Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study.

BACKGROUND: African Americans have a higher prevalence and greater severity of hypertension than do other minorities and whites. This fact is particularly problematic when one realizes that the rate of control and treatment of hypertension in the US population is getting worse rather than better. Alternative strategies to promote blood pressure control need to be tested. OBJECTIVES: The purpose of this pilot study was to test the following hypothesis: Persons who participate in nurse-managed home telemonitoring (HT) plus usual care or who participate in nurse-managed community-based monitoring (CBM) plus usual care will have greater improvement in blood pressure from baseline to 3 months' follow-up than will persons who receive usual care only. METHODS: This study used a randomized controlled design; participants were randomly assigned to 1 of 3 groups that were stratified by use or nonuse of antihypertension medication. One-way analysis of variance (ANOVA) and analysis of covariance (ANCOVA) controlling for age and body weight were used to determine changes in blood pressure from baseline to 3 months. The sample contained 26 African Americans with a mean age of 59 years. RESULTS: Both the HT group and the CBM group had clinically and statistically significant (P <.05) drops in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3 months' follow-up, with participants in the HT group demonstrating the greatest improvement (HT: baseline SBP 148.8 +/- 13.8, DBP 90.2 +/- 5.79; 3 months' follow-up SBP 124.1 +/- 13.82, DBP 75.58 +/- 11.4; CBM: baseline SBP 155.25 +/- 17.014, DBP 89.42 +/- 10.95; 3 months' follow-up SBP 142.3 +/- 12.1, DBP 78.25 +/- 6.86). There was little change in SBP or DBP at 3 months' follow-up in the usual care only group. CONCLUSION: These are important pilot results, which if replicated in a larger sample will significantly improve care for urban African Americans with hypertension.

Sex differences in patient recovery patterns after coronary artery bypass surgery.

OBJECTIVE: To describe sex differences in physical, psychologic, and social recovery patterns after coronary artery bypass surgery (CABS). DESIGN: Repeated measures between groups (men versus women) design. Data were collected before discharge from the hospital and at 1, 3, and 6 weeks after discharge. SETTING: Five teaching hospitals: one urban, three suburban, and one midstate hospital that serves rural and urban clients SAMPLE: The initial sample consisted of 187 men and 70 women; 132 men and 47 women completed the study. OUTCOME MEASURES: Physical recovery was assessed by three subscales of the Sickness Impact Profile--ambulation, sleep-rest, body care and movement; a Symptom Inventory, and a Cantril Ladder Scale. Psychologic recovery was measured by the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and a Cantril Ladder Scale. Social recovery was measured by three subscales of the Sickness Impact Profile--home management, social interaction, and recreation and pastimes. RESULTS: All measures indicated significant improvement over time with the exception of self-esteem and perception of mental health, which remained stable. There were significant differences between men and women on five recovery variables: ambulation dysfunction, physical symptoms, perceptions of physical health, symptoms of depression, and home management dysfunction. CONCLUSIONS: Though it is encouraging that both sex groups experienced significant improvement in recovery over time, men and women show some differences in recovery experiences that need to be considered when planning their care.

Selecting a model to guide family assessment.

Theoretical models can help critical care nurses deliver planned and systematic care to families in a time-efficient manner. This article describes three family theoretical models: structural-functional, family systems, and family stress.

Age differences in patient recovery patterns following coronary artery bypass surgery.

OBJECTIVE: The purpose of this study was to determine whether physical, psychological and social recovery within the first 6 weeks following coronary artery bypass surgery varied by age. METHODS: A repeated measures design was used for this study. Data were collected from a convenience sample of three age groups of patients at the following times: prior to hospital discharge and at 1, 3 and 6 weeks after discharge. The three age groups studied were less than 60 years, 60 to 70 years and more than 70 years. Data were collected by interview and mail questionnaires. The initial sample consisted of 258 patients, of whom 184 completed the study. Eleven instruments were used to measure recovery including the Sickness Impact Profile, Beck Depression Inventory, Rosenberg Self-Esteem scale and the Symptom Inventory. RESULTS: No significant differences were found among the age groups for any of the physical, psychological or social recovery measures. Within each age group physical, psychological and social recovery improved significantly over time. Although patients more than 70 years of age remained in the hospital significantly longer, once discharged, they did not have more difficulty with recovery than the other age groups. DISCUSSION: As expected, all age groups experienced significant improvement in recovery over time. CONCLUSIONS: Contrary to what past research about cardiac surgery and the elderly might lead one to expect, in this study, the oldest patients did not have the poorest recovery patterns. Persons more than 70 years had recovery patterns similar to those of younger age groups.

