Document Type : Original Article
Authors
1 PhD Candidate, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
2 Department of Medical‑Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
3 Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
BACKGROUND: Commitment to implementing cardiac rehabilitation (CR) plays an important role in
managing the problems caused by heart diseases. Commitment to the treatment plan implementation
is accompanied by numerous positive consequences. This study was carried out to explain the
consequences of commitment to CR.
MATERIALS AND METHODS: Data were collected through semi‑structured individual interviews with
26 participants (13 CR specialists and 13 patients), using purposeful sampling. Interview questions
focused on the factors influencing the formation of commitment to the CR and its consequences.
Conventional content analysis with Graneheim and Lundman’s approach was used to analyze the
data. To obtain data trustworthiness, Lincoln and Guba’s criteria were used.
RESULTS: The findings were classified in three categories: purposeful of a purposeful behavior
structure (sense of controlling and managing the condition, sense of responsibility, sense of security),
formation of active performance structure (interaction between the patient‑family‑treatment team,
stabilization of behavior and prevention of intermittent behavior, no cessation of the treatment plan
and adherence to it, directing behaviors and adaptation to conditions) and achieving dynamic and
effective care (active follow‑up of the treatment plan, sense of satisfaction, reduced readmission,
reduced costs, improved quality of life, reduced anxiety and concerns about treatment failure,
increased self‑care ability).
CONCLUSION: The results show that the patient’s commitment to CR is accompanied by optimal
consequences. The results of this study can help design the training plan for the CR staff and develop
the clinical practice guidelines to provide educational‑care approaches to patients to reinforce their
commitment.
Keywords
- Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R,
et al. Heart disease and stroke statistics‑2017 update: A report from
the American Heart Association. Circulation 2017;135:e146‑603.
2. Fryar CD, Fakhouri TH, Carroll MD, Frenk SM, Ogden CL. The
association of nativity/length of residence and cardiovascular
disease risk factors in the United States. Prev Med 2020;130:105893.
3. Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease
in Iran in the last 40 years: Prevalence, mortality, morbidity,
challenges and strategies for cardiovascular prevention. Arch
Iran Med 2019;22:204‑10.
4. Ribeiro GS, Melo RD, Deresz LF, Dal Lago P, Pontes MR,
Karsten M. Cardiac rehabilitation programme after transcatheter
aortic valve implantation versus surgical aortic valve replacement:
Systematic review and meta‑analysis. Eur J Prev Cardiol
2017;24:688‑97.
5. Mehra VM, Gaalema DE, Pakosh M, Grace SL. Systematic review
of cardiac rehabilitation guidelines: Quality and scope. Eur J Prev
Cardiol 2020;27:912‑28.
6. Prabhu NV, Maiya AG, Prabhu NS. Impact of cardiac
rehabilitation on functional capacity and physical activity after
coronary revascularization: A scientific review. Cardiol Res Pract
2020;2020:1‑9.
7. Bakhshayeh S, Sarbaz M, Kimiafar K, Vakilian F, Eslami S. Barriers
to participation in center‑based cardiac rehabilitation programs
and patients’ attitude toward home‑based cardiac rehabilitation
programs. Physiother Theory Pract 2019:1‑11.
8. Cristo DD, Nascimento NP, Dias AS, Sachetti A. Telerehabilitation
for cardiac patients: systematic review. Int J Cardiov Sci
2018;31:443‑50.
9. Sage S. Cardiac rehabilitation: Motivation and commitment. Br.J
Card Nurs 2013;8:237‑40.
10. Higgins T, Larson E, Schnall R. Unraveling the meaning of
patient engagement: A concept analysis. Patient Educ Couns
2017;100:30‑6.
11. García‑MoyanoL, AltisentR, Pellicer‑García B, Guerrero‑Portillo S,
Arrazola‑Alberdi O, Delgado‑Marroquín MT. A concept analysis
of professional commitment in nursing. Nurs Ethics 2019;26:
778‑97.
12. Creamer AM. Therapeutic Commitment and Care of Persons with
Mental Illness: A Survey of Nurse Practitioners’ Role Perceptions;
2011.
13. Salehi‑tali S, Ahmadi F, Zarea K, Fereidooni-Moghadam M.
Commitment to care: the most important coping strategies among
family caregivers of patients undergoing haemodialysis. Scand J
Caring Sci 2018;32:82‑91.
14. Holmvall C, Twohig P, Francis L, Kelloway EK. Applying justice
and commitment constructs to patient–health care provider
relationships. Can Fam Physician 2012;58:e159‑65.
15. Nijjar PS, Connett JE, Lindquist R, Brown R, Burt M, Pergolski A,
et al. Randomized trial of mindfulness‑based stress reduction
in cardiac patients eligible for cardiac rehabilitation. Sci Rep
2019;9:18415.
16. Holloway I, Galvin K. Qualitative Research in Nursing and
Healthcare. New York: John Wiley & Sons; 2016.
