Pictogram use during chest pain nurse specialist consultations in regional New Zealand: Patient experiences and clinical outcomes

Heart disease is the leading cause of morbidity and mortality in New Zealand. Ischemic heart disease is the single biggest killer of New Zealanders’ and the highest-ranked cause of premature death. The Heart Foundation reminds us “every 90 minutes a New Zealander dies from heart disease.” Maori have an increased risk of early heart disease and can develop disease ten years earlier than non-Maori. Within the existing health system, there are inequalities in disease rates and outcomes. The burden being geographically and economically significant in Hauora Tairawhiti, New Zealand. Extended nursing roles in New Zealand are currently in place to support Chest Pain Clinics. One of the purposes of this clinic is to review symptoms and determine whether further investigations for detecting medically important coronary artery disease are required. Chest pain is subjective and is the patient’s perception. Obtaining pain history can be difficult when verbal articulation is limited. This study’s concern is that if the nature and characteristics of pain are not accurately conveyed, investigations and treatment may be delayed. This study aimed to determine whether the use of a pictogram tool assists patients, regardless of health literacy competence, to accurately recall and describe their chest pain experience during the nurse-led consultation. Patients’ experiences using the pictogram tool during their Rapid Access Chest Pain Clinic consult were obtained by audio recorded interviews that were subsequently analysed for emergent themes. To determine whether the information gained from the pictogram-facilitated consults directed the patient into the correct treatment pathway line of care a retrospective audit of clinical outcomes occurred between two separate years one with and one without pictogram use. Ten participants were interviewed, ethnicity included (five Maori and five non-Maori). Five key themes emerged from the qualitative responses of the pictogram consultations. These key themes identified what counts as effective communication. The data suggests that the participant's engagement with the pictogram was ‘easy’ and facilitated communication, and was a responsive approach across cultures in keeping with the Treaty of Waitangi principles. Quantitative results showed an increase in the proportion of Rapid Access Chest Pain Clinic attendees being referred for functional investigations for cardiac sounding ischemia in the cohort of patients who had consultations facilitated by the pictogram compared to those who had not. This increase was observed within Maori only. There was no increase in the proportion of negative follow-up tests or revascularisation rates between the two years indicating that the accuracy of assessment and referral remained consistent across the years. Collectively, these results support the notion that the introduction of the pictogram along with other strategies to reduce communication barriers facilitated, particularly those associated with culture. In conclusion, the results presented in this thesis support the use of the pictogram tool for chest pain symptom communication.

Name thesis:degree_name

Master of Nursing

Level thesis:degree_level

Masters

Grantor

Eastern Institute of Technology (EIT)

Year dc:date.issued

2019

Author dc:creator

• Low, Tracy

• New Zealand
• Tairāwhiti
• heart disease
• chest pain
• pictogram tool
• communication
• patient experiences
• outcomes
• interviews

Statement dc:rights

• All rights reserved

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10652/6041

OAI identifier oai:identifier

oai:null:10652/6041