Laura P. Kimble

Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: A scientific statement from the American Heart Association Council on Cardiovascular Nursing and Stroke Council

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.

Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation

Background: Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device.

Optimism, coping, and long‐term recovery from coronary artery surgery in women

Optimism, coping strategies, and psychological and functional outcomes were measured in 55 women undergoing coronary artery surgery. Data were collected in-hospital and at 1, 6, and 12 months after surgery. Optimism was related to positive moods and life satisfaction, and inversely related to negative moods. Few relationships were found between optimism and functional ability. Cognitive coping strategies accounted for a mediating effect between optimism and negative mood. Optimists were more likely to accept their situation, and less likely to use escapism. In turn, these coping strategies were inversely related to negative mood and mediated the relationship between optimism and this outcome. Optimism was not related to problem-focused coping strategies; this, these coping strategies cannot explain the relationship between optimism and outcomes.

Sleep-wake disturbances and quality of life in patients with advanced lung cancer.

PURPOSE/OBJECTIVES To examine the scope and severity of subjective sleep-wake disturbances in patients with lung cancer and compare them to a group of healthy adults who were similar in age, gender, and race, and to examine the impact of sleep-wake disturbances on measures of health-related quality of life (QOL). DESIGN Descriptive, comparative. SETTING University-based and private urban ambulatory care clinics. SAMPLE 43 patients with advanced non-small cell or small cell lung cancer and 36 healthy adults. All participants were cognitively intact, and none had any known neurologic disorder, polysomnographically diagnosed sleep disorder, mood or anxiety disorders, or cerebral metastasis. METHODS Questionnaires, interview, and medical record review. MAIN RESEARCH VARIABLES Nocturnal sleep (quality, quantity, and disturbance), daytime sleepiness, and health-related QOL (physical, mental). FINDINGS Patients with lung cancer had poor perceived nocturnal sleep quality and excessive daytime sleepiness that differed significantly from the comparison group. Sleep disturbances in the group with lung cancer were characterized by breathing difficulty, cough, nocturia, and frequent awakenings. Sleep-wake disturbances were significantly associated with poorer health-related QOL after controlling for group. Excessive daytime sleepiness was associated most often with decreases in mental health, whereas poor nocturnal sleep was associated most often with decreases in physical health. CONCLUSIONS Findings suggest that sleep-wake disturbances are common in patients with lung cancer and that the disturbances are significantly associated with health-related QOL. Patients with lung cancer may be at risk for sleep-disordered breathing. IMPLICATIONS FOR NURSING The magnitude of nocturnal sleep disturbance and daytime sleepiness identified in this study reinforces the importance of ongoing screening and effective intervention for sleep-wake disturbances in patients with lung cancer.

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

&NA; Chronic stable angina pectoris, the chest pain associated with reversible myocardial ischemia has detrimental effects on health‐related quality of life, particularly in women. The limited research on gender differences in chronic stable angina suggests that angina may be experienced differently in women and that women report greater functional disability related to angina symptoms. No studies have examined gender differences in chronic stable angina from a multidimensional pain perspective or have included reliable and valid measures of pain that would facilitate comparing chronic angina patients with other chronic pain populations. The purpose of this descriptive study was to examine gender differences in characteristics of chronic stable angina using the short‐form McGill pain questionnaire (SF‐MPQ) and to explore relationships among these pain characteristics and perceived limitation in performing physical activities in patients with coronary artery disease (CAD) (physical limitation subscale of the Seattle angina questionnaire). One hundred and twenty‐eight subjects (30.5% women) with stable CAD and angina pectoris documented by a cardiologist completed study questionnaires in an outpatient cardiology clinic. Results of the study suggest that men and women with chronic stable angina had more similarities than differences in chest pain characteristics. No significant gender differences were demonstrated in total sensory or affective intensity scores, the present pain intensity index, or the number of pain words chosen. However, women did report significantly greater pain intensity on the SF‐MPQ visual analogue scale. Women were also significantly more likely to describe their chronic angina as ‘hot‐burning’ and ‘tender’ and to have greater intensity of pain for these two descriptors. Despite the similarities in pain characteristics, women reported greater physical limitation related to anginal pain. The variables of social status and years diagnosed with CAD significantly interacted with gender in predicting physical limitation suggesting that gender‐specific models of physical limitation in angina patients need to be explored. To our knowledge, this is one of the first studies that has assessed chronic anginal pain using a reliable and valid generic pain instrument. More research is needed to better understand the nature of gender differences in functional limitation secondary to anginal pain and the physiologic, cognitive‐perceptual and psychosocial mechanisms that lead to angina‐related functional disability.

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council*

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research.

The Seattle angina questionnaire: reliability and validity in women with chronic stable angina.

Angina pectoris causes substantial psychological and functional disability and adversely effects health-related quality of life, particularly in women. Studies of cardiac disease-specific quality of life in women with coronary artery disease and angina are limited because little reliability and validity data for these instruments exist for women. Therefore, the purpose of this study was to examine reliability and validity of the Seattle Angina Questionnaire (SAQ), a cardiac disease-related quality-of-life measure, in a sample of women with chronic stable angina. A secondary analysis was performed on SAQ data from 175 women with a confirmed diagnosis of CAD and angina pectoris. The majority of the women were older, white, living with their spouse, had a previous acute myocardial infarction, and had undergone revascularization. The Cronbach alpha was used to assess reliability of the SAQs five subscales, and factor analysis was used to assess the SAQs validity. Results suggest that the SAQ is a reliable and valid quality-of-life measure in women with CAD. The physical limitations subscale factored into two separate factors, suggesting that the subscale measures two domains of physical function: self-care and exercise tolerance/mobility. Future research is needed to determine whether examining different combinations of SAQ items might provide a more sensitive assessment of cardiac disease-specific quality of life in women.

Factors Associated With Clopidogrel Adherence in Community-Dwelling Patients.

Objective:The purpose of this study was to characterize predictors of adherence to clopidogrel therapy focusing on patients’ perceptions of clopidogrel and nuisance bleeding. Methods:This was a cross-sectional study of community-dwelling cardiovascular patients with a self-reported prescription for clopidogrel. Self-report questionnaires assessed depressive symptoms, social support, nuisance bleeding, perceptions of clopidogrel, and adherence to therapy. Low, moderate, and high adherence groups based on the Morisky Medication Adherence Scale were compared and hierarchical multiple linear regression analysis was used to predict adherence. Results:A total of 102 subjects were enrolled, and 55%, 28%, and 16% were classified as having low, moderate, and high adherence, respectively. Greater perceptions of clopidogrel necessity, lower perception of clopidogrel concern, and increased severity of nuisance bleeding were predictors of better adherence. Conclusions:Data from this cross-sectional study suggest that concerns about clopidogrel and feelings about its necessity play an important role in clopidogrel adherence.

Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study

BACKGROUND Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula. METHOD Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews. RESULTS Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results. CONCLUSION Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].