Nursing interventions based on Snyder’s hope theory for depression following percutaneous coronary interventions: A clinical study

Abstract

BACKGROUND

Patients with depression following coronary heart disease often exhibit insufficient psychological resilience and self-care abilities; therefore, emphasis must be placed on nursing interventions.

AIM

To analyze the application value of problem-oriented education combined with nursing interventions based on the Snyder hope theory model in depressed patients after percutaneous coronary intervention (PCI).

METHODS

This study included 150 patients diagnosed with PCI postoperative depression because of coronary heart disease between February 2022 and February 2024. Participants were divided into two groups: A control group (n = 75) receiving problem-oriented education and an observation group (n = 75) receiving combined nursing interventions based on the Snyder hope theory model. Depression status, psychological resilience, self-care ability, and quality of life were compared between the two groups.

RESULTS

Before nursing interventions, there were no significant differences between the two groups (P > 0.05). After the interventions, depression scores decreased while psychological resilience, self-care ability, and quality of life scores increased significantly in the observation group compared to that in the control group, with statistically significant differences noted (P < 0.05). This combined approach can enhance psychological resilience, improve self-care abilities, and elevate the overall quality of life, warranting further promotion in clinical practice.

CONCLUSION

Combination of problem-oriented education and nursing interventions based on the Snyder hope theory model effectively alleviates depression in patients following PCI for coronary heart disease.

Key Words: Problem-oriented education; Snyder hope theory model; Coronary heart disease; Depression; Psychological resilience; Self-care ability

Core Tip: Enhancing care for depressed patients post-percutaneous coronary intervention is vital for better outcomes. It boosts self-care, ensuring adherence to medication and lifestyle changes, and strengthens psychological resilience, helping patients cope with stress and prevent relapses. This comprehensive approach not only improves their physical health but also their overall well-being.

INTRODUCTION

Coronary heart disease is a form of cardiovascular disease that primarily affects middle-aged and older individuals, with its incidence worsening with age, leading to reduced cardiac function and compromised quality of life[1]. Percutaneous coronary intervention (PCI) is widely employed in clinical settings to treat this condition, aiming to eliminate arterial plaques and restore vascular patency[2]. However, patients frequently demonstrate a lack of adequate understanding of their disease and the PCI procedure, which can hinder postoperative recovery and potentially elevate the risk of restenosis. Thus, the implementation of health education is crucial to enhance patient awareness and improve treatment outcomes. Problem-oriented education, which is guided by specific issues, constructs a knowledge framework through problem discussions to assist patients in mastering disease knowledge from various perspectives and elevate their cognitive levels[3]. Additionally, the short-term effects of PCI may not be readily observable, and patients’ cardiac functions may not swiftly return to baseline, negatively impacting their psychological states and diminishing self-care capabilities. Postoperative depression is classified as secondary depression; it is not a specific psychiatric disorder but rather manifests as mental disturbances following surgical trauma. Patients may experience prolonged depressive states, harbor concerns about their prognosis, lose confidence in the effectiveness of the surgery, or exhibit physiological symptoms such as appetite loss or decline in overall health, with severe cases potentially leading to suicidal ideation[4].

The Snyder hope theory is a psychological framework that emphasizes goal-setting as a fundamental aspect of life, comprising two parts: Will and path. Its components include goal, path idea, will, belief and obstacles. Leveraging this theory, nursing strategies can assist patients in alleviating psychological stressors and fostering mental well-being[5]. This study aims to explore the role of problem-oriented education combined with the Snyder hope theory model in managing depression among patients following PCI for coronary heart disease.

MATERIALS AND METHODS

Patient selection

A total of 150 patients experiencing depression after PCI from February 2022 to February 2024 were recruited and equally divided based on the type of care received. The control group consisted of 75 patients (35 males, 40 females) aged between 42 and 80 years, with a mean age of 61.24 ± 6.32 years. Their disease duration ranged from 2-12 weeks, with a mean duration of 7.18 ± 1.64 weeks. Education levels varied from 5-20 years, with a mean of 12.78 ± 2.56 years. The observation group also comprised 75 patients (39 males, 36 females), aged between 40 and 85 years, with a mean age of 61.36 ± 6.48 years. The duration of illness ranged from 3-10 weeks, with a mean of 7.24 ± 1.68 weeks. Education levels varied from 6-18 years, with a mean of 12.84 ± 2.52 years. No statistically significant differences were identified between the two groups (P > 0.05), facilitating comparative analysis.

