Myocardial infarction patients' learning needs: Perceptions of patients, family members and nurses

The Process of Inefficient Self-Management in Patients With Myocardial Infarction in Prehospital: A Grounded Theory

Introduction

Myocardial infarction (MI) is a cardiovascular emergency that needs immediate diagnosis and treatment. utilizing incorrect strategies during a MI may lead to adverse consequences and complications. This study was conducted to explore the process of prehospital management of patients with MI.

Methods

This study was conducted using the grounded theory design. fifteen patients with MI and six family members were purposefully and theoretically selected from a leading hospital in Kashan, Iran. Data were collected using unstructured and semi-structured interviews and were analyzed through the constant comparison method proposed by Corbin and Strauss (2015). The length of the interviews was 40-60 min and data collection were kept on to reach data saturation.

Results

The patients' mean age was 70.06 years, and 53.3% of them were male. The findings were categorized into three major categories and nine subcategories. The three major categories of "fighting between awareness and preference," "taking problematic arbitrary measures," and "consulting lay people" emerged from the participants' experiences, along with the theme of "inefficient self-management."

Conclusion

Complex situation, unfamiliarity with MI and its management makes MI management very difficult for patients and family members. Therefore, MI-specific educations are needed to improve patients' self-management abilities.

Perceived Health Needs, Social Support, and Depression Among Patients with Myocardial Infarction: A Cross-Sectional Study

BACKGROUND

Cardiovascular diseases are the leading cause of mortality globally. Myocardial infarction (MI), a major type of cardiovascular disease, presents long-term challenges for patients. Recognizing patients' perceived health needs and the factors that influence them is crucial for providing comprehensive care and improving outcomes.

AIM

This paper explores the perceived health needs, levels of depression, and social support among MI patients, as well as investigates the correlations between these factors.

METHODS

A cross-sectional study was conducted at King Salman Specialist Hospital from March to June 2024, enrolling 244 MI patients through convenience sampling. Data collection was performed using the following three validated questionnaires: the Cardiac Patient Learning Needs Inventory (CPLNI) to assess the learning needs of MI patients, the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression levels, and the Oslo Social Support Scale (OSSS-3) to measure social support. Statistical analysis was carried out using IBM SPSS Statistics, Version 27.

RESULTS

Patients aged 40 years or older and those who were employed exhibited greater learning needs (p < 0.001). Female patients were more depressed than males (p = 0.008). Higher social support was reported by the female patients, those with a family history of MI, and those who were employed (p = 0.002, 0.002, and 0.003, respectively). The total mean score for perceived learning needs was 3.72, with the highest needs in "other pertinent information", "medication information", and "anatomy and physiology". Depression was indicated in 45.1% of MI patients, with significantly higher depression levels in female than in male patients. Additionally, a significant positive correlation was found between social support and perceived learning needs (r = 0.205, p = 0.001), as well as a negative correlation between social support and depression (r = -0.441, p < 0.001).

CONCLUSIONS

Addressing both the physical and psychological needs is essential for MI patients. Comprehensive educational programs and mental health support services are necessary for improving outcomes. Personalized patient education and routine depression screenings should be integrated into post-MI care. Future research should examine longitudinal changes in learning needs and mental health status.

An evaluation of the best practices and barriers for the Nagasaki acute myocardial infarction secondary prevention clinical pathway

AIMS

The Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP), a guideline-based regional clinical pathway, was developed to manage low-density lipoprotein cholesterol levels for patients with acute myocardial infarction (AMI) in the Nagasaki prefecture in Japan. This study aimed to summarize the perceived best practices and barriers for the dissemination and operation of the NASP.

METHODS

This exploratory sequential mixed methods study was developed around the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Focus group interviews were conducted with 24 physicians with experience treating AMI in alignment with the NASP at foundation hospitals. The identified themes and insights were integrated into the development of the questionnaire. The web-based, self-administered questionnaire with a cross-sectional study design was given to 62 physicians in the Nagasaki prefecture. Mixed-method data integration of the results from both study phases was conducted through meta-inferences made from the qualitative and quantitative data.

