¶ … lucidly stated to orbit around Leventhal's self-regulation theory which suggests that the actions which can help better explain behavioral changes are founded in the patient's unique view of their illness, and how they in turn regulate their behavior and the extent to which they engage in risk management. According to Burns and Grove (2009), this is a substantive theory. The framework is presented in a somewhat lose manner, largely proposing that emotional and cognitive process help one in solidifying their perceptions of their illnesses and thus, impact the mode of action during a health crisis and the way in which the individual behave. As no strict framework is presented, concepts such as the identification of the illness, the presumed causes, the prospective consequences, the length of time of the disease, and the presumed control over the disease are all factors which can impact and influence the ability or perceived ability of an individual in tackling his or her disease. This framework is founded strongly in the believe that perceptions impact a tremendous amount of patient behavior, such as how much a patient is or is not willing to minimize risk factors. Thus, other variables involved in the study, such as interventions can be taken from the theory of self-regulation as it dictates that interventions should work hard at reframing the more hard-to-articulate representations to the more concrete ones.

Major Study Variables

Independent Variable: Nurse-centric interventions during the discharge process.

Conceptual Definition: The organized and concerted meeting between the nurse and the discharged patient as a means of assessing the patient's current progress and needs in terms of their cardiac condition.

Operational Definition: These interventions manifested in three distinct stages. The first was a face-to-face meeting before the patient was discharged. The second intervention was a phone call a few days after the patient was discharged, and the final contact was a telephone call or rendezvous at the hospital 10 days after discharge. The objective of these interventions were to focus upon how the patient was managing their symptoms and the degree of physical activity that was being engaged in along with to address any risk factors that were coming into play or to suggest lifestyle modifications.

Dependent Variable: Acute Coronary Syndromes

Conceptual Definition: Symptoms and manifestations of issues, irregularity, laboring or overall lack of general proper functioning of the cardiac or circulatory system.

Operational Definition: Acute Coronary Syndromes (ACS) manifest in a range of way. For example, Coronary Heart Disease (CHD) is a form of ACS which manifests as "when the heart muscle does not receive enough oxygen rich blood. ACS includes myocardial infarction (MI), also known as a heart attack, and unstable angina, or sudden, severe chest pain that typically occurs when a person is at rest" (nih.gov, 2014).

Sample and Setting

The inclusion criteria were not explicitly stated. However, based on the foundational pillars of the study participants would have to have had a recent incident of ACS or some manifestation of ACS. The exclusive criteria for the study was more explicitly studied: discharge to a rehab center for short or long-term care, lack of fluent English or French abilities; living over 50 miles from a rehab center along with "having physical (e.g., terminal illness, hospitalization longer than 8 days, death before discharge), psychological (e.g., drug consumption, severe anxiety), or cognitive (e.g., dementia) problems; referred for surgery; already receiving regular outpatient follow-up (e.g., specialized clinics); previously completed a rehabilitation program; or having a final diagnosis other than ACS" (Cossette, 2012).

Method used to obtain the sample

The method used to obtain the sample involved baseline questionnaires and enrollment in one rehabilitation session within a month and a half of patient discharge. All the data collected on enrollment was gathered into one database.

Sample Size

The sample size was based on the ability to determine doubling in at least 15% rate of rehabilitation enrollment with ACS patients being monitored at the study hospital (Cossette, 2012). The determined difference from 15 to 30% was believed to adequately represent the most important improvement: in order to determine such a bolstering of size, the target sample was determined at 242 patients, split into two groups of 121 for a final power of .80 and a two-sided alpha of .05 (Cossette, 2012).

Identify the refusal to participate number and percentage.

There was a total of just under 5,000 patient evaluated (4,802) and 3,800 eliminated as a result of the specific study criteria. In addition, 301 refused to participate (8%) of the potential participants. The study doesn't mention an attrition or mortality rates or percentages. This study was examined and approved by the Research Ethics Board of the hospital, ultimately receiving the registration ISRCTV95784.

Study Setting

The study occurred with adult patients who were in care and treatment for ACS at the medical ward of a particular hospital in Montreal Canada.

