What are the benefits of physical activity after a heart attack base on the article?
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1. Research the importance of the topic and write an introduction that includes these main points:
· Relevant background information from a credible source to explain the importance of your topic
· A purpose statement (“The purpose of this paper is…”).
This is the topic: What are the benefits of physical activity after a heart attack base on the article?
2. Write a study synopsis that includes these main points:
· research design and setting
· sample: sampling method; number of subjects; inclusion/exclusion criteria; attrition, loss to follow up, or response rate (if any); and important characteristics of the sample
· how the study was conducted (explain how the data was collected—including measurement instruments–and, if the study involves an intervention, how the intervention was carried out)
3. Appraise the article in narrative format by answering the following questions.
· What is known and not known about the topic? What gap in knowledge does this study address?
· Was the sampling method appropriate for this study? Why or why not?
o If inclusion and exclusion criteria were noted in the report, did the criteria control for extraneous variables? Why or why not?
· Were the measurement instruments reliable and valid? Why or why not?
o If the study was experimental, was the intervention performed consistently? Why or why not?
· Were the conclusions of the study supported by the results? Why or why not?
· Were the study limitations identified and explained? If so, was the explanation sufficient? Why or why not?
4. Write a conclusion that states the nursing implications based on the findings of the study, taking statistical significance into account. (DO NOT just list the implications to nursing from the article; provide your analysis.)
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Cent Eur J Nurs Midw 2019;10(2):1026–1034 doi: 10.15452/CEJNM.2019.10.0010
© 2019 Central European Journal of Nursing and Midwifery 1026
ORIGINAL PAPER
EDUCATIONAL PROCESS IN PATIENTS AFTER MYOCARDIAL INFARCTION
Jakub Doležel1,2, Darja Jarošová1
1Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Czech Republic
2Department of Cardiovascular Diseases, University Hospital Ostrava, Czech Republic
Received November 20, 2018; Accepted January 28, 2019. Copyright: This is an open access article distributed under the terms of the Creative
Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/
Abstract
Aim: The study aimed to determine the effect of education on the prevalence of risk factors and adherence to lifestyle measures
in post-myocardial infarction patients. Design: A clinical, interventional, explanatory study. Methods: The sample (n = 165)
comprised consecutive patients hospitalized for acute myocardial infarction. The interventional, explanatory study followed
changes in two cohorts: intervention (n = 68) and control (n = 97). The intervention (prospective) group consisted of patients
educated by a nurse using a previously developed nursing standard. The control (retrospective) group comprised patients who
received no education on myocardial infarction provided by nurses. Results: After one-year follow-up, patients in the intervention
group had statistically better knowledge about their condition (p < 0.001) and used their medication more regularly (p < 0.001)
than controls. At one year, systolic blood pressure and total cholesterol decreased by a mean of 2.5 mmHg and 0.3 mmol/l,
respectively, in intervention group participants. As early as after one month, patients in this group increased their physical activity
by a mean of 35 minutes per week. Conclusion: Post-myocardial infarction patients educated according to the developed nursing
care standard were shown to better adhere to their pharmacological therapy and lifestyle changes.
Keywords: education, intervention, myocardial infarction, nurse, patient, secondary prevention.
Introduction
Over the last 25 years, cardiovascular mortality has
declined in Europe; yet the prevalence of coronary
artery disease remains high in the Czech Republic
(Čapková et al., 2016). The Czech middle-aged
population was found to have a high prevalence of the
main cardiovascular risk factors (Cífková et al., 2011).
Also data from several European Countries including
the Czech Republic continue to show that
cardiovascular disease preventive care is not
adequately provided. Many post-myocardial
infarction patients do not adhere to a healthy lifestyle,
do not know the risk factors and do not receive the
proper treatment (Kotseva et al., 2016).
The core of cardiovascular disease prevention has
shifted from drug therapy to preventive care through
non-pharmacological interventions. Drug therapy
should be initiated only after non-pharmacological
interventions fail (Magnani et al., 2018). A systematic,
comprehensive and multidisciplinary approach is
needed that is focused on lifestyle and risk factor
Corresponding author: Jakub Doležel, Department of Nursing
and Midwifery, Faculty of Medicine, University of Ostrava,
Syllabova 19, Ostrava, Czech Republic; e-mail:
jakub.dolezel@osu.cz
management by physicians, nurses and other health
workers (Piepoli et al., 2016). Nurses play a key role
in educating patients after myocardial infarction.
