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Aims and objectives. This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background. CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. Design. Systematic review. Methods. Search of electronic databases. Conclusions. Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions. Relevance to clinical practice. There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically diverse backgrounds. [ABSTRACT FROM AUTHOR]

Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To introduce and define the patient involvement climate and measure its quality and strength via views and behaviours among nurses in coronary care units. Background Patient involvement is receiving increased attention among healthcare providers. To better understand and optimise the interpersonal dynamics of patient involvement, it is important to study the organisational context in which the patient-provider interaction occurs. Design Cross-sectional, self-report questionnaire study. Methods Registered nurses across 12 coronary care units ( n = 303) completed a questionnaire reporting their views and behaviours regarding patient involvement. Analyses assessed climate quality (the positive or negative nature of nurses' perceptions) and climate strength (the degree of consensus within coronary care units). Results Climate quality and strength were greatest for the dimensions measuring nurses' views of patient involvement, the nurse-patient information exchange process and nurses' responsiveness to patient needs. Climate quality and strength were weaker for the dimensions measuring nurses' views of the hindrances associated with patient involvement, discussion of daily activities and efforts to motivate patients to take responsibility for their health. In units with consensus that patient involvement poses hindrances, nurses were less likely to address patient needs. Conclusions When nurses perceived patient involvement as less of a hindrance in their work, they were more responsive to patient needs. A patient involvement climate characterised by motivational behaviour among nurses was marked by better information exchange and discussion of suitable activities postdischarge. Relevance to clinical practice Managers can capitalise on positive climate aspects by encouraging ward activities that facilitate active patient involvement among nurses. One suggestion is educational interventions at the workplace focused on reducing perceptions of patient involvement as a hindrance and encouraging the attitudes that it can enrich nursing work and patient outcomes. [ABSTRACT FROM AUTHOR]

kilpatrick k., lavoie-tremblay m., ritchie j.a., lamothe l. & doran d. (2012) Boundary work and the introduction of acute care nurse practitioners in healthcare teams. Journal of Advanced Nursing 68(7), 1504-1515. Abstract Aim. This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams. Background. Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthcare team members and acute care nurse practitioner roles crossing the boundaries between the medical and nursing professions. Understanding the process by which the boundaries between professions changed following the introduction of an acute care nurse practitioner role was important since this could affect scope of practice and the team's ability to give patient care. Methods. The study was conducted in two university-affiliated teaching hospitals in Canada. A descriptive multiple case study design was used. Data were collected from March to May 2009. Results. Participants ( N = 59) described boundary work as a process that included: (1) creating space; (2) loss of a valued function; (3) trust; (4) interpersonal dynamics; and (5) time. The development of trust among team members was essential. The co-location of team members working on common projects, and medical and nursing leadership facilitated boundary work. Conclusion. The micro-level processes of boundary work in healthcare teams have important implications for the development of full scope of practice for acute care nurse practitioners, effective inter-professional teamwork and the integration of new roles in healthcare systems. Future research needs to be undertaken in different contexts, and with patients and families. [ABSTRACT FROM AUTHOR]

Aims and objectives To validate nursing interventions from the Nursing Interventions Classification for preventing cardiovascular events in outpatients with diabetes. Background Cardiovascular disease is the main cause of death among diabetic patients. Although nurses play an important role in preventing cardiovascular events in this population, their specific contribution is difficult to measure. Documenting nursing interventions using a standardised nursing system may provide nursing visibility. However, there are no studies that analysed which nursing interventions would be the most relevant, based on expert opinion, aimed at preventing cardiovascular events in diabetic patients. Design This is a content validation study, which was designed as a descriptive one. Methods For this content validation study, we used the Fehring model. Nursing interventions were selected from the Nursing Intervention Classification. Experts were asked to analyse the degree of relevance of 225 nursing interventions regarding the prevention of cardiovascular events in diabetic patients, considering its title and definition. We considered nursing interventions which obtained weighted arithmetic averages >0·80 to be valid. Results Among 50 invited experts, 14 (71·4% female; 36·5 + 9·7 years) responded and agreed to participate in this study. They analysed 225 preselected nursing interventions, and validated 29. Conclusion The validated nursing interventions included documentation as well as biological, social and spiritual issues. Relevance to clinical practice The validated nursing interventions encompass a wide range of nursing knowledge, and these results provide empirical evidence for further studies. [ABSTRACT FROM AUTHOR]