Arrange time and place of next session for extended programme 6 Complete relevant documentation.

Extended Programme.

Content of for extended programme is obtained from this core framework. It offers an opportunity to develop the areas , reinforce the information and assist the client with behavioural changes Üiey wish to make.

Due to the situational limitations of the inpatient phase it is likely that much of the

programme may be more nurse directed, however the extended progr^me often develops more into client directed sessions when the pjerson is in their own environment and may be ready to ask more questions and formulate discussions pertinent to their lifestyle.

As previously mentioned, assessment should be a continual process however the first home visit is particularly important and affords an opportunity to carry out a reassessment within the home environment.

The extended programme allows for further sessions on risk factor reinforcement and discussion of the relevant sections in more depth. Discussion on the family reaction and involvement is often pertinent at this time. Many people wish more information at this stage on the investigations and possible future treatment and the rehab nurse may have to perform the role of case manager and liaise between the hospital and community.

HINTS AND WRINKLES

The following is a compilation of hints and suggestions provided to assist the Cardiac Rehab. Nurse in the

implementation of the programme. THey address some commonly recurring problems and have simply been discovered through e x p e r i e n c e .

A number of patients require the assistance of a Medical Social Worker to provide advice on housing and social

benefits. It is an advantage to the patient to have this need identified while in the h o s p i t a l . A specific social worker is assigned to each ward and is available for patient consultation, A simple phone referral can initiate the process. Once the patient is discharged it is very

difficult to initiate any action from either the community social worker or the medical social w o r k e r . Every attempt should be made to arrange for an in-patient social work

referral if it is needed. The name and phone number of each ward's social worker is available at the nurse's station. The dept, secretary's telephone number is 2650 or 2144.

When a patient is discharged from the hospital , the responsibility for his care transfers to his G P . It is customary for the GP to visit the patient within 5 days of discharge and provide regular follow-up during the first 6-8 weeks post MI. Occassional 1 y , this follow-up is not

provided. During the extended sessions it may be necessary to assist in coordination of the appointments with the

patient's G P . A simple phone call to the GP's office can clarify any misinterpretations and re-establish continuity of care.

It may also be necessary to follow-up on the patient's hospital appointments. Unless contraindicated, most

patients will be scheduled for an exercise tolerance test 6 weeks post discharge, followed by a medical clinic

appointment. If the patient does not receive notification of these appointments within 4 weeks of discharge it should be brought to the attention of his doctor. Initially, contact with both the ECG dept, and clinic should be made clarify any administrative oversight. If the situation cannot be corrected at this level , the patient's hospital notes should be obtained from medical records and given to the ward secretary to either make the necessary appointments or notify the doctor of the situation. ECG dept, telephone number is 2342. Medical records can be obtained by request with the patient's name, date of birth, hospital number and admission dates.

There are also sources of support within the hospital that can be u s e f u l . Ward 1 has a portable video machine which is usually available on request. The pharmacy has a drug information centre that can provide answers to

medication questions. That number is 2351 or 3096. Many patients will be involved in physiotherapy exercise classes. The physios usually meet with their patients once or twice during their hospital stay and should be notified when a patient is recruited to the rehab, p r o g r a m m e . Communication w ith the physios will promote a collaborated effort and continuity of care. Their telephone number is 2760 or 2628.

R e f e r e n c e s

Carpenito, L . J . (1989). Nursing Diagnosis: Application to Clinical Practice (3rd ed.) (pp. 241-248,

351-359). Philadelphia: J.B. Lippincott.

Carver, C. S., Scheier,M. F ., & Weintraub, J . K . (1989). Assessing Coping Strategies: A Theoretically Based A p p r o a c h . Journal of Personalitv and Social

P s v c h o l o g y . 56 (2), 267-271.

Certo, S. C. (1989). Principles of Modern Management: Functions and Systems (4th ed.) (pp.300-302).

Boston, Mass: Allyn and Bacon , Inc.

Comoss, P. M ., Burke, E . A,, Swails, S. H. (1979). Cardiac Rehabilitation; A Comprehensive Nursing Approach (pp.1-5). Philadelphia: J.B. Lippincott. Lazarus, R. S., Folkman, S, (1984), Stress, Appraisal ,

and Coping. New York: Springer.

L e d d y , S., Pepper, J. M . (1989). Conceptual Bases of Professional Nursing (2nd ed.) (pp.182-184).

Philadelphia: J. B . Lipppincott.

Maes, S. (1989)« Theories and principles of health behaviour change. In J. D. Drenth (Ed.) . European Perspectives

in Psychology (pp.44-60). New York: John Wiley & Sons .

Orem, D. E. (1980). Nursing: Concepts of Practice (pp. 6, 179) . New York; McGraw Hill .

P o h l , M. L. (1981). The Teaching Function of the Nursing Practitioner (4th ed.) (pp. 14-39). Dubuque, Iowa; W m . C . Brown Co, Publishers.

Sanne, H ., & Wenger, N. K. (Ed.). (1989). Psvchological and Social Aspects of Coronary Heart Disease

(Scientific Council on the Rehabilitation of Cardiac Patients of the International Society and Federation of Cardiology) G r e e n w i c h , Conn.: Le Jacq

TEACHING MATERIALS Leaflets and Handouts

"Heart Information Series", numbers 1-19, British Heart Foundation

"Take Heart: Some helpful advice following a heart attack", Schwarz Pharma

" A Patient's Guide to Angina", Schwarz Pharma

"Look after your Heart: Beating Heart Disease", Health Education Board for Scotland

"Advice for those recovering from a Heart Attack", Sottish Health Education Group

"Recovering from Heart Disease: A family guide to rehabilitation", Bayer CARE Programme

"You and your angina", Pharmax Limited

"So you want to stop smoking", Health Education Board for Scotland

"Cigarettes and Heart Disease: What smoking does to your heart", Parlay International

"Passive Smoking; Unclouding the i s s u e " , The Scottish Health Education Group

"Eat to your Heart's Content: A guide to eating for good health", Health Education Board for Scotland

"Food Should be Fun", The British Heart Foundation "Take Fish to Heart: A guide to healthier eating",

Sea Fish Industry Authority

"Nutrition Plan", Institute for Aerobics Research "A 14-day eating plan for a healthy heart". Tufts

University Diet Nutrition Letter

"Resumption of Activities when Home", Cardiac Rehabilitation Programme Manual

"Warm-Up Exercises", The Wellness Centre "Exercise, Why Bother?", The Sports Council

"Take a deep breath...and relax", Parlay International "Instant Approach to Controlling Stress", Institute for

Aerobics Research

"Heart N e w s " , Bayer CARE Programme

"Relax Your Stress Away", Parlay International

"Food for Thought", Scottish Health Education Group Video tapes

"Your Life in Your Hands: Recovering from a heart attack", The Coronary Prevention Group

Audio tapes

"Recovery and Relaxation", Cardiac Rehabilitation Research Programme

Other teaching aids

Dundee Coronary R i s k - D i s k , Cardiovascular Epidemiology Unit, University of Dundee

RESOURCE LIST

Action Heart (Cardiac Rehabilitation) Wellesley House, 117 Wellington R d . Dudley, West Midlands DYl lUB

t e l . no. (0384) 230222/230601 The British Heart Foundation

14 Fitzhardinge Street