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2. Methods
This quasi experimental study was conducted from December, 2013 to June 2014
at the medical outpatient department of the Dow University Hospital Karachi, a
large tertiary care public sector hospital. Stable patients aged above 20 years with
MI (>1 month history) having mild to moderate depression (PHQ-9 score 5-14),
[23] [24] of either gender were included. Patients having any severe systemic ill-
ness, severe depression (PHQ-9 score ≥ 15) or other psychiatric disorders before
having MI, physically disabled were excluded from the study. Patients with un-
controlled diabetes, substance abuse, grade III or IV congestive heart failure,
cardiomyopathy and valvular heart disease were also excluded. Two groups of
the patients were arranged where one was interventional (modified nursing in-
terventions were applied) and other was a control group (without modified
nursing intervention on usual care). Ethical approval was sought by the Institu-
tional Review Board before commencement of the study.
2.1. Participant Groups
A sample size of 68 was calculated using PASS software with 95% Confidence
Interval and 80% power of the test and taking pre and post-test mean (µ)PHQ-9
score 5.5, 3.21 and standard deviation (SD) 4.45, 3.46 in Interventional group
and pre-test, post-test mean 9.21, 10.18 and standard deviation 5.19, 6.3 in the
control group respectively. Sample collection was done by using non probability;
purposive sampling technique. Total 115 participants were assessed where 68
were eligible. The first 34 patients were selected from interventional group and
next 34 patients were allotted the control group. After selection, 5 cases from the
intervention group and 3 from the control group were lost to follow up making a
final allocation of the study to be (Interventional group n = 29 & Control group
n = 31).
2.2. Patient Health Questionnaire 9 (PHQ 9)
Depression was defined and graded in accordance to PHQ 9, which is a good va-
lidated scale for depression containing 9 items to assess all DSM-IV criteria for
major depressive disorder. It also, assesses psychosocial impairment. Severity of
depression rated as (minimal depression, score 1 - 4), (mild depression score 5 -
9), (moderate depression score 10 - 14), (moderately severe depression score 15 -
19), and (severe depression score 20 - 27). Patients with mild to moderate de-
pression were included.
2.3. Modified Nursing Care Intervention
The interventional group had received modified nursing intervention, which in-
cluded two hours NIC session (active listening, health education, socialization
enhancement, self-esteem enhancement and Meditation facilitation activities). It
was followed by three weeks home based practice using a patient guide tool kit
(A patient guide booklet, MP3, led pencil, rubber, sharpener, patient ID Tag, in a
paper bag). Patient’s guide booklet; consists of information regarding method of