Launching Successful Beginnings for Early Career Faculty Researchers

Junior faculty follow a research path replete with challenges as they strive to create knowledge in their area of interest while balancing new responsibilities. Unlike graduate school, where students focus inward on personal development, junior faculty must add responsibilities in ways that hold them accountable as members of a university. This special article deals with three themes of interest to new junior faulty launching research programs: personal development, collaboration and team development within university settings, and funding advice. Strategies in these areas provide guidance on navigating early careers and finding success in the academic setting.

Selecting symptom instruments for cardiovascular populations

The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.

Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White

OBJECTIVES

To explore disparities between non-Hispanic Blacks and non-Hispanic Whites presenting to the emergency department (ED) with potential acute coronary syndrome (ACS).

BACKGROUND

Individuals with fewer resources have worse health outcomes and these individuals are disproportionately those of color.

METHODS

This prospective study enrolled 663 patients in four EDs. Clinical presentation, treatment, and patient-reported outcome variables were measured at baseline, 1, and 6 months.

RESULTS

Blacks with confirmed ACS were younger; had lower income; less education; more risk factors; more symptoms, and longer prehospital delay at presentation compared to Whites. Blacks experiencing palpitations, unusual fatigue, and chest pain were more than 3 times as likely as Whites to have ACS confirmed. Blacks with ACS had more clinic visits and more symptoms 1 month following discharge.

CONCLUSIONS

Significant racial disparities remain in clinical presentation and outcomes for Blacks compared to Whites presenting to the ED with symptoms suggestive of ACS.

Challenges and solutions for using informatics in research

Computer technology provides innovations for research but not without concomitant challenges. Herein, we present our experiences with technology challenges and solutions across 16 nursing research studies. Issues included intervention integrity, software updates and compatibility, web accessibility and implementation, hardware and equipment, computer literacy of participants, and programming. Our researchers found solutions related to best practices for computer-screen design and usability testing, especially as they relate to the target populations' computer literacy levels and use patterns; changes in software; availability and limitations of operating systems and web browsers; resources for on-site technology help for participants; and creative facilitators to access participants and implement study procedures. Researchers may find this information helpful as they consider successful ways to integrate informatics in the design and implementation of future studies with technology that maximizes research productivity.

Time management strategies for research productivity

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

Age and gender differences in social-cognitive factors and exercise behavior among Thais

The purpose of this study was to examine the relationship of perceived risk, outcome expectancies, and perceived self-efficacy to intention and in turn exercise behavior. A convenience sample of people 18 years or older (N = 645) was recruited from public locations in Thailand. A descriptive cross-sectional design was used with self-administered questionnaires. Path models were estimated using Amos 18. Outcome expectancies and perceived self-efficacy indirectly influenced exercise behavior via intention. Unexpectedly, perceived risk of heart disease did not contribute to the model. Differences were found across age and gender groups. The final models showed a better fit in the middle-aged group, χ2(1) = 0.374, p = .541, and in women, χ2(1) = 0.197, p = .657, than in younger individuals and men. Interventions that enhance intention to exercise through outcome expectancies and perceived self-efficacy may be effective. Interventions may be more effective if they target particular age and gender groups.

Publishing pilot intervention work

Pilot intervention studies can be viewed as rehearsals for subsequent full-scale trials. They can help investigators fine-tune later larger studies as well as explore issues related to project management and budget. Pilot studies permit testing of sampling strategies, participant recruitment, intervention content, delivery methods, data collection, and analysis. They also allow researchers to experience the more practical aspects of implementing a study, such as determining the number of study staff members needed to handle recruitment and data collection or identifying special equipment needs. Because pilot study findings may be generalizable, publication is encouraged as long as the preliminary nature of the work is clearly indicated in both the abstract and the article. The present article provides an overview of the types of information that can be gleaned from pilot intervention studies that are suitable for publication.

Psychometric properties of three instruments to measure fatigue with myocardial infarction

The purpose of this study was to evaluate the psychometric properties of three questionnaires to measure fatigue with myocardial infarction. The Fatigue Symptom Inventory Interference Scale, Profile of Moods States Fatigue subscale (POMS-F), and Short Form 36 (SF-36) Vitality Scale were completed during hospitalization (n = 116) and 30 days after hospital admission (n = 49). Moderate to strong correlations were found among each of these fatigue scales and between each fatigue scale and measures of other variables to include vigor, depressed mood, anxiety, and physical functioning. POMS-F scores decreased significantly at Time 2, but this decline in fatigue was not validated on the other fatigue scales. Patients' Time 1 scores reflected significantly more fatigue compared to published scores for healthy adults. The ability to discriminate between groups suggests that the instruments may be useful for identifying patients with cardiovascular risk factors who report clinically significant fatigue.