RESULTS

The best practices included the development of multi-disciplinary operation teams at medical facilities in preparation for the implementation of the NASP, the simplification of the document preparation process, and the establishment of an additional medical fees policy for the utilization of the NASP instead of patient referral documents. Practices tailored to the type of medical institute such as instructing patients on the NASP regimen during index hospitalization for acute-care hospitals, and the development of NASP instructions and manuals for primary care hospitals/outpatient clinics were also recommended. In addition, barriers to the implementation of the NASP such as missed eligible AMI patients for the NASP and the inconsistent implementation to eligible AMI patients were identified.

CONCLUSIONS

This study identified the perceived best practices and barriers for the NASP. This knowledge should be considered when expanding the NASP to other institutions across Japan.

Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study

AIMS AND OBJECTIVES

Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital.

BACKGROUND

After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE).

METHODS

Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study.

RESULTS

Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level.

CONCLUSIONS

This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing.

RELEVANCE TO CLINICAL PRACTICE

Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process.

NO PATIENT OR PUBLIC CONTRIBUTION

For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.

Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review

Cardiovascular diseases are a major cause of death worldwide, and coronary heart disease (CHD) is a prevalent cardiovascular condition and a significant health burden for the population. In this disease, insufficient blood flow to the heart due to plaque accumulation in the coronary arteries causes chest pain, heart attack, and even death. So, it is vital to identify risk factors, prevention, appropriate treatment, and rehabilitation. Nurses play an indispensable role in managing and caring for patients with CHD. Indeed, they possess a deep understanding of the disease and its complexities, enabling them to provide comprehensive care to patients. Nurses monitor vital signs, administer medications, and perform diagnostic tests, ensuring patients receive timely and appropriate interventions. They also educate patients and their families about CHD, emphasizing lifestyle modifications, medication adherence, and self-care practices. Moreover, nurses offer emotional support, guiding patients through the physical and psychological challenges associated with CHD. Their expertise, compassion, and dedication significantly improve patient outcomes and overall quality of life. Nurses are responsible for assessing, diagnosing, and counseling patients on how to manage their disease, making them the front line of defense in preventing and addressing this serious condition. In the current study, we reviewed the literature to consider the best practices and emerging trends in nursing interventions and care strategies for patients with CHD.

Patient Education Strategies among Patients with Acute Myocardial Infarction: A Systematic Review

  BACKGROUND: There is a need to summarize the effect of existing research-based education strategy on patients’ physical condition, health behaviour change, as well as psychosocial well-being in patients with acute myocardial infarction. AIM: to review and synthesis relevant studies on patient educational strategy and its effect on patients’ physical condition, health behaviour change, as well as psychosocial well-being in patients with acute myocardial infarction. METHODS: A literature search was conducted on MEDLINE, Academic Search Ultimate, CINAHL-EBSCO, and PubMed. Articles were selected by predefined inclusion and exclusion criteria. Assessment of methodological quality of each study was executed using The Downs and Black scale. RESULTS: Nineteen studies (3588 patients with myocardial infarction) were included. Educational intervention methods ranged from face-to-face method only, face-to-face method in combination with telephone call(s), the combination of both face-to-face method and telephone call(s) with one other method. Outcome measured on each study varied and the effectiveness of the intervention in at least one of their outcome measures demonstrated in 17 studies. CONCLUSIONS: Findings support the pivotal role of patient education on the management of myocardial infarction patient.   Key-words: coronary heart disease, education, educational strategy, learning needs, systematic review

Effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation in myocardial infarction patients undergoing PCI

OBJECTIVE

This study aimed to evaluate the effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation (CPR) in acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).

