Nursing Interventions and Cardiac Rehab Enrollment Study

Theoretical Framework

This study is grounded in Leventhal's self-regulation theory, which suggests that the actions best able to explain behavioral changes are founded in the patient's unique view of their illness and how they regulate their behavior, including 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 loose manner, largely proposing that emotional and cognitive processes help individuals solidify their perceptions of illness and thus shape the mode of action taken during a health crisis. Because no strict framework is imposed, concepts such as the identification of the illness, its presumed causes, its prospective consequences, its anticipated duration, and the degree of perceived control over the disease all become factors that can influence an individual's ability—or perceived ability—to manage their condition. This framework is strongly grounded in the belief that perceptions drive a tremendous amount of patient behavior, including how willing a patient is to minimize risk factors. Accordingly, other variables in the study, such as interventions, can be drawn from self-regulation theory, which holds that interventions should work to reframe harder-to-articulate illness representations into 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 relation to 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 discharge, and the final contact was a telephone call or in-person visit at the hospital ten days after discharge. The objective of these interventions was to focus on how the patient was managing their symptoms, the degree of physical activity being engaged in, any emerging risk factors, and potential lifestyle modifications.

Dependent Variable: Acute Coronary Syndromes

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

Operational Definition: Acute Coronary Syndromes (ACS) manifest in a range of ways. For example, Coronary Heart Disease (CHD) is a form of ACS that manifests "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, Setting, and Methods

Inclusion and Exclusion Criteria

The inclusion criteria were not explicitly stated. However, based on the foundational pillars of the study, participants would have had to have experienced a recent incident of ACS or some manifestation of ACS. The exclusion criteria were more explicitly defined and included discharge to a rehabilitation center for short- or long-term care, lack of fluent English or French abilities, and living more than 50 miles from a rehabilitation 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 approximately six weeks of patient discharge. All enrollment data collected were gathered into a single database.

Sample Size

The sample size was based on the ability to detect a doubling of the rehabilitation enrollment rate from at least 15% among ACS patients monitored at the study hospital (Cossette, 2012). The determined difference—from 15% to 30%—was believed to adequately represent the most meaningful improvement. To detect this increase, the target sample was set at 242 patients, divided into two groups of 121, yielding a final power of .80 and a two-sided alpha of .05 (Cossette, 2012).

Refusal to Participate

A total of just under 5,000 patients were evaluated (4,802), of whom 3,800 were eliminated based on the study's specific criteria. An additional 301 refused to participate, representing approximately 8% of eligible potential participants. The study does not report attrition or mortality rates. This study was examined and approved by the Research Ethics Board of the hospital and received the registration number ISRCTV95784.

Study Setting

The study was conducted with adult patients receiving care and treatment for ACS at the medical ward of a hospital in Montreal, Canada.