Nurse involvement in cardiac rehabilitation prior to hospital discharge

Cardiac rehabilitation in the acute care setting: Integrative review

BACKGROUND

Phase one cardiac rehabilitation (CR) is an essential component of care for patients with coronary heart disease. With optimal program delivery, health outcomes can be improved.

OBJECTIVES

To conduct an integrative review that explores Phase one CR for patients hospitalised with coronary heart disease.

DESIGN

Integrative literature review (2003-2014) Data sources: The literature search included Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Experta Medica Database (EMBASE), Psycinfo, Clinical Practice Guidelines Portal, Cochrane Library, Clinical Evidence (BMJ) and Google Scholar.

REVIEW METHODS

The Joanna Briggs Institute critical appraisal tools relevant to study methodology were utilised. Studies included for review were peer reviewed, published in English. Studies included Phase one CR intervention/s or the provision of education to patients diagnosed with coronary heart disease in the acute care setting prior to hospital discharge.

RESULTS

In the past decade cardiac researchers have predominantly focused on patients and health professionals perceptions, CR interventions, and patient education. Factors that impede delivery of Phase one CR, such as time, workload etc. were also reported.

CONCLUSIONS

The implementation of Phase one CR delivery requires optimisation to enable patients with coronary heart disease to achieve positive health outcomes post hospitalisation. Future interventions should address the factors that impede delivery of Phase one CR.

Impact of Satisfaction, Nurse–Patient Interactions and Perceived Benefits on Health Behaviors Following a Cardiac Event

Aims: To describe patient perceptions of quality and satisfaction with nursing care, nurse–patient interactions and barriers to and benefits of implementing a healthy lifestyle. Methods: A pretest–posttest cross-sectional correlational research design was used. Subjects were randomly selected between November 2001 and January 2002 from patients admitted to the National Institute of Cardiology in Budapest, Hungary. Participants completed 3 self-reported measures and a demographic survey, which assessed individual lifestyle behaviors (e.g. frequency of smoking, physical activity, stress and unhealthy dieting). Results: Satisfaction with nursing care and nurse–patient interactions influenced both perceived benefits and barriers. Patient satisfaction and perceived benefits at discharge were associated with more frequent exercising and less smoking. Among other factors, perceived benefits at discharge were predicted by attentive nurse behaviors toward patients and by patients’ ability to initiate discussion with nurses. Conclusions: Findings support effects of patient satisfaction and nurse–patient relationships on perceived benefits/barriers. Compared to barriers, perceived benefits more importantly determined health behaviors. Attentive nursing care and the patient's ability to discuss health concerns with nurses appear more influential in modifying patient perceptions. Exploring nursing interventions to maximize perceived benefits during hospitalization is suggested.

Enhancing cardiac rehabilitation nursing through aligning practice to theory: implications for nursing education

This article presents a case study that examined the work practice of nurses in a cardiac step-down unit (CSDU). The action research included interviews, participant observation, and a self-reporting questionnaire. Nurses in the unit used a conceptual framework that was inconsistent with the rehabilitation-oriented nursing necessary to enhance patient outcomes in a CSDU. The results of this study show that a need exists for greater alignment between the practice and the educational preparation of nurses who work in a CSDU. A framework such as Dorothea Orem's Self-Care Theory of Nursing (1995) offers a conduit for nurses to deliver care appropriate to CSDU patient needs. However, there is a need for continuing education for nursing staff to align the cardiac rehabilitation nursing philosophy and the theories that underpin it (such as the Self-Care Theory) with nursing practice. Practice development provides a mechanism through which to examine the congruence between patient needs and nurse perception of those needs.

'I'm still waiting...': barriers to accessing cardiac rehabilitation services

BACKGROUND

The United Kingdom (UK) National Service Framework for coronary heart disease challenges health services to address existing problems regarding the quality and content of cardiac rehabilitation services. Concern also exists regarding inequalities in access to services. The South Yorkshire Coalfields Health Action Zone (SYCHAZ) funded this study to harness the views and experiences of staff and patients regarding existing services. The intention is to use the information gained to develop acceptable and accessible services for the future.

