FPX4025 A2
Applying an EBP Model
Acute myocardial infarction remains a leading cause of cardiovascular mortality, affecting approximately 805,000 Americans annually according to recent data (Moini & Ferdowsi, 2024). Post-PCI cardiac rehabilitation represents a critical challenge, as studies indicate that 40-60% of AMI patients demonstrate poor adherence to rehabilitation protocols (Chai et al., 2025). This paper addresses the specific issue of inadequate patient engagement in cardiac rehabilitation programs following acute myocardial infarction treatment. Through structured application of the Iowa Model, this analysis identifies credible resources supporting enhanced cardiac rehabilitation nursing interventions.
Specific Issue Identification
Patient non-adherence to cardiac rehabilitation programs following acute myocardial infarction represents a significant clinical challenge affecting long-term cardiovascular outcomes. Current clinical practice reveals that only 30-40% of eligible AMI patients complete prescribed cardiac rehabilitation programs despite proven benefits (Crăciun et al., 2023). Barriers include inadequate patient education, lack of structured follow-up protocols, insufficient psychosocial support, and poor understanding of rehabilitation importance. Patients like Steve Buchner face complex post-discharge needs including medication management, activity progression, dietary modifications, and symptom recognition. Without systematic nursing interventions addressing these multifaceted needs, patients experience increased anxiety, confusion about self-care, and reduced motivation.
An evidence-based practice approach is essential because current conventional care methods fail to address comprehensive rehabilitation needs systematically. Poor rehabilitation adherence leads to increased hospital readmission rates, recurring cardiac events, diminished quality of life, and elevated mortality. Research demonstrates that structured, theory-based nursing interventions significantly improve patient engagement, self-management capabilities, and long-term cardiac function outcomes (Gok Metin et al., 2022). The Stetler Model provides a systematic framework for identifying clinical problems, locating best evidence, and implementing sustainable practice changes.
EBP Model Selection and Description
The Stetler Model of Evidence-Based Practice was selected to guide this systematic inquiry into cardiac rehabilitation adherence among acute myocardial infarction patients due to its practitioner-oriented approach and flexibility in clinical application. Originally developed by Cheryl Stetler in 1976 and revised in 2001, this model emphasizes individual nurses' capacity to critically evaluate and implement research evidence while acknowledging organizational constraints and resource limitations (Chays‐Amania et al., 2025). The five-phase framework includes Preparation (identifying the clinical problem and assessing organizational readiness), Validation (critically appraising evidence for credibility and scientific rigor), Comparative Evaluation/Decision Making (synthesizing findings and determining feasibility of practice change), Translation/Application (developing implementation plans and integrating evidence into practice), and Evaluation (measuring outcomes and sustainability of changes) (Gray & Milo, 2024). The Stetler Model's emphasis on critical thinking and decision-making empowers nurses to lead evidence-based practice changes that optimize patient outcomes while working within real-world healthcare constraints.
Application of EBP Model to Evidence Search
The Stetler Model guided the systematic search for evidence addressing cardiac rehabilitation adherence among acute myocardial infarction patients post-intervention. During Phase I (Preparation), the clinical problem of poor rehabilitation compliance was identified, with priority affirmed through review of institutional readmission data. Phase II (Validation) involved searching PubMed, CINAHL, and Cochrane databases using terms including "acute myocardial infarction," "cardiac rehabilitation," "nursing interventions," and "patient adherence." Three peer-reviewed articles published between 2018-2021 were identified and critically appraised using established quality criteria including study design, sample size, and statistical significance. In Phase III (Comparative Evaluation), evidence was synthesized comparing structured rehabilitation models versus conventional care, with focus on outcomes including cardiac function improvement and readmission rates. The evaluation confirmed that theory-based nursing interventions demonstrated substantial benefits warranting practice implementation, leading to Phase IV planning for protocol development (Gray & Milo, 2024). This systematic application ensured evidence-based decisions rested on credible, relevant research addressing the specific clinical issue in AMI patient populations.
Evidence Resource Analysis
Article 1: KABP Nursing Model for Cardiac Rehabilitation
The article by Qu et al. (2021) has a high level of credibility based on the CRAAP test criteria used to measure the quality of evidence research. Currency-wise, the date of publication 2021 guarantees that the article is relevant at the time of publication and the fact that the article is stored in the PubMed Central shows that it continues to be influential in the academic world. The authoritative source consists of various qualified authors whose credentials are Chinese medical institutions and have clinical expertise in cardiac rehabilitation nursing. The rigorous quantitative methodology (randomized group assignment, validated assessment tools, CSMS and CQQC scales, statistically significant findings, P<0.05) is used to demonstrate the accuracy. The relevance of the article to the AMI patients, who need to undergo post-PCI rehabilitation, is incredibly high as it specifically discusses the medication adherence, cardiac functioning recovery, and quality of life outcomes. The objective is well defined and its approach to the research is well explained through clear methodological approach where the researcher analyzes the effectiveness of the KABP model in minimizing the risk of falls and enhancing patient self-management opportunities. The resource offers important evidence of the use of structured and theory-based nursing interventions in the management of low adherence to cardiac rehabilitation among patients with acute myocardial infarction in the post-percutaneous coronary intervention period.
