@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2015;21(3):147-153

Background
… [1-5] Trait anxiety indicates personal anxiety and state anxiety shows personal situational anxiety [6]. … [7-9] Guided visualization as a mind-body technique is based on the assumption that the mind and body are linked together and can affect each other for treatment of diseases and creation of health [10]. The guided visualization is a strategy that emphasized on centralization and the use of images, sights, sounds, music and words can create the feelings of power and relaxation [11].
Previous Studies
Through creation of competitive centralization, visualization reduces pain, stress, anxiety and depression, and it increases the feeling of well-being [12]. … [13] Visualization has been known as a technique for controlling pain for treatment of arthritis, fibromyalgia, cancer, headache, acute and chronic pains and other medical condition [14]. All three methods of indoctrination, visualization and talking are effective in reducing anxiety, but talking has been more effective than others [7]. Guided visualization reduces the treatment cost, anxiety, length of hospitalization and increase the rate of satisfaction [15]. Guided visualization has not been effective on reducing pain and anxiety after surgery, but there is a direct relationship between anxiety and postoperative pain [4].
Aim(s)
This study aimed to investigate the effect of guided visualization on anxiety in patients with acute coronary syndrome admitted to the cardiac intensive care unit.
Research type
This study is a clinical trial.
Research society, place and time
Patients with acute coronary syndrome in the cardiac intensive care unit in 22 Bahman hospital, in Gonobad city, Iran, were studied in 2014.
Sampling method and number
Samples were selected through available sampling method and randomly divided into two control and experimental groups using permutated- blocks randomization with 25 blocks of two patients.
Used devices&materials
After a pilot study on 10 participants (5 participants of control group and 5 participants of experimental group), based on a formula for comparing the mean of two independent groups, the sample size was calculated 19 participants for each group for the variable of anxiety in Spielberger State Anxiety Inventory. Inclusion criteria were: consent of patients for participation in the research, definitive diagnosis based on clinical symptoms, electrocardiography, and the diagnosis of the heart specialist doctor , having heart attack for the first time, having the age between 30 and 80 years, no consumption of antiarrhythmic drugs during hospitalization, history of heart disease between 6 months and 5 years, no mental illness including delusions and hallucination, lack of cardiopulmonary resuscitation (CPR) on admission, patient awareness and the ability to response to questions, no history of sudden death due to heart disease in the family, no other serious illness that reduces life expectancy, and the doctor’s confirmation of participating in the study. Exclusion criteria included the patient`s refusal to continue the research, the incidence of arrhythmia and its treatment during the intervening period, and patient`s CPR during intervention. Data collection tools were a sample selecting form, demographic information form, Speilberger Anxiety Inventory, and Visual Analogue Scale for Anxiety [16]. Test reliability was calculated using the proportion of true scores variance to observed scores variance. In order to determine the validity of the test, the mean scores of state and trait anxiety and total anxiety were calculated and the results were significant [17]. In numerical Visual Analogue Scale for Anxiety, the patient specifies the severity of his/her anxiety with scores from zero to 10. Zero means the least amount of anxiety, and 10 means the highest imaginable amount of anxiety. The reliability and validity of this tool has been proven in previous studies [18]. To produce CDs, at first, the text was prepared using Persian and English sources under the supervision of psychologists. Then, the text was recorded during several recording phases, and essential effects were set. The intervention for experimental group was started at the beginning of hospitalization. Participants in the experimental group, in addition to usual care, were listening to the CDs of guided visualization prepared by the researcher using CD player and headphones for 16 minutes two times a day, once in the morning (between 8 and 10 am) and once in evening (between 10 and 12pm). To control the intervening factors and accuracy in using the CD, the researcher was present at all visualization meetings. The control group, only, received routine care. Spielberger questionnaire and Visual Analog Scale of Anxiety were filled by experimental group at the first day before intervention and on the last day after intervention, and it was completed by the participants in the control group at the same time. Data were analyzed through SPSS 14.5 Software. Statistical tests including Chi-square and Fisher`s Exact were used to compare demographic variables of two groups and independent T-test was used to compare the mean differences between pretest and posttest scores.
Findings by Text
The mean age of participants was 58.16 ± 0.44 years. 30 persons (60%) of them were male. 25 persons (50%) were illiterate. 15 persons (30%) had not finished high school, and 10 persons (20%) had diploma and higher education. Both groups were matched for age, gender, education level, occupation and the number of hospitalization, and there was no statistical significant difference between two groups (table 1). Comparing the mean difference between pretest and posttest scores of total anxiety and state anxiety in control and experimental groups showed that these scores significantly decreased in experimental group compared to control group. However, the mean difference between pretest and posttest scores in the groups showed that the reduction of scores in the experimental group was not significant compared to control group (table 2).
Main comparison to the similar studies
Guided visualization reduced total anxiety and trait anxiety in the experimental group, but did not reduce state anxiety in this group. This finding is consistent with results of various studies [11, 15, 19], but is different from some other studies [4, 6]. Guided visualization has been effective on reducing anxiety, length of hospitalization and increasing the patients 'satisfaction undergoing cardiac surgery [15]; and it reduces the patients' anxiety before surgery as well [19]. Guided visualization reduces pain, anxiety, and length of hospitalization [11]. Visualization could mitigate the trait anxiety which is dependent on personality, but could not reduce the state anxiety which is probably due to its intervention with the symptoms of diseases. The results of this study is not in accordance with the findings of another study showing that guided visualization was ineffective in reducing pain and anxiety after surgery [4]. Guided visualization does not reduce anxiety before surgery [6]. The results of this study are inconsistent with the findings of the current study. … [20, 21]
Suggestions
Nurses can enhance the quality of nursing care by increasing their knowledge and experience, and give a great help for better and faster treatment of patients.
Limitations
Limitations of this study were the use of self-reporting questionnaire, and the possibility of bias in filling that, as well as lack of evaluation of participants` visualization ability.
Conclusions
Guided visualization can both reduce total anxiety and trait anxiety in patients with acute coronary syndrome hospitalized in the cardiac intensive care unit.
Acknowledgments
22 Bahman Hospital Coronary Care Unit staffs and the participants are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Ethical Committee of Gonabad University of Medical Sciences has approved this research.
Funding Sources
This is a MA thesis driven article in Intensive Care Nursing.

TABLES and CHARTS

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