Validity and Reliability of the Responses to Ischemic Stroke Symptoms Questionnaire.

BACKGROUND: Prehospital delay remains an important reason for low intravenous tissue plasminogen activator administration rates. Study of ischemic stroke patients' responses to stroke onset may be hampered by lack of a questionnaire designed specifically to examine their cognitive, emotional, and behavioral responses to symptoms. METHODS: We provide evidence for content validity and reliability for the Responses to Ischemic Stroke Symptoms Questionnaire (RISQ) through, expert panel review and calculation of a content validity index and a study to examine stability reliability among hospitalized acute ischemic stroke patients. RESULTS: Expert panel review demonstrated agreement on the relevance of questionnaire items and an overall content validity index of 0.97. The study to examine stability reliability demonstrated acceptable stability of the items on the RISQ over the short term in a sample of white and black stroke patients. CONCLUSION: Preliminary evidence was gathered to support the content validity and stability reliability of the RISQ. Study of the RISQ with other population groups is needed.

Implementation of an Evidence-Based Practice Change to Offer Nitrous Oxide During Labor.

OBJECTIVE: The aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women's satisfaction with that option. DESIGN: Evidence-based practice change guided by the model for evidence-based practice change. SETTING: Labor and delivery unit in a tertiary medical center in the southwestern United States. PARTICIPANTS: Laboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period. MEASUREMENTS: Process indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women's satisfaction with the choice to use nitrous oxide. RESULTS: Nitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor. CONCLUSION: Our experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor.

Piloting a Sex-Specific, Technology-Enhanced, Active Learning Intervention for Stroke Prevention in Women.

BACKGROUND: Recent studies reveal deficiencies in stroke awareness and knowledge of risk factors among women. Existing stroke education interventions may not address common and sex-specific risk factors in the population with the highest stroke-related rate of mortality. OBJECTIVE: This pilot study assessed the efficacy of a technology-enhanced, sex-specific educational program ("SISTERS") for women's knowledge of stroke. METHODS: This was an experimental pretest-posttest design. The sample consisted of 150 women (mean age, 55 years) with at least 1 stroke risk factor. Participants were randomized to either the intervention (n = 75) or control (n = 75) group. Data were collected at baseline and at a 2-week posttest. RESULTS: There was no statistically significant difference in mean knowledge score (P = .67), mean confidence score (P = .77), or mean accuracy score (P = .75) between the intervention and control groups at posttest. Regression analysis revealed that older age was associated with lower knowledge scores (P < .001) and lower confidence scores (P < .001). After controlling for age, the SISTERS program was associated with a statistically significant difference in knowledge (P < .001) and confidence (P < .001). CONCLUSIONS: Although no change occurred overall, after controlling for age, there was a statistically significant benefit. Older women may have less comfort with technology and require consideration for cognitive differences.

Internet Stroke Preparedness for African American Women.

BACKGROUND: African American women exhibit low stroke awareness and may benefit from experiential and lay language description of stroke symptoms. OBJECTIVES: The purpose of this pilot study was to examine the effect of an online stroke preparedness intervention for identification of stroke symptoms and appropriate action in response to suspected stroke and estimate effect sizes for a larger study. METHODS: A quasi-experimental nonequivalent comparison group design was used to randomized 44 women to intervention (n = 23) or wait-list control group (n = 21). Data were analyzed with Friedman and Wilcoxon signed rank tests and Cochran-Mantel-Haenszel statistics to examine intervention effect on (1) self-efficacy to recognize stroke and know what to do in the event of stroke, (2) awareness of stroke symptoms, and (3) behavioral intent to call 911 for suspected stroke. Effect size estimates were calculated by converting z scores to r. RESULTS: Significant intervention effect was found for self-efficacy to know what to do in the event of stroke, ability to identify stroke symptoms presented in written vignettes, and ability to identify correct action in response to symptoms presented in written vignettes. Small to medium effect sizes were obtained. No improvement was found for ability to name stroke symptoms. Behavioral intent to call 911 for stroke in someone else was high, but significantly fewer women would call 911 for themselves. CONCLUSIONS: Experiential depictions of stroke symptoms in an online format showed preliminary effectiveness to improve stroke awareness among African American women.

Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education.

BACKGROUND: Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. METHODS: A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. RESULTS: School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. CONCLUSIONS: School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.

Reproductive Health and Women With Congenital Heart Disease: A Practice Update.

The purpose of this article was to examine reproductive health issues for women with congenital structural abnormalities of the heart. Because of surgical advances and innovations in healthcare, infants with congenital heart disease often live now into adulthood. Women with congenital heart disease have reported the desire to have children but expressed concern about fertility and the health consequences of pregnancy. Although many women with congenital heart disease are able to give birth without adverse outcomes, life-threatening complications can occur. Best practices for the care of women with congenital heart disease are grounded in an understanding of how cardiac defects may affect pregnancy and in communicating the implications of cardiac defects for reproductive health to support informed decision making.

Multi-institutional Collaboration to Promote Undergraduate Clinical Research Nursing.

Clinical research nursing is distinct from nursing research and includes the coordination and delivery of care for patients enrolled in clinical research trials. An innovative elective in clinical research nursing was developed collaboratively by stakeholders at a university, research institute, and national organization to provide experiential learning for undergraduate nursing students. The multi-institutional collaborative process, course overview, and precepted experience are described.

Stroke and pregnancy: an integrative review with implications for neuroscience nurses.

Stroke in association with pregnancy is an infrequent occurrence, but there is evidence that the incidence is rising. The physiological changes of pregnancy are thought to increase stroke risk, and several conditions specific to pregnancy further increase risk. The provision of optimal care to pregnant and postpartum women who experience stroke requires awareness of how the physiological changes of pregnancy may affect the course of stroke and nursing actions. This article provides an overview of current knowledge about pregnancy-related stroke including underlying pathophysiology, risk factors unique to pregnancy, and treatment issues when stroke is a complication of pregnancy. Implications for the nursing care of women with pregnancy-related stroke and maternal child considerations are discussed.

A qualitative case study of poststroke sexuality in a woman of childbearing age.

OBJECTIVE: To explore perceptions of poststroke sexuality in a woman of childbearing age. DESIGN: Qualitative case study. SETTING: Community. PARTICIPANT: A 36-year-old married mother of two children with a history of acute ischemic stroke 7 months prior to interview. METHODS: A semistructured interview guide was used to gather data during a single face-to-face interview. Data consisted of an audio-recorded interview and verbatim transcription, field notes, and demographic information. The inductive approach of qualitative content analysis was used to analyze the data. RESULTS: Four main categories, Slow to Get Back to the Sexual Life, The Vulnerable Body, Crushed by the Stroke and The Inadequate Self, were used to describe how the emotional trauma of having a stroke at a young age affected the participant's sense of self. Issues with sexuality were related to her perception of her poststroke body as vulnerable. Stage of life informed the participant's perceptions of pre- and poststroke sexuality. CONCLUSION: A stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles.

Stroke education needs of African American women.

OBJECTIVES: The purpose of this study was to explore the perceptions of African American women about stroke and examine their health information seeking practices outside of medical encounters. DESIGN AND SAMPLE: An exploratory-descriptive qualitative study was conducted with 48 women of age 35 years and older recruited from four Black churches. MEASURES: Data were collected during focus groups and analyzed with qualitative content analysis. RESULTS: Most of what participants knew about stroke came from interaction with family members or acquaintances that had strokes rather than stroke campaigns or health providers. There was confusion about the multiple symptoms of stroke, and information about stroke symptoms may not provide meaningful symptom representations. Information about breast cancer was more readily available than information about stroke. The internet, other women, and television programs were main source of health information outside of medical encounters. There was uncertainty how to assess the trustworthiness of internet health sites. CONCLUSIONS: The results suggest that culturally sensitive stroke education for African American women should include stories of women with stroke and provide experiential and visual depictions of stroke warning signs. Group forums, television, and web-based education may be acceptable ways to communicate stroke information to African American women.

