Susan L. Dunn

Hopelessness and depression in the early recovery period after hospitalization for acute coronary syndrome

PURPOSE Psychosocial factors, such as depression, have been identified as important predictors of morbidity and mortality in individuals with coronary heart disease; however, little research has been done examining hopelessness in this population. This investigation examined the frequency and severity of hopelessness and depression in the early recovery period after hospitalization for acute coronary syndrome (ACS), the relationship between hopelessness and depression, and patient characteristics leading to these 2 variables. METHODS A total of 525 post-ACS patients at 5 hospitals in Michigan were interviewed. Measures included the cognitive expectations factor of the Beck Hopelessness Scale and the Center for Epidemiologic Studies-Depression Scale. RESULTS Hopelessness symptoms were frequent and moderate to severe in 27% of the sample, whereas depression was frequent and moderate to severe in 36% of subjects. Hopelessness was moderately correlated with depression, yet a number of different patient characteristics were predictive of each. Lower educational level predicted hopelessness, but not depression. Patients who had coronary artery bypass surgery or coronary angioplasty were more hopeless, but not more depressed. Female gender predicted depression, but not hopelessness. Hopelessness and depression had a shared variance of 33%. CONCLUSIONS Hopelessness and depression were frequent and moderate to severe in a portion of patients in the early ACS recovery period. An association between hopelessness and depression exists, while different patient characteristics were more strongly associated with each. Longitudinal analysis is needed to examine hopelessness and depression in later phases of the ACS recovery period.

Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome.

PURPOSE Hopelessness has been associated with a higher risk of fatal and nonfatal coronary heart disease, yet very few studies have examined hopelessness after a cardiac event. This investigation examined hopelessness as an independent predictor of participation in a hospital-based cardiac rehabilitation exercise program. METHODS A total of 207 patients with acute coronary syndrome were interviewed at 3 and 8 months after hospital discharge. Measures included 1 factor of the Beck Hopelessness Scale, the Center for Epidemiological Studies Depression Scale, the Activity Status Index, the Charlson Comorbidity Index, a sociodemographic variables tool, and a cardiac rehabilitation exercise participation questionnaire. RESULTS Random-effects logistic regression analysis revealed that hopelessness persisted over time and was an independent predictor of lower exercise participation. In contrast, depression showed no significant influence on exercise participation. CONCLUSIONS Study findings suggest the importance of assessing hopelessness in patients with acute coronary syndrome and identifying approaches to exercise recommendations that directly address hopelessness. Interventions focused on the prevention and treatment of hopelessness symptoms may contribute to improved recovery of patient with acute coronary syndrome.

Secondary Data Analysis as an Efficient and Effective Approach to Nursing Research

Meeting the expectation for scholarly productivity can be challenging for nursing faculty, especially in the absence of grant or other funding. Secondary data analysis is one strategy to address this challenge. The use of existing data to test new hypotheses or answer new research questions has several advantages. It typically takes less time and resources, is low risk to participants, and allows access to large data sets and longitudinal data. Despite these advantages, limitations do exist, including a lack of knowledge of the existence of rich data sets and how to obtain and evaluate the contents, insufficient or outdated data, and lack of funds to hire staff to assist with the work. Exemplars of secondary data analysis using public government and private data sets are presented along with the skills needed to conduct this type of analysis. Secondary data analysis is an efficient and effective approach to conducting nursing research.

The State-Trait Hopelessness Scale: Development and Testing

Hopelessness is predictive in the development of coronary heart disease (CHD) and can persist in patients after a CHD event, adversely affecting recovery. Hopelessness may represent a temporary response (state) or a chronic outlook (trait). Common hopelessness measures fail to differentiate state from trait hopelessness, a potentially important differentiation for treatment. The State–Trait Hopelessness Scale (STHS) was developed and pilot tested with two groups of college students (n = 39 and 190) and patients with CHD (n = 44). The instrument was then used with 520 patients, confirming reliability (Cronbach’s α) for the State (.88) and Trait (.91) subscales and concurrent and predictive validity. Separate exploratory factor analyses showed two factors (hopelessness present or hopelessness absent) for the State and Trait subscales, accounting for 58.9% and 57.3% of variance, respectively. These findings support future use of the tool in clinical settings and in intervention studies focused on hopelessness.

