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Item Experiences of patients attending and participating in clinical nurse specialist-managed heart failure clinics : a thesis submitted to Massey University of Wellington in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing)(Massey University, 2007) Dewar, Suzanne JudithIt is very clear from discussions with patients attending outpatient clinics, that nurse-led clinics fulfilled an important function in the holistic care of patients with heart failure. Previously the biomedical model of health care dominated the health system and was considered all that was required. Knowledge about health care has improved greatly and this is in keeping with patients' expectations in today's world of easy access to Internet information. Ongoing health care therefore, needs to meet the needs of these patients in the interests of improved quality of life in a population with a significant chronic illness. This research sits in the mixed method paradigm, however the focus is predominantly qualitative using exploratory narrative inquiry informed by Polkinghorne (1988) to gain a perception of the meaningfulness of patients' experience of nursing clinics. The aim of this research is to explore what is important to the patients; to explore what the patient's perceive as their needs when they attend or participate in Heart Failure Clinical Nurse Specialist (HFCNS) clinics; to describe the experiences of patients attending the HFCNS services with the aim of gathering information to develop and improve the health care of these patients. All patients attending the nurse-managed heart failure secondary care clinic over an eight-week period were invited to fill in a questionnaire. Fifty-five patients completed the form. The aim of the questionnaire was to describe the clinic population demographics. Three short answer questions were also included to give direction for the interviews that were to follow. The six participants for interview were chosen purposely to give a range of age, gender and ethnicity that would be representative of the clinic population. Key themes for the patients were identified and included: gaining knowledge; making changes; partnership/mentorship; ethnicity/cultural perceptions; and collegial collaboration/ professional care. The research gave a clear picture of the patients' perceptions of the reality of the experience of nurse-managed secondary care clinics. Issues to do with cultural safety as well as general care presented a multi- faceted and complex canvas. Furthermore knowledge of ethnicity and cultural mores shows a need for ongoing efforts to be innovative in reducing disparities that persist in Maori and Pacific peoples' health and wellness. Overall the evidence indicates that nurse-managed heart failure clinics show positive outcomes for patients' perceived needs and, fill what was a gap in care.Item They did explain everything, but I can't remember : the search for relevant information following a heart attack : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Nursing at Massey University(Massey University, 2001) Phillips, Jennifer LThis qualitative descriptive study was undertaken to find out what information patients and their partners wanted following a heart attack. There were 17 participants, of whom 11 were patients and six were partners. Semi-structured interviews were conducted with participants and then thematic content analysis was used to identify the four main themes. The first two themes relate to the experience of having a heart attack and question the widely held belief that it is a dramatic experience and that patients deny what is happening. It seems more likely that the non-specific and insidious onset leaves patients genuinely not knowing what is happening. Women have an additional problem in that once they seek professional help, the medical staff often fail to correctly diagnose that they are having a heart attack. The third and fourth themes relate to the recovery period and show that in spite of a plethora of information provided during cardiac rehabilitation, there is strong evidence that patients and partners fail to receive information that meets their own needs in relation to social, physical and psychological issues. This has an impact on the major adjustments to be made after a heart attack and the coping strategies that are a part of this. An additional problem following discharge is poor communication between health professionals, resulting in anxiety for patient and partners. The role of the cardiac educator emerged as extremely useful and valuable to patients and partners as a support and source of relevant information after discharge. Further support and training for these nurses and expansion of the service would increase their availability to patients and partners. It would also be in line with the World Health Organisation (WHO) (1997) recommendations to provide an environment, which supports and motivates people to make lifestyle changes. An additional recommendation is increased flexibility in cardiac rehabilitation with a shift into the primary care setting, thus offering wider opportunities for patients and partners to obtain support and hopefully facilitate the process of adjustment following a heart attack.