Group support for couples coping with a cardiac condition

Psychological couple-oriented interventions for patients with heart disease and their partners: a scoping review and guidelines for future interventions

Objective

This scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures.

Methods

A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords "heart diseases" and "couple-based intervention." A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis.

Results

The database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient.

Conclusion

The variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients' and partners' outcomes.

Learning from the experience of peer support facilitators and study nurses in diabetes peer support: A qualitative study

OBJECTIVES

We report on the experiences of peer support facilitators and study nurses who participated in a large trial of peer support for type 2 diabetes. The support was led by volunteer peer support facilitators, who were trained in overcoming barriers to diabetes care, motivational interviewing, listening skills and setting up and running group support sessions. There is currently a distinct lack of qualitative evidence on what works in peer support.

METHODS

The peer support facilitators and study nurses completed open-answer questionnaire items on what worked well and less well, problems encountered and how they were resolved, group dynamics and suggestions for improvement. We also collected data from end-of-study meetings. Inductive thematic analysis was used to allow the emergent themes to be strongly based in the data.Findings: We find that process factors, peer support facilitator and peer characteristics, their relationships with each other and group dynamics are all fundamental for effective peer support. Sustaining and ending support also emerged as a key theme.

DISCUSSION

Given the increasing interest in peer support, these findings will be useful to those interested in running groups in the future. Training programmes should help peer support facilitators develop confidence whilst emphasising that peer support ideally entails an equal, democratic dynamic. More attention is needed on to how to end groups appropriately.

Couples coping in the community after the stroke of a spouse: A scoping review

Aim

To summarize evidence on the poststroke coping experiences of stroke patients and spousal caregivers living at home in the community.

Design

A scoping review.

Methods

Extensive searches were conducted in credible databases. Articles published in the English language were retrieved. Data were extracted based on study location, aims, study design, sample size, time after stroke and key findings.

Results

Out of 53 identified articles, 17 studies were included in the review. Five key themes were as follows: (a) emotional challenges; (b) role conflicts; (c) lack of strategies in coping; (d) decreased life satisfaction of the couples; and (e) marriage relationship: at a point of change. Couples were not sufficiently prepared to cope and manage with stroke at home on discharge from the hospital. This review emphasized the need for hospitals to implement policies to address the inadequate preparation of couples in coping with stroke.

Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease

BACKGROUND

Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care.

METHODS

Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients' demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes.

RESULTS

Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients' levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts.

CONCLUSIONS

Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.

Towards Optimal Heart Failure Care: Couples-Oriented Strategies to Improve Patient Adherence and Health Outcomes

Psychosocial factors play an important role in the development and progression of cardiovascular diseases (CVD), such as chronic heart failure (CHF). In particular, psycho-cognitive disturbance is common in CHF, which presents additional challenges to secondary prevention and management strategies. This review provides a summary of the contemporary psycho-cardiology literature, including coverage of common mood and cognitive symptoms, and explores some of the pathophysiologic evidence linking psycho-cognition to CHF, with particular emphasis on sympathetic nervous system activation and neuroendocrine functioning. Social support is identified as a strategy by which to reduce depressive symptoms, manage cognitive impairment and to, potentially, improve health outcomes through improved patient self care and adherence. Recent research outcomes suggest that the integration of family caregivers into CHF psycho-educational disease management programs, as providers and recipients of support, may achieve best outcomes. In this regard, couples-oriented strategies that promote communication, emotional attachment and support may enhance health-promoting behaviours in patients and their partners.

CABG and PTCA Patients' Expectations of Informational Support in Health-Related Quality of Life Themes and Adequacy of Information in 1-Year Follow-Up

The purpose of this study was to describe coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) patients' need for nursing informational support in health-related (HRQoL) items before and after coronary artery procedures. As well we present the adequacy of informational support from patients' viewpoint. The study sample (N=625) consisted of consecutive male (N=439) and female (N=176) patients with CAD who were treated with elective CABG or PTCA. The data were collected by structured interview before coronary artery procedures and by mailed questionnaires 6 and 12 months afterwards in 1999-2001. Patients in both groups reported needing the most information about recovery and psychosocial functioning before and after the treatments. Single HRQoL items identified that the expectations of women and men differed during the follow-up period. Women in the PTCA group needed more informational support than men before procedures, while men needed more support afterwards. Our results suggest that the content of informational support is different for male and female patients before and after the coronary artery procedures. The effects of nursing interventions and instruments for measuring change in patients' outcome resulting from nursing interventions should be developed further.