Below is a useful model for determining...

identify the study variable and link it to the measurement method used to measure this variable in the study (see Table below).
Study Variable

Name of Measurement Method and Author

Type of Measurement Method

Reliability or Precision

Validity or Accuracy

Illness perceptions

38-item Revised Illness Perception Questionnaire by IPQ-R: Moss-Morris et al., 2002

Survey

"the IPQ-R includes seven dimensions of illness perception. Higher scores on each dimension indicate that patients perceive the illness as more chronic than acute (seven items), report more negative consequences in their daily life (Cossette, 2012)

Valid but subjective.

Parent Perception of Health

14-item Family Care Climate Questionnaire by Clark & Dunbar, 2003

Survey

Score ranges from 14 to 70: the higher the score, the higher the perception of support. "Clark and Dunbar (2003) reported Cronbach's alpha of .89 for the total score. Item-to-total correlations ranged from .44 to .83" (Cossette, 2012).

Valid, but highly subjective as a result of the emotional involvement.

Anxiety

20-item state portion of the State-Trait Anxiety Inventory by Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983

Survey

Score can range from 20 to 80 with higher scores indicating higher levels of anxiety.

"Spielberger (1989) reported a series of studies demonstrating the validity of the scale. In this study, the alpha coefficients at T1 and T3 were .93 and .94, respectively" (Cossette, 2012).

Medication Adherence

4-item SelfReportedMedication-TakingScale by Morisky, Green, & Levine, 1986

Survey

Respondents had to answer regarding whether they forgot, were relaxed or completely stopped taking their medication -- both before and after hospitalization. The higher the score, the lower the adherence to meds.

Authors have attempted to prove its accuracy, but it relies heavily on total and complete honesty of the user.

Physical Activity

Do you have a healthy heart? By Program Acti-Menu

One question is asked: "In general, how many days per week are you physically active for at least 30 minutes (walking, dancing, sports, workout, etc.; does not have to be a continuous 30 minutes)."

Precision: Three answers possible: less than once a week; one or two times a week; or three or four times a week.

Somewhat accurate: three answers only limited the level of accuracy.

Healthy Diet

Are You Eating Healthy? Scale by Program Acti-Menu

20-question survey

Very detailed survey: one question asks about consumption of fat, others ask about fruits and vegetables.

Mostly accurate: bulk of the accuracy depends on the honesty of the user.

Statistical Analyses

Analysis Techniques

Socio-demographic and clinical variables were gathered together and then summarized for full validity and counted as a percentage for certain categorical variables. The Consolidated Standards of Reporting Trials statement advised that no particular tests be engaged in to determine the differences between the groups (Cossette, 2012). "The chi-square test was used for the primary outcome (rehabilitation enrollment). Logistic regression was used to assess models adjusting for baseline variables (one baseline variable at a time) that were thought to influence the results, based on the literature" (Cossette, 2012). On the other hand, some of these variables were based on the presumed imbalances that were deemed to be relevant enough to have some sort of clinical significance. The secondary outcomes were rates as a score at the one and a half month mark and were assessed using a particular analysis of covariance models along with fundamental scores including a covariate (Cossette, 2012). Subsequent outcomes were rates as particular categorical variables (such as smoking and other addictive behaviors, were assessed using a logistic regression model which looked specifically for T1 and the subsequent variables (Cossette, 2012). The relationships which were determined were very strong and these were the relationships which helped to guide and illuminate the moves that were largely projected during the study. The overall data analyses were strongly linked to the study's objective and the overarching goals.

Interpretation of Findings

The findings demonstrate that proactive and organized programs of health and lifestyle change might actually not have any meaningful impact on actual cardiac risk factors.

Expected findings:

However, researchers felt that the results were to be expected given the timing of entry into rehabilitation for both groups, which ranges from one week to sex weeks after hospital discharge (Cossette, 2012). The goals of the study were to motivate patients to view their shot at rehabilitation with more of a proactive attitude, along with an adherence to general counseling interventions. One aspect of the study which was not focused or specific was the aspect…