Women's Prodromal Myocardial Infarction Symptom Perception, Attribution, and Care Seeking: A Qualitative Multiple Case Study.

BACKGROUND: Most women experience prodromal myocardial infarction (MI) symptoms, but more information is needed about the perception, attribution, and care-seeking behaviors related to these prodromal symptoms. OBJECTIVES: We aimed to describe women's perceptions, attributions, and care-seeking behaviors related to prodromal MI symptoms. METHOD: We used a qualitative, multiple case study approach, recruiting participants during summer 2019 from a large hospital in the Midwestern United States. Data were collected from interviews with the women who experienced MI and some of their family members, journals, and electronic health records. An inductive, comparative analysis procedure was applied. RESULTS: Ten women, ages 42 to 84, participated in the study. The women experienced a mixture of certainty and uncertainty related to their symptoms and engaged in several cognitive processes to conceptualize and act upon their symptoms. Although all the women retrospectively reported at least 4 prodromal symptoms, they lacked knowledge of prodromal MI symptoms and often responded to prodromal sensations that they experienced using emotion- and avoidance-based strategies. It was difficult for the women to establish a symptom pattern that was attributable to heart disease. DISCUSSION: The findings of this study may be used as evidence to support interventions that would facilitate women's care seeking for and health care providers' recognition of prodromal MI symptoms. Additional research is necessary to more fully characterize the cognitive processes at play for women of many different sociocultural backgrounds who experience prodromal MI symptoms.

Motivation and exercise in rural postmenopausal women: A literature review.

PURPOSE: Most rural Americans are not meeting recommended guidelines for physical activity (PA); rural postmenopausal women (RPMW) have the highest inactivity rates. Self-Determination Theory, a motivational theory which examines the effects of qualitatively different types of motivation is used to conceptualize how RPMW make decisions regarding PA. The purpose of this review is to examine published literature related to motivation and exercise or PA in RPMW. The research questions include (a) what is known about the relationship of motivation to exercise in RPMW; and (b) how have motivation and exercise been measured in RPMW? METHODS: An electronic database search resulted in a sample of 251 articles, with an additional 9 articles acquired by scanning reference lists. Search terms included motivation, exercise, rural women, urban women, and PA. Criteria for inclusion were postmenopausal women, primary research published before 2019, reported in English, and taking place in the United States. FINDINGS: Thirteen articles involving RPMW were included. The sample contained four qualitative, eight quantitative, and one mixed-method studies. There is little research regarding motivation and PA in RPMW. Barriers and facilitators to PA have been measured. Motivation was mentioned in two studies but not measured. PA is most often measured with self-report questionnaires. CONCLUSION: The decision to be active or sedentary is embedded in motivation. Additional research that objectively measures both motivation and PA in a consistent manner is required to provide a knowledge base regarding motivation and PA behavior in RPMW.

A qualitative exploration of prodromal myocardial infarction fatigue experienced by women.

AIMS AND OBJECTIVES: The purpose of this study was to explore adult women's unique and shared experiences of prodromal myocardial infarction fatigue. BACKGROUND: Fatigue is the most prevalent symptom experienced by women in the weeks and months before myocardial infarction. However, dimensions of this fatigue, such as timing, distress, intensity, quality, patterns and associated characteristics have not been established through studies of this symptom. A lack of understanding of the characteristics of myocardial infarction fatigue and the context in which it occurs makes clinical decision-making difficult. DESIGN: A qualitative, multiple case study guided by the Theory of Unpleasant Symptoms. METHODS: Women were purposively enrolled from a large hospital in the Midwestern USA. Semi-structured, audio-recorded interviews were conducted during hospitalisation and at 2-3 months postdischarge; women were also provided with a journal. A supplementary interview with family members and electronic health record review also assisted in data triangulation. Analysis was inductive and conducted within and across cases, using coding and categorisation, counting, clustering, visual displays of data and thematic development. The SRQR checklist was used in reporting the study. RESULTS: Ten women, with a median age of 60, participated. Fatigue was described primarily using the terms tiredness and lack of energy, though some women described generalised weakness and cognitive fog. This fatigue was unusual and a notable change from baseline. Many women described significant difficulties performing activities of daily living due to fatigue. CONCLUSIONS: The findings of this study will advance symptom science and an understanding of prodromal myocardial infarction fatigue. Future instrument development or selection of instruments for quantitative work will be aided by this study. RELEVANCE TO CLINICAL PRACTICE: This study provides a clearer picture of prodromal myocardial infarction fatigue experienced by women, aiding healthcare professionals in understanding and identifying this symptom.

