Acute myocardial infarction in middle-aged women: narrations from the patients and their partners during rehabilitation

One size does not fit all: A qualitative study exploring preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease

Aim

To explore preferences and barriers towards the design of a loneliness reduction intervention in patients treated for coronary heart disease who experience loneliness.

Design

A qualitative study using patient involvement methodology.

Methods

Seventeen patients participated in either focus groups or individual interview sessions. The interview guide was based on patient involvement methodology. Interviews were analysed using deductive content analysis.

Results

Four overall findings emerged as follows: (a) An intervention involving a social network member must comply with patients perceived social norms; (b) An intervention involving a peer provides benefits from reciprocity and shared experiences, but also requires surplus mental energy; (c) The history of an existing relationship can act as both provider and barrier for confidentiality and (d) Start‐up, timeframe and structure of the intervention should be individually tailored to the patient's preferences. Findings illuminated preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease.

Resistance to change: Role of relationship and communal coping for coronary heart disease patients and their partners in making lifestyle changes

Background: Lifestyle behaviours are important risk factors for coronary heart disease (CHD) and, hence, motivation for lifestyle changes is suggested to be a key factor in the success of cardiac rehabilitation and secondary prevention programmes. The motivation for changing lifestyle among people with CHD may be influenced by those with whom they have long-term, intimate relationships. Aims: This study explores the role of the relationship between people with CHD and those closest to them in making lifestyle changes. This includes investigating if patients and partners experience autonomy, competence, and relatedness, and what role communal, i.e. relationship-centred coping serves in relation to patients’ health behaviour. Methods: The study is based on semi-structured, in-depth interviews with 10 couples; people who have experienced acute coronary syndrome, and their partners. Participants had diverse histories of disease and social backgrounds. A three-stage interview process was undertaken including focus group interviews, couple interviews and individual interviews. A thematic analysis, inspired by the self-determination theory and the interdependence theory, was conducted. Results: Communal coping is evident in various forms, and at different levels, among people with CHD and their partners. Satisfaction with new lifestyle, ownership of change, confidence in ability to change, and emotional distress are all factors that affect how couples deal with lifestyle changes in the aftermath of CHD. Conclusions: Rehabilitation efforts, aimed at lifestyle changes, need to address each individual, as well as the dyadic interaction within couples. Incorporating a dyadic perspective in the rehabilitation process may lead to a reduction in motivational barriers to lifestyle changes.

La autoeficacia en el post-infarto

Introducción. Después de un infarto agudo de miocardio, los pacientes experimentan altos niveles de estrés emocional y ansiedad. Estas percepciones limitan sus comportamientos saludables.Objetivo. Determinar el nivel de autoeficacia general en pacientes post-infarto agudo de miocardio según la edad, género, estado de rehabilitación y atención en una unidad de cardiología en Girardot.Materiales y métodos. Investigación descriptiva, evaluada a través de la Escala general de autoeficacia versión ll, en una población de 149 personas entre los 35 y 65 años. Para el análisis estadístico de los resultados se utilizaron medidas estadísticas descriptivas y pruebas de correlación.Resultados. La edad de los participantes tuvo una media de 52 años. El análisis de la autoeficacia por grupo de edad evidenció incidencia mínima de la autoeficacia en el grupo de edad. Según el género, los hombres se percibieron más autoeficaces que las mujeres. Además, los pacientes que no asistieron a la rehabilitación cardíaca tuvieron un nivel de autoeficacia general ligeramente mayor en comparación con los rehabilitados.Conclusiones. No hubo relación entre la edad, el género y la rehabilitación frente al nivel de autoeficacia. Estas variables dependieron de otras diferentes a las del estudio.

