Kim, Hyun Sun
(College of Nursing and Research Institute of Nursing Science, Seoul National University)
,
Kim, Hyun-Jin
(Department of Cardiology, Myongji Hospital)
,
Suh, Eunyoung E.
(College of Nursing and Research Institute of Nursing Science, Seoul National University)
Purpose: For cardiovascular patients, family caregivers play a vital role in daily nursing and cardiac emergencies. This study aimed to evaluate the effect of patient-centered CPR education (PCE) for family caregivers of patients with cardiovascular diseases. Methods: Fifty-four participants were ra...
Purpose: For cardiovascular patients, family caregivers play a vital role in daily nursing and cardiac emergencies. This study aimed to evaluate the effect of patient-centered CPR education (PCE) for family caregivers of patients with cardiovascular diseases. Methods: Fifty-four participants were randomly assigned to the PCE or control group. The PCE group received tailored counseling on overall cardiovascular disease information and CPR followed by interactive instructor-guided CPR training and re-education follow-up by telephone 2 weeks later. The control group received only video-based CPR self-education and booklets. Cardiovascular disease and CPR knowledge and self-efficacy were measured before (pre-test), immediately after (post-test 1), and 4 weeks after the PCE (post-test 2). CPR skills and performance were measured pre-test and at post-test1. Results: The PCE group demonstrated significant improvements in knowledge (F=91.09, p<.001), self-efficacy (F=15.19, p<.001) and CPR skills and performance (F=8.10, p=.008), as well as significant differences over time (knowledge: F=364.25, p<.001; self-efficacy: F=1162.28, p<.001; CPR skills and performance: F=1798.81, p<.001). There were significant group-by-time interactions for knowledge (F=8.10, p=.001), self-efficacy (F=4.30, p =.019) and CPR skills and performance (F=4.81, p=.036) by repeated measures ANOVA. Conclusion: This is the first study to demonstrate the effects of a patient-centered intervention with CPR education tailored for patients' and family caregivers' preferences, needs, and lifestyles. The results of this study encourage the use of tailored, patient-centered interventions in cardiovascular nursing practice.
Purpose: For cardiovascular patients, family caregivers play a vital role in daily nursing and cardiac emergencies. This study aimed to evaluate the effect of patient-centered CPR education (PCE) for family caregivers of patients with cardiovascular diseases. Methods: Fifty-four participants were randomly assigned to the PCE or control group. The PCE group received tailored counseling on overall cardiovascular disease information and CPR followed by interactive instructor-guided CPR training and re-education follow-up by telephone 2 weeks later. The control group received only video-based CPR self-education and booklets. Cardiovascular disease and CPR knowledge and self-efficacy were measured before (pre-test), immediately after (post-test 1), and 4 weeks after the PCE (post-test 2). CPR skills and performance were measured pre-test and at post-test1. Results: The PCE group demonstrated significant improvements in knowledge (F=91.09, p<.001), self-efficacy (F=15.19, p<.001) and CPR skills and performance (F=8.10, p=.008), as well as significant differences over time (knowledge: F=364.25, p<.001; self-efficacy: F=1162.28, p<.001; CPR skills and performance: F=1798.81, p<.001). There were significant group-by-time interactions for knowledge (F=8.10, p=.001), self-efficacy (F=4.30, p =.019) and CPR skills and performance (F=4.81, p=.036) by repeated measures ANOVA. Conclusion: This is the first study to demonstrate the effects of a patient-centered intervention with CPR education tailored for patients' and family caregivers' preferences, needs, and lifestyles. The results of this study encourage the use of tailored, patient-centered interventions in cardiovascular nursing practice.
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문제 정의
The BLS video content for lay rescuers used in the education was made by the Korean Association of CPR (KACPR) and based on the American Heart Association’s 2010 CPR guideline [18]. The researcher demonstrated the overall process of BLS using Laerdal Little Anne and participated in the video-based CPR education along with the participants. During the practice, the researcher checked whether the participants performed BLS (establish unresponsiveness, call for help, chest compression, ventilation, and recovery position) in the correct position and manner and gave real-time feedback to enhance skills and performance.
