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.

New nurse graduates and rapidly changing clinical situations: the role of expert critical care nurse mentors.

OBJECTIVES: New nurse graduates may be prone to instances of failure to rescue. Mentoring programs may be an opportunity to assist them with clinical decision making in situations of patient decline. We explored the experiences of new nurse graduates and expert nurses after participation in a mentoring program. METHODS: In this exploratory-descriptive study, five seasoned nurses were paired with five new nurse graduates. After four months, the new nurse graduates were interviewed, and the expert nurses participated in a focus group. RESULTS: Themes emerged for the new nurse graduates: 1) importance of the charge nurse, 2) differences in practice areas, and 3) supportive healthcare teams. The focus group revealed three themes: 1) remembering what it was like, 2) desiring to help, and 3) having confidence in their preparation as mentors. CONCLUSIONS: New nurse graduates relied on charge nurses for assistance. Therefore, it is imperative that charge nurses receive adequate support.

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.

Standardized Hospital Discharge Communication for Patients With Pressure Injury: A Quasi-experimental Trial.

PURPOSE: To determine if improved communication between certified wound care nurses and home health nurses, through use of standardized electronic wound care order sets and discharge instructions, decreased delay in treatment and 30-day readmission rates and improved wound healing for patients discharged to home with pressure injuries. DESIGN: Quasi-experimental, nonequivalent group trial. SUBJECTS AND SETTING: Cognitively intact adult patients hospitalized in the Midwestern United States with a stage 2 or higher pressure injury discharged to home care services. METHODS: We revised the electronic medical record to include an adapted, standardized version of the Project Re-Engineered Discharge wound care order set that included specific wound care instructions for use following discharge to home care. Medical records of 12 patients were reviewed prior to the change and 9 records were reviewed postchange for information about initiation of care, wound healing, and 30-day readmission. The Pressure Ulcer Scale of Healing tool was used to evaluate wound healing. RESULTS: Time to initiation of treatment was 2.4 days for the control group and 1.6 days for the intervention group. Missing documentation made it difficult to evaluate the control group, as 73% of all wound measurements were missing from the electronic medical record. Use of the standardized wound care order set resulted in 100% of wound care orders and 92% of discharge instructions being present in the intervention group's electronic medical record at the time of hospital discharge. There was no statistically significant difference between control and intervention group's Pressure Ulcer Scale of Healing scores for any postdischarge measurement or in 30-day readmission rates. CONCLUSIONS: The new standardized wound care order sets at the time of discharge did increase adherence to time to implementation and documentation of executing wound care orders by home care nurses. Further research of standardized order sets is needed to determine the impact on improving patient outcomes.

Lessons Learned in Implementation of an Expert Nurse Mentor Program.

Experienced critical care nurses have the expertise to respond quickly and appropriately in emergency situations. New graduate nurses, however, typically lack this expertise and may benefit from mentoring as they learn to manage rapidly deteriorating patients. The purpose of this article is to describe the lessons learned during implementation of an Expert Nurse Mentor Program. Nurse educators may benefit from this information as they strive to establish and maintain mentoring programs.

A qualitative study of influences on long-term physical activity in physically active African American women.

Performing routine physical activity (PA) is one of several measures that may be taken to prevent chronic illness; however, African American (AA) women are among the least physically active groups in the United States. The purpose of this study was to gain perspectives of AA women who are physically active and understand how they continue long-term PA. In this qualitative descriptive study, we interviewed 14 AA women using researcher-developed open-ended questions. Transcription was analyzed through content analysis. The socioecological model guided the organization of themes that emerged from the data. Individual level themes were: managing my health and lifestyle to remain physically active. Social level themes were: incorporating PA in social exchanges with family, friends, and coworkers and establishing mutual support of PA among family and friends. Environmental level themes were: using the neighborhood and work environments as venues encouraging PA. There were no emerging themes at the political level; however, there were findings at the environmental level that could be interpreted as policy-level issues. Knowing specific factors that influence long-term PA may help us with the development of interventions to increase PA in AA women.

A comparative study of social capital and hospital readmission in older adults.

