One-Year Prospective Follow-up of Women With INOCA and MINOCA at a Canadian Women's Heart Centre.

BACKGROUND: Many women with cardiac chest pain and ischemia or myocardial infarction have no obstructive coronary artery disease (INOCA or MINOCA). Studies suggest that these patients have a decreased quality of life and are at increased risk of cardiovascular events. Our study reports 1-year quality of life, frequency of angina, and outcomes following entry into a multidisciplinary Women's Heart Centre (WHC). METHODS: Patients with INOCA and MINOCA completed questionnaires on baseline demographics and clinical presentation. At 1-year, frequency of chest pain, quality of life, depression and anxiety symptoms, and cardiovascular outcomes were reported and compared with baseline. RESULTS: A total of 154 women with nonobstructive coronary artery disease were included in this study (112 patients with INOCA and 42 with MINOCA). Median age was 59 years, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have specific diagnoses. Following investigations in the WHC, 71.4% of patients with INOCA established a new or a changed diagnosis (most common was coronary microvascular dysfunction at 68%), whereas 60% of patients with MINOCA established new or changed diagnoses (the most common of which was coronary vasospasm at 60%). At 1-year, participants had significantly decreased chest pain, improved quality of life, and improved mental health. CONCLUSIONS: A multidisciplinary WHC significantly increases the yield of a specific diagnosis in patients with INOCA and MINOCA. Further, attending a WHC could significantly improve the clinical and psychological outcomes of women with INOCA and MINOCA.

Commentary: Respect in Nursing - Reflections.

Current research demonstrates that nurses still feel disrespected, particularly in the context of such an abundance of policy work and dialogue, emphasizing the importance of respect and the need for change. As Almost and Mildon (2022) note, specific recommendations such as baccalaureate entry to practice, leadership training and the publication of best practice guidelines have been implemented in abundance, further solidifying a feeling of futility. Adding my own experiences as a registered nurse, a nurse practitioner and now a nursing leader continually insisting on recognition of my education, worth and value further proves that our collective work to date has unfortunately not been enough.

Letter to the Editor.

Thank you for initiating an important conversation regarding NCLEX-RN implementation and experience in Canada. We are three nursing leaders in the province of British Columbia (BC) with continued interest in the governance, regulation and contribution of nursing locally, provincially and nationally. We hold or have held senior policy positions in BC, including in roles responsible for nursing regulation and practice. It is not our intent to replay the past in relation to the exam; rather, our commentary is intended to position the discourse in the broader context of practice regulation and the roles/responsibilities of regulators in our country.

Exploring women's health care experiences through an equity lens: Findings from a community clinic serving marginalised women.

AIMS AND OBJECTIVES: To explore how marginalised women perceive and rate equity-oriented health care at a primary care clinic using items that evaluate patients' experiences of care. BACKGROUND: Despite an increased recognition of the importance of health care that is equity-oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world. DESIGN: Items from the "EQUIP Primary Health Care" research programme were used to explore patients' experiences of equity-oriented health care. Women were invited to complete the questionnaire with the explicit aim of gaining their input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study. METHODS: Sixty-seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care. RESULTS: Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care team in establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care. CONCLUSION: Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experience equity-oriented health care. Responses from the women highlight the importance of understanding not only the what of equity-oriented care but also the how. RELEVANCE TO CLINICAL PRACTICE: The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care.

Embracing Our "Otherness".

Theories on the importance of holistic and spiritual healing within nonconventional models of care are vast, yet there is little written about the practical, clinical-level interventions required to deliver such practices in collaborative cross-cultural settings. This article describes the learning experiences and transformative journeys of non-Indigenous nurse practitioners working with a Cultural Lead from an Indigenous community in British Columbia, Canada. The goal of the Seven Sisters Healthy Heart Project was to improve heart health promotion in an Indigenous community through a model of knowledge translation. The article describes the development of a bridge between two cultures in an attempt to deliver culturally responsive programming. Our journeys are represented in a phenomenological approach regarding relationships, pedagogy, and expertise. We were able to find ways to balance two worlds-the medical health services model and Indigenous holistic models of healing. The key to building the bridge was our willingness to be vulnerable, to trust in each other's way of teaching and learning, and allowing diverse viewpoints and knowledge sources to be present. Our work has vast implications for health promotion in Indigenous communities, as it closes the gap between theory and practice by demonstrating how Indigenous models can be integrated into mainstream health promotion practices.

Women-Centered and Culturally Responsive Heart Health Promotion Among Indigenous Women in Canada.

Most women in Canada confront a combination of bio-psychosocial factors that put them at risk for cardiovascular disease. The challenge for health planners is to address these factors while contextualizing interventions that meet the specific needs of particular social and cultural groupings. The article will discuss a women-centered, group-based heart health pilot initiative designed to engage with indigenous approaches to healing. The nurse practitioners co-led the group with a representative from the indigenous community to balance women-centered practices with more traditional and culturally appropriate ones. In particular, indigenous processes, such as a Talking Circle, combined with indigenous knowledge/content were integrated into the pilot program. The project was evaluated to investigate its outcomes (how the intervention impacted the participants) and processes (how participants perceived the intervention). Evaluation involved analysis of the Talking Circle's content, a focus group, field observations, and self-completed surveys. Most women made changes regarding their diet, some began physical activities, and others focused on better managing their emotional health. Women viewed the group as successful because it embraced both women-centered and culturally appropriate health promotion practices. The intervention created a culturally safe space for learning and transformation. The findings confirm the need for employing culturally relevant, gender-specific approaches to heart health promotion that are situated in and responsive to community needs.

Nurse practitioners in postoperative cardiac surgery: are they effective?

BACKGROUND: High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role. PURPOSE: To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital. METHODS: Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction. RESULTS: Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p < or = 0.01), and had undergone more complicated surgical procedures (p < or =0.01). After discharge, more patients in the hospitalist-led group had visited their family doctor within a week (p < or =0.02) and measures of satisfaction relating to teaching, answering questions, listening and pain management were higher in the ACNP-led group. CONCLUSION/IMPLICATIONS: Although challenges in recruitment yielded a lower than anticipated sample size, this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.