Striving for balance in daily life: experiences of Swedish women and men shortly after a myocardial infarction

Experience and Perceptions among Older Outpatients after Myocardial Infarction following an Exercise Intervention: A Qualitative Analysis from the PIpELINe Trial

Traditional cardiac rehabilitation (CR) programs effectively improve physical performance and outcomes after myocardial infarction (MI). However, older patients are less likely to participate in such programs. The aim of this qualitative analysis was to investigate experiences and perceptions of cardiac outpatients enrolled in an innovative and exercise-based CR program and to identify possible barriers to improving adherence and quality of life. Semi-structured interviews were conducted on a sample of 31 patients (84% male; age 76 ± 6 years) from the Physical Activity Intervention in Elderly after Myocardial Infarction (PIpELINe) trial, after about six months of the event. Three main themes were identified: Personal feelings after the event; lifestyle change and perception of barriers; and relationships with familiars. Participants perceived sensations of fear at the time of their diagnosis and showed awareness of the importance of following specific health suggestions. They reported a significative change in previous habits and highlighted the need for periodic controls. Few of them felt insecure in carrying out daily activities or practicing exercise and reported an unnecessary protection from the family members. These findings will provide valuable insights for the development of a more feasible patient-centered CR model of intervention.

Mastery of everyday life and social support needs in older vulnerable women with myocardial infarction and their relatives: a qualitative study

AIMS

The Danish public healthcare system provides a comprehensive cardiac rehabilitation (CR) programme, but attendance rates are low among older vulnerable women. Effective interventions enabling increased CR attendance are warranted. Knowledge about everyday life and social support needs is crucial to the development of effective CR interventions in this group. To explore mastery of everyday life and social support needs in older, vulnerable women with myocardial infarction (MI) and their relatives.

METHODS AND RESULTS

A qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 21) and their relatives (n = 13) and applying thematic analysis. Five themes captured mastery of everyday life and social support needs. 'The Big Picture' suggesting that comorbidities dwarfed the impact of MI. 'Blaming the Doctor' illustrated issues of distrust and treatment delay. 'Rehabilitation Barriers' explained why these vulnerable patients failed to participate in CR. 'Caregiver Concerns' described relatives dual roles as supporters and supported. 'Finding their Way' indicated how patients were assisted by peer support to negotiate the trajectory.

CONCLUSION

The study offers a basis for the development of CR interventions customized to this group of patients. Interventions should target patients with multimorbidity, low motivation for lifestyle changes, and transportation issues. Peer support is suggested for this group of patients where relatives are also apt to be vulnerable.

What Do We Know About Young Adult Cardiac Patients' Experience? A Systematic Review

Background: Studies interested in patients coping with a cardiac illness usually focus on children, teenagers, and adults above the age of 55. Apart from the field of congenital heart diseases, there is a general lack of literature regarding young adult cardiac patients (18-55 years old) who seem to cope with psychosocial issues. Therefore, the objective of this paper was to gather all the research carried out concerning the psychological experiences of young adult cardiac patients. Methods and Results: A comprehensive, systematic review was conducted on quantitative, qualitative, and mixed-method studies in PsycINFO, PubMed, ScienceDirect, and Cochrane Library databases. Out of the 10,747 articles found, 32 were included. While we aimed to include many cardiac diseases, coronary patients dominated the data. Five main themes emerged: emotional states (depression, anxiety, emotional distress, and stress), quality of life (health-related quality of life, physical functioning, and sexuality), adjusting to the medical environment (coping with the disease, health behavior change, financial barriers, and interactions with medical professionals), social life (social support and work), and identity (parenthood, new challenges, and new meanings). The results highlighted that their levels of depression, anxiety, stress, and quality of life were sometimes worse than in the general population and than in older and younger patients coping with a cardiac illness. Social isolation, identity changes, work, and parenthood were the specific challenges that this population had to face. Furthermore, young adult cardiac patients showed worse health behavior profiles than the general population and felt that they lacked information from professionals, especially regarding sexuality. Compared to men, women had worse psychosocial outcomes, especially regarding depression, stress, emotional distress, and quality of life. Conclusions: Young adult cardiac patients are to be considered with their own identity and challenges. They may be in need of specific interventions, some dedicated to women, and better communication is necessary with their families and professional caregivers so as to improve the patient's mental health, quality of life, coping skills, and adherence.

Partners' experiences of living with men who have screening-detected abdominal aortic aneurysms: A qualitative descriptive study

AIM

To describe partners' experiences of living with men with a screening-detected abdominal aortic aneurysm (AAA).