A 3-Year Follow-Up of Participation in Peer Support Groups after a Cardiac Event

Secondary prevention is an important component of a structured rehabilitation programme following a cardiac event. Comprehensive programmes have been developed in many European countries, the vast majority of which are hospital based. In Sweden, all patients with cardiac disease are also given the opportunity to participate in secondary prevention activities arranged by the National Association for Heart and Lung Patients [The Heart & Lung School (HL)]. The aim of this 3-year longitudinal study was to compare persons who attended the HL after a cardiac event and those who declined participation, with regard to health aspects, life situation, social network and support, clinical data, rehospitalisation and mortality. Totally 220 patients were included in the study. The patients were asked to fill in a questionnaire on four occasions, in addition to visiting a health care center for physical examination. After 3 years, 160 persons were still participating, 35 of whom attended the HL. The results show that persons who participated in the HL exercised more regularly, smoked less and had a denser network as well as more social support from nonfamily members than the comparison groups. This study contributes to increased knowledge among healthcare professionals, politicians and decision makers about peer support groups as a support strategy after a cardiac event.

Family Functioning Assessed by Family Members in Finnish Families of Heart Patients

BACKGROUND

The role of family is central to the wellbeing and health of individuals. Family attitudes, habits and routines affect the way individuals promote their health. Family functioning and family health are threatened when one family member develops heart disease.

AIMS

The aim of the study was to describe family functioning and to ascertain factors related to family functioning of families with heart patient as assessed by family members.

METHODS

Data collection was done using a questionnaire (FAFHES) in 2000. The sample consisted of 161 family members of patients receiving treatment on two medical wards. The data were analysed by means and tested by parametric and non-parametric tests. The multivariate method used was stepwise regression analysis.

RESULTS

The better the family values were materialized and the greater the family's contribution to family health, the better the family's functioning is. Concrete aid was also related to family health. The more concrete aid the family received from nurses, the better family functioning is. When the background variables were included, values and activities remained in the model, but two new variables explained family functioning: family member's age and knowledge of health issues. The older the family member is and the better the knowledge in the family is, the better is family functioning.

CONCLUSION

Family functioning of families with heart patients can be supported and developed by family nursing, e.g. concrete aid from nurses. Other aspects of support, e.g. consideration of family member's age and knowledge of health issues also need to be further considered and studied as the basis of care.

Comparing Interventions in Older Unpartnered Adults after Myocardial Infarction

BACKGROUND

Older adults after myocardial infarction (MI) are a vulnerable group who may benefit from interventions to improve health outcomes. The use of a peer advisor or an advanced practice nurse (APN) to provide a self-efficacy intervention is a promising method of improving health outcomes after MI.

AIMS

The purpose of this paper was to compare the effect of two self-efficacy interventions, a peer advisor and an APN, to a group who received standard care after MI.

METHODS

The study was a three-group randomized clinical trial with a peer advisor intervention group, an APN intervention group, and a standard care group. Outcome data were collected in the hospital after MI and by telephone at 12 weeks after hospital discharge, after the interventions were completed.

RESULTS

At 12 weeks after MI, there were no significant differences between the 3 groups in health outcomes. There were similar changes in self-efficacy for performing recovery behaviors, the actual performance of recovery behavior, physical and mental health across both intervention groups and the standard care group.

CONCLUSIONS

Although the data did not validate the benefits of these self-efficacy interventions, future efforts at identifying changes in health outcomes may need to use more discrete measurements that are more sensitive to changes in the older unpartnered adult after an MI.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study

BACKGROUND

Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later.

OBJECTIVE

The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses.

METHODS

An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that "2 persons would be better than 1" at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes.

RESULTS

The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents).

CONCLUSIONS

The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

Managing uncertainty in couples living with atrial fibrillation

BACKGROUND

Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

OBJECTIVE

The aim of this study was to explore couples' main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

METHODS

Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

RESULTS

Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples' shifting between implicit and explicit sharing.

CONCLUSIONS

Atrial fibrillation affects the partner relationship by bringing uncertainty into couples' daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

Health-related quality-of-life outcomes in coronary artery bypass surgery patients and partners

PURPOSE

The purpose of this study was to examine health-related quality-of-life (HRQOL) outcomes in coronary artery bypass surgery (CABS) patients and partners enrolled together in cardiac rehabilitation versus a usual care group.

METHODS

After CABS, couples were randomly assigned to the Partners Together in Health (PaTH) intervention (n = 17) or usual care (n = 17) groups. Health-related quality-of-life was operationalized as physical function (SF-36 Physical Functioning subscale), depression (Patient Health Questionnaire), and marital adjustment (Dyadic Adjustment Scale). Data were measured in patients and partners at the start (T1) and end of cardiac rehabilitation (T2), and 3 months after cardiac rehabilitation (T3). Nonparametric statistics were used to examine changes over time and differences between groups.

RESULTS

Patients in both groups, and partners in the PaTH group, significantly improved physical function between T1 and T2. At T1, 18% of patients and 6% of partners were depressed. At T2 and T3, only 3% of patients and no partners were depressed. Almost 12% of patients and partners were maritally distressed at T1. At T2 and T3, patients' marital distress was unchanged, but more partners reported marital distress (15%).

