Structures,processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported,home based cardiac rehabilitation program for rural patients with acute coronary syndrome

Background

Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia.

Outcomes of cardiac rehabilitation participants and nonparticipants in a rural area.

Nationally, only 11%-20% of cardiac patients, on average, enroll in cardiac rehabilitation programs after their cardiac events. The purpose of this study was to examine: (a) differences in functional health outcomes, clinical risk factor outcomes, and lifestyle behaviors between patients who participated in cardiac rehabilitation (CR) and those who did not during the first year after their cardiac event; and (b) to examine predictors of and reasons for CR participation and non-participation in a Midwestern, rural clinical population. Green's health education framework guided the study. A cross-sectional, comparative design was used to mail surveys to 538 cardiac patients who were hospitalized over a 1-year period at a regional medical center; 255 surveys were returned, and the final sample numbered 222. Of these, 154 (69%) attended CR. Compared to nonparticipants (n = 68), participants reported significantly higher levels of functioning on 7 of the 8 subscales of the Medical Outcome Study Short Form-36 (SF-36). In relation to clinical risk factor outcomes, participants had a significantly lower body mass index than nonparticipants. Patients who attended CR reported that they had switched to low-fat foods, started an exercise program, lost weight, lowered stress, lowered blood pressure, and reduced blood cholesterol at significantly higher rates than non-participants. Patients were more likely to participate in CR if their physician explained its benefits, if they were told about it during their hospitalization, and if they lived close to a CR program. Patients with coronary heart disease need to be referred to CR for improved physical and psychosocial functioning and successful risk factor modification.     

Intention,beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation: An observational study

BackgroundCardiac rehabilitationis effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low.ObjectivesThis study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement.DesignA weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation.SettingsThree United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland.ParticipantsAcute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented.MethodsConsecutive patients completed a pre-hospital discharge questionnaire targeting age, diagnosis, social class and smoking history. Acute coronary syndrome patients then completed a weekly electronic diary from the first week of discharge until the start of cardiac rehabilitation. Multilevel structural equation models estimated the effects of initial, i.e. baseline and rate of change in cardiac-related cognition and mood on attendance. Intention to attend cardiac rehabilitation was reflected, log transformed, reported thereafter as “do not intend”. The role of “do not intend” was explored as a mediator of the relationship between cardiac-related cognition and mood on attendance.Results166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low “do not intend”) to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation.ConclusionsNegative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect.     

Supporting clinical nursing leadership and professional practice at the unit level

Professional practice models (PPMs) are innovative approaches for improving health care delivery. Implementation of these new practice models needs to be well planned and supported to ensure their success in producing desired outcomes. This article describes two programs used to implement a PPM in a health care organization, focusing mainly on a program design intended to support the implementation of a new PPM on a medical-surgical hospital unit. The program blends the concepts of the organization's PPM with the leadership concepts from the AACN's Clinical Nurse Leader role to help nurses further develop their professional behaviors and clinical leadership skills.     

Predictors of cardiac rehabilitation initiation.

This study determines the effects of 15 potential predictors on cardiac rehabilitation (CR) initiation: demographic information, measures of perceived severity, perceived susceptibility, perceived cardiac threat, social support, depression, comorbid conditions, left ventricular ejection fraction, strength of physician recommendation, and benefits and barriers. Results showed that greater strength of physician recommendation and less disease severity were significant predictors of higher levels of CR initiation; female gender was a marginally significant predictor of less CR initiation. The strength of the associations for these predictors varied. Strength of physician recommendation was the strongest predictor. This information can be used to increase the number of patients starting CR through programs designed to increase physician awareness of the importance of their recommendation, the continuing need to refer women to CR, and the need to design programs that meet women's needs.     

Home cardiac rehabilitation for congestive heart failure: a nursing case management approach.

As the only major cardiovascular disease increasing in incidence and prevalence, congestive heart failure (CHF) is a major health threat. Progression of the disease often leads to severe disability and requires intensive medical and psychological management. Cardiac rehabilitation for CHF can improve a patient's functional ability, alleviate activity-related symptoms, improve quality of life, and restore and maintain physiological, psychological, and social status. The expansion of home care services and advances in technology allow cardiac rehabilitation to take place in the patient's home. Because of their training in health promotion and prevention, assessment, and coordination of services, nurses are the ideal providers of comprehensive home cardiac rehabilitation. Financially, physically, and psychologically beneficial for CHF patients and their families, home cardiac rehabilitation is also cost-effective for society. This article substantiates the benefits of home cardiac rehabilitation for patients with CHF and explains why nurses are the ideal case managers for such programs.     

Why women need to sweat: the benefits of cardiac rehabilitation

The benefits of cardiac rehabilitation (CR) programs have long been documented in the literature, but these programs have been underutilized within the health care arena, particularly by women and the elderly. The goals of CR are to improve the physiologic and psychosocial condition of the patient. Understanding the benefits of an effective CR program will help critical care nurses and physicians promote and refer patients who have cardiovascular disease to this life-changing heart healthy program. This article identifies the components and benefits of a successful CR program.     

Elderly Clients'' Perceptions of Public Health Nursing Care

Although the health benefits of illness prevention and health promotion are accepted, little is known about the reasons for which elderly clients attend public health programs or the benefits they perceived from public health nursing care. This study reports the major reasons for which men and women age 60 and over sought care in a public health nursing program and the major benefits they perceived. The sample included 137 new and 360 returning clients. Responses to open-ended questions were content analyzed into categories of like statements, which in turn were placed into overall groups. The results suggest that most clients realized significant benefits from receiving public health care and were able to articulate these benefits. Eliciting client's perceptions can assist public health nurses to implement and market programs in a way that is acceptable and accessible to the recipients.     

Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program

Psychosocial risk factors, such as perceived stress, not only increase the risk of cardiovascular disease, but also act as barriers for treatment adherence and cardiac rehabilitation. In this study, we examined the predictive role of perceptions for illness to perceived stress in Iranian patients participating in a cardiac rehabilitation program. A cross‐sectional study was conducted in 2017 to determine correlations of demographic variables and domains of illness perception with perceived stress, and to develop a predictive model for perceived stress. In total, 150 patients with cardiovascular disease, who were admitted to a cardiac rehabilitation center, completed the questionnaires. (i) demographic and health‐related characteristics; (ii) the Perceived Stress Scale‐14; and (iii) the Brief Illness Perception Questionnaire. The mean perceived stress was 16.2 (8.4), and five illness perception subscales – timeline, personal control, treatment control, understanding and emotional response – were associated with increased perceived stress. Variables in the multi‐variate predictive model accounted for 48% of the total variance in perceived stress. The results demonstrated the value of assessing and managing the patients' perceptions of illness to reduce their perceived stress, which could support adherence to cardiac rehabilitation programs.     

Patient-provider communication regarding referral to cardiac rehabilitation.

This study investigated the dynamics of patient-provider communication in the cardiac rehabilitation (CR) referral process, to identify which aspects lead to CR participation. Semi-structured individual interviews were conducted with 31 patients eligible for CR. Questions probed the content and perception of the discussion that patients had with healthcare providers (HCP) regarding CR attendance. The interviews were audiotaped, transcribed, and imported into N6 software for grounded analyses. Key emerging themes were identified: illness perceptions; HCP encouragement; timing of discussion; and ease of referral. CR attenders were apt to self-advocate to ensure their enrollment in CR, whereas nonattenders were more likely to minimize the seriousness of their disease, and less likely to persevere to overcome obstacles in enrolling in a CR program. Surprisingly, the strength of the HCP referral did not influence the decision to attend CR as strongly when compared to the HCP's ability to facilitate enrollment in a CR program.     

Swedish ambulance nurses' experiences of nursing patients suffering cardiac arrest

Effective pre‐hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses’ experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio‐pulmonary resuscitation (CPR) to accord with pre‐hospital cardiac guidelines and patients’ wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses’ experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions.     

Development of an emergency nursing training curriculum in Ghana

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses.     

Nurses’ experiences with an inpatient geriatric consulting service at a Midwestern Veterans’ hospital: The elder veteran program

This qualitative project used conventional content analysis of interview data to examine nurses’ experience with and perception of the Elder Veteran Program, an inpatient geriatric consulting service, at a midwestern Veterans’ hospital. Nurses were recruited from nursing units utilizing the program and completed individual interviews (N = 10). Participants described the impact of the program within four categories: providing comprehensive care to patients, contributing to individual growth of nurses, promoting team-based care, and as a resource. Participants described several barriers and facilitators to implementation of the program on their unit, including workload and time, shifts and availability of program staff, perceived need, inclusion criteria, perception of program staff, education of nurses, communication, and the inpatient environment. This project provides opportunities for further examination of healthcare providers’ experience with inpatient geriatric programs, how those experiences may relate to effectiveness of programs, and important areas of support for hospital staff.     

The nature of nursing care and rehabilitation of female stroke survivors: the perspective of hospital nurses

Aims and objectives. The aim of this study was to explore the nature of nursing care and rehabilitation of female stroke survivors, as described by hospital nurses. The objectives were to uncover how the nurses perceived the care of female stroke survivors and to explore whether, and in what way, the nurses paid attention to the fact that the patients were women. Background. Nursing care is an important aspect of the rehabilitation of stroke survivors. Little attention has been paid to gender differences in the health care system in general and in the nursing profession in particular, although it is reasonable to think that gender issues may have important implications in the rehabilitation process following a stroke. Design. Design was phenomenological with feminist perspective. Methods. The nurses were interviewed in‐depth. In the data analysing process we were inspired by Giorgi's phenomenological method. Results. The nurses were focusing primarily on functional and practical aspects of the women's situation. They perceived the rehabilitation process predominately from a professional rather than the patient point of view, and from a non‐conscious and primarily gender‐neutral perspective. Conclusions. The results indicate that the nurses perceived nursing care primarily in terms of practical actions to promote the body's functional and practical abilities. Little attention was directed to the stroke survivors’ experiences of their life body, nor to the fact that the patients were women. Relevance to clinical practice. In order to promote care from the perspective of the female stroke survivors, we believe it is necessary to attend to the life experiences of the patient, which also mandates paying attention to how gender has an impact on their diseased bodies, every day life, values and preferences in the situation.     

Transforming the journey for newly licensed registered nurses

Newly licensed nurses entering into practice experience stressors related to daily challenges. This evidence-based practice project implemented a nurse residency program designed to ease the transition during the first year of practice. Newly licensed nurses at a Midwestern health care organization were enrolled in a yearlong nurse residency program and were required to attend one 4-hour session monthly. Program outcomes included a decrease in turnover and improved confidence.     

Outpatient nurses: from handmaiden to autonomous practitioner

Little seems to have been written about health promotion in outpatients' departments. This article argues that outpatient nurses have the potential to play a significant part in promoting people's health. Outpatient nurses may be the first hospital nurses that an individual meets. What people observe and how they are treated may make a difference to both their experience of hospital care and their health. Outpatient nurses may have been perceived as the doctors' handmaidens of yesterday, but today they are evolving into an effective force for change. For example, evaluation of nurse-led outpatients' clinics is showing that they have the potential to complement doctor-led clinics and improve the healthcare experience of patients. It is argued that the health-promoting role of the outpatient nurse can be enhanced by a department that is a health-promoting environment.