The structures, processes and outcomes of a nurse mentor supported home based cardiac rehabilitation program for rural patients: A case study
Embargoed until: 2019-04-06
MetadataShow full item record
Cardiac rehabilitation (CR) has demonstrated positive benefits for patients recovering from myocardial infarction (MI), yet participation in it is suboptimal, especially in regional Australian settings. There is a need to improve patient access, uptake and completion of CR. Home based CR programs are effective and safe and have been introduced in many countries to improve access to after hospital care for patients unable to attend hospital based programs. The Aussie Heart Guide Program (AHGP) is a home based CR program delivered to patients mainly by telephone in their homes. The program has two integral components. First, audiovisual resources are provided to patients to provide information and education about coronary heart disease and self care in terms of lifestyle management. Second, the program is delivered to patients over a six week period by CR nurses who have undertaken specific training in the program including cognitive behavioural therapy, motivational interviewing, goal setting and audit and feedback. Based on a patient centred approach, nurse mentors support and guide patients in their homes by developing a therapeutic and mutual engaging relationship with patients. This aim of this study was to evaluate the structures, processes and outcomes (SPO) of a home based CR program for patients recovering from MI and who live in rural areas of Tasmania. An explanatory case study was used in this research. Patients and nurse mentors were recruited from three metropolitan Australian hospitals between 2008 and 2011. The sample included 34 patients and seven mentors. Patients completed surveys and questionnaires that contained research instruments relating to their experiences of anxiety, depression, physical exercise, health related quality of life (HRQOL), illness representation and outcomes of self management both prior to and after completing the AHGP. A subsample of 13 patients were interviewed by telephone about their experiences relating to mentoring and the AHGP. Nurses were asked about their perceptions of their new role as mentors and the AHGP via an open ended e-mail survey. Mentor clinical notes used to record patient progress during the AHGP were also part of the data used in the study. Thematic analysis was conducted on data collected from semi structured patient telephone interviews, an open ended mentor survey and mentor clinical (patient) progress notes. The thematic findings were then considered further in relation to the SPO and new themes categorised accordingly under the three SPO elements. Descriptive statistics were used to summarise quantitative data and paired t-tests used to identify changes over time. Emergent findings from the qualitative analysis showed structures important for the program included timely recruitment of patients, specific mentor training and commitment to the mentor role, knowledge and skills associated with cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship and rapport between mentors and patients, suitability of the program within the Australian cultural setting, a patient-centred approach to care and promoting positive lifestyle behaviours. Outcomes suggested the AHGP assisted patients in their recovery from myocardial infarction. Patients were satisfied with the program’s audiovisual resources and appreciative of the support, guidance and care provided by mentors during their hospitalisation through to their discharge from the program. It appeared the program influenced patient decisions to change unhelpful lifestyle behaviours. These perceptions suggest the program was valued by patients and was acceptable to them in terms of meeting their expectation of CR. Outcomes for mentors indicated that although there were rewards and barriers associated with being a patient mentor, the AHGP was easy to use and most were satisfied with their new role. Results from the quantitative analysis demonstrated improvements for patients in relation to reducing their levels of anxiety and depression following completion of the program. There were also small to moderate improvements in activity levels and HRQOL after completing the program. While there are several limitations to this study, it provides conceptual insight into this relatively new home based, mentor supported CR program in the Australian context. Further improvements to the program in relation to mentor training, stakeholder engagement, governance issues and resource development are necessary if the program is to be adopted more widely.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
The author owns the copyright in this thesis, unless stated otherwise.