CONCLUSIONS

This study adds to our understanding of the trajectory of HRQOL outcomes after CABS for patients and partners. These findings demonstrated promise for the PaTH intervention. Future testing of the intervention is warranted in a larger sample. Because patients and partners are impacted by CABS as a shared life experience, couple-centered interventions may improve HRQOL outcomes more than individually focused interventions.

Prepare the patient for future challenges when facing hemodialysis: nurses' experiences

Chronic kidney disease is a major health problem due to the significant financial burden for the healthcare system and likewise for the patient who needs the treatment. The patient's whole life situation is turned upside down with chronic kidney disease when they are confronted with the forced change to start treatment with hemodialysis. Patients with chronic kidney disease experience a lack of adequate emotional support from nurses during the transition to hemodialysis. The purpose of this study was to explore nurses' experiences of giving support to patients during the transition to hospital-bound hemodialysis. The study had a qualitative descriptive design with a content analysis approach; eight nurses from four hospitals in the south of Sweden participated. The results showed that the nurses gave threshold support with an openness and awareness of the patient's individual needs during the transition, except that there seemed to be a lack of knowledge and ability to provide emotional support. Patient support during the transition could therefore be absent. Education, at local and national levels, is needed for the nurse to be able to give professional emotional support. Further research is also desired in order to provide nurses with the tools they need to give emotional support, which is of utmost importance.

Support groups and cardiac rehabilitation: effects of partner participation on anxiety and depression

This study analyzes the effect on levels of patient anxiety and depression of a partner joining a cardiac rehabilitation program support group, also taking into account the sex of the patient. The study was undertaken using a two-group comparison design with pre-and post-test measures in non-equivalent groups. The sample comprised patients in the cardiac rehabilitation program (CRP) at the Ramón y Cajal Hospital, Madrid (Spain). Analysis of covariance (ANCOVA) showed direct effects of sex and partner participation in support groups on the anxiety trait. Similarly, interaction effects were observed between the sex variable and partner participation. These results indicate the pertinence of designing separate groups for patients and partners.

The experience and impact of chronic disease peer support interventions: a qualitative synthesis

OBJECTIVE

Our aim was to synthesise qualitative literature about the perceived impact and experience of participating in peer support interventions for individuals with chronic disease.

METHODS

We carried out a meta-ethnography to synthesize 25 papers meeting specific inclusion criteria.

RESULTS

Thirteen concepts were identified that reflected participants' perceptions of the experience and impact of intervention participation. These were brought together in a conceptual model that highlighted both positive and negative perceptions, while also indicating if specific experiences and impacts had greater pertinence for mentors, mentees, or were mutually experienced.

CONCLUSION

Although peer support interventions may establish uneven power relationships between mentors and mentees, there is also potential for initially asymmetrical relationships to become more symmetrical over time. Our synthesis suggests that emotional support is particularly valued when delivered under conditions that do not merely reproduce biomedical hierarchies of power.

PRACTICE IMPLICATIONS

This synthesis suggests that those developing and implementing peer support interventions need to be sensitive to their potential negative effects. They will need to manage the tension between the hierarchical and egalitarian aspects of peer support interventions, and consider the impact on both mentors and mentees.

Primary health care resources for rehabilitation and secondary prevention after myocardial infarction - a questionnaire survey

BACKGROUND

During the first year after a cardiac event, many patients are offered participation in a cardiac rehabilitation programme, after which the patients are often not given the opportunity to continue to attend rehabilitation and secondary prevention programmes.

AIM

This study describes the primary health care centres' (PHCC) resources regarding cardiac rehabilitation/secondary prevention programmes for coronary heart disease (CHD) patients in a southern Swedish region.

METHOD

A questionnaire containing 26 dichotomous or multiple choice questions was sent to the responsible manager of all 137 public and private PHCCs in Region Skåne. Questionnaires from 91 (66%) of the PHCCs were completed and returned.

RESULT

Few nurses at the PHCCs had special training regarding CHD (10%), cardiac rehabilitation (8%) or heart failure (32%). Twenty-one per cent of the physicians had special training regarding CHD. One third of the PHCCs did not offer long-term secondary prevention programmes, and few (6%) had any routines for offering socio-economic support to CHD patients. Comparison of private and public PHCCs showed that the private centres could not offer a physiotherapist (61 vs. 84%) or dietician (32 vs. 73%; p = 0.03) to the same extension as the public ones. Furthermore, the majority (91%) of PHCCs had no cooperation with patient organizations.

CONCLUSIONS

The PHCCs need to improve the strategies and long-term rehabilitation programmes. Furthermore, they need to focus on education programme for the staff. The result revealed that the PHCCs lack resources, strategies and long-term care programmes for CHD patients.

