A cross-sectional study of Hispanic and Latina/o/x/e individuals' acute coronary syndrome symptom knowledge, attitudes, and beliefs.

BACKGROUND: Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. OBJECTIVES: To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. METHODS: This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. RESULTS: The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. CONCLUSIONS: Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population.

Emergency Nurses' Recognition of and Perception of Sex Differences in Acute Coronary Syndrome Symptoms.

INTRODUCTION: Emergency nurses must quickly identify patients with potential acute coronary syndrome. However, no recent nationwide research has explored nurses' knowledge of acute coronary syndrome symptoms. The purpose of this study was to explore emergency nurses' recognition of acute coronary syndrome symptoms, including whether nurses attribute different symptoms to women and men. METHODS: We used a cross-sectional, descriptive design using an online survey. Emergency nurses from across the United States were recruited using postcards and a posting on the Emergency Nurses Association website. Demographic data and participants' recognition of acute coronary syndrome symptoms, using the Acute Coronary Syndrome Symptom Checklist, were collected. Descriptive statistics and ordinal regression were used to analyze the data. RESULTS: The final sample included 448 emergency nurses with a median 7.0 years of emergency nursing experience. Participants were overwhelmingly able to recognize common acute coronary syndrome symptoms, although some symptoms were more often associated with women or with men. Most participants believed that women and men's symptoms were either "slightly different" (41.1%) or "fairly different" (42.6%). Nurses who completed training for the triage role were significantly less likely to believe that men and women have substantially different symptoms (odds ratio 0.47; 95% CI 0.25-0.87). DISCUSSION: Emergency nurses were able to recognize common acute coronary syndrome symptoms, but some reported believing that the symptom experience of men and women is more divergent than what is reported in the literature.

A Nationwide Study of Emergency Nurses' Triage Decisions for Potential Acute Coronary Syndrome.

INTRODUCTION: This study aimed to identify the symptoms used to assess angina, determine how emergency nurses make triage decisions for potential acute coronary syndrome, and determine emergency nurses' initial actions. METHODS: This was a cross-sectional, survey-based design. Emergency nurses were recruited through a posting on the Emergency Nurses Association website and through postcards. Measures included demographic data, assessment of angina, and the Nurses' Cardiac Triage Instrument. Data were analyzed using descriptive statistics and ordinal logistic regression. RESULTS: A total of 414 registered nurses with a mean age of 41.7 (SD = 12.0) years participated. They were predominantly female (80.7%), had a baccalaureate degree (60.1%), and worked as a registered nurse for a median 10.0 years. Common terms used to assess angina were chest pain (79.5%), chest pressure (77.3%), chest tightness (72.9%), and chest discomfort (72.5%). The severity of chest pressure (median 5.0, interquartile range 1.0) and nature of chest pain (median 5.0, interquartile range 1.0) had the highest overall median scores to support initial cardiac triage decisions. Associated symptoms of diaphoresis, fatigue, and shortness of breath along with health history contributed to decision making. DISCUSSION: Emergency nurses primarily used chest symptoms and health history when deciding to evaluate for acute coronary syndrome in the emergency department. Associated symptoms of diaphoresis, fatigue, and shortness of breath, along with health history, also contributed to decision making. Initial registered nurse actions were to obtain an electrocardiogram, prepare the patient for the cardiac catheterization laboratory, and notify the emergency physician of the patient's admission.

Cardiovascular Disease in Women: An Update for Nurses.

Cardiovascular disease (CVD) is the leading cause of death in women but is often underrecognized and undertreated. Women are more likely to experience delay in treatment and worse outcomes, even though they experience similar symptoms as men. Women are more likely to experience ischemia related to microvascular dysfunction, which is not readily diagnosed by commonly used diagnostic tests. Nurses are ideally positioned to be patient advocates and use evidence-based guidelines to encourage primary prevention and ensure prompt treatment. This paper provides an update on CVD in women for clinical nurses based on the latest research evidence.

Initial development of the chest pain conception questionnaire.

BACKGROUND: Even though "chest pain" is often highlighted as a key heart attack symptom for which individuals should seek care, little is known about the ways that the lay public conceives of chest pain related to acute coronary syndrome (ACS). OBJECTIVES: The purpose of this four-step process was to develop an instrument to measure the lay public's conceptions of chest pain related to ACS. METHODS: The Chest Pain Conception Questionnaire (CPCQ) was drafted based on the Theory of Unpleasant Symptoms and findings from the published literature. We then leveraged two rounds of expert feedback to calculate item-level and scale-level content validity indices. Two rounds of pilot testing (N = 51 and N = 300) were conducted with members of the target population. Psychometric testing was also conducted, including exploratory factor analysis. RESULTS: The multi-step development process resulted in an instrument that is comprised of 23 items (2 open-ended questions, 13 short scenarios with Likert-type ratings, and 8 multiple-choice questions) and written at a 7th grade level. The scale-level content validity index was 0.99. Exploratory factor analysis findings also supported construct validity. CONCLUSIONS: This paper provides preliminary evidence of the CPCQ's validity.

