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Cardiac Rehabilitation

by Suleman
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Introduction

Cardiac rehabilitation is the composite healthcare management plan given to patients diagnosed with coronary heart disease or heart failure, which includes modules of health education, physical activity, and stress control, creating awareness on cardiovascular risk reduction, and smoking cessation to help the patient stop smoking. Nursing interventions reveal that cardiac rehabilitation aid in reducing morbidity, unforeseen hospital admissions along with improvement in physical exercise capacity, and mobility rates as identified in the international nursing guidelines. Despite this evidence, cardiac rehabilitation recommendation and attendance remains poor resulting in the need for interventions to increase its use. The use of cardiac rehabilitation in these conditions is sustained by a determined committee of research demonstrating excellent clinical outcomes. The current nursing practice guidelines encourage comprehensive rehabilitation plans that should incorporate other modules to enhance heart disease reduction despite exercise training being a key component.

Modification of health behaviors through cardiac rehabilitation and smoking cessation to help the patient stop smoking effectively develop patient’s psychological and physical well-being as well as assisting the patient in recovering productive involvement and function in the society. Also, these particular nursing processes help minimize disease advancement among patients with cardiovascular disease attacks. Cardiac rehabilitation reduces the damaging effects linked to cardiac measures in patients exposed to cardiac arrests from recurring hospitalization which as a result minimizes health care costs. As an integrative action plan, cardiac rehabilitation includes activities such as smoking cessation, exercise therapeutics, nutritional advice, medication, and psychological nursing aid. Furthermore, the probability of cardiac rehabilitation succeeding in managing the risk of cardiovascular disease infections is greatly influenced by the real exercise-based therapy effectiveness. This review, therefore, focuses on the effect of cardiac rehabilitation and nursing process interventions on smoking cessation, cardiovascular mobility and quality of life for Mohamed, a 56-year-old cardiovascular disease patient.

Background

Cardiac rehabilitation is the care management plan identified for a 56-year-old Asian man, Mr. Mohamed admitted to a medical ward previously presented to A&E with a history of severe chest central pain.  Mr. Mohamed claimed to have suffered prompt onset central chest pain which felt like something heavy sitting on his chest. However, he further confirmed that he had never experienced such a feeling of aching chest before. This pain lasted for roughly 30 minutes as the patient hoped it would go away; therefore, he did not act on it. At the facility, Mr. Mohamed is connected to a cardiac monitor and a baseline 12 lead electrocardiogram due to his multiple cardiac risk factors. The electrocardiogram produced a sinus rhythm with a rate of 80/minute which is a normal ECG. The pulse rate results recorded 80/minute and a respiratory rate of 16/minute. Other findings included a blood pressure of 160/100, oxygen saturation of 100% on air with a blood glucose of 12.4 mmol/l.

Previously, Mr. Mohamed had been diagnosed with hypertension, hyperlipidemia and type two diabetes with recent signs of anxiety and depression. As a result, he was put under medication on Metformin 500mg tds, Sertraline 100mg daily, Fluoxetine 20mg daily, Amlodipine 10mg daily, and Simvastatin 20mg note to help lower blood sugar levels minimizing blood pressure. Mr. Mohamed is referred to the on-call clinical attendants the moment he is diagnosed with an Acute Coronary Syndrome. The patient is immediately prescribed on Dalteparin, Aspirin, and Clopidogrel as start medication then later admitted to the acute medical admission ward. After which, the patient is introduced to cardiac rehabilitation programs along with other secondary prevention processes. The services include comprehensive, long-lasting plans which implicating medical assessments, cardiac risk factor adjustment, prescribed exercise, and education which involves counseling on diet and overall lifestyle.