Inclusion criteria were as follows: (1) Patients that underwent PCI for coronary heart disease and experienced postoperative depression; (2) Those aged > 40 years; (3) Those with sufficient cognitive status and cooperated with the study protocol; and (4) Those with complete data records and adequate data support. Exclusion criteria were as follows: (1) Patients with severe organic disease; (2) Patients with immune system disorders; (3) Patients with malignancies; and (4) Patients with depression stemming from other etiological factors.

Interventions

In the control group, problem-oriented education was implemented with the following measures: (1) Problem-guided self-study: On the day of admission, nursing staff provided problem-oriented education to patients exhibiting emotional stability. A knowledge card summarizing coronary heart disease and postoperative depression was created to describe the causes, manifestations, potential harm, and treatment options. Health manuals along with audio and video materials were distributed to facilitate patient learning through various media, and preliminary understanding of the knowledge was assessed; (2) Problem-guided education: Nursing staff performed random sampling and assessed knowledge through questioning, focusing on postoperative depression, its causes, potential risks, and intervention measures. A mind map was developed based on this assessment to structure health education, allowing for a more comprehensive understanding of postoperative depression, highlighting the principles and advantages of PCI, and addressing the normal timeframe for postoperative cardiac function recovery. Patients were instructed to adhere strictly to medical advice regarding postoperative activity and diet to foster recovery and facilitate a return to regular life; and (3) Our study implemented a nursing intervention grounded in Snyder’s hope theory model, which is fundamentally based on the psychological constructs of goals, pathways, and agency. A pivotal aspect of this intervention was the cultivation of “dynamic thinking” among patients. This approach is designed to inspire patients not only to envision a positive future but also to outline concrete strategies for achieving their desired outcomes. To enhance clarity and facilitate replication by other researchers, we have detailed the psychological principles and specific methodologies essential to this segment of our intervention. This includes a focus on assisting patients in setting achievable goals, exploring diverse pathways to reach those goals, and fostering their sense of agency - defined as their belief in their capacity to take the necessary steps to achieve their objectives. Through this thorough exposition, the aim is to make the intervention comprehensible and replicable, thereby contributing to the broader application of Snyder’s hope theory in clinical settings. Additionally, patients received guidance on daily life practices emphasizing the importance of a balanced diet alongside regular work and rest. They were advised to abstain from tobacco and alcohol, maintain a light diet without overeating, ensure adequate nutrition, control calorie intake, limit sodium consumption to no more than 6 g per day, and increase their intake of dietary fiber and vitamins. Preference was given to healthier cooking methods.

In the observation group, the nursing interventions based on the Snyder hope theory model were implemented with specific components: (1) A departmental head nurse was designated as the group leader, supported by a team of 6-8 specialized nurses with over 3 years of experience. These nurses received training in psychological nursing practices and were involved in the construction and application of the theoretical model, nursing plans, and evaluations based on literature focused on “coronary heart disease”, “PCI”, and “postoperative depression”; (2) Target setting: Nurses and patients collaboratively established phased care goals, breaking down the overall objectives into smaller, manageable tasks prioritized from foundational to advanced levels. Goals were set with consideration of patients’ personal needs and emotional states, ensuring that fundamental needs were addressed first, while allowing for adjustments in response to changes in depression and mood to facilitate goal completion; (3) Pathway thinking: Nursing staff developed health education manuals for patients, which included sections on personal information, examinations, dietary and medication guidelines, health education, and information on postoperative depression. Care plans were created, anticipating potential issues during the nursing process, with necessary adjustments made based on the patient’s condition, dietary needs, and medication. A focus was maintained on the status of postoperative depression to achieve nursing goals at various stages. Patients were guided to manage their conditions, emotions, and daily activities, with attention given to detailing the management process and outcomes. In cases where phased goals were not met, causes were analyzed, and secondary planning was instituted to facilitate goal achievement; and (4) Dynamic thinking: Nursing staff conducted comprehensive evaluations of each patient’s personal circumstances to ensure that objectives were realistic and achievable. The application of psychological concepts, such as “commitment strategies”, was employed, rewarding patients who successfully attained their goals to boost their motivation and enthusiasm. Knowledge education was tailored to align with patients’ daily lives and interests. In instances of significant depression, structured communication was conducted with patients, emphasizing pertinent aspects of their postoperative depression, including potential negative impacts. This aimed to assist patients in developing accurate understandings of their emotional states to promote self-regulation. Throughout the communication process, staff actively observed patients’ expressions and behaviors, patiently listened, and conducted thorough analyses of depressive symptoms. Collective activities, such as patient associations, were organized to encourage active participation, bolster patients’ confidence, and foster a harmonious interpersonal atmosphere. The crucial role of family members was acknowledged to ensure comprehensive support and facilitate the successful attainment of nursing goals.