Science on a Shoestring: Building Nursing Knowledge With Limited Funding

Building the science for nursing practice has never been more important. However, shrunken federal and state research budgets mean that investigators must find alternative sources of financial support and develop projects that are less costly to carry out. New investigators often build beginning programs of research with limited funding. This article provides an overview of some cost-effective research approaches and gives suggestions for finding other sources of funding. Examples of more cost-effective research approaches include adding complementary questions to existing funded research projects; conducting primary analysis of electronic patient records and social media content; conducting secondary analysis of data from completed studies; reviewing and synthesizing previously completed research; implementing community-based participatory research; participating in collaborative research efforts such as inter-campus team research, practice-based research networks (PBRNs), and involving undergraduate and doctoral students in research efforts. Instead of relying on funding from the National Institutes of Health (NIH) and other government agencies, nurse researchers may be able to find support for research from local sources such as businesses, organizations, or clinical agencies. Investigators will increasingly have to rely on these and other creative approaches to fund and implement their research programs if granting agency budgets do not significantly expand.

Identifying and Promoting Hope in Patients

Nurses are key in identifying and fostering hope in patients. Hope has been linked to positive health outcomes in healthy and ill populations. Inversely, hopelessness (or lack of hope) has been associated with increased adverse clinical events in some illness conditions. The lack of sufficient data on patient outcomes, both positive and negative, demand that nurse scientists build a strong knowledge base on the concept of hope and use best evidence in developing clinical interventions to promote hope. For centuries, philosophers and laypersons alike have recognized hope as an important and powerful force. Hope is well accepted as an attribute or state that can be used by a person as a resource to strengthen or sustain one’s self during an illness or other hardship. Yet, hope, during and after an illness, has been understudied in most populations, and research has been primarily descriptive in nature, limiting our understanding of hope as a therapeutic intervention or preventive strategy. Hope is a multidimensional concept with affective, cognitive, and behavioral dimensions. Barriers to research in the field include lack of a standard definition of hope and the use of multiple measures. The Snyder Hope Scale, which defines hope as an enduring personality characteristic involving beliefs about one’s goals and finding ways to achieve goals, is used in psychology and health care research (Snyder, 2000; Snyder et al., 1991). Other health care researchers, including nurse scientists, use the Herth Hope Index, which defines hope as a multidimensional dynamic life force characterized by a confident yet uncertain expectation of achieving good and is perceived by the hoping person as realistically possible and personally significant (Herth, 1992). Scioli, Ricci, Nyugen, and Scioli (2011), who define hope as a futuredirected, complex network constructed from biological, psychological, and social resources, have developed State and Trait Hope Scales for use in healthy and ill populations. With the variety of theoretical and operational definitions of hope currently being used in health care, it is evident that there is a need for continued theoretical and empirical work. Continued explication of hope as a modifiable state or trait, including its antecedents and consequences, is needed. A meta-analysis of predictors of hope in adolescents (Yarcheski & Mahon, 2015) is a good example of work that 614932WJNXXX10.1177/0193945915614932Western Journal of Nursing ResearchEditorial research-article2015

Home- and Hospital-Based Cardiac Rehabilitation Exercise: The Important Role of Physician Recommendation.

