress on the S-Anxiety scores. For the contrasted groups, the higher T-Anxiety

scores in neuropsychiatric patients proves it can discriminate between normals

(working adults and students) and psychiatric patients for whom anxiety is a
major symptom. T-Anxiety scores were lower in a character disorder group for

whom absence of anxiety is an important symptom, as compared with the norms,
and S-Anxiety scores were higher in military recruits who recently began stressful
training programs versus scores of college and high school students who were

Education’s Effects

25
tested under non-stressfiil conditions. These results support the construct validity

for the STAI. Correlations between the S-Anxiety and T-Anxiety scales show the

results to be higher under conditions that pose a threat to self esteem or personal
adequacy, and are lower in situations involving personal danger. Changes in SAnxiety because of physical danger appear unrelated to the level of T-Anxiety.

The T-Anxiety scale correlates highly with the IPAT and the Taylor Manifest
Anxiety Scale, which demonstrates evidence of concurrent validity. The STAl

was correlated with the Minnesota Multiphasic Personality Inventory, the Cornell

Medical Index, and the United States Army Beta intelligence test and indicate
comparable correlations between the MMPI and STAl, and high correlations for

both the T-Anxiety and S-Anxiety scales and the Cornell Medical Index. Several

other tests were also compared with the STAI and demonstrate positive
correlations.

There was no relationship between the STAI and the Beta test,

which means that STAI is not related to measures of intelligence or scholastic

aptitude. There is no relationship between the STAI and academic aptitude and

achievement, as Spielberger demonstrated using scores from Florida’s Statewide
Twelfth Grade Placement test and College Entrance Examination scores.

Spielberger conducted several studies to look at the effect of stress on the SAnxiety scale. He noted S-Anxiety scores were higher in exam conditions than

Education’s Effects

26
for normal conditions, regardless of the participants sex. These results were
repeated in subsequent studies, further supporting the construct validity of the
STAI.

Numerous studies have used the STAI in research or in studies that further
support its reliability and validity.

These were most recently compiled and

published by Spielberger in The State-Trait Anxiety Inventory: A Comprehensive
Bibliography (1983).

Permission to use the STAI was obtained from the author by ordering it
from Consulting Psychologists Press, Palo Alto, California. The cost was $12

for the manual and test booklet, $7 for the scoring key and $16 for the booklets
needed for the data collection. (Appendices A and B)

Collection of the Data

The participants were approached by the investigator at the time of
admission and asked to participate in the study. AU potential participants had
cardiologists who are members of the same practice. The primary cardiologist

in the practice was contacted and his permission to approach patients in the

group’s practice with regards to taking part in this study was obtained (Appendix

Education’s Effects

27
C). The study was explained to them as being a part of a graduate student’s

degree requirements. Each participant was assured of the confidentiality of their
results, and informed that they would receive pre-procedure education whether

they participated in the study or not. If they agreed to participate, a consent form
was signed. (Appendix D) After signing the consent form, the participants were
given the STAI to complete. The investigator reviewed the written instructions

with each participant prior to them taking the test. After the STAI was completed
and returned to the instructor, the participants were given the cardiac education
booklet (Appendix E) and shown the cardiac catheterization film. The booklet

reviews cardiac catheterization, the tests done prior to the catheterization,
significant definitions, anatomy and physiology, what happens before, during and

after the test, and what will happen when they return to their room. The film,
produced by the hospital, walks the patient through the cardiac catheterization,
showing the patient the catheterization laboratory and another patient undergoing

the procedure while the narrator describes what the patient may feel (numbness,

heat, pain) and what the patient can do to cope with these sensations and feelings

(deep breaths, visualization). At the completion of the video, the participants are
asked to retake the STAI, which was then collected by the investigator.