Do group audiologic rehabilitation activities influence psychosocial outcomes?

PURPOSE

To attempt to determine whether group audiologic rehabilitation (AR) content affected psychosocial outcomes.

METHOD

A randomized controlled trial with at least 17 participants per group was completed. The 3 treatment groups included a communication strategies training group, a communication strategies training plus psychosocial exercise group, and an informational lecture plus psychosocial exercise group. Evaluations were conducted preclass, postclass, and 6-months postclass; they included hearing loss-related and generic quality of life scales, and a class evaluation form.

RESULTS

All treatment groups demonstrated short- and long-term improvement on the hearing loss-related quality of life scale. Minimal differences were measured across treatment groups. A significant difference was observed between the lecture plus psychosocial exercise group and the communication strategies training group for 1 hearing loss-related quality of life subscale. Better outcomes were measured for the 2 groups with psychosocial exercises versus the communication strategies training group on 1 generic quality of life subscale. The results for the class evaluation did not discriminate among the treatment groups.

CONCLUSIONS

Class content had only a minimal influence on treatment outcomes. Recommended AR class content includes a mix of interventions including information, training, and psychosocial exercises.

Review of Outcomes of Cardiac Support Groups After Cardiac Events

Cardiac support groups may positively affect adjustment after cardiac events and quality of life (QoL). However, although participation in support groups is presumed to be beneficial, there were few studies regarding the potential benefit. The purpose of this review was to examine studies focused on the effects of cardiac support groups on health-related outcomes. Four studies met the inclusion criteria for review. Eight categories of support group outcomes were identified, including psychological outcomes, health behaviors, clinical health, health-related QoL, self-reported health conditions, social support, life situation, and knowledge. Most cardiac support group outcomes, though positive, were not statistically significantly different from those of control groups in studies reviewed. Psychosocial need of patients following cardiac events is indicated, including stress management and social support, and encouraging the establishment of realistic individual goals. More research is needed to establish cost-effective formats for support groups and to determine specific outcomes that can be achieved.

Testing a Model of Physical and Psychological Recovery After a Cardiac Event

Little is known about the specific sources and types of support that assist patients in alleviating stress and achieving positive recovery outcomes after a cardiac event. The purpose of this study is to examine the effects of illness-related stress, emotional and tangible support from a significant other, and informational support from a health care provider on physical and psychological recovery outcomes in cardiac patients 8 weeks after their cardiac event. The sample consists of 220 cardiac patients. Data analysis uses structural equation modeling. Final fit indices were as follows: χ2 ( df = 110) = 156.169, comparative fit index = .963, Tucker—Lewis index = .949, and root mean square error of approximation = .044 suggesting an acceptable model. Illness-related stress has direct effects on depression, physical recovery, and activity levels. Partner emotional support has a direct effect on depression. The findings provide direction for developing social support interventions aimed at improving recovery outcomes.

Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach

AIM

To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management.

DESIGN

Systematic review.

METHOD

The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage).

RESULTS

Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase.

CONCLUSIONS

Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design.

RELEVANCE TO CLINICAL PRACTICE

To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.

Health service interventions targeting relatives of heart patients: A review of the literature

Aims: Relatives of heart patients experience anxiety, uncertainty, and low quality of life, and the hospitalization of a heart patient is associated with increased risk of death for the partner. Relatives' physical and mental problems may be rectified by activities established by the health services to support relatives and to enable them to handle the situation. This study systematically reviewed the literature on the latest health service interventions targeting relatives of heart patients. Methods: The literature about interventions targeting relatives of heart patients has been systematically reviewed to clarify what the health services do for relatives of heart patients and to assess the effects of interventions. We searched Medline, EMBASE, PsycINFO, CINAHL database, CSA and the Cochrane Library from January 2000 to March 2006. Results: Only six scientific articles reported on interventions testing health service activities for relatives of heart patients, and one literature review scrutinized earlier studies within the field. All the interventions indicate positive effects on patients' and/or relatives' health and well-being, in accordance with nurses' assessments. Nevertheless, the few studies and their questionable quality means that full evidence on the effects of the interventions is lacking. Conclusions: Future research should clarify the evidence for health service interventions and draw up guidelines for activities for the relatives of heart patients.

Factors associated with health-related quality of life in patients and significant others one month after coronary artery bypass grafting

AIM

To describe and compare the health-related quality of life of patients and their significant others and to identify factors associated with health-related quality of life one month after coronary artery bypass surgery.

BACKGROUND

Heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients might feel their quality of life is poor. Significant others are a major source of support for patients; therefore, it is important to know how their health-related quality of life is affected.

METHODS

This study is part of a major longitudinal research project. The questionnaire data for the study were collected one month after the surgical procedure from 270 patients and 240 significant others at one Finnish university hospital. Data analysis was by descriptive and inferential statistics. Stepwise linear regression analysis was used as a multivariate method.

