Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment
Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment
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DOI：
10.1097/nnr.0b013e318240dc6b
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发表时间：
2012-03-01
期刊：
影响因子：
2.5
通讯作者：
Guertin, Marie-Claude
中科院分区：
文献类型：
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作者：
Cossette, Sylvie;Frasure-Smith, Nancy;Guertin, Marie-Claude
背景：急性冠状动脉综合征（ACSs）患者住院时间短减少了入院时进行危险因素干预的机会。出院后，心脏康复可使冠状动脉事件的复发率降低25%。然而，它仍未得到充分利用。目的：本研究的目的是确定关注ACS患者个体对其疾病和治疗的认知的护理干预是否会增加出院后的康复登记。方法：242例ACS患者在专科三级心脏中心就诊，随机分为干预组和常规组（两组各121例）。干预包括出院前的一次护患会面和出院后10天内的2次额外接触（每次接触平均持续时间=40分钟）。主要结果是所有参与者在出院后6周参加免费康复计划。次要结局包括疾病知觉；家人的支持;焦虑水平;药物治疗依从性;心脏病风险因素包括缺乏锻炼、吸烟、身体质量指数和饮食。结果：样本由大多数男性，已婚工人谁经历心肌梗死或不稳定心绞痛没有严重的并发症。两组患者的平均住院时间均为3.6天。干预组患者康复登记率（45%）显著高于对照组（24%），p= 0.001。对于次要结果，只有疾病感知的个人控制维度在干预后得到显著改善。讨论：渐进式、个性化的护士干预导致更多的康复登记，从而潜在地改善长期结果。
Background: Short hospital stays for patients with acute coronary syndromes (ACSs) reduce the opportunity for risk factor intervention during admission. After discharge, cardiac rehabilitation can decrease the recurrence of coronary events by up to 25%. However, it remains underused.Objectives: The aim of this study was to determine whether a nursing intervention focused on individual ACS patients' perceptions of their disease and treatment would increase rehabilitation enrollment after discharge.Method: A total of 242 ACS patients admitted to a specialized tertiary cardiac center were randomized to either the intervention or usual care (n=121 in both groups). The intervention included one nurse-patient meeting before discharge with 2 additional contacts over the 10 days after discharge (mean duration=40 minutes per contact). The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge. Secondary outcomes included illness perceptions; family support; anxiety level; medication adherence; and cardiac risk factors including lack of exercise, smoking, body mass index, and diet.Results: The sample was composed of a majority of male, married workers who experienced a myocardial infarction or unstable angina without severe complications. The mean hospital stay in both groups was 3.6 days. There was a significantly higher rate of rehabilitation enrollment in the intervention group (45%) than in the control group (24%; p=.001). For the secondary outcomes, only the personal control dimension of illness perceptions was improved significantly with the intervention.Discussion: Progressive, individualized interventions by nurses resulted in greater rehabilitation enrollment, thereby potentially improving long-term outcome.