Barriers in the process of care transition from hospital to home in post-acute coronary syndrome: patients’ perspective

Azizah Khoiriyati; Tintin Sukartini; Kusnanto Kusnanto; Ninuk Dian Kurniawati

doi:10.15562/bmj.v10i3.2908

Barriers in the process of care transition from hospital to home in post-acute coronary syndrome: patients’ perspective

Azizah Khoiriyati ,

Tintin Sukartini ,

Kusnanto Kusnanto ,

Ninuk Dian Kurniawati ,

PDF |
DOI: https://doi.org/10.15562/bmj.v10i3.2908 |
Published: 2021-12-30

Abstract

Introduction: Acute coronary syndrome (ACS) patients are at a higher long-term risk of recurrent cardiovascular events. The transition from hospital to home is a delicate time. Patients frequently have potentially unavoidable adverse events and hospital readmissions after being discharged from the hospital. This study aims to explore the barriers of patients’ transition experiences from hospital to homecare in post-acute coronary syndromes.

Methods: An exploratory qualitative research design with a phenomenological approach was used in the study. Research data were collected using semi-structured interviews from April to Juli 2020. It was selected from 15 patients diagnosed with acute coronary syndrome (ACS) using the purposive sampling technique. The data were analyzed using thematic content analysis.

Results: This study recruited 15 participants post-ACS. Four barriers were identified: (1) Psychological barriers: stress, fear, anxiety; (2) physical barriers: chest pain, dyspnea, palpitation; (3) lack of knowledge, including diet, coronary disease, return to work, medication, and heart attack intervention; and (4) low adherence to smoking cessation, daily activity, and medication adherence.

Conclusion: At the time of discharge, there is a need for a new approach to communicating with the patients, educating patients and families, and preparing for ACS patients. The findings of this study will help nurses better understand the barriers of transitional care from the hospital to the home.