In the process of conducting a series of observations on the patient, the nurse smells cigarette smoke noticing Mr. Mohamed had gone outside for a cigarette. He makes the nurse understand that he had been stressed out and opted for a cigarette so that he could relax. Mr. Mohamed’s constant depression is caused by loneliness because he was left by to live all by himself by his estranged family. Regrettably, smoking is among the main factors resulting in high blood pressure which is a component of hypertension. This realization triggers the nurse to initiate smoking cessation as a care management plan on Mr. Mohamed to help him stop smoking. The nurse ensures the patient undergo the required phases of smoking cessation treatment including preparation, intervention, and maintenance. Development resolves to enhance the smoker’s motivation to quit as well as the self-confidence that they can achieve it. Intervention is meant to help the smoker attain abstinence while maintenance is to cope. Also, Mr. Mohamed had previously lost his job 2years earlier which has made it difficult to deal. He has had a permanent anxious feeling diagnosed with bipolar disorder, a disorder that could have led to the depression.

Every patient diagnosed with Acute Cardiac Syndrome is entitled to cardiac rehabilitation within the health facilities since lifestyle, or chronic disease are the primary cause of morbidity and mortality around the globe. Because these infections are significantly associated with risk factors such as poor diet, physical inactivity, cigarette smoking, and these diseases tend to be largely preventable. Physical therapists are therefore given the responsibility to promote health and wellness of their clients and patients. Therefore, clinical service providers should actively participate in educating clients and patients to appreciate physical therapists as the promoters of their health. Clinical service providers should first start by recognizing the influence of social livelihood, emotions, and spirituality among patients as factors which can assist in their struggles to develop more customized and suitable treatment plans for comprehensive health and wellness.

Ideally, the clinical service providers should continuously evaluate their patients’ wellness to allow them to guide the patients through an understanding of the association between values or perception and healthy behaviors (Armstrong et al. 2015). This is because the knowledge of welfare some clients might seem to hold can be a strong motivation towards the adoption of health behaviors. During the assessments, clinical service providers are to engage the patients in discussions identifying physical activities as strategies applied for physical wellness. Often, these conversations between the patient and clinical healthcare personnel strive to enhance the establishment of intrinsic motivation that has proved to be associated with routine involvement in healthy behaviors (Anderson et al. 2015). Healthcare providers are in a position of gathering information about the wellness of their patients through their history and casual conversations they hold with the patient. Also, this information can be collected by the admission of specific wellness questionnaires concerning the wellness of the patients that can be used to establish more individualized and effective treatment procedures.

Identifying engagement in healthy practices as a factor that can enhance health and wellness assist the physical therapists to implement these behaviors in their patients effectively.  The healthcare service should further be in a position to adopt as well as identify the fundamental principles associated with health promotion including personal hygiene, smoking cessation, diet, and weight control among other aspects. Multiple treatment programs tend to be more successful compared to single interventions (Kachur et al. 2017). Counselling, nicotine replacement strategies, retail and voluntary clinics, and behavior programs are strategies applied to the smokers to help them quit the habit. However, the only most cost-effective plan for smoking cessation encouraged by health professionals is self-care which include practicing to abstain on one’s own as well as acting on the advice given by the healthcare providers. Clinicians are also expected to introduce the tobacco addict patients to alternative nicotine products such as the transdermal patches and nicotine gums. These products are mainly used on patients who show adverse addiction effects which have seen a significant shift in smoking attitude.

The biopsychosocial model entails both practical clinical guide and philosophy of clinical healthcare services (Sin et al. 2016). Theoretically, it describes how suffering and chronic disease attacks are influenced by various levels of the organization, right from the public to private institutions. The biopsychosocial model offers a vital contribution to the scientific, clinical structures by supporting models of circular casualty which must be mitigated by linear estimates when thinking of treatment options. Furthermore, this particular model has encouraged the tendency of the participatory relationship between the healthcare service providers and the patients. Healthcare professionals, however, advocate for biopsychosocial-based clinical practices whose properties include active cultivation of trust, self-awareness, educating the reactions of the patients to help with a diagnosis along with the creation of therapeutic relationships and applying informed insights as well as communication of clinical evidence to adopt dialogue (Smolowitz et al 2015). However, the biopsychosocial model is not identified within the new clinical laws, but it is preferably defined as the managerial application of medical skills to the demand of each patient.

