Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors.

BACKGROUND: Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE: This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS: Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS: The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS: Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.

Effects of daily sleep on physical activity after cardiac surgery.

BACKGROUND: Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients. OBJECTIVES: This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery. METHODS: Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses. RESULTS: Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time. CONCLUSIONS: Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.

Accelerometer Use to Measure Physical Activity in Older Adults With Coronary Artery Disease: An Integrative Review.

BACKGROUND: Physical activity is necessary for improved health outcomes among older adults with coronary artery disease (CAD), and device-based assessment of physical activity is preferred for accurate measurement. Many previous studies have applied accelerometry to examine physical activity in this population, but no reviews have systematically examined the application of various accelerometers to measure physical activity in older adults with CAD. OBJECTIVE: This integrative review aimed to examine accelerometry application to measure physical activity in older adults with CAD and provide guidance for accelerometer selection and settings. METHODS: Six databases-CINAHL, PubMed, PsycINFO, Scopus, EMBASE, and Google Scholar-were searched for information sources. Authors of selected studies applied accelerometers to measure physical activity and included adults 60 years or older with CAD. RESULTS: Among 12 studies reviewed, 5 were randomized controlled trials, and most used an age cutoff of 65 years for older adults. The most frequently used accelerometer was the RT3, and the most common device placement was the waist/hip. Data collection duration was typically 3 consecutive days. However, many study authors did not report epoch length, sampling frequency, number of valid hours of data required per day, total number of valid days of data needed, or criteria for nonwear time. CONCLUSIONS: On the basis of data synthesis and previous study results, triaxial research-grade accelerometers, waist/hip placement, and a 5- to 7-day monitoring period are recommended for measuring physical activity in older adults with CAD. However, the study purpose, device and participant characteristics, and physical activity outcomes of interest should be considered during device selection.

Analysis and Evaluation of the Theory of Planned Behavior.

The Theory of Planned Behavior was developed to explain human behaviors. The theory has been broadly applied to health-related behaviors in nursing science but has not been examined in depth based on a critical nursing framework. This article systematically analyzes and evaluates the theory based on Fawcett and DeSanto-Madeya's 2013 framework. The theory reflects nursing metaparadigm concepts and has both social and theoretical significance as well as pragmatic adequacy, and its testability is supported by abundant empirical evidence. However, the theory's internal consistency and clarity could be improved with use of consistent terms for its concepts and relationships.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea.

PURPOSE: This study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea. DESIGN AND METHODS: The study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program. RESULTS: Approximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75-13.70), model 3 (OR 5.01, 95% CI: 1.73-14.50), and model 4 (OR 3.96, 95% CI: 1.29-12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21-0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74-10.67) in model 4. CONCLUSIONS: Nurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses. PRACTICE IMPLICATION: Improvement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Factors influencing physical activity after cardiac surgery: An integrative review.

BACKGROUND: Physical activity can optimize patient outcomes after cardiac surgery, but postoperative patients' physical activity generally has been inadequate. No review studies have focused on factors influencing cardiac patients' postoperative physical activity. OBJECTIVES: To identify factors influencing physical activity in patients after cardiac surgery. METHODS: This study was conducted following Whittemore and Knafl's methodology. CINAHL, MEDLINE, PsychINFO, Scopus, and Embase were searched and selected studies were analyzed using the Matrix Method. RESULTS: In 12 studies, factors facilitating physical activity included personal, socio-environmental, and intervention-related factors. Barriers to physical activity included personal, socio-environmental, and cardiac rehabilitation program-related factors. The most common predictor of physical activity was male sex, and the most frequent barrier was comorbidities. CONCLUSIONS: This study revealed facilitators and barriers that significantly influenced physical activity after cardiac surgery. Healthcare providers and exercise guideline developers should consider our findings when devising physical activity strategies for postoperative cardiac patients.