Dr Caleb Ferguson RN PhD, WSNMRC, WSU & WSLHD.
EVICOAG: An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice
Caleb Ferguson, Phillip Newton, Sally Inglis, Beata Bajorek, Louise Hickman, Lawrence Lam, Jane Phillips
University of Technology Sydney (2016-2017)
There is a need to improve cardiovascular nurses’ knowledge and practices related to stroke prevention,
atrial fibrillation and anticoagulation therapy.
The aim of this study was to evaluate the efficacy of EVICOAG – a novel mHealth, smartphone-based, spaced-learning intervention on nurses’ knowledge of atrial fibrillation and anticoagulation.
Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants’
smartphones over a 6-week period (July–December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention.
From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively (P<0.01).
The EVICOAG intervention improved nurses’ knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients’ knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.
The IDEAS study: Exploring nursing & allied health perspectives of quality oral care for individuals after stroke
Caleb Ferguson, Ajesh George, Amy Villarosa, Ariana Villarosa, Sameer Bhole, Shilpi Ajwani.
Western Sydney University & Sydney Local Health District (2018-2019)
To understand the oral health knowledge, attitudes and practices of nurses, speech pathologists, and occupational therapists in the acute and rehabilitation stroke settings.
To understand the oral health knowledge, attitudes and practices of stroke patients.
To explore the acceptability and feasibility of the IDeAS program from the perspective of acute stroke nurses, rehabilitation professionals and stroke patients.
INFORM AF: Improving atrial fibrillation self-care.
Western Sydney University & Western Sydney Local Health District
Heart Foundation (2019- 2021)
Atrial fibrillation (AF) is the most common heart rhythm disorder. Patients with AF are at a 3-5 fold increased risk of developing a stroke. Stroke prevention medications (anticoagulation) help reduce the risk of stroke in patients with AF, but adherence to these medications is poor. Improving patients knowledge about AF and their medications may help to improve adherence, self-care, quality of life and the overall quality use of these medications. This fellowship will support the design, development, implementation and evaluation of a new model of care to improve self-care of AF in the Greater Western Sydney area. This approach will combine group education sessions, case based learning scenarios, and an app based (mHealth) intervention with an aim to improve adherence to anticoagulation. Self-management programmes that teach patients and empower them to take responsibility for their own management of anticoagulation warrant investigation. A recent UK study highlighted that patient self-testing and self-management programmes that augment education and telehealth approaches present a safe, sustainable and acceptable model of care for individuals with routine anticoagulation monitoring and management needs. It is important to expand these anticoagulation self-management programmes to atrial fibrillation self-care. There is need to translate such interventions into to the Western Sydney context to meet the needs of it’s culturally and linguistically-diverse population.