Observational indicators

Depression status: Assessed using the Zung Self-Rating Depression Scale (SDS), Hamilton Depression Scale (HAMD), and Beck Depression Inventory (BDI)[6,7]. The SDS consists of 20 items scored from 0-4, with the final score multiplied by 1.25; a score < 50 indicates a normal mood, 50-59 signifies mild depression, 60-69 moderate depression, and ≥ 70 severe depression. The HAMD includes 17 items scored from 0-7, where a total score < 17 indicates no depression, 17-23 indicates mild depression, and ≥ 24 denotes major depression. The BDI includes 13 items, each scored from 0 to 3, with scores of 0-4 indicating a normal mood, and scores of 5-16, 17-24, and ≥ 25 indicating mild, moderate, and severe depression, respectively.

Psychological resilience: Evaluated via the Connor-Davidson Resilience Scale[8], encompassing 25 items scored from 0-4, assessing tenacity, optimism, and self-improvement, achieving a total score of 100 with higher scores indicating greater psychological resilience.

Self-care ability: Assessed utilizing the Exercise of Self-Care Agency Scale[9], comprising 43 items scored from 0-4, categorized into self-care skills, self-responsibility, self-concept, and health knowledge, with a total possible score of 172 with higher scores reflecting better self-care abilities.

Quality of life: Evaluated using the Chinese Cardiovascular Patients Quality of Life Assessment Questionnaire[10], which includes 24 items divided into six dimensions: Physical (2), condition (6), medical status (2), general life (5), psychosocial status (7), and work status (2), with a total maximum score of 154, where higher scores indicate improved quality of life.

Statistical analysis

Data analysis was performed using SPSS 22.0. Count data were expressed as percentages (%) and analyzed using χ² tests. Continuous data that met normal distribution characteristics were presented as mean ± SD, with statistical significance determined using parametric t-tests where P < 0.05 indicated significant differences.

RESULTS

Depression status

A t-test was conducted to evaluate differences in each index between the two groups before and after care. The t-values for SDS, HAMD, and BDI were 0.356, 0.246, and 0.084, respectively, with corresponding P values of 0.722, 0.806, and 0.933, respectively, indicating no statistically significant differences between the two groups prior to and following care on these three scales. However, within-group comparisons demonstrated statistically significant differences in each scale after care (P < 0.05). These results indicate that the nursing measures had a meaningful impact on the depressive states of both groups, resulting in significant reductions in depression-related scores post-intervention, as shown in Table 1.

Table 1 Depression status.

Group	SDS		HAMD		BDI
	Before	After	Before	After	Before	After
Control group (n = 75)	63.80 ± 5.44	52.16 ± 2.78a	21.27 ± 2.32	10.68 ± 1.24a	11.16 ± 1.42	5.78 ± 0.96a
Observation group (n = 75)	64.12 ± 5.56	47.32 ± 2.24a	21.18 ± 2.16	6.54 ± 1.18a	11.18 ± 1.48	4.12 ± 0.72a
t	0.356	11.741	0.246	20.946	0.084	11.980
P value	0.722	< 0.001	0.806	< 0.001	0.933	< 0.001

^aP < 0.05 indicates statistically significant differences when compared with the same group before care.

Scores are expressed as mean ± SD. SDS: Self-Rating Depression Scale; HAMD: Hamilton Depression Scale; BDI: Beck Depression Inventory.

Psychological resilience

A t-test assessed differences in psychological resilience scores between groups before and after care. The t-values for psychological resilience, optimism, self-improvement, and total scores were 0.081, 0.274, 0.289, and 0.106, respectively, resulting in P values of 0.936, 0.784, 0.773, and 0.916, indicating no statistically significant differences prior to and following care. Contrastingly, within-group comparisons revealed statistically significant score differences after care (P < 0.05), confirming that the nursing measures substantially influenced psychological resilience, optimism, and self-improvement among patients in both groups, as presented in Table 2.

Table 2 Psychological resilience.

Groups	Resilience		Optimism		Self-improvement		Total
	Before	After	Before	After	Before	After	Before	After
Control group	30.18 ± 4.56	37.42 ± 5.16a	8.12 ± 1.32	11.14 ± 1.48a	17.96 ± 3.36	22.54 ± 2.78a	56.26 ± 9.24	71.10 ± 9.42a
Observation group	30.12 ± 4.52	42.78 ± 3.44a	8.18 ± 1.36	13.16 ± 1.24a	18.12 ± 3.42	27.60 ± 2.18a	56.42 ± 9.30	83.54 ± 6.86a
t	0.081	7.485	0.274	9.060	0.289	12.404	0.106	9.245
P value	0.936	< 0.001	0.784	< 0.001	0.773	< 0.001	0.916	< 0.001

^aP < 0.05 indicates statistically significant differences when compared with the same group before care.