The model strives to identify the influence and sensation in the clinical relationship. The clinical relationship approaches among the patients, clients and the service providers significantly influence the achievement of the correct clinical diagnosis within the facilities. Also, biopsychosocial model aids in the interpretation of illness from a comprehensible perspective by awarding the patients the chance to articulate their concerns, investigating the patient’s anticipations as well as offering a friendly environment in which the patients can comfortably operate. Entirely, these approaches are meant to represent attainment of an open relationship whereby the clinical professionals responsibly use the powers in their capacities to offer effective healthcare services (Reed et al. 2017). An essential analysis of the influence of clinical professionals is to classify the issue of how the clinicians manage the intense emotions that describe their everyday practices.

Patients under cardiac rehabilitation will require a long-term care needs and should be guaranteed a social or health care response with a definite care plan incorporating health, collective and preventive care and entitlement to access a private coordinator at their wish. Patients are entitled to engaging in establishing the care plan, comprehend it, and have been able to identify who to approach any moment they need assistance (Chow et al. 2015). All the patients and caregivers can actively participate in decision making about treatment and care if they are provided with the right information, opportunities, and support. Engaging patients and care providers in decisions about treatment and care is an essential way of providing effective patient-based care. Various procedures of patient involvement during evaluations can lead to advanced experience understanding with accurate risk insights as well as enabling the patients to be comfortable with the decisions they make. Additionally, patient participation in the development of services has benefited those involved through giving an improved social contact, boosted their skills and knowledge along with offering prospects for learning (Anderson et al 2015).

Integration of healthcare services is necessary for the provision of collective care for patients in their best interest. The Department of Health’s Transforming Community services program points out that combined care develop quality results while promoting the efficiency through better utilization of resources. Community nursing services are committed to finding new ways of working with teams, agencies and other professionals to sustain the complex care as well as to govern assignments more efficiently (Jackson et al 2015) . Also, community nurses are embracing the use of technology to manage patient care and improve the mobile delivery of services. A model for community nursing outlines a framework for compassion in working which acts as a vision for care committee and nurses midwives. This model also provides a foundation for the call to action which provides a guideline for determining the procedures to ensure integration of community nursing vision.

The determination of community and district nursing development program is to give focus on governance and support to improve on the responsibility of community nurses and their workmates to establish the services that deliver effective healthcare services and results for the patients. The community nursing services include series of care services such as assisting patients with perennial health conditions in their private homes and giving composite and soothing care (Crook et al. 2017). Also, the general high-quality community nursing services are capable of minimizing the use of hospital facilities as well as domestic social responsibility. The purpose of community nurses, strategic partners and district is to develop a model for community nursing entitled to sustain the commissioners, and other healthcare professionals to have enlightened clinically based discussions concerning recent community nursing services in consideration to how these aspects need to develop to support developing local and national health needs.

The community nursing serviced model shows a consideration in practice aiming to enhance invention and propagate the excellent method available in various service facilities across the country (Armstrong et al. 2015). This helps minimize variation and ensure all the patients and their families receive superior services. This service model illuminates the nurses’ contribution to service delivery while they promote advanced integration existing between social care and healthcare through the opinions of critical partners and professionals while developing on the possible pieces of evidence. Additionally, the model outlines the program useful linking its relationship to the quality and results including the National Health Service Outcomes Framework, the Adult Social Care Outcomes, and Public Health Outcome Framework (Kachur et al. 2017). The role of the model consists of three essential elements which include support care for self-reliance as well as support and attention to sick patients recuperating at home.

