Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study

King's Theory of Goal Attainment: Quality of Life for People With Myocardial Infarction

The aim of this study was to evaluate the effects of a theory of goal attainment-based care plan on quality of life among patients with myocardial infarction. One hundred two patients were randomly assigned to two groups. The intervention group received a theory of goal attainment-based care plan during their hospital stay and a two-month follow-up assessment after hospital discharge. Quality of life was assessed using the Persian version of the MacNew Heart Disease Health-Related Quality of Life questionnaire. Despite no significant difference between the groups with respect to the pretest mean scores of quality of life and its dimensions (p > .05), the posttest mean scores of quality of life and its dimensions in the intervention group were significantly greater than those of the control group (p < .001). Moreover, while the mean scores of quality of life and its dimensions significantly increased in the intervention group (p < .001), they did not significantly change in the control group (p > .05), except for the mean score of physical functioning (p = .032).

Theory-based nursing interventions in adults with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

This systematic review and meta-analysis aimed to synthesize the outcomes of theory-based nursing interventions for coronary heart disease management.

DESIGN AND METHODS

Web of Science, Scopus, Science Direct, and PubMed databases were electronically searched from January 2013 to August 2021. The Preferred Reporting Item for Systematic Reviews and Meta-analyses statement guidelines was followed for this meta-analysis. Randomized controlled trials on patients with coronary heart disease, using a theory-based nursing intervention were eligible. Methodological quality was examined by two authors using the Modified Jadad Scale. Based on the heterogeneity test, the results were analyzed using a pool of data with 95% confidence intervals, p-values, and fixed or random-effect models (PROSPERO registration number X).

FINDINGS

A total of 1030 studies were initially retrieved, and 8 randomized controlled trials were eventually included in the meta-analysis after screening. The big majority (81.3%) of participants were males, and the mean age was 54.8 (SD = 8.7) years. This meta-analysis found theory-based nursing interventions had no significant effect on blood lipid profile, blood pressure, and healthy lifestyle. However, these interventions significantly reduced fasting blood glucose, and body mass index and improved the physical and psychological domains of quality of life.

CONCLUSIONS

The evidence from this meta-analysis reveals that theory-based nursing interventions have a positive effect on fasting blood glucose, body mass index, and quality of life. However, their effects on blood lipid profile, blood pressure, and a healthy lifestyle are inconclusive. The results of this metanalysis are largely based on a few trials and were limited in terms of the number of outcomes. Conducting well-designed randomized controlled trials with adequate power is needed to make a firm conclusion on the influence of theory-based nursing interventions on patient outcomes in the CHD population.

CLINICAL RELEVANCE

Considering the high mortality and morbidity of coronary heart disease, nurses may play a significant role in coronary heart disease management by providing interventions that are based on a certain theoretical framework. This meta-analysis provides insights into the implementation of theory-based nursing interventions in heart attack survivors or those newly diagnosed with coronary heart disease led by nurses and lasting longer than 6 months in coronary heart disease. In addition, future studies should consider enhancing the content of training programs for a healthy lifestyle within the theory-based nursing interventions and compare the effects of these interventions on acute and chronic coronary syndromes.

Relationship Between Frailty, Sociodemographic and Clinical Characteristics, and Disease Severity of Older Adults With Acute Coronary Syndrome

This study aimed to evaluate the relationship between frailty, sociodemographic and clinical characteristics, and disease severity of older adults with acute coronary syndrome (ACS). A total of 57 hospitalized patients ≥60 years with ACS were assessed for frailty through the Tilburg Frailty Indicator. Disease severity was assessed by the Global Registry of Acute Coronary Events, by the maximum troponin level, and by the number of severely obstructed coronary arteries. The relationship between variables was assessed by Mann Whitney's test, Pearson's chi-square test, likelihood-ratio test, Fisher's exact test, or Student's t test. Analyses were bootstrapped to 1,000 to reduce potential sample bias. About 54.4% were frail. Frailty was associated with ethnicity (p = .02), marital status (p = .05), ischemic equivalents (p = .01), self-perceived health (p = .002), arthritis/rheumatism/arthrosis (p = .002), and number of severely obstructed coronary arteries (p = .05). These relationships can support intensified surveillance planning for the elderly at greatest risk, structuring of transitional care, appropriate nurse-coordinated secondary prevention delivery in primary care, and cardiac rehabilitation following ACS.

