Claudia C. Beal

LONELINESS IN OLDER WOMEN: A REVIEW OF THE LITERATURE

Older women report more loneliness than male peers. Loneliness is an area of concern related to the well being of older women because it is a cause of emotional distress and is linked to a variety of health problems in older individuals. Life changes, including widowhood and relocation, are associated with increased vulnerability to loneliness. Gender, social, and cultural factors influence the experience of loneliness in older women. Cognitive and interactionist theoretical approaches to loneliness have utility for nursing practice and research with older women who experience loneliness.

Loneliness in Women with Multiple Sclerosis

&NA; Loneliness is an underrecognized component of the experience of chronic illness and disability. Women with multiple sclerosis (MS) may be at risk for loneliness due to social network changes that occur in the course of chronic illness. The purpose of this secondary analysis was to assess the extent of loneliness in a sample of 659 women with MS and examine the relationship of loneliness, social support, functional limitation, self‐rated health status, social demands of illness, and marital status. More than half of the women in this sample reported feeling lonely. A significant association was found between loneliness and lower levels of social support, greater social demands of illness, greater functional limitation, lower self‐rated health status, and marital status. These findings suggest that rehabilitation nurses and other health professionals should be aware that loneliness may be a common occurrence for women with MS and point to the need for screening procedures to identify loneliness in this population.

Keeping the story together: a holistic approach to narrative analysis

Delay seeking medical assistance for ischemic stroke symptoms is common worldwide, yet existing literature does not provide an adequate understanding of experiences at stroke onset. An explanatory narrative inquiry using a holistic-content approach to data was conducted to gain understanding of women’s experiences between symptom onset and hospital arrival. A holistic-content analysis retains the temporal dimension of each individual’s story so that the parts within the story are interpreted in relation to other parts of the story and the outcome of the story. The aim of this paper is to present the procedures for holistic-content analysis, address the trustworthiness of this form of narrative analysis and appraise the utility and limitations of the approach. It was concluded that holistic-content analysis is congruent with the philosophical underpinnings of narrative methodology and it is well suited to examine phenomenon that have a strong temporal dimension. The use of this approach alone to narrative data does not enable researchers to draw naturalistic generalisations and a structured comparison of the narrative accounts resulting from a holistic-content analysis is needed to identify similar and dissimilar characteristics of participants’ experiences.

Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education.

ABSTRACT Background: Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. Methods: A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. Results: School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. Conclusions: School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.

A Qualitative Case Study of Poststroke Sexuality in a Woman of Childbearing Age

OBJECTIVE To explore perceptions of poststroke sexuality in a woman of childbearing age. DESIGN Qualitative case study. SETTING Community. PARTICIPANT A 36-year-old married mother of two children with a history of acute ischemic stroke 7 months prior to interview. METHODS A semistructured interview guide was used to gather data during a single face-to-face interview. Data consisted of an audio-recorded interview and verbatim transcription, field notes, and demographic information. The inductive approach of qualitative content analysis was used to analyze the data. RESULTS Four main categories, Slow to Get Back to the Sexual Life, The Vulnerable Body, Crushed by the Stroke and The Inadequate Self, were used to describe how the emotional trauma of having a stroke at a young age affected the participants sense of self. Issues with sexuality were related to her perception of her poststroke body as vulnerable. Stage of life informed the participants perceptions of pre- and poststroke sexuality. CONCLUSION A stroke during childbearing years may affect a womans perception of herself as a sexual being and her ability to carry out gender roles.

A narrative study of women's early symptom experience of ischemic stroke.

Background and Research Objective:Delayed arrival at the emergency department after the onset of ischemic stroke symptoms is an important reason for low tissue plasminogen activator administration rates. There is evidence that women arrive at the hospital later than do men, but little is known about women’s experiences in the period between symptom onset and hospital arrival. The purpose of this naturalistic investigation using narrative methodology was to gain understanding of women’s early symptom experience of ischemic stroke. Subjects and Methods:The sample consisted of 9 women aged 24 to 86 years with an ischemic stroke within 1 year of diagnosis. Data were collected using in-depth interviews in which participants were asked to tell the story of their stroke from the moment they noticed the symptoms until they arrived at the hospital. Data were analyzed using sequential methods of narrative analysis. Results and Conclusions:The participants experienced stroke onset as the inability to carry out their accustomed activities in usual ways and as a process occurring over time rather than a discrete event. There was a tendency to objectify the body. Two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms to everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke, although all but 1 woman had risk factors. For some women, stroke onset was different from their previous ideas about this event, and this was especially the case if a woman had prodromal symptoms. Decision making during early stroke flowed from women’s evaluation of symptoms and the meaning of symptoms, and meaning was informed by a woman’s life situation. The findings from this study may yield variables for future studies of cognitive, emotional, and behavioral predictors of hospital arrival time. There is a need for research on women’s prodromal symptoms.

Stroke and pregnancy: an integrative review with implications for neuroscience nurses.

ABSTRACT Stroke in association with pregnancy is an infrequent occurrence, but there is evidence that the incidence is rising. The physiological changes of pregnancy are thought to increase stroke risk, and several conditions specific to pregnancy further increase risk. The provision of optimal care to pregnant and postpartum women who experience stroke requires awareness of how the physiological changes of pregnancy may affect the course of stroke and nursing actions. This article provides an overview of current knowledge about pregnancy-related stroke including underlying pathophysiology, risk factors unique to pregnancy, and treatment issues when stroke is a complication of pregnancy. Implications for the nursing care of women with pregnancy-related stroke and maternal child considerations are discussed.

Women's interpretation of and cognitive and behavioral responses to the symptoms of acute ischemic stroke.

ABSTRACT: Delay seeking medical assistance for acute ischemic stroke remains a barrier to the provision of optimal care, including the administration of tissue plasminogen activator. Although women report greater knowledge of stroke symptoms and stroke risk factors than men, earlier hospital arrival in women has not been consistently reported. The purposes of this study were to examine women’s interpretation of stroke symptoms and compare cognitive and behavioral responses between women who arrived at the hospital within 3 hours of symptom onset and women who arrived after 3 hours. More than half of the participants arrived at the hospital greater than 3 hours after first noticing symptoms. Most women did not recognize the cause of symptoms. Knowledge about a treatment of stroke was limited, and a minority of the women knew they were at risk for stroke despite having known risk factors. Maladaptive responses to symptoms were reported more frequently by women with hospital arrival greater than 3 hours after symptom onset than by women with earlier arrival. Efforts are needed to reduce maladaptive responses to stroke onset that may contribute to delay seeking medical assistance for the symptoms of acute ischemic stroke.

Piloting a Sex-Specific, Technology-Enhanced, Active Learning Intervention for Stroke Prevention in Women

ABSTRACT Background: Recent studies reveal deficiencies in stroke awareness and knowledge of risk factors among women. Existing stroke education interventions may not address common and sex-specific risk factors in the population with the highest stroke-related rate of mortality. Objective: This pilot study assessed the efficacy of a technology-enhanced, sex-specific educational program (“SISTERS”) for women’s knowledge of stroke. Methods: This was an experimental pretest-posttest design. The sample consisted of 150 women (mean age, 55 years) with at least 1 stroke risk factor. Participants were randomized to either the intervention (n = 75) or control (n = 75) group. Data were collected at baseline and at a 2-week posttest. Results: There was no statistically significant difference in mean knowledge score (P = .67), mean confidence score (P = .77), or mean accuracy score (P = .75) between the intervention and control groups at posttest. Regression analysis revealed that older age was associated with lower knowledge scores (P < .001) and lower confidence scores (P < .001). After controlling for age, the SISTERS program was associated with a statistically significant difference in knowledge (P < .001) and confidence (P < .001). Conclusions: Although no change occurred overall, after controlling for age, there was a statistically significant benefit. Older women may have less comfort with technology and require consideration for cognitive differences.

Internet Stroke Preparedness for African American Women

ABSTRACT Background: African American women exhibit low stroke awareness and may benefit from experiential and lay language description of stroke symptoms. Objectives: The purpose of this pilot study was to examine the effect of an online stroke preparedness intervention for identification of stroke symptoms and appropriate action in response to suspected stroke and estimate effect sizes for a larger study. Methods: A quasi-experimental nonequivalent comparison group design was used to randomized 44 women to intervention (n = 23) or wait-list control group (n = 21). Data were analyzed with Friedman and Wilcoxon signed rank tests and Cochran-Mantel-Haenszel statistics to examine intervention effect on (1) self-efficacy to recognize stroke and know what to do in the event of stroke, (2) awareness of stroke symptoms, and (3) behavioral intent to call 911 for suspected stroke. Effect size estimates were calculated by converting z scores to r. Results: Significant intervention effect was found for self-efficacy to know what to do in the event of stroke, ability to identify stroke symptoms presented in written vignettes, and ability to identify correct action in response to symptoms presented in written vignettes. Small to medium effect sizes were obtained. No improvement was found for ability to name stroke symptoms. Behavioral intent to call 911 for stroke in someone else was high, but significantly fewer women would call 911 for themselves. Conclusions: Experiential depictions of stroke symptoms in an online format showed preliminary effectiveness to improve stroke awareness among African American women.