Effect of Instructional Videos on Postoperative Respiratory Function in Patients Undergoing Off-Pump Open Heart Surgery

Document Type : Original Quantitative and Qualitative Research Paper


1 Evidence Based Care Research Centre, Instructor of Management Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Evidence Based Care Research Centre, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

4 Associate professor of Anesthesia, School of Medical, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Respiratory function in patients undergoing open heart surgery is disrupted after surgery.  Patient education on managing complications can reduce occurrence or severity of them. A variety of educational tools has been introduced, but there are controversies about the most appropriate tools.
Aim: Determine the effect of instructional videos on respiratory function of the patients after off-pump open heart surgery.
Method: This single-blind randomized clinical trial was conducted on 60 patients undergoing open heart surgery hospitalized at open heart surgery ward of Imam Reza (AS) hospital in Mashhad, Iran, in 2015. The patients were randomly allocated to intervention and control groups of 30 subjects. The instructional video during a 15-minute session was displayed in the intervention group and the control group educated by pamphlet and face-to-face training the day before the surgery. The respiratory function in both groups was assessed before intervention through spirometric variables including forced expiratory volume in 1 second (FEV1) and vital capacity (VC). After surgery, arterial oxygen saturation (SaO2) and PaO2/FiO2 Ratio (PF ratio) were measured 30 minutes after extubation, as well as the variables of FEV1, VC, SaO2 and PF ratio 24 hours after extubation. Data were analyzed by independent t-test, Mann-Whitney, Chi square, paired t-test, Wilcoxon and Friedman using SPSS version 11.5 software.
Results: The means age of patients were 57.5±4.8 and 56.2±4.2 years in the intervention and the control groups, respectively. The difference of the PF ratio 24 hours after extubation compared to 30 minutes after extubation in the intervention group was significantly higher than the control group (P<0.001), as well as the VC and the FEV1 values 24 hours after extubation statistically in the intervention group were significantly higher than the control group (P<0.05).
Implications for Practice: The results suggested superiority of the instructional videos rather than pamphlet and face-to-face training to improve postoperative respiratory function in patients undergoing open heart surgery, indicating that instructional videos considering the patient's educational level and their conditions can be effective in educating patients.