Effect of a mutual goal-based continuous care program on self-management behaviour and health outcomes in patients after percutaneous coronary intervention: A randomized controlled trial

AIMS

To evaluate the effects of mutual goal-based continuous care program on the outcomes of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

DESIGN

A single-blinded randomized controlled trial.

METHODS

87 patients with CHD after PCI in Hangzhou, Zhejiang, China, were randomly divided into study (n = 42) and control (n = 45) groups. The control group received 12-week cardiac rehabilitation and routine care. The study group received routine care and cardiac rehabilitation and the 12-week intervention program developed according to the goal attainment theory, including the mutual goal-based face-to-face guidance, and every-2-week telephone follow-ups. The self-management behaviour, quality of life, unscheduled readmission rate, and satisfaction of patients were examined.

RESULTS

For the patients subjected to the developed continuous nursing program based on mutual goals, achievement rates of all dimension mutual goals were at high levels (from 80.21% to 98.41%), except for the weight control (60.94%). Moreover, according to the comparable base data, compared with the control group, the self-management behaviour (study group 93.43 vs. control group 76.00), quality of life (QoL), and patients' satisfaction (study group 4.64 vs. control group 4.11) were higher, while the unscheduled readmission rate (study group 4.76% vs. control group 22.22%) was lower, in the study group, with statistically significant differences.

The effect of applying the nursing process based on the Theory of Goal Attainment on activities of daily living and quality of life in persons with multiple sclerosis during COVID-19 pandemic: a clinical trial

BACKGROUND

The chronic nature of multiple sclerosis (MS) affects patient's activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients' active participation in goal-setting can be beneficial in improving ADL and QOL.

AIMS

This study aimed to determine the effect of applying the nursing process based on King's Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic.

METHODS

In this clinical trial, 70 patients referred to the MS Society of Hamadan, Iran, were recruited using the convenience sampling method and randomly assigned into 2 groups. A 4-stage TGA was developed and implemented for the intervention group for a month. Data were gathered by ADL, instrumental ADL (IADL), and QOL questionnaires, and Goal of Attainment Scale (GAS) before and 2 months after the intervention.

RESULTS

Intervention group achieved a higher number of prioritized goals (p < 0.001) and reported higher QOL (P < 0.001) and instrumental ADL (IADL; P = 0.002) than the control group.

CONCLUSIONS

Given the results, TGA could effectively promote mutual goal attainment, QOL, and IADL for PwMS during the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTriasl.gov Identifier: IRCT20201210049668N1.

Patient Education Strategies among Patients with Acute Myocardial Infarction: A Systematic Review

  BACKGROUND: There is a need to summarize the effect of existing research-based education strategy on patients’ physical condition, health behaviour change, as well as psychosocial well-being in patients with acute myocardial infarction. AIM: to review and synthesis relevant studies on patient educational strategy and its effect on patients’ physical condition, health behaviour change, as well as psychosocial well-being in patients with acute myocardial infarction. METHODS: A literature search was conducted on MEDLINE, Academic Search Ultimate, CINAHL-EBSCO, and PubMed. Articles were selected by predefined inclusion and exclusion criteria. Assessment of methodological quality of each study was executed using The Downs and Black scale. RESULTS: Nineteen studies (3588 patients with myocardial infarction) were included. Educational intervention methods ranged from face-to-face method only, face-to-face method in combination with telephone call(s), the combination of both face-to-face method and telephone call(s) with one other method. Outcome measured on each study varied and the effectiveness of the intervention in at least one of their outcome measures demonstrated in 17 studies. CONCLUSIONS: Findings support the pivotal role of patient education on the management of myocardial infarction patient.   Key-words: coronary heart disease, education, educational strategy, learning needs, systematic review

Effect of Nurse-Led Program in Coronary Heart Diseases Patients: A Systematic Review

BACKGROUND: Coronary Heart Diseases (CHD) is one of the leading causes of death worldwide. Proper management for CHD patients is needed to reduce mortality. Nurses have a very important role in making CHD patients can carry out optimal health behaviors. AIM: This review study aims to identify the effect of the nurse-led program on CHD patients. METHODS: This systematic review was based on four electronic databases (Scopus, Science Direct, ProQuest, SAGE Journals) and published between 2011 and 2020. This review used the Joanna Briggs Institute and Prisma guidelines. The study’s eligibility was assessed from the title, abstract, research methodology, and full text. The review results were presented in tabulated data and narrative form. RESULTS: Nine articles showed that the nurse-led program significantly improved health behavior, health-related quality of life, clinical outcome, and illness perception in CHD patients. CONCLUSIONS: It is expected that the improvement of management in CHD patients will improve patients’ quality of life. Hence, it could reduce the number of morbidities and mortality.

