Ann L. Eckhardt

Fatigue in the Presence of Coronary Heart Disease

Background:Fatigue is a prevalent and disabling symptom associated with many acute and chronic conditions, including acute myocardial infarction and chronic heart failure. Fatigue has not been explored in patients with stable coronary heart disease (CHD). Objectives:The purpose of this partially mixed sequential dominant status study was to (a) describe fatigue in patients with stable CHD; (b) determine if specific demographic (gender, age, education, income), physiological (hypertension, hyperlipidemia), or psychological (depressive symptoms) variables were correlated with fatigue; and (c) determine if fatigue was associated with health-related quality of life. The theory of unpleasant symptoms was used as a conceptual framework. Methods:Patients (N = 102) attending two cardiology clinics completed the Fatigue Symptom Inventory, Patient Health Questionnaire-9, and Medical Outcomes Study Short Form-36 to measure fatigue, depressive symptoms, and health-related quality of life. Thirteen patients whose interference from fatigue was low, moderate, or high participated in qualitative interviews. Results:Forty percent of the sample reported fatigue more than 3 days of the week lasting more than one half of the day. Lower interference from fatigue was reported on standardized measures compared with qualitative interviews. Compared with men, women reported a higher fatigue intensity (p = .003) and more interference from fatigue (p = .007). In regression analyses, depressive symptoms were the sole predictor of fatigue intensity and interference. Discussion:Patients with stable CHD reported clinically relevant levels of fatigue. Patients with stable CHD may discount fatigue as they adapt to their symptoms. Relying solely on standardized measures may provide an incomplete picture of fatigue burden in patients with stable CHD.

Symptoms Suggestive of Acute Coronary Syndrome: When Is Sex Important?

Background: Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences. Objective: The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS. Methods: A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled. Demographic and clinical variables, symptoms, comorbid conditions, and functional status were measured. Results: The sample was predominantly male (n = 664, 62.4%), white (n = 739, 69.5%), and married (n = 497, 46.9%). Women were significantly older than men (61.3 ± 14.6 vs 59.5 ± 13.6 years). Most patients were discharged with a non-ACS diagnosis (n = 590, 55.5%). Women with ACS were less likely to report chest pain as their chief complaint and to report more nausea (odds ratio [OR], 1.56; confidence interval [CI], 1.00–2.42), shoulder pain (OR, 1.76; CI, 1.13–2.73), and upper back pain (OR, 2.92; CI, 1.81–4.70). Women with ACS experienced more symptoms (6.1 vs 5.5; P = .026) compared with men. Men without ACS had less symptom distress compared with women. Conclusions: Women and men evaluated for ACS reported similar rates of chest pain but differed on other classic symptoms. These findings suggest that women and men should be counseled that ACS is not always accompanied by chest pain and multiple symptoms may occur simultaneously.

The MIXED framework: A novel approach to evaluating mixed-methods rigor

Evaluation of rigor in mixed-methods (MM) research is a persistent challenge due to the combination of inconsistent philosophical paradigms, the use of multiple research methods which require different skill sets, and the need to combine research at different points in the research process. Researchers have proposed a variety of ways to thoroughly evaluate MM research, but each method fails to provide a framework that is useful for the consumer of research. In contrast, the MIXED framework is meant to bridge the gap between an academic exercise and practical assessment of a published work. The MIXED framework (methods, inference, expertise, evaluation, and design) borrows from previously published frameworks to create a useful tool for the evaluation of a published study. The MIXED framework uses an experimental eight-item scale that allows for comprehensive integrated assessment of MM rigor in published manuscripts. Mixed methods are becoming increasingly prevalent in nursing and healthcare research requiring researchers and consumers to address issues unique to MM such as evaluation of rigor.

Evidence-based Practice in Action: Ensuring Quality of Pediatric Assessment Frequency

&NA; Optimal frequency of head‐to‐toe assessment in hospitalized pediatric patients is unknown. An alteration in head‐to‐toe assessment frequency was proposed at a Midwestern regional hospital. The purpose of this descriptive study was to evaluate patient safety and staff satisfaction following a change in head‐to‐toe assessment frequency. Method: Chart audits were performed on all patients upon discharge and after any change in level of care to assess the risk to patient safety following the change in head‐to‐toe assessment frequency. Nurses were surveyed to determine satisfaction with the change. Results: A total of 421 patients were included in the study. After the change, there was no increase in the number of unplanned transfers to the intensive care unit from the previous year. Registered nurses (N = 15) perceived no decrease in patient safety following the change. Registered nurses were satisfied with the change in assessment frequency noting they perceived more time to provide direct patient care. Conclusions: The change in head‐to‐toe assessment frequency did not impact patient safety, but had a positive impact on nurse satisfaction. Following the study period, the unit policy was changed to reflect the new evidence based head‐to‐toe assessment interval. Further research is needed with a larger, more diverse sample of pediatric patients and pediatric nurses.