Black, Hispanic, and White Women's Knowledge of the Symptoms of Acute Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75146/1/0884217505278222.pd

Chronic unexplained orchialgia: a concept analysis

Aims To conduct an analysis of the concept of chronic unexplained orchialgia. Background Chronic unexplained orchialgia is a concept unique to men's health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. Design Walker and Avant's framework was used to guide this concept analysis. Data sources Literature sources included bibliographic databases. Review methods Literature published in English from January 1970 to December 31, 2012 was reviewed. Thematic analysis identified critical attributes, antecedents and consequences of the concept. Results Based on the analysis, a contemporary definition for chronic unexplained orchialgia is proposed, rooted in the concept of chronic pain. This definition is based on the concept analysis and the defining attributes that were identified in the literature. Chronic unexplained orchialgia is a subjective negative experience of adult men, perceived as intermittent or continuous pain of variable intensity, present at least three months, localizing to the testis(es) in the absence of objective organic findings and that interferes with quality of life. Conclusion This analysis provides a precise definition for chronic unexplained orchialgia and distinguishes it from other similar terms. This concept analysis provides conceptual clarity that can guide understanding and development of a conceptual framework, middle range theory, or situation‐specific theory. Further exploration of this concept is recommended to uncover the influence of social, sexual and cultural factors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108040/1/jan12340.pd

Caring for Survivors of Prolonged Mechanical Ventilation

Approximately 54 million adults in the United States are involved in some form of family care-giving, with 15% of these individuals providing complex care in their homes. Therefore, it is essential to identify the nuances associated with complex community-based family care-giving. This study investigated family caregivers’ perceptions of caring for individuals who survived tracheostomy for prolonged mechanical ventilation. Using a quantitative approach, family caregivers (n = 15) reported that they were somewhat prepared for this experience. The findings suggested that family caregivers experience considerable physical and psychological effects throughout their care-giving careers. Despite physical and mental health challenges, the caregivers were able to derive personal gratification from complex care provision. The challenge before home care nurses is to prepare family members for their newly acquired care-giving roles, implement interventions that support their physical and mental well-being, and facilitate the engagement in health-promoting behaviors

\u27It Could be Worse ... Lot\u27s Worse!\u27 Why Health-Related Quality of Life is Better in Older Compared with Younger Individuals with Heart Failure

Background: health-related quality of life (HRQOL) is markedly impaired in patients with heart failure (HF). Despite worse prognosis and physical status, older patients have better HRQOL than younger patients. Objective: to determine reasons for differences in HRQOL in older compared with younger HF patients. Methods: a mixed methods approach was used. HRQOL was assessed using the Minnesota Living with HF Questionnaire and compared among HF patients (n = 603) in four age groups (≤53, 54–62, 63–70 and ≥71 years). Socio-demographic/clinical and psychological factors related to HRQOL were determined in four groups using multiple regressions. Patients (n = 20) described their views of HRQOL during semi-structured interviews. Results: HRQOL was worse in the youngest group, and best in the two oldest groups. The youngest group reported higher levels of depression and anxiety than the oldest group. Anxiety, depression and functional capacity predicted HRQOL in all age groups. Qualitatively, patients in all age groups acknowledged the negative impact of HF on HRQOL; nonetheless older patients reported that their HRQOL exceeded their expectations for their age. Younger patients bemoaned the loss of activities and roles, and reported their HRQOL as poor. Conclusions: better HRQOL among older HF patients is the result, in part, of better psychosocial status. The major factor driving better HRQOL among older patients is a change with advancing age in expectations about what constitutes good HRQOL

The Decision to Care: A Life-Altering Experience

The decision to care is often mandated by unavoidable alterations within the family, requiring a primary caregiver. One population that often requires complex community-based care is survivors of prolonged mechanical ventilation (PMV). This investigation explored the choices and challenges of eight family caregivers of PMV survivors. Using content analysis, several mutually exclusive themes emerged describing the care-giving experience as a physically exhausting, emotionally stressful decision that required a lifestyle change to actualize. Even with the burdensome challenges and overwhelming nature of the care-giving experience, participants identified positive rewards associated with the care-giving role. Home health care nurses are in a unique position to facilitate an effective transition to the care-giving role, serving as conduits for caregiver education and skill acquisition and advocating for the development of vital infrastructures that will provide resources, reassurance, and respite from burdensome care-giving challenges

The triaging of men and women for coronary artery disease: Knowledge, experience, or bias.

