ABSTRACTCardiovascular heart disease has been one of the most common causes of death worldwide. However, with today’s technology, many patients who have experienced myocardial infarcts are surviving the event but need support to manage their symptoms. Cardiac rehabilitation (CR) has been shown to decrease morbidity and mortality(1). Despite the research, only one-third of patients with post-myocardial infarcts are participating in CR (2,3) . This MSN Project focuses on two main interventions (a) educating patients about the benefits of participating in CR and (b) educating physicians on how to use motivational interviewing (MI) to improve patient compliance in CR. Surveys were developed to evaluate the education of patients and providers. In addition, random patients who completed CR will be contacted and asked what factors helped them remain active in CR.

PICO QUESTIONDoes educational handouts and motivational interviewing increase patient compliance to CR?

LITERATURE REVIEW• Strong evidence in the literature shows that

exercise-based CR reduces the risk of cardiovascular mortality but not total mortality. Although there is significant reduction in the risk of hospitalization with CR, there is no reduction in the risk of myocardial infarction or surgical intervention for revascularization. Further evidence supports improved health-related quality of life (HRQL) with exercise-based CR, decreased anxiety and depression, and increased exercise capacity (1).

• Studies found that less than one-third of eligible patients participate and or complete the program (2,3) .

• A recent systematic review of 72 studies showed that MI outperformed traditional advice giving by 80% (4)..

• Studies show that even brief MI sessions (5 to 15 minutes) to be efficacious in inducing behavior change(5,6)

USING MOTIVATIONAL INTERVIEWING AND EDUCATION TO HELP INCREASE PATIENT ADHERENCE TO CARDIAC

REHABILITATIONKaren Beck, BSN, RN, MSN-FNP Student

Plan and Implementation Process

Patient Education• The patient education will be completed on the Intensive Care

Unit (ICU) at Logan Regional Hospital. • ICU nursing staff will give an educational handout to all patients

who have experienced a myocardial infarction. • Patients will be allowed to read this handout. The survey will

then be administered by the ICU nursing staff to evaluate how useful the handout is and whether it increases their motivation to attend CR.

Provider Education• The provider education will be completed at the Budge Internal

Medicine Office in Logan.• This will be presented in a practitioner staff meeting by a

research assistant. • After reading the handout out loud, a short survey will be

administered regarding if the handout clarifies MI techniques, if they feel that using MI will increase patient compliance to CR, if they plan on using MI, and what suggestions they may have.

Random Phone Calls• Follow up calls will be directed to patients who complete the CR

program to assess a common motivating factor.

SUMARY

• Goal: Increase patient compliance in CR.

• Educational handouts will be given to both patients and practitioners.

• Handouts will educate patients and provide practitioners with a tool to motivate patients to participate in CR.

Evaluation

• To evaluate the effectiveness of the handouts, a brief survey will be given to both the patient and the practitioner.

• In addition, follow up calls will be directed to patients who completed the CR program to assess a common motivating factor.

THEORETICAL FRAMEWORK• Orem’s self-care theory was used as the framework

for this project. It focuses on people being self-reliant and responsible for their own care and the care of others in their family.

• The theory also assumes that a person’s knowledge of potential health problems is necessary for promoting self-care behaviors.

• The self-care theory includes illness-related behaviors, such as adherence to follow-up visits and examinations.

• The theory also includes health-promoting behaviors, such as eating a healthy diet or engaging in CR.

• In addition, the theory shows that the motivations for healthy behaviors are to avoid disease and complications (8).

CONCLUSIONSThe literature review substantiates the benefits of CR. Compared with no exercise control group, exercise-based CR reduces the risk of cardiovascular mortality but not total mortality. There was a significant reduction in the risk of hospitalization with CR but not in the risk of myocardial infarction or revascularization. The literature also showed evidence supporting improved HRQL with exercise-based CR (1). Despite the research, only one-third of post-myocardial infarct patients are participating in CR(2,3). A systematic review shows that MI outperformed traditional advice giving by 80% (6).

The evidence was used in the handouts. These were to be delivered to the patients with post-myocardial infarctions and practitioners as outlined to assess whether information influenced patients to enroll in CR and whether providers considered MI useful for motivating patients to attend CR. One obstacle is that practitioners will not likely be proficient at MI and may not have the time to do it. Also, patients may glance over the handout and not take the survey.

REFERENCES1. Anderson, L., Thompson, D. R., Oldridge, N., Zwisler, A., & Rees, K. (2016). Exercise-based

cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 2016(1). http://dx.doi.org/ doi: 10.1002/14651858.CD001800.pub3.

2. Minvielle, C. (2016). Barriers to cardiac rehabilitation after myocardial infarction: Bordeaux university hospital example. Annals of Physical and Rehabilitation Medicine, 59. http://dx.doi.org/10.1016/j.rehab.2016.07.111

3. Peters, A. E., & Keeley, E. C. (2017). Trends and predictors of participation in cardiac rehabilitation following acute myocardial infarction: Data from the behavioral risk factor surveillance system. Journal of the American Heart Association, 7(1), 1-6. http://dx.doi.org/doi: 10.1161/JAHA.117.007664.

4. Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55, 305-312.

5. De Almeida Neto, A. C. (2017). Understanding motivational interviewing: An evolutionary perspective. Evolutionary Psychological Sciences, 3, 379-389. http://dx.doi.org/10.1007/s40806-017-0096-6

6. Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Motivational interviewing. British Medical Journal, 340, 1242-1245. http://dx.doi.org/10.1136/bmj.c1900

7. (Marty Haws, personal communication, January 20, 2018) 8. Nursing theories a companion to nursing theories and models. (2012). Retrieved from

http://www.currentnursing.com/nursing_theory/self_care_deficit_theory.html

PROJECT METHODOLOGYThis MSN Project focuses on two main interventions: • Educating patients about the benefits of participating in CR. • Educating physicians on how to use MI to improve patient compliance in CR.

Patient Handout: An educational summary informing patients about CR and given when patients are eligible for participation.

Practitioner Handout: Focuses on using MI techniques to increase patient participation in CR. • According to CR management at Logan Regional Hospital, most patients start dropping out of CR around week

three (7). • Using MI techniques in the office at week two is likely to decrease the number of patients dropping out of CR.

Cardio Smart American College of Cardiology. (2016). Cardiac rehabilitation. Retrieved from https://www.cardiosmart.org/Posters Copies of the poster can be downloaded, printed, and distributed to patients. In addition, the posters, 17 x 22 inches can be ordered. See details in link.

Coro_Man.jpg. (2007). Retrieved from https://en.wikipedia.org/wiki/Coronary_artery_disease#/media/File:Coro_Man.jpg

Taken by Tina Lerohl, purchased by Karen Beck, including copyrights.