published_or_final_version / Nursing Studies / Master / Master of Nursing

Purpose: The primary purpose of the study was to assess if physical activity (PA) habits change between the first and final week in a phase II cardiac rehabilitation (CR) population and to determine if the PA habits differ on CR days versus non-CR days. The secondary purpose of the study was to determine if there were differences between the two PA assessment methods. Methods: There were 41 male subjects and 16 female subjects that volunteered for the study; however only 25 male subjects (age: 64.7 ± 11.4 years, BMI: 28.8 ± 4.5 kg/m2) and 11 female subjects (age: 65.2 ± 13.3 years, BMI: 31.6 ± 4.0 kg/m2) were included in the data analyses after accounting for dropouts and subject's whose data did not meet validation criteria. Subjects were required to wear both of the activity devices (pedometer and accelerometer) during both the first and final week assessments. Steps/day, activity counts/day, inactive minutes/day, light minutes/day and walking minutes/day were assessed by the Actigraph Accelerometer. Results: There was no significant difference in step counts from 5,290 ± 1,561 steps/day during the first week assessment to 5,730 ± 1,447 steps/day during the final week assessment. However, significant differences were seen between rehabilitation and nonrehabilitation days step counts/day (6,503 ± 1,663 steps/day vs. 4,517 ± 1517 steps/day, respectively). Furthermore, there was a significant increase between the first and final weeks activity counts/day (144,185 ± 56,399 counts/day vs. 165,220 ± 51,892 counts/day respectively) and a significant increase between rehabilitation and non-rehabilitation days activity counts/day (175,692 ± 58,239 counts/day vs. 133,712 ± 46,139 counts/day respectively). Conclusions: The results of the study suggest that patients are performing significantly more activity on days they attend rehabilitation versus days they do not attend rehabilitation. Furthermore, activity counts/day increased between the first and final weeks of rehabilitation and were higher on CR days vs. non-CR days, which may be due to the progressive exercise prescription associated with Phase II CR. Therefore, it was concluded that Phase II CR successfully increases the intensity of PA on CR days and between the first and final week of CR.Key Words: Cardiac Rehabilitation, Coronary Artery Disease, Pedometer, Accelerometer. / School of Physical Education, Sport, and Exercise Science

Physical inactivity is a significant health concern for individuals in the United States, and is especially an issue for those with a history of coronary artery disease. Increased physical activity is encouraged for those who are participants in Phase III cardiac rehabilitation to promote a healthy lifestyle after a cardiac event. The purpose of the study was to assess and characterize the physical activity levels of Phase III cardiac patients. Other objectives of this study were to compare various forms of physical activity assessment and compare the activity levels of the cardiac rehabilitation participants with other populations. Comparisons of three physical activity devices were analyzed as well as activity levels on rehab and non-rehab days. Those who participated in home exercise vs. those who did not do home exercise were compared as well as those who were retired vs. those who were employed. Subject inclusion criteria included Phase III cardiac patients who were 40-69 years of age and who attended rehab a minimum of two days per week. The subjects were required to wear a pedometer and accelerometer for at least 12 days and complete a questionnaire following the trial. The mean ± S. D. for age, height, weight and BMI of the subjects was 59.4±8.2 years, 69.1±3.1 inches, 200.9±41.8 lbs., and 29.4±4.8 kg/m2 respectively. The Lifecorder, ActiGraph and International Physical Activity Questionnaire (IPAQ) were used to measure physical activity levels of the Phase III cardiac patients. The IPAQ did not correlate well with the Lifecorder or ActiGraph in assessing physical activity in Phase III cardiac patients (R=0.251, P=0.226-ActiGraph and R=0.280, P=0.175-Lifecorder), however, the Lifecorder and the ActiGraph had a significant correlation coefficient with one another (R=0.83, P<0.001). Rehab vs. non-rehab day data as well as rehab session and non-rehab session physical activity levels were compared among the subjects. On a rehab day, subjects took 9,770±3132 steps/day, which was significantly higher than what they took on a non-rehab day, 5,404±2843 steps/day. Those who did not exercise at home accumulated on average 8,194±2912 steps/day on a rehab day, while on a non-rehab day they accumulated 3,475±1579 steps/day (P<0.001). Those who did exercise at home, took 10,883±2856 steps/day on a rehab day, while on a non rehab day they took 6,767±2768 steps/day (P<0.001). Those who were employed were more active than those who were retired. In conclusion, Phase III cardiac rehabilitation is an effective way to increase physical activity levels of those with a history of coronary artery disease. All participants in Phase III cardiac rehabilitation should be encouraged to come into the center-based facility at least 4-5 days per week or implement a home exercise program into their weekly regimen. / School of Physical Education, Sport, and Exercise Science

M.Cur. (Intensive General Nursing) / The incidence of coronary heart disease is still rising due to man's stressful way of life. Angioplasty is a relatively new procedure used to dilate coronary arteries which have been narrowed by sclerosis. This is seen as the 'instant solution' for a select group of patients with coronary artery sclerosis. It fits in well in the fast paced society. Angioplasty is painful and causes anxiety as the patient is awake during the whole procedure. The goal of the study is to determine the patient's experience during angioplasty and to set guidelines for nurses for the preparation of other patients for angioplasty. The Phenomenological method of interviewing was used for data-collection. Interviews were conducted with 9 participants who had had their first experience of angioplasty. Data was subjected to Phenomenological analysis and verified with suitable literature. The conclusions that were reached were used to set guidelines and make suggestions for the counselling of patients for angioplasty.