BACKGROUND

Diagnosis of a chronic life-threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life-threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well-being, it is still unclear how it affects their partners.

DESIGN

Qualitative descriptive design.

METHODS

Twenty-one partners of men with AAA were purposely selected to participate in individual semi-structured interviews between August 2017-February 2018 in Sweden. Data were transcribed and imported into NVivo-12^® . The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist.

RESULTS

Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle.

CONCLUSION

The partners' well-being and daily lives were impacted by the awareness of the screening-detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories.

RELEVANCE FOR CLINICAL PRACTICE

The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information.

Patients' Experiences of Cardiovascular Health Education and Risk Communication: A Qualitative Synthesis

Coronary heart disease (CHD) has no cure, and patients with myocardial infarction are at high risk for further cardiac events. Health education is a key driver for patients' understanding and motivation for lifestyle change, but little is known about patients' experience of such education. In this review, we aimed to explore how patients with CHD experience health education and in particular risk communication. A total of 2,221 articles were identified through a systematic search in five databases. 40 articles were included and synthesized using thematic analysis. Findings show that both "what" was communicated, and "the way" it was communicated, had the potential to influence patients' engagement with lifestyle changes. Communication about the potential of lifestyle change to reduce future risk was largely missing causing uncertainty, anxiety, and, for some, disengagement with lifestyle change. Recommendations for ways to improve health education and risk communication are discussed to inform international practice.

Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study

Background

In managing a life with coronary heart disease and the possibility of planning and following a rehabilitation plan, patients’ empowerment and self-efficacy are considered important. However, currently there is limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical characteristics associated with patient empowerment are not known.

The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment, general self-efficacy and other related factors such as quality of life and demographic variables.

Methods

A sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital. Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records and interviews.

Results

The mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and 3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak (r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment (Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient empowerment and current self-rated health. General self-efficacy was not independently associated with any of the variables.

Conclusions

Patients with a diagnosis of coronary heart disease reported high levels of empowerment and general self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health care.

Trial registration

NCT01462799.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0749-y) contains supplementary material, which is available to authorized users.

Women's Sexual Issues After Myocardial Infarction: A Literature Review

BACKGROUND

Sexual activity after myocardial infarction (MI) is a concern for patients and often a challenge for health care professionals to address. It is widely recognized that most patients, of both sexes, report sexual problems or concerns after MI. However, there are reported differences between men and women. Women with sexual concerns may seek less help from health care providers and are more inclined to conceal them because of cultural barriers.

OBJECTIVE

The aim of the current study is to present a comprehensive review of the literature describing women's sexual issues after MI.

METHOD

A systematic search of the relevant literature was performed within international databases, including PubMed/Medline, Scopus, ScienceDirect, and ProQuest, as well as Google Scholar using relevant keywords. Also, Persian electronic databases such as Magiran, Scientific Information Databases, and Iran Medex were searched from the inception to October 2014. Articles focusing on the sexual issues after MI only in women, as well as articles on both sexes where women's results could be separated, were included in this review.

RESULTS

A total of 8 articles were included in the final dataset. The main themes of women's sexual concerns after MI were "loss or decrease of sexual activity," "dissatisfaction of sexual relationship," "doubt about resumption time of sexual activity," "fear of reinfarction or sudden death during sexual activity after MI," "knowledge deficit regarding sexual activity after MI," and "poor performance of health care providers in sexual counseling."

DISCUSSION

The results of this review demonstrate that women's post-MI sexual activity is affected by many concerns. The concerns may be a knowledge deficit related to not receiving necessary consultation on this topic. Nurses, as first-line care givers, can provide appropriate consultation and education for patients post-MI. As a result, breaking taboo imposed by cultural barriers, personal assumptions, or lack of confidence on giving sexual consultation may ultimately help patients to improve their quality of life.

Factors associated with anxiety and depression in hospitalized patients with first episode of acute myocardial infarction

Introduction

Evaluation of anxiety and depression in cardiac patients is an area of nursing practice that is frequently neglected. The aim of the study was to explore anxiety and depression in hospitalized patients with their first episode of acute myocardial infarction.

Material and methods

The study sample included 148 hospitalized patients who had a first episode of acute myocardial infarction. Data collection was performed by the interview method using a specially designed questionnaire which included socio-demographic, clinical and other patients’ characteristics as well as the Hospital Anxiety and Depression Scale (HADS) to assess patients’ levels of anxiety and depression.