Numerous factors contribute to hospital readmissions of older adults. The role social capital may play in preventing hospital readmissions is unknown. The aim of this descriptive, cross-sectional study was to determine if levels of personal social capital differ in two groups of patients aged 65 and older, those readmitted to the hospital within 30 days of discharge and those not readmitted. Participants in this study (N = 106) were community-dwelling older adults discharged from 11 hospitals in the Midwestern United States. The Personal Social Capital Scale and a demographic questionnaire were mailed to eligible participants for completion. Multivariate Analysis of Variance (MANOVA) was computed to examine the differences in the dependent variables of bonding and bridging social capital between those patients readmitted within 30 days and those not readmitted within 30 days. No significant differences between the two groups' mean levels of bonding or bridging social capital were identified.

Social capital, health, health behavior, and utilization of healthcare services among older adults: A conceptual framework.

Meeting the health needs of Americans must change as the population continues to live longer. A strategy that considers social well-being is necessary. One way to improve social well-being is through increased social capital, which includes networks among individuals and norms of reciprocity and trust between them. Supporting attainment of bonding social capital from close-knit groups, such as family, and bridging or linking social capital from those who are dissimilar are vital. Research shows there is a relationship among social capital and self-reported mental and physical health, health behaviors, healthcare utilization, and mortality. Because older adults are often dependent on others for their healthcare needs, it is posited that social capital plays a key role. Nurses can be instrumental in investigating levels of social capital for individuals and determining what type of social support is needed and who in the individual's network will provide that support. When support is absent, the nurse serves as the link between patients and available resources. The purpose of this article is to introduce a conceptual framework that can assist nurses and other healthcare providers to consider social capital in older adults in the context of relationships and the social environments to which they belong.

A measure of facilitators and barriers to rapid response team activation.

PURPOSE: Poor patient outcomes and increased costs may be associated with underutilization of RRTs. The aim of this study was to develop and test an instrument that identifies specific facilitators and barriers to rapid response team (RRT) activation. METHODS: Using an exploratory design, we surveyed a convenience sample of 250 registered nurses (RNs) employed in five Illinois hospitals. Participants completed the online RRT Facilitators and Barriers Survey (RRT-FBS), a 36 item survey developed by the researchers. The survey contains two sections, facilitators and barriers. Items in the facilitators subscales described nursing unit culture, RRT knowledge, and RRT member characteristics. Items in the barriers subscales described nursing unit culture, RRT education, and RRT member characteristics. Item analyses were conducted through exploratory factor analyses; internal consistency estimates were obtained. Descriptive statistics were conducted on the demographic data to describe sample and setting characteristics. RESULTS: The final sample consisted of 202 nurses from four hospitals. We conducted an item analysis and were able to reduce the survey to 30 items with a secondary analysis. The full scale alpha was 0.752. Cronbach's alphas for subscales ranged from 0.770-0.897. CONCLUSIONS: Facilitators and barriers may vary across institutions. This scale shows promise for identifying facilitators and barriers to nurses' use of rapid response teams and may provide a foundation for interventional studies promoting RRT utilization. In addition, more frequent education, emphasizing the RRT process, may be an effective method to maintain high rates of RRT activation and increase confidence.

Lessons from the Homeless: Civil and Uncivil Interactions with Nurses, Self-Care Behaviors, and Barriers to Care.

BACKGROUND: Civility, rooted in social justice, is a fundamental value of nursing. Homeless people are particularly at risk for experiencing uncivil behavior from nurses. PURPOSE: The purpose of this study was to explore homeless people's perceptions of their interactions with nurses. METHOD: In this descriptive, qualitative study, we interviewed 15 homeless adults who described their experiences with nurses. The interview guide, developed by the researchers, consisted of open-ended questions and probes. Transcriptions and field notes were analyzed through thematic analysis. RESULTS: Three major themes emerged: nurses should be civil, self-care behaviors, and barriers to good care. Subthemes included listening, compassion, attentiveness, and judgment as components of civility; where they go for care and who cares for them as self-care behaviors; and lack of money and homeless status as barriers to care. CONCLUSIONS AND IMPLICATIONS: Our findings indicate people who are homeless often perceive nurses to be uncivil and uncaring toward them; furthermore, our participants provide a unique description of healthcare interactions from the perspective of the homeless. These findings can be used as a basis for the development of education interventions for students and practicing nurses to assist them in learning to provide civil and compassionate care for the homeless.