M.Cur. (Intensive General Nursing Science) / "Patient experiences in a critical contextual, qualitative research phenomenological method to obtain and objectives of the study are: care unit" is a study using the analyse data. The - to establish and describe how myocardial infarction patients experience the critical care unit (CeU) environment, and - to propose guidelines for optimal nursing care. The Nursing for the Whole Person Theory forms the paradigmatic framework of the study. The central proposition states that the myocardial infarction patient's experience of the CCU as his external environment, will have direct impact upon his quest for health. Five participants were interviewed. The interviews were coded by the researcher and an independent nursing specialist, using the Kerlinger method of content analysis. The findings were compared to relevant available literature. Data obtained revealed that certain aspects of the CCU environment generate anxiety and therefore impede the quest for health in myocardial infarction patients! Guidelines for optimal nursing care of myocardial infarction patients were proposed.

Background Coronary heart disease deprives millions of lives in the world annually and this number has increased steadily in recent years. In Hong Kong, coronary heart disease claimed 4360 lives in 2009 and it is one of the major burdens of the healthcare system. In order to reduce cardiac mortality and morbidity and to enhance patients’ quality of life, cardiac rehabilitation program is developed. Exercise training is a pivotal part of the cardiac rehabilitation program. Objective The main objective of this translational nursing research is to translate quality research evidences regarding the effects of exercise training in improving quality of life of patients with coronary heart disease to the local setting. This is achieved by developing an evidence-based protocol. Methods A systematic search of literature was conducted in 5 electronic databases. 8 relevant randomized controlled trials were eventually obtained. Then, the 8 identified studies were summarized to form a table of evidence and the critical appraisal was performed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. After performing the quality assessment, evidences were assembled for synthesis and recommendations are made for developing the evidence-based protocol. Since the implementation potential of the proposed exercise training program is considered to be high, an evidence-based protocol is developed for the local context. In order to implement the evidence-based protocol smoothly, implementation plan is developed in which a communication plan and a pilot test are included. Lastly, evaluation plan is established to assess the effectiveness of the program in fulfilling its objectives. Results In total, 7 recommendations are made based on the 8 appraised studies. According to the SIGN’s “Grades of recommendation”, all the recommendations in the protocol are graded with “A”. The significance of this evidence-based protocol is that it adds a symptom-limited exercise test for evaluating participant’s level of exercise tolerance before the start of exercise training, so that exercise intensity can be tailored. It is relatively safer than the current practice. Conclusion A 6-week exercise training program for patients with coronary heart disease is effective in improving their quality of life and increasing their level of physical activity. Since the program has a high implementation potential in the local context and is safer than the current practice, the evidence-based exercise training protocol is worthwhile to be introduced to the cardiac units in Hong Kong. / published_or_final_version / Nursing Studies / Master / Master of Nursing

There is no abstract available for this dissertation. / Department of Counseling Psychology and Guidance Services

M.Cur. / Patients with coronary artery disease are forced as a result of physiological changes, to make life style adjustments, whether by means of diet, or by adjusting their activities. Only if the patient's attitude toward his illness is of such a nature that he himself takes responsibility for this state of health, life style adjustments can be effective. The objective of this study is to determine the life style adjustments of angioplasty patients, in order to establish guidelines with regard to a patients education programme for nursing professionals. Literature study has brought to light the risk factors which influence coronary artery disease, as well as the crucial need for life style adjustments, which are investigate and described in this study. From this, criteria were derived for use in the further phases of data compilation. The research model is based on retrospective ex-post-facto correlation, to compare the adjustment of patients after angioplasty, with their life style before the procedure. A contextual-descriptive record regarding education given to patients before discharge, is included in the design. A descriptive survey was made of the structure and effectiveness of the educational programme of the chosen unit. Despite reveal results part of the fact that the analyses indicates that the majority of patients a positive tendency regarding life style adjustment, the expected are not achieved, because of a lack of sufficient knowledge on the the patients. The major recommendation evolving from this study, is, that all institutions where angioplasty is performed, should include an educating programme, which should be executed under supervision and which should from part of the rehabilitation process.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Community Medicine / Master / Master of Public Health