Patterns of concerns and demands experienced by spouses following coronary artery bypass surgery.

The purpose of this study was twofold: first, to describe spouses' concerns and demands related to their partner's recovery from coronary artery bypass surgery (CABS) prior to discharge and at 1, 3, and 6 weeks following discharge; and second, to describe how spouses' concerns and demands change from the time of hospitalization through 6 weeks after discharge. The study used a descriptive panel design. Ninety females (82.6%) and 19 (17.4%) males constituted the sample. Respondents' mean age was 60.7 years. Manifest content analysis revealed that spouses' concerns and demands changed from week to week. The study findings support a convalescence trajectory and lend support for paying close attention to the timing of interventions after surgery and during early convalescence.

Spouses' perceptions of readiness for discharge after cardiac surgery.

The purpose of this study was to describe spouses' perceptions of readiness for discharge after a partner's coronary artery bypass graft (CABG) surgery. An exploratory design was used to address the research questions. Six weeks after discharge, a nonrandom sample of 67 female spouses responded to open-ended questions about discharge readiness. The data were examined using content analysis. One hundred eighty-six statements were coded from the 67 questionnaires. Forty-two women (62%) reported they felt prepared for discharge. Four key people were identified as very helpful to spouses at discharge: nurse, physician, immediate family member, and friends who have had the same experience. Availability of social support, use of coping strategies, personal resources, and knowing what to expect were the major factors that influenced spouses perceptions of readiness for discharge.

Spouse adaptation to mate's CABG surgery: 1-year follow-up.

OBJECTIVE: The purpose of this study was to describe spouses' life stressors, supports, perceptions of illness severity, role strain, physical and mental symptoms of stress, and marital quality 1 year after the mate's coronary artery bypass graft surgery. METHODS: This descriptive study was the third component of a longitudinal panel investigation. (The first component was a period within 48 hours of surgery, and the second was 6 weeks after discharge.) One year after the mate's surgery, spouses received the following instruments in the mail: the Family Inventory of Life Events and Changes, the Norbeck Social Support Questionnaire, the Cantril Ladder Scale, the Strain Questionnaire, the Role Strain Scale and the Dyadic Adjustment Scale. Subjects were a convenience sample of 49 women whose husbands were alive 1 year after their first bypass surgery. Of the women in the sample (n = 49), 98% were white, and the mean age was 56 years. RESULTS: Social support was moderate and significantly less 1 year after surgery than during the first two components (48 hours and 6 weeks after surgery). Women still perceived their husbands to have some illness severity 1 year after surgery. They continued to have physical and mental symptoms of stress and had significantly greater role strain than during the first two periods. Marital quality was average. Spouses reported making several life-style changes. DISCUSSION: During the first year after the patient's bypass surgery, spouses experienced many changes. Although physical and mental symptoms of stress remained the same, role strain increased and social support decreased. The findings suggest testing of such interventions as stress management and time management techniques, support groups, and other psychoeducational interventions. CONCLUSIONS: Although the situation remains difficult for the spouse 1 year after the patient's surgery, nurses and physicians can foster and support spouses through many adjustments and changes.

Stress experience of spouses of patients having coronary artery bypass during hospitalization and 6 weeks after discharge.

The purpose of this study was to describe stress process variables in spouses of patients having coronary artery bypass surgery during hospitalization (T1) and 6 weeks after discharge (T2). Problems and concerns of spouses at T1 and T2 and spouse perceptions of nurse support were also addressed. Eighty-six women participated in the study at T1 and 67 women participated at T2. Data were collected by self-report instruments and open-ended questions. Women reported an average number of family life changes and high levels of social support at T1 and T2. Women perceived their husband's illness severity at the extreme end of the continuum at T1 and T2. Physical and mental symptoms of stress were high at T1 but significantly less at T2. Marital quality was average at T1 but significantly less at T2. Hospital environment, lack of information, and family members were frequently reported to make hospitalization more difficult. Husband's self-care activities, uncertainty, and husband's physical and mental symptoms were concerns that spouses frequently reported at T2.

Family member perceptions of a cardiac surgery event.

The findings from this study reveal that family members have many perceptions related to the stress of a cardiac surgery event. It is essential for nurses to have knowledge of family member perceptions if they are to have therapeutic interactions with family members and have a basis on which to plan nursing care. Therapeutic interactions will be less stressful for the nurse and will result in improved quality of nursing care for both the patient and the family.