Preliminary Literature Review and Action Item Checklist

Preliminary Literature Review

Anderson, L. J., & Taylor, R. S. (2014). Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. International journal of cardiology, 177(2), 348-361.

The study aimed at providing evidence for delivery of cardiac rehabilitation and to identify current evidence gaps with an aim of informing new cardiac rehabilitation. To achieve this, the study conducted a review of The Cochrane Database of Systematic Review and did a tabular presentation of the trials in the studies selected, and the results of such studies. The study utilized six reviews to be fit for the study with a total of 148 randomized controlled trials and a total of 98,093 participants. In the end, the study found out that exercise-based cardiac rehabilitation had no impact on mortality especially on low-risk people but it reduced hospital admissions besides improving the quality of life. Psychological and education based interventions had minute or no effect on mortality but improved quality of life related to health. Further, the study found out that home and center-based programs were effective in improving quality of life at equivalent cots.

The study demonstrated that exercise based cardiac rehabilitation is an effective and safe way of managing patients who are stable. The study further holds that such patients have equal quality care at the same costs is possible for patients at home or at a recovery center. This study is significant to this capstone by drawing confidence that home or center-based care is equally sufficient to recovering cardiac patients. Further, the study gives alternative or additional methods of speeding the recovery pace which are exercise and patient education.

Beswick, A. D., Rees, K., West, R. R., Taylor, F. C., Burke, M., Griebsch, I., … & Ebrahim, S. (2005). Improving uptake and adherence in cardiac rehabilitation: literature review. Journal of advanced nursing, 49(5), 538-555.

The study aimed at conducting a literature review to identify studies that evaluated methods of improving uptake, adherence and professional compliance in cardiac rehabilitation. To execute the study, a grey literature search was done to determine specialist journals as well as conference abstracts. As such, the study acquired 957 studies from which a few were selected for the furtherance of the study. The study found out that use of volunteers and self-management improves rehabilitation uptake or lifestyle change. A nurse led coordination of care was shown to have a great impact on rehabilitation uptake. Health care professionals were expected have intervisit intervals of 6 to 12 months.

The study has the significance to this capstone project by demonstrating how to up the rehabilitation uptake. To this end, the study showed that a third party, such as a nurse or a volunteer might be necessary as an intervention to help discharged patients improve their uptake, adherence, and professional compliance in cardiac rehabilitation. The study’s findings cement the role of trained professionals in the care of recovering cardiac patients. The study emphasizes on the use of technology to further the care of cardiac patients.

Ricci, R. P., Morichelli, L., Gargaro, A., Laudadio, M. T., & Santini, M. (2009). Home monitoring in patients with implantable cardiac devices: is there a potential reduction of stroke risk? Results from a computer model tested through Monte Carlo simulations. Journal of cardiovascular electrophysiology, 20(11), 1244-1251.

The study aimed at evaluating how home monitoring remote control coupled with automatic alerts for atrial fibrillation is important in driving early anticoagulation in a bid to reduce stroke risk. To achieve the end, the study included 136 pacemakers and 33 implantable defibrillators patients. The patients were either with or without cardiac resynchronization therapy and not taking anticoagulation at implant. All the patients were monitored with home monitoring. The study was conducted over two years and data was entered into a computer for Monte Carlo Model Simulation to simulate the real population. The study found out that daily home monitoring had the potential to reduce the stroke risk within the range of 9-18%.

This study is a perfect match for the capstone project as it is indicated that patients with cardiac stents can be monitored from home. The study further brought in the concept of anticoagulant (blood thinners) and how the combination of the two (home monitoring and use of blood thinners) are critical in reducing the risk of stroke to patients.

Karmali, K. N., Davies, P., Taylor, F., Beswick, A., Martin, N., & Ebrahim, S. (2014). Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database of Systematic Reviews, (6).

            The study is aimed at determining the effects of interventions that are directed at raising the uptake of, and adherence to cardiac rehabilitation. The study was qualitative and took the form of a literature review. To obtain relevant studies, a search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science among other numerous databases were searched. To collect data, titles and abstracts of identified studies were assessed for relevance and bias. Ten studies were identified and it was found out that motivation, home visits, co-ordination of care by a trained nurse, supervised exercise sessions, and goal-setting are some of the measures that improve uptake of cardiac rehabilitation were effective.

            The study is significant to the capstone project as it will inspire ideas on how to motivate cardiac patients to uptake and adhere to rehabilitation. As such, the study gives caregivers in the capstone project the chance to experiment with different proven interventions that will improve the uptake and adherence to cardiac rehabilitation.

Grines, C. L., Bonow, R. O., Casey, D. E., Gardner, T. J., Lockhart, P. B., Moliterno, D. J., … & Whitlow, P. (2007). Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Journal of the American College of Cardiology, 49(6), 734-739.