A qualitative study of influences on long-term physical activity in physically active African American women.

Performing routine physical activity (PA) is one of several measures that may be taken to prevent chronic illness; however, African American (AA) women are among the least physically active groups in the United States. The purpose of this study was to gain perspectives of AA women who are physically active and understand how they continue long-term PA. In this qualitative descriptive study, we interviewed 14 AA women using researcher-developed open-ended questions. Transcription was analyzed through content analysis. The socioecological model guided the organization of themes that emerged from the data. Individual level themes were: managing my health and lifestyle to remain physically active. Social level themes were: incorporating PA in social exchanges with family, friends, and coworkers and establishing mutual support of PA among family and friends. Environmental level themes were: using the neighborhood and work environments as venues encouraging PA. There were no emerging themes at the political level; however, there were findings at the environmental level that could be interpreted as policy-level issues. Knowing specific factors that influence long-term PA may help us with the development of interventions to increase PA in AA women.

A measure of facilitators and barriers to rapid response team activation.

PURPOSE: Poor patient outcomes and increased costs may be associated with underutilization of RRTs. The aim of this study was to develop and test an instrument that identifies specific facilitators and barriers to rapid response team (RRT) activation. METHODS: Using an exploratory design, we surveyed a convenience sample of 250 registered nurses (RNs) employed in five Illinois hospitals. Participants completed the online RRT Facilitators and Barriers Survey (RRT-FBS), a 36 item survey developed by the researchers. The survey contains two sections, facilitators and barriers. Items in the facilitators subscales described nursing unit culture, RRT knowledge, and RRT member characteristics. Items in the barriers subscales described nursing unit culture, RRT education, and RRT member characteristics. Item analyses were conducted through exploratory factor analyses; internal consistency estimates were obtained. Descriptive statistics were conducted on the demographic data to describe sample and setting characteristics. RESULTS: The final sample consisted of 202 nurses from four hospitals. We conducted an item analysis and were able to reduce the survey to 30 items with a secondary analysis. The full scale alpha was 0.752. Cronbach's alphas for subscales ranged from 0.770-0.897. CONCLUSIONS: Facilitators and barriers may vary across institutions. This scale shows promise for identifying facilitators and barriers to nurses' use of rapid response teams and may provide a foundation for interventional studies promoting RRT utilization. In addition, more frequent education, emphasizing the RRT process, may be an effective method to maintain high rates of RRT activation and increase confidence.

Lessons from the Homeless: Civil and Uncivil Interactions with Nurses, Self-Care Behaviors, and Barriers to Care.

BACKGROUND: Civility, rooted in social justice, is a fundamental value of nursing. Homeless people are particularly at risk for experiencing uncivil behavior from nurses. PURPOSE: The purpose of this study was to explore homeless people's perceptions of their interactions with nurses. METHOD: In this descriptive, qualitative study, we interviewed 15 homeless adults who described their experiences with nurses. The interview guide, developed by the researchers, consisted of open-ended questions and probes. Transcriptions and field notes were analyzed through thematic analysis. RESULTS: Three major themes emerged: nurses should be civil, self-care behaviors, and barriers to good care. Subthemes included listening, compassion, attentiveness, and judgment as components of civility; where they go for care and who cares for them as self-care behaviors; and lack of money and homeless status as barriers to care. CONCLUSIONS AND IMPLICATIONS: Our findings indicate people who are homeless often perceive nurses to be uncivil and uncaring toward them; furthermore, our participants provide a unique description of healthcare interactions from the perspective of the homeless. These findings can be used as a basis for the development of education interventions for students and practicing nurses to assist them in learning to provide civil and compassionate care for the homeless.

Nephrology Nurse Perceptions Toward Advance Care Planning: Validation of a Measure.

