Coping with the effects of myocardial infarction from the viewpoint of patients' spouses

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.

Resistance to change: Role of relationship and communal coping for coronary heart disease patients and their partners in making lifestyle changes

Background: Lifestyle behaviours are important risk factors for coronary heart disease (CHD) and, hence, motivation for lifestyle changes is suggested to be a key factor in the success of cardiac rehabilitation and secondary prevention programmes. The motivation for changing lifestyle among people with CHD may be influenced by those with whom they have long-term, intimate relationships. Aims: This study explores the role of the relationship between people with CHD and those closest to them in making lifestyle changes. This includes investigating if patients and partners experience autonomy, competence, and relatedness, and what role communal, i.e. relationship-centred coping serves in relation to patients’ health behaviour. Methods: The study is based on semi-structured, in-depth interviews with 10 couples; people who have experienced acute coronary syndrome, and their partners. Participants had diverse histories of disease and social backgrounds. A three-stage interview process was undertaken including focus group interviews, couple interviews and individual interviews. A thematic analysis, inspired by the self-determination theory and the interdependence theory, was conducted. Results: Communal coping is evident in various forms, and at different levels, among people with CHD and their partners. Satisfaction with new lifestyle, ownership of change, confidence in ability to change, and emotional distress are all factors that affect how couples deal with lifestyle changes in the aftermath of CHD. Conclusions: Rehabilitation efforts, aimed at lifestyle changes, need to address each individual, as well as the dyadic interaction within couples. Incorporating a dyadic perspective in the rehabilitation process may lead to a reduction in motivational barriers to lifestyle changes.

The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress

BACKGROUND

As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients' construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future.

AIM

An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX).

METHOD

A phenomenological-hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28-67 years).

RESULTS

Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR's whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional's perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life.

CONCLUSION

This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.

Patient perceptions of nurse mentors facilitating the Aussie Heart Guide: A home-based cardiac rehabilitation programme for rural patients

AIM

To explore and describe long-term thoughts and perceptions of the Aussie Heart Guide Programme including the role of the mentor, held by patients recovering from myocardial infarction.

DESIGN

A qualitative design.

METHODS

Thirteen patients recovering from myocardial infarction who were unable to attend a hospital-based or affiliated outpatient cardiac rehabilitation programme were interviewed by telephone at the completion of the programme and asked to describe the relationship with their assigned nurse mentor and their perception of the audiovisual used in the programme.

RESULTS

Three themes emerged; assisting me to cope, supporting me and my family and tailoring the programme to my needs. Patients were satisfied with the programme and appreciative of the supportive and caring relationships provided by mentors during their hospitalization through to their discharge from the programme.

Thinking big, supporting families and enabling coping: the value of social work in patient and family centered health care

Patient and family-centered care has become a focus in health services. Social work has a rich history of providing responsive patient care. This study identified the contribution and value of social work to PFCC from the key stakeholder perspectives of health social workers (n = 65). Utilizing interpretive description, four themes emerged: (1) Thinking big and holistically, (2) Intervening with families, (3) Enabling patient and family coping, and (4) Maximizing hospital and community resources. Barriers included a lack of power, professional isolation and role creep. Implications for research and practice are provided.

"I tell my partner everything . . . (or not)": patients' perceptions of sharing heart-related information with their partner

This study is grounded in theories of information management. Patients with a diagnosed heart-related condition (N=253) completed a survey regarding their perceptions of sharing/not sharing information with a partner about their health condition. Data were analyzed using descriptive and inferential statistics. Results indicated that although most patients reported sharing "everything" with their partner, others reported not sharing certain topics such as health issues and physical symptoms/ailments. In addition, patients who reported sharing everything with a partner reported significantly greater communication efficacy, and breadth, depth, and frequency of communication about a heart-related condition compared with those who reported not sharing certain topics. Finally, as hypothesized, there were no significant group differences in terms of sharing specific physical and psychological health information. We discuss the findings and implications of the study for nursing practice.