Kristen A. Sethares

The Minnesota Living with Heart Failure Questionnaire: Sensitivity to differences and responsiveness to intervention intensity in a clinical population

BackgroundThe Minnesota Living With Heart Failure Questionnaire (LHFQ) is a commonly used measure of health-related quality of life in persons with heart failure. Researchers have questioned whether LHFQ is sensitive to subtle differences and sufficiently responsive to clinical interventions because the instrument has demonstrated variable performance in clinical trials. ObjectivesA secondary analysis was conducted to assess the LHFQ for sensitivity to different clinical states and responsiveness to varying intensities of clinical intervention. MethodsA convenience sample of nine experimental or quasi-experimental studies from eight clinical sites in the United States yielded data from 1,136 patients with heart failure. Data in the studies had been collected at enrollment and one, three, and/or six months later. Data were analyzed using descriptive, univariate, and multivariate techniques. ResultsTotal and subscale scores on LHFQ were poorer in those with worse New York Heart Association functional class, although there was no difference in LHFQ scores between classes III and IV. No difference in LHFQ scores was found when patients were classified by ejection fraction. Scores improved significantly following hospital discharge, even in those in the control group. Changes in LHFQ scores were greatest in those receiving high intensity interventions. ConclusionsThe LHFQ is sensitive to major differences in symptom severity but may not be sensitive to subtle differences. It is responsive to high intensity interventions. Investigators are cautioned against using this instrument without first maximizing intervention power or without a control group for comparison.

Symptom Clusters of Heart Failure

Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N = 687) was conducted. The sample was 51.7% female, mean age 71 +/- 12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of nine items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact.

Ethnic differences in quality of life in persons with heart failure

BACKGROUND Chronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure. METHODS Data for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. RESULTS Significant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients. CONCLUSION Cultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients.

Partnerships in mending hearts: nurse and peer intervention for recovering cardiac elders.

As a growing number of older adults recover from cardiac events, volunteer programs have emerged to provide low-cost community support to vulnerable elders. Although an increasing number of studies have described the beneficial relationships between patients and volunteers, little is known about the unique partnership between the advanced practice nurse (APN) and the volunteer peer. The purpose of this article was to explore the interaction between the APN and the peer advisor who provide support for unpartnered elders after myocardial infarction or coronary artery bypass grafting. As part of a larger research study, “Improving Health Outcomes for Unpartnered Cardiac Elders” (R01-NR05205), interactions with peers were recorded by APNs. Essential themes related to working with 20 peer advisors emerged from 30 logs. Findings suggest that establishing the peer support role, acknowledging abilities, and overcoming difficulties are important steps in the relationship. A partnership between healthcare professionals and peer advisors enhances social support for vulnerable elders recovering from myocardial infarction and coronary artery bypass grafting.

Factors associated with delay in seeking care for acute decompensated heart failure.

Background:Despite reports that persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment, few studies have prospectively explored specific factors influencing treatment-seeking delay in this population. Objective:The purpose of this study was to explore how factors related to the symptom experience, such as perception (number and intensity), evaluation (attribution and understanding), and response (behaviors of patients and others) influence delay in seeking treatment for symptoms of acute decompensated HF. Methods:Patients hospitalized for acute HF were enrolled into an exploratory, descriptive study. Only those who had HF for 3 months or longer and a previous HF admission were eligible. Data on factors related to the symptom experience, response to symptoms, and delay time were collected by interview during hospitalization. Delay time measured in hours was analyzed using generalized linear modeling. Results:The sample of 131 adults was predominately older (77 ± 11.3 years) men (55.7%). The median delay time was 60 hours (2.5 days), with a range of 1 to 336 hours (14 days). Only 34 (25.9%) sought care in less than 12 hours. Three variables were statistically significant determinants of long delay time—waiting to see if the symptoms would abate, receiving a passive response to symptoms from others, and living in a rural environment. These variables explained 13.9% of the variance in delay time. Clinical characteristics were not significant predictors of delay. Conclusions:The response of patients (wait-and-see) and others (eg, don’t worry) contributed to delay, as did living in a rural environment. Evaluative characteristics of attribution and understanding were not significant determinants of delay, suggesting that patient education alone will not effectively decrease delay. Instead, interventions directed toward decision making in response to symptoms and inclusion of family members in such discussions may be more effective.

