Lesley Lockyer

Women's Interpretation of their Coronary Heart Disease Symptoms:

Background: Men and women are known to delay in seeking medical attention when experiencing acute cardiac symptoms. However, women are more likely to have had chronic undifferentiated symptoms prior to an acute episode and then when experiencing an acute episode delay longer than do men. Studies have shown once women do present they tend to be further along the disease trajectory than men. Aims: The aim of this study was to explore womens own interpretation of the presenting symptoms they experienced. Methods: Twenty-nine women consented to take part in semi-structured interviews that focussed on their experience of coronary heart disease (CHD). The womens narrative around the initial disruption of their illness was analysed focusing on routine and reconstructed forms of narration. Results: The results showed that many failed to recognise and act on their symptoms. Most only sought medical attention after family or friends intervened. None of the women had seen themselves at risk of developing coronary heart disease despite many have a strong family history. Conclusion: The womens early symptoms of coronary heart disease were often undifferentiated and difficult to interpret by the women themselves. There is a need for further research to understand and recognise early symptoms of coronary heart disease in women. This will allow women and health professionals to assess risk and identify women with coronary heart disease early on in their disease trajectory so therapy to prevent the morbidity associated with coronary heart disease and acute life threatening episodes will be reduced.

Should I Go Or Should I Stay? A Study of Factors Influencing Students' Decisions on Early Leaving.

The article reports on selected findings from a multi-method research project on student retention on a nursing programme. Although the research identified some factors specific to the experiences of students on the particular programme, this article focuses on findings and recommendations of generic interest. The article compares data from semi-structured interviews with two groups of students: students who had withdrawn without completing their programme and students who considered leaving, but chose to stay. The article suggests that, in most cases, decisions to leave cannot be reduced to single factors, but are the culmination of complex interacting factors. Six ‘push’ factors are explored. These factors were mentioned by both groups of students. The article also discusses four ‘pull’ factors which act to hold students on their courses. Recommendations for improving retention include increasing support for students, and adapting provision to meet the needs of a diverse student population.

Issues with e-learning in nursing and health education in the UK: are new technologies being embraced in the teaching and learning environments?

In this paper we present aspects of a study that scoped e-learning implementation in nursing and health science disciplines throughout the UK and explored the factors affecting use. Data related to the use of technologies are presented here. While there are many drivers for the use of e-learning, the current scope of engagement in nursing and health science disciplines is unknown and variations in adoption have not been explored. A postal questionnaire sent to a purposive sample of 93 Higher Education Institutions (HEIs) obtained data from 25 universities (response rate of 28%) related to their uptake and development of e-learning. Questionnaire data was analysed using descriptive statistics. From this, nine HEIs were identified, reflecting a range of levels of engagement in e-learning. Data was collected through 35 staff interviews across the sites. Qualitative data from the interviews was transcribed to allow thematic analysis. Though e-learning adoption and use vary across the sector, the predominant learning and teaching engagement is instructivist and managed through a virtual learning environment. There is limited experimentation with e-learning and teaching use, linked to key centres of excellence and the efforts of ‘champions’. It is suggested that a more systematic approach to development and funding is required to achieve enhanced use of e-learning.

Family witnessed resuscitation: the views and preferences of recently resuscitated hospital inpatients, compared to matched controls without the experience of resuscitation survival.

AIM OF THE STUDY To compare the preferences of patients who survived resuscitation with those admitted as emergency cases about whether family members should be present during resuscitation. METHODS We used a case control design and recruited, from four large hospitals, 21 survivors of resuscitation and 40 patients admitted as emergency cases without the experience of resuscitation (control group) who were matched by age and gender at a ratio of 1:2. Data collection involved face-to-face interviews using a standardised 22 item questionnaire. Data analysis sought to identify differences between the two groups. RESULTS Both groups were broadly supportive of the practice, however resuscitated patients were more likely to favour witnessing the resuscitation of a family member (72% versus 58%), preferred to have a relative present in the event they required resuscitation (67% versus 50%) and believed that relatives benefited from such an experience (67% versus 48%). Additionally, both groups indicated that staff should seek patient preferences about family witnessed resuscitation following hospital admission, and stated that they were unconcerned about confidential matters being discussed with family members present during resuscitation (91% and 75%, respectively). However none of these differences between the two groups achieved statistical significance. CONCLUSION Hospitalised patients report a favourable disposition towards family witnessed resuscitation, and this view appears to be strengthened by successfully surviving a resuscitation episode. Practitioners should strive to facilitate family witnessed resuscitation by establishing, documenting and enacting patient preferences. Research exploring the perceptions of the wider public would help further inform this debate.

Women's interpretation of cardiac symptoms.

It is accepted that in many industrialised countries coronary heart disease (CHD) is one of the major causes of morbidity and mortality in women. The paper by Ruston [1] published in this edition is one of a number of papers that have focused on an aspect of womens experience of CHD, namely the difficulty experienced by women and health professionals in interpreting symptoms that may or may not be indicative of CHD or an acute cardiac event. The latter particularly having long term implications for women as they delay seeking medical assistance at an early stage, reducing the effectiveness of modern thrombolytic therapies, a factor that may have implications for their future health or survival. This difficulty is exacerbated for women two main ways. Firstly many women do not perceive themselves at risk of CHD a perception complicated by a poor understanding of the long term nature of CHD. This aspect of CHD is explored by Emslie et al. [2] who suggest as a result of their research that many individuals when asked about their understanding of ‘who is likely to develop heart problems?’ will answer the question ‘who is likely to suffer a sudden fatal heart attack?’. Secondly the symptoms experienced by some women are not what they expect them to be [3]. Both the flawed perception of risk and the misinterpretation of symptoms can lead to delay in accessing medical help when experiencing an acute cardiac event.

