Improving care for people undergoing percutaneous coronary interventions: elements of effective interventions

Abstract

Percutaneous coronary interventions (PCIs) are a frequent strategy for myocardial revascularisation in both the elective and emergency setting. In contrast to surgical techniques such as coronary artery bypass grafting (CABG), there is less procedural burden and a reduction in hospitalisation times. This rapid treatment means a reduced exposure of the individual to healthcare providers in the acute care setting limiting the time to prepare individuals and their families to cope and adjust to living with a chronic condition.In spite of the expansive research in respect of acute coronary syndromes (ACS), PCI and CABG, there is substantially less person centred research focussing on the needs of the individual undergoing PCI. Similarly, in spite of the number of evidence based practice guidelines for ACS and PCI, evidence supporting specific PCI nursing practice remains of a low level and minimally mentioned in practice guidelines. This thesis was undertaken to address these gaps in knowledge.The Chronic Care Model (CCM), promoting evidence based practice, communication and coordination of care for people with chronic conditions has informed the study design, implementation and interpretation of findings.Using the approach of the patient journey and the CCM, a sequential mixed method study was undertaken to describe the barriers and facilitators to improving the care outcomes of people undergoing PCI. Firstly, a study describing the clinical and demographic characteristics of individuals undergoing PCI and their perception of cardiovascular risk was completed. Secondly, a qualitative multi method study investigating patients’, carers’ and healthcare providers’ perceptions of the barriers, facilitators and opportunities for improving PCI care was conducted. Thirdly, an online survey of cardiovascular nurses’ beliefs, values, and practices. This survey was informed by a comprehensive literature review and issues identified through a consensus conference.Fourthly, clinical practice guidelines for PCI nursing care were developed to address limitations in providing coordinated and evidence based nursing care. A systematic method was adopted from the National Health and Medical Research Council’s recommended approach for developing guidelines. This project was conducted under the auspices of the Australasian Cardiovascular Nursing College and the Cardiovascular Nursing Council of the Cardiac Society of Australia and New Zealand; both peak cardiovascular nursing bodies in Australia and New Zealand.Finally, based upon study finding identifying challenges in communication and coordination across care settings, elements of effective interventions aimed at improving risk reduction and secondary prevention uptake have been identified.The series of studies presented in this thesis have contributed to ability of nurses to improve the health outcomes of individuals undergoing PCI across the care continuum. Information obtained from the series of studies in this thesis have provided useful information for further research in developing and implementing effective strategies to improve care for individuals undergoing PCI.