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The purpose of this paper is to summarize the study conducted by Cossette, Frasure-Smith, Dupuis, Juneau, & Guertin (2012) titled “Randomized Controlled Trial of Nursing Interventions to Improve Cardiac Rehabilitation Enrollment,” published in Nursing Research. This paper also explains the ways in which the findings of this study might be used in nursing practice and ethical considerations associated with the conduct of the study.
Background of the Study
The research problem explored by Cossette et al. (2012) is the underutilization of rehabilitation regardless of its ability to decrease the recurrence of cardiac events by about 25% among patients with Acute Coronary Syndrome (ACS). The authors acknowledge that the enrollment in rehabilitation programs among ACS patients depends mainly on referral as well as other factors like the type of rehabilitation services provided, schedule, issues with transportation, and the distance from home. Moreover, they point out that these issues can be partly solved using organizational changes such as adapting rehabilitation programs to participants’ needs and automatic referrals. Other barriers to enrollment in rehabilitation programs among the ACS patients include lack of interest, feeling too weak, lower education levels, financial problems, and social isolation. Although patient-related factors constitute the bulk of the barriers, few intervention studies have investigated the impact of rehabilitation programs designed to address these factors.
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This problem is significant to nursing since cardiac diseases remain one of the major causes of hospitalization and death in developed nations. ACS and other cardiac diseases, such as unstable angina and myocardial infraction, contribute to the majority of cardiac-related admissions and deaths.
The primary purpose of the research conducted by Cossette et al. (2012) was to ascertain whether a nursing intervention tailored and focused on the ACS patients’ perceptions regarding their treatment and disease would help increase the enrollment to rehabilitation after their discharge. Cossette et al. (2012) hypothesized that patients placed in the experimental group would exhibit greater enrollment to cardiac rehabilitation programs within six weeks following their discharge when compared to those in the control group. The main concept examined in this study is the rehabilitation enrollment among ACS patients.
Methods of the Study
The study by Cossette et al. (2012) was quantitative. The research design used in the study was the randomized controlled trial, which is often used when testing the effect on intervention. The authors used the RCT design to test their hypothesis. The sample participants in the study consisted of adult patients hospitalized and suspected to have ACS. Although the sampling methods have not been clearly stated, it appears that the authors used random sampling based on their design. The sample size was determined by the ability to notice no less than a doubling in the 15 percent rehabilitation enrollment rate among the ACS patients in the study hospital. A detectable difference in the range of 15-30% was deemed a clinically significant improvement. Detecting such improvement required a target sample size of 242 patients with 121 patients for each group at a two side alpha of 0.05 and sample power of 0.80.
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An exclusion criteria was developed for the participants, which included being unable to communicate in English or French; residing at least 50 miles from the study hospital; referrals for surgery; having previously finished attending a rehabilitation program; cognitive problems; and currently getting frequent outpatient follow-up. Eligible participants were randomly placed in the control and intervention group. Patients in the control group received regular care, which was characterized by a regular nurse offering care up to the point of discharge and were contacted after six weeks. Following discharge, all participants were referred to the rehabilitation center. Patients in the intervention group received the coronary care unit (CCU) transit nursing intervention, which entailed three encounters with the patients including face-to-face meetings prior to being discharged; telephone calls three days after being discharged; and either phone call or meeting at the hospital 10 days after being discharged. The first encounter had the aim of addressing the way patients managed the symptoms as well as physical activity after being discharged, their understanding regarding the illness episode as well as their worries and concerns. The second meeting had the main aim of assessing the clinical patient of the condition and his/her ability to manage the illness following discharge as wells as any other issues and the modifications of risk factors. The third meeting dealt with treatment and clinical issues, modification of lifestyle as well as clinical modification, and enrollment in a rehabilitation program.
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Results of the Study
The findings of the research by Cossette et al. (2012) showed that the intervention group had higher enrollment (45 percent) when compared to the control group (24 percent). The difference was statistically significant. The researchers had hoped to use the intervention to modify patients’ perceptions concerning their illness in order to improve their perceived control and enable patients to develop a positive attitude towards enrolling in cardiac rehabilitation programs. Using this finding, authors suggested that a higher level of personal control among the patients in the intervention group is a likely explanation to their higher enrollment in cardiac rehabilitation programs. The findings also indicated that their intervention did not have an effect on the risk factors for cardiac diseases like diet, physical inactivity, smoking, and the Body Mass Index (BMI). However, Cossette et al. (2012) assert that this unexpected finding can be attributed to the timing of entry into the rehabilitation program.
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The findings, reported in the study, have nursing implications. In particular, these findings underscore the importance of nurses tailoring the intervention in accordance with the patient’s psychological and clinical needs after he/she has been discharged. Such an approach offers a clinical pathway for addressing the worries that patients might have after experiencing a significant cardiac event. In addition, Cossette et al. (2012) point out that nurses play a crucial role in offering care to cardiac patients; thus, they can base their clinical judgment using the findings reported in the study.
These findings contribute to nursing knowledge by impacting practice. Specifically, the results highlight the significance of nurses individualizing interventions based on the particular patient’s needs. Moreover, the findings add to nursing knowledge by suggesting a progressive intervention that has been customized specifically to suit the psychological and clinical requirements of patients, which could be used to encourage ACS patients to enroll in rehabilitation programs rather than simply rely on the referrals.
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The study was reviewed and approved by the Research Ethics Board of the study hospital. Its approval number is ISRCTN95784143 (Cossette et al., 2012). The privacy of the patients was protected. The authors did not make any direct references to patients. In addition, they did not provide any personal information that could help identify the participants in the study. Another ethical consideration in the study is that the researchers provided eligible participants with an informed consent form prior to their randomization. Patients were informed of the random assignment to the treatment and control groups. Cossette et al. (2012) did not outline any ethical considerations regarding the treatment such as the potential harms likely to emanate from the lack of efficacy of the intervention.
This study addressed a pertinent issue in nursing practice – the underuse of cardiac rehabilitation programs despite their potential to decrease the recurrence of cardiac events. The researchers used the RCT design to evaluate the effect of an intervention tailored to the needs of patients in encouraging enrollment to rehabilitation. The findings show that the intervention encouraged enrollment. Thus, the researchers emphasized the importance of nurses considering the clinical as well as psychological needs of patients.
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