Moving from one state to another among patients experiencing unexplained chest pain during physical activity: A secondary qualitative analysis by Meleis transition theory.

BACKGROUND: Unexplained chest pain is a common condition in medical settings. Nurses usually coordinate the rehabilitation of patients. Physical activity is recommended; however, it is one of the major avoidance behaviours in patients with coronary heart disease. There is a need for a deeper understanding of the transition that patients with unexplained chest pain undergo during physical activity. AIM: To develop deeper understanding about experiences of transition in patients with unexplained chest pain during physical activity. DESIGN: Secondary qualitative analysis of data from three exploratory studies. METHOD: Meleis et al.'s transition theory was used as a framework for the secondary analysis. FINDINGS: The transition was complex and multidimensional. The participants experienced personal processes of change toward health within the illness, corresponding to indicators of healthy transitions. CONCLUSION: The process can be identified as a transition from an uncertain and often sick role to a healthy role. Knowledge regarding transition promotes a person-centred approach in which patients' perspectives are included. Nurses and other health professionals can better direct and plan the caring and rehabilitation of patients with unexplained chest pain by deepening their knowledge of the transition process based on physical activity.

Reassured on a background of vulnerability - people with microvascular angina 12 months after high-intensity physical exercise program.

PURPOSE: Physical activity is recommended for patients with coronary microvascular dysfunction, however, avoided due to fear about the heart. The aim is to achieve an understanding of the meaning of physical activity one year after participating in a high-intensity exercise training program. METHOD: Twelve people were interviewed using a phenomenological hermeneutic approach. RESULTS: Four themes were formulated and revealed that one year after participating in high-intensity exercise training participants had an awareness of the meaning of the project, their chest pain and daily life: Being reassured, Daily life's impact on chest pain and continuing doing high-intensity exercise training, A strengthened body and mind, Being part of a group of people with similar problems.Comprehensive understanding was formulated as "Being reassured according being physically active in a background of vulnerability". CONCLUSION: This study indicates that by going through the high-intensity exercise training program the person regains more unity with the lived body and an unfolding life. A person-centred approach is suggested including an underlying dimension of vulnerability. A lifeworld led care means meeting the patient in their way of relating to the world bodily and existentially. Taking this understanding into consideration will advance the requirements for establishing person-centred care.

Experiences of unexplained chest pain and physical activity: A Meta-Ethnography.

AIMS AND OBJECTIVES: The aim was to examine the experiences of physical activity in the patients with unexplained chest pain. BACKGROUND: Previous qualitative studies have compiled data on the physical activity experiences of people with unexplained chest pain. Nevertheless, no meta-synthesis exists on this topic to advance the theoretical development of future-related studies. DESIGN: A meta-ethnographic synthesis of qualitative studies was conducted. Original qualitative studies on the physical activity experiences of people with unexplained chest pain were identified and systematically synthesised using a meta-ethnographic approach. METHODS: Seven databases were searched for relevant full-text articles in English, Danish, Norwegian and Swedish. There were no limitations concerning year of publication. Articles were first screened against inclusion criteria for eligibility and then assessed for quality and analysed using Noblit and Hare's seven-step meta-ethnography process. The ENTREQ checklist for systematic reviews was used. RESULTS: Nine qualitative studies were included in the analysis. The physical activity experiences of people with unexplained chest pain illuminates the metaphor: "Physical activity means balancing uncertainty" with four themes: looking for possible explanations, feeling vulnerable, feeling uncertain of consequences and being physically active may mean becoming more capable. CONCLUSION: For people with unexplained chest pain, being physically active meant moving toward being more capable. The participants felt vulnerable and physical activity helped in balancing uncertainty. A comprehensive model illustrates the antecedents and succedent for the physical activity experiences of individuals with unexplained chest pains. RELEVANCE TO CLINICAL PRACTICE: An approach to care which considers the patient's experience might be applicable; however, it needs to be accompanied with a biomedical perspective. Nurses and other health professionals need to provide a bridge between the patient's experiences and health professionals' advice and recommendations.

Confronting one's vulnerability - patients with chest pain participating in a high-intensity exercise programme.

AIMS AND OBJECTIVES: To explain the transitional process that individuals with unexplained chest pain undergo while participating in an exercise training programme over time. BACKGROUND: Angina-like chest pain in patients with no obstructive coronary artery disease is a growing problem. Functional limitations, restricted daily activities and reduced quality of life are reported. In addition, physical activity is avoided in this population. DESIGN: The study follows a qualitative classic grounded theory (Glaser ). METHODS: Three times a week for 12 weeks, twelve patients with no obstructive coronary artery disease participated in a high-intensity aerobic exercise training programme supervised by physiotherapists and nurses. The data collection was based on diaries and interviews about the experience and analysed according to the principles of classic grounded theory. RESULTS: The core category was identified as 'confronting one's vulnerability' and included three subcategories: 'balancing existential uncertainty', 'transforming bodily perceptions' and 'becoming a more capable person'. CONCLUSION: The transition was described as a process of becoming more capable. Health professionals should be aware of the significance of high-intensity exercise training for people with unexplained chest pain and of the underlying dimension of vulnerability. RELEVANCE TO CLINICAL PRACTICE: Understanding the transition process that people with unexplained chest pain undergo while participating in a high-intensity exercise training programme promotes a person-centred approach. Taking this substantive theory into consideration will improve the prerequisites for establishing person-centred care.

Unexplained Chest Pain and Physical Activity: Balancing Between Existential Uncertainty and Certainty.

Chest pain is one of the most common complaints in medical settings, but the majority of cases have no detectable cause. Physical activity is recommended, but is one of the major avoidance behaviors in patients with coronary heart disease. The article aims at achieving an understanding of the meaning of physical activity for people with unexplained chest pain. Fifteen people were interviewed using a phenomenological hermeneutic approach, with the results revealing four themes: "awareness of the influence of previous life experiences on the decision to be physically active," "unanswered questions related to physical activity and unexplained chest pain," "intertwinement of body and mind," and "physical activity as a source of personal growth." Comprehensive understanding was formulated as "Being physically active while living with unexplained chest pain means balancing between existential uncertainty and certainty." The results are discussed in relation to capability. It is suggested that health professionals adopt a person-centered approach.

Exploring the information needs of patients with unexplained chest pain.

BACKGROUND: Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient's pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients' expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations. METHODS: A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21-62 years. The interviews were analyzed by qualitative content analysis. RESULTS: The results are described in two subthemes, ie, "experiencing lack of focus on individual problems" and "experiencing unanswered questions". These were further abstracted under the main theme "experiencing unmet information needs". CONCLUSION: Existing models of consultations should be complemented to include a person-centered approach to meeting patients' beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience.