Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Sibbald, Shannon

2nd Supervisor

Orange, Joseph B.

Co-Supervisor

Abstract

Older adults who transition from hospital to cardiac rehabilitation settings often are vulnerable and at risk of experiencing adverse health care outcomes. Given the complexities of transitional care, it is crucial to engage older adults in the clinical decision-making process and to promote their active participation in their medical care. Older adults have unique ways of understanding their participation in the transitional care process. Gaining an in-depth understanding of their specific needs during this process can help inform clinical practice and interventions aiming to improve care for older adults living with cardiovascular disease. Focused ethnography methodology was used to explore the perspectives of older adults and health care providers on patient participation in transitional care from hospital to cardiac rehabilitation. The study also sought to identify and to gain a better and more in-depth understanding of the challenges and opportunities that shape participation for older adults during transitional care from hospital to cardiac rehabilitation. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers from cardiac rehabilitation and cardiology units. Additional methods included document analysis and reflexive journaling. Thematic analysis revealed six themes and fifteen subthemes. Themes included: Follow-up from Healthcare Provides, Interactions with Healthcare Providers, Support from Family Members, Information about Medical Care and Rehabilitation, Decision-Making and Participation, and Healthcare Journey during COVID-19. Older adults reported gaps in follow-up and insufficient spaces or opportunities for participation in decision-making. Healthcare provider’s support was reported as essential for a smooth transition, particularly nurses’ support. The COVID-19 pandemic was mostly reported as a major barrier for participants, especially in terms of delayed medical procedures and difficult hospitalization experiences. Some participants, particularly those who seek social connection, viewed technology and virtual care negatively. However, virtual care delivery also was reported as a fruitful strategy to engage older adults in their care and to overcome transportation barriers. The results of this study can help inform the implementation of strategies that will engage older adults more actively in their care, as they transition from hospital to cardiac rehabilitation settings.

Summary for Lay Audience

The transition from hospital to cardiac rehabilitation can be a vulnerable time for older adults. It is very important for older adults and their families to engage in their medical care during this complex transition and to promote opportunities for their participation in the decision-making processes. The current study used focused ethnography methodology to explore the perspectives of older adults and health care providers in cardiac rehabilitation and cardiology units on patient participation in transitional care from the hospital to cardiac rehabilitation. The current study also sought to identify challenges and opportunities for the active participation of older adults in their care. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers in cardiac rehabilitation and cardiology units. Results revealed six themes and fifteen subthemes. Themes included: Follow-up from Healthcare Provides, Interactions with Healthcare Providers, Support from Family Members, Information about Medical Care and Rehabilitation, Decision-Making and Participation, and Healthcare Journey during COVID-19. Older adults reported gaps in follow-up and insufficient spaces or opportunities for participation in decision-making. Healthcare providers’ support was reported as important to ensure a smooth transition to cardiac rehabilitation, particularly nurses’ support. The COVID-19 pandemic was mostly reported as a major barrier for participants, especially in terms of delayed medical procedures and difficult hospitalization experiences. Some participants, particularly those who seek connection, viewed the use of technology and virtual care negatively. However, virtual care delivery was also reported as a good strategy to engage older adults in their care and to overcome transportation barriers. The results of this study can help inform clinical practice and research aiming to better engage older adults in their care, as they transition from hospital to cardiac rehabilitation settings.

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