Journal of Cardiovascular Nursing最新文献

Background: Heart failure (HF) is associated with substantial morbidity and mortality worldwide. Although self-care is crucial for long-term HF management, individuals with HF often face challenges in maintaining self-care behaviors over time. This highlights the need to understand people's motivation to engage in self-care and how those motivations might change over time. Self-determination theory provides a valuable framework for understanding the link between motivation and self-care, but the specific conditions that shape this relationship in daily life remain uncertain.

Objectives: An ecological momentary assessment study was conducted to investigate the relationship between intention and self-care among patients with HF, as well as the moderating role of motivation types.

Methods: Participants completed 2 surveys per day for a week using the Sema3 mobile application.

Results: A total of 63 patients with HF (49.2% male) with a mean age of 61.7 years (standard deviation = 17.1) completed the study. Medication adherence demonstrated high stability (intraclass correlation coefficient [ICC] = 0.99) in daily life, while diet (ICC = 0.80) and weighing behaviors (ICC = 0.79) were also largely consistent within participants. In contrast, exercise demonstrated greater day-to-day fluctuation (ICC = 0.46). Morning self-care intentions significantly predicted evening behaviors for weighing and exercise, but not for diet-related self-care. Identified and integrated motivation were the most commonly endorsed types of motivation across different self-care behaviors.

Conclusions: This study highlighted the dynamic nature of motivation and self-care in daily life. Health professionals should recognize that intention does not necessarily translate into actual behavior, and some behaviors require greater support than others.

Background: Coronary heart disease is a leading cause of death worldwide with treatments including invasive surgical procedures coronary artery bypass grafting and heart valve replacement surgery. The creation of innovative multimedia health programs has the potential to support patient engagement at the bedside. The MyStay Cardiac multimedia program was developed to support patient engagement in the acute phase of postoperative recovery.

Objective: The aim of this study was to evaluate the feasibility and acceptability of a multimedia program (MyStay Cardiac).

Methods: A prospective cohort study utilizing a concurrent mixed methods approach. Feasibility and acceptability were measured by determining (i) patient engagement and (ii) patient and external factors impacting individual use of MyStay Cardiac.

Results: A total of 19 participants were recruited and most participants independently used MyStay Cardiac. There was a significant association between participants' total score on Health Literacy Questionnaire Domain 8 "Ability to find good health information," the total number of postoperative complications experienced, and experiencing postoperative cardiac arrhythmias and independent use of MyStay Cardiac. Factors enabling feasibility and acceptability of MyStay Cardiac included (i) program design and resources, (ii) participant health literacy, and (iii) social supports. Factors impeding feasibility and acceptability of MyStay Cardiac included (i) unstable internet, (ii) patient acuity and postoperative complications, and (iii) inconsistencies in information provided between clinicians and MyStay Cardiac.

Conclusion: MyStay Cardiac is a feasible and acceptable multimedia program for patient engagement in the context of acute cardiac care. Further investigation is needed to evaluate if the implementation of multimedia health programs results in improved patient outcomes.

Background: Implantable cardioverter defibrillator (ICD) shocks are unexpected, painful, traumatic, and can lead to posttraumatic stress disorder (PTSD).

Objective: To describe the feasibility and efficacy of the Heart Rate Self-Monitoring (HRSM) intervention to reduce PTSD symptoms post-ICD shock.

Methods: A single-group, prepost design was used to assess study outcomes. In the HRSM intervention we used Polar HR monitoring and 4-weekly, nurse-led coaching sessions to review responses to tailored walking and deep breathing exercises. Outcomes included ICD shock anxiety, PTSD symptoms, depression, steps/day, self-efficacy, and salivary cortisol.

Results: Ten participants (100% male, 89% Caucasian, 58 years, and 55% prior ICD shock) completed the study. Intervention feasibility was established. Postintervention, ICD shock anxiety (P = .03), PTSD symptoms (P = .06), self-monitoring behaviors (P = .02), and salivary cortisol (P = .10) decreased. Steps/day and depression remained stable.

Conclusion: After ICD shock, participation in HRSM was associated with decreased anxiety, PTSD symptoms, and salivary cortisol.

Background: Stress is one of the psychosocial risk factors predicted to reduce the incidence of coronary artery disease when in good control.

