Cydnee Seneviratne

South Asians’ cardiac medication adherence

Aim: This paper is a report of a narrative review examining the current state of knowledge regarding adherence with cardiac medication among South Asian cardiac patients. Background: South Asians experience higher rates of cardiovascular disease than any other ethnic group. South Asians may be less adherent with a cardiac medication regimen than Caucasians. The factors contributing to adherence are important to discover to assist South Asians to optimize their cardiac health. Data sources: CINAHL, Medline (Ovid), PsychINFO, EMB Reviews-(Cochrane), and EMBASE were accessed using the key words: ‘South Asian’, ‘Asia’, ‘East India’, ‘India’, ‘Pakistan’, ‘Bangladesh’, ‘Sri Lanka’, ‘medication compliance’, ‘medication noncompliance’ and ‘medication adherence’. English language papers published from January 1980 to January 2013 were eligible for inclusion. Review methods: Abstracts were reviewed for redundancy and eligibility by the primary author. Manuscripts were then retrieved and reviewed for eligibility and validity by the first and last authors. Content analysis strategies were used for the synthesis. Results: Thirteen papers were in the final data set; most were conducted in India and Pakistan. Medication side-effects, cost, forgetfulness and higher frequency of dosing contributed to non-adherence. South Asian immigrants also faced language barriers, which contributed to non-adherence. Knowledge regarding the medications prescribed was a factor that increased adherence. Conclusion: South Asians’ non-adherence to cardiac medications is multifaceted. How South Asians who newly immigrate to Western countries make decisions regarding their cardiac medication adherence ought to be explored in greater detail.

Weight and Patients’ Decision to Undergo Cardiac Surgery

Obese patients are less likely to have cardiac surgery than normal weight patients. This could be due to physician or patient decision-making. We undertook a qualitative descriptive study to explore the influence of obesity on patients’ decision-making to have cardiac surgery. Forty-seven people referred for coronary artery bypass graft (CABG) surgery were theoretically sampled. Twelve people had declined cardiac surgery. Participants underwent in-depth interviews aimed at exploring their decision-making process. Data were analyzed using conventional content analysis. Though patients’ weight did not play a role in their decision, their relationship with their cardiologist/surgeon, the rapidity and orchestration of the diagnosis and treatment, appraisal of risks and benefits, previous experience with other illness or others who had cardiac surgery, and openness to other alternatives had an impact. It is possible that there is a lack of comfort or acknowledgment by all parties in discussing the influence of weight on CABG surgery risks.

Review: organised stroke unit care reduces mortality more than other forms of care for inpatients.

P Langhorne Professor P Langhorne, University of Glasgow, Glasgow, UK; p.langhorne@clinmed.gla.ac.uk For patients in hospital with stroke, does organised stroke unit (OSU) care improve patient outcomes more than alternative forms of care? Studies selected compared OSU care with alternative care for patients in hospital with stroke, defined as a focal neurological deficit due to cerebrovascular disease, excluding subarachnoid haemorrhage and subdural haematoma. Core features of inpatient OSUs included delivery of a complex package of care by a multidisciplinary team specialising in stroke management. Outcomes were mortality and composite outcomes of mortality and dependency (need for physical assistance with transfers, mobility, dressing, feeding, or toileting) or need for institutional care (residential or nursing home care, or continued hospital stay) at the end of scheduled …

From apprehension to advocacy: a qualitative study of undergraduate nursing student experience in clinical placement in residential aged care

BackgroundUndergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students’ experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care.MethodsThis qualitative study used a participatory action research approach, and this paper reports on the thematic analysis of data from one cycle of undergraduate nursing placement in a Canadian residential aged care setting, with two groups of 7–8 students and two university instructors. Staff and residents at the research site were also included. Researchers interviewed both groups of students prior to and after placement. Instructors, staff and residents were interviewed post placement.ResultsStudents commenced placement full of apprehension, and progressed in their learning by taking initiative and through self-directed learning pathways. Engagement with residents was key to student learning on person-centred care and increased understanding of older adults. Students faced challenges to their learning through limited exposure to professional nursing roles and healthcare aide/student relationship issues. By placement end, students had gained unique insights on resident care and began to step into advocacy roles.ConclusionsIn learning on placement within residential aged care, students moved from feelings of apprehension to taking on advocacy roles for residents. Better formalizing routes for students to feedback their unique understandings on resident care could ensure their contributions are better integrated and not lost when placements end.

1315: The social construction of stroke rehabilitation: An ethnographic study of neuroscience nursing practice.

Purpose: There are approximately 238,000 registered nurses in Canada. Of these, approximately 671 (0.29%) have Doctoral level education, the basic training required for independent investigators. Less than half of those with PhDs are actively engaged in peer-reviewed, competitively funded research, a recognized benchmark of success, and still fewer (an estimated 15–20 in the entire country) specialize in cardiovascular research. The purpose of this 6year, nationally funded program is to strategically advance the training of cardiovascular nurse scientists, provide collaborative training and learning opportunities, provide flexibility for students and supervisors, enrich the students’ learning and increase research productivity in the cardiovascular and cerebrovascular areas. The FUTURE Program formally links nurse scientists from across Canada and will define a new national standard for nursing research training. Methods: The hub of the curriculum for the FUTURE Program is formed by integrated courses related to research designs (e.g. clinical trials), research methods (both quantitative and qualitative), scientific manuscript and grant writing, evidence-based practice and knowledge translation. The 5 required curriculum elements of the Program are: 1) a web-based distance education course in Evidence Based Health Care, 2) a monthly web-conference seminar series with presentations by funded nurse scientists, 3) a 2-week Trainee Research Interchange Program (TRIP), where students visit a nurse scientist in another part of the country, 4) a 1-week Summer Institute which focuses on research methods and 5) an annual scientific meeting which is held in conjunction with the Canadian Cardiovascular Congress. At the annual meeting students present their developing research and network with cardiovascular nurse scientists from across Canada. Results: We are currently in the third year of the program and, to date, have admitted 9 nurses who are doing PhD study and 2 Post-Doctoral Fellows. Approximately 60% of our trainees have been successful in garnering competitive personnel awards. All trainees are publishing and presenting their work in peer-reviewed venues. Experiences of the first two years will be presented. Conclusion: The FUTURE Program has the potential to make an immediate and significant impact on both knowledge and research capacity. Graduates of the Program will establish programs of research and contribute importantly to the national and international communities of scholarship.