A Randomized Controlled Trial of a Discharge Nursing Intervention to Promote Self-Regulation of Care for Early Discharge

2.50
Hdl Handle:
http://hdl.handle.net/10755/157195
Category:
Abstract
Type:
Presentation
Title:
A Randomized Controlled Trial of a Discharge Nursing Intervention to Promote Self-Regulation of Care for Early Discharge
Author(s):
Ahern Gould, Kathleen
Author Details:
Kathleen Ahern Gould, RN,PhD, Boston College/Northeastern University, Boston, Massachusetts, USA, email: gouldkc@bc.edu
Abstract:
POSTER PURPOSE: To compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and patients who receive a discharge nursing intervention (DNI). The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at lifestyle changes to reduce secondary events after treatment for CVD is needed to guide evidence-based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or 1 to 2 days of the procedure. Cardiac disease is then managed as a chronic but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: (a) the burden of care shifts from the hospital setting to home, (b) patients are discharged without extensive education about complications and disease management, (c) the occurrence of secondary events and disease progression remain a valid threat, and (d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions.


Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence?

Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction?

Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care?

Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by 7 components of the revised Illness Perception Questionnaire: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations?

BACKGROUND/SIGNIFICANCE:As a result of the new era of angiodynamics, the care trajectory following a cardiac event has changed dramatically. The traditional care of extended bed rest, surgery, prolonged hospitalizations, and the support of cardiac rehabilitation classes and educational support groups is no longer the standard; that care trajectory is now reserved primarily for unstable or severely compromised patients. TodayÆs cardiac patients are more often fast tracked through rapid care protocols. Interventional procedures are provided within hours of the acute event. Patients recover in short-stay areas and return home within hours or 1 to 2 days of the procedure. Cardiac disease is then managed as a chronic but often stable condition, as patients continue their recovery at home. The occurrence of secondary events and disease progression after a cardiac event remains a valid health threat for more than 70% of CVD patients. More than 40% to 50% of these patients will need additional treatment because of restenosis of ballooned and stented coronary vessels or progression of vascular disease. Despite advances in technology, patients with cardiac disease must continue to manage a chronic condition. Care aimed at lifestyle changes and the reduction of secondary events is needed to improve patientsÆ outcomes. Nursing care of patients with CVD is occurring in very different settings as recovery from acute care moves from the hospital to home. Attention to "after care" of short-stay patients requires new models of discharge care that are evidence-based and focused on engaging the patients to self-manage their disease. METHOD: Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred fifty-four patients were randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI, which included (1) additional written information about taking medications, (2) a medication pocket card, (3) a list of 3 cardiac Internet sites, and (4) a phone call, 24 hours after the procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. RESULTS: Analyses on 4 outcome measures-medication adherence, use of urgent care, patient satisfaction, and illness perception-revealed 1 statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on 1 measure, the timeline (acute/chronic) component of illness perception (P = .006), indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant differences between groups. This study provides support for nursing intervention research guided by self-regulation theory that examines the patientÆs perception of illness. Patients with cardiac disease who received the DNI were significantly more likely to acknowledge that their illness would last a long time. This awareness may improve adherence to a prescribed regimen of medication and lifestyle modification. CONCLUSIONS: Nursing interventions guided by an understanding of patientsÆ belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleA Randomized Controlled Trial of a Discharge Nursing Intervention to Promote Self-Regulation of Care for Early Dischargeen_GB
dc.contributor.authorAhern Gould, Kathleenen_GB
dc.author.detailsKathleen Ahern Gould, RN,PhD, Boston College/Northeastern University, Boston, Massachusetts, USA, email: gouldkc@bc.eduen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157195-
dc.description.abstractPOSTER PURPOSE: To compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and patients who receive a discharge nursing intervention (DNI). The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at lifestyle changes to reduce secondary events after treatment for CVD is needed to guide evidence-based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or 1 to 2 days of the procedure. Cardiac disease is then managed as a chronic but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: (a) the burden of care shifts from the hospital setting to home, (b) patients are discharged without extensive education about complications and disease management, (c) the occurrence of secondary events and disease progression remain a valid threat, and (d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions. <br/><br/><br/>Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence? <br/><br/>Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction? <br/><br/>Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care? <br/><br/>Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by 7 components of the revised Illness Perception Questionnaire: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations? <br/><br/>BACKGROUND/SIGNIFICANCE:As a result of the new era of angiodynamics, the care trajectory following a cardiac event has changed dramatically. The traditional care of extended bed rest, surgery, prolonged hospitalizations, and the support of cardiac rehabilitation classes and educational support groups is no longer the standard; that care trajectory is now reserved primarily for unstable or severely compromised patients. Today&AElig;s cardiac patients are more often fast tracked through rapid care protocols. Interventional procedures are provided within hours of the acute event. Patients recover in short-stay areas and return home within hours or 1 to 2 days of the procedure. Cardiac disease is then managed as a chronic but often stable condition, as patients continue their recovery at home. The occurrence of secondary events and disease progression after a cardiac event remains a valid health threat for more than 70% of CVD patients. More than 40% to 50% of these patients will need additional treatment because of restenosis of ballooned and stented coronary vessels or progression of vascular disease. Despite advances in technology, patients with cardiac disease must continue to manage a chronic condition. Care aimed at lifestyle changes and the reduction of secondary events is needed to improve patients&AElig; outcomes. Nursing care of patients with CVD is occurring in very different settings as recovery from acute care moves from the hospital to home. Attention to "after care" of short-stay patients requires new models of discharge care that are evidence-based and focused on engaging the patients to self-manage their disease. METHOD: Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred fifty-four patients were randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI, which included (1) additional written information about taking medications, (2) a medication pocket card, (3) a list of 3 cardiac Internet sites, and (4) a phone call, 24 hours after the procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. RESULTS: Analyses on 4 outcome measures-medication adherence, use of urgent care, patient satisfaction, and illness perception-revealed 1 statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on 1 measure, the timeline (acute/chronic) component of illness perception (P = .006), indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant differences between groups. This study provides support for nursing intervention research guided by self-regulation theory that examines the patient&AElig;s perception of illness. Patients with cardiac disease who received the DNI were significantly more likely to acknowledge that their illness would last a long time. This awareness may improve adherence to a prescribed regimen of medication and lifestyle modification. CONCLUSIONS: Nursing interventions guided by an understanding of patients&AElig; belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home.en_GB
dc.date.available2011-10-26T19:30:25Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:30:25Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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