Article 2: In-Hospital Cardiac Rehabilitation Program Impact
The article by Soldati et al. (2021) in BMC Cardiovascular Disorders is a highly believable population-based study that deals with the issue of medication compliance and clinical outcome after AMI. The article is current, as it is published in 2021 and examines 2013-2015 data in the Lazio region of Italy, which includes 13,540 patients. The validity of authority is demonstrated due to open-access publication in a peer-reviewed journal indexed in various databases and written by epidemiologists of the Lazio Regional Health Service. It is very accurate, based on admission wide administrative health information systems, three-year follow-ups and strict Poisson regression models controlled by 18 comorbidities. The applicability to the cardiac rehabilitation adherence topic is high, with the results showing that in-hospital CR attendance was much higher in enhancing medication adherence (OR 1.85 in NSTEMI-NO-PCI patients) and lowering mortality by 24% (Soldati et al., 2021). The aim of the study explicitly explores the effects of CR on the adherence of polytherapy and long-term cardiovascular events and is really strong in the application of structured rehabilitation programs especially in patients who did not receive PCI as an index hospitalization.
Article 3: Factors Associated with Cardiac Rehabilitation Participation
The article of Wang et al. (2023) is a high-quality synthesized evidence of CR participation barriers published in Clinical Cardiology, and it is a review with meta-analysis. The article also shows a high level of currency with its publication date of 2023 and database analysis up to October 2022, which will guarantee the up-to-date evidence synthesis. The authority is built in a systematic approach in line with PRISMA guidelines, registration in PROSPERO (CRD42023367431) and publication in a well-known journal of the peer-reviewed article in the cardiovascular field. The inclusion criteria of 14 studies (n=114,542) and 144,542 participants, use of Newcastle-Ottawa Scale to evaluate quality of the studies, and extensive statistical analysis have demonstrated accuracy of the topic by stating that there were 34% overall CR participation rates. Its applicability to the study of cardiac rehabilitation adherence barriers among AMI populations is remarkable, and it has specified and examined factors such as age, level of education, socioeconomic status, and comorbidities that would affect participation (Wang et al., 2023). The objective systematically explores the rate of participation and influencing factors, which offer meta-analytic results and can be used to create specific interventions and to improve CR use impacting the identification of barriers among different patient populations with AMI.
Conclusion
The systematic evaluation of three high-quality evidence-based resources using CRAAP criteria confirms strong credibility, contemporary relevance, and substantial applicability to addressing cardiac rehabilitation adherence challenges in acute myocardial infarction patients. Collectively, these resources provide comprehensive evidence supporting implementation of systematic, theory-based cardiac rehabilitation protocols that address patient education, self-management behaviors, and identified participation barriers. The convergent findings across quantitative studies, population-based research, and meta-analytic evidence strengthen clinical recommendations for prioritizing cardiac rehabilitation referral.
References
Chai, Z., Fan, Y., Gong, X., Zhang, Y., Hu, Y., Li, X., Fan, Z., & Han, Y. (2025). Adherence to phase I cardiac rehabilitation in post-PCI patients: A latent class analysis. Frontiers in Cardiovascular Medicine, 12. https://doi.org/10.3389/fcvm.2025.1460855
Chays‐Amania, A., Schwingrouber, J., Melnyk, B. M., Haller, P. H., Soler, J., & Colson, S. (2025). Mapping implementation strategies and outcomes when using evidence based practice implementation models in nursing settings: A scoping review. Worldviews on Evidence-Based Nursing, 22(3). https://doi.org/10.1111/wvn.70050
Crăciun, L., Florina Buleu, Ana Maria Pah, Marius Badalica-Petrescu, Bodea, O., Dana Emilia Man, Oana Catalina Cosor, Stela Iurciuc, Drăgan, S., & Rada, M. (2023). The benefits of a comprehensive cardiac rehabilitation program for patients with acute coronary syndrome: A follow-up study. Journal of Personalized Medicine, 13(10), 1516–1516. https://doi.org/10.3390/jpm13101516
Gok Metin, Z., Izgu, N., Gulbahar Eren, M., & Eroglu, H. (2022). Theory‐based nursing interventions in adults with coronary heart disease: A systematic review and meta‐analysis of randomized controlled trials. Journal of Nursing Scholarship, 55(2). https://doi.org/10.1111/jnu.12839
Gray, A. K., & Milo, R. B. (2024). “Shoes enthused”: The application of an evidence-based practice podiatry consultation and footwear education in older adults living with diabetes. https://doi.org/10.22371/07.2023.063
Moini, J., & Ferdowsi, K. (2024). Myocardial infarction. CRC Press EBooks, 141–153. https://doi.org/10.1201/9781003453376-12
Qu, B., Hou, Q., Men, X., Zhai, X., Jiang, T., & Wang, R. (2021). Research and application of KABP nursing model in cardiac rehabilitation of patients with acute myocardial
