الفهرس 
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Abstract
One of the cases of cardiovascular emergency is acute coronary syndrome (ACS)
which occurs suddenly. Delays in treatment cause the condition to worsen, so time is the
essence in the treatment of ACS patients; acute cardiac rehabilitation (ACR) is important to
reduce adverse effect of acute cardiac event. Management of nursing care that can be done to
maintain hemodynamic stability of ACS patients is the implementation of ACR. ACR
included physical rehabilitation, risk factors modification, nutrition counseling, and
psychological rehabilitation. The aim of this study was to determine the outcomes of implementing of cardiac
rehabilitation protocol for acute coronary syndrome patients in the acute phase. To
achieve this aim, a quasi-experimental research design was used to conduct this study.
This was done at the coronary care unit of the main university hospital in Alexandria.
This study included convenience samples from 60 adult conscious patients with ACS
who were recently admitted to the previously stated CCU. The sample was divided
into two equal groups (thirty patients in each): group ”A” was the control group, which
received unit usual care, and group ”B” was the study group, which received the early
cardiac rehabilitation protocol. The power analysis application (Epi-Info) was used to
compute the research sample size: population size = 100, expected frequency = 50%,
tolerable error = 5%, design effect = 1, confidence coefficient = 95%, and power =
80%.
Tools of the study: Two tools were used in this study for data collection. Tool one:
―physical outcomes of cardiac rehabilitation protocol assessment tool‖ This tool was
developed by the researcher after extensive review of the related literature. This tool
was used to determine the physical outcomes of implementing of ACR protocol for
acute coronary syndrome patients in the acute phase. It consisted of four parts: Part Ι ’’
Patients‘ Socio-Demographic and Clinical Data’’, Part ΙΙ ”Risk factors assessment”,
part III: Patient physiological outcomes and Part IV: Patient physical outcomes. Tool
two: the Depression, anxiety and stress scale. The Arabic version of the Depression,
anxiety and stress scale (DASS) was adopted from Moussa et al., 2016. This tool was
used to assess the emotional state of patients.
The ethics committee of the nursing faculty approved the study. Approval for the
study was received from the hospital’s responsible authority after an explanation of the
study’s purpose and receipt of an official letter from the Faculty of Nursing.
The main results of the current study: Sixty patients were recruited in the current
study. Regarding the age, 76.7% of the control group and 53.3% of the study group
were more than 50 years old. About three quarters (70.0%) of the control group were
males compared to (76.7%) in the study group. The most common encountered past
medical history in both groups was cardiovascular disorder (80.8%) and (85.2%) in
the control and study group correspondingly, followed by endocrine/metabolic
disorder in the control group was (57.7%) and in the study group.
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Summary
It was noted that (53.3%) of the control group and (70%) of the study group had no
previous admission to cardiac care units (CCUs) and no history of ACS. more than
half (63.3%) of the control group and (53.3%) of study group had not compliance with
prescribed medications. In relation to lifestyle risk factors, It was noted that more
than half (56.7%) of control group and (53.3%) of study group were smoker. As
regards body mass index 40% of control group had obesity in compere to 50% of
study group had overweight.
Regarding physiological parameter (vital signs) was improved in the study group more
than in the control group. Dependency of ROM improved in the study group more than
in the control group after protocol (73.3%) of the control group had independent ROM
and compare to study group was (93.3%). The Mean distance significant increase of
six minute walking test for control group was (24.30±4.36) compare to study group
was (27.30 ± 5.66).As regard depression, anxiety and stress level were significant
improved in the study group more than tae control group.
It can conclude that, Early Implementation of ACR by nurses may have reduced
progression to recurrent acute cardiac attacks and improved survival for patients in
hospital. Implementation of ACR significantly improved physiological and clinical
outcomes of patients, reduced length of hospital stay.
The most important recommendations of this study are as follow:
Recommendation regarding clinical practice: Critical care nurses (CCNs) should
conduct a baseline physical and psychological assessment for patients who are
suffering from acute cardiac attacks. Critical care nurses should implement ACR
protocol that is tailored to the patients’ needs and capabilities.
- Recommendations regarding education: Undergraduate critical care nursing courses
should incorporate the concepts of the ACR protocol for ACS patients focusing on its
positive outcomes. Regular CCNs meetings and conferences must be conducted on a
regular basis to discuss importance of ACR protocol for ACS patients.
Recommendations regarding administration: Standardized guidelines and
interventions must be available in the form of educational handouts provided to
nurses. Inclusion of psychological assessment scale in the nursing flow sheet both at
admission and discharge.
Recommendations regarding future research: A larger sample size is required for this
study to be replicated in order for the findings to be generalized. Future studies are
needed to determine whether the approaches used in this study may be translatable to
other organizations and care settings across the continuum of ACS management.