Main Subjects

1.   Renault JA, Rossetti MB. Respiratory Physiotherapy in the Pulmonary Dysfunction after Cardiac Surgery. Rev Bras Cir Cardiovasc. 2008;23(4):562-9.
2.   Keenan T, Abu-Omar Y, Taggart D. Bypassing the Pump: Changing Practices in Coronary Artery Surgery. Chest. 2005 Jul;128(1):363-9. PubMed PMID: 16002958.
3.   Westerdahl E, Lomi C. Physical Therapy Treatment after Cardiac Surgery: A National Survey of Practice in Greece. J Clin Exp Cardiolog. 2013 Jun 19; 2013
4.   Westerdahl E. Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery: Uppsala: Acta Universitatis Upsaliensis; 2004.
5.   Westerdahl E, Lindmark B, Eriksson T, Friberg Ã, Hedenstierna G, Tenling A. Deep-Breathing Exercises Reduce Atelectasis and Improve Pulmonary Function after Coronary Artery Bypass Surgery. Chest. 2005;128(5):3482-8.
6.   Yanez-Brage I P-FS, Juffe-Stein A, Martinez-Gonzalez U, Pertega-Diaz S, Mauleon-Garcia. A. Respiratory Physiotherapy and Incidence of Pulmonary Complications in Off-Pump Coronary Artery Bypass Graft Surgery:An Observational Follow-Up Study. BMC Pulm Med. 2009;9:36.
7. Nascimento Junior P, Modolo N, Andrade S, Guimaraes M, Braz L, El Dib R. Incentive Spirometry for Prevention of Postoperative Pulmonary Complications in Upper Abdominal Surgery. Cochrane Database Syst Rev. 2009;2:58-60. PubMed PMID: 24510642.
8.   Aziznejad P, Zabihi A, Hosseini S, Bijani A. Nurses and Nurses Managers Opinions about a Patient,s Traning Barriers. Journal of Babol university of medical sience. 2010;12(1). (Persian)
9.   Nabavi FH, Vanaki Z. Administrative Barriers to Education Reviewing and its Rating Outlook By Nurses. Kerman Razi Journal of Nursing and Midvifery 2006;6(6). (Persian)
10. Fink C, Diener MK, Bruckner T, Müller G, Paulsen L, Keller M, et al. Impact of Preoperative Patient Education on Prevention of Postoperative Complications after Major visceral Surgery: study protocol for a randomized controlled trial (PEDUCAT trial). Trials. 2013;14(1):271.
11. Dunn J, Steginga SK, Rose P, Scott J, Allison R. Evaluating Patient Education Materials about Radiation Therapy. Patient Educ Couns. 2004;52(3):325-32.
12. Friedman AJ, Cosby R, Boyko S, Hatton-Bauer J, Turnbull G. Effective Teaching Strategies and Methods of Delivery for Patient Education: a systematic review and practice guideline recommendations. J Cancer Educ. 2011;26(1):12-21.
13. Wilson EA, Makoul G, Bojarski EA, Bailey SC, Waite KR, Rapp DN, et al. Comparative Analysis of Print and Multimedia Health Materials: A review of the literature. Patient Educ Couns. 2012;89(1):7-14.
14. Jamshidi N, Abaszade A, Najafi kelyani M. Comparison of Video Education and Training of Oral Satisfaction and Postoperative Complications in Patients Undergoing Coronary Angiography. Journal of Fasa University of Medical Sciences. 2012;1(4):233-7.
15. Cornoiu A, Beischer AD, Donnan L, Graves S, de Steiger R. Multimedia Patient Education to Assist the Informed Consent Process for Knee Arthroscopy. ANZ J Surg. 2011;81(3):176-80.
16. Zare AR, Jahanpoor F, Alhani F, ostovar A. The Effect of Family-Centered Empowerment Model Training Using Multimedia on Quality of Life in Children with Asthma. Journal of Boshehr medical university. 2014:54-62. (Persian)
17. Hughes S. The Effects of Giving Patients Pre-Operative Information. Nurs Stand. 2002;16:33-7.
18. Bondy LR, Sims N, Schroeder DR, Offord KP, Narr BJ. The Effect of Anesthetic Patient Education on Preoperative Patient Anxiety. Reg Anesth Pain Med. 1999 Mar-Apr;24(2):158-64. PubMed PMID: 10204903.
19. Ong J, Pamela S, Renee A, Rebecca A, Anna G. Effect of a Preoperative Instructional Digital Video Disc on Patient Knowledge and Preparedness for Engaging in Postoperative Care Activities. Nurs Clin North Am. 2009;44(1):35-56.
20. Mirbagher Ajorpaz N, Sadat Z, Hoseinain M. Comparison of Lecture and Multimedia Software Methods on Learning and Satisfaction of Surgical Technology Students in Gastrointestinal Surgical Technology Course. Community Health Journal. 2014;8(2):47-55. (Persian)
21. Mladenovski A, Kieser J. The Efficacy of Multimedia Pre-Operative Information for Patients: a pilot study. N Z Dent J. 2008;104(2):36-43.
22. Moradyan T, Farahani M, Mohammadi N, Jamshidi R. The Effect of Planned Breathing Exercises on Oxygenation in Patients after Coronary Artery Bypass Surgery. Cardiovascular Nursing Journal. 2011;1(1):8-14.
23. Huber J, Ihrig A, Yass M, Bruckner T, Peters T, Huber CG, et al. Multimedia Support for Improving Preoperative Patient Education: a randomized controlled trial using the example of radical prostatectomy. Ann Surg Oncol. 2013;20(1):15-23.
24. Khan MA, Shah S, Grudzien A, Onyejekwe N, Banskota P, Karim S, et al. A Diabetes Education Multimedia Program in the Waiting Room Setting. Diabetes Therapy. 2011;2(3):178-88.