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Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW

Feinberg, Jodi L. RN, BSN; Russell, David PhD; Mola, Ana PhD, RN, ANP-C; Bowles, Kathryn H. PhD, RN; Lipman, Terri H. PhD, CRNP

Journal of Cardiopulmonary Rehabilitation and Prevention: November 2017 - Volume 37 - Issue 6 - p 404–411
doi: 10.1097/HCR.0000000000000228
Cardiac Rehabilitation

Purpose: There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease.

Methods: Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test.

Results: Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists.

Conclusions: Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.

This article describes the development, implementation, and evaluation of an adapted cardiac rehabilitation training program for home care nurses, physical therapists, and occupational therapists at a certified home health agency. The training was developed from clinical guidelines and content expert review, supplemented with themes identified among patients and clinicians.

President's Engagement Prize Fellowship, University of Pennsylvania, Philadelphia (Ms Feinberg); Visiting Nurse Service of New York, Center for Home Care Policy & Research, New York (Drs Russell and Bowles); NYU Langone Medical Center, Department of Care Transitions & Population Health, New York (Dr Mola); School of Nursing, University of Pennsylvania, Philadelphia (Drs Lipman and Bowles).

Correspondence: Jodi L. Feinberg, RN, BSN, Visiting Nurse Service of New York, 1250 Broadway, 7th Floor, New York, NY 10001 (

No conflicts of interest were declared by the authors.

The University of Pennsylvania President's Engagement Prize provided funding for this project.

All authors have read and approved the submission of the article.

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