Authors: Yidan Lv, Zhi Li, Linyan Shen
Categories: 3400, discharge guidance quality, discharge readiness, mind mapping, pacemaker
Source: Medicine
Authors: Yidan Lv, Zhi Li, Linyan Shen
Postoperative complications following pacemaker implantation are relatively common, necessitating that patients acquire relevant knowledge, manage risk factors, and maintain a healthy lifestyle. However, the effectiveness of traditional health propaganda is often limited, resulting in suboptimal discharge preparedness. This study aimed to evaluate the impact of mind map-based propaganda on improving discharge readiness and the quality of health propaganda among patients undergoing pacemaker implantation, providing evidence for optimizing discharge propaganda strategies in clinical practice. A total of 120 patients who underwent pacemaker implantation at the Department of Cardiology, Huzhou Central Hospital, between January and August 2024 were enrolled and randomly assigned to either a control group or an experimental group (n = 60 each). The control group received standard discharge propaganda, while the experimental group received propaganda using a mind map approach. Discharge readiness and the quality of discharge guidance were assessed and compared between groups. Multivariate logistic regression analysis was conducted to identify independent factors associated with the effectiveness of discharge propaganda. The experimental group demonstrated significantly higher scores in personal status (22.1 ± 3.0 vs 20.1 ± 2.3), coping ability (33.8 ± 4.2 vs 31.1 ± 3.0), anticipatory support (32.9 ± 2.7 vs 30.3 ± 2.3), and total discharge readiness (88.9 ± 6.3 vs 81.5 ± 5.6), all with P < .05. Similarly, higher scores were observed in content acquisition (41.4 ± 4.1 vs 38.2 ± 3.1), instructional skills and effectiveness (94.6 ± 5.8 vs 86.8 ± 4.8), and overall discharge guidance quality (136.0 ± 8.8 vs 124.9 ± 6.8) in the experimental group (P < .05). Multivariate analysis identified anticipatory support and instructional skills/effectiveness as independent predictors of improved discharge propaganda outcomes. Mind map-based propaganda significantly enhances discharge readiness and the quality of discharge instruction in patients following pacemaker implantation. As a practical and effective tool, mind mapping holds promise for broader application in clinical discharge propaganda.
Cardiac pacemakers have been utilized in clinical practice for over 60 years and remain an effective treatment for bradyarrhythmias.^[1]^ The incidence of complications following pacemaker implantation is approximately 4.2%,^[2]^ with a higher rate observed within the first 30 days postoperatively.^[3]^ Given the need for long-term follow-up, patients must acquire essential health knowledge, manage risk factors, and maintain a healthy lifestyle to support continued recovery. Therefore, it is imperative for healthcare professionals to deliver comprehensive health propaganda and implement targeted cardiac rehabilitation experiments after surgery.^[4]^ However, traditional health propaganda is often constrained by factors such as diverse patient populations, limited adherence, inconsistent nursing quality, procedural discharge instructions, and the absence of practical and effective propaganda strategies. Consequently, the overall quality of discharge guidance remains suboptimal, leading to poor compliance with rehabilitation protocols and limited patient understanding of relevant health knowledge.^[5]^ These limitations highlight the urgent need for more effective discharge propaganda methods. Mind mapping, which transforms interrelated information into a visual semantic network, addresses the limitations of linear verbal instruction. By integrating both text and images, mind mapping facilitates divergent thinking, reduces cognitive load on the verbal processing channel, and enhances both memory retention and understanding^[6]^ This approach has been widely adopted in nursing management, propaganda, and patient health propaganda.^[7–10]^ This study aimed to implement mind-map-based health propaganda for patients following pacemaker implantation with the goal of providing a scientific foundation for more effective clinical discharge teaching and health propaganda strategies.
This study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Ethics Committee of the Huzhou Central Hospital (No. 202312009-01). Written informed consent was obtained from all the adult participants prior to data collection.
This study included 120 patients who met the inclusion criteria and were admitted to the Department of Cardiology at [REDACTED] for pacemaker implantation between March 2023 and October 2023. Participants were randomly assigned to either the control group or the experimental group using a random number table method, with 60 patients allocated to each group.
Inclusion criteria: Patients undergoing their first permanent pacemaker implantation; aged ≥ 45 years, with sufficient reading, comprehension, and communication abilities; volunteered to participate in the study and provided written informed consent; were conscious and able to communicate verbally, with the capacity to complete the questionnaire; had severe concomitant diseases affecting the brain, liver, kidneys, or other vital organs, or other serious physical illnesses, including severe anxiety; and were unable to complete the questionnaire due to symptoms such as depression.
A mind-mapping research team was formed, consisting of a head nurse, 4 responsible nurses, and 3 senior doctors from the Department of Cardiology. All team members completed a systematic study of The Mind Map Book by Tony Buzan and participated in online mind mapping courses offered through MOOC platforms by Chinese universities. The team first reviewed the relevant guidelines and literature to extract discharge propaganda content for patients undergoing pacemaker implantation. This content was then logically organized for health propaganda and preliminary mind maps were created. Experts and professors in cardiology from provincial-level hospitals were consulted to evaluate the mind maps. Based on their feedback, the head and responsible nurses made revisions. After 2 rounds of revisions, the final version of the “Mind Map for Health propaganda in Cardiac Rehabilitation of Pacemaker Implantation Patients” was developed. Special terms and concepts are highlighted using different colored fonts for clarity.