Advance care planning is critical for persons with chronic kidney disease because they face a shortened lifespan. There is a paucity of reliable and valid measures exploring nephrology nurse perceptions toward advance care planning. This article reports the results of testing the factor structure, reliability, and validity of a newly developed measure of nephrology nurse perceptions toward advance care planning as well as information on nephrology nurses'perceptions on advance care planning. Measuring nephrology nurse perceptions toward advance care planning may facilitate planning of interventions to assist nurses to become more active in the process.

Exploring Advance Care Planning from the Nephrology Nurse Perspective: A Literature Review.

Advance care planning is a process that engages healthcare providers and patients to articulate wishes of patients as their illness progresses. Persons with chronic kidney disease require earlier and more frequent advance care planning conversations because they are faced with increased co-morbidities and a shortened lifespan. This literature review explores the phenomenon of advance care planning and the potential factors affecting nephrology nurse engagement in these discussions.

Development and Initial Validation of the NephRN Perceptions Toward Advance Care Planning Instrument.

The purpose of this study was to develop and pilot test an instrument to measure the perceptions of nephrology nurses toward advance care planning, the NephRN Perceptions Toward Advance Care Planning instrument. Four components of advance care planning were identified: knowledge, attitudes, comfort, and support. The four-component solution explained 63.88% of variance. Cronbach's alpha was 0.92, and subscale reliability ranged between 0.86 and 0.94. This instrument shows promise as a reliable and valid measure of nephrology nurse perceptions toward advance care planning for persons with chronic kidney disease.

Gambling and perceived health among adult jail inmates.

Gambling problems have been associated with lower perceived health in community samples, but little research has examined this relationship in an incarcerated population. The purpose of this study was to determine the perceived health and gambling problems of adult inmates (18-49 years old) in a county jail. We surveyed 184 male and female inmates aged 18-49 years. Nearly 35% of inmates scored as problem or pathological gamblers, and inmates scored significantly lower on all Short Form-36 Version 2 perceived health scales than the U.S. population norm. There were no significant differences on perceived health scores between recreational and problem/pathological gamblers. The high prevalence of gambling problems and poor perceived health necessitates research to provide screenings and test effectiveness of gambling and health interventions in this population.

Perceived health and gambling behavior of inmates: a review of the literature.

PURPOSE: An integrative review was conducted to determine perceived health and gambling behavior in incarcerated adults (ages 18-49), measures of perceived health and gambling behavior, and relationships between perceived health and gambling behavior. CONCLUSIONS: Adult inmates report poorer perceived health and increased levels of gambling problems than those who are not incarcerated. No research investigating the relationships between perceived health and gambling among adult inmates was found. PRACTICE IMPLICATIONS: Knowledge of relationships between perceived health and gambling can assist healthcare providers in understanding potential healthcare needs of the inmates and begin treatment while they are still incarcerated. Nurses in settings such as free and private clinics, homeless shelters, churches, and emergency departments need to screen for problem gambling in this population. This will facilitate appropriate referrals and continued treatment as these inmates transition back into society.

The clinical nurse leader: prepared for an era of healthcare reform.

PROBLEM: Passage of the 2010 Patient Protection and Affordable Care Act will require change in the healthcare systems. The clinical nurse leader must be prepared to lead and shape the changing environment to achieve maximum outcomes for patients and families. Movement toward integrated care delivery across the care continuum, the transition of the Centers for Medicare & Medicaid Services to a value-based funding model, and accountability for high-quality, cost-effective care are just some of the drivers of this new integrated healthcare system. IMPLICATIONS: Reimbursement models that reward those health systems that are able to meet benchmark performance standards will result in major shifts in how health systems operate. Expertise in care coordination across the healthcare continuum is essential for maximum reimbursement. Payment for value instead of volume delivered is a major reimbursement transition coming to the acute care setting, necessitating increased attention to mining data necessary to capture quality patient outcomes for maximum reimbursement. CONCLUSIONS: The clinical nurse leader is ideally suited to function within these integrated systems of the future, and possesses the skills needed to assist healthcare systems to meet this challenge.

Qualitative exploration of nurses' decisions to activate rapid response teams.

