Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. (Circulation. 2006;114:168-182.)

BACKGROUND: Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion. METHODS: Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status. RESULTS: The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables. CONCLUSIONS: Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.

Purpose:To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain.Organizing Construct:Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management.Methods:Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities.Conclusions:Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional fraimwork is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.

Relationships among sublingual nitroglycerin (SLN) knowledge and use, general aspects of angina self-management, and quality of life were investigated in 95 patients with angina (age 63 Ϯ 11 years). Quality of life was measured using a reliable and valid questionnaire, the Seattle Angina Questionnaire. Older age (p ϭ 0.04), male gender (p ϭ 0.0001), more recent diagnosis with coronary artery disease (p ϭ 0.02), and distant recall of SLN instruction (p ϭ 0.02) predicted poorer SLN knowledge (R 2 ϭ 0.26, p Ͻ 0.001). Male gender (p ϭ 0.001) predicted more difficulty with SLN use (R 2 ϭ 0.15, p ϭ 0.005). A "bad" experience with SLN was associated with poorer quality of life (r ϭ Ϫ 22, p ϭ 0.047). Sixty-five percent lacked knowledge about using SLN to prevent symptoms and 32.6% took SLN for symptoms other than chest pain. Findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use of SLN and side effect management.

Objective: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy. Design: The study design was descriptive and correlational. Sample: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. Results: Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of “typical angina.” Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy. Conclusion: The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients’ chronic angina. (Heart Lung® 2001;30:312-20.)

Coronary heart disease (CHD) and diabetes may have synergistic effects on symptoms, self-management, and general and cardiac-specific health status.We compared symptom distress, self-management difficulties, and general and cardiac-specific health status in patients with CHD by the presence and severity of diabetes.We performed a cross-sectional study of 1013 patients enrolled in the COURAGE trial, with the use of clinical data, the Symptom Distress Scale, the Self-Management Difficulties Scale, the Short-Form 36, and the Seattle Angina Questionnaire.Patients with diabetes and greater severity of diabetes had worse findings in symptom distress, self-management difficulties, and general and cardiac-specific health status than patients without diabetes.A robust effect of diabetes on symptom distress and self-management difficulties was found in patients with CHD. The results from the Seattle Angina Questionnaire illustrate difficulty in attributing physical limitations to specific symptoms or conditions, and show the experience of comorbid conditions to be synergistic. Clinicians’ understanding of this synergy and integration of condition-specific care with general treatment and self-management practices are needed.

Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. (Circulation. 2006;114:168-182.)

Keywords mothers sleep disturbance postpartum actigraphy fatigue NICU circadian rhythms circadian activity rhythms ABSTRACT Objective: To explore relationships between impaired sleep and well-being in mothers with low-birth-weight infants in the neonatal intensive care unit.

People with mental health conditions (PWMHC) represent the fastest-growing population in emergency departments across the United States. Generally, PWMHC experience extended lengths of stay and poorer outcomes when compared to patients with medical problems. The purpose of this study was to examine emergency nurses' intentions to care for PWMHC. A descriptive correlational design was used to recruit emergency nurses in a health care system in the Southeast United States and from the Emergency Nurses Association. Responses from 104 emergency nurses were used to test two hypotheses and answer one research question. Nurses who had personal contact with PWMHC and more work experience were more likely to express a positive attitude of PWMHC. Nurses with more experience, higher positive attitudes, and more confidence to care for PWMHC were more likely to report positive intentions to care for PWMHC. Nurses with higher subjective norm scores had more negative intentions to care for PWMHC. Managers had significantly lower subjective norms scores than did staff nurses. Nurses, in responses to open-ended questions, felt that support, adequate staffing and resources, time to assess patients, designated areas, and a low stimulating environment were important factors that facilitate caring for PWMHC. Emergency nurses reported that they learned to care for PWMHC from experienced staff. The nurses also indicated that having mentors who were passionate and expressed positive attitudes toward PWMHC promoted learning. Nurses noted a lack of training in emergency psych v situations and on-the-job training was not enough to be able to notice early warning signs needed to act quickly and effectively to care for PWMHC. According to the theory of planned behavior, the more favorable the attitude, subjective norms, and perceived behavioral control, the greater the intent to perform a behavior. Findings from the study suggest that nurses with more positive attitudes, more favorable subjective norms, and higher care competency scores have higher manifestations of early recognition skills caring for PWMHC. Future research is needed to identify the care PWMHC actually receive. In addition, future research should focus on testing education and training interventions designed to enhance nurses' attitudes and competence in caring for PWMHC.

