This thesis is concerned with the role of the nurse in coronary rehabilitation. The primary hypothesis is that a nurse practitioner, trained in coronary medicine and experienced in relevant medical nursing, can intervene independently of team efforts to help rehabilitate the patient who has suffered and survived a myocardial infarction. The term nurse counsellor is used in the study to better represent the actual role of the nurse in intervention which includes assessment, patient and close family counselling for adaptation and rehabilitative efforts, aid in adjustment to social conditions, and reinforcement for psychological recovery. The study is a longitudinal cohort effort which embodies several methods of empirical research. Those methods include the clinical classification of data, assessment, description, and measurement through statistical analyses of variables derived from data. The cohort is comprised of male patients between the ages of 30 and 64 who could be returned to work, and the study takes place in Glasgow, Scotland, through Southern General Hospital. Several prognostic indices are employed together with various assessment tools to include: the Schiller Index, Modified Schiller Index for Paramedics, Norris Prognostic Index Rahe Life Change Unit procedure, Middlesex Hospital Questionnaire, and the Southern General Hospital Outcome Assessment Evaluation. The results focus on the primary emphasis of the research, which was to intervene for secondary prevention and therefore to reduce risk factors among individual patients through counselling and reinforcement of systematic programmes of rehabilitation. The results for the nurse's cohort reflect similar or better success rates compared with published data and parallel studies by team intervention. These results and comparisons are analysed with statistical procedures as well as descriptive information. A case is therefore put forward and supported by the research which endorses the nurse practitioner for coronary rehabilitation intervention. There are several interesting implications as well involving the roles of general practitioners, patient behaviour patterns, family situations and associated problems encountered during the research. The thesis is presented through the Department of Community Medicine, University of Glasgow, and therefore it reports a community medicine approach to rehabilitation. However, the thrust of the work and results are strongly nurse oriented and have the greatest application to the fields of nursing research, nursing theory, nursing education, and specifically coronary nursing specialisation. Every attempt is made to hold to established procedures for intervention, yet the nurse entered this study with the clear idea of caring for patients who had suffered and survived a myocardial infarction. That is to say, the responsibility and commitment to nursing care was foremost in the intervention while research procedures were subordinated to the needs of the patient. With that in mind, there are limitations to the conclusions, limited mainly by small numbers in the cohort (31), yet control groups and parallel studies by team efforts at Southern General Hospital provide much greater numerical qualification. The results and conclusions are specific to outcomes for secondary prevention, including smoking control, weight control, lipid levels control, and exercise programmes. The nurse's role is in part validated by the results, but also in part by qualitative survey data from patients, wives, family, and general practitioners who commented on aspects of the intervention programme and the nurse's performance. Return to work data are provided with case-by-case analysis and risk factor interaction analysis. Specific comments are made. General conclusions are concerned with the future role and feasibility of the nurse practitioner working as a coronary rehabilitation counsellor, and that role is found to be acceptable, feasible, and economic use of health care personnel