            The article is not strictly a study but an advisory to cardiac patients. The article examines possible scenarios that can come with premature discontinuation of antiplatelet therapy. The article starts by acknowledging that antiplatelet therapy with both aspirin and thienopyridine has been proven to reduce cardiac events especially after coronary stenting. The problem the article aims at addressing is premature discontinuation of such therapies. With discontinuation of therapies, the article explains that a patient is exposed to risks such as stent thrombosis, myocardial infarction, and even death. The advisory emphasizes the importance of a patient receiving 12 months of antiplatelet therapy after placement of a drug-eluting stent. Further the advisory is of the opinion that patients and healthcare providers need to be educated on the hazards and risks that accompany premature discontinuation.  The advisory opine that elective surgery can be deferred for a year and if it is not possible, a patient can continue with aspirin in the perioperative period in high-risk patients who have drug-eluting stents.

            This advisory is critical to the capstone project. It is a great source of motivation to patients and healthcare providers on the need to have a pre-informed mentality on the dangers of starting antiplatelet therapy and then quitting midway. As such, the advisory, from an expert and an informed point of view elucidates the importance of getting the medication completed on full cycle. Using other references, nurses should come up with means to ensure that home based care patients are always motivated enough to finish their medication as required by doctors.

Bowman, S., Gass, J., & Weeks, P. (2018). Antiplatelet Therapy Bridging With Cangrelor in Patients With Coronary Stents: A Case Series. Annals of Pharmacotherapy, 1060028018795840.

The study is a qualitative study and it aimed at evaluating the appropriate dosage, monitoring and potential clinical outcomes of treating a patient with a drug-cangrelor which is designed to work as an antiplatelet agent. The study evaluated patients with coronary stents who were treated with the drug. It was found out that out of 11 patients who were identified for the study, a median cangrelor dose of 0.5µg/kg/min was maintained in 7 patients. Of the seven, only three experienced bleeding complications in the therapy period and no stent thrombosis was experienced. The study concluded that a low dose antiplatelet therapy in patients with coronary stents can be an effective option since very majority of the patients received sufficient platelet inhibition without the risk of stent thrombosis.

The study sheds important light to the process of home care. If patients follow appropriate doses, it follows that stent thrombosis, which can be fatal through stroke or mycocardial infarction. This indicates to the caregivers the relevance of sticking to medication since failure to do so, might lead to drastic outcomes in the near future. Further, the study highlights the danger solved by antiplatelet drugs to coronary stent patient.

Turner, K. M., Winder, R., Campbell, J. L., Richards, D. A., Gandhi, M., Dickens, C. M., & Richards, S. (2017). Patients’ and nurses’ views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ open, 7(9), e017510.

The study aimed at exploring the views of both patients and nurses on the feasibility and acceptability of providing psychological care in services that are marked by cardiac rehabilitation. The study adopted an in-depth interview which was analyzed thematically and involved 18 patients and 7 cardiac nurses. The nurses involved were those who were handling patients displaying signs of depression. The study revealed that both nurses and patients were of the view that psychological support was critical in cardiac rehabilitation. Patients demonstrated that they held in high regard nurses who tended both to their physical and psychological needs and the approach was viewed by patients as essential to their overall recovery. Nurses on the other hand were found to root for psychological support to be accorded to patients in organized ways.

The study is important to the capstone project since it helps in the development of measures by nurses that are beyond the use of physical drugs such as blood thinners. The study adds to the therapy to be conducted by the nurse and it specifically identifies psychological support as critical. Having been assessed from patients and nurses themselves, the study demonstrates the willingness of both parties to partake in the exercise as it delivers a life changing effect. In the capstone project, psychological support will thus be taken seriously.

Richards, S. H., Dickens, C., Anderson, R., Richards, D. A., Taylor, R. S., Ukoumunne, O. C., … & Davey, A. (2018). Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial. Trials, 19(1), 211.

            The study started by recognizing that about 17% of cardiac rehabilitation patients in the U.K. were experiencing depression. The study aimed at piloting an enhanced psychological care intervention that would be tied to cardiac rehabilitation to test uncertainly areas. The team ha eight cardiac rehabilitation teams which included patients that were eligible for cardiac rehabilitation. The study instituted measures that were performed at baseline followed up at 5 and 8-months. In total, the study found 55 eligible patients but only 29 participated. The study found out that of the patients who participated, they were of the perception that a one-on-one session with a nurse was viewed as important in handling their psychological problems. As such, the nurse was viewed as critical in assisting the patients to recover in a timely fashion. Nurses on the other hand were revealed to sufficiently equipped to deliver intervention and important training.

The study is important to the capstone project as it affirms the need for giving nurses the opportunity to accord their cardiac patients support to fight depression. Further, the study reveals that nurses are ready for the task and actively looking for such opportunities to extend their much needed services. Patients have since confirmed that it is necessary to have such services since an almost a fifth of them suffer from depression. As such, this capstone project will include psychological support to patients besides motivation to continue with medication and other identified therapies such as exercise.