RESULTS

Coronary artery bypass grafting patients had a poorer health-related quality of life than both the age and gender-standardised general population and their significant others. Significant others, on the other hand, had the same health-related quality of life as the general population. In patients, health-related quality of life was associated with the occurrence of cardiac symptoms and New York Heart Association class; in significant others, it was explained by chronic illnesses, employment, gender and emotional support received from members of the support network.

CONCLUSION

In the early stages of recovery, the health-related quality of life of coronary artery bypass grafting patients is inferior to that of the general population. There are also differences in the health-related quality of life of patients and their significant others.

RELEVANCE TO CLINICAL PRACTICE

Postcoronary artery bypass grafting rehabilitation programmes should provide support for both patients and significant others through networks that involve both professionals and peer supporters.

An exploration of the information needs of spouse/partner following acute myocardial infarction using focus group methodology

This study aimed to explore spouse/partners' experience of the information received and required in the acute myocardial infarction (AMI) in-hospital recovery period. A dearth of information exists that uncovers the information needs of spouse/partners following AMI. Although information needs, emotional reactions, support and information provision are prevalent themes within the literature, there are few studies that specifically address these issues in this population. While survey methods abound, with more recent qualitative interviews apparent, focus group methodology is underused. The study employed a qualitative descriptive design. Using focus group techniques, 15 partners were interviewed. Emerging themes included: reactions to the event, feeling like a burden on the health service, the need for information and pulling apart - pulling together. Spouse/partners play a critical role in helping patients recover from acute cardiac events thus information and support for the latter are crucial. While spouse/partners commonly seek information as a problem-solving coping strategy, in an effort to regain personal control, spouses often lack information. This study identifies spouse/partner isolation and suggests that additional supports need to be in place to adequately deal with the challenges that AMI brings to family life. Suggested support mechanisms to enhance current provision are inclusion of spouse/partner in cardiac rehabilitation programs and hospital-based care, self-help groups supported and attended by professionals and telephone support systems.

Impact of cardiac disease on couples' relationships

AIM

This paper reports a study to describe meanings that couples mutually assign to, and practices they develop, after the onset of cardiac disease and to understand the impact of the illness on the couples' relationships in everyday life.

BACKGROUND

Patients as well as partners are affected by the onset of cardiovascular disease. Social support within intimate relationships has been shown to be important for patient survival and well-being, and couples' coping strategies are pivotal for well-being and adjustment to the chronic condition in both patients with cardiovascular disease and their partners.

METHOD

Twenty-four couples participated in this phenomenological study. Data were collected during 2003. Participants were interviewed after having been hospitalized due to an acute event and having participated in a rehabilitation programme. Three in-depth interviews were obtained for each dyad: one couple interview and two individual interviews with each partner of the dyad. Paradigm cases were sought and thematic analyses conducted.

FINDINGS

All couples experienced a 'brush with death' at the onset of heart disease, which called for changes in lifestyle. Three distinct patterns of dealing with the illness emerged. The first revealed that some couples assess the illness as a positive, transformative experience in their lives, bringing them closer together. The second showed that a proportion of couples experience the illness as a threat which imposes fear on both partners. The challenges are faced as mutual tasks and new routines are developed. The third pattern revealed couples who experience a missed opportunity to change. These couples are disenchanted about each other but return to life as usual.

CONCLUSIONS

Nurses can use the information gained from this study to support couples in their attempts to come to terms with the illness, and can enhance their supportive role in rehabilitation efforts.

Palliative and supportive needs of older adults with heart failure

BACKGROUND

Chronic heart failure (CHF) affects older people and carries a heavy burden in terms of poor prognosis and quality of life. Palliative and supportive care services are being advocated in the UK to relieve that burden but older people's needs require further understanding to ensure effective service models.

AIM

To explore the experiences of older adults with CHF to gain a deeper understanding of their palliative and supportive needs and the value of possible interventions.

METHODS

This qualitative study collected data from ten patients with CHF in New York Heart Association Classes II to IV, aged 80-90 years, attending a support programme. Semi-structured interviews were conducted and transcripts were analysed using constant comparative analysis.

FINDINGS

The narratives revealed the consequences of living with heart failure in terms of physical symptoms and disability, psychological sequalae, social isolation and existential concerns. The variety of ways in which participants adjusted to and coped with these consequences was revealed in terms of their approach to their illness, and utilizing the resources available to them, including the support programme. Needs were conceptualized in terms of requirements to supplement deficits in coping resources.

CONCLUSIONS

Services designed to meet palliative and supportive needs of older people should aim to identify individual coping strategies and resources and highlight deficits in order to target appropriate interventions.

Stress in women's daily life before and after a myocardial infarction: a qualitative analysis

BACKGROUND

Little is known about women's perceptions of their daily life before and after a myocardial infarction (MI), especially with regard to stress, which is a risk factor for coronary heart disease (CHD).