References

Villanueva T. Transitioning the patient with acute coronary syndrome from inpatient to primary care. J Hosp Med. 2010;5(SUPPL. 4):8–14.
Bumpus SM. Transitional Care to Reduce Cardiac Readmissions: 5-Year Results from the BRIDGE Clinic. J Fam Med Dis Prev. 2017;3(3):3–9.
World Health Organization. Transitions of Care. Technical Series on Safer Primary Care. 2016. 3–5 p.
Barnason S, Zimmerman L, Nieveen J, Schulz P, Young L. Patient recovery and transitions after hospitalization for acute cardiac events: An integrative review. J Cardiovasc Nurs. 2012;27(2):175–91.
Corona-lobos L, Harduin M, Boivin C. Psychosocial Factors Associated with Hospital-to-Home Transitions of Older People : A Review. 2018;7(4).
Ciric-Zdravkovic S V, Zikic O V, Stanojevic D, Petrovic-Nagorni S. Anxiety in Patients With Acute Coronary Syndromes. Eur J Psychiatry. 2014;28(3):165–71.
Meyer T, Hussein S, Lange H, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol. 2015;22(1):75–82.
Chesnay M De. Nursing Research using Phenomenology. Classic Writings for a Phenomenology of Practice. New York: Springer Publishing Company; 2015. 1–217 p.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1–13.
Castleberry A, Nolen A. Thematic analysis of qualitative research data: Is it as easy as it sounds? Curr Pharm Teach Learn. 2018;10(6):807–15.
Altino DM, Nogueira-Martins LA, de Barros ALBL, Lopes J de L. Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome. Arch Psychiatr Nurs. 2017;31(6):549–52.
Atik D, Ne?e A, Çak?r M, Ünal A, Yüce UÖ. Post traumatic stress and anxiety in patients with acute coronary syndrome. Int J Res Med Sci. 2015;3(8):1878–84.
Ciric-Zdravkovic S V, Zikic O V, Stanojevic DM, Petrovic-Nagorni SM. Anxiety in Patients With Acute Coronary Syndromes. Eur J Psychiatry. 2014;28(3):165–71.
Meyer T, Hussein S, Lange HW, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol. 2015;22(1):75–82.
Nadarajah SR, Buchholz SW, Wiegand DL, Berger A. The lived experience of individuals in cardiac rehabilitation who have a positive outlook on their cardiac recovery: A phenomenological inquiry. Eur J Cardiovasc Nurs. 2017;16(3):230–9.
Falun N, Fridlund B, Schaufel MA, Schei E, Norekvål TM. Patients’ goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction. Eur J Cardiovasc Nurs. 2016;15(7):495–503.
Khoiriyati A, Kusnanto K, Kurniawati ND, Afik AA. Patient’s transition experiences from hospital to home after an acute cardiac event. Open Access Maced J Med Sci. 2021;9(T4):27–34.
Liu XL, Willis K, Wu CJ, Shi Y, Johnson M. “Better to save one life than build a seven-storied pagoda”: A qualitative study of health education for patients with acute coronary syndrome and type 2 diabetes mellitus in Shanghai, China. BMJ Open. 2018;8(8):1–11.
Kassab YW, Hassan Y, Aziz NA, Zulkifly HH, Iqbal MS. Report: Trends in adherence to secondary prevention medications in post-acute coronary syndrome patients. Pak J Pharm Sci. 2015;28(2):641–6.
Piraino E, Heckman G, Glenny C, Stolee P. Transitional Care: who is left behind? A systematic review. Int J Integr Care. 2012;12(August).
Cheng K, Ingram N, Keenan J, Choudhury RP. Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies. Open Hear. 2015;2(1):e000166.
Kitakata H, Kohno T, Kohsaka, Fujino S, J. Nakano N, Fukuoka, et al. Patient confidence regarding secondary lifestyle modification and knowledge of heart attack’ symptoms following percutaneous revascularisation in Japan: A cross-sectional study. BMJ Open. 2018;8(3).
Davidson L, Wilcox J, Kim D, Benton S, Fredi J, Vaughan D. Clinical features of precocious acute coronary syndrome. Am J Med. 2014;127(2):140–4.
Bakker EC, Nijkamp MD, Sloot C, Berndt NC, Bolman CAW. Intention to abstain from smoking among cardiac rehabilitation patients: The role of attitude, self-efficacy, and craving. J Cardiovasc Nurs. 2015;
Kadda O, Marvaki C, Panagiotakos D. The role of nursing education after a cardiac event. Heal Sci J. 2012;6(4):634–46.
Khoiriyati A, Kusnanto K, Kurniawati ND. Nurses’ Role in Discharge Preparation for Acute Coronary Syndrome Patients. 2021;316–20.
Kamermayer AK, Leasure AR, Anderson L. The Effectiveness of Transitions-of-Care Interventions in Reducing Hospital Readmissions and Mortality: A Systematic Review. Dimens Crit Care Nurs. 2017;36(6):311–6.

[1] Villanueva T. Transitioning the patient with acute coronary syndrome from inpatient to primary care. J Hosp Med. 2010;5(SUPPL. 4):8–14.

[2] Bumpus SM. Transitional Care to Reduce Cardiac Readmissions: 5-Year Results from the BRIDGE Clinic. J Fam Med Dis Prev. 2017;3(3):3–9.

[3] World Health Organization. Transitions of Care. Technical Series on Safer Primary Care. 2016. 3–5 p.

[4] Barnason S, Zimmerman L, Nieveen J, Schulz P, Young L. Patient recovery and transitions after hospitalization for acute cardiac events: An integrative review. J Cardiovasc Nurs. 2012;27(2):175–91.

[5] Corona-lobos L, Harduin M, Boivin C. Psychosocial Factors Associated with Hospital-to-Home Transitions of Older People : A Review. 2018;7(4).

[6] Ciric-Zdravkovic S V, Zikic O V, Stanojevic D, Petrovic-Nagorni S. Anxiety in Patients With Acute Coronary Syndromes. Eur J Psychiatry. 2014;28(3):165–71.

[7] Meyer T, Hussein S, Lange H, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol. 2015;22(1):75–82.

