NURSING INTERVENTIONS FOLLOWING SUDDEN CARDIAC ARREST

本项目旨在测试两部分护理干预，以改善经历心脏骤停（SCA）和内部心律转复除颤器（ICD）植入后个体的身体机能、心理调节和医疗保健利用。SCA声称，美国每年约有50万人死于心血管疾病，占心血管疾病死亡总数的40%。随着先进的紧急医疗服务的出现，更多的人被复苏并在SCA发作中幸存下来。大约29%的患者在最初的心脏骤停后存活下来，每年超过16,000例。正在进行自动内部心律转复除颤器（ICD）植入。本研究的目的是测试书面结构化信息（SI）小册子和护理电话支持（NTS）协议的效果，这两者都是根据Bandura的社会认知理论和先前研究“心脏骤停后恢复的经历”的数据构建的。电话指导干预，由高级执业护士影响病人护理结果以前没有测试过的人群。这些干预措施的目的是包括SCA幸存者，他们居住的地方离植入ICD的医疗中心没有开车距离，交通不便，以及生活在偏远地区。在三年的时间里，SI手册和NTS干预将通过两组（N=75/组）的实验纵向设计与常规护理进行测试。干预的结果包括在ICD植入后的第一年5次（出院、1个月、3个月、6个月和12个月）测量SCA幸存者的身体功能、心理调整和医疗保健利用。为了使生活在偏远地区的人更容易获得护理，护理干预措施和收集的所有数据都是专门设计的，以便通过邮件或电话提供。治疗效果的主要分析是结果变量从基线到1个月和3个月的变化。其次，探索理论模型中指定的中介效应将被确定。研究结果有望推广到其他高危患者人群，他们在很短的停留后离开医院，对他们密切的随访由高级执业护士将是有利的。

The goal of this project is to test a two-part nursing intervention to improve the physical the physical functioning, psychological adjustment, and health care utilization of individuals after experiencing to sudden cardiac arrest (SCA) and internal cardioverter defibrillator (ICD) implantation. SCA claims approximately 500,000 in the US per year, represent5ing 40% of the total deaths resulting from cardiovascular disease. With the advent of sophisticated emergency medical services, a greater number of persons are resuscitated and survive SCA episodes. Approximately 29% of persons survive the initial cardiac arrest, with a greater than 16,000/year. Undergoing automatic internal cardioverter defibrillator (ICD) implantation. The purpose of this study is to test the effects of a written structured informational (SI) booklet and a protocol of nursing telephone support (NTS), both of which are constructed from Bandura's Social Cognitive Theory and data from the previous study "Experiences of Recovery Following Sudden Cardiac Arrest." Telephone coaching interventions by advanced practice nurses that influence patient care outcomes have not been tested previously in this population. These interventions are designed to include SCA survivors who do not live within driving distance to the medical center where their ICD was implanted, those do not have easy access to transportation, and those living in remote areas. Over a three year period the SI booklet and NTS intervention will be tested against usual care using a 2 group (N=75/group), experimental longitudinal design. Outcomes of the intervention include physical functioning, psychological adjustment, and health care utilization of SCA survivors measured at 5 times (hospital discharge, 1 month, 3 months, 6 months, and 12 months) during the first year subsequent to ICD implantation. To increase access tot those living in remove areas, the nursing intervention and all data collected are designed specifically to be delivered through the mail or on the telephone. The primary analysis for treatment effect is the change in outcome variables from baseline to 1 and 3 months. Secondarily, exploring the mediating effects specified in the theoretical model will be determined. The findings are expected to be generalizable to other populations of high risk patients who leave the hospital after a very short stay, and to whom close follow-up cre by advanced practice nurses would be advantageous.