The Role of the Nurse in Cardiac Rehabilitation Programmes

Cardiac rehabilitation programmes are intended to enhance the effect of acute treatment actions and to prevent risk factors, thus leading to an improvement in the patient's well being and recovery. Accordingly, all cardiac rehabilitation activities do not take place at the same time, which is the reason why the nurse's role changes in character over time. The aim of this paper is, therefore, to highlight the role of the nurse in cardiac rehabilitation programmes. The nurse's multiple roles in cardiac rehabilitation have a 'spider in the web-like' character and, depending on the phase of the patient's recovery, he/she acts as a container, a counsellor, a coach and an educator. To implement a successful cardiac rehabilitation, the nurse needs to have improved evaluation tools in clinical practice as well as to be self-critical and serve as a good role model. Finally, the cardiac rehabilitation nurse has to have a four-fold comprehensive perspective of the cardiac rehabilitation concept; an impact perspective, a timing perspective, a lifespan perspective, and a personal perspective.

Women's Social Support and Social Network after Their First Myocardial Infarction; A 4-Year Follow-Up with Focus on Cardiac Rehabilitation

Background: Knowledge about women's recovery following a myocardial infarction (MI) with focus on how their social support and network change over time as a result of participation in a cardiac rehabilitation programme (CRP) is not well established.

Aim: The aim of this study was to describe and compare social support and network changes over a 4-year period in women with a first MI, based on socio-demographic and situational data.

Method: A longitudinal, comparative study with a non-randomised design including pre- and post-tests (1 and 4 years after MI) was carried out in 18 hospitals in Sweden. Consecutively chosen women ( N = 240) answered a questionnaire on the subject of social support and network.

Results: The women who participated in a CRP were mainly dependent upon professional support during the first year after MI ( p < 0.0001), while those who declined to participate in a CRP needed professional support throughout the whole 4-year period ( p = 0.001). Participation in CRP was dependent on the women's age, those under 60 years ( p = 0.050).

Conclusion: There is a need to develop CRPs that are specifically designed for women based on their age and family relationships. Nurses' training programmes should place greater emphasis on cardiac rehabilitation from the perspective of women with focus on professional support.

Self-Reported Behavioural and Medical Changes in Women after Their First Myocardial Infarction: A 4-Year Comparison Between Participation and Non-Participation in a Cardiac Rehabilitation Programme

Background: Women's recovery following a myocardial infarction (MI) has not yet been studied in a thorough manner. Aim: Therefore, the aim of this study was to compare women's self-reported behavioural and medical changes, both in those women who voluntarily participated and those women who did not participate in a cardiac rehabilitation programme (CRP). Methods: A non-randomised comparative study design, including pre- (baseline) and post-tests (1 and 4 years after), was implemented in 18 hospitals in Sweden. Consecutively chosen women suffering their first MI ( N=240) completed a questionnaire regarding behavioural and medical factors. Results: At baseline, significant differences existed between the groups regarding time stress (increased in the CRP group) and hypertension (increased in the non-CRP group). The behavioural factors improved, irrespective of CRP participation or not, with the exception of time stress, which was consistently high in the CRP group both 1- and 4-years after the MI. Regarding the medical factors, the significant difference in hypertension disappeared after 1 year. Four years after the MI, the CRP group reported significantly less rehospitalisation and more interventive cardiology compared to the non-CRP group. Conclusion: The women benefited from CRP participation in relation to medical factors, but not at all in relation to behavioural factors. Accordingly, randomised clinical trials are necessary to perform in order to determine the effects of a long-term individual-based supportive CRP, performed by well-educated healthcare professionals.

Can Anyone Hear Me? Does Anyone See Me? A Qualitative Meta-Analysis of Women's Experiences of Heart Disease

Female heart patients are underdiagnosed and undertreated. The purpose of this qualitative meta-data-analysis was to explain how societal expectations related to gender and the treatment environment influence women's experiences and can inform optimal care. The authors used grounded theory methodology and a social constructionist gender lens to analyze 43 studies (1993-2012) of women's experiences of heart disease. The analysis illustrates how social expectations within both medical and relational contexts led to women experiencing barriers to diagnosis and treatment and inadvertent minimization of their experience and knowledge. Women's descriptions of their experiences suggest three kinds of health care strategies that have the potential to increase women's engagement with heart disease treatment and rehabilitation: (a) support give and take in relational connections, (b) identify and acknowledge unique health-promoting behavior, and (c) focus on empowerment. These findings have interdisciplinary implications for practice with women with heart disease.