Education’s Effects
28

Analysis of Data

Each STAI item has a weighted score of one to four. For ten S-Anxiety

and eleven T-Anxiety items, a rating of four indicates a high level of anxiety
(anxiety-present). A high rating of four for the remaining ten S-Anxiety and nine

T-Anxiety items, indicates the presence of low anxiety (anxiety-absent). This

occurs because the weights for the anxiety absent items are based on a reversed

Likert scale (response #1=4 points). The anxiety-absent items for the S
Anxiety scale are numbers 1, 2, 5, 8, 10, 11, 15, 16, 19, 20. The anxiety-absent
items for the T-Anxiety scale are numbers 21, 23, 26, 27, 30, 33, 34, 36, 39.

Scores are obtained by adding the totals for each item on the scales together.

Scores can range from 20 to 80.

Norms for the STAI were established by

Spielberger and are listed in the test manual. A Student’s t-Test was used to
analyze the pre to post test differences in the scores for both State and Trait
Anxiety.

Education’s Effects
29

Chapter IV

Presentation of Data

The purpose of this study was to determine the effect that education,
provided prior to the cardiac catheterization, had on pre-cardiac catheterization

anxiety. Over a seven month period of time, a convenience sample consisting of
16 white males between the ages of 30 and 65 were interviewed and agreed to
participate in the study. Their average age was 52.13. Each participant lived

within the tri-state area, and traveled 60 miles or less to keep their appointment
in the Pre-Admission area. Of the 16, only 14 of the STAI surveys could be

used. One gentleman did not complete the entire post test and the responses of

a second gentleman were not used due to his learning handicap (his father
completed the pretest and post test for him). Each of the answer sheets was hand
scored using the STAI answer sheet. This answer sheet takes into account the

weighing of each question, and the individual scores are based upon the weighing
scale discussed earlier. Each person ended up with four separate scores; a pretest

State Anxiety score, a pretest Trait Anxiety score, a post test State Anxiety score,
and a post test Trait Anxiety score. The pre and post test State Anxiety scores

Education’s Effects
30
were compared to each other, as were the pre and post test Trait Anxiety scores.

Table 1 summarizes the data collected. Table 2 lists the State Anxiety statistical

results from pre to post test. Table 3 lists the Trait Anxiety statistical results
from pre and post test.

Analysis of Data

The purpose of this study was to determine the effect that education,
provided prior to the cardiac catheterization, had on pre-cardiac catheterization

anxiety. The study was set up as a repeated measures design. This design allows
for the same group to act as its own control. The test was given to the members
of the group before and after the experimental procedure. This ensures that both
groups are equal. The statistical test used to analyze the data was the two-tailed
Student’s t-Test. This test was designed for small sample sizes.
In order to test for significance with the smaller sample size, the Student’s

t-Test can be used. This test looks at the t distribution, instead of the normal

curve. The t distribution looks very much like the normal curve, except that as
sample sizes get smaller the curve becomes narrower and taller in the middle

(leptokurtic). This results in the tails being higher, and one must go farther out

Education’s Effects
31
to find t values that correspond to the 5% and 1% areas in the distribution. As

the sample size gets larger the curve looks more like the normal curve. When

a sample size of 30 is reached, the curves are almost identical. As the sample
size gets smaller, the curve becomes more leptokurtic. This means that a larger

t value is needed to reject a null hypothesis. Significance is determined by using
the degrees of freedom (df) and the t value of the sample size and comparing
them to the t table.

The t table lists the t values which must be equaled or

surpassed for the usual significance levels of .05, .01, and .001 for various

sample sizes, using degrees of freedom.
Several assumptions are associated with the Student’s t-Test (Bartz, 1976).
They are:

1. The scores must by interval or ratio in nature; 2. The scores
must be measures on random samples from the respective

populations; 3. The populations from which the samples were
drawn must be normally distributed; 4. The populations from
which the samples were drawn must have approximately the same

variability (homogeneity or variance), (p. 253)
Before the t value can be looked at as significant, the above assumptions must be

met.

