Theresa A. Beery

Gender bias in the diagnosis and treatment of coronary artery disease

Women are at high risk for cardiovascular disorders, but referrals for both diagnostic and therapeutic procedures seem to reflect a gender bias. Procedures and therapies currently used have been developed predominantly or exclusively for men. Medical history demonstrates a disregard of womens health problems that still may be operative today. Women are older and sicker when they have angioplasty or bypass grafting, and they receive far fewer implantable cardioverter defibrillators and heart transplantations. They have more hypertension, diabetes, longer stays in intensive care units, and poorer outcomes. This may be the result of a problem with referral or a difference in the way women experience cardiac symptoms. It may also be related to the way women perceive themselves and their illness. Efforts are being made to provide equitable and relevant health care for women and to conduct research that will describe womens cardiac symptoms and their responses to cardiovascular technology.

Spirituality in Persons with Heart Failure

Spiritual expression has been proposed as a dimension of quality of life. Persons with chronic diseases such as AIDS or cancer have described the value of spiritual expression in living with their illnesses. The authors examined the role spirituality plays in the lives of 58 people with heart failure being treated medically or by transplant. Instruments used included the Medical Outcome Survey Short Form 36 and Index of Well-Being measures of quality of life, the Spiritual Well-Being Scale, and the Relative Importance Scale. Combined spirituality scores predicted 24% of the variance in global quality of life. There were no significant gender differences in spiritual well-being or quality of life.

Sex differences in infection and sepsis

Sex and gender-based differences in responses to infection and sepsis are evident. Estrogens increase immune function, sometimes to the point of inducing autoimmune disease. Testosterone suppresses immune function, sometimes leading to a worsened outcome following traumatic injury. Therapies using sex hormones to improve outcomes after sepsis and hemorrhagic shock and to reduce exacerbations of autoimmune diseases are being studied. Differences in sex hormone levels may not tell the whole story. Studies of immune function in girls and boys before puberty may be helpful. Differences found early might indicate that factors other than estrogen and androgen levels are contributing. Variations in societal role acculturation and exposures that are gender based also may be involved. Clinicians must consider sex and gender when attempting to determine the risk of infection, sepsis, and immune dysfunction in populations. Clinical applications of sex and gender differences are just beginning to occur with the genesis of sex hormone-based treatments. The large-scale efficacy of such treatments has yet to be reported. Innovative strategies based on sex or gender differences in immune responses may soon be available and may lead to essential data for clinical decision making. The impact of sex and gender differences on long-term health outcomes remains to be seen.

An exploratory study of body awareness in persons with heart failure treated medically or with transplantation.

Heart failure is a chronic disabling problem afflicting a growing number of adults. These individuals experience episodes of exacerbation demonstrated by increasing shortness of breath, fatigue, and fluid retention. The symptoms often develop in a slow and insidious manner making perception of worsening difficult to determine. Theoretically, an increase in body awareness may help individuals recognize symptoms of worsening heart failure earlier, but it is not known whether increased body awareness leads to somatization, an abnormal dwelling on body symptoms. This study was conducted to describe body awareness in 90 persons with heart failure or after transplant. We found that the Body Awareness Quesionnaire was a reliable measure of this concept in this sample. When body awareness was examined for age, gender, and treatment (HF or transplant) group were examined, no significant differences were found. Furthermore, there were no significant relationships between body awarenss and negative moods such as anxiety, depression, or anger. Interventions to enhance body awareness may be a fruitful new direction that will improve symptom recognition without increasing somatization in persons with heart failure.

Focused Life Stories of Women with Cardiac Pacemakers

Biotechnical devices such as cardiac pacemakers are implanted into people to manage a range of disorders, yet comparatively little is known about the emotional impact of this experience. Women may have a unique response to implanted devices due to cultural messages about the masculinity of technology. In this qualitative study using Hall’s focused life stories design, 11 women from teenagers to elders with permanent cardiac pacemakers were asked to describe their experiences using semistructured interviews. The themes that emerged are relinquishing care, owning the device, experiencing fears and/or resistance, imaging the body, normalizing, positioning as caretaker, finding resilience, and sensing omnipotence. Understanding what it means for women to live with an implanted biotechnical device may facilitate planning interventions to support their psychological and physiological health. Effective pacemaker function may depend, in part, on recipients’ successful emotional attachment to the device.

