Evidenced-based journal on Practice application: Journals in regard to use of

Informatics Nursing Field (RLE Group 24)

I. TITLE
The Research Title: The Effect of the Revised Clinical Pathway of Cardiac
Rehabilitation on Participation Rates in Patients with Myocardial Infarction: A
Retrospective.
Authors: Jae Ung Ko; Goo Joo Lee; Han Mi kim; Heui Je Bang
Date of Acceptance for Publication: October 29, 2018
Name of the Journal: Korean Journal of Adult Nursing
Journal Details: Korean Journal of Adult Nursing (KOREAN J ADULT NURS),
Oct2018; 30(5): 536-545. (10p)

II. INTRODUCTION
Research Problem
The study aims to determine the effect of the Revised Clinical Pathway of Cardiac
Rehabilitation on Participation Rates in Patients with Myocardial Infraction in a
Retrospective manner.

Background of the Study

Cardiac Rehabilitation (CR) is designed to decrease the statistics of

Cardiovascular-related deaths, hospital readmission, mortality, and any unfortunate
events related to cardiovascular tenses. In the United States of America, benefits and
evidence-based favorable outcomes of CR is indeed emphasized but patient the average
of patient participation is below than the optimal statistics. This phenomenon is also
happening in Canada and the United Kingdom; places which are deemed to have good
quality healthcare. The below than average numbers of patients’ participation of CR is
due to transportation problems, patients cannot drive, financial & socioeconomic status,
the lack of will or motivation, dismissive awareness of patients and physicians of CR
programs and its importance, and the likes. Some studies also suggest that waiting time
and hassle related to schedule are also elements that affects patient participation. Liaison
nurses are added to the program to increase referral rates, as they serve as links between
the community and hospitals, but outcomes were not appreciated. The medical center of
 Evidenced-based journal on Practice application: Journals in regard to use of
Informatics Nursing Field (RLE Group 24)
the researchers established a Clinical Pathway (CP) as a way to try and increase patient
participation. As the new revision of the medical center’s CP, lacking of evidences and
knowledge of its effectivity is not clear and known yet.

Objectives

The revision of the staffs’ new CP and its effect to the patients with Myocardial
Infraction (MI) compliance and participation with their CR program is to be determined by
the researchers with the use of the current study.

Significance of the Study

To deliver the importance of the study in an expounded way, the researchers

implemented the study in order to determine the effects of the revised CP of a medical
center in South Korea. This following are the significance of the study:

The nurses. The result of the study can help nurses understand why CP is important and
timely to current nursing practice.

The doctors. The result of the study can enlighten physicians on how can CP help
implement proper patient treatments and outcomes.

The patients. The result of the study can educate patients on why CP can help deliver
better patient satisfaction and how it can optimize the health of individuals, families, and
groups.

The nursing curriculums. The result of the study can contribute further knowledge and
information regarding nursing informatics, specifically CP.

The future researchers. The nature of the research is cyclical which answers the
research questions and problems which shall bring new research questions and
problems, which gives future researchers something to ponder to.
 Evidenced-based journal on Practice application: Journals in regard to use of
Informatics Nursing Field (RLE Group 24)
III. METHODOLOGY

Research Subjects

The researchers utilized 258 MI patients admitted to their hospital establishment;

Chungbuk National University Hospital located in Chungcheongbuk-do, South Korea who
underwent Percutaneous Coronary Intervention (PCI), a treatment for MI. Timeliness
considered the range of dates from July 1, 2015 to December 31, 2016. Patients were
referred by their attending cardiologist. 8 patients were excluded from the initial screening
due to the following: 4 deaths, 2 who abstained from the study, and 2 with insufficient
information on their charts.110 patients from the prior CP were included and 140 under
the revised CP, concluding to 250 participant. Later on, 51 patients were excluded from
the said research study due to the following contraindications: ongoing unstable angina,
HF, pulmonary embolism, deep vein thrombosis, physical disability, and the likes. This
measure was done to establish a control against extraneous variables that might
influence the results of the study. Alas, 51 a final participant count of 199 was concluded.

Research Design

A retrospective study was initiated by the researchers in order to swiftly acquire

the estimated effect of an exposed outcome data status. This allowed the researchers to
examine the effect of the implementation of the revised CP on the rates of MI patient
participation rates of CR.