Kähkönen, O., Saaranen, T., Kankkunen, P., Lamidi, M. L., Kyngäs, H., & Miettinen, H. (2018). Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention. Journal of clinical nursing, 27(5-6), 989-1003.

The study aimed at identifying predictors of adherence in patients with coronary heart disease after an intervention. Adherence has been identified by the study as a critical factor in the prevention of coronary heart disease. Adherence in the study meant the adherence to medication and a healthy lifestyle. The study adopted an analytical multihospital survey where 416 postpercutaneous coronary intervention patients were studied. The study paid emphasis to adherence and other factors such as sociodemographic, health, and disease specific factors. The study showed that there was good adherence among the patients. However, it was found out that inconsistencies existed in adherence to a healthy lifestyle. The study identified that gender, close personal relationships, length of education, physical activity, vegetable and alcohol consumption, cholesterol, and duration of cardiac problems without intervention were predictors of adherence.

This study is a perfect match to the capstone project. It highlights those aspects of the study that need to be evaluated and worked on right from the onset of a cardiac stent patient home care. A patient’s life needs to be considered and a checklist formed to evaluate each of the mentioned predictors to ensure that they are passed. As such, the capstone project will be heralded as a success since the loopholes that patients might explore, either in their conscious or subconscious are sealed. As such, the capstone project will record high levels of transition of the patients as all of them will be guided to adherence along the entire length of the project.

Saeidzadeh, S., Darvishpoor Kakhki, A., & Abed Saeedi, J. (2016). Factors associated with self‐care agency in patients after percutaneous coronary intervention. Journal of clinical nursing, 25(21-22), 3311-3316.

            The study aimed to assess the factors that are associated with self-care agency in coronary intervention patients. The study is a descriptive study with a sample size of 300. The study collected data from a university hospital in 2015. Data for the study was collected using demographic and basic conditioning factors questionnaire as well as an appraisal of self-care agency scale. The study showed that 72% of patients had a sufficient level of self-care agency and it was even higher in married and high income patients. The study concluded that self-care agency is an aspect influenced by economic and marital situations.

The study’s relevance to the capstone project is tied to the project’s is aimed of providing care to home based cardiac stent patients. As such, the patients will be left alone for considerable moments since a nurse will be visiting periodically. With this in mind, the patients will be subjected to the self-care agency. This, will require them to look out for themselves. This study will inform nurses of the appropriate methods to use as well as what to assess to confirm that the patient is well catered for during the time when the nurse will be in absentia.

Action Item Checklist

Action	Expected Completion Date
Prepare and submit capstone project	29th September 2018
Preliminary Literature Review	26th September 2018
Application of the change model start	3rd October 2018
End of application of the change model	5th  October  2018
Evaluation completion date	15th November 2018
Compiling a final report	17th November 2018

References

Anderson, L. J., & Taylor, R. S. (2014). Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. International journal of cardiology, 177(2), 348-361.

Beswick, A. D., Rees, K., West, R. R., Taylor, F. C., Burke, M., Griebsch, I., … & Ebrahim, S. (2005). Improving uptake and adherence in cardiac rehabilitation: literature review. Journal of advanced nursing, 49(5), 538-555.

Bowman, S., Gass, J., & Weeks, P. (2018). Antiplatelet Therapy Bridging With Cangrelor in Patients With Coronary Stents: A Case Series. Annals of Pharmacotherapy, 1060028018795840.

Grines, C. L., Bonow, R. O., Casey, D. E., Gardner, T. J., Lockhart, P. B., Moliterno, D. J., … & Whitlow, P. (2007). Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Journal of the American College of Cardiology, 49(6), 734-739.

Karmali, K. N., Davies, P., Taylor, F., Beswick, A., Martin, N., & Ebrahim, S. (2014). Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database of Systematic Reviews, (6).

Kähkönen, O., Saaranen, T., Kankkunen, P., Lamidi, M. L., Kyngäs, H., & Miettinen, H. (2018). Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention. Journal of clinical nursing, 27(5-6), 989-1003.

Richards, S. H., Dickens, C., Anderson, R., Richards, D. A., Taylor, R. S., Ukoumunne, O. C., … & Davey, A. (2018). Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial. Trials, 19(1), 211.

Ricci, R. P., Morichelli, L., Gargaro, A., Laudadio, M. T., & Santini, M. (2009). Home monitoring in patients with implantable cardiac devices: is there a potential reduction of stroke risk? Results from a computer model tested through Monte Carlo simulations. Journal of cardiovascular electrophysiology, 20(11), 1244-1251.

Saeidzadeh, S., Darvishpoor Kakhki, A., & Abed Saeedi, J. (2016). Factors associated with self‐care agency in patients after percutaneous coronary intervention. Journal of clinical nursing, 25(21-22), 3311-3316.

Turner, K. M., Winder, R., Campbell, J. L., Richards, D. A., Gandhi, M., Dickens, C. M., & Richards, S. (2017). Patients’ and nurses’ views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ open, 7(9), e017510.