Coronary heart disease patients transitioning to a normal life: perspectives and stages identified through a grounded theory approach

AIMS AND OBJECTIVES

To explore how Iranian patients with coronary heart disease experience their lives.

BACKGROUND

Coronary heart disease is a leading cause of death in Iran and worldwide. Understanding qualitatively how patients experience the acute and postacute stages of this chronic condition is essential knowledge for minimising the negative consequences of coronary heart disease.

DESIGN

Qualitative study using grounded theory for the data analysis.

METHODS

Data for this study were collected through individual qualitative interviews with 24 patients with coronary heart disease, conducted between January 2009 and January 2011. Patients with angina pectoris were selected for participation through purposive sampling, and sample size was determined by data saturation. Data analysis began with initial coding and continued with focused coding. Categories were determined, and the core category was subsequently developed and finalised.

RESULTS

The main categories of the transition from acute phase to a modified or 'new normal' life were: (1) Loss of normal life. Experiencing emotions and consequences of illness; (2) Coming to terms. Using coping strategies; (3) Recreating normal life. Healthcare providers must correctly recognise the stages of transition patients navigate while coping with coronary heart disease to support and educate them appropriately throughout these stages.

CONCLUSION

Patients with coronary heart disease lose their normal lives and must work towards recreating a revised life using coping strategies that enable them to come to terms with their situations.

RELEVANCE TO CLINICAL PRACTICE

By understanding Iranian patients' experiences, healthcare providers and especially nurses can use the information to support and educate patients with coronary heart disease on how to more effectively deal with their illness and its consequences.

The experience of younger adults following myocardial infarction

The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.

Coping with the effects of myocardial infarction from the viewpoint of patients' spouses

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

Coping Experiences: A Pathway towards Different Coping Orientations Four and Twelve Months after Myocardial Infarction-A Grounded Theory Approach

Background. Patients recovering from a myocardial infarction (MI) are faced with a number of serious challenges. Aim. To create a substantive theory on myocardial infarction patients' coping as a continuum. Methods. Grounded theory method was used. Data were collected by using individual interviews. The informants were 28 MI patients. Results. The core category “coping experiences—a pathway towards different coping orientations” includes 2 main categories: “positive and negative coping experiences” (4 months after MI) and “different coping orientations” (12 months after MI). Conclusion. Coping with a myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. Coping is threatened, if the patient denies the seriousness of the situation, suffers from depression and emotional exhaustion, or if there are serious problems in the interaction with family members. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centered approach involving a posthospital counseling intervention is recommended. Relevance to Clinical Practice. The results of this study can be used in nursing care practice when organizing support interventions for myocardial infarction patients.

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.

A qualitative study exploring why people do not participate in cardiac rehabilitation and coronary heart disease self-help groups, and their rehabilitation experience without these resources

BACKGROUND

Secondary prevention and self-management of coronary heart disease (CHD) are of major importance to people who survive myocardial infarction (MI). This can be facilitated by cardiac rehabilitation (CR; the formal health service programme) and informal CHD self-help groups. Non-participation is an important issue, yet it is poorly understood. Rehabilitation difficulties and prevention challenges have been identified among people following MI, but the particular experience and perspective of CR and CHD group non-participants are largely unknown.

AIM

The study aimed to understand non-participation in CR and CHD self-help groups from the perspectives of the non-participants and to provide insight into their experience and that of their 'significant others' in rehabilitating in the absence of these resources.

METHODS

In-depth interviews were conducted with 27 people who had not participated in either hospital-based CR or a CHD group, 6-14 months post-MI, and 17 'significant others' in Lothian, Scotland.

FINDINGS

Factors influencing non-participation fell into three broad themes 'No need/no point', 'Not worth it', and 'Not possible'. In the latter two categories, non-participation in these resources was often considered a 'missed opportunity' and needs had remained unmet. Shifts between categories could occur over time. Non-participation was linked to rehabilitation difficulties for some people and family members. Recommendations to enhance post-MI support are made.