Results

Analysis of data showed that 52% and 38% of participants had high levels of anxiety and depression, respectively. Furthermore, anxiety levels revealed a statistically significant association with anxiolytics (p = 0.005) and antidepressant medication (p = 0.026) in hospital, the belief that they will face difficulties in relations with the social and family environment (p = 0.009 and p = 0.002, respectively) and whether they considered themselves anxious (p = 0.003). Depression was statistically significantly associated with education level (p = 0.001), profession (p = 0.007), antidepressant medication in hospital (p ≤ 0.001), patients’ relations with nursing staff (p = 0.019) and patients’ belief that they will face difficulties in relations with the social and family environment (p ≤ 0.001 and p ≤ 0.001, respectively).

Conclusions

The results showed that socio-demographic and clinical characteristics should be taken into serious consideration when exploring anxiety and depression in patients with a first episode of acute myocardial infarction in order to implement appropriate interventions.

The emotional challenges of conducting in-depth research into significant health issues in health geography: reflections on emotional labour, fieldwork and life course

Emotions are increasingly being recognised and integrated into human geography and it has been highlighted that focusing on the 'interrelatedness' of the research process is crucial. By contextualising fieldwork within the life course of the researcher, greater acknowledgement of the 'emotional labour' involved in fieldwork can be highlighted. The author reflects on the 'emotional geographies' of conducting PhD research into significant health issues with participants who had recently suffered a heart attack in Fife, Scotland. This paper reveals emotions involved in this kind of research, drawing on perspectives from participants as well as the researcher. The author also draws attention to, and reflects on, the lack of engagement with researcher's emotional labour within formal academic structures, such as research training and ethics application processes. Reflecting on fieldwork experiences from a distance, the author discusses the influence and impact of her emotional experiences of fieldwork. This paper contributes to work concerned with emotions and fieldwork in geography and asserts that greater importance and value needs to be given to this type of emotion work as embedded and situated within researchers' life courses.

Another Chance at Life: Jordanian Patients' Experience of Going Through a Myocardial Infarction

BACKGROUND AND PURPOSE

Myocardial infarction (MI) is a life-threatening health condition that has physical, spiritual, emotional, and social changes. Understanding feelings and thoughts of patients who suffered MI attacks is essential to recovery. Among Jordanian patients who suffered an acute attack of MI, the aim of the study was to describe the experiences and the varied meanings that they assign to their experiences.

METHODS

A qualitative hermeneutic phenomenological research design was used. Five participants were engaged in in-depth semistructured interviews. The participants were identified using a purposeful sampling technique, after being admitted at a coronary care unit in a university hospital located in Amman, the capital city of Jordan. The hospital provides a full range of cardiovascular medical and surgical care for patients admitted from different socioeconomic levels. Transcribed data were analyzed following inductive qualitative content analysis method.

RESULTS

The experience of MI was a traumatizing event characterized by life-threatening symptoms, and participants feared they would not come back home. However, cultural values and religiosity among the Jordanian patients played a major role in facilitating their positive coping during and after the MI attack. The participants' recount of their experience was summed-up into 5 major themes: frightening experience, needed support, religiosity, experiencing changes, and lifestyle modifications. After the MI attack, most of the participants felt that they had given another chance to live, showing a pressing need to make healthier lifestyle modifications to avoid another MI attack.

IMPLICATIONS FOR PRACTICE

Health care workers should need not only pay attention on physical and physiological caring aspects but should also consider other patients' needs, while supporting the patients and their family members.

Perceived needs for attaining a 'new normality' after surviving myocardial infarction: A qualitative study of patients' experience

Background: A comprehensive understanding of the various aspects of patients’ myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many uncertainties they face and help them to stabilize their lives after the disruption they experienced.

Objectives: To explore MI patients’ experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals.

Methods: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis.

Results: Three main themes and explanatory models emerged from the data analysis: a good adaptation – the ‘new normality;’ maladjustment – a continuous search for a ‘new normality;’ and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about ‘my MI’ in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context.

Conclusion: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations.

KEY MESSAGES

Most MI patients achieve a new normality.

My physical identity is new: my body is different but still functional.

My personal identity is new: I am not the same as before, the disease is part of me, but I retain parts of my previous self.

Meanings of balance for people with long-term illnesses

The aim of this study was to elucidate meanings of balance in everyday life for people with long-term illnesses living at home. People living with long-term illnesses are in need of help and support to manage their daily lives. Twelve adults with extensive needs for help and support were interviewed. A phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that balance in everyday life for people with long-term illnesses means striving for independence through care and support in their surroundings. It was also important to be able to choose how their lives would be and to be with others who listened and understood them for who they are. By building a relationship with patients at an early stage of their illnesses, nursing staff have an opportunity to understand what people who are living at home with long-term illnesses need in order to achieve balance in their everyday lives.