Objective: This study was conducted to determine the relationship between perceived stress level and the severity of coronary artery disease in patients admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI).

Methods: The descriptive and correlational study was conducted with 240 patients with a diagnosis of NSTEMI. The data were collected using a demographic form, plus the Perceived Stress Scale-14 (PSS-14), SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) Score, and Global Registry of Acute Coronary Events (GRACE) risk score.

Results: The mean age of the patients included in the study was 60.75 ± 11.75 years, and 72.5% of the participants were male. The mean PSS-14, GRACE, and SYNTAX scores of the patients included in the study were 31.70 ± 6.71, 101.27 ± 24.48, and 11.90 ± 9.21, respectively. A moderately significant positive correlation was observed between the SYNTAX score and both the PSS-14 score (r = 0.550; P <.001) and the GRACE score (r = 0.555; P <.001). Additionally, a weak positive correlation was identified between the PSS-14 score and the GRACE score (r = 0.261; P < 0.001). Multiple linear regression analysis revealed that the GRACE score, age, presence of diabetes mellitus, and PSS-14 score were significant predictors of moderate to high SYNTAX scores (P <.001; P <.05).

Conclusions: Perceived stress levels were found to be high among patients with NSTEMI, and elevated stress may contribute to the severity of coronary artery disease. Based on these findings, patients of advanced age, those with chronic conditions such as diabetes mellitus, and individuals experiencing high levels of stress should be closely monitored for the development and progression of coronary artery disease.

Background: Cardiac surgery often disrupts patients' sleep patterns during the perioperative period, adversely affecting recovery. Understanding sleep trajectories and their influencing factors is crucial for developing personalized interventions to improve patient outcomes.

Objective: To investigate perioperative sleep trajectories in cardiac surgery patients and identify the factors influencing these trajectories using a growth mixture model.

Methods: We conducted this prospective observational study at a tertiary hospital in Zhejiang Province from March 2023 to September 2024. Data from 348 cardiac surgery patients were collected using a demographic questionnaire, the Chinese version of the Richard-Campbell Sleep Questionnaire, the Self-Rating Anxiety Scale, and the Mini-Mental State Examination. Perioperative sleep trajectories were analyzed using a growth mixture model, and multivariate logistic regression identified associated factors.

Results: Four distinct perioperative sleep trajectory groups were identified: the progressively declining sleep (21.55%), the rapid sleep improvement (27.59%), the moderate sleep improvement (18.10%), and the persistent poor sleep (32.76%). Risk factors for poor sleep included female gender (odds ratio [OR]: 1.913; 95% confidence interval [CI]: 1.835-2.703, P < .05), age > 60 years (OR: 2.580; 95% CI: 2.339-2.935, P < .05), and a history of alcohol consumption (OR: 1.605; 95% CI: 1.488-1.796, P < .05). The appropriate use of sedative-hypnotic medications was potentially beneficial to sleep (OR: 0.227; 95% CI: 0.214-0.916, P < .05).

Conclusions: Our findings highlight significant variability in perioperative sleep trajectories among cardiac surgery patients and underscore the importance of identifying high-risk individuals and implementing targeted interventions to optimize sleep and recovery outcomes.

Background: Heart failure (HF) is on the rise worldwide, and the economic burden is gradually increasing. Spirituality positively impacts mental and physical health of people with HF through regaining purpose, meaning, and self-transcendence.

Objectives: In this study, our aim was to identify gaps in knowledge by analyzing and synthesizing evidence related to benefits, barriers, definition, and measurement of spirituality and its relationship to HF self-care.

Methods: For this integrative review, we searched CINAHL, MEDLINE, PubMed, APA PsycINFO, Web of Science, and manual search between January 2013 and August 2024. Search terms included combinations of HF, self-care, and spirituality-related keywords. Hawker and colleagues' critical appraisal tool was utilized to analyze the quality of this review.

Results: We analyzed 15 studies and derived 3 themes: Heterogeneous and interconnected, spirituality as a predictor of self-care, and social and cultural consideration. Most define spirituality as seeking meaning and connection to a transcendent being, and the FACIT-Sp scale was the most commonly used. In 20% of studies, the influence of spirituality was examined using self-care measurements in people with HF. The facilitating factors to integrating spirituality into care included social support, resilience, gratitude, approach coping, prayer, meditation, and religious affiliation, while the barriers included disease severity, burden, and cultural differences.

