Acceptability of mHealth Technology for Self-Monitoring Eating and Activity among Rural Men.

OBJECTIVE: To examine rural men's use and perceptions of mobile and wireless devices to self-monitor eating and physical activity (mHealth). DESIGN AND SAMPLE: Men in this 3-week pilot study used FitBit One® to log daily food intake and monitor activity. A companion application (app) allowed activity monitoring of fellow participants. Health-related text messages were received 1-3 times daily. A purposive sample of 12 rural men (ages 40-67) was recruited by community leaders. MEASURES: (1) baseline heart rate, blood pressure, and BMI, (2) FitBit One® usage, (3) investigator-generated surveys on acceptability of mHealth, and (4) focus group on experience with mHealth. RESULTS: Men were overweight (n = 3) or obese (n = 9) and 9 of 12 were hypertensive. Nine of twelve wore FitBit One® all 21 days. Eleven of 12 men logged food, with 9 of 12 doing this at least 15 of 21 days. Self-monitoring and daily text messaging increased awareness of energy intake and output. Companion app's food log needed targeting for rural foods. Rotating seasons (occupational, religious, recreational) and weak cellular signals created contextual barriers to self-monitoring eating and activity. CONCLUSIONS: FitBit One® and text messaging were perceived as useful among the rural men, while the companion apps require adaptation to reflect dietary norms.

Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP).

After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.

Illness perceptions, coping strategies, and symptoms contribute to psychological distress in patients with recurrent symptomatic atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a prevalent, life-complicating illness associated with psychological distress. Interventions to manage the psychological challenges of living with AF are needed. Evidence suggests that illness perceptions, coping strategies, and symptoms that contribute to psychological distress may be modified by psychoeducational interventions to reduce psychological distress. However, little is known about how illness perceptions, coping strategies, and symptoms contribute to psychological distress in patients with AF. OBJECTIVE: The aim of this correlational study guided by Levethal's Common Sense Model of Self-regulation was to identify the extent to which illness perceptions, coping strategies, symptom frequency, and symptom severity contributed to psychological distress in patients with recurrent symptomatic AF. The contribution of these factors was considered with respect to the effects of gender, age, type of AF, and time since AF diagnosis. METHODS: Participants (n = 207; 56% male; 64.2 ± 12.3 years old) completed the Illness Perception Questionnaire-Revised, the COPE Inventory, the Symptom Checklist-Frequency and Severity, and the Profile of Mood States. Data were analyzed using Pearson correlation and hierarchical multiple regression. RESULTS: Illness perceptions contributed most to psychological distress, followed by coping strategies and symptom frequency. Illness perceptions explained the largest portion of the total variance for the following: Tension-Anxiety, 44/56%; Depression-Dejection, 38/50%; Fatigue-Inertia, 43/53%; Confusion-Bewilderment, 41/49%; Vigor-Activity, 24/35%; and Total Mood Disturbance, 47/63%. Illness perceptions of AF as having serious consequences, a psychological cause, and perceived poor understanding of AF together contributed more (.47) to Total Mood Disturbance than did coping by focusing on emotion (.08) or symptom frequency (.06). CONCLUSIONS: Illness perceptions are important contributors to psychological distress in patients with AF. Assessment of patients' illness perceptions may reveal those that increase the risk for psychological distress. Research is warranted to evaluate interventions to modify psychological cause and consequence beliefs and to promote understanding of AF.

Illness beliefs in patients with recurrent symptomatic atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a prevalent condition associated with adverse outcomes that need to be addressed by clinicians. Functional limitations and psychological distress occur in association with AF and may be influenced by patients' illness beliefs. Current knowledge of illness beliefs of AF patients is insufficient to guide interventions to improve clinical outcomes. AIMS: To (1) describe illness beliefs in patients with recurrent symptomatic AF and (2) describe relationships among illness beliefs having implications for self-management. METHODS: Subjects (n = 207), 56% male, 64.2 ± 12.3 years, from an arrhythmia clinic completed the Illness Perception Questionnaire-Revised. Data were analyzed with descriptive statistics and Pearson correlations. RESULTS: Subjects perceived AF as chronic and unpredictable with serious consequences. Subjects believed psychological factors, age, and heredity caused AF and reported that AF induced worry, anxiety, and depression. Stronger beliefs about AF as cyclic, unpredictable (r = 0.30), having psychological causes, (r = .36), and greater consequences (r = .58) were associated with more negative emotion. Subjects reporting a good understanding of AF, endorsed fewer negative emotions related to AF (r =-0.38) held stronger beliefs that AF was controllable with treatment, (r = 0.33), and appraised AF as less serious with fewer negative consequences, (r =-0. 21). CONCLUSIONS: Relationships between AF illness beliefs and negative emotion suggest assessment of illness beliefs may identify patients at risk for psychological distress. Although relationships between higher perceived understanding of AF, higher control, lower consequence, and negative emotion suggest that interventions to promote patients' understanding of AF may contribute to positive outcomes, further investigation is warranted.