Nurses’ educational activities contribute to improving
the health status of both individuals and communities,
leading to reduced cardiovascular risk and fewer
rehospitalizations (Lachman et al., 2015).
The aim of the study was pilot implementation
of a nursing care standard called Education of Post-
Myocardial Infarction Patients. The nursing standard
was developed by a multidisciplinary working group.
The first step in the development of the standard was
to formulate the basic STANDARD definition
in accordance with Standard nursing care: an asset
(Danasu, 2007). Subsequently, activities were defined,
measured and selected using the Dynamic Standard
Setting System (Kitson, 1990). To justify the nursing
processes in the standard, an analysis from a literature
search was used. The final standard consists of nine
nursing processes complemented by justification,
references to relevant studies and levels of evidence.
Aim
The study aimed to determine the effect of education
on the prevalence of risk factors and adherence to
lifestyle measures in post-myocardial infarction
patients.
Doležel J, Jarošová D. Cent Eur J Nurs Midw 2019;10(2): 1026–1034
© 2019 Central European Journal of Nursing and Midwifery 1027
Methods
Design
A clinical, interventional, explanatory study was
conducted.
Sample
Included in the study were consecutive patients
(convenience sampling) hospitalized for acute
myocardial infarction (Figure 1). Data were collected
at the Department of Cardiovascular Diseases,
University Hospital Ostrava. The sample (Table 1)
comprised a total of 165 participants divided into two
groups, intervention (n = 68) and control (n = 97).
The inclusion criteria were patients after acute
ST-elevation myocardial infarction, after
percutaneous coronary intervention, aged 30–85
years. Excluded were patients in cardiogenic shock,
after cardiopulmonary resuscitation, with serious
complications or life-threatening comorbidities.
The intervention (prospective) group consisted
of patients consecutively admitted for acute
myocardial infarction in 2016. Their mean age was 58
years (SD = 11.4). The patients were educated by
a nurse using the above nursing standard, with a
follow-up at one, six and twelve months.
The control (retrospective) group comprised patients
hospitalized for acute myocardial infarction in 2015,
with a mean age of 61 years (SD = 11.1). They were
approached by telephone twelve months after their
heart attack. The controls received no education
on their condition (i.e. myocardial infarction).
Figure 1 Patient selection process
INTERVENTION GROUP
361 patients eligible
CONTROL GROUP
329 patients eligible
258 patients excluded
death (n = 25)
inclusion criteria (n = 112)
exclusion criteria (n = 29)
other (n = 92)
PRIMARY ANALYSIS
103 patients included
68 PATIENTS
included in the final analysis
SAMPLE
690 post-myocardial infarction patients eligible
232 patients excluded
death (n = 24)
inclusion criteria (n = 101)
exclusion criteria (n = 30)
other (n = 77)
PRIMARY ANALYSIS
97 patients included
97 PATIENTS
included in the final analysis
35 patients excluded
death (n = 2)
loss to follow-up (n = 33)
Doležel J, Jarošová D. Cent Eur J Nurs Midw 2019;10(2): 1026–1034
© 2019 Central European Journal of Nursing and Midwifery 1028
Table 1 Patient characteristics
Description of the intervention
Interventions were provided in accordance with the
standard. The nurse educated the patient within three
days of myocardial infarction, during their stay at the
Department of Cardiovascular Diseases, University
Hospital Ostrava. Educational sessions were repeated
after one, six and twelve months in an outpatient ward
of the department. The date of the first follow-up
session was set during the hospital stay; the other dates
were agreed on during the preceding sessions in the
outpatient ward. The education session duration was
30–60 minutes. In each patient, a nursing assessment
was carried out based on an educational history and an
educational plan was developed. Patients were
educated individually through motivational
interviewing.
During the initial session, patients were informed
about their condition (myocardial infarction), warning
signs, therapeutic regimen, use of medication and
lifestyle changes. The latter included
recommendations on an adequate diet, proper physical
activity, smoking cessation and blood pressure
control. At the end of the session, the nurse determined
whether the goals were met and assessed the
effectiveness of education.
At the beginning…