Effects of the COVID-19 Pandemic on Emergency Department Triage Nurses' Response to Patients With Potential Acute Coronary Syndrome.

BACKGROUND: The COVID-19 pandemic added challenges to patient assessment and triage in the emergency department (ED). OBJECTIVE: The aim of this study was to describe the effects of the COVID-19 pandemic on ED triage nurse decisions for patients with potential acute coronary syndrome (ACS). METHODS: This was a secondary analysis of data from a descriptive, electronic, survey-based study. Participants were asked 2 questions: whether the COVID-19 pandemic had affected their triage and/or assessment practices for patients with potential ACS and, if so, how. Descriptive statistics were used to compare the characteristics of participants. A qualitative descriptive approach was used to analyze responses to the open-ended questions about the pandemic's effect on the triage process. RESULTS: Participants from across the United States had a mean age of 41.7 (12.3) years; 358 (80.6%) were women. The participants had a median of 10.0 (interquartile range, 16.0) years of experience as a registered nurse, with a median of 7.0 (interquartile range, 11.0) years of ED experience. A total of 180 of 444 participants (40.5%) indicated that the COVID-19 pandemic affected their triage processes and assessment of potential ACS patients; 156 (86.7%) provided a response to the open-ended question. Responses revealed 4 themes: (1) delays in triage and treatment, (2) ambiguous patient presentation, (3) heightened awareness of COVID-19 complications and sequelae, and (4) process changes. CONCLUSIONS: Forty percent of ED triage nurses participating reported that triage processes for patients with potential ACS were affected by the COVID-19 pandemic. Most expressed barriers that resulted in delayed assessment and treatment of patients and often resulted from overlapping cardiac symptoms and COVID-19.

The Lay Public's Knowledge of the Most Common Acute Coronary Syndrome Symptoms Experienced by Women and Men.

BACKGROUND: Although extensive research and public education for the last 2 decades has focused on symptom differences experienced by men and women, little is known about what acute coronary syndrome symptoms the lay public associates with men, with women, and with both men and women. OBJECTIVE: The aim of this study was to describe what acute coronary syndrome symptoms the lay public associates with men, with women, and with both men and women and to explore whether differences in participant gender affect how these symptoms are associated. METHODS: A descriptive, cross-sectional survey design was used, using an online survey. We recruited women (n = 209) and men (n = 208) living in the United States from the crowdsourcing platform Mechanical Turk in April and May 2021. RESULTS: Most participants (78.4%) selected a chest symptom as the most common acute coronary syndrome symptom experienced by men, compared with only 49.4% who selected a chest symptom as the most common for women. Almost half (46.9%) of women indicated that they believe men and women have "fairly different" or "very different" acute coronary syndrome symptoms, compared with 17.3% of men. CONCLUSIONS: Whereas most participants associated symptoms with both men and women's experiences of acute coronary syndrome symptoms, some associated symptoms in ways that are not reflected in the literature. Additional research is needed to further understand the impact of messaging on acute coronary syndrome symptom differences between men and women and the lay public's interpretation of these messages.

Predictors of acute coronary syndrome symptom knowledge, attitudes, and beliefs in adults without self-reported heart disease.

BACKGROUND: The time of symptom onset to the time an individual decides to seek care is the most significant contributor to total treatment delay. OBJECTIVES: To explore predictors of ACS symptom knowledge, attitudes, and beliefs in adults without diagnosed heart disease. METHODS: We used a cross-sectional, descriptive, and correlational design, employing an online survey including the ACS Response Index and the avoidance subscale of the Coping Strategy Indicator. We leveraged social media platforms and a university email list-serv to enroll participants. Stepwise hierarchical linear regressions were used. RESULTS: We analyzed responses from 981 participants, with a mean age of 35.2 years (SD 16.5) and 75% female. The regression analyses yielded models that explained 14%, 23%, and 25% of the variance for knowledge, beliefs, and attitudes, respectively. Ethnicity, race, exposure to ACS symptom information (in the media or by teaching), and perceived health were the predictors of ACS symptom knowledge, attitudes, and beliefs with the largest effect, though others were statistically significant. CONCLUSIONS: The findings underscore the importance of community education to raise awareness of ACS symptoms while considering social determinants of health. Future research and clinician interventions for ACS symptom knowledge, attitudes and beliefs should be expanded with a focus on ethnicity and gender.