Living with atrial fibrillation: a qualitative study.

BACKGROUND AND RESEARCH OBJECTIVE: Atrial fibrillation (AF) is a public health burden associated with stroke, cardiomyopathy, and diminished quality of life (QOL). Although surveys suggest that AF impairs physical functioning and mental health, little is known about patients' experiences contributing to those findings. Understanding patients' experiences of living with AF may provide a foundation for interventions to improve QOL. In this qualitative descriptive study, we describe the experience of living with recurrent symptomatic AF from patients' perspectives. SUBJECTS AND METHODS: Seven women and 8 men, recruited from a Midwest medical center, with a mean age of 59.8 (SD, 14.5) years, diagnosed with recurrent symptomatic AF, participated in open-ended interviews. Data were analyzed by qualitative descriptive methods. RESULTS AND CONCLUSIONS: Themes were identified that reveal experiences of living with recurrent symptomatic AF over time and how AF may diminish QOL. Themes included (1) finding the meaning of symptoms, (2) feeling uninformed and unsupported, (3) turning points, (4) steering clear of AF, (5) managing unpredictable and function limiting symptoms, (6) emotional distress, and (7) accommodation to AF tempered with hope for a cure. Participants experienced delays in diagnosis and minimization of their concerns by clinicians and others and did not receive counseling regarding the nature of AF and self-management. Strategies to manage AF and its symptoms were learned through trial and error and were transiently effective. Support for coping with the emotional burden of AF was lacking. Interventions to improve recognition of AF symptoms and promote prompt evaluation and treatment are needed. Psychoeducational programs to teach patients and families about the nature of AF, guide self-management, and address the emotional burden of AF need to be developed and tested.

Longitudinal field comparison of the RT3 and an activity diary with cardiac patients.

This study investigated reliability and validity of two methods of measuring patients' physical activity following coronary artery bypass graft (CABG) surgery. Sixty-five patients wore an RT3 accelerometer and recorded activity in a diary at 3 weeks, 6 weeks, and 3 months postsurgery. Generalizability coefficients greater than .80 required approximately 2 to 4 days of data, fewer than reported elsewhere. Energy expenditure estimates correlated .77, .72, and .57 (p < .01), with mean RT3 estimates higher, especially when overall energy expenditure was low. Changes from 3 to 6 weeks correlated only moderately (r = .37-.46) across methods. The methods produce reliable but differing estimates of physical activity in this population. Although no method bias is evident in assessing change over time, correlations support the importance of using multiple methods.

Student-Perceived Influences on Performance During Simulation.

BACKGROUND: Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. METHOD: This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. RESULTS: Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. CONCLUSIONS: More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Development and content validity testing of the Cardiac Symptom Survey in patients after coronary artery bypass grafting.

BACKGROUND: Patients who have undergone coronary artery bypass grafting often experience numerous symptoms after surgery. There is a need for a symptom tool for this population that is disease-specific, comprehensive, and responsive to change. AIMS: The aims of this study were to describe the development and preliminary content validity testing of the Cardiac Symptom Survey (CSS), assess further content validity of the CSS through an expert panel, and assess responsiveness of the CSS to change. METHODS: The original development of the CSS is described. An expert panel of four judges was used to rate the clarity of the items (content validity) and the relevance of the symptoms and items to the domain. Responsiveness to change of the CSS was assessed in a sample of 90 subjects who underwent coronary artery bypass grafting. RESULTS: Percent agreement and content validity index coefficients ranged from .90 to 1.00. Repeated measures analyses of variance showed significant changes over time as hypothesized in some of the symptom evaluation and symptom response scores. CONCLUSION: Support is documented for both content validity and responsiveness of the CSS.

Patterns of recovery following percutaneous coronary intervention: a pilot study.

Percutaneous coronary intervention (PCI) is the most common type of cardiac revascularization performed. However, there has been limited research examining the recovery of PCI patients after their hospital discharge. This descriptive, longitudinal study examined patterns of recovery (cardiac symptoms experienced, impact of cardiac symptoms on physical functioning and enjoyment of life, postprocedure problems experienced, and functioning) of 37 PCI patients at 2, 4, and 6 weeks following PCI. Fatigue was the most frequent and persistent symptom, and significantly, F(2, 26) = 3.6, p < .05, it impacted physical functioning at 4 weeks following PCI. Both physical and psychosocial functioning improved over time. Coronary restenosis and heart rhythm disturbance were the most common self-reported heart-related problems. Understanding normal variation in recovery patterns can assist clinicians in developing interventions to facilitate optimal outcomes.