If you’ve had a heart attack, changing your diet and getting more exercise is crucial to your recovery. But that’s not always easy. You’re more likely to make those changes and stick with them if you have help.
Patients in cardiac rehabilitation at Cheshire Medical Center/Dartmouth-Hitchcock Keene (CMC/DHK) in Keene, New Hampshire, can get that help through a program that’s in the forefront of the field. Professionals in several branches of medicine, including biological, social, and behavioral, are coordinating their care of rehab patients to improve the patients’ chances of better and enduring recovery.
Value for students
Advanced students in the Department of Clinical Psychology at Antioch University New England (AUNE), working alongside Dr. Vic Pantesco, director of AUNE’s Psychological Services Center, are part of that care. Their interventions are designed to improve the likelihood that patients will comply with a regimen—such as maintaining a better diet, exercising, not smoking and managing stress more effectively—that has been shown to extend their lives and their quality of life after heart attacks.
The innovative, integrated-care model benefits students as well as patients. Hannah Lord, now assistant director of the Psychological Services Center, was a senior mentoring student in the program, an experience she found invaluable. “Sitting with people at such a pivotal time in their lives gives you skills you can take with you into many settings,” Lord said. “You’re also working on a multidisciplinary team at a time when you’re beginning to develop your professional voice. That integrated care is what the field of medicine is moving toward.”
CMC/DHK has collaborated with AUNE’s Clinical Psychology department since 1997. A senior AUNE student, like Lord, works on the cardiac rehab unit under Pantesco’s direction, at the same time mentoring several second-year students. “It’s neat that things are firing in all directions. You’re a consultant to other professionals, being mentored by Vic and mentoring second-year students at the same time,” Lord said.
Working closely with a faculty member and with professionals in other disciplines is not yet typical in the field of psychology, Pantesco said. “Observing faculty doing the work is relatively rare, apart from practicum,” he said. “But these students are right at my elbow.”
Helping people to change
In the first four weeks of the program, the students observe Pantesco working with patients, a charge nurse and an exercise physiologist. In the second four weeks, they take on some of the work themselves. During the last weeks of the program, they shoulder the main responsibility, with Pantesco observing and supervising. The AUNE students also spend those twelve weeks of training learning how people change and ways to help mobilize them to make healthy changes such as quitting smoking and coping with stress.
“Cardiac health is particularly sensitive to stress,” Pantesco said. But stress is everywhere in our modern lives. The average number of daily “hooks,” or stressful events that can trigger a slip into eating doughnuts or lighting up a cigarette, is about fifty, he said. The key is to help patients plan ahead. “One of the big enemies of compliance is generality. Once you get specific about plans, you get it down to a place where you can do something about it, and the solutions can be quite elegant.”
“One of the ways we at the hospital give back to the community is to help educate incoming professionals,” said Donna Dubuc, director of development at CMC/DHK. “It’s part of our culture and something we really value, to be a training ground for students and interns who come in, learn and gain hands-on experience.
AUNE students have worked with about 900 cardiac rehab patients since the program began. Pantesco said the hospital’s assessment data shows that patients think very highly of the cardiac rehab program. “For me, it’s a real treat to have the opportunity to train a student at such depth while working in an area that I value so much.”