[8] Chesnay M De. Nursing Research using Phenomenology. Classic Writings for a Phenomenology of Practice. New York: Springer Publishing Company; 2015. 1–217 p.

[9] Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1–13.

[10] Castleberry A, Nolen A. Thematic analysis of qualitative research data: Is it as easy as it sounds? Curr Pharm Teach Learn. 2018;10(6):807–15.

[11] Altino DM, Nogueira-Martins LA, de Barros ALBL, Lopes J de L. Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome. Arch Psychiatr Nurs. 2017;31(6):549–52.

[12] Atik D, Ne?e A, Çak?r M, Ünal A, Yüce UÖ. Post traumatic stress and anxiety in patients with acute coronary syndrome. Int J Res Med Sci. 2015;3(8):1878–84.

[13] Ciric-Zdravkovic S V, Zikic O V, Stanojevic DM, Petrovic-Nagorni SM. Anxiety in Patients With Acute Coronary Syndromes. Eur J Psychiatry. 2014;28(3):165–71.

[14] Meyer T, Hussein S, Lange HW, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur J Prev Cardiol. 2015;22(1):75–82.

[15] Nadarajah SR, Buchholz SW, Wiegand DL, Berger A. The lived experience of individuals in cardiac rehabilitation who have a positive outlook on their cardiac recovery: A phenomenological inquiry. Eur J Cardiovasc Nurs. 2017;16(3):230–9.

[16] Falun N, Fridlund B, Schaufel MA, Schei E, Norekvål TM. Patients’ goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction. Eur J Cardiovasc Nurs. 2016;15(7):495–503.

[17] Khoiriyati A, Kusnanto K, Kurniawati ND, Afik AA. Patient’s transition experiences from hospital to home after an acute cardiac event. Open Access Maced J Med Sci. 2021;9(T4):27–34.

[18] Liu XL, Willis K, Wu CJ, Shi Y, Johnson M. “Better to save one life than build a seven-storied pagoda”: A qualitative study of health education for patients with acute coronary syndrome and type 2 diabetes mellitus in Shanghai, China. BMJ Open. 2018;8(8):1–11.

[19] Kassab YW, Hassan Y, Aziz NA, Zulkifly HH, Iqbal MS. Report: Trends in adherence to secondary prevention medications in post-acute coronary syndrome patients. Pak J Pharm Sci. 2015;28(2):641–6.

[20] Piraino E, Heckman G, Glenny C, Stolee P. Transitional Care: who is left behind? A systematic review. Int J Integr Care. 2012;12(August).

[21] Cheng K, Ingram N, Keenan J, Choudhury RP. Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies. Open Hear. 2015;2(1):e000166.

[22] Kitakata H, Kohno T, Kohsaka, Fujino S, J. Nakano N, Fukuoka, et al. Patient confidence regarding secondary lifestyle modification and knowledge of heart attack’ symptoms following percutaneous revascularisation in Japan: A cross-sectional study. BMJ Open. 2018;8(3).

[23] Davidson L, Wilcox J, Kim D, Benton S, Fredi J, Vaughan D. Clinical features of precocious acute coronary syndrome. Am J Med. 2014;127(2):140–4.

[24] Bakker EC, Nijkamp MD, Sloot C, Berndt NC, Bolman CAW. Intention to abstain from smoking among cardiac rehabilitation patients: The role of attitude, self-efficacy, and craving. J Cardiovasc Nurs. 2015;

[25] Kadda O, Marvaki C, Panagiotakos D. The role of nursing education after a cardiac event. Heal Sci J. 2012;6(4):634–46.

[26] Khoiriyati A, Kusnanto K, Kurniawati ND. Nurses’ Role in Discharge Preparation for Acute Coronary Syndrome Patients. 2021;316–20.

[27] Kamermayer AK, Leasure AR, Anderson L. The Effectiveness of Transitions-of-Care Interventions in Reducing Hospital Readmissions and Mortality: A Systematic Review. Dimens Crit Care Nurs. 2017;36(6):311–6.

Barriers in the process of care transition from hospital to home in post-acute coronary syndrome: patients’ perspective

Abstract

References

How to Cite

Search Panel