Women's interpretation of and cognitive and behavioral responses to the symptoms of acute ischemic stroke.

Delay seeking medical assistance for acute ischemic stroke remains a barrier to the provision of optimal care, including the administration of tissue plasminogen activator. Although women report greater knowledge of stroke symptoms and stroke risk factors than men, earlier hospital arrival in women has not been consistently reported. The purposes of this study were to examine women's interpretation of stroke symptoms and compare cognitive and behavioral responses between women who arrived at the hospital within 3 hours of symptom onset and women who arrived after 3 hours. More than half of the participants arrived at the hospital greater than 3 hours after first noticing symptoms. Most women did not recognize the cause of symptoms. Knowledge about a treatment of stroke was limited, and a minority of the women knew they were at risk for stroke despite having known risk factors. Maladaptive responses to symptoms were reported more frequently by women with hospital arrival greater than 3 hours after symptom onset than by women with earlier arrival. Efforts are needed to reduce maladaptive responses to stroke onset that may contribute to delay seeking medical assistance for the symptoms of acute ischemic stroke.

A narrative study of women's early symptom experience of ischemic stroke.

BACKGROUND AND RESEARCH OBJECTIVE: Delayed arrival at the emergency department after the onset of ischemic stroke symptoms is an important reason for low tissue plasminogen activator administration rates. There is evidence that women arrive at the hospital later than do men, but little is known about women's experiences in the period between symptom onset and hospital arrival. The purpose of this naturalistic investigation using narrative methodology was to gain understanding of women's early symptom experience of ischemic stroke. SUBJECTS AND METHODS: The sample consisted of 9 women aged 24 to 86 years with an ischemic stroke within 1 year of diagnosis. Data were collected using in-depth interviews in which participants were asked to tell the story of their stroke from the moment they noticed the symptoms until they arrived at the hospital. Data were analyzed using sequential methods of narrative analysis. RESULTS AND CONCLUSIONS: The participants experienced stroke onset as the inability to carry out their accustomed activities in usual ways and as a process occurring over time rather than a discrete event. There was a tendency to objectify the body. Two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms to everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke, although all but 1 woman had risk factors. For some women, stroke onset was different from their previous ideas about this event, and this was especially the case if a woman had prodromal symptoms. Decision making during early stroke flowed from women's evaluation of symptoms and the meaning of symptoms, and meaning was informed by a woman's life situation. The findings from this study may yield variables for future studies of cognitive, emotional, and behavioral predictors of hospital arrival time. There is a need for research on women's prodromal symptoms.

Gender and stroke symptoms: a review of the current literature.

Ischemic stroke accounts for 87% of the 780,000 strokes occurring annually in the United States and is a leading cause of death and functional limitations worldwide. The prompt recognition of stroke symptoms and timely arrival at the emergency room are important to stroke outcomes. Recent literature was suggestive that women may have different stroke symptoms compared with men. If women have nontraditional symptoms at stroke onset, this may contribute to delay in diagnosis and treatment. The purpose of this manuscript was to review the current literature regarding gender differences in stroke symptoms. Ten articles met the inclusion criteria for the review. Overall, the extant research was not indicative of robust gender differences in the classic symptoms of stroke or a greater frequency of nontraditional symptoms in women. One study found that women were significantly more likely than men to report nonspecific "somatic" symptoms, and in another study women were significantly more likely to have a change in mental status compared with men. Implications for nursing practice and suggestions for future research are discussed.

The use of goal attainment scaling to facilitate and assess individualized change in a wellness intervention for women with fibromyalgia syndrome.