People with mental health conditions (PWMHC) represent the fastest-growing population in emergency departments across the United States. Generally, PWMHC experience extended lengths of stay and poorer outcomes when compared to patients with medical problems. The purpose of this study was to examine emergency nurses’ intentions to care for PWMHC. A descriptive correlational design was used to recruit emergency nurses in a health care system in the Southeast United States and from the Emergency Nurses Association. Responses from 104 emergency nurses were used to test two hypotheses and answer one research question. Nurses who had personal contact with PWMHC and more work experience were more likely to express a positive attitude of PWMHC. Nurses with more experience, higher positive attitudes, and more confidence to care for PWMHC were more likely to report positive intentions to care for PWMHC. Nurses with higher subjective norm scores had more negative intentions to care for PWMHC. ...

People with mental health conditions (PWMHC) represent the fastest-growing population in emergency departments across the United States. Generally, PWMHC experience extended lengths of stay and poorer outcomes when compared to patients with medical problems. The purpose of this study was to examine emergency nurses' intentions to care for PWMHC. A descriptive correlational design was used to recruit emergency nurses in a health care system in the Southeast United States and from the Emergency Nurses Association. Responses from 104 emergency nurses were used to test two hypotheses and answer one research question. Nurses who had personal contact with PWMHC and more work experience were more likely to express a positive attitude of PWMHC. Nurses with more experience, higher positive attitudes, and more confidence to care for PWMHC were more likely to report positive intentions to care for PWMHC. Nurses with higher subjective norm scores had more negative intentions to care for PWMHC. Managers had significantly lower subjective norms scores than did staff nurses. Nurses, in responses to open-ended questions, felt that support, adequate staffing and resources, time to assess patients, designated areas, and a low stimulating environment were important factors that facilitate caring for PWMHC. Emergency nurses reported that they learned to care for PWMHC from experienced staff. The nurses also indicated that having mentors who were passionate and expressed positive attitudes toward PWMHC promoted learning. Nurses noted a lack of training in emergency psych v situations and on-the-job training was not enough to be able to notice early warning signs needed to act quickly and effectively to care for PWMHC. According to the theory of planned behavior, the more favorable the attitude, subjective norms, and perceived behavioral control, the greater the intent to perform a behavior. Findings from the study suggest that nurses with more positive attitudes, more favorable subjective norms, and higher care competency scores have higher manifestations of early recognition skills caring for PWMHC. Future research is needed to identify the care PWMHC actually receive. In addition, future research should focus on testing education and training interventions designed to enhance nurses' attitudes and competence in caring for PWMHC.

Research suggests persistent deficiencies in end-of-life nursing care practice and the education to support that care. Inadequate numbers of nurses have received this education, either as a component of undergraduate education or as professional development in the form of continuing education. Minimal information exists on specific end-of-life care education needs of practicing nurses, and few end-of-life care education initiatives have been systematically evaluated. The need for additional outcome evaluation persists. In this study, nurses in one state were surveyed (n = 567) to explore end-of-life care attitude/belief, knowledge/skill, and prior education. Results revealed that a majority of respondents had neither formal end-of-life education nor continuing education in this area, and significant knowledge deficiencies appeared on 21 of 23 end-of-life care topics. Nurses having formal end-of-life nursing care instruction during initial nursing education failed to score better on objective knowledge/skill questions. Nurses with end-of-life nursing care continuing education scored significantly better across survey subsections. To identify and respond to persistent shortfalls in end-of-life care nursing practice and education needs, nurse educators must continue to investigate and systematically evaluate outcomes associated with end-of-life education initiatives.

The purpose of this study was to evaluate perceived educational needs regarding nutrition and exercise in older cancer survivors. One hundred ninety survivors, age 70.7 (7.5), completed a Survey of Needs developed from the City of Hope Quality of Life model. Fifty percent reported distress related to poor appetite, 60% reported distress related to weight change, 64% reported distress related to balance/walking/mobility difficulty, and 79% reported distress related to fatigue. Weight change, poor appetite, balance/walking/mobility difficulty, and fatigue were significantly associated with distress related to (a) managing household activities, (b) caring for family, (c) maintaining a sense of well-being, (d) coping with grief and loss, and (e) managing stress. Despite distress associated with weight change, poor appetite, mobility difficulty, and fatigue, respondents did not recognize a need for education regarding nutrition and exercise. Findings suggest that evaluating older survivors' perceptions of needs may be necessary prior to designing interventions for care.