NURSING INTERVENTIONS FOLLOWING SUDDEN CARDIAC ARREST

本项目的目标是测试两部分护理干预措施，以改善个体在经历过心脏骤停(SCA)和内部心律转复除颤器(ICD)植入后的身体机能、心理调节和医疗保健利用。在美国，SCA每年索赔约50万人，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%的人在最初的心脏骤停后存活下来，每年超过16,000次。接受自动心脏复律除颤器(ICD)植入术。本研究的目的是测试书面结构化信息手册(SI)和护理电话支持协议(NTS)的效果，这两种方法都是根据班杜拉的社会认知理论和先前研究《心脏骤停后恢复的经验》中的数据构建的。由高级执业护士进行的影响患者护理结果的电话指导干预以前从未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，他们住在离植入ICD的医疗中心不在车程内的地方，那些交通不方便的人，以及那些生活在偏远地区的人。在三年的时间里，SI手册和NTS干预将使用2组(N=75个/组)的纵向实验设计，对照常规护理进行测试。干预的结果包括ICD植入后第一年内SCA幸存者的身体功能、心理调适和卫生保健利用情况。为了增加那些居住在偏远地区的人的机会，护理干预和收集的所有数据都是专门设计通过邮件或电话传递的。治疗效果的主要分析是从基线到1个月和3个月的结局变量的变化。其次，将确定理论模型中规定的中介效应。预计这一发现将推广到其他高危患者群体，他们在非常短的住院时间后离开医院，高级执业护士的密切随访将对他们有利。

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.