Commentary on Kilonzo B & O’Connell R (2011) Secondary prevention and learning needs post percutaneous coronary intervention (PCI): perspectives of both patients and nurses. Journal of Clinical Nursing 20, 1160–1167

Authors


Geraldine A. Lee, Arrhythmia Research Nurse, Heart Centre, Alfred Hospital, Melbourne, Vic. 3181, Australia. Telephone: +613 9076 3352.
E-mail:g.lee@alfred.org.au

With the increasing numbers of patients presenting for treatment and management of coronary heart disease (CHD), it is imperative to plan care and engage patients in secondary prevention. Kilonzo and O’Connell (2011) examined nurses and patients’ learning needs postpercutaneous coronary intervention (PCI) and observed that patients valued their interaction with nurses. The results revealed that patients were more concerned with their immediate state and their physical, emotional and psychosocial status compared to nurses. Patients are often not offered a choice of treatment but advised by their cardiologist on the most appropriate treatment. Patient perceptions are not usually a consideration, but one issue is whether patients fully appreciate the clinical significance of their CHD. Patient perceptions, especially in chronic diseases such as CHD, are extremely important and have previously been examined in relation to quality of life (QoL) (Ballan & Lee 2007, Lee 2008).

Thus, examining patients learning needs is an important consideration post-PCI, especially if a further CHD event is to be avoided. Kilonzo and O’Connell (2011) recruited 33 patients and 13 nurses, and the participants completed a suite of questionnaires; however, women were under-represented (12% of sample) as well of those with failed procedures, non-English speaking patients and those who were too physically ill. The finding that patients valued their interaction with nurses is not unexpected. Nurses provide holistic care, and for the patients presenting for the first time with CHD, they require reassurance and education. The issue of short hospital stay is acknowledged as an issue, and this factor plays a significant role in how much time nurses can spend with patient providing information. Thus, it is commendable to examine nurses’ perceptions to ensure that we focus on what the patient perceives as their priorities.

Psychological well-being, in particular, anxiety and depression play an important role in CHD and are independent risk factors for CHD (Lee 2009). Although Kilonzo and O’Connell (2011) highlight studies acknowledging the importance of anxiety and depression, they did not record pre-existing mental health issues nor describe in detail the other cardiac conditions. The relationship between depression and CHD is now well established, and as researchers, we need to record previous depression and screen patients for depression on admission. It is quite feasible that those with anxiety and/or depression may continue with poor lifestyle choices such as smoking and having a poor diet. The provision of adequate information about associated risk factors may help patients make lifestyle changes.

The relationship between poverty and CHD is well known (Lee & Carrington 2007), and this may worsen with the current economic climate and partly explain patients’ focus on their immediate health and their focus on getting back to work. Given the global financial crisis, it would be interesting to know what community/tertiary cardiac services are available for this population.

It is important to investigate patients’ perceptions, and this study adds to our knowledge by highlighting the importance of secondary prevention and providing patients with adequate information to help them modify their lifestyle and prevent further CHD events.

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