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Amakali, K Masule, Lilian Sinte 2025-10-29T08:03:26Z 2025-10-29T08:03:26Z 2025 http://hdl.handle.net/11070/4177 A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Nursing science 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) ii 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 en University of Namibia Heart valve surgery Cardiac rehabilitation Educational programme Nurses Patients Caregivers Namibia University of Namibia An educational programme for nurses to facilitate cardiac rehabilitation of patients who had heart valve repair or replacement surgery in Namibia Thesisopen.access