title: Implementation of efficacy enhancement nursing interventions with cardiac elders.
abstract: 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.
authors.affiliation: Massachusetts General Hospital, Boston, USA. lhiltunen@comcast.net
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Hiltunen
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Winder
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Rait
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Buselli
authors.forename: Diane L
authors.initials: DL
authors.lastname: Carroll
authors.forename: Sally H
authors.initials: SH
authors.lastname: Rankin
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D002140:California; D003142:Communication; D001026:Coronary Artery Bypass / Q000451:nursing* / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005851:Geriatric Nursing / Q000458:organization & administration; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008404:Massachusetts; D009042:Motivation; D009203:Myocardial Infarction / Q000451:nursing* / Q000523:psychology / Q000534:rehabilitation; D009720:Nurse Clinicians / Q000458:organization & administration*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic; D019145:Rehabilitation Nursing / Q000458:organization & administration; D020377:Self Efficacy; D012944:Social Support