A Community Health Volunteer Involvement Program for Glycated Hemoglobin Reduction Among Thai Patients With Uncontrolled Type 2 Diabetes: A Mixed-Method Study

Background:

Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors.

Aim:

The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA_1c) levels among Thai patients with uncontrolled type 2 diabetes.

Methods:

This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA_1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King’s General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent t-test, and paired t-test.

Results:

The intervention group exhibited a lower mean HbA_1c (p < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen’s d > 1.0, effect size large).

Conclusion:

Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.

The Effect of Cardiac Rehabilitation on Lipid Levels in Patients with Coronary Heart Disease. A Systematic Review and Meta-Analysis

Background

Cardiac rehabilitation (CR) is a multidisciplinary medical program. Most studies have emphasized the effect of exercise-based CR in lowering lipid levels; however, the effect of CR as a comprehensive program on lipid levels remains unclear.

Methods

Electronic database were searched up to 2022. Randomized controlled trials with lipid profile indicators were included. Standardized mean differences (SMDs) and 95% CIs were used to evaluate the effect size. Begg's funnel plot and Egger's linear regression test were used to assess publication bias.

Results

CR remarkably reduced low-density lipoprotein cholesterol (LDL-C) levels (SMD = -0.23; 95%CI: [-0.38, -0.08]; P < 0.001), triglyceride (TG) levels (SMD = -0.17; 95%CI: [-0.28, -0.06]; P < 0.001), and total cholesterol (TC) levels (SMD = -0.30; 95%CI: [-0.43, -0.16]; P < 0.001) and increased high-density lipoprotein cholesterol (HDL-C) levels (SMD = 0.19; 95%CI: [0.10, 0.29]; P < 0.001).

Conclusions

CR reduce TC, TG, and LDL-C levels while improving HDL-C levels. CR should be promoted and more trials should be conducted for long-term CR.

Application Value of Rehabilitation Nursing in Patients with Stroke Based on the Theory of Interactive Standard: A Randomized Controlled Study

Objective

To explore the application value of rehabilitation nursing based on the theory of interactive standards in stroke patients.

Methods

A total of 120 stroke patients who were treated in our hospital from December 2018 to September 2020 were selected as the research objects, and the patients were divided into a control group (60 cases) and an observation group (60 cases) according to the random number table method. The control group used routine nursing care, and the observation group used interactive rehabilitation care based on the control group. The Barthel Index, National Institute of Health Stroke Scale (NIHSS) score, Specific Quality Of Life Scale (SS-QOL) score, rehabilitation standard rate, nursing satisfaction, improvement time of limb function, and compliance with rehabilitation exercise were compared between the two groups of patients.

Results

After intervention, the Barthel Index of the two groups increased, and the Barthel Index of the observation group was comparatively higher (P < 0.05); the NIHSS scores of the two groups of patients reduced, and the NIHSS scores of the observation group were significantly lower than those of the control group (P < 0.05); the SS-QOL scores of the two groups of patients improved, and the increase in SS-QOL scores in the observation group was found to be significantly higher than those in the control group (P < 0.05); the compliance rate was found to be in favor of the observation group (83.33 (50/60) vs 63.33 (38/60)) (χ² = 6.136, P˂0.05); the total satisfaction of nursing care of patients in the observation group was superior to the control group (96.67% vs 78.33%) (χ² = 9.219, P˂0.05); the limb function improvement time of the observation group was significantly shorter (P < 0.05); the observation group had significantly higher rehabilitation exercise compliance scores (P < 0.05).

Conclusion

The rehabilitation nursing based on the interactive standard theory can promote the stroke patients to complete the rehabilitation goals, improve the neurological and limb functions, and enhance the patients' daily living ability, quality of life, and nursing satisfaction, which is worthy of clinical promotion and application.

Medium reach theory for nursing in cardiovascular rehabilitation

OBJECTIVES

to describe a medium-range nursing theory for the cardiovascular rehabilitation process.