Couples' thoughts about and expectations of their future life after the patient's hospital discharge following acute myocardial infarction

AIM

To describe and interpret couples' thoughts and expectations about their future life after the patient's discharge following acute myocardial infarction.

BACKGROUND

An acute myocardial infarction is a challenge for both the patient and his/her partner, as it can disrupt family functioning and dynamics. Earlier research has generally focused on either the patient or the partner, and few studies have explored the experiences of the couple.

DESIGN

Qualitative descriptive and interpretative.

METHODS

Fifteen couples took part in individual interviews, 4-8 weeks after discharge. Data were analysed in two phases using qualitative content analysis.

RESULTS

The first phase of the analysis revealed two categories: 'an active approach to the future' and 'a wait-and-see approach to the future', both of which described the participants' thoughts about the future. In the second phase, the couples' stories were interpreted and grouped into four positions: 'the life companions', 'the tightrope walkers', 'the pathfinders' and 'the observers', which illustrated their visions of the future.

CONCLUSIONS

Our results reveal differences in the couples' thoughts about and expectations of their future life, most of them managed the situation by having a positive attitude to life and their future. The couples discovered their resources and compensated for or balanced each other in the early recovery period.

RELEVANCE TO CLINICAL PRACTICE

The results indicate the importance of giving both partners the opportunity to express their views of the situation, as this increases nurses' understanding of the impact of the illness on their life and relationship. However, the results also highlight the significance of seeing the couple and showing them consideration both as individuals and as a unit.

Illness experiences of patients with ischemic heart disease during their transitional phase from hospitalization to discharge in Japan

The purpose of this study was to explore the experience of patients with ischemic heart disease (IHD) during the transitional phase from hospitalization to discharge. Twenty-four patients who experienced IHD for the first time comprised the sample of the study. Semi-structured interviews were conducted during the transitional phase. The results of the qualitative inductive analysis showed two categories of illness experience: (i) the connection of heart attack experience with the self, and (ii) the instability of the self as a patient with heart disease. The participants were found to vacillate between the self as patient with a heart disease and the typical self before the disease onset. The transitional phase is the time when patients experience changes in their symptoms and physical conditions rather than a condition of stability signifying recovery. Patients are expected to manage the symptoms of their heart disease by themselves; however the participants showed signs and symptoms of confusion and anxiety about facilitating their own care. These findings suggest the importance of outpatient nursing practice focusing on the support and emphasis on nursing interventions for patient anxiety and alleviation of confusion through the management of symptoms of heart disease after discharge.

Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients

AIM

Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark.

METHODS

We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey and 50 of 55 invited hospital departments participated.

RESULTS

Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments. Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients.

CONCLUSIONS

Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack of resources, lack of interest and knowledge among staff, and practical and psychological barriers among patients and relatives. More research is needed on health services concerning relatives of cardiac patients, regarding both the prevalence of activities and barriers to these.

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.

‘The intruder’: spouses’ narratives about life with a chronically ill partner

AIM

The aim of this study was to illuminate the meaning of middle-aged spouse's experiences of living with a chronically ill partner. A purposive sample of four female spouses was selected for interviews using a narrative approach.

BACKGROUND

When someone is diagnosed with a chronic illness, it is easy to understand that a considerable number of devastating consequences follow, both for the afflicted as well as for the family. Families often feel neglected and that their problems and needs are underestimated, if they do not personally draw attention to this fact.

METHODS

A phenomenological hermeneutic method, inspired by the philosophy of Ricoeur, was used when interpreting the interview text.

RESULTS

The experiences of spouses living with a chronically ill partner often brought a feeling of detachment from their partner's lives. The women experienced changes in their relationships because of their partners' disabilities; they had emotions of loneliness, despite living together as a couple. Through their actions, the women sought reassurance and support in order to maintain a meaningful partnership with their spouses and this is expressed in three themes: feelings of limitation, the struggle of everyday life and a striving for normalization.

CONCLUSIONS

Middle-aged women living with a chronically sick partner are still of an active disposition and regard themselves as still being in mid-life. They wish to be loved as a wife and not as a care provider.

