Cardiovascular Nursing Research Initiatives in Canada

Sylvie Robichaud-Ekstrand, PhD, RN

Disclosures

Prog Cardiovasc Nurs. 2002;17(3) 

In This Article

Montreal Heart Institute and the University of Montreal Faculty of Nursing

This investigative team has developed, evaluated, and implemented several cardiac secondary prevention programs, including: 1) patients education programs (1997-2000); 2) telephone nurses' services (1995-1999); 3) nurse case management for coronary artery bypass graft patients (1995-1999); 4) primary care providers follow-up programs for first-time coronary artery bypass graft patients (1996-2000); 5) self-help groups for internal cardiac defibrillator patients (1993-1994); 6) a music program for patients awaiting heart catheterization (1998-2000); and 7) cardiac teaching programs meeting specific learning and psychosocial needs of postmyocardial infarction men and women (1995-2000). These studies have provided evidence to decision makers, resulting in funds to create Nurse Specialist positions, and to implement these programs in current nursing practice. In predicting factors for early hospital discharge (1995-1999), and need for community nursing care (1996-2000), a more coordinated and integrated nursing approach has been created within and between the Montreal Heart Institute and nine Montreal ambulatory care agencies. In addition, several instruments have been either developed or translated into French, and validated (e.g., self-care agency, self-efficacy, learning needs, stages of change, attitudes, intentions, sense of mastery, coping strategies, social supportive behavior, health motivation assessments, and nurses' perception of nursing research).

This previous work has lead to the development of a computer-tailored feedback system, which includes activities such as clinical decision-making, efficient information management, knowledge acquisition and dissemination, and informed patient participation. Computerized tailoring means adapting content material to the characteristics of an individual through a computerized process. The iterative computer-tailored feedback system that has been developed consists of reminders and tailored messages that are generated by computerized algorithms. Reminders identify health professionals responsible in managing specific cardiovascular risk factors, and provide feedback on which cardiovascular risk factors require tighter control according to established clinical guidelines. Messages provide evidenced-based information, computerized counseling, and recommendations according to readiness to change and level of self-efficacy. The intent of the computer-tailored feedback system is to better manage continuity by enhancing the transfer of health information. It is hypothesized that the impact of the iterative computer-tailored feedback system will be greater when using reminders, compared to usual care, and even greater if tailored messages are also included as a counseling method to assist patients in modifying their health behaviors.

In the Province of Quebec, this research project is being developed within a platform that creates a comprehensive and long-term approach to integrated clinical informatics. It consists of a consortium of four university hospital centers, affiliated to the four Quebec faculties of medicine and nursing with their research institutes on one hand, and three regional councils for health and social services with their respective technocentres on the other hand. These incentives are supported by the Ministry of Health's strategic plan for developing and implementing health informatics in the Province of Quebec, as they will dramatically enhance the capacity to conduct innovative clinical and population health interventions and research, and promptly introduce evidenced-based data into practice. Concurrently, the National Heart Foundation of Australia is taking the lead to adapt and implement this project in the New South Wales area. It is an ideal fit with the Commonwealth and State Health Department initiatives in cardiovascular disease. In the coming year, further international collaborations will be sought with the British Heart Foundation Research Unit at the University of York, and Department of Health Coronary Heart Disease Information Strategy in the United Kingdom. Other current collaborative projects include: 1) developing and testing an ethnocultural- and gender-based model examining cognitive processes when faced with managing cardiovascular disease risk; and 2) evaluating the effects of a self-regulated, daily, home program of exercise ergometry in the poststroke period on the occurrence of subsequent stroke and myocardial infarction, physical functioning, and quality of life.

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