It is known that people who have suffered a heart attack can hold misconceived or maladaptive beliefs and that these can have a deleterious effect on quality of life and functioning. It has also been noted that clinicians do not routinely elicit these maladaptive beliefs. It is probable that angina sufferers also hold such beliefs. As angina is a great burden in the western world, with over two million people with angina in the UK alone, there may be large numbers of people who suffer from these frightening and unhelpful misconceptions. We believe that there is a need for a simple questionnaire that could assist the delivery of tailored education directed at dispelling common misconceptions. This article details the development and psychometric properties of just such a brief questionnaire, designed for use both in research and in clinical practice.

Activities of Daily Living↗

PubMed2003

Development of a reliable and valid Chinese version of the diabetes empowerment scale.

OBJECTIVE: To translate the Diabetes Empowerment Scale (DES) into Chinese and establish its psychometric properties among Hong Kong Chinese people. RESEARCH DESIGN AND METHODS: A two-stage study design, incorporating qualitative and quantitative components, determined the cultural equivalency and content validity of the translated scale and established the psychometric properties of the Chinese DES (C-DES) in 207 patients. RESULTS: Psychometric analysis supported the reliability and validity of the 20-item Chinese DES (C-DES-20) and five subscales: overcoming barriers (alpha = 0.89), determining suitable methods (alpha = 0.79), achieving goals (alpha = 0.78), obtaining support (alpha = 0.78), and coping (alpha = 0.76). The test-retest reliability of the intraclass correlations was satisfactory when a subsample of 20 patients was tested after a 2-week interval. There was criterion validity between the global scale and metabolic control (HbA(1c)) of respondents with type 2 diabetes (P = 0.03). CONCLUSIONS: The C-DES-20 is a reliable and valid outcome measure for patient education and psychosocial interventions among Hong Kong Chinese people with diabetes.

Adaptation, Psychological↗

PubMed2003

The first 12 weeks following discharge from hospital: the experience of Gujarati South Asian survivors of acute myocardial infarction and their families.

The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs. Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience.

Adaptation, Psychological↗

PubMed2002

A comparison of the illness beliefs of people with angina and their peers: a questionnaire study.

BACKGROUND: What people believe about their illness may affect how they cope with it. It has been suggested that such beliefs stem from those commonly held within society. This study compared the beliefs held by people with angina, regarding causation and coping in angina, with the beliefs of their friends who do not suffer from angina. METHODS: Postal survey using the York Angina Beliefs Questionnaire (version 1), which elicits stress attributions and misconceived beliefs about causation and coping. This was administered to 164 people with angina and their non-cohabiting friends matched for age and sex. 132 people with angina and 94 friends completed the questionnaire. RESULTS: Peers are more likely than people with angina to believe that angina is caused by a worn out heart (p < 0.01), angina is a small heart attack (p = 0.02), and that it causes permanent damage to the heart (p < 0.001). Peers were also more likely to believe that people with angina should take life easy (p < 0.01) and avoid exercise (p = 0.04) and excitement (p < 0.01). CONCLUSIONS: The beliefs of the peer group about causation and coping in angina run counter to professional advice. Over time this may contribute to a reduction in patient concordance with risk factor reduction, and may help to create cardiac invalids.

Adaptation, Psychological↗

PubMed2002

Guideline-based early rehabilitation after myocardial infarction. A pragmatic randomised controlled trial.

OBJECTIVES: To determine the effectiveness of individualised educational behavioural treatment delivered by cardiac nurses in hospital compared to usual care for patients following acute myocardial infarction. METHODS: One hundred and fourteen consecutive patients were randomised to receive the intervention or usual care. Outcome assessment was by self-report questionnaire (the Hospital Anxiety and Depression Scale and Dartmouth COOP Health Status), interview at 1 month, and self-report at 3 and 12 months. The primary outcome was improvement in the Dartmouth COOP total score from baseline to 3 months. RESULTS: Four patients needed to be treated to give an additional patient with improvement in health status at 3 months (number needed to treat [NNT] 4, 95% confidence intervals [CIs] 3 to 12). The intervention group were more confident about returning to activities 1 month after discharge from hospital. Treated patients had fewer further treatment needs. CONCLUSIONS: An individualised educational behavioural treatment delivered by cardiac nurses in hospital may have substantial benefits. A large-scale pragmatic RCT is needed.

Activities of Daily Living↗

PubMed2002

Trial of the effects of an advice and relaxation tape given within the first 24 h of admission to hospital with acute myocardial infarction.

BACKGROUND: The study was performed to examine the effects of giving patients with acute myocardial infarction an advice and relaxation audio tape within 24 h of admission to hospital. METHODS: A prospective, two-group design was used with 243 subjects randomised to receive either the advice and relaxation tape or a music tape of their choice within 24 h of sustaining a myocardial infarction. Outcomes comprised anxiety, cardiac misconceptions, lifestyle change, attendance at a cardiac rehabilitation programme, and quality of life. RESULTS: Although the advice and relaxation tape reduced the number of cardiac misconceptions this did not lead to any improvements in outcome, whilst in hospital or at 6 months. Both tapes were equally appreciated by the patients, 98% of whom said that they would recommend them to other patients. CONCLUSIONS: An advice and relaxation tape reduces cardiac misconceptions but does not confer any other benefits over a music tape.