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

OBJECTIVES

To evaluate the effectiveness of interventions used to support self-management, and to explore patients' experiences after acute coronary syndrome in relation to self-management.

DESIGN

Scoping review.

DATA SOURCES

Keyword search of CINAHL Plus, Medline, the Cochrane Library, and PsycINFO databases for studies conducted with adult population and published in English between 1993 and 2014.

REVIEW METHODS

From title and abstract review, duplicated articles and obviously irrelevant studies were removed. The full texts of the remaining articles were assessed against the selection criteria. Studies were included if they were original research on: (1) effectiveness of self-management interventions among individuals following acute coronary syndrome; or (2) patients' experience of self-managing recovery from acute coronary syndrome.

RESULTS

44 articles (19 quantitative and 25 qualitative) were included. Most studies were conducted in western countries and quantitative studies were UK centric. Self-management interventions tended to be complex and include several components, including education and counselling, goal setting and problem solving skills which were mainly professional-led rather than patient-led. The review demonstrated variation in the effectiveness of self-management interventions in main outcomes assessed - anxiety and depression, quality of life and health behavioural outcomes. For most participants in the qualitative studies, acute coronary syndrome was unexpected and the recovery trajectory was a complex process. Experiences of making adjustment and adopting lifestyle changes following acute coronary syndrome were influenced by subjective life experiences and individual, sociocultural and environmental contexts. Participants' misunderstandings, misconceptions and confusion about disease processes and management were another influential factor. They emphasised a need for ongoing input and continued support from health professionals in their self-management of rehabilitation and recovery, particularly during the initial recovery period following hospital discharge.

CONCLUSIONS

Evidence of the effectiveness of self-management interventions among people with acute coronary syndrome remains inconclusive. Findings from the patients' experiences in relation to self-management following acute coronary syndrome provided important insights into what problems patients might have encountered during self-managing recovery and what support they might need, which can be used to inform the development of self-management interventions. Theoretical or conceptual frameworks have been minimally employed in these studies and should be incorporated in future development and evaluation of self-management interventions as a way of ensuring clarity and consistency related to how interventions are conceptualised, operationalised and empirically studied. Further research is needed to evaluate self-management interventions among people following acute coronary syndrome for sustained effect and within different health care contexts.

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study

BACKGROUND

Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities.

OBJECTIVES

The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices.

DESIGN

This is a qualitative descriptive study.

SETTING

Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes.

PARTICIPANTS

Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center.

METHODS

Data were collected through semi-structured audio-recorded interviews that took place in their places of residents.

RESULTS

Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them.

CONCLUSION

Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their sociocultural context so that interventions to promote self-care are tailored accordingly.

Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and further involvement of relatives must be considered.

Role of the Lebanese family caregivers in cardiac self-care: a collective approach

AIMS AND OBJECTIVES

The purpose of this study was to explore perceptions of cardiac self-care among Lebanese family caregivers of cardiac patients. The specific aims were to describe the cultural context of cardiac care-giving in Lebanon and to explore the roles of family caregivers in enhancing self-care practices in patients with cardiac diseases.

BACKGROUND

The role of family caregivers in Lebanon, a country in the Middle East, is assumed to extend beyond care-giving to making decisions on behalf of the patient and assuming responsibility for patient care. To date, there has been no study done to empirically validate this impression.

DESIGN

The design of the study is qualitative descriptive that used semi-structured individual interviews with family caregivers of Lebanese cardiac patients.

METHOD

Thirteen family caregivers of cardiac patients were recruited from a referral medical centre in Lebanon. The participants were designated by their patients and interviewed in a place of their choice.

RESULTS

One overarching and three themes emerged from data analysis describing roles of family care givers in cardiac self-care. The overarching theme was: Family caregivers of Lebanese cardiac patients were unfamiliar with the term, concept and meaning of Self-Care. The moral and emotional duty to care for the family member stemmed from obligation and responsibility towards patients (theme I). Interdependent care (theme II) between cardiac patients and their families emerged as a significant cultural role. Family members play multiple supportive roles in care-giving namely emotional, informational and instrumental role (theme III).

CONCLUSION

In this study, family caregiver role is shown to be based in the sense of obligation and duty towards the sick family member who collectively provide different types of supportive care.

RELEVANCE TO CLINICAL PRACTICE

Nurses have to give significant importance to the family caregiver role as an integral part of any culturally sensitive patient/family intervention.

The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease

BACKGROUND

Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture.

PURPOSE

To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients.

DESIGN

Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon.

FINDINGS

The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II).

