Journal of Cardiovascular Nursing最新文献

Background: Providing care aligned with patient values is key to high-quality cardiovascular care. However, it is unclear how recipients of a ventricular assist device (VAD) engage in values-centered discussions during the postimplantation period.

Objective: To understand how recipients of a VAD engage in conversations focused on clarifying what matters most.

Methods: Sequential explanatory mixed methods study. Adult recipients of a VAD were recruited from a Southeastern U.S. outpatient clinic. Participants completed a cross-sectional survey characterizing values discussions (with whom, who is present, timing, frequency, location, feelings). A subset completed a semi-structured interview to provide a richer understanding of survey findings.

Results: Survey respondents (response rate 31%; N = 32) were 37 to 77 years, mostly male (59%) and non-Hispanic Black (53%). Qualitative analysis (n = 12) identified 3 themes: (1) Relational trust and emotional safety, (2) Timing and readiness, and (3) Contextual fit and communication environment. Synthesis of findings revealed congruence between survey and interview data. Patients indicated comfort with trusted, approachable individuals who were willing/able to offer support (with whom/who is present); acceptance and clarity about their new reality/identity (timing), trusting relationships built over time (frequency), and in-person interactions (location) were key; negative experiences emerged from frustration, conflict, negative attitudes, and lack of understanding (feelings).

Conclusions: Findings highlight the importance of relational trust, emotional readiness, and a supportive communication environment in facilitating values-centered discussions and offer practical guidance for nurses to foster meaningful, values-centered discussions by prioritizing continuity, accessibility, and emotional safety in their interactions.

Background: Nurses educate patients/informal caregivers during hospitalization; however, knowledge about heart failure (HF) medication classes and medication taking is unknown.

Objective: To examine and compare hospital-based nurses' and patients'/caregivers' knowledge about HF medications.

Methods: A prospective, cross-sectional, comparative design and survey methods were used to conduct this study. Cardiac and medical-surgical hospital nurses, patients/caregivers completed a 20-item medication knowledge assessment about HF medication classes and medication-taking. After obtaining univariate analyses between total knowledge score and nurse and patient/caregiver characteristics, multivariable linear models were run to compare scores between nurses and patients, adjusting for variables with P values < .2 in univariate analyses.

Results: Of 145 nurses, 264 patients and 67 caregivers from 4 medical centers, standardized mean (SD) HF medication knowledge scores for nurses, patients, and caregivers were 58 (10.4), 48.7 (13.7), and 54.8 (13.7), respectively. All groups scored highest for loop diuretics and lowest for mineralocorticoid receptor antagonists. Nurses working in an academic center versus community hospitals had higher overall knowledge scores, P = .003, and patients had lower scores than caregivers, P = .001. After adjusting for nurse and patient factors that were associated with univariate knowledge scores, most results remained similar to univariate scores, except that nurses who perceived themselves to be moderately to very knowledgeable versus not/somewhat knowledgeable had higher renin angiotensin system inhibitor scores (P = .020) and patients with HF diagnoses greater than 3 years had lower scores than those with HF for less time, P = .007.

Conclusions: Nurses and patients/caregivers lack foundational HF medication knowledge. Better understanding may enhance adherence and support medication up-titration.

Background: Cognitive dysfunction is prevalent in patients with heart failure (HF). Subjective cognitive concerns (SCC) refer to an individual's concerns, worries, and difficulties about their own perceived cognitive dysfunction, which may or may not be consistent with scores on objective cognitive assessments (eg, neuropsychological tests). However, little is known about SCC in patients with HF.

Objective: The purpose of this study was to characterize SCC in patients with HF by identifying the prevalence and severity (aim 1), influencing factors (aim 2), and potential outcomes (aim 3).

Methods: An integrative literature review was conducted by searching CINAHL, PubMed, PsycINFO, and EMBASE. Search keywords were heart failure, subjective, cognit*, concerns, and associated synonyms in combination. Of 453 articles retrieved, 9 were included in this review.

Results: The articles reviewed included 567 individuals with HF (ranges of mean age = 49-63 years, female = 0%-49%). The prevalence of SCC in patients with HF was 40% to 91%. Severity of SCC was reported to be mild to moderate. Factors significantly influencing SCC were worse HF severity, more psychological distress (ie, depressive and anxiety symptoms, and perceived stress), multimorbidity (ie, chronic obstructive pulmonary disease, insomnia, higher body mass index), and worse objective cognitive function. Outcomes significantly associated with SCC in HF were poorer quality of life and health-related quality of life, less participation in meaningful activities (ie, instrumental, leisure, and social activities) and increased efforts to maintain HF self-care.

Conclusions: In this sample, SCC were highly prevalent in HF, with mild to moderate severity. Potentially influencing factors and outcomes may guide future studies identifying at-risk individuals for SCC and improving health outcomes in HF.

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: 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: There is little data on how heart failure (HF) symptoms change after hospitalization for HF (HFH) or with social determinants of health (SDOH). Such gaps in knowledge limit the ability of clinicians to intervene earlier to reduce symptoms and prevent rehospitalization.

Objective: The aim of this study was to explore HF symptoms from HFH through 6 months postdischarge and explore associations of SDOH and demographic characteristics with symptom trajectories.

Methods: We used an observational longitudinal design from HFH through 6 months postdischarge in 49 patients with New York Heart Association class III HF. Dyspnea (HF Somatic Perception Dyspnea Scale), fatigue (PROMIS-Fatigue), sleep quality (Pittsburg Sleep Quality Index), pain (PROMIS-Pain Interference), depressive symptoms (8-item Patient Health Questionnaire), anxiety (PROMIS-Anxiety), and HF-specific health-related quality of life (Kansas City Cardiomyopathy Questionnaire Short Version) measures were collected during HFH and at 1, 3, and 6 months postdischarge. Latent growth curve modeling and multivariate regression were used to characterize trajectories in symptoms and to determine associations of growth model estimates with SDOH and demographic characteristics.

Results: Participants (N = 49) were 68 ± 10 years, 53% women, with an average ejection fraction of 44 ± 20%. Fatigue, dyspnea, anxiety, and HF-specific health-related quality of life improved significantly from HFH through 6 months posthospitalization (P < .05). Sleep quality, pain interference, and depressive symptoms did not change significantly from HFH through 6 months postdischarge. Novel associations between HF symptom trajectories and race, sex, education, and income were identified.

Conclusions: Symptoms associated with congestion improved to 6 months after HFH while other less frequently assessed symptoms did not improve after discharge. Associations between SDOH, demographic characteristics, and HF symptoms provide new insights into social factors that may influence HF symptoms.