RELEVANCE TO CLINICAL PRACTICE

The findings from this study can help increase the knowledge and understanding of the problems and concerns encountered by middle-aged spouses living with chronically ill partners and can be useful in the education and supervision of nurses and in relationship with relatives.

Women, men and coronary heart disease: a review of the qualitative literature

AIM

This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes.

BACKGROUND

Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender.

METHODS

Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease.

FINDINGS

Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work.

CONCLUSIONS

There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease.

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction

BACKGROUND

The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men.

AIM

The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners.

METHODS

Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub-themes were then extracted from the text.

RESULTS

The first theme was 'living in a changed life situation' with the sub-themes: 'showing consideration', 'taking responsibility', 'living side by side' and 'desiring what to do'. The second theme was 'looking to the future' with the sub-themes: 'feeling uncertain', 'feeling powerless', 'feeling limited' and 'feeling hope'.

CONCLUSIONS

The results revealed that couples lived in a changed life situation, somewhat in 'discordance', and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this 'discordance', couples may experience loneliness, in that they may not share feelings about the event and the situation it causes.

RELEVANCE TO CLINICAL PRACTICE

Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.

Myocardial infarction: gender differences in coping and social support

AIM

The aim of this review is to summarize current knowledge about gender differences in perceptions of coping and social support among patients who have experienced myocardial infarction.

RATIONALE

Women with coronary heart disease have physical, social and medical disadvantages compared with their male counterparts, which can influence their perception of recovery after cardiac events. No review has been found which focuses on gender differences in coping and social support in myocardial infarction patients.

METHOD

A computerized search was conducted using the keywords 'myocardial infarction', 'coping', 'gender differences' and 'social support'. Forty-one articles, published between 1990 and October 2002, were scrutinized.

FINDINGS

Two studies report that women used more coping strategies than men. Several qualitative studies found that women used a variety of coping strategies. Women minimized the impact of the disease, tended to delay in seeking treatment and did not want to bother others with their health problems. Household activities were important to them and aided their recovery. Men were more likely to involve their spouses in their recovery, and resuming work and keeping physically fit were important to them. Women tended to report that they had less social support up to 1 year after a myocardial infarction compared with men. They received less information about the disease and rehabilitation and experienced lack of belief in their heart problems from caregivers. Further, they received less assistance with household duties from informal caregivers. Men tended to report more support from their spouses than did women.

CONCLUSIONS

Traditional gender-role patterns may influence the recovery of patients who have experienced myocardial infarction. Caregivers may need to be more sensitive to gender-specific needs with regard to risk profiles, social roles, and the patient's own role identity. For many women, especially older ones, household duties and family responsibilities may be an opportunity and a base for cardiac rehabilitation.

Women's health after a first myocardial infarction: a comprehensive perspective on recovery over a 4-year period

BACKGROUND

Little attention has so far been focused on follow ups of women's long-term recovery after a myocardial infarction (MI), especially from a comprehensive perspective.

AIM

The aim of this study was to prospectively determine women's self-rated health after a first MI from a comprehensive perspective on recovery over a 4-year period.

METHODS

Consecutively chosen women (n=240) who had suffered a first MI were asked to complete a self-rated questionnaire regarding health (including not only biophysical, but also behavioral, emotional, social and working conditions) before being discharged from hospital as well as 1 and 4 years later. The results were analyzed by descriptive and inferential statistics.

RESULTS

Health improvements, especially during the first year, could be observed in the women's behavioral condition regarding their attitude to diet consciousness, exercise, simultaneous capability and smoking behavior as well as in the emotional condition regarding their stressful life events, depressed mood and loss of control. In the social condition, the women considered that the healthcare professionals had improved their support over time as well as treating the women's complaints more seriously. Regarding the working condition, the women felt that they were being controlled at work, especially during the first year after the MI.

CONCLUSIONS

Based on a comprehensive perspective on women's recovery after a first MI, a favorable development of the women's health was observed in the behavioral and emotional conditions while deterioration in the social and working conditions was observed over time. Thus, further efforts are needed in the two latter conditions by means of further studies in combination with greater support from healthcare professionals.