Counseling↗

PubMed2002

Effective nurse-led interventions in heart disease.

Nurses are increasingly being involved in initiatives to improve the co-ordination, delivery and eventual outcomes of health care. Key components of these initiatives include application of evidence-based treatments, ensuring individualised follow-up and the provision of "seamless" care overall. There is evidence in key areas that nurse-led interventions for patients with heart disease are effective, and that they are likely to work in other areas if properly supported and appropriate structures and systems are put in place to promote such practice. Given the promising results to date, it would be disappointing if these issues remain unresolved and the potential value of this type of interventions unfulfilled.

Heart Diseases↗

PubMed2002

The experiences and needs of Gujarati Hindu patients and partners in the first month after a myocardial infarction.

BACKGROUND: South Asian people living in the United Kingdom are at increased risk of coronary heart disease, have higher mortality rates and are less likely to be treated when compared to the white population. There is, however, little information about the experiences and needs of this group after discharge from hospital. AIMS: To explore the experiences and needs of Gujarati Hindu patients and their partners in the first month after a myocardial infarction. METHODS: Using a qualitative research approach, semi-structured interviews were conducted by a Gujarati-speaking researcher with 35 patients and their partners at home during early convalescence. RESULTS: A number of categories emerged from the data which pertained to a lack of information and advice, poor performance of activity, little lifestyle adjustment, poor expectations, lack of future plans, strong family support, dissatisfaction with the family doctor, and a significant belief in fate. CONCLUSION: Experiences and health care needs of Gujarati Hindu patients with myocardial infarction appear different to those of non-Asians. Cardiac aftercare and rehabilitation services should take account of such information

Adaptation, Psychological↗

PubMed2002

Nurse-directed services: how can they be made more effective?

Explore the source record for details and available documents.

Cardiovascular Diseases↗

PubMed2002

Improving cardiac rehabilitation: a view from the United Kingdom.

Cardiac rehabilitation has assumed more prominence over the past decade, due largely to an increase in user demand, an improvement in the evidence base and an enhancement of its status. This paper presents a view from the United Kingdom and suggests some ways in which cardiac rehabilitation can be improved by focusing on a number of key issues: service organisation and delivery, process and outcome measurement, performance management, and education, training and continuing professional development. The paper concludes that there is a need to make cardiac rehabilitation more widely available using creative and flexible approaches to enhance access, participation and adherence.

Benchmarking↗

PubMed2002

Acute care nurses' perceptions of barriers to using research information in clinical decision-making.

AIM: To examine the barriers that nurses feel prevent them from using research in the decisions they make. BACKGROUND: A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. DESIGN: Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). RESULTS: Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. CONCLUSIONS: Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community.

Adult↗

PubMed2002

Cultural aspects of adjustment to coronary heart disease in Chinese-Australians: a review of the literature.

BACKGROUND: The burden of illness associated with Coronary Heart Disease (CHD) has determined this as a key focus for research at a basic science, individual and population level. Although considerable research has been conducted on specific aspects of the experience of CHD, such as anxiety or depression, there is a lack of research investigating the global aspects of the illness experience from the individual's perspective. Furthermore, there is a paucity of research examining the cross-cultural experiences of patients from Non-English Speaking Backgrounds (NESB). Given the multicultural nature of Australian society, and that health and illness are culturally constructed experiences (Manderson 1990), it is important to include the perspectives of people from minority cultures in health related research in order to provide culturally sensitive and appropriate health care and information during an illness. Further, the potential to prevent and modulate the course of CHD, by strategies such as smoking cessation and lipid management, mandate a health promotion agenda based on equity and access for all members of society. AIMS: This article discusses cultural aspects of CHD in relation to nursing and allied health care during the recovery phase of an acute cardiac event. It reviews the research that has been conducted in this area, focusing on the Chinese-Australian population. LITERATURE SEARCH: The CINAHL, MEDLINE, FAMILY (Australian Family and Society Abstracts Database), PsychINFO, and Multicultural Australian and immigration Studies (MAIS) databases were searched, identifying literature published from 1982. Keywords used were Chin* (Chinese, China), Asia* (Asia, Asian), experience, adjustment, psychological, heart, coronary, cardiac, health and services. Reports not written in English were excluded. Australian Government reports were also searched, as well as hand searching of nursing and medical textbooks. These searches resulted in over 1000 articles. However, only around 50 were relevant for this review. IMPLICATIONS: Chinese-Australians are one of the fastest growing populations in Australia, and are at increased risk of CHD upon settling to Australia. Recommendations for future research and for the practice of nursing are provided.

Adaptation, Psychological↗

PubMed2002

A response to Gary Rolfe Nurse Education Today (2002) 22(1): 3-12. Faking a difference: evidence-based nursing and the illusion of diversity.

Explore the source record for details and available documents.

Evidence-Based Medicine↗

PubMed2002

Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review.

Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.

Diet↗