Tips for better visual elements in posters and podium presentations

CONTEXT

The ability to effectively communicate through posters and podium presentations using appropriate visual content and style is essential for health care educators.

OBJECTIVES

To offer suggestions for more effective visual elements of posters and podium presentations.

METHODS

We present the experiences of our multidisciplinary publishing group, whose combined experiences and collaboration have provided us with an understanding of what works and how to achieve success when working on presentations and posters. Many others would offer similar advice, as these guidelines are consistent with effective presentation. FINDINGS/SUGGESTIONS: Certain visual elements should be attended to in any visual presentation: consistency, alignment, contrast and repetition. Presentations should be consistent in font size and type, line spacing, alignment of graphics and text, and size of graphics. All elements should be aligned with at least one other element. Contrasting light background with dark text (and vice versa) helps an audience read the text more easily. Standardized formatting lets viewers know when they are looking at similar things (tables, headings, etc.). Using a minimal number of colors (four at most) helps the audience more easily read text. For podium presentations, have one slide for each minute allotted for speaking. The speaker is also a visual element; one should not allow the audience's view of either the presentation or presenter to be blocked. Making eye contact with the audience also keeps them visually engaged.

CONCLUSIONS

Health care educators often share information through posters and podium presentations. These tips should help the visual elements of presentations be more effective.

Symptom clusters in acute myocardial infarction: a secondary data analysis

BACKGROUND

Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified.

OBJECTIVES

To identify clusters of symptoms that represent AMI.

METHODS

This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an a theoretical method that uses only information contained in the data.

RESULTS

Five distinct clusters of symptoms were identified. Age, race, and sex were statistically significant in predicting cluster membership. None of the symptom clusters described in this analysis included all of the symptoms that are considered typical. In one cluster, subjects had only a moderate to low probability of experiencing any of the symptoms analyzed.

DISCUSSION

Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI.

Knowledge of stroke symptoms and risk factors among Korean immigrants in the United States

Korean immigrant's knowledge of stroke symptoms and risk factors was assessed in a convenience sample (n = 119) in a Midwestern metropolitan area. Knowledge ranged from very low to moderate. Cluster analysis showed that there were two groups. One cluster had higher knowledge of stroke symptoms and risk factors, but lower knowledge of symptoms and risk factors not associated with stroke. Participants who were older, were not married, and had a history of hypertension had significantly lower knowledge of stroke symptoms and stroke risk factors. Lower knowledge among older adults and/or those who had hypertension is a particular concern because such individuals are at highest risk for stroke.

An ecological approach to physical activity in African American women

Physical activity in women has assumed increasing significance as a policy issue as a result of the release of the 1996 Surgeon General's Report on Physical Activity and Health. This report revealed that women in the United States were less likely than men to adhere to the recommended guidelines for physical activity. African American women are less likely than white women to participate in leisure time physical activity across age, occupational, and income groups. The purpose of this study was to use the Ecological Model of Health Promotion to explore policy, environmental, and individual factors influencing physical activity of middle- to older-aged African American women in a mixed income community in a large midwestern city. Focus group discussions were held with 3 groups of women -- administrators/community leaders, exercisers, and nonexercisers. Thirty-three women between the ages of 40 and 78 participated in the study. The women identified 6 themes influencing physical activity: perceptions of physical activity and exercise; perceived barriers to exercise; perceived benefits of and motivators to exercise; past and present opportunities for exercise; factors that enhance the successful delivery of an exercise program; and coalition building to deliver an exercise program to women in the community. The results of this study reveal that to successfully increase physical activity in an ethnic urban community, researchers and other concerned individuals need to collaborate at multiple ecological levels, with an initial emphasis on establishing coalitions between institutions, community groups, policy makers, and individuals.

Concerns and risk factor modification in women during the year after coronary artery surgery

BACKGROUND

Future plans or return to a usual lifestyle has been shown to be of concern to persons recovering from coronary artery surgery. However it is not clear whether early concerns remain stable or evolve over time.

OBJECTIVE

To examine women's concerns about having coronary artery surgery and living with coronary artery disease after surgery over time.

METHODS

Concerns and risk factor modification strategies were measured in 55 women at 1, 6, and 12 months after coronary artery surgery. The Carr and Powers Stressor Scale and an investigator-developed interview were used.

RESULTS

Women's primary concerns shifted over the year from surgical recovery to living with coronary heart disease. At 1 month after surgery, issues related to future plans, such as progress in recovery and resuming lifestyle, were rated as causing the most concern. Concern about diet was the highest rated concern 1 year after surgery. More than half of the women reported exercising more, and approximately three fourths reported eating a better diet 1 year after surgery.