IMPLICATIONS FOR PRACTICE

Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs.

Patients’ Experiences of Sexual Activity Following Myocardial Ischemia

The purpose of this article is to describe patients’ experiences of sexual activity after suffering myocardial ischemia. We conducted semi-structured qualitative interviews with people who had suffered myocardial ischemia in the last 6 to 24 months before the interview. We used maximum variation sampling method. After reaching theoretical saturation, a 19-informants sample was formed. Data were analyzed using the Giorgi method. Four themes were identified: “sexual activity becomes different,” “determinants of the return to sexual activity,” “how sexual activity ought to be,” and “sexual information received.” Patients showed a decrease both in frequency and desire for sexual activity influenced by fear of sexual activity and health care professionals’ recommendations. These recommendations were about “avoiding sexuality at the beginning” and conducting “sexual activity without overdoing it.” Health care professionals should educate patients about the right time to resume sexual activity. Nurses can help patients to deal with fears related to sexual activity.

Lifestyle advice and lifestyle change: to what degree does lifestyle advice of healthcare professionals reach the population, focusing on gender, age and education?

Health promotion practice in health care has a high priority in the endeavour to achieve equal opportunities for health and diversity in health among the population. The purpose of the study was to investigate whether there is any connection between the lifestyle advice given by healthcare professionals and the lifestyle change of the population, focusing on age, gender and education level. The study is based on the data from a national population survey in Sweden in which 52 595 patients who had attended health care were interviewed by phone. The participants were asked whether healthcare professionals had raised the subject of lifestyle during the visit and whether the advice they gave had contributed to a lifestyle change. The results indicated that lifestyle issues were raised with 32.2% of those who attended health care, particularly among men, younger patients and those with a high education level. When lifestyle issues were raised, the advice contributed to 39.2% of patients making a lifestyle change, to a higher extent among men, older patients and those with a low education level. The study shows that lifestyle advice given by healthcare professionals, during both emergency and outpatient healthcare visits, is an important contributor to patients' lifestyle change.

Strategies for recreating normal life: Iranian coronary heart disease patients' perspectives on coping strategies

AIMS AND OBJECTIVES

To identify coping strategies used by Iranian patients with coronary heart disease.

BACKGROUND

One of the most important nursing interventions is facilitating adjustment for patients. A deeper understanding of patients' coping strategies for controlling illness and its consequences is needed.

DESIGN

A qualitative design.

METHODS

Participants were hospitalised patients diagnosed with coronary heart disease, based on documented angiographic results. A qualitative study using semi-structured interviews was conducted, and purposive sampling was performed. The qualitative content analysis determined categories and subcategories for describing and understanding coping strategies.

RESULTS

The term 'coping strategies' refers to the strategies used by participants living with coronary heart disease as they attempt to understand and control their chronic condition and return to a social and physical state as similar to their predisease condition as possible. During the data analysis, six strategies emerged: searching for meaning and information; trying to achieve comfort and control; resting more, doing less and slowing down; motivating, prioritising and caring for self; turning to religion and spirituality; and expectations and receiving assistance and support.

CONCLUSIONS

This qualitative study describes the coping strategies of Iranian patients with coronary heart disease and the commonalities with strategies for others dealing with chronic illnesses in Iran. The patients were found to use a variety of coping strategies to deal with their illness and its impacts on their lives.

RELEVANCE TO CLINICAL PRACTICE

This study contributes to the existing body of knowledge about optimal nursing care strategies for patients with coronary heart disease. Through increasing awareness of coping strategies, nurses can help their patients employ the most effective tools and reinforce constructive successful coping styles for patients who are dealing with coronary heart disease.

Coronary heart disease patients transitioning to a normal life: perspectives and stages identified through a grounded theory approach

AIMS AND OBJECTIVES

To explore how Iranian patients with coronary heart disease experience their lives.

BACKGROUND

Coronary heart disease is a leading cause of death in Iran and worldwide. Understanding qualitatively how patients experience the acute and postacute stages of this chronic condition is essential knowledge for minimising the negative consequences of coronary heart disease.

DESIGN

Qualitative study using grounded theory for the data analysis.

METHODS

Data for this study were collected through individual qualitative interviews with 24 patients with coronary heart disease, conducted between January 2009 and January 2011. Patients with angina pectoris were selected for participation through purposive sampling, and sample size was determined by data saturation. Data analysis began with initial coding and continued with focused coding. Categories were determined, and the core category was subsequently developed and finalised.

