Assessment of Nurses’ Awareness and Applications Regarding Dietary Modifications in Patients Undergoing Mechanical Valve Replacement at PIC Hospital Lahore

Naila Khadim; Aneela Masood; Zohrah Perveen; Farzana Iqbal

doi:10.54112/bcsrj.v7i6.2331

Authors

Naila Khadim Punjab Institute of Cardiology, Pakistan
Aneela Masood District Headquarter Hospital Sheikupura, Pakistan
Zohrah Perveen College of Nursing, Allama Iqbal Medical College Lahore, Pakistan
Farzana Iqbal College of Nursing, Allama Iqbal Medical College Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i6.2331

Keywords:

Heart Valve Prosthesis Implantation; Diet Therapy; Nurses; Awareness; Patient Education

Abstract

Dietary modification is an essential component of postoperative care for patients undergoing mechanical valve replacement, particularly because these patients require lifelong anticoagulation, stable vitamin K intake, sodium control, adequate nutrition, and individualized dietary counseling. Nurses play a central role in patient education; however, gaps in dietary awareness and clinical application may affect recovery and long-term outcomes. Objective: To assess nurses’ awareness and application regarding dietary modifications in patients undergoing mechanical valve replacement at Punjab Institute of Cardiology Hospital, Lahore. Methods: A descriptive cross-sectional study was conducted from August 2025 to March 2026 at Punjab Institute of Cardiology Hospital, Lahore. A total of 88 registered nurses working in cardiac surgery wards and cardiac intensive care units were recruited using non-probability purposive sampling. Data were collected through a structured self-administered questionnaire assessing demographic characteristics, awareness, and application of dietary modification practices. Data were analyzed using IBM SPSS Statistics version 26, and findings were presented as frequencies, percentages, means, and standard deviations. Results: Most nurses were aged 26–30 years, 37 (42.0%), followed by 31–35 years, 29 (33.0%). More than half had BSN qualification, 53 (60.2%), and 43 (48.9%) had 5–10 years of nursing experience. Only 5 (5.7%) nurses had previous cardiac nutrition training. The mean awareness score was 1.86 ± 1.64, while the mean application score was 22.58 ± 4.96. Overall, 83 (94.3%) nurses had low awareness, 3 (3.4%) had moderate awareness, and only 2 (2.3%) had high awareness. Regarding application, 55 (62.5%) nurses demonstrated low application and 33 (37.5%) demonstrated moderate application, while no nurse achieved a high application level. Major gaps were observed in sodium restriction, protein requirements, saturated fat restriction, fluid management, vitamin K counseling, dietitian consultation, and weight management counseling. Conclusion: The study revealed substantial deficiencies in nurses’ awareness and application of dietary modifications for patients undergoing mechanical valve replacement. These findings highlight the need for structured cardiac nutrition training, standardized dietary counseling protocols, and stronger collaboration among nurses, physicians, and dietitians to improve postoperative patient education and long-term cardiac care.

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References

1. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5).

2. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.

3. Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;144(23).

4. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761.

5. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18).

6. Stoppe C, Dresen E, Wendt S, Elke G, Patel JJ, McKeever L, et al. Current practices in nutrition therapy in cardiac surgery patients: an international multicenter observational study. JPEN J Parenter Enteral Nutr. 2023;47(5):604-613.

7. Juliana N, Abd Aziz NAS, Maluin SM, Abu Yazit NA, Azmani S, Kadiman S, et al. Nutritional status and post-cardiac surgery outcomes: an updated review with emphasis on cognitive function. J Clin Med. 2024;13(14):4015.

8. Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, et al. Perioperative care in cardiac surgery: a joint consensus statement by the Enhanced Recovery After Surgery Cardiac Society, ERAS International Society, and Society of Thoracic Surgeons. Ann Thorac Surg. 2024;117(4):669-689.

9. Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: a systematic review. Br J Clin Pharmacol. 2021;87(2):352-374.

10. Tariq K, Ahmad U, Sheikh M. Anticoagulation knowledge assessment in unprivileged people of Baluchistan. J Pak Med Assoc. 2024;74(12):2164-2167.

11. Doménech Briz V, Gea-Caballero V, Chover-Sierra E, Czapla M, Fehler P, Rodríguez-Calvo A, et al. Knowledge level of ICU nurses regarding nutritional assessment of critically ill patients: a systematic review. Nurs Rep. 2024;14(1):586-602.

12. Hamdan M, Zidan S, Badrasawi M, Shweikeh H, Al-Masri R, Al-Khateeb R. Palestinian nurses’ knowledge, attitudes, and practices regarding enteral nutrition: cross-sectional study. Appl Nurs Res. 2022;63:151545.

13. Al-Sayaghi KM, Alqalah TAHS, Alkubati SA, Alrubaiee GG, Alshoabi SA, Atrous MH, et al. Critical care nurses’ perceptions of enteral nutrition: a descriptive cross-sectional study. Open Nurs J. 2022;16.

14. Lu P, Yang S, Shi Y, Zhu J, Duan L, Lin J, et al. Influencing factors on nutritional knowledge, attitudes, and practices among nursing assistants in nursing homes: a multicenter cross-sectional study. BMC Nurs. 2024;23:886.

15. Ang WLS, Zhang D, Cai H, Chew HSJ. Nurses’ knowledge, attitude and practice in nutrition management of hospitalised adults: a mixed-methods study. J Clin Nurs. 2025;34(5):1665-1690.

16. Eltheni R, Schizas N, Michopanou N, Fildissis G. Effects of a personalized nurse-led educational program for new patients receiving oral anticoagulant therapy after mechanical heart valve prosthesis implantation on adherence to treatment. J Chest Surg. 2021;54(1):25-30.

17. Zhu Z, Li C, Shen J, Wu K, Li Y, Liu K, et al. New internet-based warfarin anticoagulation management approach after mechanical heart valve replacement: prospective, multicenter, randomized controlled trial. J Med Internet Res. 2021;23(8).

18. Chu MWA, Ruel M, Graeve A, Gerdisch MW, Damiano RJ Jr, Smith RL 2nd, et al.; PROACT Mitral Investigators. Low-dose vs standard warfarin after mechanical mitral valve replacement: a randomized trial. Ann Thorac Surg. 2023;115(4):929-938.

19. Dresen E, Bear DE, DePriest A, Modir R, Naidoo O, Compher C, et al. Role of dietitians in optimizing medical nutrition therapy in cardiac surgery patients: a secondary analysis of an international multicenter observational study. JPEN J Parenter Enteral Nutr. 2025;49(4):476-487.

20. Nadeem S, Khilji SA, Ali F, Jalal A. Continued use of warfarin in lower dose has safe maternal and neonatal outcomes in pregnant women with prosthetic heart valves. Pak J Med Sci. 2021;37(4):933-938.

21. Mullens W, Damman K, Dhont S, Banerjee D, Bayes-Genis A, Cannata A, et al. Dietary sodium and fluid intake in heart failure: a clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail. 2024;26(4):730-741.