AIMS

To explore what barriers exist for patients in accessing cardiac rehabilitation services within the South Yorkshire Coalfield locality.

ETHICAL ISSUES AND APPROVAL

Patients were identified and recruited with the assistance of staff responsible for their care. Informed consent was obtained prior to participation. Approval was obtained from the relevant Ethics Committees.

METHODS

Qualitative methods were used, including semi-structured interviews and Framework Analysis techniques. Purposive sampling was used to select participants.

INSTRUMENTS

Semi-structured individual interviews of 15 staff and 20 postmyocardial infarction patients. One group interview with seven health visitors and two with lay members of heart support groups.

OUTCOMES

Barriers to accessing cardiac rehabilitation.

RESULTS

This study revealed a limited service capacity. Big gaps exist between patches of service activity that most patients appear to slip through. Problems in accessing the service were categorized into five themes: absence, waiting, communication, understanding, and appropriateness. Some groups fared worse in terms of access to services, for example women, the elderly and those in traditional working class coalfields communities. Professional and more affluent participants appeared better able to negotiate their way around the system by seeking out advice or 'going private'.

LIMITATIONS

The omission of medical staff and ethnic minority patients.

CONCLUSIONS

Cardiac rehabilitation in the policy targets in UK will only be met with substantial investment to address the barriers identified here.

Return to work after myocardial infarction/coronary artery bypass grafting: patients' and physicians' initial viewpoints and outcome 12 months later

Nonmedical factors play an important role in determining whether patients resume their work after myocardial infarction or CABG. The main questions dealt with in this study are: What is the respective basis of physicians' and patients' judgements as far as vocational disabilities are concerned, and what are the decisive factors that facilitate a prediction as to who will return to work and who will not? 132 male patients participating in a cardiac rehabilitation program served as subjects. The age group was limited to patients between 40 and 59 yr of age. The work situation 12 months following rehabilitation is known for 119 subjects; 74 had resumed their occupations. Results of regression analyses show that patients' and physicians' views on disabilities and re-employment are based on different factors. The physicians derive their estimates mainly from medical variables (cardiac status and comorbidity), whereas the patients' views are based on the overall health status, their former job status, job satisfaction, and negative incentives for the return to work. Three variables were found that allow a prediction to be made as to re-employment in 85% of all cases: (1) age, (2) patients' feelings about the extent to which they are disabled by their cardiac problem, and (3) the physicians' views on the extent to which the patient is vocationally disabled by his overall medical situation. Medical variables (e.g. cardiac status) had little relevance to re-employment. The results are discussed with regard to the consequences for cardiac rehabilitation.

Acute myocardial infarction in middle-aged women: narrations from the patients and their partners during rehabilitation

The purpose of this study was to examine the meaning of lived experiences after an acute myocardial infarction (AMI) and being a partner to an afflicted woman, as it is narrated during rehabilitation. Nine women and their partners narrated their experiences three and twelve months after AMI. The interview texts were transcribed and then interpreted, using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. The result showed that their experiences of the illness contained two themes: 'rehabilitation needed' and 'loss of freedom' which contains eight sub-themes; 'adapting to it', 'struggling against it', 'living as normally as possible', 'having insight into how it can be', 'feeling guilty and ashamed about being weak', 'withholding feelings', 'feeling useless', and 'feeling fatigued and losing strength'. After further interpretation, the themes gave a deeper meaning of living with AMI and how it affects women and their partners. The women conceded that they felt distressed and vulnerable but struggled against the fear the illness means. The partner's role appears to be one of trying to adapt to the women's experiences of the illness. That the women withheld their feelings and did not talk about them indicates a lack of communication between the couples. As coronary care nurses often come very close both to the afflicted persons and the relatives they fill an important function in each patient's recovery. The nurses could help and prepare the patients and their relatives to understand better such feelings and reactions as could appear after discharge from hospital.