Education’s Effects
32

In Table 2 and Table 3, the statistical test results for the State and Trait
Anxiety are listed. In order for the t value to be significant at the .05 level a t
value of 2.160 was needed. The t value for State (S) Anxiety was .10 and for

Trait (T) Anxiety -.38. This test was two-tailed so that both positive and negative
t values would be calculated. The results were not significant, which supports the
null hypothesis of there is no difference between pretest and post test scores for
State or Trait Anxiety.

Education’s Effects
33
Table 1
Number of Valid Observations

Variable

Mean

SD*

Min

Max

N

State Anxiety

40.07

9.22

23

54

14

Label
State Anxiety-

Pretest
Trait Anxiety

34.71

7.80

27

53

14

Trait Anxiety-

Pretest

State Anxiety

39.93

8.93

23

53

14

State AnxietyPost Test

Trait Anxiety

35.14

8.76

20

51

14

Trait Anxiety-

Post Test
*SD—Standard Deviation

Education’s Effects
34

Table 2
Paired Samples Student’s t-Test-State Anxiety
Variable

N

Mean

Standard

Standard

Deviation

Error

Pretest

14

40.0714

9.219

2.464

Post Test

14

39.9286

8.931

2.387

Results
Mean

.1429

SD*

5.376

SE*

1.437

*SD—Standard Deviation

SE-Standard Error
df—Degrees of Freedom

Corr

.825

2 Tail

t

Prob

Value

.000

.10

df*

2 Tail
Prob

13

.922

Education’s Effects
35

Table 3

Paired Samples Student’s t-Test-Trait Anxiety
Variable

N

Mean

Standard

Standard

Deviation

Error

Pretest

14

34.7143

7.800

2.085

Post Test

14

35.1429

8.761

2.341

Results

Mean

-.4286

SD*

4.256

SE*

1.137

*SD—Standard Deviation

SE—Standard Error
df—Degrees of Freedom

Corr

.874

2 Tail

t

Prob

value

.000

-.38

df*

2 Tail

prob
13

.712

Education’s Effects
36

Chapter V

Conclusion

The purpose of this study was to determine the effect that education,
provided prior to the cardiac catheterization, had on pre-cardiac catheterization

anxiety.

In response to the research question, is there a positive correlation

between patient anxiety levels in outpatient cardiac catheterization patients before
they receive education and their anxiety levels after the education has been

provided, the following was noted. There was very little difference in the SAnxiety scores from pre to post test, though there was a slight decrease. The
decrease was not enough to demonstrate significance, even with a sensitive test

for small sample sizes.

The decrease is supported by the literature. In the

review of literature for this study, education was noted to decrease anxiety levels
in a statistically significant manner (Anderson, 1987; Oberle, et.al., 1990;

Bowman, 1992; Cochran, 1984; Felton, et.al. 1976; Sheridan, et.al., 1990;
Sigsbee and Geden, 1990; Sides, Brown, and Hilyer, 1991; Ixickard, 1989; Hill
and Balk, 1987; Duryee, 1992).

However, Cuppies (1991) reported that the

experimental group in her study experienced less anxiety post operatively, but that

Education’s Effects
37
this decrease was not staUstic.fi, significant. Her stud, invoiced preoperadve

education, offered at various times prior to the procedure, and anxiety. She

surmises that the preoperative level of anxiety for CABG patients was so high that
nothing would bring it down and concludes by recommending that the study be

repeated. Several other studies found no reduction in anxiety after education was
provided. Zeidner, Klingman, and Papko (1988) attribute the lack of significant

reduction in test taking anxiety to the possibility that the students transferred some
of the skills learned in the program to performance. As a result, performance
improved but test taking anxiety did not decrease. Peace and Vincent (1988)
suggested that the return rate of the questionnaires, sending of the questionnaires

in the mail versus personal interviews and using ANA members as the source of

the sample may have contributed to the lack of significance in death anxiety levels
between Hospice Care Nurses (HCN) and Technical Care Nurses (TCN). They
further speculated that differences in the education level of HCNs and TCNs

might have had an effect on death anxiety levels and they recommend further
research along this line. Glass (1990) found no change in the death anxiety
scores of children after the death education classes. This he attributed to the fact

that many losses were discussed in the class, not just death and dying. Also,
there was the possibility that Ute following could have influenced the results: two

