A multidisciplinary approach to cardiac rehabilitation care

In reviewing our rehabilitation service in line with the national service framework a number of issues were identified to be addressed by the nursing and psychology team. It was decided that a group should be set up to help address and contain anxieties in line with patient needs and provide practical information during this interim period of treatment. Patient feedback has shown the sessions meet their needs and staff have found that less time is taken up during individual appointments answering commonly asked questions and repeating information that is frequently asked for.     

A multidisciplinary approach to cardiac rehabilitation.

As health care professionals we believe rehabilitation and patient education should commence on admission and continue through to discharge. Ideally it should be started from birth, with education by the family, school, GPs and well person clinics. This should include family screening an awareness of health and factors which may affect this. When patients develop angina, support should be given so that they can control the effects more adequately and reduce potential risk factors. There should be no exclusion criteria for patients accepted on these programmes as those who would probably be excluded are those who would require rehabilitation the most. Every individual can participate in discussion and any form of exercise can be tailored to meet the individual's needs. Many benefits have been mentioned, but the most important one is the improved quality of life for the patient and her or his family. Cardiac rehabilitation programmes and self-help groups may provide additional support to the patient and family during convalescence. Group programmes through their dynamics help to overcome feelings of isolation. Patients feel they gain support from their peer-group and they in turn can help each other overcome residual symptoms and practical difficulties. This 'social' rehabilitation is often the most beneficial aspect of the course; the group really helps them succeed. Rehabilitation must be accepted as part of the treatment and not a luxury for a few patients. This is a very exciting time when interest in this area is developing and research is examining the quality of life. We need to evaluate continually and undertake research to improve nursing practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

A team approach to rehabilitation

Through assessment, goal setting, planning, implementation, evaluation, and modification of goals and plans, members of the rehabilitation team individualize the meaning of "rehabilitation" for a client and establish a coordinated plan of action.     

Co-production—an approach to cardiac rehabilitation from a service management perspective

Aim The aim of the study was to describe and analyse the hospital delivery system for patients recovering from myocardial infarction, applying the offering and value concepts from service management theory
Background In Nordic hospital care patients traditionally played a minor role. But changes have taken place. By means of information giving and systematic education from the staff many chronically ill patients are now taking a significant part in their treatment and care.
Method The method was a case study including 12 individual interviews.
Conclusions The principal conclusion is that the short and intense periods of hospital inpatient stay make it advantageous to consider the patient a member of the health care team taking an active part in the caring process.     

心脏康复相关研究

M aintenance of exercise capacity andphysical activity patterns2years aftercardiac rehabilitation.Journal of Car-diopulm onary Rehabilitation2005;25(1):14-21心脏康复两年后运动能力和运动方式的坚持情况Know ledge of heart attack sym ptom s inolder m en and w om en atrisk for acutem yocardialinfarction.JournalofCardiopul-m onaryRehabilitation2005;25(1):33-9有急性心肌梗塞危险的老年患者对心脏梗塞发作症状的了解Prevalence of depressive disorders inm en and w om en enrolled in cardiac re-habilita…     

Automatic referral to cardiac rehabilitation

OBJECTIVES: Cardiac rehabilitation (CR) remains underused and inconsistently accessed, particularly for women and minorities. This study examined the factors associated with CR enrollment within the context of an automatic referral system through a retrospective chart review plus survey. Through the Behavioral Model of Health Services Utilization, it was postulated that enabling and perceived need factors, but not predisposing factors, would significantly predict patient enrollment. SUBJECTS: A random sample of all atherosclerotic heart disease (AHD) patients treated at a tertiary care center (Trillium Health Centre, Ontario, Canada) from April 2001 to May 2002 (n = 501) were mailed a survey using a modified Dillman method (71% response rate). MEASURES: Predisposing measures consisted of sociodemographics such as age, sex, ethnocultural background, work status, level of education, and income. Enabling factors consisted of barriers and facilitators to CR attendance, exercise benefits and barriers (EBBS), and social support (MOS). Perceived need factors consisted of illness perceptions (IPQ) and body mass index. RESULTS: Of the 272 participants, 199 (73.2%) attended a CR assessment. Lower denial/minimization, fewer logistical barriers to CR (eg, distance, cost), and lower perceptions of AHD as cyclical or episodic reliably predicted CR enrollment among cardiac patients who were automatically referred. CONCLUSION: Because none of the predisposing factors were significant in the final model, this suggests that factors associated with CR enrollment within the context of an automatic referral model relate to enabling factors and perceived need. A prospective controlled evaluation of automatic referral is warranted.     