Cardiac rehabilitation: structure, effectiveness and the future

Despite advances in the investigation and treatment of angina and myocardial infarction, and increased knowledge of the factors associated with the development and progression of ischaemic heart disease, it remains the leading cause of death and morbidity in the majority of industrialized countries. Cardiac rehabilitation provides a means of modifying lifestyle and other risk factors in patients presenting with established, symptomatic coronary artery disease, thereby reducing the risk of further cardiac events. It has also been proven to be cost-efficient.

Cardiac rehabilitation following myocardial infarction

Coronary heart disease is the major cause of death in the UK, but cardiac rehabilitation programmes have tended to develop in an ad hoc and unsystematic way. This article considers some of the deficits in current practice and suggests ways in which nurses can contribute more fully to care in this area. The need for better training and the necessity to develop skills in psychological care are highlighted. The authors also emphasize the importance of giving greater attention to a number of areas such as family involvement, sexuality and gender issues, and community follow-up.

Problems with providing education on resuming sexual activity after myocardial infarction: developing written information for patients

This article contains a review of the importance and the adverse consequences of patients not receiving information about resuming sexual activity following an acute myocardial infarction (AMI). The available evidence indicates that nurses are failing to supply this form of advice for a number of reasons. Therefore this paper is focused on the development of an information leaflet which can be used as a vehicle for assisting nurses in meeting patients' needs in this area, the content of which may not have been conceived as important or considered at all during the period of the patients' hospitalisation.

Cancer pain education for patients

OBJECTIVES

To review the basic principles of patient education, models of innovative approaches to patient education, and needs for future development in patient education.

DATA SOURCES

Review articles, research studies, book chapters, personal communication, and standards pertaining to cancer pain education.

CONCLUSIONS

Patient education based on principles of effective teaching and learning is the cornerstone of effective pain management. Improved methods of patient teaching combined with novel approaches to delivering appropriate pain content can lead to enhanced patient compliance with the prescribed pain medication regimen.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are essential to improving the care of cancer patients in pain by providing patient education as a care component of professional nursing practice. The challenge remains to overcome significant barriers of limited time and resources to achieve these goals.

Patients' and nurses' knowledge of cardiac-related symptoms and cardiac misconceptions

OBJECTIVE

To compare knowledge and reported incidence of cardiac-related symptoms among patients with nurses' knowledge and estimated incidence of symptoms in this patient group.

DESIGN

Retrospective collection of patient data by means of postal questionnaire and postal survey of hospital nurses.

SETTING

Five non-randomly selected hospitals in northeast England.

SUBJECTS

One hundred seventy-five male patients with a first uncomplicated myocardial infarction (MI), cared for by 168 registered nurses working in coronary care or medical wards.

OUTCOME MEASURES

Reported and estimated occurrence of 11 common cardiac symptoms in the 3 weeks after MI and 15-item knowledge and 10-item misconception scales about cause of and recovery from MI.

RESULTS

The percentage of nurses who correctly estimated the incidence of symptoms was low, 25% of nurses did not make any correct estimates, and the mean number of correct estimates was not associated with nurses' experience or qualifications. The overall mean score for the knowledge scale was 9.6 (SD 1.9) for nurses, which was significantly higher (t=7.5, p<0.001) than that for patients (mean 7.9, SD 2.3); the nurses' score was not significantly associated with experience or place of work. For the misconception scale the mean score for nurses was 6.8 (SD 1.5), which was significantly higher (t=6.85, p<0.001) than the mean score for patients (5.5; SD 2.6); nurses working in specialized cardiac wards and more experienced nurses had significantly higher scores.

CONCLUSIONS

Nurses should be provided with sound knowledge on cardiac symptoms and risks so that they can educate patients accordingly and, in particular, can correct misconceptions about the condition, prognosis, and appropriate lifestyle changes. Advanced-training personnel should recognize the need to enhance nurses' skills in patient education and rehabilitation; the importance of these skills also should be recognized in first-level training.