Education’s Effects
38
weeks was not enough time for the study, that students realized they very
dependent on their parents and fear the death of these people, and the students

interacted with each other during the course of the school day.

He also

recommends further study.

The T-Anxiety scores increased slightly from the pre- to the post test,
although this difference was not statistically significant. The T-Anxiety score

measures general anxiety. The education the participants received would not be
expected to affect it.

Essentially, the change indicates the participants rated

themselves as more anxious in general after they saw the video. This result was

not anticipated and was not supported by the literature.
Several factors could play a part in these results. The sample was not a
true random sample; it was a convenience sample since only those males who
came through the Pre-Admission Unit who met the criteria and agreed to
participate in the study were interviewed. The sample was not large enough, and

results cannot be generalized to the larger population. A Type II sampling error
should be considered. There was no way to guarantee that all patients scheduled

to have an outpatient cardiac catheterization would or actually did come to the

Pre-Admission area for their tests and teaching.

This would affect the sample

from which the participants were obtained. The design of the study, also, did not

Education’s Effects
39
control for the Hawthorne effect.

Recommendations

The purpose of this study was to determine the effect that education
provided prior to the cardiac catheterization, had on pre-cardiac catheterization

anxiety. A positive correlation was noted between the participants’ State Anxiety

test scores before they received education and their post test scores. The Trait
Anxiety scores were increased from pretest to post test. Neither of these results

were statistically significant. Listed below are the recommendations based upon
these results.

1.

This study should be repeated with a larger sample of males in the

same situation.

2.

All outpatient cardiac catheterization patients should be considered

for the sample.

3.

Random sampling technique should be used.

4.

This study should be repeated with women in a similar age group

who are outpatients undergoing their first cardiac catheterizations.

There were some

benefits to this study in that it helped to identify a

Education’s Effects
40

process problem for the Pre-Admission Unit and the physician office.

This

problem is being addressed by the Unit Nurse Manager and several others. The

study was able to show that education has an effect on anxiety, as demonstrated
by the slight decrease in S-Anxiety scores.

Appendix A

January 25, 1994

Consulting Psychologists Press
P.O. Box 10096
Palo Alto, CA 94303-0979

Dear Sir or Madam;
I am a student at Edinboro University of Pennsylvania in their graduate Nursing program. My
thesis, at this time, focuses on Education’s Effects on Anxiety in Outpatient Cardiac
Catheterization Patients. I would like to utilize the State-Trait Anxiety Inventory (STAI) as my
tool. The STAI would not be altered or adapted in any way, and would be given to patients
before they receive any education about the catheterization procedure and then immediately after
they receive education about the procedure. Given this information, I would like to request your
permission to use this tool. As directed, my Thesis committee chairperson, Dr. Mary Lou
Keller, has signed this letter at the bottom.
In anticipation of receiving your permission, I would like to order the following items:
Cost
Description
Quantity
Item #
$12.00
Manual and Test Booklet
1
#4201
$7.00
1
Scoring key
#4206
$16.00
50
Test Booklets
#4217

Shipping and Handling
Total (enclosed)

$3.50 (10% of total)
$38.50

I hope that this letter meets your requirements and that you will send the above material as soon
as possible to the address listed below. If the information I have provided is not complete,
please let me know so that I may send the missing information to you. My home and work
phone numbers are included for your convenience. Thank you for your help.