AIM

To describe and explore women's perceptions of stress before and after an MI.

METHOD

Two interviews with women who suffered an MI, the first at the hospital (n = 20) and the second 4-10 months after the MI (n = 14), were analysed using a phenomenographic approach.

FINDINGS

The stress emanated either from within themselves (personal traits) or as an effect of their immediate surroundings. The period before the MI was stressful due to the different roles they had to maintain in their private and professional lives. They lost control over their daily life. After hospital discharge they both wanted and needed support, as they were terrified when they returned home. They did not know how much they could do and neither did their relatives, while little or no support was provided by the healthcare professionals.

CONCLUSIONS

To prevent CHD in daily life and avoid reinforcing stress, it is important to place greater emphasis on stress as an important risk factor. An understanding of this phenomenon can assist primary healthcare, coronary care unit (CCU) and rehabilitation nurses in supporting these women as well as their partners to adapt their daily lives both before and after an MI. It is essential to formulate and implement individualised treatment plans and to provide support groups for women.

Professional support for next of kin of patients receiving chronic haemodialysis treatment: a content analysis study of nursing documentation

AIM AND OBJECTIVES

The aim of this study was to examine the content of nursing documentation with a focus on professional support for next of kin (NoK) of patients receiving chronic haemodialysis treatment.

BACKGROUND

Professional support in nursing focuses on promotion, maintenance and restoration of health and prevention of illness.

DESIGN

The study had a descriptive design and qualitative content analysis was used to search for themes based on descriptions contained in the collected nursing documentation.

METHODS

The total number of nursing records of patients receiving chronic haemodialysis treatment (n = 50) for the 5-year period 1998-2002 was included. All nursing documentation was systematic in accordance with the VIPS-documentation model.

RESULTS

The professional support could be described within the framework of three themes: to explore NoK's supportive resources, to enable NoK' readiness in caring for the patient and to co-operate with NoK in the care of the patient in the home, captured by the core theme which described the professional support as a continuous process.

CONCLUSIONS

Next of kin are a supportive resource in the nursing care of patients receiving chronic haemodialysis treatment and professional support for NoK focuses on planning their participation in the care of patients in the home.

RELEVANCE TO CLINICAL PRACTICE

Professional support for NoK should be documented in family focused nursing diagnoses, which would make it possible to search for different types of support. Future research might explore nurses' or NoK's views on carer support.

An analysis of the stressors and coping strategies of Chinese adults with a partner admitted to an intensive care unit in Hong Kong: an exploratory study

AIMS

The aim of this study was to identify the major stressors affecting Chinese adults whose partner had been admitted to an intensive care unit and to understand the major coping strategies employed to manage such stressors.

BACKGROUND

Recently a greater number of patients of higher acuity have been admitted to intensive care units and survive lengthy illnesses of an unpredictable course. Such critical illnesses have been identified as a major life event to family members of these patients. Little is known, however, about the stressors and coping mechanisms of Chinese adults whose critically ill partner is admitted to an intensive care unit.

METHODS

An exploratory qualitative design was selected to achieve the aims of the study. A purposive sample of 10 Chinese adults with a partner in an intensive care unit of a regional general hospital in Hong Kong participated in tape-recorded semi-structured interviews. Content analysis was employed to analyse the translated interviews.

FINDINGS

Categories of stressors included uncertainty, difficulties in communication, changes in roles and responsibilities, difficulties in decision making, financial strain as well as changes in relationships. Analysis identified a range of coping strategies which included seeking information, seeking support, reliance on cultural beliefs and practices, turning to religious beliefs, maintaining hope and acceptance of illness.

CONCLUSIONS

The findings demonstrate the importance of cultural beliefs and practices in determining the coping mechanisms employed to manage the stressors identified by this sample of Chinese adults. Such findings indicate the use of both internal and external coping strategies in order to maintain equilibrium in the family.

RELEVANCE TO CLINICAL PRACTICE

Implications for nursing practice highlight the significance of seeking information throughout the critical period and also culturally appropriate support from healthcare professionals.

Significance of fellow patients for patients with myocardial infarction

The purpose of the study was to present both positive and negative experiences with respect to the significance of fellow patients for patients with myocardial infarction (MI), both inside and outside the hospital. Five focus group sessions were carried out, each having between four and six participants. A total of 25 patients with MI at an age of 40-71 participated. The analysis was carried out by the moderator and co-moderator of the focus groups. The results, which are elucidated by theories of social support, show a great amount of positive support in the interactions of patients, such as support from others in the same situation, a lot of humour, encountering true understanding and consideration, getting practical assistance, and benefiting from other patients' knowledge and experience as well as experiencing an increase in motivation. The participants also discussed negative experiences such as dramatic situations when fellow patients got worse and sometimes even died. Many patients were bothered by various kinds of noise and other disturbances. Insight into the significance of fellow patients will make health personnel able to encourage a patient environment that will strengthen positive and reduce negative effects of fellow patients on the health of each individual patient. One relevant measure would be involving former patients or starting up physical activity in groups. The findings show that the informal patient community among fellow patients is an important part of their social support system and thereby also may contribute to health and well-being.