Emotional representation of tuberculosis with stigma, treatment delay, and medication adherence in Russia.

This descriptive cross-sectional study aimed to explore emotional representation and illness coherence, the understanding a person has about an illness which helps them make sense of the experience, in Russians with tuberculosis. In a secondary analysis of questionnaires from 105 Russians treated for pulmonary tuberculosis, social isolation and disease consequences were predictors of negative emotions related to tuberculosis and accounted for 49 percent of the variance. Participants who scored higher on illness coherence were less likely to experience negative emotions. Development of programs to help patients understand tuberculosis and to manage emotional responses and stigma is suggested.

Nephrology Nurse Perceptions Toward Advance Care Planning: Validation of a Measure.

Advance care planning is critical for persons with chronic kidney disease because they face a shortened lifespan. There is a paucity of reliable and valid measures exploring nephrology nurse perceptions toward advance care planning. This article reports the results of testing the factor structure, reliability, and validity of a newly developed measure of nephrology nurse perceptions toward advance care planning as well as information on nephrology nurses'perceptions on advance care planning. Measuring nephrology nurse perceptions toward advance care planning may facilitate planning of interventions to assist nurses to become more active in the process.

Development and Initial Validation of the NephRN Perceptions Toward Advance Care Planning Instrument.

The purpose of this study was to develop and pilot test an instrument to measure the perceptions of nephrology nurses toward advance care planning, the NephRN Perceptions Toward Advance Care Planning instrument. Four components of advance care planning were identified: knowledge, attitudes, comfort, and support. The four-component solution explained 63.88% of variance. Cronbach's alpha was 0.92, and subscale reliability ranged between 0.86 and 0.94. This instrument shows promise as a reliable and valid measure of nephrology nurse perceptions toward advance care planning for persons with chronic kidney disease.

An intervention to promote civility among nursing students.

AIM: The purpose of this exploratory, mixed-methods study was to test an intervention to build social capital and civility among nursing students. BACKGROUND: Incivility impacts nurses and nursing students, and can negatively influence patient care and the quality of nursing education. The Institute of Medicine and the Joint Commission recommended implementation of strategies to manage incivility and build social capital. METHOD: Twenty-five student nurses completed the Ways of Coping Questionnaire and participated in interviews; 10 participated in the intervention, a journal club focused on civility in nursing. This study provided insight into student nurses' perceptions of civility. RESULTS: Participation in the intervention changed students' attitudes and behavior regarding civility. Specifically, students refused to participate in uncivil behavior, helped peers, were supportive, and tried to prevent or avoid incivility. CONCLUSION: Expansion of this study to further test the impact of civility-focused journal clubs is recommended.

Qualitative exploration of nurses' decisions to activate rapid response teams.

AIMS AND OBJECTIVES: To identify barriers and facilitators to nurses' decisions regarding activation of rapid response teams (RRTs) in hospitals. BACKGROUND: Hospitalised patients in the United States who experience cardiopulmonary arrest seldom recover. Most of these patients show signs of clinical deterioration prior to cardiopulmonary arrest. RRTs have been shown to decrease the incidence of cardiopulmonary arrest by bringing needed resources to unstable patients. Despite the evidence in support of the activation of RRTs, nurses do not always use this resource. Nurses' decisions to activate or not to activate the RRT are not clearly understood. DESIGN: We used a qualitative design for this study. METHODS: A purposive sample of 15 medical/surgical nurses was recruited from a small medical centre in the Midwest. Researchers used semistructured, open-ended questions to elicit subject responses regarding facilitators and barriers to activating RRTs. RESULTS: Themes emerged and were categorised as facilitators and barriers to calling the RRT. Facilitators and barriers were then subdivided into distinct subthemes: RRT characteristics and unit culture. The expertise of the RRT members and support and encouragement from nursing unit colleagues and leaders emerged as two potential facilitators. Communication of the RRT members and calling the physician first emerged as two potential barriers. We also identified educational factors that were not clearly facilitators or barriers to calling the RRT. CONCLUSIONS: Further study is needed using quantitative designs with larger sample sizes. RELEVANCE TO CLINICAL PRACTICE: Nurses can build upon knowledge of facilitators and barriers related to RRT characteristics and nursing unit culture.