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An introduction for the periodical "Journal of Clinical Nursing" is presented in which editor discusses articles within this issue include nursing education, clinical nurses, and nursing academics.

Background: Caregivers (CGs) play a major role in cardiac surgery patients’ adoption of secondary prevention strategies. Little research has examined spousal CGs activities to preserve their own health and support patients’ heart-healthy behaviors. Purpose: The aims of this descriptive pilot study are to: 1) compare cardiovascular (CV) risk factors and physical activity (PA) levels and 2) examine trajectories of change in PA patterns at 3 and 6 weeks and 3 and 6 months after cardiac surgery. Sample: 28 rural residing adult (> 60 years) cardiac surgery patients and their spousal CGs. Methods: PA data was obtained from ActiGraph® accelerometers mailed to dyads at 4 time points after cardiac surgery. Descriptive analyses and multivariate hierarchical modeling were used to describe and identify PA patterns. Findings: The dyads were older (CG M = 68.5 ± 6.6, Patient M = 70.7 ± 6 years) with primarily female CGs (92%) residing in small rural towns (n=26, 46.4%) or farm/ranch (n=16, 28.6%). CV risk factor concordance was evident particularly for hypertension (60.7%) and hypercholesterolemia (25%). CGs and patients spent the majority of time in sedentary activity. Most patients (89.3%) completed cardiac rehabilitation programs and increased their mean minutes/day spent in moderate to vigorous PA over the 4 time points (13.3 ± 15.6 to 22.6 ± 24.4). However, CGs mean minutes/day remained virtually unchanged over time (15.8 ± 20.8 to 12.7 ± 11.7). Considered as dyads, 38% (n=8) showed essentially no change for either member, but for 29% (n=6) the caregiver showed no change while the patient activity increased. Conclusions: CGs were similar in age and comorbidities to their spouses, however, CGs were less likely to increase their PA levels. Health disparities in CVD mortality in the rural population may have additional impact and underscores the need for future targeted interventions addressing CV risk in CGs. [ABSTRACT FROM AUTHOR]

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate heart failure knowledge (p=.005), low self-efficacy (p<.001) and low engagement in heart failure self-management behaviors (p<.001) after discharge from hospital.

Unlabelled: Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients' health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. , Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053.