Patients’ perspectives on the educational preparation of cardiac nurses

Background: Over the last two decades the UK health service has endeavoured to place patient and public involvement at the heart of its modernisation agenda. Despite these aspirations the role of patients in the development of nursing curricula remains limited. Aim: A descriptive qualitative design was used to explore the views of cardiac patients about the educational preparation of cardiac nurses. Method: Eight participants attending an annual conference of a patient and carer support group were recruited to the study. A focus group was conducted to explore their views on how the educational preparation of cardiac nurses in the UK should develop. Tape-recorded data were transcribed and a thematic analysis was undertaken. Findings: Four themes were identified: contradictions around practice and education; demonstrating compassion; delivering rehabilitation expertise; leadership in practice. Participants perceived that they had a valuable role in the educational development of nurses, enhancing nurses’ understanding of how individuals live and adjust to living with cardiovascular disease. Conclusion: Cardiac patients believe that the education of cardiac nurses should be driven by experiences in practice, nevertheless they want nurses to be equipped to deliver care that is underpinned by a strong knowledge base and skills combined with an ability to engage, educate and deliver high quality care that is both compassionate and individualised.

Time spent studying on a pre-registration nursing programme module: An exploratory study and implications for regulation

European Union (EU) regulations require that university programmes are of specified duration. Additional EU regulations apply specifically to university based nurse education, enacted in the UK by the Nursing and Midwifery Council (NMC). However, little is known about how much time student nurses spend on their studies. In this exploratory study, students undertaking a single module in the pre-registration diploma programme at an English university were asked to keep a log of learning activity for the duration of the module. Twenty-six students completed the log. These students achieved higher grades and attended more lectures than the average for the module. The mean study time was 128.4 h against a regulatory assumption that the module should take 200 h. More than half of the 26 students undertook paid work during the module run, though this work was not associated with poorer performance. Problems in regulation for course duration are discussed and it is suggested that undertaking a 4600 h course in 3 years is problematic. More research is required so that patterns of study can be better understood and student centred programmes meeting regulatory requirements developed.

Pre-hospital thrombolysis for acute ST segment elevation myocardial infarction: A survey of paramedics’ perceptions of their role

Background: The effectiveness of pre-hospital thrombolysis (PHT) in reducing mortality following ST segment elevation myocardial infarction (STEMI) is well established. In England, PHT is provided to around 17% of STEMI patients, and responsibility for treatment rests largely with paramedics rather than physicians as in some other countries, but little is known about how paramedics perceive their role, or whether age or experience influence such perceptions. Aim: To describe paramedics’ perceptions of PHT. Methods: Questionnaire survey to all 106 paramedics working within a single ambulance service in England. Results: 60 (56.6%) paramedics responded. Overall, there were few significant differences by age or length of service in responses given. However, paramedics who had administered PHT gave more positive responses compared to those who had not, in relation to duty of care, professional image, individuals’ influence on paramedic role development, and preparedness for practice. Conclusion: Paramedics hold a range of views and perceptions of their role in delivering PHT; some of which appear to be related to age and length of experience, and actual administration of PHT. The vast majority view PHT as a positive step to providing patient care that is evidence based.

Preparing non-medical clinicians to deliver GP out-of-hours services: Lessons learned from an innovative approach

ABSTRACT Despite the need to develop a non-medical out-of-hours (OOHs) workforce to address increasing healthcare demands and to support a strained GP workforce, there is no consensus on the required training and clinical competencies needed for nurses and paramedics to be developed as safe OOH practitioners. This paper presents the development and evaluation of one programme delivered in 2017 to paramedics seeking to work in OOHs services. Details of the course delivery are outlined and the mixed-methods evaluation presented. Following successful university ethical approval, student and staff experiences were reviewed through interviews, questionnaires and graded feedback of completed electronic patient case records. The findings provided useful learning that can be transferred to other organisations seeking to develop such training. In particular, the findings suggest the course was able to provide the students with the skills, knowledge and confidence to become safe practitioners in the OOHs service. Challenges in course delivery were highlighted. It was suggested that course organisation, duration and scope require careful consideration to enable students to complete and practise successfully.

Review: The significance of cognitive representations of symptoms of acute coronary syndrome and coping responses to the symptoms in predicting prehospital delay in Omani patients:

Coronary heart disease (CHD) is a comparatively new pandemic with roots in Western Europe and North America but with the incidence and prevalence rising elsewhere in the world. Risk factors for CHD are well known and the role of social risk factors is known to be fundamental. Papers reporting on individuals with CHD and why they delay when experiencing the symptoms associated with acute coronary syndrome (ACS) have been published since the 1970s, when it was first highlighted that there were difficulties in establishing ‘absolute definitions of onset or to measure patient delay’ (Maclean, 1975: 23). Analysis of this phenomenon continued with the advent of thrombolytic therapy as the length of time between onset of symptoms and therapy increases, the less effective treatment becomes. However, it was recognised during the 1990s that this was irrelevant if an individual did not attend hospital within 2 h of the onset of symptoms and research designed to identify the factors that influenced the decision to seek care or delay were begun. Original, mainly qualitative studies around delay were undertaken in North America and Western Europe; however, there have been a series of studies replicating this original work undertaken by researchers in different parts on the world. This study may be viewed as part of this continuing, although slowing, trend. The researchers aim to contribute new knowledge specifically about the ethnically and culturally distinct Omani population. The background literature to this study indicates a lack of knowledge pertaining to the population living in Oman and the authors provide an acceptable rationale for undertaking