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Growth and Development of a Cardiac Rehabilitation Support Group
Abstract
This article describes the initiation and evolution of the support group component of a cardiac rehabilitation pilot program. It also outlines how the group was initiated and discusses the group's development during the 20 weeks of its existence. The description of this nurse-facilitated support group provides a model for clinicians interested in integrating such an approach into their own cardiac rehabilitation programs.
Self-help groups can be regarded as supplementary sources of support outside of clients' existing social network, and as such, are important in planning nursing care. Nurses traditionally are socialized and educated in the expert care provider role. Although they are not used to responding to lay support networks, they can effectively cooperate with self-help groups. The aim of this qualitative study using the case study approach was to describe capabilities of a female cardiac nurse who includes self-help groups in her plan for the support of cardiac clients. Her confidence in human strength and her insight into the disease situation were interpreted as factors that may have accounted for her flexible attitude to caring and her ability to appreciate lay care. This nurse has expanded her professional role by increasing clients' care with regard to their social environment. When using self-help groups as a support strategy, she acts as a resource mobilizer and facilitator, who contributes to the empowerment of her clients.
Psychological and behavioral factors play an important role in recovery from myocardial infarction. Compliance with medication, dietary and exercise regimens, for example, has been addressed from a psychological perspective. This paper provides some examples of psychological intervention to improve recovery prospects in this patient group.
This volume is intended as a guide for doing social support research, as a compendium of . . . work in this field, and as a source of information on the implications of existing work for social policy. . . . We focus on nonprofessional (informal) social support provided by friends, relatives, and acquaintances.
This book is of special interest to the large interdisciplinary group of research professionals concerned with the role of psychosocial factors in both physical and mental health. It is also of special interest to practitioners involved in the increasing number of programs designed to support or establish natural helping networks. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To compare the survival of elderly patients hospitalized for acute myocardial infarction who have emotional support with that of patients who lack such support, while controlling for severity of disease, comorbidity, and functional status.
A prospective, community-based cohort study.
Two hospitals in New Haven, Connecticut.
Men (n = 100) and women (n = 94) 65 years of age or more hospitalized for acute myocardial infarction between 1982 and 1988.
Social support, age, gender, race, education, marital status, living arrangements, presence of depression, smoking history, weight, and physical function were assessed prospectively using questionnaires. The presence of congestive heart failure, pulmonary edema, and cardiogenic shock; the position of infarction; in-hospital complications; and history of myocardial infarction were assessed using medical records. Comorbidity was defined using an index based on the presence of eight conditions.
Of 194 patients, 76 (39%) died in the first 6 months after myocardial infarction. In multiple logistic regression analyses, lack of emotional support was significantly associated with 6-month mortality (odds ratio, 2.9; 95% CI, 1.2 to 6.9) after controlling for severity of myocardial infarction, comorbidity, risk factors such as smoking and hypertension, and sociodemographic factors.
When emotional support was assessed before myocardial infarction, it was independently related to risk for death in the subsequent 6 months.
Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.
In a prospective, randomised, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year, 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative coronary angiography. The average percentage diameter stenosis regressed from 40.0 (SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.
Lack of patient adherence to prescribed regimens is a fundamental problem in cardiac rehabilitation programs. A causative factor in lack of patient adherence may be related to failure to address differences in individual health behavior motivation in cardiac rehabilitation. A group of 52 patients who had had myocardial infarction were sampled to test the relationship between social support systems, health locus of control, health value orientations, and wellness motivation. Pearson correlation coefficients indicated significant positive correlations between health locus of control variables, health value orientation variations, and wellness motivation. Health locus of control and health value orientation variables entered into a multiple regression equation to explain 32% of the variation in wellness motivation. Awareness of individual motivational responses that influence health behaviors in cardiac rehabilitation may enable nurses to develop intervention strategies for patients with cardiovascular disease who would benefit from modifying their risk-producing life-styles.
This article describes identifying the need for a support/educational group, as well as implementing and evaluating the group. The group was formed to give stroke patients a method of obtaining support. The role of the clinical nurse specialist as a consultant, liaison, and educator is illustrated.
This article describes the use of a small group approach as a strategy for nurses working with individuals having chronic health problems. Examples from one specific small group experience are delineated. Details of group membership, objectives, process, content, and evaluation are addressed.
This 28-week observational study measured adherence to and acceptability of the diet and nutrition component of an Ornish-type program among patients in a rural southern setting. Ten volunteers followed a very-low-fat (10% of energy), total vegetarian diet and participated in a program of exercise, stress management, and group support. Patients made significant dietary changes and found the diet "acceptable." Three patients consumed less than 10% of energy from fat and two additional patients consumed less than 20% of energy from fat. Eighty-five percent of the patients' meals adhered to a near vegetarian diet. Weight loss ranged from 0.1 to 11.7 kg (0.25 to 26 lb). Lipid values were unchanged. At 12 months, without the benefit of the structured program, one patient reported 100%, six reported 85%, and two reported 50% adherence to the dietary principles. We conclude that motivated patients with coronary artery disease can follow a very-low-fat, near vegetarian diet but experience difficulty without a structured program.
The aim of the pilot study was to find out the need for social support and the choice of social network after acute myocardial infarction (AMI). In an experimental study critically ill male patients (AMI-patients) were enrolled for an intervention group (n = 18) or a control group (n = 18) in accordance with their own choice of caring support. The intervention consisted of a 3-month-caring programme for AMI-patients and their next-of-kin together with an interdisciplinary team. A 10-item questionnaire was developed in order to measure social network and social support at the time of AMI and 3 months later. Nine patients in both groups expressed a need for complementary social support, the character differed between the groups concerning emotional and informative support. Both groups reported sufficient social network built on the family. The intervention group expressed more heart trouble compared to the control group at the time of AMI (p = 0.03). 3 months later the trouble had decreased in the intervention group but increased in the control group. Complementary social support soon after an AMI from care professionals confirms the AMI-patients' recovery and the whole family has to be supported.
Can lifestyle changes reverse coronary heart disease?
- D. Ornish
- S. Brown
- L. Scherwitz
- J. Billings
- W. Armstrong
- T. Ports
- S. McLanahan
- R. Kinkeeide
- R. Brand
- K. Gould
Myocardial infarction survivors: Social support and self-care behaviors
- B.J. Rodeman
- V.S. Conn
- S. Rose
Myocardial infarction survivors: Social support and self-care behaviors
- Rodeman