Medical devices and attachment: holistic healing in the age of invasive technology.

The environment is filled with wonderful examples of medical technology that provide emergency life support, improve well-being, and offer the possibility of a longer and more productive life. But these devices are no longer only a part of the external environment. As technology advances, more devices are becoming a part of the internal environment (i.e., our bodies) as well. For some people an implanted mechanical device, such as a cardiac pacemaker or a cardioverter defibrillator, is readily accepted; for others it may be seen as an encroachment. It may be a symbol of loss and debilitation or of independence and resilience. What makes the difference? How can nurses facilitate a healthy adjustment and healing in an era permeated with technology? A discussion of the symbolism, related theory, and nursing implications is provided.

An Exploratory Study of Developmental Growth in Adults with Heart Failure

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.

Experiences of college-age youths in families with a recessive genetic condition.

Growing up in a family with a recessive genetic condition can trigger questions about progeny effect. This study explored perceptions of family hardiness and information sharing by 18- to 21-year-olds about genetic risk. Semistructured interviews, the Family Hardiness Index (FHI), and a Family Information Sharing Analog Scale (FISAS) were used. Participants included 11 youths who had relatives with hemophilia and 4 with sickle cell anemia. Findings revealed seven themes: assimilating premature knowledge; caring for others, denying self; cautioning during development; experiencing continual sickness; feeling less than; magnifying transition experiences; and sustaining by faith. There was no significant correlation between total FHI and FISAS. However, there was a statistically significant difference in FISAS between genetic condition variance. Specifically, higher hardiness was found and information sharing correlated among college youths in families with hemophilia. Additional research can lead to nursing interventions to provide genetic information to youths in families for illness variance.

Development of the implanted devices adjustment scale.

Advances in microelectronics have resulted in exponential growth in the number of implanted medical devices. Most people do well adjusting to their devices, but others show signs of depression and/or anxiety. The Implanted Device Adjustment Scale (IDAS) was developed to measure how well a person is adjusting to an implanted device. First, a pool of items was generated and reviewed by 2 panels of clinicians and psychometricians for content validity. The revised version was then administered to a small sample that provided information about problematic items. Finally, a convenience sample of 45 persons (66% males) with implanted devices (18 pacemakers only, 37 cardioverter/defibrillators) completed the revised IDAS twice. After deleting weak items, the Cronbach alpha was 0.90. No age, gender, or device differences were found. Test-retest reliability was 0.92. The IDAS may be useful to evaluate how well a person is adjusting to her/his device. This may lead to more timely and appropriate interventions to improve outcomes.

Infection precautions with temporary pacing leads: A descriptive study*

OBJECTIVE To describe infection precautions used by nurses when caring for patients with temporary epicardial and transvenous pacemakers. DESIGN Descriptive, nation-wide survey. SETTING All U.S. hospitals performing cardiac surgery. RESPONDENTS Nurse managers and clinical specialists from cardiac and thoracic intensive care, coronary care, and telemetry units at all U.S. hospitals performing cardiac surgery. INTERVENTION The Pacemaker Electrode Care and Safety Survey. RESULTS Responses came from 43% (388) of the 895 hospitals. Most respondents indicated that they wore gloves when handling electrodes (approximately 96%); usually the gloves were nonsterile (73%). A sterile procedure was often used to perform site care (37% for epicardial and 65% for transvenous). The most common agent used for site cleansing was povidone-iodine. Concern has been expressed in the literature about use of this agent. Gauze was the most common type of dressing (used by 60% for epicardial dressings and 31% for transvenous). CONCLUSION There is diversity in clinical practice. Further study is recommended to establish the safety, efficacy, and cost-effectiveness of identified infection precautions.