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"August 2003" / Includes biblographical references. / 227 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2004

published_or_final_version / Nursing Studies / Master / Master of Nursing

The purpose of this research was to describe the relationships among patient characteristics, care processes, and care outcomes for patients in a coronary care unit (CCU). The sample consisted of 179 CCU patients. Data collectors reviewed charts and retrieved the chart information needed to measure the operational variables of APACHE II score (Acute Physiology and Chronic Health Evaluation II), years of age, CCU length of stay, nurse to patient ratio, and mortality. Descriptive statistics were used to analyze the demographic data of the patient characteristics. Correlational statistics were used to analyze the five operational variables in the "CCU Patient Outcomes Model." Pearson correlations revealed significant positive relationships between APACHE II score and age and nurse to patient ratio. Point Biserial correlations revealed significant positive relationships between mortality and APACHE II score and nurse to patient ratio. Patient characteristics were related to care processes. Patient characteristics and care processes were related to patient outcomes.

The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha. / School of Nursing

This study assessed differences in the knowledge of cardiac risk factors and the attitude toward computer assisted instruction (CAI) in cardiac rehabilitation patients instructed by lecture and transparencies or CAI. The quasi-experimental two-group posttest design used a convenience sample of 30 volunteers enrolled in a cardiac rehabilitation program. After randomization, cardiac risk factor instruction was conducted via lecture or the investigator developed CAI. The subjects completed a knowledge instrument which demonstrated content validity and a Kuder-Richardson formula 20 reliability coefficient of .0 and the Attitude Toward CAI scale which demonstrated content validity and a Cronbach's alpha .853 and .759. The data were analyzed by the two-sample t-test utilizing the .05 probability level. The results indicated a nonsignificant t value of .00 (df 28, p = 1.00) in the knowledge scores and a nonsignificant t value of 2.00 (df 28, p = .05) in attitude scores therefore the results failed to reject both null hypotheses. The conclusions drawn from this study are that CAI was as effective as lecture for patient education and that attitudes toward CAI were favorable. / School of Nursing

Nurses constitute the foundation of America's healthcare system, and their roles are central to effective patient care in a variety of settings. Nurses are trained to give care and comfort to others. The purpose of this qualitative exploratory case study is to explore the experiences of registered nurses who take care of critically ill patients in telemetry units to gain a deeper understanding of how these telemetry nurses describe the self-care practices they employ to deal with the high demands of their job. There exists a need to set in motion plans to preserve a healthy nursing workforce to care for America's aging population, now and in the future. Therefore, studying the well-being of telemetry nurses and how they care for themselves is crucial. Very little is known about how telemetry nurses manage their well-being through self-care practices. However, Duffy (2015) suggests this is important because "the secret of caring for patients is caring for our caregivers" (p. 5). The intent of the study is to gain a deeper understanding of the self-care practices employed by telemetry nurses and the real or perceived effectiveness of such practices. A deeper understanding of the phenomenon of “self-care practices” among this group of nurses may provide findings that allow nurse leaders, educators, regulatory agencies, and policy makers to design and implement the appropriate training, education, and environment needed to sustain a healthy telemetry nursing workforce. The major finding from this study is this group of telemetry nurses’ self-care activity was primarily “Spirituality”. Thus, in relation to the Six Dimensions Wellness model, more attention is needed in the five other components as an indicator they are fully practicing self-care.

Acute Coronary Syndrome (ACS) is common and associated with high mortality. Effective treatments are available but require prompt administration. Studies have consistently demonstrated that delays to treatment are common, with patient decision time accounting for most delay. Interventions aimed at reducing delay have had little success. Evidence suggests that psychological factors, in particular illness representations (Leventhal’s Commonsense Model of Self-Regulation (CS-SRM)) might be important in relation to patient decision time. This thesis describes a two-stage investigation, undertaken within NHS 24, exploring the content and timing of people’s initial presentations with possible symptoms of ACS. The first stage comprised a CS-SRM-guided content analysis of peoples’ initial symptom presentations. The second stage utilised the Illness Perception Questionnaire-revised (IPQ-R) to explore how illness representations relate to patient decision time. Results show that the components of illness representations accounted for 95% of participants’ initial presentations. The components most related to behaviour and outcome were volunteered least (cause, consequences, cure/control and coherence). Decision time for most participants (89%) was out-with the ideal and appraisal time accounted for most of the delay. Appraisal delay was shorter for those with fewer symptoms and high emotion. Illness delay was longer where the person making the call reported high treatment control. Interventions may need to raise awareness of the range of possible presentations and of the consequences associated with delay. Interventions should also provide guidance as to an appropriate time-limit for self-care. Individuals may benefit from being informed about how to respond to strong emotional responses. Interventions aimed at bystanders may need to differ from those for patients. People at high risk of ACS should be informed about how and when to access healthcare out-of-hours.

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)