This study brings attention to the importance and effectiveness of integrating patient- centered education by nurses into CPR training for the family caregivers of cardiovascular patients. Overall knowledge about cardiovascular disease and knowledge, self-efficacy, and performance of CPR were significantly im-proved after completing the PCE program.
This study was a prospective randomized controlled trial in which participants were randomly assigned to receive (PCE group) or not receive (control group) PCE. In the PCE group, a nurse guided and trained the participants through individualized PCE; participants in the control group received the usual educa-tion.
This study was conducted to investigate the effects of patient-centered CPR education (PCE) on knowledge, self-efficacy, and performance in a cardiac emergency of family caregivers of car- diovascular patients. The concept of patient-centered intervention was applied via counseling and interactive CPR education provided by a nurse.
This study was the first to develop a patient- centered intervention including CPR education for the family caregivers of patients with cardiovascular diseases in South Korea. The PCE program in this study was tailored using individual families’ preferences, needs, and values, as opposed to previous cardiovascular interventions or education programs that did not consider the families’ own lifestyles.
제안 방법
CPR skills and performance were measured at pre-test and post-test 1 using Laerdal Little Anne® (Laerdal Medical AS, Stavanger, Norway).
The researcher demonstrated the overall process of BLS using Laerdal Little Anne and participated in the video-based CPR education along with the participants. During the practice, the researcher checked whether the participants performed BLS (establish unresponsiveness, call for help, chest compression, ventilation, and recovery position) in the correct position and manner and gave real-time feedback to enhance skills and performance.
In this face-to-face counseling session, the researcher taught overall knowledge of cardiovascular nursing and made a patient- centered diet and exercise plan according to the specific cardiovascular disease, each family’s preferences, and feasibility.
Participants in the PCE group received a 30-minute one- on-one counseling session with a booklet about CPR, dietary and exercise recommendations, and warning signs of cardiovascular disease. In this face-to-face counseling session, the researcher taught overall knowledge of cardiovascular nursing and made a patient- centered diet and exercise plan according to the specific cardiovascular disease, each family’s preferences, and feasibility.
The PCE program was developed by nurse researchers, based on the concepts of patient-centered care, which concentrates on the individual preferences, needs, and values of the patient and their family [17]. The PCE program was composed of counseling with a booklet and interactive CPR training on manikins (one hour) and telephone follow-up after 2 weeks (10 minutes) in which family caregivers directly participated. One of the researchers provided support as a professional partner, as well as providing information to the participants on cardiovascular disease and how to cope with a cardiac emergency.
The data were collected via questionnaires on knowledge and self-efficacy and a checklist on CPR skills and performance com-pleted by a researcher with American Heart Association BLS instructor certification, who provided PCE education. Demographic data were collected before the intervention.
According to the result of group assignment, the participants were allocated into either PCE treatment or usual CPR education. The education and test sessions were performed by a single researcher to standardize the quality of the intervention. The participants did not know each other in person, thus, the possibility for contamination of the PCE treatment seemed minimal.
Content validity of the knowledge instrument was established by an expert group consisting of a professional cardiologist, a professor of nursing, and basic life support (BLS) instructors (AHA certification). The experts assessed the instrument for the percentage of total items rate for content validity index (CVI) that is being measured as either 3 or 4 on a 4 -point scale. The CVI was reported as 0.
The checklist con-sisted of nine questions assessing whether CPR was performed in the correct position. The items included checking for a response and for no breathing or gasping, activating EMS, and giving high-quality CPR.
90. The knowledge instrument consisted of 10 questions in two areas (five questions about coping with a cardiac emergency and CPR, and five questions about dietary and exercise planning for cardiovascular disease). This knowledge instrument comprised 2 OX quizzes, and 8 multiple- choice questions.
