According to Peterson, Allegratnte, Pirraglia, et al (2010) coronary artery disease affects 16 million American in 2008. More than 650,000 patients undergo percutaneous transluminal coronary angioplasty (PTCA) or stent procedures annually representing a 324% increase in PTCA procedures between 1987 and 2002. A World Health Organization expert committee recommends that cardiac rehabilitation be provided for all patients undergoing PTCA. Despite of the recommendation, patients often fail to adopt a healthier lifestyle after angioplasty.
More than 45% of African Americans have cardiovascular disease which is the leading cause of death among African American and women (Mosca, Benjamin& Berrak, 2004). Some studies have reported that knowledge deficit regarding health behavior contributes to the lack behavior change among patients with cardiovascular disease. Purpose of study Witt, Jacobsen, and Weston (2004) stated that women are 55% less likely than men to participate in a cardiac rehabilitation program and that patients aged more than 70 years are 77% less likely to engage in cardiac rehabilitation program than younger patients.
Therefore, the purpose of this qualitative study was to document the values, attitudes and belief among a demographically and culturally diverse group of patients post PTCA who had been successful or unsuccessful at multiple behavior change three years after angioplasty. Introduction In her article Living with Heart Disease after Angioplasty: A Qualitative Study of Patients Who have Been Successful or Unsuccessful in Multiple Behavior Change, Janey Peterson (2010) documents the attitude, beliefs and values of a cultural and demographically diverse group of patients.
This study focused on how healthy behavior changes can change patient outcomes. This area of nursing is important, relevant and of interest to making improvements in patients outcome after a heart disease diagnosis. In 2008, over 16 million people are diagnosed with coronary heart disease at an estimated cost of $156 billion (Peterson, 2010). Nurses must continue to develop strategies to bring these numbers down. Several studies have indicated that knowledge defect is the culprit of the lack of behavior change with heart disease patients (Peterson, 2010).
Several themes surface from data that was collected from subjects. These themes are discussed during the interviews. The themes are evolving and allow the researcher to create a hypothesis. The grounded theory was used to show that positive patient outcomes can be achieved with education. What can nurses do to enhance the education process for heart disease patients? Review of the Literature As a qualitative study, this study involved a wealth of background information from a previous research study entitled: The Parent Study: Healthy Behavior Trial.
This study involved 660 patients who underwent urgent stinting. After signing a written informed consent the subjects enrolled within one month of having a stent and were followed over a two year period by phone. There have not been many studies on patients post angioplasty. From the parent trial emerged the current qualitative study. The background literature used for this study was obtained from The World Health Organization. Their committee has recommended that all patients undergoing angioplasty have cardiac rehabilitation.
The American Heart Association recommends that patients deal with modifiable risk factors. Although both organizations have made these recommendations, patients have failed to change their unhealthy behavior. The nursing practice area studied in this article was Cardiovascular. Most hospitals have a series of areas that are included under the cardiovascular umbrella. They include Cardiac rehabilitation, Endovascular pre/post unit and Telemetry. Study Design The grounded theory and semistructured interviews were used to gather and investigate the data in this article.
According to Burns and Grove (2009), Grounded theory methodology refers to the process of ”developing increasingly abstract ideas about research participants’ meaning, actions and worlds and seeking specific data to fill out, refine, and check the emerging conceptual categories. ” Thus, the findings of this study are grounded in real-world knowledge of the subjects. Only participates who completed the “parent trial” were invited to participate. Patients were urged to change at least 2 or more of the 12 targeted healthy behaviors.
Methods, Sampling, Data Collection & Data Analysis Qualitative researchers use a variety of methods when doing research. The samples used for this article were chosen with precision. There were many of aspects that the investigator took in account prior to sampling. Peterson chose maximum variation sampling. The goal of this type of sampling is to study and observe the subjects experience in an attempt to clearly recognize the social contexts of the participants in the study while at the same time, uncovering some level of transferability (Polite, 2010).
The other type of sampling used was Purposive Sampling. The goal of this type of sampling is to choose cases that will best contribute to the information needed (Burn & Grove, 2009). Prior to any interviews an informed written consent was obtained. Semi structured interviews were constructed to explore and elicit responses related to the aspects being investigated. Quantitative and qualitative data analysis was used for this study. Successful and unsuccessful patient were analyzed using chi-square. This included the patient’s perception of the cause and treatment of heart disease.
Then questions were refined to use more formative methods. This method allowed for confirming, refining, or refuting data that evolved from the formative interviews (Peterson, 2010). All of the interviews were conducted by trained staff. An interview guide was used to ensure that all subjects reported all aspects of their lives. The same interview guide was used regardless of behavior change. Any other questions that the interviewer asked were based on the answers given by the subjects. All interviews were monitored by Peterson as well as recording by audiotape.
The software used for the study was called Ethnograph version 5. 0 (Peterson, 2010). This computer analysis program facilitates the open-coding methods used to conduct this study (Peterson, 2010). Open coding methods permit for identification of patient’s common concepts. Triangulation techniques helped to develop concepts, categories and themes. Trustworthiness was established by using these techniques. Results The result showed the patients who were successful had characteristics of being obese and had a history of a previous CABG surgery, and had insulin dependent diabetes.
In comparison to the unsuccessful patient, they reported a higher incidence of previous PTCA, unstable angina, hypertension, diabetes with end-organ damage, and a smoking history (Peterson et al, 2010). Peterson et at (2010) stated that patients was willing to work on many risk factors after having a PTCA such as taking their blood pressure medication (46. 9%), n=15), increase physical activity (43. 85, n=14), smoking cessation (34. 4%, n=11), and decreasing overall cholesterol through diet and medication (34. 4% n=11). In contrast, unsuccessful patients were more likely to choose and succeed at smoking cessation (13. %, n=4), taking blood pressure medication as prescribed (13. 8%, n=4), and increasing overall physical activity (10. 3%, n=3). Between the two groups, there were no differences in the rate of recommendation of the various risk factors. Limitation In the study, some of the patients had previous experience in intervention studies. The patients who had experiences may have different results than the patients who not had previous experiences with behavior changes. Therefore, the history of experience possible limits the results of the finding.
The study should have also divided the patient up accordingly to the ones who have had experience and conclude the results from that finding. Conclusion In conclusion, qualitative and quantitative data was used in this research study and the questions were answered. It is shown that, out of 61 patients interviewed 32 (52%) had successfully changed 2 or more out of 12 health behaviors and 29(48%) had been unsuccessful at changing those behaviors (Peterson, 2010). Although studies have proven that cardiac rehabilitation will improve the patients’ health, many elderly and women are most likely not to be compliant with program.