Embracing the Life Course Perspective: Innovations in Cardiac Rehabilitation and Holistic Care
Dr Maria Alejandra Pinero de Plaza, PhD
Research Fellow, Flinders University, Caring Futures Institute, CNHS, Flinders University
I have been sharing my recently published research article, "The Caring Life Course Theory: Opening New Frontiers in Care—A Cardiac Rehabilitation Example," in the Journal of Advanced Nursing. Here, I wanted to reflect on its relevance and the broader context of life course theory in healthcare. You can access the full article here.
Our research underscores the importance of considering the cumulative impact of life events on health and well-being. By incorporating the life course perspective, we aim to provide a more comprehensive and holistic approach to cardiac rehabilitation, which aligns with and extends insights from several schools of thought in the field.
Life Course Theory in Care-Leaving Studies
Leaving care research involves the study of young individuals transitioning out of formal care systems, such as foster care or orphanages, into independent living. The life course perspective is one theoretical perspective used to have a good effect in several care-leaving studies. Life course theory has brought new insights into care-leaving; however, these studies have mostly been executed in the Global North. Kelly (2023) extends this perspective to youth leaving care in four African countries, emphasising these concepts: biography, linked lives, waithood, and agency.
Integrating Rehabilitation and Palliative Care
Pulmonary rehabilitation is a care programme for patients with chronic respiratory diseases to improve their quality of life through education, exercise, and psychological support. Our findings align with research on the integration of rehabilitation and palliative care. McCormick (2009) highlighted that patients in pulmonary rehabilitation programmes are open to discussions about advance care planning, suggesting these programmes could serve as valuable forums for such conversations. This underscores the need for a holistic approach that addresses both physical and psychosocial needs.
Dyadic Approaches in Postacute Rehabilitation
Postacute rehabilitation typically follows an acute medical event and aims to support recovery and improve function. In post-acute rehabilitation, psychosocial providers working with older adults believe their role complements individualised rehabilitation care plans by addressing psychosocial factors such as motivation and fear, which can create barriers to physiotherapy. This patient-centred approach is often balanced with a family-centred lens to address declining health and function towards the end of life. Plys (2023) highlights the need for dyadic psychosocial intervention approaches with older adults and their family care-partners to reduce emotional distress and improve collaborative illness management.
Cultural Understandings in Care
Palliative care focuses on relieving the symptoms and stress of serious illness, aiming to improve the quality of life for both the patient and the family. Rezende et al. (2022) discussed the continuum of care from advanced cancer diagnosis to palliative care, emphasising cultural understandings associated with stigma, inclusion, and quality of life. Rehabilitation aims to overcome adversities and chronic diseases, while palliative care focuses on relieving suffering and improving quality of life. This dual approach is essential in providing comprehensive care.
The Role of Nurses in Rehabilitation
Nursing care in rehabilitation involves a holistic approach that considers patient recovery's physical, emotional, and social aspects. The relationship between caregivers and care receivers is pivotal in successful rehabilitation outcomes. St-Germain, Boivin, and Fougeyrollas (2011) emphasised the importance of trust and positive feedback in transforming patients' lives. This caring approach, informed by Watson's caring philosophy and the Quality-Caring Model, underscores the transformative potential of nursing care.
Psychological Care in Cardiac Rehabilitation
Enhanced Psychological Care (EPC) in cardiac rehabilitation aims to address patients' mental health needs alongside their physical rehabilitation. Richards, Dickens, Anderson, et al. (2018) assessed the effectiveness of EPC for patients with depressive symptoms attending cardiac rehabilitation compared to treatment as usual. Their study highlighted the significant barriers to EPC implementation due to organisational and workload constraints while emphasising the need for new models of psychological care within cardiac rehabilitation.
Gender Differences in Cardiac Rehabilitation Outcomes
Cardiac rehabilitation involves a structured programme of exercise and education designed to improve the health and well-being of people with heart problems. Rana, Batool, and Khan (2019) conducted a study on gender-based differences in quality of life after phase II cardiac rehabilitation in patients with coronary artery bypass graft surgery. They found significant improvements in all quality of life domains, with notable differences between male and female participants, suggesting tailored approaches may be beneficial.
Family Medicine and the Life Course Paradigm
The life course paradigm in family medicine provides a framework for understanding health trajectories over time. It helps gather patient care data and feedback, providing a comprehensive view of health and illness over time. Daaleman and Elder (2007) discussed how this approach is crucial in understanding patient trajectories, transitions, and turning points, enhancing the quality of care.
Clinical Caring Science
Clinical caring science integrates various theoretical and practical concepts to enhance patient care. Rehnsfeldt, Arman, and Lindstr?m (2016) emphasised the importance of uniting various concepts within clinical caring science to provide meaningful and effective patient care. Their model stresses the need for integrating core, basic, and practice concepts in clinical research to avoid fragmented care.
Conclusion
The healthcare and medical literature has been calling for holistic approaches like the Caring Life Course Theory (CLCT), and our work brings an innovative attempt to put it into practice. It highlights the operationalisation of a holistic approach that considers the cumulative impact of life events, cultural understandings, and the vital role of caregivers. Our research in "The Caring Life Course Theory: Opening New Frontiers in Care—A Cardiac Rehabilitation Example" demonstrates the power of integrating life course theory into healthcare. I encourage you to read our full article and explore how these insights can be applied to enhance care in various contexts.
Read the full article here.
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