Heart failure and palliative care services working in partnership: report of a new model of care

It is widely acknowledged that people with advanced heart failure have at least as great a need for supportive and palliative care as those with malignant disease. However, specialist palliative care services are seldom involved in their care in the UK. We describe a three-year collaboration between community-based heart failure nurse specialists and existing specialist palliative care services. In the model of care that has evolved, the heart failure nurses remain key workers throughout the illness. They run a regular support group for patients and carers in the setting of a hospice day therapy unit, referring patients for other palliative care involvement as necessary. Activity data and the results of patient interviews are presented. These suggest that the model is a cost effective, sustainable way of providing high quality care for people with heart failure.

Depression, Isolation, Social Support, and Cardiovascular Disease in Older Adults

Research evidence related specifically to psychosocial issues in older adults with cardiovascular disease remains sparse; however, widespread recognition of the impact of the changing population demographic is spurring new research in this important area. National guidelines for cardiac rehabilitation and secondary prevention in several countries include recommendations related to psychosocial issues; authors are beginning to address the older cardiac patient in their recommendations. The purpose of this article is to highlight some key psychosocial factors that have been independently associated with coronary heart disease but to do so with a focus on the older adult in the secondary prevention setting. The selected psychosocial factors are social support, social isolation, and depression. Although evidence supports a relationship between psychosocial factors and coronary heart disease, the issue addressed in this article is whether such relationships hold true in the older adult and whether rehabilitation and secondary prevention interventions are targeted to address these factors. As much as possible, current recommendations (related to psychosocial issues) from worldwide Clinical Practice Guidelines are highlighted. Finally, any examination of psychosocial factors and coronary heart disease must consider the possibility of sex and/or gender differences. Therefore, a commentary on reported differences between men and women with respect to social support, social isolation, and depression is included.

Living with pulmonary artery hypertension: patients' experiences

BACKGROUND

Research on the outcomes of medical therapy in persons with pulmonary artery hypertension (PAH) has increased as new therapeutic options have emerged. Little investigation has been done on the impact of living with PAH despite inferences that quality of life (QOL) improves.

PURPOSE

The purpose of this qualitative study was to describe patient experiences of living with PAH and identify factors that may have an impact on QOL.

PARTICIPANTS

Participants (n = 11; 8 women, 3 men) were selected from among 42 adult patients, 40 to 72 years of age, followed in an outpatient setting at a tertiary care hospital. Multiple types of treatment modalities were represented including calcium channel blockers, endothelin-receptor antagonists, prostacyclin analog, and lung transplantation.

METHODS

Semistructured interviews allowed participants to describe experiences living with PAH. Interviews were recorded on audiotape and transcribed verbatim. Analysis was conducted in accordance with Colaizzi's 7-step process for analysis of phenomenologic data.

RESULTS

Two overarching themes emerged indicating that participants experience uncertainty associated with a variety of aspects of this illness but also learn to cope with this uncertainty and move on with their lives.

IMPLICATIONS

Assisting patients to cope with the uncertainty associated with this chronic health problem is essential if patients are to successfully adjust to the demands of the illness and its treatment. Attention to the findings of this study should guide health care professionals in their efforts to improve QOL in this patient population.

Surviving sudden loss: When life, death, and technology collide

Patients who survive sudden cardiac arrest are at risk for anxiety, depression, and other psychosocial difficulties. By exploring the impact of surviving sudden cardiac arrest as it relates to the expectations and emotions of patients and their families, nurses can promote realistic and readily usable processes for facilitation of healthy grieving, adaptive coping, and reinvestment in life.

Partnerships in Mending Hearts

As a growing number of older adults recover from cardiac events, volunteer programs have emerged to provide low-cost community support to vulnerable elders. Although an increasing number of studies have described the beneficial relationships between patients and volunteers, little is known about the unique partnership between the advanced practice nurse (APN) and the volunteer peer. The purpose of this article was to explore the interaction between the APN and the peer advisor who provide support for unpartnered elders after myocardial infarction or coronary artery bypass grafting. As part of a larger research study, "Improving Health Outcomes for Unpartnered Cardiac Elders" (R01-NR05205), interactions with peers were recorded by APNs. Essential themes related to working with 20 peer advisors emerged from 30 logs. Findings suggest that establishing the peer support role, acknowledging abilities, and overcoming difficulties are important steps in the relationship. A partnership between healthcare professionals and peer advisors enhances social support for vulnerable elders recovering from myocardial infarction and coronary artery bypass grafting.