RESULTS

The main categories of the transition from acute phase to a modified or 'new normal' life were: (1) Loss of normal life. Experiencing emotions and consequences of illness; (2) Coming to terms. Using coping strategies; (3) Recreating normal life. Healthcare providers must correctly recognise the stages of transition patients navigate while coping with coronary heart disease to support and educate them appropriately throughout these stages.

CONCLUSION

Patients with coronary heart disease lose their normal lives and must work towards recreating a revised life using coping strategies that enable them to come to terms with their situations.

RELEVANCE TO CLINICAL PRACTICE

By understanding Iranian patients' experiences, healthcare providers and especially nurses can use the information to support and educate patients with coronary heart disease on how to more effectively deal with their illness and its consequences.

I've lost the person I used to be--experiences of the consequences of fatigue following myocardial infarction

Fatigue has been found to be the most frequent and bothersome symptom after myocardial infarction (MI), influencing health-related quality of life negatively. Moreover, fatigue after MI has been described as incomprehensible due to its unpredictable occurrence and lack of relationship to physical effort. The aim of this study is therefore to explore persons' experiences of consequences of fatigue and their strategies for dealing with it 2 months after MI. In total, 18 informants, aged 42-75 years, participated in the study. Interviews were conducted and analysed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category, was: I've lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Furthermore, attempts to relieve fatigue were limited. These findings indicate that patients with symptoms of fatigue should be supported in developing relief strategies, for example, rest and sleep hygiene as well as physical activity. In conclusion, the results show that fatigue can be understood in light of the concepts "comprehensibility" and "manageability." They also indicate that, working from a person-centered perspective, health-care professionals can support patients experiencing post-MI fatigue by giving them opportunities to straighten out the question marks and by inviting them to discuss involuntary thoughts and feelings of being restricted in their daily life functioning.

The experience of younger adults following myocardial infarction

The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.

A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral

BACKGROUND

Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood.

METHODS

A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995.

RESULTS

Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients' decisions to attend. The main personal factors affecting attendance after referral included patients' knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influenced patient attendance, including family and, less commonly, health professionals. Regardless of the perceived severity of heart disease, patients could view risk as inherently uncontrollable and any attempts to manage risk as futile.

CONCLUSIONS

Decisions to attend programs are influenced more by social factors than by health professional advice or clinical information. Interventions to increase patient attendance should involve patients and their families and harness social mechanisms.

Psychology and Theology Meet

This descriptive exploratory study explored illness appraisal and spiritual coping of three groups of individuals with life-threatening illness. These were hospice clients with cancer (Ca; n = 10), clients with first myocardial infarction (MI; n = 6), and parents of children with cystic fibrosis (CF; n = 16). Qualitative data were collected by audiotaped face-to-face interviews (parents) and focus groups (MI and Ca). Similarities in illness appraisal and spiritual coping were found across the three groups except appreciation of crafts, which was found only in clients with Ca and causal meaning of parents (CF). Overall, illness was appraised negatively and positively, whereas spiritual coping incorporated existential and religious coping. These findings confirm the psychological theory (Lazarus & Folkman, 1984) and theological theory (Otto, 1950), which guided this study. Recommendations were proposed to integrate spirituality and religiosity in the curricula, clinical practice and to conduct cross-cultural comparative longitudinal research.

Depressive symptoms after a myocardial infarction and self-care

This descriptive study examined depressive symptoms impacting the performance of self-care behaviors in patients (N = 62) who have experienced a myocardial infarction (MI). Having had a prior MI is inversely associated with decreased self-care behaviors at 30 days. Depressive symptoms of agitation and loss of energy significantly impacted self-care performance 30 days after discharge from the hospital. A variance of 21% (P < .05) in patients who experienced a prior MI and exhibited depressive symptoms of agitation and loss of energy at 30 days suggests patient vulnerability after discharge and a window for therapeutic interventions.

Six year stability of Type-D personality in a German cohort of cardiac patients

OBJECTIVE

The aim of the study was to systematically analyze the stability of Type-D personality over a time span of several years in a clinical sample.

METHODS

In a prospective cohort study, cardiac patients from different medical settings in Germany were assessed using the DS14 questionnaire at baseline (n=1240) and at a mean follow-up time of six years (n=679). Different types of stability were examined and compared with the stability of the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Rank-order stability was moderate (r=.61 for Negative Affectivity [NA] and r=.60 for Social Inhibition [SI]) and didn't differ from the rank-order stability of the HADS. Whereas the mean level of SI didn't change over time, the mean level of NA increased (d=0.08). On an individual level, approximately one quarter of the participants showed a significant increase or decrease. The factorial structure of the DS14 was stable over time. Finally, the agreement of Type-D classification between the two measurement points was moderate (κ=.42) with 22% of the participants changing their Type-D classification over time.