Conclusions: Spirituality serves as an inner resource that enhances HF self-care by providing personal meaning and self-transcendence, extending beyond traditional religious practices. Healthcare providers should assess the spiritual needs of individuals with HF and provide individualized self-care support that considers the social and cultural backgrounds that can enhance spirituality.

Background: The Control Attitudes Scale-Revised (CAS-R) is widely used to explore cardiac patients' beliefs about their ability to manage illness. The CAS-R's construct validity may be questionable in different cultural contexts. Conclusions/applications based on inaccurate construct validity can be misleading and incorrect.

Objective: In this study, we aimed to evaluate the psychometric properties of the Arabic version of the CAS-R.

Methods: Within a cross-sectional design involving 180 Omani patients with heart failure (mean age = 70.3 ± 9.8 years, 51.7% females), exploratory/confirmatory factor analysis (CFA) and multigroup CFA were used to evaluate the construct validity and measurement invariance of the CAS-R across gender and marital groups.

Results: In exploratory factor analysis, 2 factors with eigenvalues >1 explained 37.9% of the variance. Despite the poor fit of the unidimensional CAS-R, CFA revealed an excellent fit of a 2-factor structure. Negative (5 and 8) and cross-loading items (1) contributed to scale variance at the configural level. Eliminating negative items and item 6 improved model fit, reliability (Cronbach's α = 0.66 vs. 0.56), and invariance at all levels. In support of its convergent and criterion validity, the CAS-R 5 correlated with the CAS-R and depression (r = 0.953, -0.268; P values <.01).

Conclusions: Negative items comprised a minor weak factor (helplessness) that was not stable across groups. Eliminating items 5, 6, and 8 resulted in a clean invariant short form (CAS-R 5) with superior properties that may implicate nursing decisions and interventions concerning perceived control.

Background: Although digital health technologies have the potential to improve cardiac patient health outcomes, there are significant digital health inequities experienced by immigrant communities. It is important to understand the barriers to digital health equity within cardiovascular healthcare for immigrants.

Purpose: The purpose of this paper is to apply the Health Equity Impact Assessment, Digital Health Supplement within the context of immigrant communities with an intersectional lens.

Conclusion: The Health Equity Impact Assessment, Digital Health Supplement can be used to ensure health equity remains central in digital health technologies used within cardiovascular healthcare. The instrument includes 5 steps: (1) scoping, (2) potential impacts, (3) mitigation, (4) monitoring, and (5) dissemination. Social determinants of health, intersectional factors, and patient and family involvement are necessary to understand digital health inequities experienced among immigrants. Access is one of the potential impacts highlighted by the framework. Access can be promoted through funding and tailored digital health technologies. Immigrants need to be active partners in the design and development of the digital health technologies. It is important that equity remains a central outcome. Multiple experts are needed to analyze the results in a fair manner. Findings should be disseminated within various avenues.

Clinical implications: Future research is necessary to strengthen the evidence base for applying the Health Equity Impact Assessment, Digital Health Supplement among immigrant populations. Since digital health equity research requires an intersectional lens, the diversity dimensions can serve as a foundational framework in future studies.

Background: Electronic health record (EHR) outcome ascertainment may introduce challenges if measurements are inconsistently or infrequently captured.

Objective: To evaluate the effects of the "Balance" intervention on EHR-derived secondary/exploratory outcomes and assess outcome frequency, timing, and variability.

Methods: Balance was a 2-arm, 12-month pragmatic randomized trial of a digital weight gain prevention intervention (N = 443). Cardiometabolic outcomes (eg, blood pressure, hemoglobin A1c, triglycerides, and total cholesterol) were extracted from the EHR and analyzed using linear mixed models.

Results: The intervention arm (n = 223) had lower systolic (-3.4 mm Hg, 95% confidence interval [CI]: -6.7 to -0.2) and diastolic blood pressure (-2.4 mm Hg, 95% CI: -4.3 to -0.6) at 6 months. Effects attenuated by 12 and 24 months. Other outcomes showed no significant differences. Blood pressure was measured 11.9 times per participant, 4.2 months apart. Other outcomes were measured 12 to 17.4 months apart. Variability averaged 1.0 standardized units.

Conclusions: Trials using EHR data should account for data variability and sparsity in trial planning, implementation, and analysis.