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

Psychometric Evaluation of the Sex After Myocardial Infarction Knowledge Test in Iranian Context

PURPOSE

To translate, adapt, and assess the psychometric properties of the Sex After MI Knowledge Test in Iranian context (where MI is myocardial infarction).

DESIGN AND METHODS

A cross-sectional descriptive survey was performed. The sample comprised 250 patients with MI. Confirmatory factor analysis was applied to extract three indicators.

FINDINGS

The Sex After MI Knowledge Test indicated good reproducibility (Cronbach's α = .76, Intraclass correlation (ICC) = 0.729, CI = 0.7280-0.781, p < .001 ICC: Intraclass correlation). Nonnormed and normed fit indices (FI) were 0.89, and incremental and comparative FIs were 0.90. Goodness-of-fit index (GFI) and adjusted GFI were below the criteria. After a varimax rotation, the first six items of the instrument explained 58.71% of total variance.

PRACTICE IMPLICATIONS

The instrument showed acceptable psychometric properties in terms of construct validity and internal consistency. The instrument might be used to stimulate conversations patients with MI regarding sexual knowledge and concerns.

A meta-ethnographic synthesis on phenomenographic studies of patients' experiences of chronic illness

Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients' various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients' experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations.

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 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.

Middle-aged women and everyday life: implications for health

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either 'handle life', describing a framework of how everyday life should manifest itself in different areas of life, or 'relate to life' implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.

Women's experience of a myocardial infarction: 5 years later

BACKGROUND

Myocardial infarction (MI) has long been seen as a male disease despite the fact that it is also a health problem for women. Factors that may influence their recovery, such as co-morbidity and requirements for support, have received less scientific attention.

AIM

To explore and describe how women conceived their health and daily life 5 years after an MI.

METHOD

An explorative and descriptive approach inspired by phenomenography was chosen as the design. The present study includes 12 women who have been described in earlier short-term studies.

FINDINGS

The women described how the MI caused limitations in their lives even 5 years after the MI. They experienced physical restrictions, fatigue and also other health complaints. Furthermore, the older women suffered from various co-morbidities such as diabetes, kidney disease, high blood pressure, and stroke. Some women did not perceive their heart disease to interfere in daily life. Many of the women had thoughts about having a new MI. Furthermore, some women were grateful and described it as having a second opportunity.

CONCLUSION

  The present study indicates how women in the recovery process 5 years after an MI still need support to continue with lifestyle changes. The women continue to struggle with different kinds of issues, such as financial stress, co-morbidity and side effects of medication. Support from the health care only in the first year after the MI is not enough. The women should benefit from the possibility to visit or consult professionals in primary care with knowledge of CHD.

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.

Adaptation Positions and Behavior Among Post—Myocardial Infarction Patients

This study explores myocardial infarction patients' experiences of adaptation to illness consequences after one year, focusing on experiences of “the self.” The study sample consisted of 19 respondents (10 women, 9 men) who have suffered a first-time myocardial infarction. They were interviewed 1 year after the acute heart attack. A constant comparative method for grounded theory provided the strategies used for data collection and analysis. Codes emerged and memos clarified theoretical reflections. The resulting model was able to illustrate possible mechanisms underlying two different behaviors: self-modifying and self-protecting behavior. Four different adaptation positions were identified: put up with current health, struggle for health, ignore illness , and struggle against illness. These categories were related to two core categories: self-agency and coping with illness consequences . This model may clarify the different adaptive behavior observed among post—myocardial infarction patients.

Recent research in stress, coping and women's health

PURPOSE OF REVIEW

To highlight recent publications in the area of stress and coping, with specific reference to women's physical health status.

RECENT FINDINGS

The transactional model of stress and coping continues to be the mainstay of research in this area. Several longitudinal studies have demonstrated that stress appraisal and resultant coping responses affect health outcome and health-related quality of life in women. In addition to problem-focused coping, women often use distraction methods, seeking social support and faith or religious coping. Psychological interventions in chronic medical conditions need to move beyond education and incorporate more cognitive behavioral components, at the same time addressing women's specific needs.

SUMMARY

Coping behaviors in response to the negative threat appraisal of a chronic or severe medical illness serve to reduce psychological distress. However, it is still not clear how they impact at the physiological level. In addition, coping responses, which enhance positive effects and promote health-related quality of life, merit greater attention from researchers. There is a need for more gender comparative research to improve health outcomes in men and women.

Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study

OBJECTIVE

To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status.

DESIGN

Multicentre study with a prospective short-term follow-up design.

SETTING

A university hospital, a central hospital and a district hospital in southern Sweden.

SUBJECTS

Consecutive sample of 246 patients with a suspect or manifest myocardial infarction.

MAIN MEASURES

The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables.

RESULTS

Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence.

CONCLUSIONS

Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.

Acute coronary syndrome: social support and coping ability on admittance

AIM

To compare social support and coping ability in acute coronary syndrome patients at the time of the cardiac event with a healthy community-based sample, with regard to age, sex, education and marital status.

METHOD

The study comprised 241 patients and 316 healthy controls. The participants answered a self-administered questionnaire that included three well-established scales. Multiple logistic regression was used in the analysis to compare the health situation between the patients and controls.

RESULTS

Persons suffering from acute coronary syndrome rated emotional support significantly lower than the healthy controls. However, there were no differences between the two groups in terms of socio-demographic variables.

CONCLUSION

This study indicates that social support may be a predictor of acute coronary syndrome.