Information Needs of Myocardial Infarction Patients

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Information Needs of Myocardial Infarction
Patients
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The Aims of the Study

• Evaluate patients perceptions of the importance
  to them of items commonly taught post MI
• To compare these perceptions with those of the
  nurses who care for them
• To compare the perceptions among the nurse groups
  themselves (CCU, ward, Rehab)

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The Sample

• 27 patients post first MI at one Dublin hospital
• All CCU nurses at this hospital (27)
• All cardiac ward nurses at this hospital (27)
• Cardiac rehabilitation nurses in Ireland (35)

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The instrument The Cardiac Patients Learning
Needs Inventory (CPLNI)

• Devised by Gerard Peterson (1984) USA
• Orignal questionnaire had 8 categories,
  containing 43 individual items pertaining to
  usual teaching areas.
• The respondent is invited to respond to each
  individual item within the category using a five
  point likert scale to determine strength of
  agreement with each statement.

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The Cardiac Patients Learning Needs Inventory
(CPLNI)

• Cardiovascular Anatomy Physiology (AP)
• Psychological factors
• Risk Factors
• Information about Medications
• Dietary Information
• Physical Activity
• Miscellaneous information
• Introduction to the Coronary Care Unit CCU

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The Cardiac Patients Learning Needs Inventory
(CPLNI)

• Gerard Peterson (1984) USA
• Karlik Yarcheski (1987) USA
• Wingate (1990) USA
• Chan (1990) USA
• Ashton (1997) USA
• Turton (1998) UK
• Hughes (2000) UK

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Summary of Previous Results of the CPLNI

• All areas were rated as important
• Learning about anatomy and physiology were deemed
  important both during hosptial stay after
  discharge
• Psychological factors were often regarded as
  being of moderate importance particularly after
  discharge
• Risk factors/ lifestyle factors emerged as of
  primary concern to patients in all studies

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Summary of Previous Results of the CPLNI

• Medication information was regarded as an
  important area for learning at most times during
  recovery.
• Information regarding diet and activity was rated
  as important for learning, however both areas
  were considered to be of low priority when rank
  order was considered.

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Variations between patient and nurse perceptions

• Nurses ranked medication information needs as
  priority learning
• Nurses ranked medication information needs as
  being of greater importance than risk factor/
  lifestlye needs (CCU nurses ranked medicaton
  information needs higher than non CCU nurses)
• Nurses percieved the individual item of
  resuming sexual activity to be high prority
  learning area, however, patients placed low
  priority on this topic.

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CPLNI Used in the Study

• Categories reduced by 1,an additional category
  added ( symptom management), items reduced from
  43 to 38 (6 added). Turton (1998)
• Term risk factor was substituted with lifestyle
  factor, as patients appeared to misinterpret the
  former.

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Results- patients

• significantly different than nurses (p0.001)
• Mostly accounted for by a large proportion of NI
  responses by the patients, in contrast to the
  nurses, to three main (Physical Activity) items
  when to resume driving, sexual activity, and
  work.
• Most similar to the CCU nurse
• The mean score of the Physical Activity category
  is significantly smaller than any other category,
  this was not the case for any of the nurse groups
• Patients overall mean score was significantly
  smaller than any of the nurse groups

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Results- Nurses

• The divergence of the distributions of the 3
  nurse groups was significant (p0.033)
• The CCU nurses had a lower overall score mainly
  due to lower scores in categories 2 3
  (Psychological factors Lifestyle factors)
• Lifestyle medication also significantly higher
  than 3 lowest mean scores

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Comparison of Nurse Patient Views

• Score of symptom management significantly
  exceeds the mean scores of all other other
  categories
• Both nurses and patients agreed that symptom
  management was of greatest importance when rank
  order was considered
• Categories 3 (lifestyle) 4 (medication) were
  also ranked highly by all groups
• Analysis reveals that all groups had similar
  priorities, but patients scores were generally
  lower

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Comparison of Nurse Patient Views

• 4 individual items were scored highest or nearly
  highest by all
• What to do if I get chest pain
• What the signs symptoms of a heart attack are
• When to call a GP or ambulance
• What I can do to reduce the chances of me having
  another heart attack
• Biggest disagreement on items, scored lower by
  patients than any other items.
• When I can resume driving
• When I can resume sexual activity

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Changes in patient scores

• Of the 27 patients, 18 were re-administered the
  questionnaire on self-completion basis at home
  following discharge.
• No overall change in score
• On Psychological factors there was a
  significant mean score increase of 0.35,
  (P0.006), and on Medication information a
  significant mean decrease of 0.28, (P0.013).

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Discussion

• More congruence among nurse groups than
  previously reported
• Priority of symptoms as per Roebuck et al
  (2001) QL
• Medications usually ranked high among nurse
  groups risk factors among patients
• Changes in needs over time noted

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Discussion

• Physical activity low priority as per Turton
  (1998)
• Sexual activity information - low priority unless
  indicated by patient or spouse?(Turton,1998)
• Sexuality as a topic?

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What the signs symptoms of a heart attack are
What to do for chest pain

• When to call a GP or ambulance

Reducing the chance of having another heart attack
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Most helpful information- addressed their
concerns about having another MI
Lack of direction-bewilderment

• Credibility of information

Perceptions of the cause of MI
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Recommendations

• Patient information needs assessment using simple
  methods
• Teaching tailored to individual needs
• Practical information central to survival crucial
  core of teaching
• Language, terminology and approach congruent with
  patients needs