Women who suffer a myocardial infarction (MI) are less likely than men to be diagnosed based on their presenting symptoms, to receive aggressive treatment, and to survive an acute cardiac event. Yet, controversy continues as to the underlying reasons for these disparities. Therefore, the purpose of this study was to examine if emergency department (ED) nurses triage decisions were substantively different when the nurse was presented with similar cues for MI, but different patient gender. Hammond's (1964) lens model for clinical inference and Evan's (1984) two-stage reasoning model provided the theoretical underpinnings. This non-experimental, descriptive investigation was conducted using methodological triangulation. A random sample of 500 ED nurses received a clinical vignette questionnaire (CVQ) that described simulated patient presentations that differed only by patient sex. Of the 500 CVQs distributed, 260 were returned (52%). The results indicated that ED nurses perceived respiratory, demographic, and medication cues as more relevant in the 43 year-old male vignette patient than the age-matched female patient. Additionally, the male vignette patient was perceived to be in need of more urgent triage, an admission to an ICU bed, and more likely to have a cardiac diagnosis considered than the female. However, no differences were found in the triage decisions that ED nurses rendered for the 66 year-old male or female vignette patients. The quantitative findings were supported by the qualitative data. Content analysis of four focus group sessions (n = 12) revealed several important issues influencing triage decisions: patient presentation, nursing knowledge and experience, practice environment, intuition, the fear of liability, and gender specific behaviors. Nurses held different perceptions regarding the significance and likelihood of coronary artery disease (CAD) for male and female patients seeking evaluation and treatment. Nurses admitted that CAD is not the first diagnosis considered for middle-aged females who come to the ED. Although middle-aged women may not suffer the same number of MIs as middle-aged men, their increased morbidity and mortality warrants its consideration. The findings of this study suggest that gender bias and ageism may account for the disparities in triage decisions for middle-aged women with complaints suggestive of CAD.Ph.D.Health and Environmental SciencesMedicineNursingSocial SciencesWomen's studiesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132064/2/9959696.pd

A Tough Decision: Parents’ Perspective on Shared Decision-Making About Tracheostomies

Often when patients and families face the decision to pursue a tracheostomy or not, there is not a clear “right answer” as to whether this is in the child’s best interest. These decisions should be instead based on anticipated outcomes and patient/family values around those possible outcomes, and the burden of making these decisions shared between clinicians and patients/parents. Limited decision tools exist, however to support parents and clinicians facing pediatric tracheostomy decisions. This is likely because most patient- or parent-facing decision tools focus on communicating specific information about the options, risks, and outcomes, which differ widely across pediatric conditions. For many of these conditions, no population data exist to guide decision-making. Most the education around shared decision-making has targeted clinicians; relying on the assumption that clinicians will become adept at this and utilize it effectively in practice. Unfortunately, not all clinicians receive or use this training, and evidence shows that patients and families are not well engaged in shared decision-making in practice. To address this gap, we sought to develop a clinical, bedside intervention with peer parent narratives to help parents understand the shared decision making (SDM) process, their role in the decision, and other parents’ considerations in this context. We identified nine parents of eight parents who had faced a tracheostomy decision for their child and were willing to talk about their experiences on a video recording. Half of the parents had chosen tracheostomy; some children of parents making either choice had died. We included parents of diverse racial backgrounds whose children had different diagnoses. Parent interviews, along with an explanation of SDM for parents based on the literature and professional society recommendations, were edited into a 17-minute video guided by iterative feedback from parents and clinicians. This video is intended to complement individualized counseling about the tracheostomy decision and discussions of patients/families goals, values, and preferences.University of Michigan M-Cubed 3.0 Granthttp://deepblue.lib.umich.edu/bitstream/2027.42/192788/1/ToughDecisionAbstract.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/192788/4/PituchEmailCorrespondence.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/192788/5/KukoraEmailCorrespondence.pdfDescription of ToughDecisionAbstract.pdf : AbstractSEL