Assignment Task:
Stakeholders on Educational Intervention to Improve Therapeutic Adherence in Ischemic Heart Disease
In the Cardiac Care Unit at Mount Sinai Medical Center there is a large influx of patients with a high rate of readmissions due to ischemic heart disease and lack of therapeutic adherence is pointed out as an important factor. Therefore, an educational intervention by nursing is needed to improve therapeutic adherence of patients with Ischemic Heart Desease (IHD) at the Cardiac Care Unit at Mount Sinai Medical Center. The ultimate goal of the intervention is to improve cardiovascular stability and reduce the rate of hospital readmissions of patients with IHD over a period of two months, which will provide a measurable and objective result in terms of adherence to pharmacological treatment and lifestyle changes. To achieve these objectives, the participation of important stakeholders is needed, which will play a key role within the Cardiac Care Unit to successfully implement the nurse-led educational intervention, contributing with their experience and specific competencies in the different aspects of the project, ensuring its comprehensive and patient-centered implementation. Precisely the objective of this work is to describe the stakeholders, their functions and importance.
The primary stakeholder and manager of the team should be an advanced practice nurse (APN), due to their advanced clinical training and leadership skills. APNs are trained to conduct comprehensive assessments, identify barriers to therapeutic adherence, and design personalized educational interventions for patients with ischemic heart disease (Brunt & Bogdan, 2024). This professional, being the APN administrator of the cardiac unit, also has the ability to assign the necessary resources for the implementation of the project, including educational materials, technological tools and staff time. His/her logistical and administrative support is essential to overcome possible operational barriers and ensure that the intervention is sustainable over time (Brunt & Bogdan, 2024). His/her ability to lead the team, coordinate collaborative efforts with other health professionals, and monitor patients' progress ensures continuity and effectiveness of care (Boehning & Punsalan, 2024). In addition, as administrator, APN have the authority to manage resources, prioritize evidence-based strategies, and make critical decisions in real-time, ensuring project success. The team of cardiology nurse practitioners is also a critical component, as their specific clinical knowledge of cardiovascular disease and skills in health education complement the activities led by the APN (Vay-Demouy et al., 2023). These nurses will be responsible for running educational sessions, conducting initial and follow-up assessments, and monitoring individual patient progress, ensuring therapeutic goals are met.
The cardiologist is another key stakeholder, as their experience in the management of cardiovascular diseases ensures that recommendations on lifestyle changes and pharmacological adherence are aligned with current clinical protocols and are personalized. Their participation also strengthens the credibility of the intervention among patients and other members of the health team (Fernández-Rubio et al., 2022). The cardiologist can also participate in periodic clinical evaluation consultations that provide guidance on cardiovascular stability variables, in which his or her opinion on adjustments to the educational intervention could be very useful. It should be clarified at this point that the project does not contain within its objectives or guidelines, making changes in therapeutic protocols, but will be limited to educational methodology.
Another important actor is the nutritionist. Su is an essential role in guiding patients towards a cardioprotective diet, adjusting the recommendations to the individual needs of each patient. This is especially relevant to address metabolic risk factors for the development of atherosclerosis such as obesity, Diabetes Mellitus, Hyperlipoproteinemia, and Arterial Hypertension (Gupta & Wood, 2019; Iguacel et al., 2025). In the same way, the physiotherapist must also participate, to contribute to the design of adequate physical activity programs to improve cardiovascular health, promote sustainable habits over time, and achieve cardiovascular rehabilitation in the post-discharge period (Prabhu et al., 2020). In addition, patients with IHD face many fears related to physical activity, generally due to lack of knowledge about the specificities of the type of exercise they can perform, the duration, frequency and intensity, so their participation is essential to achieve adherence to healthy lifestyles, which is one of the objectives of the project (Saarikoski et al., 2024).
The social worker will provide a psychosocial approach. In the characterization of the patient population to which the intervention is directed, the social determinants of health, the heterogeneity of ethnic composition, the socioeconomic barriers that hinder therapeutic adherence were highlighted (Kris-Etherton et al., 2020) and a particularly worrying fact related to the predominant age over 75 years of age of patients with IHD, older adults being the most vulnerable (Fadah et al., 2022), with biopsychosocial limitations and who also in many cases live alone (National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults, 2020). Therefore, the role of the social worker is especially relevant in patients who face financial challenges, lack of social support, or conditions of vulnerability (Wagle et al., 2021).
Taking into account that In the state of Florida, about 29.9% speak a language other than English (Florida for Florida, n.d.) many of the patients with IHD face language barriers (Al Shamsi et al., 2020), so to achieve effective communication that is also essential for an educational intervention (Sharkiya, 2023), a professional health interpreter will be included in the team who will ensure communication with patients who face language barriers, improving their understanding of educational recommendations and strengthening their participation in treatment (Heath et al., 2023).
A statistical data analyst will be included whose responsibility will be to collect, analyse and interpret the data generated during the intervention, which will facilitate the assessment of the impact of the intervention and support evidence-based decision-making (Clarke et al., 2019). Their work is crucial to documenting results, measuring success indicators, and providing feedback for future improvements in strategy. Finally, patients and their families are direct stakeholders whose active participation is essential for the success of the project. Patients are at the center of the intervention and their collaboration, motivation, and commitment are essential to achieve goals related to therapeutic adherence, cardiovascular stability, and reduction of hospital readmissions (Kosobucka et al., 2022). Families, on the other hand, play a supportive role, providing an environment that reinforces lifestyle changes and treatment adherence (Wenn et al., 2022). Education and empowerment of both groups are essential to consolidate the expected results.
In conclusion, each stakeholder plays a specific role that contributes to the success of the educational intervention. Choosing an APN as the team manager is particularly relevant, as she combines clinical, educational, and management skills needed to effectively lead such a comprehensive, patient-centered project. The multidisciplinary approach ensures high-quality care that holistically addresses the needs of patients with ischemic heart disease.
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