Data Collection

Comparison between the two groups, namely, Previous CP control and Revised
CP control’s compliance with their CR program was collected through the hospital’s
records. Medical chart review study was approved within the ethical considerations by the
e Institutional Review Board of Chungbuk National University Hospital, to ensure proper
disclosure of information was processed.
 Evidenced-based journal on Practice application: Journals in regard to use of
Informatics Nursing Field (RLE Group 24)
Data Analysis

Categorical variables of the two said distinct groups were tested via g Pearson’s x
2 or Fisher’s. This included the patient’s gender, age, subgroup, diagnosis, habits, and
underlying conditions other than MI. A t-test was used to analyze age, ejection fraction
retrieved by the test echocardiogram. This included the waiting days of patients for their
scheduled CR days.

IV. RESULTS

The results of the study provided the researchers a data of comparison between
the old CP version and the revised CP version. Under the previous CP version, 92
younger patients complied with their CR programs while 107 older patients complied from
the other group. Other traits from the two groups exhibited no significance or no
relationship at all. Hospitalization visits and waiting times are decreased with the revised
CP group.

V. DISCUSSION

This research is favorable to nursing in terms of practice, education and research.

Providing that because of the revised CP which provided automated scheduling and text
alerts to patients, the statistics of patient participation was enhanced. This information
can supply nursing textbooks specific to Nursing Informatics, emphasizing the
advantages of new evidence-based practices like the revised CP of the study. The study’s
cyclical nature provides new gaps which can formulate new researches relevant to the
field of nursing.

One strength of the journal was research design since it enabled the researchers
to describe the predicted results and its nature. It quickly estimated the expected outcome
of the study which emphasized the answer to their research question.

However, its generalizability is poor when it comes to less resourceful communities

like countries of the 3rd world and isolated far-off places. Its requirement of advanced
 Evidenced-based journal on Practice application: Journals in regard to use of
Informatics Nursing Field (RLE Group 24)
technology can make the study not applicable to said possible communities where
technology is not fostered.

VI. CONCLUSION

The results of the study is highly relevant to current nursing practice, respectfully
to the cardiology nursing department and in the surgery department. Post-op care of
patient with MI who underwent PCI are regulated with the revised CP which decreased
waiting time and declined the times of hospital visits. Hospital visits are not so much
practical for patients who can’t drive, financial restraints, and factors relating to attending
hospital follow-ups. Because of the revised CP, care is possible rendered without the
attendance of the MI patients frequently, showing up only when really needed. The
decrease of unnecessary time spent on the hospital increased the participation of MI
patients with their CR programs. The results of the study can ensure that patients
discharged from hospitals continue to get appropriate treatment after discharge, as well
as offer persons with health-care requirements with a vital link between the hospital and
the community. Furthermore, we may apply the knowledge we obtained from this paper
to make recommendations and contribute to hospitals where we may work in the future
that lack clinical pathway utilization. Nurse researchers can also add to these standards
based on their own personal experiences to create a more precise and personalized set
of pathways. We believe that as a result of this, patient care will improve, which is the
ultimate goal for all healthcare providers worldwide.

As future nurses, this kind of study will be of importance to us as it incorporates

the utilization of Nursing Nnformatics to the nursing practice. That indeed, using the
discoveries of technologies involved in the health care settings can help us to provide a
better diagnosis and treatment for the patients to increase patient satisfaction and for
better health outcomes. In line with the study which is primarily about the Revised Version
of the Institution's Cardiac Rehabilitation, this only manifest that applying and using this
type of creations in providing services to the patients will lead to a more easier and
convenient ways on how to administer and deliver care to leading to the provision of good
quality health care.
 Evidenced-based journal on Practice application: Journals in regard to use of
Informatics Nursing Field (RLE Group 24)

VII. REFERENCE

Jae Ung Ko, Goo Joo Lee, Han Mi kim, & Heui Je Bang. (2018). The Effect of the
Revised Clinical Pathway of Cardiac Rehabilitation on Participation Rates in
Patients with Myocardial Infarction: A Retrospective. Korean Journal of Adult
Nursing, 30(5), 536–545. https://doi.org/10.7475/kjan.2018.30.5.536

NEDARC. (2019, August 5). NEDARC - Retrospective Study. NEDRAC.

https://www.nedarc.org/statisticalhelp/projectdesign/retrospectivestudy.html