Scores are expressed as mean ± SD.

Self-care ability

A t-test evaluated the differences in self-care abilities between the two groups before and after care. The t-values for self-care skills, self-responsibility, and concept of the self were 0.142, 0.094, and 0.655 respectively, with corresponding P values of 0.887, 0.925, and 0.514 respectively, revealing no significant differences between the two groups before and after care in these aspects. However, within-group comparisons indicated statistically significant improvements in self-care skills, self-responsibility, and self-concept post-care across both groups (P < 0.05), signifying the effectiveness of the nursing measures in enhancing these aspects after care, as shown in Table 3.

Table 3 Self-care ability.

Groups	Self-care skills		Self-responsibility		Concept of self		Health knowledge level		Total score
	Before	After	Before	After	Before	After	Before	After	Before	After
Control (n = 75)	30.16 ± 3.42	37.12 ± 4.18a	21.24 ± 2.56	25.36 ± 2.18a	23.12 ± 3.16	26.64 ± 2.92a	40.12 ± 3.56	47.80 ± 3.12a	114.64 ± 12.70	136.92 ± 12.40a
Observation (n = 75)	30.24 ± 3.48	41.32 ± 4.24a	21.28 ± 2.64	28.12 ± 1.44a	22.78 ± 3.20	30.18 ± 3.42a	40.24 ± 3.52	51.18 ± 2.78a	114.54 ± 12.84	150.80 ± 11.88a
t	0.142	6.109	0.094	9.149	0.655	6.817	0.208	7.005	0.048	7.000
P value	0.887	< 0.001	0.925	< 0.001	0.514	< 0.001	0.836	< 0.001	0.962	< 0.001

^aP < 0.05 indicates statistically significant differences when compared with the same group before care.

Scores are expressed as mean ± SD.

Quality of life

No statistically significant differences in quality of life scores were observed between the two groups across dimensions of physical strength, illness status, medical status, general life status, psychosocial status, work status, and total scores (P > 0.05). Nevertheless, the scores in each dimension demonstrated significant increases within groups (P < 0.05), as illustrated in Table 4.

Table 4 Quality of life.

Groups	Physical strength		Illness		Medical status		General life		Psychosocial status		Work status		Total score
	Before	After	Before	After	Before	After	Before	After	Before	After	Before	After	Before	After
Control (n = 75)	50.18 ± 3.72	56.12 ± 4.18a	17.78 ± 2.24	20.12 ± 1.86a	3.12 ± 0.54	4.16 ± 0.48a	8.18 ± 1.64	11.16 ± 2.12a	17.12 ± 2.44	21.16 ± 1.96a	4.92 ± 1.12	6.32 ± 1.24a	101.30 ± 11.70	119.04 ± 11.84a
Observation (n = 75)	50.24 ± 3.56	62.36 ± 3.54a	17.82 ± 2.32	23.18 ± 1.78a	3.18 ± 0.56	5.12 ± 0.52a	8.22 ± 1.56	13.36 ± 2.18a	17.18 ± 2.48	23.12 ± 1.72a	4.78 ± 1.16	7.58 ± 1.16a	101.42 ± 11.64	134.72 ± 10.90a
t	0.101	9.866	0.107	10.293	0.668	11.748	0.153	6.266	0.149	6.509	0.752	6.426	0.063	8.438
P value	0.920	< 0.001	0.915	< 0.001	0.505	< 0.001	0.879	< 0.001	0.881	< 0.001	0.453	< 0.001	0.950	< 0.001

^aP < 0.05 indicates statistically significant differences when compared with the same group before care.

Scores are expressed as mean ± SD.

DISCUSSION

PCI is a widely employed therapeutic intervention for coronary heart disease, aimed at alleviating luminal stenosis and occlusion, thereby restoring myocardial tissue perfusion, enhancing cardiac function, and improving overall quality of life. However, patients often do not experience full recovery of cardiac function in the short term, compounded by a lack of comprehensive understanding of their condition and procedure, which can adversely affect their mental health and lead to postoperative depression. There is a pressing need to augment health education and provide psychological support for maintaining mental well-being and enhancing postoperative quality of life.