17. Graneheim UH, Lindgren BM, Lundman B. Methodological
challenges in qualitative content analysis: A discussion paper.
Nurse Educ. Today 2017;56:29‑34.
18. Speziale HS, Streubert HJ, Carpenter DR. Qualitative Research
in Nursing: Advancing the Humanistic Imperative. Philadelphia:
Lippincott Williams & Wilkins; 2011.
19. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12.
20. Drisko J. Standards for qualitative studies and reports. Qualitative
Res Soc Work 2013:3‑34.
21. Guba EG, Lincoln YS. Competing paradigms in qualitative
research: Theories and issues. Approaches to qualitative research:
A reader on theory and practice. Oxford University Press,
New York 0.2004: 17‑38.
22. Kassymova GK, Tokar OV, Tashcheva AI, Slepukhina GV,
Gridneva SV, Bazhenova NG, et al. Impact of stress on creative
human resources and psychological counseling in crises. Educ
Inf Technol (Dordr) 2019;13:26‑32.
23. Fowler Davis S, Hinde S, Ariss S. Complex programme evaluation
of a ‘new care model’ vanguard: A shared commitment to quality
improvement in an integrated health and care context. BMJ Open
2020;10:e029174.
24. Kramer M. Learning about emotions in illness: Integrating
psychotherapeutic teaching into medical education, edited by
peter shoenberg and. Psychodyn Psychiatry 2015;43:316‑20.
25. Becker HS. Notes on the concept of commitment. Am J Sociol
1960;66:32‑40.
26. Rather RA, Tehseen S, Itoo MH, Parrey SH. Customer brand
identification, affective commitment, customer satisfaction, and
brand trust as antecedents of customer behavioral intention of
loyalty: An empirical study in the hospitality sector. J Acad Mark
Sci 2019;29:196‑217.
27. Hadden BW, Agnew CR, Tan K. Commitment readiness and
relationship formation. Pers Soc Psychol Bul 2018;44:1242‑57.
28. Ooi J, Francová A, Székely M, Michael J. The sense of commitment
in individuals with borderline personality traits in a non‑clinical
population. Front Psychiatry 2018;9:519.
29. Chai DS, Hwang SJ, Joo BK. Transformational leadership and
organizational commitment in teams: The mediating roles of
shared vision and team‑goal commitment. Perform Improv Q
2017;30:137‑58.
30. Agnew CR, Hadden BW, Tan K. It’s about time: Readiness,
commitment, and stability in close relationships. Soc Psychol
Personal Sci 2019;10:1046‑55.
31. Cifci SD, Erdogan BZ. Antecedents and measurement of brand
commitment and behavioural loyalty. J Cust Behav 2016;15:321‑36.
32. Mohiuddin AK. Pharmacist‑patient relationship: Commitment
to care. Biomed J Sci Tech Res 2019;19:15588‑9.
33. Karataş T, Bostanoğlu H. Perceived social support and
psychosocial adjustment in patients with coronary heart disease.
Int J Nurs Pract 2017;23:e12558.
34. Hadden BW, Harvey SM, Settersten RA Jr., Agnew CR. What do
I call us? The investment model of commitment processes and
changes in relationship categorization. Soci Psychol Personality
Sci 2019;10:235‑43.
35. Falk A, Zimmermann F. Information processing and commitment.
Economic J 2018;128:1983‑2002.
36. MeyerJP, Espinoza JA. Occupational commitment. In: Handbook
of Employee Commitment. Cheltenham: Edward Elgar
Publishing; 2016. - 37. Boyd NM, Nowell B. Sense of community, sense of community
responsibility, organizational commitment and identification, and
public service motivation: a simultaneous test of affective states
on employee well‑being and engagement in a public service work
context. Public Manag Rev 2020;22:1‑27.
38. Rodrigues D, Lopes D, Kumashiro M. The “I” in us, or the eye on
us? Regulatory focus, commitment and derogation of an attractive
alternative person. PLoS One 2017;12:e0174350.
39. Putnam DE, Finney JW, Barkley PL, Bonner MJ. Enhancing
commitment improves adherence to a medical regimen. J Consult
Clin Psychol 1994;62:191.
40. Setyajidi B, Kambuaya B, Tuhumena R, Bharanti E. Influence
of patient satisfaction through commitment to loyalty inpatient
HOSPITALS Jayapura. Adv Soc Sci Res J 2018;5:370‑378. https://
doi.org/10.14738/assrj. 54.4298.
41. Ruano‑Ravina A, Pena‑Gil C, Abu‑Assi E, Raposeiras S,
van’t Hof A, Meindersma E, et al. Participation and adherence to
cardiac rehabilitation programs. A systematic review. Int J Cardiol
2016;223:436‑43.
42. Vargas J, Goel A, Stoner T, Fowler K. Heart failure hospitalist can
reduce length of stay, Can Reduce Readmission, and Can Reduce
Cost. J Card Fail 2019;25:S121.
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