Sincerely,

Diann C. Cooper, RN
6500 Avonia Road
Fairview, PA 16415
phone: (H) 814-474-3188
(W) 814-877-3540

Dr. Mary Lou Keller, RN, Ph.D.
Edinboro University of Pennsylvania

SELF-EVALUATION QUESTIONNAIRE
Developed by Charles D. Spielberger
in collaboration with
R. L. Gorsuch, R. Lushene, P. R. Vagg, and G. A. Jacobs
STAI Form Y-l

Name
Age

Date
Sex: M

S

F

DIRECTIONS: A number of statements which people have used to
describe themselves are given below. Read each statement and then
blacken in the appropriate circle to the right of the statement to indi­
cate how you feel right now, that is, at this moment. There are no right
or wrong answers. Do not spend too much time on any one statement
but give the answer which seems to describe your present feelings best.

T___

•x'
®

1. I feel calm

©

©

2. I feel secure

©

©

3. I am tense

©

©

©

®

4. I feel strained

©

©

©

®

5. I feel at ease

©

©

©

®

6. I feel upset

©

©

®

7. I am presently worrying over possible misfortunes

©

©

® ©

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

©

®

©

8. I feel satisfied
9. I feel frightened

10. I feel comfortable

11. I feel self-confident
12. I feel nervous
13. I am jittery

14. I feel indecisive
15. I am relaxed .. .
16. I feel content

17. I am worried

..

18. I feel confused . . .
19. I feel steady

©

®

.. -

20. I feel pleasant

Consulting Psychologists Press, Inc.
3803 E. Bayshore Road • Palo Alto, CA 94303

SELF-EVALUATION QUESTIONNAIRE
STAI Form Y-2

Name

DIRECTIONS: A number of statements which people have used to
describe themselves are given below. Read each statement and then
blacken in the appropriate circle to the right of the statement to in­
dicate how you generally feel. There are no right or wrong answers. Do
not spend too much time on any one statement but give the answer
which seems to describe how you generally feel.

Date

X.-4

*p

21. I feel pleasant

©

®

®

22. I feel nervous and restless

©

®

®

23. I feel satisfied with myself

©

®

®

®

24. I wish I could be as happy as others seem to be

©

®

®

®

25. I feel like a failure

®

®

®

®

26. I feel rested

©

®

®

®

27. I am “calm, cool, and collected”

®

®

®

®

28. I feel that difficulties are piling up so that I cannot overcome them

©

®

®

®

29. I worry too much over something that really doesn’t matter

©

®

®

®

30. I am happy

©

®

®

®

®

@

®

31. I have disturbing thoughts

®

32. I lack self-confidence

©

®

®

®

33. I feel secure

©

®

®

®

34. I make decisions easily

®

®

®

35. I feel inadequate

®

®

®

36. I am content

©

®

®

®

37. Some unimportant thought runs through my mind and bothers me

©

®

®

®

®

®

®

®

®

®

®

®

®

38. I take disappointments so keenly that I can’t put them out of my
mind .. .

39. I am a steady person

©

40. I get in a state of tension or turmoil as I think over my recent concerns

and interests . ..

Copyright 1968. 1977 by Charles D. Spielberger. Reproduction of this test or any portion thereof
by any process without written permission of the Publisher is prohibited. Sixteenth pnnttng.

Education’s Effects
44

Appendix C

Physician Approval

I have been approached by Diann Cooper for permission to ask patients
in my group’s practice to be included in her graduate research study. The
purpose of this research investigation is to determine the effects pre-procedure
education has on outpatient cardiac catheterization patient’s anxiety.

The study will take place in the Pre-Admission Teaching and Testing
(PATT) area. Our first time cardiac catheterization outpatients who go to this
area prior to their catheterization will be asked to sign an informed consent in
order to participate in this study.
I give Diann Cooper, BSN, permission to ask our patients for thenconsent to participate in this study.

