The World Health Organization has defined cardiac rehabilitation as, “the sum of activities required to influence favorably the underlying cause of the disease, as well as to ensure that patients’ best possible physical, mental and social conditions so that they may, by their own efforts, preserve, or resume when lost, as normal a place as possible in the life of the community” (Thompson & Lewin, 2000, 102). The role of the nurse is to educate the patient about myocardial infarction and its treatment, lifestyle changes (drugs, diet, exercise), teach self-monitoring and management (especially the early detection and treatment of chest pain), coordination of care with other health care providers, and provide rehabilitation support (Timmins & Kaliszer, 2003). Education is a vital component of care for patients after myocardial infarction. By informing patients about the disease process of an MI, it helps to reduce anxiety and aid recovery, as the underlying cause of MI is related to lifestyle. Nurses need to educate patients based on what the patient has concerns about and not follow a standard protocol regarding post-MI teaching. Every patient has various experiences and a wide range of emotions, and needs the appropriate methods pertaining to teaching the client when he/she is ready to listen. Bores and Sinclair (2009) mention how crucial it is to have post-MI education and programs individualized to each patients’ specific needs, and to examine the organizational factors influencing their performance on the patient teaching role.
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Thompson and Lewin (2000) mention how patients report a fear of resuming sexual activity and enjoyment, but what these patients need to be told is that there is no evidence that suggests sex is in anyway dangerous, but the exercise involved may have significant protective effects in post-MI patients. As a nurse, it is important to encourage the client to identify what they felt may have been the cause of their MI and if the client is associating this as psychological distress. Thompson et al. (2000) mention that initial distress predicts outcome for return to work and for some other aspects of quality of life outcome, lifestyle changes, and compliance with medical care. Every patient should be helped to develop an individualized and concrete plan for recovery in the weeks following the MI (Thompson et al., 2000). Its also important that the patient’s partners should be advised to alter the family routines as little as possible except for lifestyle changes, such as smoking or diet, which should begin immediately (Thompson et al., 2000). The patient and partner’s understanding of the advice should be checked during the course and at the end of each session, by asking them to summarize the advice imparted, it may be helpful if information provided was written or tape recorded for review throughout the rehabilitation phase.
According to Skinner, Cooper, and Feder (2007), who have summarized some recommendations from the National Institute for Health and Clinical Experience (NICE) on effective secondary prevention in patients with post-MI. Nurses can utilize this information, by taking into account the recommendation of lifestyle advice that should be consistent and take into consideration the patients’ current habits. Patients should be advised to increase physical activity, quit smoking, eat a Mediterranean-style diet, consume at least seven grams of omega 3 fatty acids a week, keep weekly alcohol consumption within safe limits, achieve and maintain a healthy weight if obese, and advise patients against taking supplements containing carotene, vitamin E or C supplement and folic acid supplements (Skinner, et. al, 2007).
Another recommendation by NICE regarding the exercise component to all patients, as well advise patient to return to work and to get involved in activities of daily living while taking into account the patient’s physical and psychological status, and the nature of the patient’s work. Exercise has been shown to increase myocardial oxygen delivery, and improvements are seen on changes in the oxygen utilization of the peripheral skeletal muscles, resulting in decreased demand placed on the myocardium at any given workload (Nolewajka, Kostuk, Rechnitzer, & Cunningham, 1979). Furthermore, Luszczynska (2006) found that the promotion of an active lifestyle after eight months post-MI can help patients to increase their sessions of moderate physical activity.
Drug treatments post acute MI such as angiotensin converting enzyme inhibitor, Aspirin, beta blockers, and statin. For effective implementation of all these recommendations, secondary prevention measures are generally started before discharge. Furthermore, timely discharge summary with recommendations for ongoing care are very important to start prior to discharge from the hospital. Amin (2006) found that the use of aspirin, beta-blockers, statins, and ACE inhibitors at discharge was improved dramatically and adherence to these medications persisted during the follow-up period.
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After reviewing all related nursing research articles on secondary prevention of clients with myocardial infarction, we noticed that nurses have an important role as the educators in the health promotion setting. Secondary prevention is a clinical approach to reduce the risk of recurrent events in individuals who have experienced myocardial infarction and individuals who at high risk of cardiac problems. By educating the clients about secondary preventions such as pharmacotherapy, health education and psychological support in developing lifestyle medications, clients are able to develop coping strategies for treating and preventing MI and ultimately yield to better health outcome and restore their function in normal daily living activities. The most appropriate time of starting the education is not mentioned in the research articles. However, most of the studies take place after the clients discharge from hospital. The future practice in nursing about education in secondary prevention of MI should focus on the discharge planning of the client. Effective communication between the acute care nurses and the community nurses can bridge the gaps when transferring the clients from hospital to home or long term care setting and can ensure the clients are receiving excellent nursing care in services across setting. Also, nurses should ensure interpreters are used and translated written materials are available when conducting family meeting about discharge, teaching with clients and family members. This can ensure that information is delivered to clients correctly and the clients will understand the purpose and meaning of the teaching. Moreover, the hospital can implement a telephone system for follow up to discharge clients to reinforce the teaching especially the detail of medication and plan of emergency incident. At last, nurses should integrate cultural-ethical content into teaching and provide holistic care which can help the health care providers to work effectively with diverse populations.
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