Exercise reduces morbidity and mortality for patients with heart disease. Despite clear guidelines and known benefits, most cardiac patients do not meet current exercise recommendations. Physician endorsement positively affects patient participation in hospital-based Phase II cardiac rehabilitation programs, yet the importance of physician recommendation for home-based cardiac rehabilitation exercise is unknown. A prospective observational design was used to examine predictors of both home-based and Phase II rehabilitation exercise in a sample of 251 patients with coronary heart disease. Regression analyses were done to examine demographic and clinical characteristics, physical functioning, and patient’s report of physician recommendation for exercise. Patients with a strong physician referral, who were married and older, were more likely to participate in Phase II exercise. Increased strength of physician recommendation was the unique predictor of home-based exercise. Further research is needed to examine how health professionals can motivate cardiac patients to exercise in home and outpatient settings.

Impact of Home- and Hospital-Based Exercise in Cardiac Rehabilitation on Hopelessness in Patients With Coronary Heart Disease

PURPOSE: Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). The purpose of this research was to examine the effect of regular home- and hospital-based cardiac rehabilitation (CR) exercise on hopelessness levels in patients with CHD, hypothesizing that increased exercise in either setting would lead to decreased state hopelessness. METHODS: A descriptive longitudinal design was used at a large teaching hospital in Michigan. A total of 324 patients provided data during hospitalization and at least 1 followup time point (3, 8, and 12 months). RESULTS: The patients had persistent, modest levels of state and trait hopelessness across all time points. Among home exercisers with moderate to severe state hopelessness at baseline, both mean state (P = .002) and trait (P = .02) hopelessness were reduced at later time points compared with those who quit or did not start exercise. Multivariable models showed that when individuals had moderate to severe baseline state hopelessness, home exercise remained associated with decreases in state hopelessness compared with no exercise, even after adjusting for hospital exercise, depression, and demographic variables. CONCLUSIONS: Exercise may be effective in reducing moderate to severe hopelessness in patients with CHD. Moderate to severe baseline state hopelessness was a predictor of attrition in this cohort, especially for home exercisers, but this was mediated in hospital-based programs. Further research is needed to determine how hopeless individuals can be encouraged to exercise and whether home- or a hospital-based CR exercise is superior in impacting hopelessness.

Embedding Research in Undergraduate Learning Opportunities

As a means of promoting scholarship, faculty are increasingly including undergraduate nursing students as team members in faculty-led research projects. Research involvement is a high-impact educational practice that enhances student engagement and retention rates and enables the reflection and integration of learning. The purpose of this article is to describe the benefits and innovative ways of directly involving undergraduate nursing students in faculty-guided research projects. Case examples from four non-research-intensive nursing programs are presented to illustrate the benefits of undergraduate student research involvement to students, faculty, their communities, as well as the nursing profession. Student assistance in all phases of the research process, ranging from research question generation, literature reviews, methods development, and data collection and analysis, to presentations and manuscript publication, motivates and helps faculty progress with their research programs. Benefits also include the creation of effective learning experiences that build nursing knowledge and potentially contribute to community health.

Association of cardiac drugs with depression after acute coronary syndrome

Background: Depressive adverse effects of major cardiac medications in patients with cardiovascular disease have been suggested. Objective: To investigate the influence of the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and/or β-blockers on subsequent depressive symptoms in patients hospitalized for acute coronary syndrome. Methods: A sample of 521 patients was followed for 8 months during 1,340 observations. Data were collected from structured telephone interviews and medical record chart reviews. Pooled time series generalized estimating equations regression models were used to evaluate depressive symptom scores, controlling for major clinical and sociodemographic patient characteristics. Results: No significant independent or interactive effects were found linking the use of these medications to subsequent depressive symptoms, despite changes in depressive symptoms over time. Factors that did affect subsequent depression included sociodemographic (eg, increased age, less education) and clinical characteristics (eg, higher composite comorbidity, prior history of depression and/or first myocardial infarction, higher postdischarge pain levels). Conclusions: Our results suggest that potential depressive adverse effects should not be considered a contraindication to the use of recommended cardiac medications. Observed increases in depressive symptoms after an acute cardiac injury will more likely be attributed to other patient characteristics independent of the use of major drug therapy prescribed to prevent further acute cardiac events.