O'Driscoll Jamie M, Shave Robert, Cushion Christopher J
School of Sport and Education, Brunel University, Middlesex, and Health and Exercise Sciences Group, Thames Valley University, Berkshire, UK. jamie.o'
J Clin Nurs. 2007 Oct;16(10):1908-18. doi: 10.1111/j.1365-2702.2007.01815.x.
This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients.
Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services.
A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in-depth semi-structured interviews were the instruments used to collect data.
Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service-related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities.
Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi-professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals.
The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.
本文报告一项从医疗保健专业人员和患者的角度研究伦敦国民保健服务信托医院心脏康复计划有效性的研究。
心血管疾病是全球主要的死亡和残疾原因。大量研究表明，心脏事件发生后，心脏康复可促进康复、提高运动能力和患者健康水平、降低各种冠状动脉疾病风险因素，并随后降低住院成本。尽管有这些发现以及《冠心病国家服务框架》的出台，但心脏康复服务的实践、管理和组织仍存在很大差异。
选取了在选定医院的心脏康复计划中登记的3名心肌梗死后患者以及11名医疗保健专业人员作为有目的的样本。患者作为个体案例研究。作者跟踪了所有3名患者完成其心脏康复计划的第三阶段。该研究试图通过一个涉及定性研究方法的解释性框架来探索伦敦一家医院心脏康复计划的作用和程序。参与观察和深入的半结构化访谈是用于收集数据的工具。
尽管医疗保健专业人员对冠心病预防充满热情，但伦敦国民保健服务信托医院的心脏康复计划存在若干障碍，这些障碍降低了该计划的成功率，并使其无法实现国家服务框架目标。这些障碍很复杂，主要包括与服务相关的因素，如缺乏专业培训、初级和二级护理之间沟通不畅以及角色和身份混淆。
尽管该研究与当地直接相关，但它突出了与心脏康复和二级预防计划发展更具普遍相关性的问题，例如多专业工作环境中的沟通以及角色和身份认知，以及为心脏康复医疗保健专业人员制定正式培训计划的必要性。
本研究结果强调需要增加投资、改进规划并为心脏康复领域的医疗从业者引入全面的培训计划。实施这些行动可能会减少目前围绕心脏康复计划的许多服务限制和障碍。