AIMS AND OBJECTIVES: To identify barriers and facilitators to nurses' decisions regarding activation of rapid response teams (RRTs) in hospitals. BACKGROUND: Hospitalised patients in the United States who experience cardiopulmonary arrest seldom recover. Most of these patients show signs of clinical deterioration prior to cardiopulmonary arrest. RRTs have been shown to decrease the incidence of cardiopulmonary arrest by bringing needed resources to unstable patients. Despite the evidence in support of the activation of RRTs, nurses do not always use this resource. Nurses' decisions to activate or not to activate the RRT are not clearly understood. DESIGN: We used a qualitative design for this study. METHODS: A purposive sample of 15 medical/surgical nurses was recruited from a small medical centre in the Midwest. Researchers used semistructured, open-ended questions to elicit subject responses regarding facilitators and barriers to activating RRTs. RESULTS: Themes emerged and were categorised as facilitators and barriers to calling the RRT. Facilitators and barriers were then subdivided into distinct subthemes: RRT characteristics and unit culture. The expertise of the RRT members and support and encouragement from nursing unit colleagues and leaders emerged as two potential facilitators. Communication of the RRT members and calling the physician first emerged as two potential barriers. We also identified educational factors that were not clearly facilitators or barriers to calling the RRT. CONCLUSIONS: Further study is needed using quantitative designs with larger sample sizes. RELEVANCE TO CLINICAL PRACTICE: Nurses can build upon knowledge of facilitators and barriers related to RRT characteristics and nursing unit culture.

Construct validity of four exercise stage of change measures in adults.

Measuring readiness to exercise, or exercise stage of change (ESOC), is an important first step when counseling adults about exercise. However, minimal construct validity testing of ESOC measures has been reported. With a sample of 95 adults, we estimated the construct validity of four ESOC measures with commonly used response formats (true/false, ladder, 5 choice, interview). Participants completed all four ESOC measures in random order as well as six validation measures: physical activity performed, exercise self-efficacy, decisional balance pros and cons, and behavioral and experiential processes of change. Few participants were in the earliest stage of change. The true/false measure demonstrated the strongest validity. Further studies are needed in diverse samples with more representation across the stages of change.

Merging health literacy with computer technology: self-managing diet and fluid intake among adult hemodialysis patients.

OBJECTIVE: The Dietary Intake Monitoring Application (DIMA) is an electronic dietary self-monitor developed for use on a personal digital assistant (PDA). This paper describes how computer, information, numerical, and visual literacy were considered in development of DIMA. METHODS: An iterative, participatory design approach was used. Forty individuals receiving hemodialysis at an urban inner-city facility, primarily middle-aged and African American, were recruited. RESULTS: Computer literacy was considered by assessing abilities to complete traditional/nontraditional PDA tasks. Information literacy was enhanced by including a Universal-Product-Code (UPC) scanner, picture icons for food with no UPC code, voice recorder, and culturally sensitive food icons. Numerical literacy was enhanced by designing DIMA to compute real-time totals that allowed individuals to see their consumption relative to their dietary prescription. Visual literacy was considered by designing the graphical interface to convey intake data over a 24-h period that could be accurately interpreted by patients. Pictorial icons for feedback graphs used objects understood by patients. PRACTICE IMPLICATIONS: Preliminary data indicate the application is extremely helpful for individuals as they self-monitor their intake. If desired, DIMA could also be used for dietary counseling.

Readiness to exercise: a comparison of 3 instruments and an interview.

Exercise stage of change (ESOC), or readiness to exercise, has been measured using at least 13 instruments and 4 interviews, yet no comparison studies are available to determine optimal measures for use by health care providers. This pilot study compares ESOC classification between 3 instruments (scale-ladder, scale-true/false, and scale-5 choice); explores the feasibility of using a face-to-face structured interview; compares classification between instruments and interview; and examines the influence of sex, age, and education level on stage classification. Thirty healthy adults completed ESOC instruments in random order and then the interview. Scale-ladder and scale-true/false instruments exhibited almost perfect agreement (weighted kappa, 0.897). All instruments exhibited substantial agreement with interview (weighted kappa, 0.620-0.790). Stage classification did not differ significantly by sex, age, or education level. The authors recommend word clarification revision of the scale-5 choice instrument and further testing of the interview.