2nd Annual Spring Meeting of the ESC Working Group on Cardiovascular Nursing: Key Issues in Cardiac Care: Dublin, Ireland 5–6 April, 2002

Extract

1 1768—The nurse's role in patient education post-myocardial infarction through the phases of cardiac rehabilitation

Lynch C.

St James Hospital, Ireland

This literature review examines the research literature on patient education post myocardial infarction through the phases of cardiac rehabilitation. The four phases are: (1) in hospital=7–10 days; (2) immediate=2–6 weeks; (3) intermediate=2–6 months; (4) maintenance/long term (See appendix 1). The level of patient education in each phase is assessed. Nurses are identified in the literature as being in an ideal position to deliver and co-ordinate cardiac rehabilitation programmes (Thompson and Bowman, 1998). According to Sanford, 2000 patient education is unique to the nursing profession when it is given through caring in a caring environment. Models of patient education post MI can be used to guide nursing practice (Lane, 1997; Egan, 1999 cites Mirka, 1994). Phase one, the in hospital phase is extensively researched. It is not realistic to expect patients to learn the vast amount of information that patient education programmes contain during the in hospital phase (Chan, 1990). Patients are too preoccupied with issues of survival at this time (Steele and Ruzicki, 1987; Murray, 1989; Turton, 1998). The perspectives of patients and nurses of patients information needs post MI are identified using CPLNI, cardiac patients learning needs inventory, an instrument designed by Gerard and Peterson (1984) cited in Hughes (2000). An imbalance between the perspectives of nurses and cardiac patients was found. Risk factors rated consistently as the category of primary concern for patients whereas nurses rated risk factors of lesser importance (Karlik and Yarcheski, 1987; Hughes, 2000). In an age of shorter hospital stays and reduced nurse-patient contact time, Hughes, 2000 recommends the use of an instrument or tool, CPLNI (modified, updated) to rapidly assess and identify patient needs post MI. Phase two, the immediate phase is identified at a time when patients experience psychological and emotional difficulty when discharged home (Thompson et al., 1995; Jaarsma et al., 1995; Stewart et al., 2000, Dixon et al., 2000). Phase three, the intermediate phase is well established in the literature. The nurse's role is emphasised particularly as co-ordinators of the out-patient programme. The final phase, phase four is under-researched. Ford (1989) explored the experience of MI, in the maintenance phase and found that patients have unmet needs up to two years after the event. Services that provide information and support need to be established in phases two and four so that patient education is reinforced over time, thus linking the four phases of cardiac rehabilitation.