Pain intensity, interference and patient pain management strategies the first 12 weeks after coronary artery bypass graft surgery

BACKGROUND Pain is a distressing and often undertreated symptom of cardiac surgery. Little is known about pain levels, interference and treatment strategies beyond the 9 week period. AIM The purpose of this study was to describe pain intensity, interference and strategies used to manage pain in post-operative CABG patients. METHODS Baseline data were collected by interview in the hospital after CABG surgery using the Modified Brief Pain Inventory. One to 12 weeks after discharge, weekly telephone interviews were conducted to collect data. RESULTS Pain levels and interference with activities of daily living were greatest during hospitalization and decreased over 12 weeks. Pain interfered the most with coughing and sleep. Once opioid medications ran out, activity modification was primarily used to manage pain. CONCLUSIONS Activity modification below recommended levels was reported as a pain management strategy. Patients reported pain lasting longer than they expected and the need for more education about activity and pain management strategies.

An Integrative Review of the Use and Outcomes of HESI Testing in Baccalaureate Nursing Programs

AIM To evaluate the current utilization of the Health Education Systems, Inc. (HESI) examinations in nursing education. BACK GROUND HESI exam results are frequently predictive of NCLEX‐RN results in nursing education. METHOD The integrative review method of Whittemore and Knafl was used to search and evaluate the existing evidence to answer the following research questions: a) What is the current utilization of the HESI examinations in baccalaureate nursing education? b) What is the evidence supporting or contraindicating their use in nursing education? c) What is known regarding outcomes related to their use? RESULTS There is a wide variation in the use and outcomes of HESI exams in baccalaureate nursing education. CONCLUSION Despite validity and reliability, there are many gaps in evidence regarding use of these exams in nursing education.

Chronic Sorrow in Parents of Children with a Chronic Illness or Disability: An Integrative Literature Review

Problem This integrative review aims to synthesize the findings of studies on chronic sorrow in parents, to analyze the findings along three specific research questions, and to identify areas for future research. Eligibility Criteria Studies of parents, mothers and/or fathers of non‐adult children published in peer‐reviewed journals that answered the research questions: 1) How does the experience of chronic sorrow differ between mothers and fathers? 2) What factors have been identified to impact the experience of chronic sorrow over time? 3) What strategies by health care providers for helping parents cope with chronic sorrow have been identified to be most and least helpful? Sample Nineteen studies from a literature search within the databases of CINAHL, MEDLINE, PsycINFO, Psycarticles and SocIndex were included in the review. Results Findings suggest that mothers experience more intense chronic sorrow compared with fathers. Health care crises and developmental milestones are potent triggers for resurgence of chronic sorrow. Helpful strategies by healthcare providers include providing information, helping to procure respite and being empathetic and compassionate. Conclusions Healthcare providers need to understand that chronic sorrow is a normal consequence of having a child with a chronic illness or disability. Implications Family‐centered interventions should be individualized and aimed at providing increased comfort to parents in times of need. Further research that looks at the effectiveness of interventions is needed. HighlightsChronic sorrow is prevalent among parents of children with a chronic illness or disability.Common events trigger a resurgence of sorrow periodically across the lifespan.Pediatric healthcare providers are positioned to provide support to parents with chronic sorrow.Further research is warranted on the effectiveness of healthcare interventions.

Perceived benefits and barriers of heart failure self-care during and after hospitalization.

This longitudinal study describes the heart failure (HF) patients perceived benefits and barriers to self-care during hospitalization, 1 week, and 1 month after hospitalization. Seventy-eight patients with acute HF completed the Health Belief Scales to determine the greatest benefits and barriers to self-care at each time point. Findings suggest that early benefits to performing self-care include reducing symptoms and improving quality of life. Later benefits focus more on promoting health. Barriers to self-care include forgetfulness and knowledge deficits about self-care behaviors. At 1 month, 15.1% to 48.5% patients reported that monitoring increases worry about HF. Home care clinicians can promote self-care through education and skills training.

iHANDs: Intelligent Health Advising and Decision-Support Agent

This paper describes an intelligent health and decision support agent (iHANDs) built with various artificial intelligence mechanisms. Upon receiving the users symptom descriptions, iHands conducts both web search and local medical knowledge database search, utilizing the users electronic health records (EHR) to direct the search process. An information-fusion algorithm is developed based on Dempster-Shafer theory to merge the information from various sources with different reliabilities and generate the strength of support for each possible cause. A dynamic reference network is created and updated to record all information obtained during the interleaved search and reasoning process. Ihands performs a bi-directional search: from symptoms to possible causes and also from possible causes to most likely symptoms and risk factors. Bayesian inference mechanism is used to identify the confidence level for each possible cause given the users symptoms and EHR. When needed, an iterative broaden search will be conducted to increase the confidence level to exceed a pre-set threshold or to further distinguish a few possible causes with very close confidence levels. The preliminary experiment results show the promise of iHands in assisting individuals in their healthcare decision-making process.