Integrated visuals are established to shape how community nursing health care services articulate between service delivery and the need to the purpose for ensuring patients and their families are incorporated in community service plans. The community service models also develop new skilled ways aiming to support careers. Statement sheets are established to improve the program to the highly esteemed audiences generating approaches for active, loyal service user response for quality assurance. This integrated model, therefore, is committed to assisting the commissioners, professionals, and the stakeholders to appreciate the opportunity and perspective of the community nursing service (Reed et al. 2017). This helps in building a variety of proposed programs and enterprises for local regions to deliberate inclusion of end of life strategies as well as career strategies.

Nursing assessment involves two components which include systematic collection of data described the patient as well as those observed by the nurse. This assessment is conducted by acquiring the nursing history and later examining the patient. The second component of this assessment involves the analysis of data after which a meaningful way to generate a more comprehensive and precise nursing care plan (Butler et al. 2017). This can be possibly done by utilizing nursing diagnoses to develop and patient-based results and the possible nursing interventions.  Verbal, physical, and behavioral reactions along with health caregiver observation reports from other fields are fundamental aspects of the response mechanism that allow the healthcare team to uphold an active, adaptable health care plan.

Significant analysis of data obtained in the process of nursing interventions is used in the modification of family involvement in the overall treatment and administrative policies. The evaluation and creation of the nursing diagnosis result into development of plan care through the partnership with the patient. Multiple diagnoses among patients are prioritized while establishing the healthcare plans (Chow et al. 2015). This might lead to cardiac rehabilitation caused as a result of immediate acute respiratory problems receiving a higher priority than other chronic diseases concerning attention. Outcomes will then identify patient, family, behaviors, and insights evaluated along a range applied in reaction to nursing interventions. Therefore, nurses in supportive care and clinic responsibilities often need not inform patients on what they may not want to hear. They also need to offer or highlight a great deal of information within a short while. The nurses have further delegated the duty of creating awareness to patients and families including information associated with diseases, opportunities for disease advancement and prognosis (Jackson et al. 2015).

Critical attention staff development can be titled to educate the workforce nurses within the proficiencies of the synergy demonstration. These programs develop on the nurses’ prior education and career nursing experience which promotes the achievement, maintenance, and proficiency. Concepts aligned to the educational progression and critical care treatment are exercised as the framework within which professional advancement opportunities are generated.   Patients are involved in engaging in establishing the care plan, comprehend it, and have been able to identify who to approach any moment they need assistance ( Reed et al. 2017). All the patients and caregivers can actively participate in decision making about treatment and care if they are provided with the right information, opportunities, and support. Engaging patients and care providers in decisions about treatment and care is an essential way of providing effective patient-based care. Various procedures of patient involvement during evaluations can lead to advanced experience understanding with accurate risk insights as well as enabling the patients to be comfortable with the decisions they make (Smolowitz et al. 2015). Besides, patient participation in the development of services has benefited those involved through giving an improved social contact, boosted their skills and knowledge along with offering prospects for learning.

In conclusion, Recent studies draw different conclusions on how cardiac rehabilitation is linked to the overall morbidity and mortality rates. Cardiac rehabilitation is offered to patients with acute cardiac syndrome for assessment, physical wellness along with medication among other nursing interventions to ensure the patients with these conditions survive. Several nursing interventions which include educating the nurses is applied to enable future interventions to seek appropriate patient and healthcare service level factors to predict the probability of attaining advanced overall aspects as well as the cardiac mortality and to minimize constant re-hospitalization. Furthermore, it would be of great significance for the government to introduce more community and district nursing development with the purpose of maximizing the role of community nurses, professionals, and other nursing stakeholders to develop effective service delivery and healthcare results for the patients.

References
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  • Sin, N. L., Kumar, A. D., Gehi, A. K., & Whooley, M. A. (2016). Direction of association between depressive symptoms and lifestyle behaviors in patients with coronary heart disease: the Heart and Soul Study. Annals of Behavioral Medicine50(4), 523-532.
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