An educational programme for nurses to facilitate cardiac rehabilitation of patients who had heart valve repair or replacement surgery in Namibia
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Date
2025
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Publisher
University of Namibia
Abstract
Heart valve disease is a critical global public health issue, contributing to
cardiovascular morbidity and mortality worldwide. It serves as an indication for heart
valve repair and replacement surgeries, which are invasive procedures that can
potentially compromise patients’ quality of life. Therefore, patients who have had
heart valve surgery require cardiac rehabilitation to prevent potential complications
and to improve patients’ quality of life. Recognizing the need for enhanced post surgery care, there is a compelling need for the development of an educational
programme for nurses to facilitate cardiac rehabilitation of patients following heart
valve surgery. This initiative not only would improve the patient’s quality of life but
also provide support to caregivers in their roles. The study was aimed at the
development of an educational programme for nurses to facilitate the cardiac
rehabilitation of patients who have had a heart valve repair or replacement surgery at
the Windhoek Central Hospital’s Cardiac Unit. The objectives of the study were to:
describe the knowledge, attitudes, and practices of nurses regarding the cardiac
rehabilitation of patients after heart valve surgery, explore and describe the challenges
experienced by nurses when providing cardiac rehabilitation services to patients after
heart valve surgery, explore and describe patient’s experiences of recovery and coping
after heart valve surgery, explore and describe caregivers’ experiences in providing
support and care to family members after heart valve surgery. The study followed a
structured approach with four distinct Phases: Phase one was a situational analysis
comprising four objectives, Phase two was about conceptual framework development
based on Dickoff’s theory of practice-oriented; Phase three, was about the educational
programme development and Phase four was about the programme implementation,
evaluation, and validation. A sequential explanatory mixed method design was
employed, encompassing quantitative data collection and analysis in Phase One to
determine nurse’s knowledge, attitudes, and practices in cardiac rehabilitation. This
was followed by qualitative data collection and analysis on the challenges experienced
by nurses when providing cardiac rehabilitation services, patients' experience in
recovery and coping, and caregivers’ experiences in supporting and caring for family
members after heart valve surgery.
Quantitative data were collected using self-administered questionnaires from a sample
of twenty-three (23) nurses, out of the total study population of twenty-nine (29)
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nurses. Data were analysed using the Statistical Software Program SPSS (version 27).
The descriptive statistics analysis, Fisher’s exact test, to describe the association
between demographic characteristics and variables of knowledge, attitudes, and
practices was performed. Qualitative data were collected through in-depth individual
face-to-face semi-structured interviews using an interview guide for all three (3)
objectives. A non-probability, purposive sampling method was used to select
participants, resulting in a total of ten (10) nurses, twelve (12) patients, and eight (8)
caregivers who consented to and participated in the study. Data collection continued
until data saturation was achieved. Qualitative data were analysed using Tesch’s eight
steps of coding. The quantitative findings show that the majority of nurses, 20 (87%),
had a high level of knowledge, with only 3 (13%) having average knowledge about
CR. Similarly, the majority of nurses, 21 (91.3%), displayed positive attitudes while
only 1 (4.3%) had a negative attitude. However, the findings on practices indicated
that only half of the nurses, 13 (56.5%), showed good practice, while 8 (34.8%) had
average practice, and 1 (4.3%) had poor practice in cardiac rehabilitation. Despite the
high level of knowledge, respondents displayed a lack of knowledge specifically about
the indications, benefits, phases, and core components of cardiac rehabilitation. In the
qualitative findings, regarding nurses’ challenges, two main themes and eleven (11)
subthemes highlighted the challenges experienced by nurses in delivering cardiac
rehabilitation interventions and their opinions on the importance of rehabilitation
programmes after heart valve surgery. Regarding patients’ experiences, two main
themes and nine subthemes emerged indicating the challenges patients experienced
(physical, emotional, psychological, and social factors) during recovery and coping
after heart valve surgery as well as challenges regarding the support and care from
nurses and family members after heart valve surgery. Regarding caregivers’
experiences, two main themes and eight sub-themes emerged regarding the emotional
disturbances and demand for care, along with varying experiences regarding the
support and care provided by healthcare providers. Based on these findings,
recommendations were put forth among others to the Ministry of Health and Social
Services (MoHSS) for the development of a cardiac rehabilitation programme for
nurses, improvement of nursing practice, as well as recommendations on future
research in this area
Description
A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Nursing science
Keywords
Heart valve surgery, Cardiac rehabilitation, Educational programme, Nurses, Patients, Caregivers, Namibia, University of Namibia