Preliminary Literature Review
Cardiac patients take long periods to recover from operations and stenting. As such, there is need for specialized care which is critical in their recovery. Due to their long periods of recovery, there is the tendency to put them under home care or center care. Understanding their situation and needs is critical to their recovery both from the perspective of the patient and the care giver. This literature review will assess different needs and how to address them.
Adherence to Medication and its Predictors
Beswick et al. (2005) aimed at conducting a literature review to identify studies that evaluated methods of improving uptake, adherence and professional compliance in cardiac rehabilitation. To execute the study, a grey literature search was done to determine specialist journals as well as conference abstracts. As such, the study acquired 957 studies from which a few were selected for the furtherance of the study. Beswick et al. (2005) found out that use of volunteers and self-management improves rehabilitation uptake or lifestyle change, an opinion that was upheld by Richards et al. (2018). A nurse led coordination of care was shown to have a great impact on rehabilitation uptake.
Kähkönen et al. (2018) aimed at identifying predictors of adherence in patients with coronary heart disease after an intervention. Adherence has been identified by the study as a critical factor in the prevention of coronary heart disease. Adherence in the study meant the adherence to medication and a healthy lifestyle. The study adopted an analytical multihospital survey where 416 postpercutaneous coronary intervention patients were studied. The study paid emphasis to adherence and other factors such as sociodemographic, health, and disease specific factors. The study showed that there was good adherence among the patients. However, it was found out that inconsistencies existed in adherence to a healthy lifestyle. The study identified that gender, close personal relationships, length of education, physical activity, vegetable and alcohol consumption, cholesterol, and duration of cardiac problems without intervention were predictors of adherence.
In determining the effects of interventions that are directed at raising the uptake of, and adherence to cardiac rehabilitation, Karmali et al. (2014) conducted a qualitative study which took the form literature review. To obtain relevant studies, a search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science among other numerous databases was done. Ten studies were identified and it was found out that motivation, home visits, co-ordination of care by a trained nurse, supervised exercise sessions, and goal-setting are some of the measures that improve uptake of cardiac rehabilitation.
Grines et al. (2007) aimed at addressing premature discontinuation of antiplatelet therapies. With discontinuation of therapies, Grines et al. (2007) explain that a patient is exposed to risks such as stent thrombosis, myocardial infarction, and even death. The advisory emphasizes the importance of a patient receiving 12 months of antiplatelet therapy after placement of a drug-eluting stent. Further Grines et al. (2007) is of the opinion that patients and healthcare providers need to be educated on the hazards and risks that accompany premature discontinuation. Bowman, Gass, and Weeks (2018) support this view and explain that that a low dose antiplatelet therapy in patients with coronary stents can be an effective option since very majority of the patients received sufficient platelet inhibition without the risk of stent thrombosis if taken properly.
Home and Nursing Care
Saidzadeh, Darvishpoor Kakhki, and Abed Saeedi (2016) aimed to assess the factors that are associated with self-care agency in coronary intervention patients. The study is a descriptive study with a sample size of 300. The study collected data from a university hospital in 2015. Data for the study was collected using demographic and basic conditioning factors questionnaire as well as an appraisal of self-care agency scale. The study showed that 72% of patients had a sufficient level of self-care agency and it was even higher in married and high income patients. The study concluded that self-care agency is an aspect influenced by economic and marital situations.
17% of cardiac rehabilitation patients in the U.K. were experience depression according to Richards et al. (2018). The study aimed at piloting an enhanced psychological care intervention that would be tied to cardiac rehabilitation to test uncertainly areas. The team had eight cardiac rehabilitation teams which included patients that were eligible for cardiac rehabilitation. The study instituted measures that were performed at baseline followed up at 5 and 8-months. In total, Richards et al. (2018) found 55 eligible patients but only 29 participated whom were of the perception that a one-on-one session with a nurse was viewed as important in handling their psychological problems. As such, the nurse was viewed as critical in assisting the patients to recover in a timely fashion. Nurses on the other hand were revealed to sufficiently equipped to deliver intervention and important training.
Turner et al. (2017) explored the views of both patients and nurses on the feasibility and acceptability of providing psychological care in services that are marked by cardiac rehabilitation. Turner et al. (2017) adopted an in-depth interview which was analyzed thematically and involved 18 patients and 7 cardiac nurses. The nurses involved were those who were handling patients displaying signs of depression. Turner et al. (2017) revealed that both nurses and patients were of the view that psychological support was critical in cardiac rehabilitation. Patients demonstrated that they held in high regard nurses who tended both to their physical and psychological needs and the approach was viewed by patients as essential to their overall recovery (Turner et al., 2017). Nurses on the other hand were found to root for psychological support to be accorded to patients in organized ways.