Routine discharge health propaganda was provided to the control group. Specifically, within 24 hours before discharge, the responsible nurses delivered oral discharge propaganda to patients following the standard nursing protocol of the Department of Cardiology. Propaganda covered key topics such as diet, exercise, rehabilitation, identification and prevention of risk factors, and follow-up visit schedules. Additionally, paper-based discharge propaganda summaries were distributed and patients were encouraged to actively review the health propaganda display boards in the department.
In the experimental group, mind mapping was used for post-discharge health propaganda, as outlined
General Information Questionnaire: This questionnaire was designed by the researchers and revised by experts. It gathers demographic information, including gender, age, propaganda level, marital status, place of residence, living arrangements (e.g., living alone), religious beliefs, current occupation, payment method for medical expenses, and per capita family income. Additionally, it includes disease- and treatment-related information such as tube indwelling status and length of hospital stay.
Readiness for Hospital Discharge Scale (RHDS): The RHDS developed by Weiss et al^[11]^ was used to assess patients’ discharge readiness. This scale comprises 3 personal status, adaptability, and anticipatory support. The first item, the yes/no question, was excluded from the total score. The remaining items are rated on a 0 to 10 scale, where 0 indicates complete unpreparedness and 10 indicates complete readiness. A score >7 on any item indicates high discharge readiness, while a score of 7 or below indicates low readiness.^[12]^ The scale demonstrated strong reliability, with a Cronbach α coefficient of 0.89, content validity index of 0.88, and individual item validity indices ranging from 0.80 to 1.00.
Quality of Discharge Teaching Scale (QDTS): The English version of the QDTS was developed by Weiss in 2007.^[13]^ This scale comprises 3 content required, content acquired, and guidance skills and effects. The first 2 dimensions are directly related, with the score difference indicating whether the discharge teaching content met patients’ needs. A 0 to 10 grading scale was used, and the total score was calculated by summing the scores for the “content acquired” and “guidance skills and effect” dimensions. A higher total score indicates a better quality of discharge teaching. The scale demonstrated strong reliability, with a Cronbach α coefficient of 0.924, a content validity index of 0.98, and Cronbach α coefficients for each dimension ranging from 0.882 to 0.935.
Owing to differences in the number of items and score range between dimensions, each dimension’s score was standardized by averaging the item scores. The standardized average score was calculated by dividing the dimension score by the number of items in that dimension.
The sample size was estimated based on the number of items in the questionnaire, using a multiplier of 5 to 10 per item, with an additional 30% added to account for potential attrition. The QDTS includes 18 items; thus, the required sample size was calculated as 18 × (5–10) × (1 + 30%), resulting in a range of 117 to 234 participants. To ensure adequate statistical power and account for rounding, a minimum final sample size of 120 participants was determined.
Patient information was gathered using a questionnaire survey. The research team consisted of a primary investigator and 2 nursing staff members with over 5 years of experience in the department. All investigators received standardized training on the questionnaire prior to the survey. On the day of discharge, patients received health education and were then provided with a questionnaire. After the investigator explained its contents, the patients completed the questionnaire independently. All questionnaires were collected on-site, yielding a 100% response rate.
Data entry was performed using Excel, followed by statistical analysis using SPSS 22.0. Measurement data with a normal distribution are presented as mean ± standard deviation. An independent samples t test was used to compare the measurement data between the 2 groups. Enumeration data are expressed as percentages (%), and the chi-square (χ²) test was used for intragroup comparisons. A P-value of <.05.
No patient dropped out from either group, and no statistically significant differences were observed between the 2 groups in terms of general clinical data (P > .05), as shown in Table 1.
The scores of patients in the experimental group for personal status, adaptability, anticipatory support, and total readiness for hospital discharge were all higher than those in the control group, with all differences being statistically significant (P < .05), as shown in Table 2.
There was no significant difference in the scores for content needed between the 2 groups; however, the scores for content acquired in the experimental group were higher than those in the control group, with all differences being statistically significant (P < .05). Additionally, the total scores for the dimensions and the overall QDTS score in the experimental group were both higher than those in the control group, with all differences being statistically significant (P < .05), as shown in Table 3.
Variables from the RHDS and the QDTS with a univariate analysis result of P < .05 were included in the logistic regression analysis. Multivariate analysis revealed that anticipatory support and guidance skills and effects were independent factors significantly influencing the effectiveness of patient health propaganda, as shown in Table 4.