CONCLUSION

The stability of NA and SI didn't differ from the stability of measures of emotional distress that are generally considered to be less stable. In particular, the only moderate stability of the dichotomous Type-D classification raises some questions.

Systematic review of cardiovascular disease in women: assessing the risk

Cardiovascular disease is the number one cause of death for women. In an effort to reduce cardiovascular burden for women, identifying risk factors and increasing awareness of sex differences are fundamental. This systematic review examines cardiovascular disease risk for women. A search of the literature was undertaken using key health databases. Search terms used were cardiovascular disease AND women OR gender. Additional references were manually identified from this literature; 58 articles were reviewed in total. On average, cardiovascular disease presents 10 years later in women compared to men. By this time, they are more likely to suffer from more comorbidities, placing them at higher risk. The complexity of cardiovascular disease identification in women is accentuated through atypical symptoms, and has the potential to lead to delayed and/or misdiagnosis. It is clear through identifying sex differentiation in cardiovascular risk factors that there has been an increased awareness of symptom presentation for women. In light of the sex differences in risk factors, sex-specific aspects should be more intensively considered in research/practice to improve clinical outcomes for female cardiovascular disease patients.

Calibrating and adjusting expectations in life: A grounded theory on how elderly persons with somatic health problems maintain control and balance in life and optimize well-being

AIM

This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this.

METHOD

In total, 14 individuals (mean=74.2 years; range=68-86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method.

RESULTS

The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life.

CONCLUSION

The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being.

Couples' thoughts about and expectations of their future life after the patient's hospital discharge following acute myocardial infarction

AIM

To describe and interpret couples' thoughts and expectations about their future life after the patient's discharge following acute myocardial infarction.

BACKGROUND

An acute myocardial infarction is a challenge for both the patient and his/her partner, as it can disrupt family functioning and dynamics. Earlier research has generally focused on either the patient or the partner, and few studies have explored the experiences of the couple.

DESIGN

Qualitative descriptive and interpretative.

METHODS

Fifteen couples took part in individual interviews, 4-8 weeks after discharge. Data were analysed in two phases using qualitative content analysis.

RESULTS

The first phase of the analysis revealed two categories: 'an active approach to the future' and 'a wait-and-see approach to the future', both of which described the participants' thoughts about the future. In the second phase, the couples' stories were interpreted and grouped into four positions: 'the life companions', 'the tightrope walkers', 'the pathfinders' and 'the observers', which illustrated their visions of the future.

CONCLUSIONS

Our results reveal differences in the couples' thoughts about and expectations of their future life, most of them managed the situation by having a positive attitude to life and their future. The couples discovered their resources and compensated for or balanced each other in the early recovery period.

RELEVANCE TO CLINICAL PRACTICE

The results indicate the importance of giving both partners the opportunity to express their views of the situation, as this increases nurses' understanding of the impact of the illness on their life and relationship. However, the results also highlight the significance of seeing the couple and showing them consideration both as individuals and as a unit.

Knowledge of heart disease risk in patients declining rehabilitation

BACKGROUND

Participation in cardiac rehabilitation programmes (CRPs) allows patients to increase their knowledge of the importance of established risk factors to help them maintain healthy lifestyle changes after coronary heart disease (CHD).

AIM

To explore perceived importance and knowledge of known risk factors for CHD among non-attendees in CRPs.

METHOD

Consecutive non-attendees in CRPs (n=106) answered a questionnaire focusing on patients' attitudes towards risk factors and cardiac rehabilitation.

RESULTS

The non-attendees lacked knowledge of non-physical characteristics such as depression and social isolation. They also had poor knowledge about biological causes and hereditary factors. However, those who said they knew enough about CHD to prevent recurrent illness did have sufficient knowledge about the established risk factors.

CONCLUSION

There is a lack of knowledge about social isolation and depression and their importance in the development of CHD among the non-attendees. They show greater knowledge about biological risk factors than the importance of companionship, joy and happiness. CHD and loneliness are intimately correlated, so creating a sense of belonging must not be underestimated as a measure to prevent CHD.

Patients' Perspectives on Cardiac Rehabilitation, Lifestyle Change and Taking Medicines: Implications for Service Development

Objectives

Cardiac rehabilitation programmes offer eligible coronary heart disease patients information on lifestyle modification and medicines. Our aim was to understand patients' perspectives on these topics.

Methods

In-depth qualitative interviews were conducted and audiotaped with 15 patients approximately three months after hospital discharge, after they had completed a hospital-based cardiac rehabilitation programme. Repeat interviews with ten patients explored whether their perspectives had changed when interviewed again approximately nine months later.