Physician Signature

Education’s Effects
45

Appendix D

Informed Consent
I understand that I am being asked to be a part of a study to determine the
effect that education given the outpatient cardiac catheterization patients has upon
their anxiety level prior to the cardiac catheterization.
I understand that I have the right to refuse to be a part of this study and
that if I refuse, it will not change how the nurse cares for me. I also understand
that I have a right to withdraw from this study at any time.
I understand that my confidentiality will be maintained and that I will be
given a code number known only by the investigator. I also understand that the
result will be reported as a part of a group and that I may contact the
investigator, Diann Cooper, at 877-3540 if I want the results of the study.
By signing my name below, I am showing that I have read and understood
the above information and that I give my consent to volunteer as a research
subject in this study.

PATIENT SIGNATURE

DATE

INVESTIGATOR SIGNATURE

DATE

Appendix E

CARDIAC CATHETERIZATION

left coronary
artery

left
main
circumflex

right
coronary
artery '

J

-9 ¥

u

r

.octuse
marginal

Inside
Heart

s

left
? /
anterior
descending

aortic
valve

posterior
descenoing

mitral
valve

Outside Heart

pulmonary
vatve
tncuspid
valve

CARDIAC CATHETERIZATION
WHAT IS A CARDIAC CATHETERIZATION?
Cardiac Catheterization is a test used to discover any abnormalities in
your heart valves, chambers, major blood vessels, or fatty deposits in the
coronary arteries. It is not surgery. Some people may call it different
names: ■ 'Coronary Arteriogram", ■ "Coronary Angiogram", ■ "Dye
study of the Heart". These all refer to the same test.

WHAT IS THE PREPARATION FOR A CARDIAC
CATHETERIZATION?
A.
Your doctor must know if you:
1.
Are allergic to any medication, x-ray dye (contrast media)
or food.
2.
Are or may be pregnant.
Cannot be flat on your back for long periods of time.
3.
Have trouble urinating when you are lying down or have
4.
been told you have prostate disease.
Have
glaucoma.
5.
Have been taking aspirin, products containing aspirin or
6.
blood thinners such as coumadin.
Are a diabetic and if you take insulin.
7.
Have or are being treated for infections in any part of your
8.
body.
Have had a previous cardiac catheterization.
9.
Before the test, you may have:
B.
A chest x-ray.
1.
An EKG.
2.
Several routine blood tests.
3.

4.
5.
6.

c.

An IV started.
An examination by the cardiologist (heart specialist).
Hair shaved on your arm or groin.

You should not have anything to eat or drink after midnight the
night before your catheterization.

A consent must be signed showing that you understand the procedure and
give your informed consent for it to be done. Ask questions and make
sure you understand the test before you sign the consent form.
A Cardiac Catheterization film is available on the patient education
channel. Your nurse can tell you the times it is to be shown.

WHAT HAPPENS BEFORE THE TEST?
You will be given medication to relax you before you go for the test.
You will then be taken to the holding area of the Cardiac Catheterization
Laboratory.
Your chart will be reviewed and you will be asked a few questions about
how you feel, allergies and past illnesses.

You will then be taken to the procedure room, placed on an x-ray table
and prepared for the test.

Three staff members will be with you in the procedure room. One will
assist the doctor, one will take care of you, answer your questions and
collect data, and one will be responsible for your x-ray pictures.

WHAT HAPPENS DURING THE TEST?
A.
Medicine will be injected to numb your skin (either at the bend in
your elbow or in your groin).

B.

A long thin flexible tube called a catheter will be placed in a blood
vessel and then guided to your heart. The catheter may be placed
in either arteries
------- s or veins, depending on what information is
needed.

C.

A special medicine called contrast dye or contrast media will be
injected through the catheter into the blood vessels and heart
chambers. You will feel warm all over when this is injected. The
contrast medium makes it possible to see inside the vessels and
heart chambers. Blockages or narrowings in the vessels can be
seen. Their location is documented on movie film. The heart
muscle’s ability to pump, the function of the valves between the
heart chambers, and narrowings in the coronary arteries can be
seen during cardiac catheterization.