EXPLORATORY AND CONFIRMATORY FACTOR ANALYSIS OF THE ACS-RESPONSE INDEX IN ADULTS WITHOUT DIAGNOSED HEART DISEASE.

Background and Purpose: To report on the psychometric properties of the Acute Coronary Syndrome Response Index in adults without heart disease. Methods: Participants were enrolled online, using social media platforms and an email listserv. The sample of 1,040 was randomly split into two sub-samples for exploratory and confirmatory factor analysis. Results: Exploratory factor analysis yielded a four-factor solution for the knowledge subscale, a one-factor solution for the attitudes subscale, and a two-factor solution for the belief subscale. Subsequent confirmatory factor analysis demonstrated an excellent fit for the attitudes and beliefs subscales and an acceptable fit for the knowledge subscale. Conclusions: The Acute Coronary Syndrome Response Index can be used with individuals without diagnosed heart disease. However, researchers may wish to omit the incorrect items in the original version of this instrument.

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

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

Nurses' personal perceptions of clinical work adaptation during COVID-19.

BACKGROUND: The clinical work of nurses across the United States was profoundly impacted by the Coronavirus (COVID-19) pandemic. Nurses in both hospital and outpatient settings had to adapt quickly to the continuously changing healthcare environment. OBJECTIVE: To describe nurses' responses to open-ended questions of their clinical work adaption during the COVID-19 pandemic. METHODS: A descriptive, cross-sectional survey with four open-ended questions was completed by practicing HF nurses. Content analysis was used to analyze the written data. RESULTS: The 127 nurses who provided one to four narrative responses, 55.1% were clinical registered nurses and 44.9% were advance practice nurses. Four categories emerged: changing paths exemplifies work challenges, developing technical skills and resources, asking better questions while listening, and showing resilience through new paths to optimize work. CONCLUSION: Understanding perceptions of nurses' adaptions to clinical work made during the pandemic provides insight into the challenges and opportunities for development in the future.

Perceptions of changes in practice patterns and patient care among heart failure nurses during the COVID-19 pandemic.

BACKGROUND: The Coronavirus (COVID-19) had a profound impact on the delivery of care in both hospital and outpatient settings across the United States. Patients with heart failure (HF) and healthcare providers had to abruptly adapt. OBJECTIVE: To describe how the COVID-19 pandemic affected practice patterns of HF nurses. METHODS: Practicing HF nurses completed a cross-sectional, anonymous, web-based survey of perceptions of HF practice. Analyses involved descriptive and comparative statistics. RESULTS: Of 171 nurses who completed surveys, outpatient HF visits decreased and 63.2% added telehealth visits. Despite spending about 29 min educating patients during visits, 27.5% of nurses perceived that the pandemic decreased patients' abilities to provide optimal self-care. Nurses reported decreased ability to collect objective data (62.4%; n = 78), although subjective assessment stayed the same (41.6%; n = 52). CONCLUSION: Nurses' practice patterns provided insight into patient care changes made during COVID-19. Most core components of HF management were retained, but methods of delivery during the pandemic differed.

Perceived personal risk and vulnerability in recognizing and responding to symptoms of acute coronary syndrome: an integrative review.

BACKGROUND: Simply knowing the common symptoms of acute coronary syndrome (ACS) is not sufficient to ensure prompt care-seeking when these symptoms occur. Factors other than symptom knowledge contribute to prompt care-seeking behaviours and correct symptom attribution to the heart. OBJECTIVES: To explore how perceived personal risk and perceived personal vulnerability towards ACS affect a person's ACS symptom recognition and attribution and also how this perception affects a person's response to ACS symptoms. DESIGN: An integrative review, using Whittemore and Knafl's approach. DATA SOURCES: PubMed, Academic Search Complete, CINAHL Complete, APA PsycINFO, and APA PsycARTICLES. ELIGIBILITY CRITERIA FOR STUDY SELECTION: We included studies that (i) were original human-subjects research or secondary analyses of human-subjects research, (ii) provided information about how perceptions of risk or perceptions of vulnerability towards ACS or heart disease affect symptom recognition, attribution, and/or response to symptoms, and (iii) were published in English. RESULTS: Thirteen articles were included. Studies were conducted in nine different countries and were descriptive or exploratory in nature. The existing evidence suggests that perceived personal risk or vulnerability towards heart disease may promote earlier care-seeking for ACS symptoms and facilitates attribution of symptoms to the heart. CONCLUSION: The designs of the included studies limit causal attribution, and additional prospective and intervention-based research is needed to determine how perceived risk/vulnerability may affect care-seeking and ACS symptom attribution. Increasing perceptions of vulnerability towards heart disease may reduce care seeking delay.

