NURSING INTERVENTIONS FOLLOWING SUDDEN CARDIAC ARREST

本研究目的在探讨一套两阶段护理介入法，以改善心脏骤停及植入心脏复律除颤器后病患的生理功能、心理调适及医疗服务利用。SCA每年在美国索赔约500，000例，占心血管疾病导致的总死亡人数的40%。随着先进的紧急医疗服务的出现，越来越多的人被救活并在SCA发作中幸存下来。大约29%的人在最初的心脏骤停后存活下来，每年超过16，000人。正在植入自动内部心律转复除颤器（ICD）。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，这两个协议都是根据班杜拉的社会认知理论和先前的研究“心脏骤停后恢复的经验”的数据构建的。“高级执业护士的电话辅导干预影响病人护理结果，以前没有在这一人群中进行过测试。这些干预措施旨在包括SCA幸存者，这些幸存者居住在距离植入ICD的医疗中心不远的地方，交通不便，以及居住在偏远地区。在三年的时间内，将使用2组（N=75/组）实验性纵向设计，对照常规护理对SI手册和NTS干预进行测试。干预的结果包括ICD植入后第一年内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、心理调整和卫生保健利用。为了增加对居住在偏远地区的人的访问，护理干预和收集的所有数据都是专门通过邮件或电话提供的。治疗效果的主要分析是结局变量从基线至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。研究结果预计将推广到其他人群的高风险患者谁离开医院后，一个非常短的停留，并密切跟进cre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.