Attitude of cardiac surgery nurses on kinesiophobia management: a qualitative study

Discussion

Combined with the KAP Model, constructing a kinesiophobia management programme necessitates the consideration of how the knowledge and attitudes of implementers impact programme implementation.9 The results of this study indicate that healthcare professionals lack training in kinesiophobia, leading to unmet job expectations, conflicts with patients, and a decrease in affective domain abilities.10 11 Although nurses recognise the effectiveness of kinesiophobia management, external factors influence their motivation and commitment. Therefore, it is imperative to establish individualised training programmes for medical staff and clarify the reward and penalty systems within the management plan.

This study suggests that the current health education model needs improvement. In situations of ineffective communication and information dissemination, misunderstandings and information mismatches can occur.12–14 Patient understanding of medical terminology is often limited, as their knowledge primarily stems from subjective perceptions of their condition and basic medical knowledge acquired in daily life. Patient’s comprehension of medical terminology is poor and they may be unlikely to express whether they truly understand the information provided by healthcare professionals.14 Interviewees in our study thought that the current method of one-way, colloquial education model might be unable to overcome the cognitive gap and improve the communication. To address this, it is recommended to avoid using specialised medical terminology and instead employ various communication methods such as visual aids based on the ‘pictorial superiority effect’15 16 and the Teach-back Method.17 Additionally, there is a need to provide patients with a professionally supervised communication platform, which ensures the authenticity and accuracy of information related to CR and improves the facilitation of information exchange.

Collaboration between nurses and family caregivers enables round-the-clock observation and care.18 19 This study revealed that some nurses believe that when they are absent, family caregivers can step in and provide some basic care. Optimistic and supportive family caregivers can provide emotional encouragement to patients, assisting them in adhering to treatment recommendations, and effectively coping with crises,20 such as kinesiophobia. Furthermore, family caregivers can also offer supplementary resources for medical staff in the care process.21 This collaboration enables a valuable exchange of information, allowing medical staff to gain insights into the patient’s kinesiophobia even when they are not present. However, in our research, it was observed that there exists a lack of effective collaboration between nurses and family caregivers. It seems kinesiophobia is also present in family caregivers.

Regarding the feasibility of implementing the programme, several objective factors need consideration. On one hand, psychological therapy is often overlooked compared with physical therapy.22 Based on the results of this interview, most respondents believed it was necessary to simplify the kinesiophobia management programme and continually improve and adapt it according to real-world needs. For instance, using multimedia presentations, centralised education, and providing individual guidance can reduce the need for extensive human labour. On the other hand, establishing a dedicated Enhanced Recovery After Surgery (ERAS) cardiac team is essential. However, there is an unclear division of responsibilities between specialties when dealing with psychological problems during patients’ treatment, which can result in a tendency to pass the buck. Also, it is crucial to acknowledge that when members of the ERAS team provide conflicting information about CR, it can have a detrimental impact on the patient’s motivation.23 Due to the challenge of rapid rehabilitation to traditional surgical theory, some medical staff may be hesitant to trust rapid rehabilitation programmes for fear of the adverse effects of early mobilisation on their patients.24 Consequently, when there is a lack of unified opinions or effective communication within the ERAS team, inconsistent responses to patients’ questions can easily arise. Therefore, it is crucial to overcome communication barriers among specialties, promote multidisciplinary cooperation and exchange activities regularly, and establish information-sharing platforms.

Implications on practice

When formulating kinesiophobia management plans, subjective initiative of implementers, individual patient characteristics and objective factors influencing plan implementation should be considered. Currently, there is a shortage of professionals in kinesiophobia management. It is essential to create personalised training plans containing theoretical learning and practical simulation techniques. These programmes can help deepen healthcare professionals’ understanding of kinesiophobia management. Furthermore, the management plan should clarify the reward and punishment system.

To achieve better cooperation with family caregivers, there is a need to focus on preserving the positive psychology of caregivers and improving their caregiving capacity. It can be achieved through various strategies such as offering educational resources and information, facilitating problem-solving assistance, teaching coping skills and behaviours, using available resources effectively, seeking social support and recognising indicators of distress.

Furthermore, a clear interdisciplinary responsibility team is advisable. Considering the characteristics of each discipline and the current state of medical policies, department heads should supervise plan implementation, nurses should be responsible for screening and evaluating kinesiophobia, and physicians should diagnose and treat physiological factors causing kinesiophobia.

Conclusion and limitations

As the primary implementers of kinesiophobia, nurses’ thoughts and actions significantly impact the successful implementation of the plan. In summary, kinesiophobia management is still in its early exploration stage. Cardiac surgical nurses currently have limited exposure to this concept and possess insufficient knowledge regarding its significance, and therefore exhibit a lack of motivation for active intervention. In addition, from the perspective of professionals, they also provided many suggestions for the improvement of the programme.

Due to time and budget constraints, the study’s scope is limited, with a restricted sample source and no investigation into the viewpoints of healthcare professionals from other departments. The extracted themes also do not cover medical policy aspects. The study did not differentiate cardiac surgery types, and further quantitative research is needed to validate related issues. Moving forward, it is recommended to explore this topic more comprehensively by expanding the geographical reach of the study and including patients in the interview process.

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