To evaluate how home monitoring remote control coupled with automatic alerts for atrial fibrillation is important in driving early anticoagulation in a bid to reduce stroke risk, Ricci et al. (2009) included 136 pacemakers and 33 implantable defibrillators patients. The patients were either with or without cardiac resynchronization therapy and not taking anticoagulation at implant. All the patients were monitored with home monitoring. The study was conducted over two years and data was entered into a computer for Monte Carlo Model Simulation to simulate the real population. Ricci et al. (2009) found out that daily home monitoring had the potential to reduce the stroke risk within the range of 9-18%.
To inform new cardiac rehabilitation programs, Anderson and Taylor (2014) found out that exercise-based cardiac rehabilitation had no impact on mortality especially on low-risk people but it reduced hospital admissions besides improving the quality of life. Psychological and education based interventions, according to Anderson and Taylor (2014) have minute or no effect on mortality but improve the quality of life related to health. Further, Anderson and Taylor (2014) found out that home and center-based programs were effective in improving quality of life at equivalent cots.
Significance of the Studies to this Capstone Project
Anderson and Taylor evaluated studies have demonstrated that exercise based cardiac rehabilitation is an effective and safe way of managing patients who are stable. Beswick et al. (2005) has shown that a third party, such as a nurse or a volunteer might be necessary as an intervention to help discharged patients improve their uptake, adherence, and professional compliance in cardiac rehabilitation. Further the findings of Beswick et al. (2005) cement the role of trained professionals in the care of recovering cardiac patients. Ricci et al. (2009) indicated that patients with cardiac stents can be monitored from home. Further, Ricci et al. (2009) brought in the concept of anticoagulant (blood thinners) and how the combination of the two (home monitoring and use of blood thinners) are critical in reducing the risk of stroke to patients. To evaluate how cardiac stent patients should be motivated to stay within the realm of medication, Karmali et al. (2014) and Kähkönen et al. (2018) evaluated factors that would help patients maintain the momentum for treatment. Further the impact of medication has been assessed above together with the contribution of attending to cardiac patients’ psychological wellbeing can be of significance to their recovery.
The Care of cardiac patients who have stents can be accelerated by understanding the different factors that affect them. Through this literature review, it has been demonstrated that having patients under professional care at home has its advantages besides helping them learn how to care for themselves. Another important discovery is the confirmation that exercises and stress management techniques are important when applied to such patients. The importance of medication has been emphasized besides the importance of taking medication through to the end.
Action Item Checklist
Expected Completion Date
Prepare and submit capstone project
29th September 2018
Preliminary Literature Review
26th September 2018
Application of the change model start
3rd October 2018
End of application of the change model
5th October 2018
Evaluation completion date
15th November 2018
Compiling a final report
17th November 2018
Anderson, L. J., & Taylor, R. S. (2014). Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. International journal of cardiology, 177(2), 348-361.
Beswick, A. D., Rees, K., West, R. R., Taylor, F. C., Burke, M., Griebsch, I., … & Ebrahim, S. (2005). Improving uptake and adherence in cardiac rehabilitation: literature review. Journal of advanced nursing, 49(5), 538-555.
Bowman, S., Gass, J., & Weeks, P. (2018). Antiplatelet Therapy Bridging With Cangrelor in Patients With Coronary Stents: A Case Series. Annals of Pharmacotherapy, 1060028018795840.
Grines, C. L., Bonow, R. O., Casey, D. E., Gardner, T. J., Lockhart, P. B., Moliterno, D. J., … & Whitlow, P. (2007). Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Journal of the American College of Cardiology, 49(6), 734-739.
Karmali, K. N., Davies, P., Taylor, F., Beswick, A., Martin, N., & Ebrahim, S. (2014). Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database of Systematic Reviews, (6).
Kähkönen, O., Saaranen, T., Kankkunen, P., Lamidi, M. L., Kyngäs, H., & Miettinen, H. (2018). Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention. Journal of clinical nursing, 27(5-6), 989-1003.
Richards, S. H., Dickens, C., Anderson, R., Richards, D. A., Taylor, R. S., Ukoumunne, O. C., … & Davey, A. (2018). Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial. Trials, 19(1), 211.
Ricci, R. P., Morichelli, L., Gargaro, A., Laudadio, M. T., & Santini, M. (2009). Home monitoring in patients with implantable cardiac devices: is there a potential reduction of stroke risk? Results from a computer model tested through Monte Carlo simulations. Journal of cardiovascular electrophysiology, 20(11), 1244-1251.
Saeidzadeh, S., Darvishpoor Kakhki, A., & Abed Saeedi, J. (2016). Factors associated with self‐care agency in patients after percutaneous coronary intervention. Journal of clinical nursing, 25(21-22), 3311-3316.
Turner, K. M., Winder, R., Campbell, J. L., Richards, D. A., Gandhi, M., Dickens, C. M., & Richards, S. (2017). Patients’ and nurses’ views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ open, 7(9), e017510.
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