School of Medicine, National University of Ireland Galway, Ireland.
National Institute for Preventive Cardiology, Ireland.
Eur J Cardiovasc Nurs. 2019 Oct;18(7):584-592. doi: 10.1177/1474515119850072. Epub 2019 May 16.
BACKGROUND/AIMS: Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses' perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses' encounters within the context of the current health service.
This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes.
A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses' training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices.
Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.
背景/目的：促进心血管疾病危险因素管理对于心血管疾病事件的二级预防至关重要。在爱尔兰，心脏康复后的患者被转交给社区公共卫生护士进行护理，而社区公共卫生护士则承担着健康促进的角色。然而，人们对他们在心血管疾病危险因素管理方面的角色的认知或知识知之甚少。本研究基于建构主义观点，旨在直接从公共卫生护士在当前卫生服务背景下的遭遇中生成有关该现象的经验证据。
这是一项定性的横断面分析，涉及对 17 名公共卫生护士进行面对面、半结构化访谈。访谈进行了录音、转录，并进行了主题内容分析，随后报告中纳入了逐字逐句的引述。
预防心血管疾病的循证指南与当前实践之间存在显著差距。公共卫生护士的培训、经验和知识存在差异，导致实践不一致，公共卫生护士认为这是一个他们没有能力胜任的专业领域。公共卫生护士角色的变化和工作量的增加导致他们将其他护理职责放在健康促进之前。护理提供系统效率低下以及缺乏社区康复计划也对二级预防实践产生负面影响。
研究结果支持需要开发社区心血管疾病专科角色，以有效支持持续的心血管疾病危险因素管理。需要评估当前服务提供机制，以确保根据社区需求和当前循证实践指南提供高质量、公平的服务。建议进行一项定量三角测量研究。