The PCE program in this study was tailored using individual families’ preferences, needs, and values, as opposed to previous cardiovascular interventions or education programs that did not consider the families’ own lifestyles. This study showed that the PCE program was an effective nursing intervention for family caregivers and provided preliminary evidence about enhancing knowledge about cardiovascular disease and CPR, self- efficacy, and skills and performance in a cardiac emergency.
대상 데이터
The assignments were concealed in opaque envelopes. A research assistant, who was responsible for participant recruitment and blinded to the random assignment, enrolled the participants. Upon their participation agreement, the research assistant obtained a written consent from each participant and opened the envelope for group allocation.
Given the effect size was identified in a previous study that suggested significantly clinical and educational implications[16], the priori sample size was calculated at 26 participants per group. Assuming an attrition rate of 14%, we planned to recruit 30 participants per group. Of the 60 participants, 2 in the PCE group and 4 in the control group withdrew from study involvement, 2 because they did not complete the intervention for business related reasons, 1 for giving up for physical fatigue, and 3 because they did not have a phone connection.
Participants were the family caregivers of outpatient cardiology patients who visited M hospital in Gyeonggi- do, South Korea, from July to September 2015. Potential participants were eligible for study participation in the study when they came for reserved cardiology outpatient care with their family.
Of the 60 participants, 2 in the PCE group and 4 in the control group withdrew from study involvement, 2 because they did not complete the intervention for business related reasons, 1 for giving up for physical fatigue, and 3 because they did not have a phone connection. Therefore, a total of 54 participants, 28 in the PCE group and 26 in the control group, completed the study.
데이터처리
945) on the pre- and two post-tests for both groups, so the skewed values were log transformed to meet the assump-tion of normality. Specifically the following were calculated: (a) Frequencies and percentages, means, and standard deviations per item were used to describe participant characteristics; (b) t-tests, χ2 tests, Fisher’s exact tests and analysis of covariance (ANCOVA) tests were used to compare participant characteris-tics between the two groups; (c) repeated measures ANOVA (RM ANOVA) was used to compare differences in knowledge, self-efficacy, CPR skills and performance between the two groups during the research period. Levene test for homogeneity of vari-ance (0.
이론/모형
These measurements used an essential BLS checklist for non-healthcare providers, developed by the Korean Association of CPR (KACPR) based on the American Heart Association’s 2010 CPR guidelines [18].
성능/효과
The concept of patient-centered intervention was applied via counseling and interactive CPR education provided by a nurse. We hypothesized that participants in PCE would demonstrate 1) improved knowledge about cardiovascular disease, and 2) increased CPR knowledge, self-efficacy, and performance compared with participants receiving the usual education.
For improvements in patients’ emotional states and psychosocial adjustment, it was more effective to provide CPR instruction in combination with education about cardiac risk factors and a social support group compared to providing CPR instruction alone.
Prior study showed a significantly higher level of knowledge, positive atti-tude, and skills after a one- day CPR course for cardiac arrest survivors and their families [5]. One month after parents of in-fants and children completed CPR education, self-efficacy had improved significantly, and anxiety about CPR performance had decreased. However, this previous study did not measure CPR skills and performance, and there was no statistically significant differences in CPR knowledge [21].
Although everyone acknowledges the vital role of family caregivers in resuscitation following a cardiac emergency, tailored CPR education for patients and family caregivers have not commonly been provided. The results of the present study show the synergistic effect of a patient-centered intervention with CPR training on the quality of care in both usual and emergency situations. Therefore, the present study is worthwhile, because it is able to show that tailored PCE is a comprehensive nursing intervention for patients with cardiovascular diseases and their family caregivers.
후속연구
Long-term follow-up studies are needed to demonstrate whether the effects of PCE are maintained afterwards. Additionally, further research is recommended to investigate the effectiveness and feasibility of PCE for other people and in various settings.
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