Continuity of Nursing Care in Patients with Coronary Artery Disease: A Systematic Review

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness

AIM

To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients.

DESIGN

A cross-sectional multi-centre study was conducted.

METHODS

Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver.

RESULTS

The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours.

CONCLUSION

The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education.

IMPLICATION FOR PROFESSION AND PATIENT CARE

Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours.

IMPACT

Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad.

REPORTING METHOD

STROBE checklist for cross-sectional studies was followed in this study.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the sample of the study.

Self-Care Practices and Perspectives in Managing Coronary Heart Disease Patients: A Qualitative Study

Background/Objectives: Self-care experiences and understanding of coronary heart disease (CHD) play a pivotal role in the management of CHD and can contribute to positive health outcomes. This qualitative study aimed to explore the views and experiences of CHD patients, their families, and Indigenous leaders about self-care practices of CHD. Methods: A qualitative design employing semi-structured interviews and a focus group discussion was used. Employing purposive sampling, 49 respondents, comprising 30 patients, 10 family members, and 9 Indigenous leaders, were recruited and interviewed from April to September 2022. The data were analyzed using content analysis. Results: Five major categories were constructed: (1) inadequate knowledge and early symptom identification; (2) self-care activities for physical, psychosocial, and spiritual needs; (3) family and kinship support for self-care efforts; (4) barriers to self-care including physical, psychological, and access issues; and (5) health improvement expectations based on culturally sensitive health education. Conclusions: The study reveals significant gaps in knowledge about CHD and the identification of early symptoms among patients, families, and Indigenous leaders. Despite efforts to meet physical, psychosocial, and spiritual needs, self-care is hindered by various barriers, including limited access to healthcare and entrenched habits. The support from family and kinship systems is crucial for self-care. Participants expressed a strong desire for culturally tailored health education and better health control to improve heart health outcomes.

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.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model

AIM

The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge.

DESIGN

Correlational design based on cross-sectional data from a multicentre survey study.

METHODS

People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling.

RESULTS

In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90.

CONCLUSION

Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care.

IMPACT

This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes.

PATIENT OR PUBLIC CONTRIBUTION

People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Analysis of the application effect of continuous care for patients with viral keratitis

BACKGROUND

In recent years, the incidence of viral keratitis has been on the rise.

OBJECTIVE

This study explored the application effect of continuous care for patients with viral keratitis.

METHODS

A total of 148 patients with viral keratitis admitted to the ophthalmology department of the authors' hospital from January 2019 to December 2020 were selected and divided into the observation group and the control group via the random number table method, with 74 cases in each group. Continuous care was conducted following routine discharge guidance for patients in the observation group, while routine discharge guidance only was provided for the control group. The patients in both groups were continuously observed for one year. The medication compliance, return visit rate, recurrence rate, nursing satisfaction, and quality of life between the two groups were compared and analyzed after one year.

RESULTS

The medication compliance was higher in the observation than in the control group and the difference was statistically significant (P< 0.05). The rate of return visits at 1 week, 1 month, 3 months, 6 months, and 1 year in the observation group were higher than those in the control group and the differences were statistically significant (P< 0.05). The difference in the recurrence rate between the two groups at 1 week was not statistically significant (P> 0.05), while the recurrence rate at 1, 3, and 6 months, and 1 year in the observation group were higher than those in the control group, and the difference was statistically significant (P< 0.05). The total score of the quality of life in the observation group was higher than in the control group and the difference was statistically significant (P< 0.05).

CONCLUSION

Continuous care had a good application effect on patients with viral keratitis, which could potentially effectively improve medication compliance and the rate of return visits, reduce recurrence rate, and improve patient satisfaction and their quality of life. Accordingly, the results of this study present high clinical value.

The effect of extended continuous nursing strategy applied to patients with mild brain injury on their quality of life and self-efficacy

Postoperative rehabilitation of craniocerebral injury requires a long process and has many complications. In addition, patients with severe craniocerebral injury are usually accompanied by impaired nervous system function, which will affect the patients’ normal life and work in a period of time after surgery. Reasonable rehabilitation nursing plays an active role in restructuring central nervous system function and coordinating muscle and joint activities. Since the rehabilitation of cerebral trauma is a long process, how to ensure the patients to carry out limb and brain function as well as self-care ability and self-care skills according to the rehabilitation exercise plan and intervention measures formulated before discharge has aroused hot debate. This study analyzed the impact of out-of-hospital continuous nursing strategy applied to patients with mild cerebral trauma on their quality of life and self-efficacy level.

Continuing Care Bundle in Elderly Patients with Rectal Cancer after Radical Resection with Permanent Stoma

Objective. A continuing care bundle can achieve a better outcome than a single implementation after discharge. This study aims to investigate the effect of this intervention in elderly patients with rectal cancer after radical resection with a permanent stoma. Methods. Elderly patients diagnosed with rectal cancer underwent radical resection with permanent stoma, they were divided into the control group (n = 42) and bundle group (n = 42). The control group received the conventional care, and the bundle group received the continuing care bundle in addition to the conventional care. At 1- and 3-month after discharge, self-efficacy, self-care knowledge, ability to change stoma appliances, negative emotions, quality of life, and patient satisfaction were observed. Results. The increased levels of self-efficacy, self-care knowledge, and ability to change stoma appliances were displayed in the bundle group after discharge as compared with that in the control group, along with the enhanced score of SF-36 subscales, including physical function (PF), role physical (RP), global health (GH) and vitality (V), social function (SF), and mental health (MH). Furthermore, patients showed alleviated depression and anxiety after the continuing care bundle as compared to those after conventional care. Besides, the bundle groups had higher patient satisfaction than the control group. Conclusions. Continuing care bundle can serve as an effectiveness intervention in elderly rectal cancer patients after radical resection with permanent stoma via increasing self-efficacy and self-care knowledge, enhancing the ability to change stoma appliance, reliving the negative emotion, and improving quality of life and patient satisfaction.

Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.