Cultural aspects of adjustment to coronary heart disease in Chinese-Australians: a review of the literature

BACKGROUND

The burden of illness associated with Coronary Heart Disease (CHD) has determined this as a key focus for research at a basic science, individual and population level. Although considerable research has been conducted on specific aspects of the experience of CHD, such as anxiety or depression, there is a lack of research investigating the global aspects of the illness experience from the individual's perspective. Furthermore, there is a paucity of research examining the cross-cultural experiences of patients from Non-English Speaking Backgrounds (NESB). Given the multicultural nature of Australian society, and that health and illness are culturally constructed experiences (Manderson 1990), it is important to include the perspectives of people from minority cultures in health related research in order to provide culturally sensitive and appropriate health care and information during an illness. Further, the potential to prevent and modulate the course of CHD, by strategies such as smoking cessation and lipid management, mandate a health promotion agenda based on equity and access for all members of society.

AIMS

This article discusses cultural aspects of CHD in relation to nursing and allied health care during the recovery phase of an acute cardiac event. It reviews the research that has been conducted in this area, focusing on the Chinese-Australian population.

LITERATURE SEARCH

The CINAHL, MEDLINE, FAMILY (Australian Family and Society Abstracts Database), PsychINFO, and Multicultural Australian and immigration Studies (MAIS) databases were searched, identifying literature published from 1982. Keywords used were Chin* (Chinese, China), Asia* (Asia, Asian), experience, adjustment, psychological, heart, coronary, cardiac, health and services. Reports not written in English were excluded. Australian Government reports were also searched, as well as hand searching of nursing and medical textbooks. These searches resulted in over 1000 articles. However, only around 50 were relevant for this review.

IMPLICATIONS

Chinese-Australians are one of the fastest growing populations in Australia, and are at increased risk of CHD upon settling to Australia. Recommendations for future research and for the practice of nursing are provided.

Patient participation in peer support groups after a cardiac event

Peer support groups may be important in long-term rehabilitation after a cardiac event. Questions can be raised about the clients that peer support groups attract. The aim of this study was to compare people who chose to attend peer support groups after a cardiac event with people who declined to attend with regard to health conditions, personal traits, lifestyle and available social support. Patients who sustained a myocardial infarction or were treated with percutaneous transluminal coronary angioplasty or coronary artery bypass surgery (n = 197) responded to a questionnaire. The results showed that there were differences between attenders (n = 64) and non-attenders (n = 133). Attenders reported more health problems than non-attenders, but scored higher on several dimensions of social support. Non-attenders, however, seemed to have a somewhat more relaxed attitude to life than attenders. The homogeneity of the subjects made it difficult to discern which personal and situational factors were of importance for social support seeking in peer support groups. The research indicates that innovative approaches are needed to encourage participation in existing peer support groups.

Caregivers of ICU patients discharged home: what burden do they face?

Reforms in healthcare aimed at cost-cutting have led to early hospital discharge for many patients, including those who have sustained critical illness or injury requiring admission to an intensive care unit (ICU). Many former ICU patients experience ongoing health-related problems following discharge from hospital, and need ongoing support and care from their family once discharged. However, family members who take on a caregiving role often experience an enormous burden. The literature has demonstrated the impact of economic, social, physical and psychological factors on those who care for the critically ill following discharge. It is therefore essential that all nurses involved in the ongoing management of ICU patients have an understanding of the caregiving role, and consider both the patient and his/her carer in the discharge planning process. This paper reviews the literature on caregiving, and examines research studies which describe and measure the factors involved in the caregiving role. Although only a small number of studies specifically focus on caregivers of former ICU patients, findings suggest that these caregivers experience a substantial burden which is associated with the complexity of the patient's physical and psychological impairment, and complex technology. To enable nurses to incorporate planning strategies and interventions aimed at minimizing the impact on the caregiver, further research is needed to more fully explore, examine and measure the factors involved in caring for ICU patients post-discharge. Furthermore, ongoing research and evaluation of interventions will build an evidence-base to inform future practice.