Nurse-coordinated home-based cardiac rehabilitation for patients with heart failure: A scoping review

For nursing students

Study summary

This article, published in the International Journal of Nursing Sciences (October 2023), is a scoping review that explores how nurses can coordinate home-based cardiac rehabilitation programs for patients with heart failure. The authors aim to summarize existing research on this topic.

The study uses Arksey and O'Malley's framework for conducting a scoping review, which helps identify key concepts, types of evidence available, and gaps in the current knowledge base. A systematic search was performed across eight databases (including PubMed, Embase, Web of Science, EBSCO, SinoMed, CNKI, Wanfang Database, and CSTJ) as well as the Chinese Clinical Trial Registry. The search covered studies from their inception up to April 30, 2023.

The review included articles relevant to nurse-coordinated home-based cardiac rehabilitation for patients with heart failure. A total of eighteen such studies were identified and analyzed.

The main findings indicate that nurses play a crucial role in these programs by focusing on several key activities: 1. **Patient Assessment:** Nurses evaluate the patient's condition, needs, and suitability for home-based rehabilitation. 2. **Home-Based Cardiac Rehabilitation Planning and Guidance:** They develop individualized plans tailored to each patient's specific situation and provide guidance on how to implement these programs at home. 3. **Follow-Up:** Ongoing monitoring and support are provided by nurses to ensure the program is effective, safe, and that patients adhere to their rehabilitation plan.

The studies reviewed also reported positive outcomes associated with nurse-coordinated home-based cardiac rehabilitation: 1. **Patient Safety:** The programs were found to be generally safe for patients when managed by trained nurses. 2. **Feasibility:** Implementing these programs at home was deemed feasible, meaning it could be done practically and effectively in a patient's own environment. 3. **Efficacy:** There is evidence suggesting that these nurse-led programs are effective in improving patient outcomes related to heart failure management.

The authors conclude that home-based cardiac rehabilitation coordinated by nurses offers significant benefits for patients with heart failure. They also highlight areas for future research, such as exploring the full potential of nurses in this role, determining optimal evaluation criteria for these programs, and developing safe, effective, and economical rehabilitation plans suitable for a wide range of patients.

For nursing students, it's important to understand that cardiac rehabilitation is not just about hospital-based interventions. This review shows how nurses can extend their care into the home setting, which can be particularly beneficial for heart failure patients who may have difficulty attending regular in-person sessions or prefer the comfort and convenience of their own homes.

When appraising this research, consider the following: * **Scope:** As a scoping review, it aims to map existing literature rather than synthesize quantitative data into a single effect size. It's good for identifying what is known and unknown in an area. * **Inclusion Criteria:** The specific criteria used for selecting studies are important. Were only peer-reviewed articles included? What about study designs (e.g., RCTs, observational studies)? * **Methodology of Included Studies:** While the review summarizes findings from eighteen studies, it doesn't detail their individual methodologies or quality assessments. * **Source Rights and Access:** The paper is open access via DOAJ. This means you can read it directly through its DOI link (https://doi.org/10.1016/j.ijnss.2023.09.022). Always verify the publisher's website for any specific usage rights or copyright information, even if a paper is open access.

A nurse would reason from this evidence by considering how to integrate these findings into practice. For instance: * **Advocacy:** Promote home-based cardiac rehabilitation as an option for eligible heart failure patients. * **Education:** Develop training programs for nurses on how to effectively assess, plan, and guide home-based CR. * **Policy Development:** Advocate for healthcare policies that support the implementation of nurse-led home-based CR programs. * **Resource Allocation:** Consider how resources can be allocated to ensure these programs are accessible and sustainable. The review suggests a promising role for nurses in this area, but it also points out the need for further research. Nurses should stay updated on new findings as more studies become available.

For educators

Teaching and appraisal notes

This scoping review by Ruan et al., published in the International Journal of Nursing Sciences (October 2023), systematically examines nurse-coordinated home-based cardiac rehabilitation (HB-CR) programs for patients with heart failure. The authors employed Arksey and O'Malley's framework to conduct a comprehensive search across eight major databases, including PubMed, Embase, Web of Science, EBSCO, SinoMed, CNKI, Wanfang Database, and Chinese Science and Technology Journals (CSTJ), as well as the Chinese Clinical Trial Registry. The inclusion criteria focused on studies relevant to nurse-coordinated HB-CR for heart failure patients, resulting in eighteen articles being analyzed.

The review highlights that nurses are central to these programs, primarily engaged in three key activities: patient assessment, home-based cardiac rehabilitation planning and guidance, and ongoing follow-up. These functions underscore the multifaceted role of nurses as coordinators, educators, and supporters within this care model.

Crucially, the findings indicate positive outcomes associated with nurse-led HB-CR: 1. **Patient Safety:** The programs were generally found to be safe when managed by trained nursing professionals. 2. **Feasibility:** Implementing such programs in a home setting was deemed practical and achievable. 3. **Efficacy:** There is evidence supporting the effectiveness of these interventions in improving patient outcomes related to heart failure management.

The authors conclude that HB-CR coordinated by nurses offers substantial benefits for patients with heart failure, potentially enhancing their quality of life and disease management capabilities outside traditional clinical settings. They also identify important avenues for future research: exploring the full scope of nurse-led initiatives in this domain, establishing robust evaluation criteria to standardize program effectiveness assessment, and developing safe, effective, and cost-efficient rehabilitation protocols tailored to diverse patient needs.

For faculty teaching nursing students or practicing nurses, this review serves as a valuable resource. It underscores the expanding role of nurses beyond traditional hospital settings into community-based care models like HB-CR. The study's methodology (a scoping review) is appropriate for mapping existing evidence and identifying knowledge gaps in an emerging field.

Key considerations for faculty include: * **Educational Implications:** This research can inform curriculum development, emphasizing skills related to home-based care coordination, patient assessment in non-clinical settings, and the design of individualized rehabilitation plans. It highlights the need for nurses to be prepared to manage chronic conditions like heart failure through comprehensive, ongoing support. * **Critical Appraisal Skills:** While the review itself is a good example of scoping methodology, it's important to guide students in critically appraising such reviews. They should understand that scoping reviews map literature rather than synthesize quantitative data into definitive conclusions about effect sizes (which would be more typical of systematic reviews or meta-analyses). The quality and heterogeneity of the eighteen included studies are not detailed within this review, so further investigation might be needed to assess overall evidence strength. * **Research Opportunities:** The identified limitations and future research directions provide clear pathways for students interested in nursing research. Topics like optimizing evaluation criteria or developing economical programs offer fertile ground for inquiry. * **Practical Application:** Faculty can use this review to discuss how nurses can advocate for and implement HB-CR programs, considering resource allocation, policy development, and patient education strategies. The open access nature of the paper (via DOAJ) facilitates easy dissemination and student access. The DOI landing page provides a direct link for verification and citation purposes.