PURPOSE: The authors examined goal achievement over an 8-month period in women with fibromyalgia participating in a holistic health promotion intervention using Goal Attainment Scaling. DESIGN: Descriptive. METHODS: Goal attainment was assessed by interviews at five points: baseline (retrospectively), immediately after the 8-week classes, at the middle and end of the telephone support period, and 3 months later. FINDINGS: The percentage of women who attained or exceeded their goals in the four health promotion areas of Lifestyle Adjustment, Physical Activity, Nutrition, and Stress Management increased from between 15% and 26% at the end of the classes to between 58% and 76% at the end of the telephone support period. Although scores declined somewhat in the following 3 months, at least 60% of the women continued to report behaviors at or above their goal level in all areas except Physical Activity. CONCLUSIONS: Goal Attainment Scaling, an individually determined measure of change, can effectively capture behavioral changes associated with a holistic health promotion intervention. A nurse facilitator, who not only understood the need for specific, measurable GAS but was also able to encourage and support women's identification of goals that were meaningful to them, was key to the positive findings observed here.

Predictors of a health promoting lifestyle in women with fibromyalgia syndrome.

The purpose of this study was to describe the health practices of women with fibromyalgia syndrome (FMS) and the predictors of an overall health promoting lifestyle in these individuals. The predictors of a health promoting lifestyle examined in this study were barriers, social support, self-efficacy, demographic characteristics and illness factors. The sample consisted of 198 women who participated in a randomised clinical trial to test the effectiveness of a health promotion intervention for women with FMS. The women in this sample engaged most frequently in health practices in the domains of interpersonal relations and spiritual growth and least frequently in the domain of physical activity. Self-efficacy and social support were significant predictors of an overall health promoting lifestyle.

Women's experiences as members of attention control and experimental intervention groups in a randomized controlled trial.

Attention control groups are often used in research testing the efficacy of psychosocial and behavioural interventions in order to control for placebo effects. The authors conducted a descriptive qualitative study to investigate how participants viewed their experiences in attention control and experimental intervention groups following a randomized controlled trial for women with fibromyalgia syndrome. Moderately structured interviews were conducted with 18 women (12 from the experimental intervention group and 6 from the attention control group). Members of the control group reported some benefits but few behavioural changes as a result of participating in the RCT, and some participants expressed disappointment at not receiving the intervention. Perceptions of changes in attitudes towards fibromyalgia syndrome and behaviours reported by the intervention group appear to be consistent with the theory underlying the intervention. Possible placebo effects identified in both groups include negative and positive social interactions with other participants.

Depression in multiple sclerosis: a longitudinal analysis.

High rates of depression have been documented in persons with multiple sclerosis (MS), but few studies have examined depression over time. This analysis considered data from 607 persons with MS in a 7-year period as part of an ongoing longitudinal study of quality of life in chronic illness. Latent growth curve analysis was used to examine trajectories in depression and the effects of covariates such as age, time since diagnosis of MS, type of MS, and functional limitations on the extent to which depression changed in the study period. Results of the analysis indicated that depressive symptoms fluctuated over time for individuals but did not show a tendency to an overall significant increase or decrease for the group as a whole. Younger age, longer time since diagnosis of MS, progressive forms of MS, and greater extent of functional limitation were predictive of greater depressive symptoms at Time 1. With the exception of functional limitation, which showed an association with depression at all periods, these variables did not predict changes in depressive symptoms over time. Gender was not a significant predictor of changes in depressive symptoms, nor did women have higher rates of depression as expected from previous research. The results of this analysis indicate the importance of screening for depression in all persons with MS.

Loneliness in women with multiple sclerosis.

Loneliness is an underrecognized component of the experience of chronic illness and disability. Women with multiple sclerosis (MS) may be at risk for loneliness due to social network changes that occur in the course of chronic illness. The purpose of this secondary analysis was to assess the extent of loneliness in a sample of 659 women with MS and examine the relationship of loneliness, social support, functional limitation, self-rated health status, social demands of illness, and marital status. More than half of the women in this sample reported feeling lonely. A significant association was found between loneliness and lower levels of social support, greater social demands of illness, greater functional limitation, lower self-rated health status, and marital status. These findings suggest that rehabilitation nurses and other health professionals should be aware that loneliness may be a common occurrence for women with MS and point to the need for screening procedures to identify loneliness in this population.