METHODS

theoretical development study, addressing the elaboration of medium-range theory, based on Roy's Adaptation Model, which combined theoretical deduction with induction strategies, based on literature review and concept analysis.

RESULTS

the Medium-Range Theory for Nursing in Cardiovascular Rehabilitation presents eleven concepts and respective definitions, organized in relationships that represent elements, through modeling and image representation. Theoretical assumptions and propositions are presented.

FINAL CONSIDERATIONS

the theory presented aims to contribute to the description of the cardiovascular rehabilitation process from the perspective of the adaptation of the person, family and groups, as well as to impact the nursing care implemented to patients in the process. The procedures advanced from conceptualization to operationalization, through the production of theoretical propositions that will guide future theoretical testing.

Effects of Nurse-Led Intervention Programs Based on Goal Attainment Theory: A Systematic Review and Meta-Analysis

This study aimed to evaluate the effects of the goal attainment theory-based nurse-led intervention programs using a systematic review and meta-analysis. Randomized and non-randomized controlled trials, published from January 2001 to December 2020, were examined using four international databases and four domestic databases. The search, selection, and coding were performed independently by two researchers. R version 4.0.3 and Review Manager (version 5.3) were employed for meta-analysis and quality assessment, respectively. Of the 7529 articles retrieved, 18 were selected for analysis. The random overall effect size of the programs was 0.77 (95% CI = 0.61-0.94). Effect size by dependent variables were 2.36 (95% CI = 0.91-3.82), 1.25 (95% CI = 0.66-1.83), 0.83 (95% CI = 0.55-1.10), 0.64 (95% CI = 0.39-0.89), and 0.58 (95% CI = 0.30-0.85) for interpersonal, cognitive, health behavior, psychological, and indicators of physical health, respectively. Effect size by independent variables were 1.25 (95% CI = 0.86-1.64), 0.76 (95% CI = 0.48-1.03), 0.72 (95% CI = 0.37-1.06), 0.35 (95% CI = 0.21-0.49), and 1.35 (95% CI = -0.15-2.85) for prevention, health promotion, counseling and education, goal-setting and health contract, and parent participation programs, respectively. The effect size by control variables was 1.72 (95% CI = 0.88-2.56) at age ≤17, 0.85 (95% CI = 0.54-1.15) at time (min) 61-90, 1.04 (95% CI = 0.76-1.32) at sessions seven to eight, and 0.93 (95% CI = 0.66-1.19) at duration (weeks) five to eight. Thus, these programs were effective in improving various health aspects. Additionally, they can be recommended in various settings. Because efficacy is also influenced by control variables, considering treatment designs based on intervention characteristics and methodological approaches is warranted.

Development and Evaluation of an Antiviral Agent Medication Adherence Education Program for Patients with Chronic Hepatitis C

This study aimed to develop and evaluate a goal attainment theory-based antiviral agent medication adherence education program (AMAEP) for patients with chronic hepatitis C. A nonequivalent control group pretest-posttest design was used. Data were collected from December 2019 to March 2020 from a control group of 35 outpatients and an experimental group of 28 outpatients older than 20 years old who had been diagnosed with chronic hepatitis C. The data analysis included an independent t-test, a χ²-test or Fisher’s exact test, a Kolmogorov–Smirnov test, an analysis of covariance, and a Mann–Whitney U test. The results showed the effectiveness of the education program for patients with chronic hepatitis C. There were significant differences between the control group and experimental group in patients’ knowledge of chronic hepatitis C (Z = −5.91, p < 0.001), medication self-efficacy (Z = −5.02, p < 0.001), medication adherence rate (t = −3.88, p < 0.001), medication misuse behavior (Z = −5.00, p < 0.001), and patients’ satisfaction with their interaction with healthcare practitioners (Z = −6.61, p < 0.001). Therefore, we hope that the education program developed in this study will be utilized as an intervention for patients with chronic hepatitis C and be further developed for other patients with viral hepatitis.

[Development and Effect of a Fall Prevention Program Based on the King's Goal Attainment Theory for Fall High-Risk Elderly Patients in Long-Term Care Hospital]

PURPOSE

The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects.

METHODS

This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an χ²-test, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software.

RESULTS

For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368).

CONCLUSION

These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.