The present study sought to address this gap through a combined nursing intervention rooted in the Snyder hope theory model. This approach has been demonstrated to effectively alleviate negative emotions associated with spinal cord injuries by bolstering patients’ confidence in treatment and self-management capabilities through goal setting and positive psychological reinforcement. According to the Snyder hope theory, individuals with elevated hope levels exhibit enhanced optimism and motivation towards achieving their goals through constructive thinking. The integration of this model in the current intervention resulted in significant improvements in the observed patients’ hope levels, indicating its potential to alleviate psychological burdens and elevate emotional well-being in post-PCI patients[11].

These findings align with previous research emphasizing the significance of hope in the recovery process and broader psychological well-being. The problem-oriented educational approach, while beneficial, may not sufficiently encompass the multifaceted nature of depression and psychological resilience among post-PCI patients. A systematic literature review has indicated that competencies such as reflection and self-regulation, integral to the Snyder hope theory model, may not be adequately developed through problem-oriented education alone. The results of this study suggest that the combined nursing intervention resulted in not only improved depression scores but also enhanced psychological resilience and self-care capabilities, which are vital for patient quality of life following PCI.

Postoperative depression is a common occurrence among patients with coronary heart disease. These individuals often confront postoperative pressures characterized by persistent negative emotions, prolonged depressive states (minimum duration of two weeks), apathy, lack of energy, decreased appetite, and, in severe cases, suicidal ideation. Therefore, it is essential to monitor psychological changes during postoperative care and provide timely interventions addressing depression[12]. The results of this study demonstrated that the observation group exhibited significantly lower scores on the SDS, HAMD, and BDI (P < 0.05), indicating that the combined educational and nursing interventions effectively mitigated depressive symptoms in patients following PCI.

Problem-oriented education and Snyder hope theory model could relieve depression in patients after PCI. In the problem-oriented education phase, nursing staff emphasized postoperative depression, analyzing its causes, consequences, and intervention strategies. Utilizing a random questioning format assisted in enhancing patients’ understanding of postoperative depression, thus cultivating a positive attitude and coping mechanisms. Additionally, the application of the Snyder hope theory facilitated personalized goal-setting for patients, breaking larger objectives into manageable steps reflective of their individual depressive states. Rewarding progress through psychological strategies further supported patient motivation and engagement in their care. For patients experiencing significant depression, establishing effective communication between nurses and patients, while promoting social interaction and family involvement, contributed to alleviating psychological stress and reducing depressive symptoms.

Psychological resilience denotes an individual’s psychological and behavioral adaptation in response to external environmental changes. It is dynamic and adjusts according to environmental shifts, representing adaptive capacity. Generally, enhanced psychological resilience correlates with improved adaptability to environmental changes[13,14]. The comparisons in this study demonstrated that the observation group achieved higher psychological resilience scores (P < 0.05), signifying that nursing interventions based on the Snyder hope theory effectively bolstered psychological resilience among post-PCI patients diagnosed with depression. Integrating the Snyder hope theory in clinical nursing allows for the formulation of practical nursing objectives tailored to patients’ conditions and needs, fostering achievement and equipping patients with relevant disease and surgery knowledge, thereby instilling confidence about the future and enhancing psychological resilience.

Self-care ability refers to the active actions individuals engage in to maintain health and improve comfort, comprising both therapeutic self-care and self-care competence[15]. In instances where patients demonstrate inadequate self-care abilities, adjustments to their self-care routines are necessary, with nursing support aiding in the enhancement of personal self-care capabilities, ultimately promoting health maintenance and disease prevention. This study revealed that the observation group displayed higher self-care scores (P < 0.05), suggesting that the nursing intervention rooted in the Snyder hope theory could facilitate improved self-care abilities among patients post-PCI for coronary heart disease. The Snyder hope theory framework assists in establishing overarching goals while breaking them down into smaller, progressive objectives, ultimately guiding patients toward achieving their goals and addressing their self-care needs throughout the nursing process.

Comparing the quality of life between the two groups revealed that the observation group attained higher scores (P < 0.05), indicating that the nursing intervention based on the Snyder hope theory positively impacted the quality of life for patients post-PCI for coronary heart disease. The application of the Snyder hope theory provides positive psychological guidance and encourages self-management among patients, emphasizing the involvement of family members - a comprehensive approach that fundamentally supports patients’ physical and mental health while improving their quality of life.

CONCLUSION

In conclusion, the integration of problem-oriented education with nursing interventions rooted in the Snyder hope theory effectively alleviates depression following PCI for coronary heart disease, enhances psychological resilience, and improves self-care abilities and quality of life. This combined approach is recommended for implementation within clinical settings.