Get access

Reframing the dilemma of poor attendance at cardiac rehabilitation: an exploration of ambivalence and the decisional balance

Authors

  • Bronwyn Everett,

    1. Authors:Bronwyn Everett, MSc, RN, PhD Candidate, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Yenna Salamonson, PhD, RN, Senior Lecturer, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Robert Zecchin, RN, MN(Cardiac), Nursing Unit Manager – Area Cardiac Rehabilitation/Chronic Care Programmes, Westmead Hospital, Sydney West Area Health Service, Sydney, NSW, Australia; Patricia M Davidson, PhD, RN, Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney, NSW, Australia
    Search for more papers by this author
  • Yenna Salamonson,

    1. Authors:Bronwyn Everett, MSc, RN, PhD Candidate, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Yenna Salamonson, PhD, RN, Senior Lecturer, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Robert Zecchin, RN, MN(Cardiac), Nursing Unit Manager – Area Cardiac Rehabilitation/Chronic Care Programmes, Westmead Hospital, Sydney West Area Health Service, Sydney, NSW, Australia; Patricia M Davidson, PhD, RN, Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney, NSW, Australia
    Search for more papers by this author
  • Robert Zecchin,

    1. Authors:Bronwyn Everett, MSc, RN, PhD Candidate, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Yenna Salamonson, PhD, RN, Senior Lecturer, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Robert Zecchin, RN, MN(Cardiac), Nursing Unit Manager – Area Cardiac Rehabilitation/Chronic Care Programmes, Westmead Hospital, Sydney West Area Health Service, Sydney, NSW, Australia; Patricia M Davidson, PhD, RN, Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney, NSW, Australia
    Search for more papers by this author
  • Patricia M Davidson

    1. Authors:Bronwyn Everett, MSc, RN, PhD Candidate, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Yenna Salamonson, PhD, RN, Senior Lecturer, School of Nursing, University of Western Sydney, Sydney, NSW, Australia; Robert Zecchin, RN, MN(Cardiac), Nursing Unit Manager – Area Cardiac Rehabilitation/Chronic Care Programmes, Westmead Hospital, Sydney West Area Health Service, Sydney, NSW, Australia; Patricia M Davidson, PhD, RN, Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney, NSW, Australia
    Search for more papers by this author

Bronwyn Everett, PhD Candidate, School of Nursing, College of Health & Science, University of Western Sydney, Bankstown Campus, Building 3, Locked Bag 1797, Penrith South DC 1797, Sydney, NSW, Australia. Telephone: +612 02 9772 6382.
E-mail: b.everett@uws.edu.au

Abstract

Aim.  To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence.

Background.  Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence – the experience of simultaneously wanting to and yet not wanting to, or the ‘I want to, but I don’t want to’ dilemma.

Design.  Discussion paper.

Method.  This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation.

Conclusions:  This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes.

Relevance to clinical practice.  Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward.

Get access to the full text of this article

Ancillary