European Journal of Cardiovascular Nursing

Nurses have a key role in teaching cardiovascular (CV) surgical patients to manage their post-surgical care after discharge. There is evidence that effective patient teaching contributes to improved quality of life, decreased anxiety and depression and fewer post-CV surgery emergency department visits and hospital readmissions. Despite this, there are no guidelines or standards for how best to educate CV surgical patients for discharge.

To conduct a literature review of published research on discharge education for CV surgical patients to inform guidelines for educating CV surgical patients.

An exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of Systematic Reviews, and ERIC was executed using the following search terms: cardiovascular, cardiac, cardio*, heart, surg*, transplant, discharge, self-manage*, teach*, educat*, preop*, patient, care. In addition, an ancestry search of all reference lists was completed. Studies were included if they were published between 2007 and 2012 and focused on preoperative CV surgery adult patient education.

The search yielded 20 studies, 12 were excluded because they did not meet the inclusion/exclusion criteria. Eight studies were included in the final review. Three studies reported statistically significant decreases in reported anxiety and depression and increased subjective health. Four studies had mixed results with both positive and neutral findings. No studies reported negative findings in relation to preoperative education.

Patients and staff identified that patient education is essential. Standardized educational tools are appropriate as they can spare resources, but are only effective if used in conjunction with individualized education.

In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients’ pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care.

To add a deeper understanding of patients’ thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction.

Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis.

Four themes were conceptualized: ‘being incapacitated by fear, anguish and powerlessness’, ‘being ashamed of oneself’, ‘fear of losing a healthy identity’ and ‘striving to avoid fear by not interacting with others’. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care.

The present study indicates that emotional reactions are important and influence patients’ pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

This study aimed to explore and identify the relationship between health-related quality of life (HRQoL) and perceived social support among Chinese patients with coronary heart disease (CHD) in mainland China.

A descriptive correlational study was conducted with a convenience sample of 200 Chinese patients with CHD recruited from the cardiac outpatient departments of two university-affiliated hospitals in Xi’an, China. The Chinese Mandarin versions of the Short-form 36-item health survey (CM:SF-36) and the Medical Outcomes Study Social Support Survey (CM:MOS-SSS) were administered to assess HRQoL and perceived social support.

The results indicated that Chinese patients with CHD reported a poorer HRQoL and lower social support compared with their Western and Hong Kong counterparts. Multiple regression analyses identified four significant predictors of deteriorated physical health (increasing age, co-morbidity with heart failure or hypertension, and smoking status) and two significant predictors of poor mental health (co-morbidity with heart failure and perceived social support).

Health status and social support in Chinese people with CHD should be routinely assessed and, where feasible, addressed through appropriate individually tailored interventions.

Despite the established benefits of cardiac rehabilitation (CR) attendance rates remain variable. Physical barriers to attendance have been extensively investigated but relatively less is known about the relationship between attendance at CR and psychosocial variables such as illness perceptions and social isolation.

To examine the influence of socio-demographic factors, illness perceptions and social isolation on patient attendance at cardiac rehabilitation.

All individuals offered CR over a two-year period were invited to take part in a postal survey. The survey collected socio-demographic data and included completion of the Friendship Scale, to assess social isolation, and the Brief Illness Perceptions Questionnaire. Parametric and non-parametric statistical tests were used as appropriate.

One hundred and twenty-eight (47%) questionnaires were returned. Non-attendees reported higher total illness perception scores and those who attributed their illness to non-modifiable factors were significantly less likely to attend CR (p = 0.042). Attendees reported lower levels of social isolation; however, this finding was not statistically significant. No differences were found between attendees and non-attendees in terms of their age, gender, educational status or proximity to cardiac rehabilitation centre.

Psychosocial barriers, specifically illness perceptions and attributions, were found to be significant with patients who did not attend CR reporting more negative illness perceptions. Distance to CR was not a significant factor influencing attendance. Early screening of perceived causal attributions may help to identify those who would benefit from early and targeted intervention to increase participation in CR. Future prospective studies would permit testing of screening approaches and early interventions.

Patients with congenital heart disease (CHD) have poor understanding of their heart condition, treatment and prevention of complications. To improve their level of health-related knowledge, a structured education program was implemented in the adult congenital heart disease program. This study aimed (a) to evaluate the level of knowledge of patients who received structured CHD education as compared to patients who did not receive this education; (b) to explore if the provision of structured education is an independent determinant of knowledge; and (c) to evaluate whether patients who received structured education reached the educational target (>80% correct answers).

A total of 317 patients were included: 226 in the education group, and 91 in the comparison group. Knowledge was assessed using the ‘Leuven Knowledge Questionnaire for Congenital Heart Disease’. The mean total knowledge score in the education group (57%) was significantly higher as compared to the comparison group (43%) (p<0.001). However, only 24 patients (11%) in the education group reached the educational target of the program. After adjusting for patient’s age, educational level and disease complexity, hierarchical multivariable linear regression analysis showed that the provision of structured CHD education was an independent determinant of higher levels of knowledge.

A structured education program was associated with a higher level of knowledge. However, the educational target for sufficient knowledge was reached in a very limited number of patients. Hence, continuous efforts in educating patients and developing alternative education methods are needed.

Patients with heart failure managed by community heart failure specialist nurses (CHFSNs) may have episodes of (often unrelated) ill-health managed separately in hospital. Inadequate communication and multi-disciplinary working between these different providers can impact on the effectiveness of care.

This service improvement project explored the potential of patient-held alert cards to improve communication and continuity of care for heart failure patients moving between CHFSNs and hospital settings.

Alert cards were distributed to 119 patients on a community case load for presentation at hospital or emergency department. Follow-up data were obtained from practitioners and patients at 12 months.

At 12 months, 38 patients from the CHFSN caseload experienced 61 hospital admissions. CHFSNs were informed of 80% of admissions by practitioners (61%) and family members (38%). They were also informed of 59% of discharges. Notification of admission by hospital staff increased from zero in the previous 12 months, to 19 notifications. CHFSNs were more involved with hospital care, and patients reported increased confidence with the alert cards.

The study has shown that alert cards can increase the involvement of CHFSNs in the ongoing care and discharge planning process. They can also empower patients and carers to take an active role in their own care.

Age-adjusted stroke mortality rates in Israel are higher among Arabs compared with Jews; therefore, knowledge of stroke signs and prevention strategies is especially important in the Arab population. Data on stroke knowledge among Arabs in Israel are lacking.

We aimed to examine knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis.

A complementary mixed method design was used. Ninety-nine Arab Muslims living in Israel, older than 40 years, with no history of stroke, were personally interviewed. Knowledge of stroke was assessed using quantitative analysis by a semi-structured interview. Information on perceptions and thoughts evoked by stroke was analyzed using qualitative analysis by the constant comparative method. Rates of reported knowledge-related variables were presented.

Mean (SD) age of participants was 50.1 (8.0) years, 52.5% were women. Most of the participants (84.8%) knew the causes of stroke but only 29.3% mentioned sudden weakness or paralysis in one side of the body as a warning sign and other warning signs were even less known. The main known risk factor was hypertension (43.3%). Although knowledge of stroke prevention was poor, 89% were interested in learning about stroke and its prevention. The qualitative findings showed that stroke evokes negative thoughts of mental and physical burden and is associated with death, disability, dependence and depression.

Levels of stroke knowledge among Arab-Muslim Israelis are low to moderate. Healthcare professionals should assist high risk populations in controlling and treating risk factors in order to reduce mortality and disability following a stroke.

To improve patients’ quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients’ illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations.

To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL.

A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL.

Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL.

Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients’ beliefs about their illness. For example, increasing patients’ knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL.