Is severity of chest pain a cue for women and men to recognize acute myocardial infarction symptoms as cardiac in origin?

Recognizing symptoms as cardiac in origin is associated with the prompt seeking of medical care in patients with acute myocardial infarction (AMI). Therefore, the authors compared the symptom attribution of men and women experiencing AMI and examined factors associated with cardiac attribution by sex. In a cross-sectional study, a total of 1059 AMI patients were consecutively recruited across 5 countries. A structured interview was performed during hospitalization. Approximately 40% of both men and women interpreted their symptoms as cardiac in origin. In men, a history of coronary heart disease (CHD) and chest pain severity were significantly associated with symptom interpretation as cardiac in origin (odds ratio [OR], 4.0; 95% confidence interval [CI], 2.9-5.6; OR, 2.0; 95% CI, 1.4-2.7, respectively). In women, a history of CHD was also significantly associated with symptom interpretation as cardiac in origin (OR, 4.95; 95% CI, 2.39-10.25), but not severity of chest pain. As opposed to men, severe chest pain may not be a cue for women to interpret their symptom as cardiac in origin. Education and counseling must take sex differences into account to be effective.

Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study.

AIM: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors. BACKGROUND: The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences. METHODS: Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005. RESULTS: In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale. CONCLUSION: The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.

Clinical track faculty: merits and issues.

Clinical track faculty (CTF) has been in operation for more than two decades in the United States, and 12 of the top 20 schools of nursing with the highest National Institutes of Health funding in the United States have CTF in place. Yet, only limited articles have been published regarding the merits and issues related to its operation. This article examines the advantages/merits of establishing CTF in schools of nursing, discusses the qualification criteria and types of appointment for CTF, and analyzes issues related to operating CTF in Korea. A questionnaire survey and two workshops were conducted involving faculty from a college of nursing and clinical nurse managers from university-affiliated medical centers and community agencies. Most of the respondents indicated that establishing CTF was advantageous. Merits included the following: increasing reality-based clinical education and training; decreasing the reality shock of students; increasing student satisfaction; and linking education, practice, and research more effectively. Major issues were as follows: getting the approval of medical centers/universities; developing an agreement on CTF operation between the college of nursing and clinical agencies; clarifying types and criteria of appointment and promotion; and developing a statement on role and compensation policies. Most issues are similar to what U.S. schools of nursing have faced, except for the first one. In conclusion, establishing CTF in Korea appears to be highly desirable. Merits outweigh issues/concerns, and Korean nursing schools may look for an opportune time for obtaining the approval of medical centers/universities. Nursing schools in other countries that face a similar challenge of providing clinical teaching with high research performance may consider instituting CTF.

[Development of standards and criteria for accreditation of a baccalaureate nursing education program: reflections on the unique characteristics of the nursing profession].

PURPOSE: The purpose of this study was to determine characteristics of nursing science and identify expected outcomes from baccalaureate graduates, and to develop accreditation standards and criteria reflecting the characteristics of the nursing profession. METHODS: A methodological research design was utilized in this study. Related literature reviews and the nursing education program goals and objectives of the 99 nursing schools in Korea were analyzed. A cross-sectional survey research design was utilized to test the validity of the developed characteristics of the nursing profession and their accreditation criteria and standards. The face validity was from the advisory committee and public committee hearing. RESULTS: The characteristics of nursing science were defined with five concepts including humanity, scientific knowledge, professionalism, therapeutic relationship, and facilitating well-being. The expected outcomes from graduates were identified as providing holistic nursing, critical thinking, establishing professionalism and leadership, construction of a therapeutic relationship, and skilled nursing practice. Finally 6 standards and 14 criteria reflecting the unique characteristics of the nursing profession were developed for accreditation. These proposed accreditation standards and criteria are a challenge to promote the quality of nursing science.

[Factors influencing functional status in patients with heart failure].

PURPOSE: The purpose of this study was to identify the factors that influence the functional status of patients with heart failure. METHOD: A descriptive, correlational study design was used. The participants in this study were 260 patients with heart failure who were admitted at Y University and U University in Seoul, Korea. Between September 2005 and December 2005 data was collected by an interview using a questionnaire and from medical records. The Functional status was measured with KASI. Physical factors (dyspnea, ankle edema, chest pain, fatigue, and sleep dysfunction), psychological factors (anxiety and depression), and situational factors (self-management compliance and family support) were examined. RESULT: In general, the functional status, anxiety, depression, self-management compliance, and family support was relatively not good. The level of fatigue was highest and the level of ankle edema was lowest for physical symptom experiences. In regression analysis, functional status was significantly influenced by dyspnea(23%), age(13%), monthly income(7%), fatigue(3%), ankle edema(2%), depression(1%), and length of stay in the hospital(1%). These factors explained 50% of the variables in the functional status. CONCLUSION: These results suggest that psycho-physiological symptoms management should be a focus to improve the functional status in patients with heart failure.

Attitude, beliefs, and intentions to care for SARS patients among Korean clinical nurses: an application of theory of planned behavior.

PURPOSE: This study examined Korean clinical nurses' intentions to care for SARS patients and identify determinants of the intentions. Theory of planned behavior was the framework to explain the intentions of Korean nurses for SARS patients care. METHODS: A convenient sample of six hundreds and seventy nine clinical nurses from four university-affiliated hospitals located in Seoul and in Kyung-gi province was used. Self-administered (83-items) questionnaire was used to collect data. Intentions, attitude, subjective norm, perceive behavioral control, behavioral beliefs, normative beliefs, and control beliefs were the study variables. All items were measured using 7-point Likert scale (-3 to +3). Data were analyzed using descriptive statistics, Pearson correlation method, and stepwise multiple regression methods. RESULTS: Intentions and attitudes toward SARS patient care among Korean clinical nurses were moderate, but their subjective norm and perceive behavioral control of SARS patients care were negative. Stepwise multiple regression analysis indicated that attitude toward SARS patient care, perceived behavioral control, subjective norm were the determinants of the intentions for SARS patients care as theory proposed. Among the behavioral beliefs, "SARS-patient caring would be a new experience", "during SARS-patient caring, I should be apart from my family", "after completing SARS-patient caring, I would be proud of myself being able to cope with a stressful event" and "with my SARS-patient caring, patients could recover from SARS" were the significant determinants. Among the normative beliefs, colleague approval, spouse approval, and physician approval were significant determinants of the intentions. Among the control beliefs, "SARS-patient caring would be a challenge" "SARS-patient caring is a professional responsibility", "tension during the care of SARS patients" and "support from team members" were the significant determinants of the intentions. CONCLUSIONS: Korean clinical nurses in this study were not willing to care for SARS patients and showed negative attitude toward the care. They believed their friends and family were not approved their care for SARS patients. Nurses were in conflicts between professional responsibilities to care for SARS patients and personal safety. This study was the first to understand stress and burden of Korean clinical nurses who are in front line to care for newly developed communicable disease such as SARS. Under the circumstance where several fatal communicable diseases are predictable, conflicts between professional responsibility and their personal risks should be taken into considerations by nurses themselves and by nursing administrators in order to improve quality of care.

[The effects of psychosocial interventions to improve stress and coping in patients with breast cancer].

PURPOSE: The purpose of this study was to examine stress, coping, and immune response effects of a psychosocial intervention program based on the PNI model and Stress-Appraisal-Coping for Korean patients with breast cancer. METHODS: A nonequivalent control group pretest-posttest design was used. The participants who had survived breast cancer and lived in Wonju city and the surrounding area were assigned to an intervention group (N=21) or a control group (N=18). We conducted a 12-week intervention, 2 hours a day weekly, and measured the variables at baseline, six and twelve weeks later. Dependent variables are: stress, anxiety-depression and anger, and immune response. RESULTS: Patients in the psychosocial intervention program reported significantly less stress perception (U=31.500, p=.023), more problem solving ability and less problem avoidance in coping (U=20.500, p= .013; U=29.500, p=.040), and less anxiety-depression (U=22.000, p=.023). No difference, however, was found in anger and immune responses between the two groups. Intervention effects were evident at week 6 and 12 for anxiety-depression, and at week 6 for problem avoidance in coping, the same time that NK cell counts and the T8 decreased. CONCLUSIONS: These results suggested positive effects of a psychosocial intervention program. However, the results are inconclusive due to the small sample.

[Developing and testing the effects of a psychosocial intervention on stress response and coping in Korean breast cancer survivors: a pilot study].

PURPOSE: The purpose of this study was to develop a socioculturally-appropriate psychosocial intervention program for Korean patients with breast cancer and test its effects on stress, anxiety, depression, and coping strategies. METHODS: One group pretest and posttest design was used to test the effects of the intervention. A post-intervention interview was conducted to refine the nature of the intervention. A convenience sample of 10 breast cancer survivors was recruited from the outpatients clinics. Psychosocial intervention was developed to provide the health education, stress management, coping skill training and support weekly (90 min) for 6 weeks. RESULTS: There was a significant decrease in stress scores following the intervention (Z= -2.388, p=0.017). However, no significant changes were noted in the use of problem-focused and emotion-focused coping strategies, nor in the changes of anxiety and depression levels. Content analysis of interview data revealed six clusters; changes in perception, changes in problem solving approaches, changes in anger management, changes in life pattern, social support and reduction of perceived stress. CONCLUSIONS: Based on quantitative and qualitative data, we recommend the refinements of the intervention in the following areas for future studies: 1) duration, activities, and progression of psychosocial intervention; 2) research design and sample size; and 3) measurements.

International comparison of factors associated with delay in presentation for AMI treatment.

BACKGROUND: Prehospital delay in response to acute myocardial infarction (AMI) symptoms is well documented in the US and Europe, but little is known about it in Asian countries where cardiovascular disease is increasing. AIMS: We conducted an observational study of delay times and factors associated with hospital presentation times in 595 patients with AMI from the US, England, Japan and South Korea. METHODS: Patients were interviewed about responses to symptoms within 72 h of hospital admission and the medical records were reviewed. RESULTS: The proportions of patients with delay times of 1 h or less were: US--23%, Korea--18%, England--15% and Japan--8%. In the US and England when others present at symptom onset called an ambulance patients presented two to three times sooner. Independent predictors of presentation within an hour of symptom onset were attribution of symptoms to the heart and not waiting for symptoms to go away. CONCLUSION: Similar education about the need to seek treatment early in response to AMI symptoms may be applicable in Western and Eastern industrialised populations.

A five-country comparison of anxiety early after acute myocardial infarction.

BACKGROUND: Anxiety is common after acute myocardial infarction (AMI) and has the potential to negatively affect physical and psychosocial recovery. There have been no cross-cultural comparisons of anxiety among AMI patients. AIMS: To evaluate whether anxiety after AMI differs across five diverse countries and to determine whether an interaction between country, and sociodemographic and clinical variables contributes to variations in reporting anxiety. METHODS AND RESULTS: A total of 912 individuals with confirmed AMI were enrolled in this prospective, comparative, cross-cultural study. Anxiety was assessed within 72 h of hospital admission using the Brief Symptom Inventory. The mean level of anxiety in the entire sample was 0.62+/-0.76, which is 44% higher than the normal mean level. Anxiety levels were not significantly different among the countries with the exception that patients in England reported lower levels of anxiety than those in the US (P=0.03). However, this difference disappeared after controlling for sociodemographic variables on which the countries differed. CONCLUSION: Patients from each country studied experienced high anxiety after AMI. Even though various cultures were represented in this study, culture itself did not account for variations in anxiety after AMI. It appears that anxiety after AMI is a universal phenomenon.

Correlates of fatigue in Koreans with chronic lung disease.

OBJECTIVES: The purpose of this study is to explain the multidimensional characteristics of fatigue in Korean persons with chronic lung disease. FRAMEWORK: The Unpleasant Symptom Theory by Lenz et al (1995) provided the theoretical framework for the study. DESIGN: A descriptive correlational study design was used. SAMPLE: A convenience sample of 128 subjects (age = 64.2 +/- 11.3; forced expiratory volume in 1 second percent predicted value = 64.5 +/- 28.8%) was recruited from the outpatient respiratory clinic at a large university hospital in Korea. INSTRUMENTS: Fatigue was measured with the Multidimensional Fatigue Inventory. To identify the factors influencing fatigue, demographic variables, physiological variables, psychological variables, and a situational variable were measured. RESULTS: Subjects had a moderate degree of fatigue in general. The mean score for physical fatigue was relatively higher than that of mental fatigue. Using regression analysis, 48.4% of the variance in overall fatigue was explained by dyspnea and negative mood state. CONCLUSION: This study provides an understanding of multidimensional characteristics of fatigue experienced by Korean persons with chronic lung disease. It suggests that nurses need to include fatigue in their assessments and develop interventions to decrease dyspnea and negative mood in the management of fatigue.

An international perspective on gender differences in anxiety early after acute myocardial infarction.

OBJECTIVE: Higher anxiety is linked to poorer outcomes after acute myocardial infarction (AMI), including increased in-hospital reinfarction and potentially life-threatening complications. If clinicians can identify patients at greatest risk for anxiety after AMI, they can institute early treatment. Previous research on the influence of gender on the incidence of anxiety post-AMI reflects inconsistent findings, and differences across cultures have not been studied. Therefore, the purposes of this study were to determine: 1) whether there are gender differences in anxiety in a diverse international sample of AMI patients, and 2) whether there was an interaction between gender and sociodemographic and clinical variables thought to influence anxiety. METHODS: In this prospective, comparative study, 912 AMI patients were enrolled from Australia, South Korea, Japan, England, and the United States. Anxiety was assessed, using the Brief Symptom Inventory, within the first 72 hours of admission to the hospital for AMI symptoms. RESULTS: Women had higher anxiety levels than men (0.76 +/- 0.90 vs. 0.57 +/- 0.70, p =.005), and this pattern of higher anxiety in women was seen in each country studied. Neither sociodemographic nor clinical variables interacted with gender to influence anxiety. CONCLUSION: Across a variety of cultures, women have higher anxiety than men after AMI and this relationship is independent of age, education level, marital status, or presence of comorbidities or severity of AMI.

An international perspective on the time to treatment for acute myocardial infarction.

PURPOSE: To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan. DESIGN: Comparative prospective design. METHODS: Patients diagnosed with AMI (N = 913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients' interviews. Analysis of variance was used to test differences in delay time among countries. FINDINGS: Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%). CONCLUSIONS: In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients' first responses to symptoms are considered, as well as differences in health care systems.

Priorities for nursing research in Korea.

PURPOSE: To identify priorities for nursing research in Korea. METHODS: A national sample of nurses in academic and clinical settings, representing varied clinical specialties, participated in two rounds of a Delphi survey. Participants listed five most important nursing research problems rated on three dimensions: the degree of nurses' lead role, contribution to nursing profession, and nurses' contribution to health and welfare of patients and clients. A total of 29 research areas were derived from 1,013 research problems identified from the Delphi surveys, and 26 expert panel members who participated in a 1-day workshop to determine the priority of these areas. Key words of 706 research articles published in the major nursing research journals in Korea were analyzed to identify priorities. RESULTS: In the two rounds of Delphi surveys 347 of 1,047 nurses participated (31%-33% response rates respectively). To three research areas common to both Delphi survey and literature analysis were: clinical nursing practice, nursing education, and nursing research. Cultural nursing was rated the lowest in the Delphi survey but was rated third by the expert panel members. CONCLUSIONS: In the clinical practice area, research on the advanced practice nursing system was the first priority research problem followed by development of nursing interventions, clinical competency, quality and effectiveness of nursing care, and standardized nursing tasks. Research on home health care, nursing education, utilization of nursing research, and geriatric nursing were other areas of priority. Nurses around the world are encouraged to develop collaborative research projects based on common priority areas.