Jokar Fariba, Yousefi Hojatllah, Yousefy Alireza, Sadeghi Masoumeh
1PhD, Assistant Professor, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 2PhD, Associative Professor, Adult Health Nursing Department, School of Nursing, Isfahan University of Medical Sciences, Isfahan, Iran; 3PhD, Full Professor and Head, Medical Education Department, Isfahan University of Medical Sciences, Isfahan, Iran; 4PhD, Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
J Nurs Res. 2017 Oct;25(5):344-352. doi: 10.1097/JNR.0000000000000220.
Cardiovascular diseases are a main cause of mortality worldwide. However, new diagnostic techniques and treatments have increased the rate of survival for patients with cardiovascular disease. Cardiac rehabilitation programs aim to maintain and enhance the quality of life of patients and improve the secondary prevention of coronary artery disease. Suboptimal participation in rehabilitation programs, early exit from these programs, and not achieving lasting changes are cardiac rehabilitation challenges that are associated with health issues, including the increased need for medication, repeated hospitalization, failure in the secondary prevention programs, and long waiting lists. Exploring the meaning of behavioral changes in the context of cardiac rehabilitation may facilitate the design of effective interventions that are critical to achieving the goals of cardiac rehabilitation programs.
This study explored the mechanisms that underlie behavioral changes within cardiac rehabilitation centers.
We used a descriptive qualitative approach, which is widely acknowledged as the best approach for eliciting in-depth descriptions of behavioral changes in the context of cardiac rehabilitation centers. Using purposive sampling, 15 men and 8 women with coronary heart disease were referred to the two cardiac rehabilitation centers participating in this study. The inclusion criteria were participation in four cardiac rehabilitation sessions and ability and willingness to participate. The data were collected using semistructured in-depth interviews, and the inductive thematic analysis method was used for analysis.
"Trying to stay alive" and "begin again" arose as the two main themes related to behavioral change. These themes include the changes in cognition and values that lead to improvements in the process of behavioral change as a major outcome of cardiac rehabilitation.
Using psychosocial interventions such as creating and strengthening hope and meaningful intrinsic motivation in the context of rehabilitation centers often helps deal with these challenges. "Trying to stay alive" may take place before referral to a cardiac rehabilitation center. Therefore, psychosocial nursing interventions such as motivational interviewing are designed to improve a process that may be already underway. Thus, stress and anxiety may be treated based on beliefs and emotions. The primary emphasis in cardiac rehabilitation should include changing the beliefs of the patient and motivating her or him to achieve sustainable behavioral change.
心血管疾病是全球主要的死亡原因。然而，新的诊断技术和治疗方法提高了心血管疾病患者的生存率。心脏康复计划旨在维持和提高患者的生活质量，并改善冠状动脉疾病的二级预防。康复计划参与度欠佳、过早退出这些计划以及未能实现持久改变是心脏康复面临的挑战，这些挑战与健康问题相关，包括药物需求增加、反复住院、二级预防计划失败以及长等待名单。在心脏康复背景下探索行为改变的意义可能有助于设计有效的干预措施，这对于实现心脏康复计划的目标至关重要。
本研究探讨了心脏康复中心内行为改变的潜在机制。
我们采用了描述性定性方法，这种方法被广泛认为是深入描述心脏康复中心背景下行为改变的最佳方法。通过目的抽样，15名男性和8名女性冠心病患者被转介到参与本研究的两个心脏康复中心。纳入标准为参加四次心脏康复课程以及有参与的能力和意愿。数据通过半结构化深度访谈收集，并采用归纳主题分析法进行分析。
“努力活下去”和“重新开始”成为与行为改变相关的两个主要主题。这些主题包括认知和价值观的变化，这些变化导致行为改变过程的改善，这是心脏康复的主要成果。
在康复中心使用心理社会干预措施，如创造和增强希望以及有意义的内在动机，通常有助于应对这些挑战。“努力活下去”可能在转介到心脏康复中心之前就已发生。因此，诸如动机性访谈等心理社会护理干预措施旨在改善一个可能已经在进行的过程。因此，压力和焦虑可以基于信念和情绪进行治疗。心脏康复的主要重点应包括改变患者的信念并激励他或她实现可持续的行为改变。