With ongoing healthcare reforms and increased focus on Enhanced Recovery After Surgery protocols, reducing the average length of hospital stay has become a major objective. However, earlier discharges often occur during transitional phases rather than after full recovery, requiring patients to continue disease monitoring and daily health management at home. Readiness for Hospital Discharge has therefore become a vital bridge between inpatient care and post-discharge self-management. A thorough assessment of a patient’s physical, psychological, and social status before discharge is essential to determine whether they are adequately prepared for a safe transition to home care. Readiness for Hospital Discharge evaluates a patient’s ability to be safely discharged and continue recovery. Higher discharge readiness is associated with better post-discharge self-management,^[14]^ helping to reduce health risks, support recovery, and improve quality of life.
Previous studies have shown that patients with higher propaganda levels, higher incomes, and urban residency generally exhibit greater readiness for hospital discharge.^[15]^ This trend is often attributed to better financial resources, increased access to healthcare services in urban areas, and the tendency for individuals with higher propaganda to live in cities. However, in the present study, most participants were elderly, and univariate analysis revealed no statistically significant differences in discharge readiness based on residence, income, or propaganda level.^[16]^ Studies have shown that adequate health propaganda can improve patients’ readiness for hospital discharge,^[17]^ which is consistent with the findings of this study. The results indicated that patients in the experimental group scored significantly higher than those in the control group (P < .05), suggesting that the mind-mapping-based health propaganda model can effectively enhance patients’ health knowledge and improve their readiness for discharge. The adaptability scores for patients in the control and experimental groups were 31.1 ± 3.0 and 33.8 ± 4.2, respectively, with standardized average scores of 6.2 ± 0.6 and 6.8 ± 0.8. Both groups had scores below 7, likely because many patients were elderly, with lower propagandaal levels and limited memory and comprehension abilities. Furthermore, their children, often preoccupied with work, have limited time to assist in rehabilitation, resulting in inadequate retention of necessary knowledge and skills. Although the experimental group scored higher than the control group, the average scores remained below the optimal threshold of 7, indicating that the traditional “one-size-fits-all” discharge teaching model is insufficient to meet patients’ post-discharge needs. Personalized propaganda should be implemented based on individual patient circumstances. Additionally, the importance of health propaganda should be emphasized for elderly patients and their families. Considering age-related declines in memory, hearing, and vision, health propaganda should be delivered in various formats and include rich content, with repeated guidance provided. The duration of health propaganda sessions should also be extended to improve readiness for discharge and meet optimal discharge criteria. A higher level of anticipatory support reflects greater patient confidence and a more positive outlook toward illness, which can significantly enhance discharge readiness. In this study, univariate analysis revealed that the mean anticipatory support score in the experimental group was 32.9 ± 2.7, significantly higher than the control group’s score of 30.3 ± 2.3 (P < .05). Furthermore, multivariate analysis identified anticipatory support as an independent factor influencing the effectiveness of health propaganda. These findings suggest that stronger anticipatory support is positively associated with improved discharge readiness. Accordingly, future health propaganda efforts should emphasize identifying patients’ areas of vulnerability, exploring contributing factors, and implementing targeted experimentals. Personalized guidance may enhance anticipatory support, increase patients’ sense of security, foster broader social recognition, and ultimately improve readiness for hospital discharge.
Studies have shown that the quality of discharge teaching is positively correlated with patients’ readiness for hospital discharge.^[18]^ Discharge teaching equips patients and their families with essential information on self-care methods, diet, exercise rehabilitation, medication administration, and other aspects of medical care. The teaching skills used also play a crucial role in how well patients understand and apply information. High-quality discharge teaching can enhance patients’ self-care abilities and improve their clinical outcomes. In this study, univariate analysis showed that the mean score for instructional skills and effectiveness in the experimental group was 94.6 ± 5.8, significantly higher than the control group’s 86.8 ± 4.8 (P < .05). Multivariate analysis identified instructional skills and effectiveness as an independent factor influencing the outcomes of patient health propaganda. The rationale is that mind maps employ keywords, images, colors, and connecting lines to visually represent abstract cognitive processes in a simple and clear manner, organizing information hierarchically and radially to create an intuitive educational framework.^[19]^ By expanding each branch keyword of the mind map, the teaching content becomes more detailed and specific, preventing the omission of important information. Mind map-based guidance facilitates patient comprehension and acceptance, thereby improving nursing efficiency and fostering better collaboration between nurses and patients to enhance the quality of discharge propaganda.
In conclusion, mind mapping proved to be an effective tool for enhancing both patients’ readiness for hospital discharge and quality of discharge teaching for those undergoing pacemaker implantation. Compared with traditional oral or text-based health propaganda methods, mind mapping-based propaganda, which incorporates both images and text, offers a simple yet practical approach. This method not only meets the diverse needs of patients, but also enhances understanding and retention, making it a valuable strategy for clinical practice and widespread application.
Conceptualization: Yidan Lv, Linyan Shen.
**Data ** Zhi Li.
**Funding ** Yidan Lv.
Methodology: Yidan Lv, Zhi Li.
**Project ** Linyan Shen.
Resources: Zhi Li.
Supervision: Linyan Shen.
**Writing – original ** Yidan Lv.
**Writing – review & ** Linyan Shen.