Automatic referral to cardiac rehabilitation

The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.     

A patient self-assessment tool for cardiac rehabilitation

A patient self-assessment tool was designed, tested, and implemented to promote cardiac-specific data collection, based on Gordon's Functional Health Patterns, to maximize patient/family involvement in determining a plan of care, and to streamline primary nurses' documentation requirements. Retrospective and concurrent chart reviews provided data for quality assurance monitoring. The results of the monitoring demonstrated that the self-assessment tool markedly improved the patient-specific data base.     

Physical medicine rehabilitation approach to pain

A physical medicine and rehabilitation approach to acute and chronic pain syndromes includes a wide spectrum of treatment focus. Whether assessing or treating acute or chronic pain syndromes, management should include a biopsychosocial approach. Assessment may include a focused joint and functional examination including more global areas of impairment (ie, gait, balance, and endurance) and disability. More complicated multidimensional chronic pain conditions may require the use of a more collaborative continuum of multidisciplinary and interdisciplinary treatment approaches. Regardless of the scope of care that each individual patient requires, treatment options may include active physical therapy, rational polypharmacy, CBT, and the use of passive modalities. Treatment goals generally emphasize achieving analgesia, improving psychosocial functioning, and reintegration of recreational or leisure pursuits (ie, community activities and sports). Progress in all therapies necessitates close monitoring by the health care provider and necessitates ongoing communication between members of the treatment team. Although this article focuses on diagnoses related to acute and chronic low back pain, OA, and musculoskeletal disorders, assessment and treatment recommendations may be generalized to most other pain conditions.     

Stroke rehabilitation. A problem-oriented approach

Optimal rehabilitation of stroke disability depends on a detailed analysis of neurologic impairments, associated medical conditions, psychosocial status, activities of daily living, and environmental barriers. Such analysis will permit design of the most appropriate management program, aimed at minimizing disability, maximizing function, and returning the stroke patient to a gratifying existence in spite of residual impairment and disability.     

Racial disparities in access to cardiac rehabilitation

OBJECTIVE: This study sought to assess the association between race and referral to cardiac rehabilitation programs. DESIGN: A total of 1933 cardiac patients enrolled in the Cardiac Access Study (n = 9275) who met the criteria selection of the American College of Cardiology Guidelines of eligibility for cardiac rehabilitation were evaluated to determine factors associated with accessing cardiac rehabilitation programs. Referral to a cardiac rehabilitation program among eligible participants was the outcome of interest. Potential factors associated with referral were entered into a logistic regression analysis to determine factors associated with referral. RESULTS: Whites were more likely to be referred for cardiac rehabilitation than were blacks (crude odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.75-3.63). After controlling for age, education, socioeconomic status, and insurance, race was still independently associated with referral for cardiac rehabilitation (OR = 1.81; 95% CI = 1.22-2.68). CONCLUSION: Among those patients who were eligible for cardiac rehabilitation, race is independently associated with the likelihood of referral for cardiac rehabilitation. The decreased utilization of such services in this population could lead to further disparity in cardiac outcomes. Future studies should address ways to eliminate this disparity and increase referral to such services.     

Addressing current challenges to cardiac rehabilitation care

Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a strong nurse-patient relationship. This relationship provides a foundation for meeting current healthcare challenges. Three challenges are presented and addressed through specific examples. The challenge of the changing cardiac rehabilitation population is addressed through the example of the heart failure patient. The challenge to create innovative programming is addressed through the example of the Therapeutic Rehabilitative Intensive Program, developed to meet the needs of people who live in communities without cardiac rehabilitation services. The challenge to measure outcomes is addressed through the example of choosing a blood pressure measurement method. In addressing each challenge, the role of the advanced practice nurse is described.