WHAT HAPPENS AFTER THE TEST?
After the test is over, you will be taken back to the holding area
A.
where:
Your blood pressure will be checked.
1.
The catheter will be removed.
2.
Pressure will be held over the puncture site until the
3.
bleeding stops.
A dressing will be applied to the puncture site.
4.
Your
pulses below the puncture site will be checked.
5.
You will be given post procedure instructions.
6.

B.

C.

An orderly will take you back to your room. You will be gone
from your nursing unit for 1 1/2 to 2 hours.
WE REQUEST THAT YOUR FAMILY/VISITORS REMAIN
IN YOUR ROOM DURING THE PROCEDURE. This will
enable us to reach them if that should become necessary. The
doctor will come to your room to give you and your family the
results of your test when he has had the opportunity to view the
final films.

WHAT HAPPENS BACK IN MY ROOM?
The nurse will examine the puncture site, check your pulses and take
your blood pressure.
If your groin area was used, you will be asked to stay in bed for up to
6 hours, keeping your leg straight (This will prevent bleeding). A
sandbag may be placed on your groin site to remind you to keep that leg
straight.

If your arm was used, bed rest will not be necessary, but you will need
to keep your elbow straight for 6 hours (This will prevent bleeding).
You can eat and drink after the test is over.

Contrast dye is passed out of your body through the kidneys. Extra
fluids will help your kidneys get rid of the dye. There will not be a
change in the color of your urine.

Please talk to your doctor or nurse if you have any questions about this
test.

FOR YOUR INFORMATION:
A.
DEFINITIONS1.
VEINS- vessels that carry blood from the body back to the
right side of the heart.

B.

2.

ARTERIES - vessels that carry blood that has been pumped
out of the heart to the rest of the body.

3.

CORONARY ARTERIES - vessels that carry blood to the
muscle of the heart.

4.

VALVES - valves are located between the heart chambers
to keep the blood moving forward through the heart.

5.

CONTRAST MEDIUM - a clear injectable liquid, usually
called DYE, that x-rays can not penetrate (see through).

6.

CORONARY BLOCKAGES - a condition which results
from the buildup of fatty deposits in the walls of an artery
in the heart.

ANATOMY AND FUNCTION The heart is a four chambered muscular organ which
1.
functions as a pump.
2.

The heart muscle receives oxygen and nutrient rich blood
supply from the coronary arteries.

3.

The volume of blood that the heart is able to pump to the
body depends upon the strength of the heart muscle’s
contractions.

4.

Blockages and narrowing in the coronary arteries decrease
the amount of blood that the heart muscle receives.

5.

Angina (heart pain) may also be felt when the heart muscle
is not receiving a full blood supply.

6.

The heart’s strong pumping action can be weakened when
there are blockages and narrowings. A tired feeling results.

7.

Weakness, fluid in the lungs and shortness of breath may
result when heart valves are narrowed or leaking.

8.

Cardiac catheterization gives your doctor the information he
needs to diagnose and recommend treatment for your
specific cardiac problems.

QUESTIONS I WANT TO ASK MY CAREGIVER...

PATIENT EDUCATION COMMITTEE
njv/PTED/044
7/93

Education’s Effects
47
References

Aguilera, D. C. & Messick, J. M. (1974). Crisis Intervention: Theory and

Methodology. St. Louis: C. V. Mosby Company.
Allen, M., Knight, C., Falk, C., & Strang, V. (1992). Effectiveness of a
preoperative teaching program for cataract patients. Journal of Advanced

Nursing, 17, 303-309.

Anderson, E. A. (1987). Preoperative preparation for cardiac surgery facilitates
recovery, reduces psychological distress, and reduces the incidence of
acute postoperative hypertension. Journal of Consulting and Clinical

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