An Analysis of the Use of the Terms Sex and Gender in Research Reported in Nursing Journals.

Accurately measuring and reporting the demographic characteristics of research participants are imperative to provide consumers of research with an understanding of who was included in a study. While researchers often, incorrectly, use the variables sex and gender interchangeably, these 2 variables are different. We conducted a content analysis of 239 randomly selected research articles, with the purpose of describing how researchers have used sex and gender in studies published in nursing journals and identifying opportunities for improved clarity and precision in measuring these 2 variables. We found that significant improvement is needed in the way these variables are used/reported.

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

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

Words Matter: Sex and Gender as Unique Variables in Research.

Sex and gender are not equivalent concepts, even though these 2 variables are often used interchangeably by researchers. The precise use of variables is critical to ensure that research and theoretical work is of the highest quality. This article defines sex and gender and the importance of recognizing both of these variables as being unique and then demonstrates the benefit of measuring both of these variables using the cardiovascular disease literature as an exemplar. Additionally, recommendations for scholars regarding the use of sex and gender in the research and theoretical literature are provided.

Beliefs and Experiences of Nurse Educators Regarding Changing Answers on Examinations.

AIM: The purpose of this study was to explore nurse educators' beliefs and experiences regarding students changing answers on multiple-choice examinations. BACKGROUND: Studies suggest that answer-changing behavior does not negatively affect academic performance and may actually have a positive impact, but published studies reporting nurse educators' beliefs and experiences on this topic are limited. METHOD: A mixed-methods approach, QUAN + Qual, was employed. A survey with closed- and open-ended questions was emailed to nurse educators in Illinois. RESULTS: Of the 125 nurse educators who completed the survey, a majority held negative views of answer-changing behavior; many noted that their experiences with students had shaped their views. CONCLUSION: Nurse educators in this sample held an overall negative view of this behavior, contrary to the overall body of evidence suggesting there is possible benefit in changing answers. Several reasons exist to explain the inconsistency observed.

An integrative review of the theory of unpleasant symptoms.

AIMS: The aim of this study was to explore how the theory of unpleasant symptoms (TOUS) has been used in the methodological design and analysis of symptom research. DESIGN: An integrative review, using Whittemore and Knafl's approach. DATA SOURCES: Searches were conducted between 26 January-10 February 2018. Databases included CINAHL Complete, PubMed, Proquest Nursing and Allied Health Source, Health Source: Nursing/Academic Edition, Academic Search Complete and Google Scholar. REVIEW METHODS: A systematic approach to searching, screening and analysing the literature was applied. The matrix method, content analysis, constant comparison, counting and clustering were used. RESULTS: Sixty-four records were included. Most studies were quantitative, cross-sectional, instrument-based and conducted in the USA. Various symptoms and patient populations were represented and each of the TOUS concepts were explored. CONCLUSION: Although the theory has a role to play in furthering symptom science, attention should be paid to the areas of the model and of symptom research that have received less attention. More complex statistical approaches and big data will help to illuminate symptom experiences. Additional focus on intervention studies and all symptom dimensions will help to advance symptom science research. IMPACT: This review is the first to provide a comprehensive, systematic summary of the uses of the TOUS across the research literature to date. This theory is a diverse, holistic middle-range theory capable of being applied to multiple symptoms and populations. Researchers should consider using the theory as a conceptual framework for studies to advance symptom science and explore symptoms holistically.

Prodromal Myocardial Infarction Fatigue: A Concept Analysis.

Patients' care-seeking behaviors are often based on the symptoms they experience. Prodromal myocardial infarction symptoms are those symptoms that occur prior to a myocardial infarction, and fatigue is common. However, the concept of prodromal myocardial infarction fatigue has not been explored from a multidimensional perspective using a concept analysis approach. The purpose of this concept analysis was to analyze this concept, using Walker and Avant's (2011) concept analysis methodology. A comprehensive literature search revealed 41 records for analysis. The structure and function of this concept was examined, and an operational definition of prodromal myocardial infarction fatigue was developed.