Effectiveness of nurse-led patient-centered care behavioral risk modification on secondary prevention of coronary heart disease: A systematic review

BACKGROUND

Despite establishment of advocacies centered on using patient-centered care to improve disease-related behavioral changes and health outcomes, studies have seldom discussed incorporation of patient-centered care concept in the design of secondary cardiac prevention.

OBJECTIVES

This review aimed to identify, appraise, and examine existing evidence on the effectiveness of nurse-led patient-centered care for secondary cardiac prevention in patients with coronary heart disease.

DESIGN

A systematic review of randomized controlled trials focusing on nurse-led patient-centered care for secondary cardiac prevention was conducted. Primary outcomes were behavioral risks (e.g. smoking, physical activity), secondary outcomes were clinically relevant physiological parameters (e.g. body weight, blood pressure, blood glucose, blood lipoproteins), health-related quality of life, mortality, and self efficacy.

DATA SOURCES

Twenty-three English and seven Chinese electronic databases were searched to identify the trials.

REVIEW METHODS

The studies' eligibility and methodological quality were assessed by two reviewers independently according to the Joanna Briggs Institute guidelines. Statistical heterogeneities of the included studies were assessed by Higgins I2 and quantitative pooling was performed when studies showed sufficient comparability.

RESULTS

15 articles on 12 randomized controlled trials were included in this review. Methodological quality of the included studies was fair. Based on the Joanna Briggs Institute critical appraisal tool for experimental studies, the included studies had met a mean of six criteria out the ten in this appraisal tool. The meta-analyses of the included studies revealed that nurse-led patient-centered care had significantly improved patients' smoking habits, adherence toward physical activity advices, and total cholesterol level with medical regime optimization, in short- to medium-term. The intervention was also favorable in improving the patients' health-related quality of life in several domains of SF-36. Furthermore, from single-study results, the intervention was favorable in improving the patients' weight management and alcohol consumption. However, it did not show significant effects on improving the patient's dietary habits, certain cardiac physiological parameters, mortality and self-efficacy. Currently, no addition long-term benefit of the intervention on secondary cardiac prevention was identified.

CONCLUSION

This review has systematically analyzed the effects of nurse-led patient-centered care on patients' behavioral risks, cardiac physiological parameters, mortality, health-related quality of life and self-efficacy. Given limited quantity of existing evidence regarding certain outcomes and long-term follow-up period; cross-trial heterogeneity of the interventions, measurement methods and statistical results; high or unclear risk of bias in some quality dimensions, the effectiveness of the intervention on secondary cardiac prevention remains inconclusive and subject to additional trials and evidences.

Validation of the King's transaction process for healthcare provider-patient context in the pharmaceutical context

BACKGROUND

With the impressive advantages of patient-pharmacist communication being advocated and poor pharmacist-patient communication in different settings, it is of great significance and urgency to explore the mechanism of the pharmacist-patient communicative relationship. The King's theory of goal attainment is proposed as one of the most promising models to be applied, because it takes into consideration both improving the patient-pharmacist relationship and attaining patients' health outcomes.

OBJECTIVES

This study aimed to validate the King's transaction process and build the linkage between the transaction process and patient satisfaction in a pharmaceutical context.

METHODS

A cross-sectional study was conducted in four tertiary hospitals in two provincial cities (Wuhan and Shanghai) in central and east China in July 2017. Patients over 18 were investigated in the pharmacies of the hospitals. The instrument for the transaction process was revised and tested. Path analysis was conducted for the King's transaction process and its relationship with patient satisfaction.

RESULTS

Five hundred eighty-nine participants were investigated for main study. Prior to the addition of covariates, the hypothesised model of the King's transaction process was validated, in which all paths of the transaction process were statistically significant (p < 0.001). The transaction process had direct effects on patient satisfaction (p < 0.001). After controlling the effects of covariates, the Multiple Indicators, Multiple Causes (MIMIC) model showed good fit to data (Tucker-Lewis index [TLI] = 0.99, comparative fit index [CFI] = 0.99, root mean square error of approximation [RMSEA] = 0.05, weighted root mean square residual [WRMR] = 1.00). The MIMIC model showed that chronic disease and site were predictors for both identifying problems and patient satisfaction (p < 0.05).

CONCLUSIONS

Based on the well-fitting path analytic model, the transaction process was established as one valid theoretical framework of healthcare provider-patient communication in a pharmaceutical context.