Rehabilitation after coronary heart disease: spouses' views of support

BACKGROUND

Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

AIM

The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

METHOD

Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

FINDINGS

The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

CONCLUSION

Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Coronary artery bypass grafting: social support for patients and their significant others

BACKGROUND

Patients and significant others may experience physical and psychological stress symptoms during the recovery time from coronary artery bypass surgery. It has been shown that social support is associated with health and well-being in various situations. It is important to study how patients and significant others describe the social support received.

AIM AND OBJECTIVE

To describe social support for bypass surgery patients and their significant others from the social network and nurses during hospitalization and the association between demographic variables and support received from nurses.

DESIGN

A descriptive study using a questionnaire. This was a pilot study.

METHOD

Questionnaires were mailed to 146 subjects and 103 responded. The questionnaires included background variables, the Social Support from the Social Network Scale and the Support from Nurses during Hospitalization Scale.

RESULTS

In most cases, the spouse, children and friends were the major sources of support for patients and significant others. Patients reported equal amounts of both affect and aid or concrete support while significant others reported the highest level of affect and the lowest level of affirmation from the social network. Patients and significant others reported the highest level of affirmation and the lowest level of aid from nurses during hospitalization.

CONCLUSIONS

Relatives are important sources of support for bypass surgery patients and their significant others. Patients reported higher levels of all types of social support from both the social network and nurses than did significant others.

RELEVANCE TO CLINICAL PRACTICE

The provision of nursing support for significant others can be enhanced by focusing nursing care on the whole family. This would promote the health of the whole family.

Audio-visual relaxation training for anxiety, sleep, and relaxation among Chinese adults with cardiac disease

The long-term effect of an audio-visual relaxation training (RT) treatment involving deep breathing, exercise, muscle relaxation, guided imagery, and meditation was compared with routine nursing care for reducing anxiety, improving sleep, and promoting relaxation in Chinese adults with cardiac disease. This research was a quasi-experimental, two-group, pretest-posttest study. A convenience sample of 100 cardiology patients (41 treatment, 59 control) admitted to one large medical center hospital in the Republic of China (ROC) was studied for 1 year. The hypothesized relationships were supported. RT significantly (p <.05) improved anxiety, sleep, and relaxation in the treatment group as compared to the control group. It appears audio-visual RT might be a beneficial adjunctive therapy for adult cardiac patients. However, considerable further work using stronger research designs is needed to determine the most appropriate instructional methods and the factors that contribute to long-term consistent practice of RT with Chinese populations.

In-hospital social support for families of heart patients

Chronic illness in one family member influences all aspects of family life. Research has documented the positive contributions of social support in an unexpected and stressful event such as a family member's heart disease. The aim of the study was to describe in-hospital social support provided by nurses to families of heart patients and to identify factors related to social support. Data were collected using a mailed questionnaire to family members of heart patients (n = 161) receiving treatment on two medical wards of a university hospital in southern Finland. The results show that the family members were not very satisfied with the social support from nurses, because about 40% were dissatisfied with the concrete aid and affirmation they received and about 30% with emotional support. According to regression analysis the most important predictors of social support were family structure, patient's age, gender of family member and whether the patient had been hospitalized for cardiac symptoms. This report shows that supporting families of cardiac patients need development according to the family nursing practice.

Are psychosocial factors associated with the pathogenesis and consequences of cardiovascular disease in the elderly?

It is well known that older individuals are at higher risk of developing cardiovascular disease (CVD). In addition, evidence exists for the relationship between psychosocial factors and the pathogenesis and cognitive consequences of CVD. However, less is known about the effect of psychosocial factors on the development and consequences of CVD in older individuals. Using a biopsychosocial framework, this article examines the influence of psychosocial factors, specifically depression, anxiety, and social isolation on older persons with CVD as well as the influence of CVD on psychosocial factors. The effectiveness of interventions for modifying adverse psychosocial factors is also discussed.

Psychological therapies for recipients of implantable cardioverter defibrillators

Implantable Cardioverter Defibrillators (ICDs) are an increasingly common therapy for the treatment of ventricular arrhythmias. Whereas most ICD recipients adjust well to living with the implant, a substantial minority suffer anxiety, depression, and anger that appears to be related to the ICD. A large number of studies have reported on the incidence of psychopathology and common psychosocial problems among patients with ICDs, however very few psychological interventions with this cohort have been reported. In an extensive literature search we identified only a handful of studies that described outcomes of psychological interventions, and most of these were in pilot form. Only one randomized controlled study with a homogenous sample of ICD patients has been reported to date. Given the unique situation of patients with ICDs and the particular vulnerability of those who experience frequent shocks, the evaluation of interventions that may improve psychological adjustment within this group would appear a worthwhile endeavor.