CONCLUSIONS

The findings demonstrate that women are concerned about diet and exercise, and many women attempt to change their behavior. Capitalizing on women's concerns about living with coronary artery disease may help address risk factors. However, specialized interventions may be needed that focus on women who are not concerned about and/or not engaged in risk reduction behaviors.

Clinical simulation laboratory. An adjunct to clinical teaching

Videotaped and telephone simulations role-played by students were used in a clinical laboratory setting to enhance student learning. The authors discuss the structure, implementation, evaluation, and potential uses of these simulated activities.

Patient delay in seeking treatment for acute myocardial infarction symptoms

Patient delay before seeking treatment for the symptoms of acute myocardial infarction has a significantly negative effect on morbidity and mortality. Most patients delay 2 or more hours before accessing the emergency medical system, which limits the ability to use reperfusion strategies. This article reviews variables that have been implicated in delay and explores possible explanations for why certain characteristics may be associated with longer delays. The outcomes of educational campaigns that have targeted delay behavior will be examined and directions for future research are identified.

Treating urinary tract infections in the elderly

Elderly patients in critical care settings are at increased risk for nosocomial infections, especially urinary tract infections (UTIs), the most common type of nosocomial infection. Catheter-related UTIs in critically ill elderly patients present a particular challenge to the advanced practice nurse and critical care nurse in terms of clinical features, diagnosis, and management.

Acute myocardial infarction in the workplace

1. Cardiovascular disease is a leading cause of death in the United States. Significant numbers of individuals in the work force experience an acute myocardial infarction (AMI) each year. 2. Strategies are available that can be used to facilitate rapid assessment and management of the employee suspected of having AMI. 3. The occupational health nurse can make a significant contribution in reducing the morbidity and mortality associated with AMI through the development of a system for rapid assessment and activation of the emergency medical system.

Symptoms of acute myocardial infarction: expectations of a community sample

OBJECTIVE

To identify the lay public's expectations of the symptoms of acute myocardial infarction (AMI).

DESIGN

Street-intercept survey method.

SETTING

Four neighborhoods in a large metropolitan area.

SAMPLE

One hundred ninety-seven women and 217 men.

INSTRUMENT

The Representation of Heart Attack Symptoms questionnaire (RHAS), a 48-item instrument that identifies subjects' expectations concerning the associated symptoms of AMI and the location, quality, and intensity of the discomfort of AMI.

RESULTS

The symptoms most individuals expected during AMI included: chest pain, irregular heart beats, inability to move, and shortness of breath. The locations selected as most likely included: middle, left, and right side of the chest, upper and lower back. The most common descriptors of the expected discomfort were "tight," "pressure," and "heaviness." More than 88% of subjects expected the intensity of a heart attack to be at least a 9 on a scale of 0 (No discomfort) to 10 (The most discomfort imagined).

CONCLUSIONS

The lay public have both accurate and inaccurate expectations about the symptoms of AMI.

Optimism, coping and long-term recovery from coronary artery surgery in women

Optimism, coping strategies, and psychological and functional outcomes were measured in 55 women undergoing coronary artery surgery. Data were collected in-hospital and at 1, 6, and 12 months after surgery. Optimism was related to positive moods and life satisfaction, and inversely related to negative moods. Few relationships were found between optimism and functional ability. Cognitive coping strategies accounted for a mediating effect between optimism and negative mood. Optimists were more likely to accept their situation, and less likely to use escapism. In turn, these coping strategies were inversely related to negative mood and mediated the relationship between optimism and this outcome. Optimism was not related to problem-focused coping strategies; this, these coping strategies cannot explain the relationship between optimism and outcomes.

Perceptions of patients with cardiovascular disease about the causes of coronary artery disease

This study was an examination of perceptions about the causes of coronary artery disease and the timeline of the disease among 105 patients hospitalized because of myocardial infarction or for coronary angiography and receiving the diagnosis of coronary artery disease. Although 79% of subjects named at least one of three modifiable risk factors (smoking, hypertension, elevated cholesterol), only 7% identified all three. Subjects known to have risk factors varied in their recognition of those risks as a cause of their coronary artery disease. Sixty-four percent of smokers recognized smoking as a personal cause of their coronary artery disease, whereas only 15% of subjects with hypertension recognized hypertension as a cause. The majority of subjects (55%) believed that coronary artery disease was a chronic disease. The other subjects were unsure (13%) or believed the situation would be short term (28%). Despite general knowledge about coronary artery disease, individuals with known risk factors continue to be largely ignorant of their personal risks and to some extent of the course of the disease.