Shining light on the complexity of cardiac rehabilitation utilization by patients with heart disease

Chronic heart disease is one of the most prevalent forms of chronic disease, and generates significant negative impacts on patients/families, the healthcare system, and the overall Canadian economy. Cardiac rehabilitation (CR) has become recognized as a comprehensive care program for the management of chronic heart disease. However, despite significant evidence of their efficacy, cardiac rehabilitation programs continue to be underutilized in Canada and other parts of the world. Current literature regarding CR underutilization has illuminated its complexity by beginning to point to numerous factors operating at healthcare system, healthcare provider, and patient levels. This research project makes a significant contribution by exploring the experiences of cardiac patients utilizing CR programs, and critically examining how their experiences were shaped by intersections of personal, social and political contexts that overlap at individual, healthcare provider, and healthcare system levels. Guided by the qualitative methodology of interpretive description and the theoretical perspective of intersectionality, data were collected and analyzed from 19 cardiac patient informants through semi-structured one-to-one interviews and participant observations of CR programs. Constant comparative data analysis was employed to inductively analyze themes. The findings showed that cardiac patients’ utilization of a CR program involved an interplay between elements of a prescribed CR program utilization journey and the concomitant personal journey of each individual. The theoretical perspective of intersectionality allowed for the identification of how cardiac patients participating in this study were caught in an interconnected dynamic web of social relationships that acted as influences promoting or interfering with their ability to utilize a CR program. Discussion of the findings in this research highlight several implications, including the need for a shift in the delivery of the CR programs from a ‘one-size-fits-all’ approach to a person-centered care approach that values both the personal and prescribed journeys. The findings also pointed to a need to assess, develop, and implement provincial based harmonized systematic referrals that include the entire geography of the province. CR participants’ experiences also pointed to a need for restructuring CR programs to include extended hours/days of operation, childcare onsite, patient input regarding the content of information sessions, and family/caregiver involvement.Applied Science, Faculty ofNursing, School ofGraduat

Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent

Abstract Aim While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID‐19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. Design Secondary data from a cross‐sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. Methods Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. Results Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. Patient or Public Contribution The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study