Biomedical subjects

Debra Moser

Publications and source records attributed to Debra Moser.

6 recordsLinked to original sources

PubMed2006

Caring for patients with chronic heart failure: The trajectory model.

The purpose of this paper is to examine gaps in our understanding of the heart failure experience and describe the use of Trajectory of Chronic Illness Theory to bridge these gaps. New pharmacotherapeutic strategies have improved survival in heart failure, but research has consistently shown that clinical outcomes in these patients do not depend on physiologic variables alone. Psychological, behavioral, environmental, social and socioeconomic variables also contribute to a patient's ability to manage chronic illness. However, we have not yet identified the essential elements in helping patients engage in self-management and adhere to increasingly complex medical regimens. Theoretical models facilitate disciplinary integration, providing a comprehensive and cohesive foundation for building better science. The Trajectory of Chronic Illness Theory is particularly salient for heart failure because of its emphasis on patients' ability to manage a chronic illness. By using theory to explore gaps in our understanding of the heart failure experience, investigators may be able to develop more targeted interventions to help patients manage heart failure.

Adaptation, Psychological↗

PubMed2006

Hemodynamic changes during discontinuation of mechanical ventilation in medical intensive care unit patients.

BACKGROUND: Cardiac dysfunction can prevent successful discontinuation of mechanical ventilation. Critically ill patients may have undetected cardiac disease, and cardiac dysfunction can be produced or exacerbated by underlying pathophysiology. OBJECTIVE: To describe and compare hemodynamic function and cardiac rhythm during baseline mechanical ventilation with function and rhythm during a trial of continuous positive airway pressure in medical intensive care patients. METHODS: A convenience sample of 43 patients (53% men; mean age 51.1 years) who required mechanical ventilation were recruited for this pilot study. Cardiac output, stroke volume, arterial blood pressure, heart rate, cardiac rhythm, and plasma catecholamine levels were measured during mechanical ventilation and during a trial of continuous positive airway pressure. RESULTS: One third of the patients had difficulty discontinuing mechanical ventilation. Successful patients had significantly increased cardiac output and stroke volume without changes in heart rate or arterial pressure during the trial of continuous positive airway pressure. Unsuccessful patients had no significant changes in cardiac output, stroke volume, or heart rate but had a significant increase in mean arterial pressure. The 2 groups of patients also had different patterns in ectopy. Concurrently, catecholamine concentrations decreased in the successful patients and significantly increased in the unsuccessful patients during the trial. CONCLUSIONS: Patterns of cardiac function and plasma catecholamine levels differed between patients who did or did not achieve spontaneous ventilation with a trial of continuous positive airway pressure. Cardiac function must be systematically considered before and during the return to spontaneous ventilation to optimize the likelihood of success.

Adult↗

PubMed2004

Functional status and perceived control influence quality of life in female heart transplant recipients.

BACKGROUND: The purpose of this study was 2-fold: (1) to describe and compare the quality of life (QOL) and psychologic well-being of 2 groups of women matched for age and functional status (6-minute walk distance), including those who had received a heart transplant and those who were candidates on a transplant waiting list; and (2) to identify correlates of QOL in female heart transplant recipients. METHODS: Data were collected from 50 female recipients (mean age 54.7 +/- 13.0 years) and 50 female candidates (mean age 56.8 +/- 12.2 years) from a major heart transplant facility using the Minnesota Living with Heart Failure Questionnaire, the Beck Depression Inventory and the Control Attitude Scale. RESULTS: The overall QOL scores were 28.0 +/- 26.4 and 56.3 +/- 26.1 for recipients and candidates, respectively (p < 0.01), with lower scores denoting higher QOL. The mean physical health (11.3 +/- 11.2 vs 19.9 +/- 12.1, p < 0.01) and emotional health (7.5 +/- 8.2 vs 12.8 +/- 7.8, p < 0.001) scores were also lower (reflecting higher physical and emotional health) for recipients as compared with candidates. Likewise, recipients reported significantly (p < 0.001) lower depressive moods (23.2 +/- 8.2 vs 45.8 +/- 16.3) and higher perceived control (10.9 +/- 4.3 vs 8.6 +/- 1.9) compared with candidates. Functional status, depression and perceived control were significant correlates of QOL among female recipients and accounted for 49% variance in overall QOL. CONCLUSIONS: Although overall QOL of was better among female heart transplant recipients than candidates, both groups of women reported poor QOL. Clinicians need to identify potential resources and interventions to improve QOL both before and after heart transplant surgery.

Adaptation, Psychological↗

PubMed2003

Perceptions and experiences of heart disease: a literature review and identification of a research agenda in older women.

BACKGROUND: Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease. This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease. METHODS: The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women. RESULTS: Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs. CONCLUSION: Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.

Aged↗

PubMed2002

Can we talk? Developing a social support nursing intervention for couples.

Social support is an important influence on success during lifestyle modification attempts. According to the theory of expressed emotion, support that is perceived by the recipient as critical or overprotective is unhelpful and perhaps harmful. This article describes an intervention for couples and preliminary assessment of its feasibility and acceptability by the nurses who trialed it. Four staff nurses and 2 advanced practice nurses administered the intervention to 15 couples and reported on the benefits and limitations of the intervention. One individual in each couple had a chronic or an acute cardiac illness. The nurses perceived the intervention as valuable; even a single session stimulated discussion between the couple about important issues. Complexity, logistic barriers, and time constraints limited the technique. The authors conclude that this intervention may be most useful to clinical nurse specialists who have additional education, training in communication, and teaching and consulting skills.

Communication↗

PubMedDate not supplied

The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature.

As advances in medical treatment of heart failure (HF) become limited, other factors are being studied to improve outcomes. There is much evidence that supportive social relations have a major impact on health outcomes and that social support is essential for adjustment to illness. This article describes current research on the influence of social support on outcomes in patients with HF. A computerized literature search in Medline, CINAHL, and PsychLit was performed on each of the different outcomes in relation to social support, covering the period 1993 to 2003. Seventeen studies were found that investigated the relationship between social support and different outcome measures in HF. Four studies found clear relationships between social support and rehospitalizations and mortality; the relationship between quality of life and depression was less clear. Up to now, limited research has been done on the impact of social support on outcomes in patients with HF. The available studies suggest that social support has an impact on HF outcomes but further research is necessary before firm conclusions about the nature of these relationships can be reached.

Adaptation, Psychological↗