METHODS

With the random number table, 130 myocardial infarction patients undergoing PCI were divided into two groups, including the control group (n=65) receiving routine emergency resuscitation and nursing care, and the study group (n=65) receiving a structured team care model. The efficacy of CPR, cardiac function, exercise tolerance, ability of daily living activities, quality of life, complication rate and nursing satisfaction were compared between the two groups.

RESULTS

The door-to-balloon time, length of stay at the emergency department, duration of balloon dilation, bedtime and hospital stay in the study group were shorter than those in the control group (P<0.05). The study group showed lower LVEDD and LVESD and higher LVEF than the control group after nursing (P<0.05). The extend of physical limitation, angina stability, level of disease awareness, number of angina attacks, and treatment satisfaction scores in the 6-MWT, MBI, and SAQ scales in the study group after nursing were higher than those in the control group (P<0.05). The complication rate in the study group (7.69%) was lower than that in the control group (20.00%) (P<0.05). The study group had higher satisfaction with operational skills, teamwork, clinical practice, rescue awareness, orderliness, and timeliness than the control group (P<0.05).

CONCLUSION

Structured team nursing model is helpful to improve the timeliness and quality of CRP, shorten the treatment time, improve patients' cardiac function and exercise tolerance, improve self-care ability and quality of life, reduce the occurrence of complications, and enhance the patient-nurse relationship.

Trajectoire et vécu des personnes traitées pour un infarctus du myocarde en région éloignée : étude exploratoire descriptive

Introduction&#160;: Cardiovascular disease is on the rise and is the second leading cause of death among Canadians. Background&#160;: The care pathway followed by myocardial infarction patients in remote areas has an impact on their continuity of care.Objective&#160;: To describe the care pathway of myocardial infarction patients living in a remote area.Methods&#160;: A qualitative formative research design was used. Two samples were created, the first comprising sixteen people who had undergone a percutaneous transluminal coronary angioplasty, and the second made up of four health professionals working in Family Medicine Groups (FMGs).Results&#160;: Eight steps were identified and three priority needs were raised, namely&#160;: 1) understanding the pathway of care and services&#160;; 2) effectively communicating health information to the various establishments&#160;; and 3) setting up follow-up by FMG health professionals when the patient returns home.Discussion&#160;: Nurses play a key role in all steps of the pathway and in meeting patients&#8217; needs.Conclusion&#160;: The care and service pathway are suboptimal but the same for participants from this remote area.

Information Needs in Percutaneous Coronary Artery Intervention: Validation and Reliability Analysis of NPCI-10 Item Scale

Introduction: Percutaneous coronary intervention (PCI) is a nonsurgical procedure used in the treatment of coronary heart disease.

Purpose: The purpose of this study was to validate a scale created in order to assess the importance and fulfillment of information needs in patients after PCI.

Methods: A 10-item scale was created by the researchers to explore the level of information needs and the level of fulfillment of these needs. The total scores have a possible range of 10 to 40 with higher scores indicating higher importance and fulfillment. The validation of the questionnaire included face and content validity, construct validity, internal consistency, repeatability, and discriminant validity.

Results: Forty patients contributed to this validation. Mean and median scores for each question separately and also overall scores suggest that patients consider the need to be informed very important and that it was fulfilled to a very high degree (mean scores 39.5 and 39.3, respectively). All questions were found to be significantly correlated with the overall scores (rho > 0.3) meaning strong construct validity. Cronbach’s α coefficients were high (>0.7) indicating great consistency. Both total scores had great repeatability, which suggests a high degree of reliability of the participants' responses (ICCs > 0.8). Regarding discriminant validity, a statistically significant association was observed only between marital status and the degree of fulfillment of the need to be informed (p = 0.036). More specifically, divorced or widowed patients had a lower degree of fulfillment than married patients (mean 38.6 vs. 39.6).

Conclusion: It is a reliable instrument that will help clinicians who are at close contact with patients after PCI to gain a better understanding of their needs.