Implementation of efficacy enhancement nursing interventions with cardiac elders.

Intervention strategies based on social cognitive theory and encompassing the bio-psycho-behavioral domains are proposed to enhance self-efficacy in men and women 65 years and older recovering from myocardial infarction and coronary artery bypass grafting. This paper describes a study in which the theory-based development of efficacy enhancement (EE) nursing interventions and their implementation and utilization with interventions from the Nursing Interventions Classification (NIC) were used with cardiac elders in the treatment group of the community-based randomized clinical, trial, "Improving Health Outcomes in Unpartnered Cardiac Elders." Advanced practice nurses (APNs) provided the nursing intervention to 110 participants (mean age = 76.2, SD = 6.0) for the first 12 weeks after discharge to home. After an initial introductory meeting in the acute-care setting, participant contacts by the APNs were made at a home visit and telephone calls at 2, 6, and 10 weeks. Results describe the number of participants receiving interventions at all contacts over 12 weeks, at specified contact points, and the intensity (nurse time) of the interventions. Verbal encouragement and mastery were EE interventions used with the greatest number of participants. Exercise promotion, energy management and active listening were NIC interventions used with the most participants. Variations in the use of interventions over 12 weeks and their intensities, suggest patterns of recovery in the elders. During rehabilitation EE interventions can be successfully implemented with men and women 65 years and older and individualized to the recovery trajectory. Nurses can integrate specific EE interventions with more general interventions from the bio-psycho-behavioral domains to enhance the recovery process for cardiac elders.

Partnerships in mending hearts: nurse and peer intervention for recovering cardiac elders.

As a growing number of older adults recover from cardiac events, volunteer programs have emerged to provide low-cost community support to vulnerable elders. Although an increasing number of studies have described the beneficial relationships between patients and volunteers, little is known about the unique partnership between the advanced practice nurse (APN) and the volunteer peer. The purpose of this article was to explore the interaction between the APN and the peer advisor who provide support for unpartnered elders after myocardial infarction or coronary artery bypass grafting. As part of a larger research study, "Improving Health Outcomes for Unpartnered Cardiac Elders" (R01-NR05205), interactions with peers were recorded by APNs. Essential themes related to working with 20 peer advisors emerged from 30 logs. Findings suggest that establishing the peer support role, acknowledging abilities, and overcoming difficulties are important steps in the relationship. A partnership between healthcare professionals and peer advisors enhances social support for vulnerable elders recovering from myocardial infarction and coronary artery bypass grafting.