Results

Patients tended to talk about the exercise component of cardiac rehabilitation and only talk about the information provision component when prompted, which suggested they viewed the programme as being primarily about exercise. They seemed to have little subsequent contact with health services, except routine six-monthly check-ups for their coronary heart disease. Unmet information needs were common, especially about medicines. Nevertheless, all patients reported continuing to take cardiac medicines, but tended to only maintain changes to aspects of lifestyle perceived as causes of coronary heart disease, rather than viewing lifestyle recommendations as standards to achieve.

Conclusion

Ensuring that individual patients' information needs about medicines and lifestyle are adequately met remains a key focus for cardiac rehabilitation development. Key aspects include individualizing information and actively seeking and responding to patients' needs during and after cardiac rehabilitation.

Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study

BACKGROUND

Most patients with minor stroke are discharged directly home from acute care, under the assumption that little will be required in the way of adaptation and adjustment because informal caregivers will manage the stroke recovery process. We explored male patients with minor stroke and their wife-caregivers' perceptions of factors affecting quality of life and caregiver strain encountered during the first year post-discharge.

METHODS

Data were obtained from responses to two open-ended questions, part of quality of life and caregiver strain scales administered to participants in a larger descriptive study. Conventional content analysis was used to assess narrative accounts of living with minor stroke provided by 26 male patients and their wife-caregivers over a period of 1-year post-discharge.

RESULTS

Two major themes that emerged from these data were 'being vulnerable' and 'realization'. Subthemes that arose within the vulnerability theme included changes to patients' masculine image and wife-caregivers' assumption of a hyper-vigilance role. In terms of 'realization' patients and their wife-caregivers shared 'loss' as well as 'changing self and relationships'. Patients in this study focused primarily on their physical recovery and their perceptions of necessary changes. Wife-caregivers were actively involved in managing the day-to-day demands that stroke placed on individual, family and social roles.

CONCLUSIONS

We conclude that patients and wife-caregivers expend considerable time and energy reestablishing control of their lives following minor stroke in an attempt to incorporate changes to self and their relationship into the fabric of their lives.

Adaptation Positions and Behavior Among Post—Myocardial Infarction Patients

This study explores myocardial infarction patients' experiences of adaptation to illness consequences after one year, focusing on experiences of “the self.” The study sample consisted of 19 respondents (10 women, 9 men) who have suffered a first-time myocardial infarction. They were interviewed 1 year after the acute heart attack. A constant comparative method for grounded theory provided the strategies used for data collection and analysis. Codes emerged and memos clarified theoretical reflections. The resulting model was able to illustrate possible mechanisms underlying two different behaviors: self-modifying and self-protecting behavior. Four different adaptation positions were identified: put up with current health, struggle for health, ignore illness , and struggle against illness. These categories were related to two core categories: self-agency and coping with illness consequences . This model may clarify the different adaptive behavior observed among post—myocardial infarction patients.

Managing consequences and finding hope--experiences of Swedish women and men 4-6 months after myocardial infarction

Research has focused more on symptoms, risk factors and treatment, than on individuals' experiences of illness and recovery after myocardial infarction (MI). Therefore, the aim of the study was to describe the experiences of present everyday life of women and men 4-6 months after MI and their expectations for the future. Semi-structured interviews were conducted with 20 women and 19 men from January 2000 to November 2001. Data were analysed with content analysis. Two themes, 'Managing consequences of MI' and 'Finding a meaning in what had happened', were generated. The first theme reveals that many of the patients had not established a stable health condition, even if symptoms and emotional distress had diminished over time. They had to manage health problems, lifestyle modifications, emotional reactions and changes in social life. The support from their social network encouraged them to move on. The second theme shows that patients also found positive consequences of what they had gone through, new life values and hopes in the future. The conclusions were that most of the patients moved on and began to regain a balance in everyday life, but some patients still struggled hard to find this balance. Those patients experienced large difficulties with managing their everyday life and felt a lack of support from their social network. Health professionals can be an important resource in helping patients in their adaptation to changes if they are more sensitive to patients' needs of support both in a short- and long-term perspective.

Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study

OBJECTIVE

To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status.

DESIGN

Multicentre study with a prospective short-term follow-up design.

SETTING

A university hospital, a central hospital and a district hospital in southern Sweden.

SUBJECTS

Consecutive sample of 246 patients with a suspect or manifest myocardial infarction.

MAIN MEASURES

The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables.

RESULTS

Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence.

CONCLUSIONS

Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.