Bonnie J. Garvin

Women’s Early Warning Symptoms of Acute Myocardial Infarction

Background—Data remain sparse on women’s prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women. Methods and Results—Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66±12), with 95% (n=489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3±4.8; range, 0 to 29) than prodromal (mean, 5.71±4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5±52.7, whereas the average acute score, symptom weighted by intensity, was 16.5±12.1. These 2 scores were correlated (r =0.61, P <0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology. Conclusions—Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.

Critical care nursing practice regarding patient anxiety assessment and management

Anxiety is common in critically ill patients and can adversely affect recovery if not properly assessed and treated. The objectives of this study were to: (1) identify the clinical indicators that critical care nurses consider to be the defining attributes of anxiety in critically ill patients; and (2) delineate the interventions that critical care nurses use to alleviate anxiety in their patients. A total of 2500 nurses who worked in adult critical care areas were randomly selected from the membership of the American Association of Critical Care Nurses. Nurses selected were mailed a survey designed to determine what they considered to be the important attributes of anxiety in their patients and what interventions they commonly used to manage anxiety. The 593 nurses (31.6% response rate) who responded identified 70 individual anxiety indicators and 61 anxiety management strategies that were categorized into four and three major categories, respectively. The four major anxiety assessment categories were: (1) physical/physiological; (2) behavioral; (3) psychological/cognitive; and (4) social. The three major anxiety management strategies were: (1) care techniques; (2) improving knowledge and communication; and (3) support. Critical care nurses reported numerous and distinctive anxiety indicators and management strategies. Further research is needed to examine exactly how appropriate and effective these assessment indicators and management strategies are.

Racial Differences in Women’s Prodromal and Acute Symptoms of Myocardial Infarction

BACKGROUND Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority womens symptoms of coronary heart disease may contribute to these disparities. OBJECTIVE To compare black, Hispanic, and white womens prodromal and acute symptoms of myocardial infarction. METHODS In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. RESULTS Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. CONCLUSIONS Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of womens prodromal and acute symptoms should assist providers in interpreting womens symptoms.

Effects of gender and preference for information and control on anxiety early after myocardial infarction

BackgroundMen and women differ in anxiety, which is one of the most stressful outcomes of an acute myocardial infarction (AMI). This anxiety may be moderated by coping styles of preference for information and control. ObjectiveThis study aimed to examine the relation of gender and preference for information and control to anxiety during the critical care period after AMI. MethodsAs part of a larger study on complications after AMI, a descriptive cross-sectional multicenter one-group investigation designed with a convenience sample of AMI patients admitted to acute care units was conducted. Within the first 48 hours after the patients were admitted to the hospital, anxiety was assessed using the State Anxiety Inventory, and preference for information and control was measured using the Krantz Health Opinion Survey. ResultsThe sample of AMI patients (N = 410) was 68% male, 87% White, 68% married. The women were significantly older than the men (p < .05) and significantly more anxious (p < .05). Multiple stepwise regression analysis with a control for age demonstrated that neither preference for information nor preference for control moderated the relation of gender and anxiety. ConclusionsThe women expressed greater anxiety than the men. However, the men and women were similar at all levels of anxiety in their preference for information and control. The search for other factors related to the stress of AMI will help healthcare providers design effective interventions to reduce anxiety among men and women.

Using a 0-10 Scale for Assessment of Anxiety in Patients with Acute Myocardial Infarction

Patients with acute myocardial infarction (AMI) often experience anxiety, an emotion that predicts adverse physiologic outcomes. The purpose of this study was to determine whether a single-item anxiety assessment instrument, the Anxiety Level Index (ALI), is a valid alternative to the State Anxiety Index (SAI) or the anxiety subscale of the Brief Symptom Inventory (BSI) for assessing state anxiety for patients with AMI. In this prospective multicenter study, 243 inpatients with AMI rated their anxiety using the SAI, the anxiety subscale of the BSI, and the ALI. Anxiety Level Index scores were compared to SAI and BSI anxiety subscale scores. There were moderate, positive correlations between the SAI and the ALI (rs = 0.52, P < .001), and between the ALI and the anxiety subscale of the BSI (rs = 0.45, P < .001). Although ALI scores were moderately and significantly correlated with scores on the SAI and the BSI anxiety subscales, the results of the Bland-Altman method indicate a lack of construct validity of the single-item measure. The quest continues to construct a simple self-report measure of anxiety that is appropriate for critically ill patients with AMI.

Nurse-Physician Communication

The quality of communication in interprofessional relationships was investigated. Forty nurse-physician interactions were videotaped in a laboratory setting. Nurses and physicians were found to be generally confirming (87%) in their interactions. No statistical differences were found in confirmation proportions between nurses and physicians nor between men and women. Further, no statistical differences were found when physicians and nurses spoke with men or women of the other discipline. The implications of these findings and the limitations of the laboratory setting are discussed.

Confirmation and disconfirmation in nurse/physician communication

This research used a confirmation/disconfirmation framework to analyze communication in nurse‐physician dyads in an attempt to better understand the quality of these inter‐professional relationships. Nurses and physicians were found to be primarily confirming (87%) in their interactions. No differences were found in confirmation proportions between nurses and physicians nor between men and womem. The implications of these findings and the limitations of the laboratory setting are discussed.

Interpersonal communication between nurses and patients.

Many nurse theorists consider the nurse-patient relationship to be a central component in their conceptualizations of nursing. Most theop fists and practitioners recognize that the nursepatient relationship is developed through interaction and is the essence of nursing. Nursepatient interaction is made possible through communication, a process through which individuals create meaning. Through this communication process the nurse and patient influence one another and the patients health can be influenced therapeutically and supportively (Kim, 1987).

Confirming communication of nurses in interaction with physicians.

Communication is an essential component of the theory and practice of nursing. This study used a confirmation/disconfirmation framework to describe the communication characteristics of 40 registered staff nurses videotaped in a decision-making task with a resident physician. Nurses were found to be confirming in 87% of their discourse. Differences in confirmation proportions were not found when educational preparation and sex were examined. Older nurses and nurses with more years of professional experience were more confirming in their communication than younger and less experienced nurses. Implications of the study are discussed.

Nonorganic failure to thrive: a theoretical approach.

Nonorganic failure to thrive (NOFTT) is a significant health problem of infancy. Although NOFTT is thought to be a result of multiple factors, exactly what these factors are is unclear. Explaining the development of NOFTT has been hindered by a lack of a theoretical approach. The purpose of this article is to provide a review of the literature and the discussion of a theoretical framework to guide future research in the area of NOFTT.