Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course

Abstract

Background: A policy statement recommending that healthcare providers (HCPs) encourage cardiac patients to enroll in cardiac rehabilitation (CR) was recently endorsed by 23 medical societies. This study describes the development and evaluation of a guideline implementation tool. Methods: A stepwise multiple-method study was conducted. Inpatient cardiac HCPs were recruited between September 2018-May 2019 from two academic hospitals in Toronto, Canada. First, HCPs were observed during discharge discussions with patients to determine needs. Results informed selection and development of the tool by the multidisciplinary planning committee, namely an online course. It was pilot-tested with target users through a think-aloud protocol with subsequent semi-structured interviews, until saturation was achieved. Results informed refinement before launching the course. Finally, to evaluate impact, HCPs were surveyed to test whether knowledge, attitudes, self-efficacy and practice changed from before watching the course, through to post-course and 1 month later. Results: Seven nurses (71.4% female) were observed. Five (62.5%) initiated dialogue about CR, which lasted on average 12 s. Patients asked questions, which HCPs could not answer. The planning committee decided to develop an online course to reach inpatient cardiac HCPs, to educate them on how to encourage patients to participate in CR at the bedside. The course was pilot-tested with 5 HCPs (60.0% nurse-practitioners). Revisions included providing evidence of CR benefits and clarification regarding pre-CR stress test screening. HCPs did not remember the key points to convey, so a downloadable handout was embedded for the point-of-care. The course was launched, with the surveys. Twenty-four HCPs (83.3% nurses) completed the pre-course survey, 21 (87.5%) post, and 9 (37.5%) 1 month later. CR knowledge increased from pre (mean = 2.71 ± 0.95/5) to post-course (mean = 4.10 ± 0.62; p ≤ .001), as did self-efficacy in answering patient CR questions (mean = 2.29 ± 0.95/5 pre and 3.67 ± 0.58 post; p ≤ 0.001). CR attitudes were significantly more positive post-course (mean = 4.13 ± 0.95/5 pre and 4.62 ± 0.59 post; p ≤ 0.05). With regard to practice, 8 (33.3%) HCPs

Importance of cardiac rehabilitation in rural and remote areas of Australia

“…30 In response to this, Canadian practitioners successfully delivered face-to-face and online in-service, education programs, to assist staff to use 'teaching moments.' 31 This study demonstrated that CE were pivotal in the provision of Phase-1-CR. However, CE were not employed by all hospitals, and not available after hours, on weekends and public holidays, thereby reducing their ability to see all eligible in-patients.…”

“…Further, whilst direct care staff identified lack of time for in‐patient education, another study identified ‘teachable moments’ in everyday health care, in which Phase‐1‐CR could be provided 30 . In response to this, Canadian practitioners successfully delivered face‐to‐face and online in‐service, education programs, to assist staff to use ‘teaching moments.’ 31 …”

Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review

“… % represented the percentage of papers that identified the subtheme as important; a. Ahmed et al., 2020; b. Birkin et al., 2016; c. Bonder et al., 2020; d. Devries et al., 2017; e. Hermes et al., 2019; f. Katzman et al., 2016; g. Keddem et al., 2020; h. Licskai et al., 2012; i. Melo & Bishop, 2020; j. Ross et al., 2018; k. Shrubsole, 2019; l. Svensson et al., 2017; m. Vogel et al., 2016; n. Wolfe et al., 2019; o. Hunter et al., 2020; p. Hunter, Kim, et al., 2020; q. Santiago et al., 2020; r. Srivastava et al., 2020; s. Wiecha et al., 2004; t. Williams et al., 2021; u. Newhouse & White, 2011; v. Puga et al., 2013; w. Ray et al., 2019; x. Walston et al., 2006 ( n = 24). …”

Evaluation of an Online Course in 5 Languages for Inpatient Cardiac Care Providers on Promoting Cardiac Rehabilitation

“…13 Correspondingly, following a needs assessment, a free, theoretically based 14 online course was developed for HCP as a tool to implement these findings (http://learnonthego.ca/Courses/promoting_patient_partici pation_in_CR_2020/promoting_patient_participation_in_ CR_2020EN/story_html5.html). 15 It educates HCP about CR, conveys the importance of their encouragement, as well as how they can provide strong, positive CR endorsement to patients at the bedside. No other courses addressing this are available internationally to our knowledge.…”

“…Initial evaluation at a single center in Canada was positive. 15 A generic version has been created that is applicable globally to promote CR also in low-resource settings where it is greatly needed. It has been translated to four other languages.…”