Biomedical subjects

Sandra B Dunbar

Publications and source records attributed to Sandra B Dunbar.

8 recordsLinked to original sources

PubMed2003

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease.

Chronic stable angina pectoris, the chest pain associated with reversible myocardial ischemia has detrimental effects on health-related quality of life, particularly in women. The limited research on gender differences in chronic stable angina suggests that angina may be experienced differently in women and that women report greater functional disability related to angina symptoms. No studies have examined gender differences in chronic stable angina from a multidimensional pain perspective or have included reliable and valid measures of pain that would facilitate comparing chronic angina patients with other chronic pain populations. The purpose of this descriptive study was to examine gender differences in characteristics of chronic stable angina using the short-form McGill pain questionnaire (SF-MPQ) and to explore relationships among these pain characteristics and perceived limitation in performing physical activities in patients with coronary artery disease (CAD) (physical limitation subscale of the Seattle angina questionnaire). One hundred and twenty-eight subjects (30.5% women) with stable CAD and angina pectoris documented by a cardiologist completed study questionnaires in an outpatient cardiology clinic. Results of the study suggest that men and women with chronic stable angina had more similarities than differences in chest pain characteristics. No significant gender differences were demonstrated in total sensory or affective intensity scores, the present pain intensity index, or the number of pain words chosen. However, women did report significantly greater pain intensity on the SF-MPQ visual analogue scale. Women were also significantly more likely to describe their chronic angina as 'hot-burning' and 'tender' and to have greater intensity of pain for these two descriptors. Despite the similarities in pain characteristics, women reported greater physical limitation related to anginal pain. The variables of social status and years diagnosed with CAD significantly interacted with gender in predicting physical limitation suggesting that gender-specific models of physical limitation in angina patients need to be explored. To our knowledge, this is one of the first studies that has assessed chronic anginal pain using a reliable and valid generic pain instrument. More research is needed to better understand the nature of gender differences in functional limitation secondary to anginal pain and the physiologic, cognitive-perceptual and psychosocial mechanisms that lead to angina-related functional disability.

Activities of Daily Living↗

PubMed2003

Identifying possible depression in clinical research: ethical and outcome considerations for the investigator/clinician.

Most nurse researchers are aware of the ethical implications of research including the need to ensure confidentiality for research participants, as well as to provide full disclosure of the risks and benefits of the study. However, another consideration that can impact methodology from the perspective of the protection of human subjects from research risks includes the measurement of certain psychosocial variables such as depression and appropriate disclosure of such information to research participants. This issue has received little attention in the nursing literature. The intent of this article is to provide an overview of (1) the importance of informing participants about possible depression, (2) issues of identifying potential depression in clinical research including those related to depression measures, (3) strategies for the investigator/clinician to ensure protection of research participants and potential impact of those strategies, and (4) considerations in addressing depression in study design and analysis.

Data Interpretation, Statistical↗

PubMed2003

Family partnership intervention: a guide for a family approach to care of patients with heart failure.

While family focused care is recommended in standards of care for heart failure (HF), little data exist to guide the structure, content, and delivery of family care. The purpose of this article is to describe what is known about the impact of HF, and to examine a family based approach to improve self-management and adherence in HF. A scientific and theoretical background was used to formulate a family based approach to HF care, the Family Partnership Intervention (FPI), and to determine the feasibility and acceptability of the intervention to family members and HF patients. The components of the intervention are described as well as examples of how it was used. Lessons learned in implementing the intervention during a pilot study are addressed.

Caregivers↗

PubMed2002

Sleep and heart failure.

Sleep problems and symptoms of sleep disturbance are very prevalent in patients with heart failure (HF). Numerous contributing factors include sleep-related breathing disorders, increasing age, medications, anxiety and depression, and comorbidities. Thus, the cardiovascular nurse has an important role in the recognition and management of sleep-related problems in persons with HF. This article provides an overview of sleep disturbances in patients with HF, suggests evidence-based strategies for managing the sleep problems, and identifies pertinent areas for future nursing inquiry.

Cheyne-Stokes Respiration↗

PubMed2002

A new foundation for methodological triangulation.

PURPOSE: To show how triangulation with qualitative and quantitative methods can help confirm a theory to a greater degree than can either method alone. CONSTRUCT: Coherence view of theory structure and confirmation. Evidence helps confirm a theory if the theory is the most coherent way of accounting for the evidence, and one theory is more coherent than another insofar as it leaves fewer unanswered questions (and fewer unquestioned answers). METHODS: The method of this theoretical essay is analytic. Analysis of the debate over methodological triangulation reveals presuppositions about theory structure and confirmation. Well-known arguments in the philosophy of science are presented to show that the presuppositions are false. The arguments provide evidence for the construction of an alternative, coherence model of theory structure and confirmation. FINDINGS: Three consequences of the analysis are: (a) qualitative and quantitative methods do not produce theories with different structures; (b) qualitative and quantitative methods help to confirm theory in the same ways; and (c) used together, qualitative and quantitative methods can confirm a theory to a greater degree than the use of either method alone. CONCLUSIONS AND IMPLICATIONS: A coherence of model of theory structure and confirmation supports a version of the blending view of methodological triangulation. Triangulation can provide completeness, abductive inspiration, and confirmation. This version of blending provides principles for resolving issues of methodological dominance and order, and it indicates how different methods can disconfirm theory.

Humans↗

PubMedDate not supplied

Patient experiences with atrial fibrillation and treatment with implantable atrial defibrillation therapy.

BACKGROUND: Patient perspectives about their illness experiences, symptoms, and treatment are essential aspects of quality of life and provide direction for patient and provider decision making regarding innovative therapies such as implantable devices for arrhythmia. PURPOSE: The purpose of this qualitative study was to describe: 1) the experience of patients living with symptomatic, drug-refractory atrial fibrillation (AF) and 2) patient experiences and acceptance of treatment with the implantable cardioverter defibrillator (ICD) with atrial therapies (ICD-AT) including ventricular and atrial defibrillation therapy. PARTICIPANTS: Subjects were 3 women and 8 men, 35 to 80 years of age, who received the Medtronic Jewel AF 7250 ICD-AT as therapy for recurrent, drug-refractory AF, had a history of AF for 3 to 20 years and had experienced multiple treatment modalities including frequent external cardioversion in an effort to control their AF. METHODS: A semi-structured interview addressed experiences of symptoms and prior treatment for AF and experiences, concerns, and perceived benefits of the ICD-AT. Interviews were recorded and transcribed verbatim. Narratives were coded and categorized using Atlas Ti(R) software. Qualitative interpretive analysis methods were used to identify key themes. RESULTS: Before ICD-AT, patient themes focused on AF that was: 1) misdiagnosed, minimized, and poorly treated; 2) distressful because of frequent and intense AF symptoms (fatigue, dizziness, shortness of breath, and anxiety) before ICD-AT; 3) limiting of activities of daily living; 4) associated with distress from enduring previous treatment; and 5) associated with the continuous pursuit of successful treatment and maintenance of normalcy. Decision making regarding ICD-AT therapy included weighing symptom or treatment distress versus anticipated risks or benefits, hope for better outcomes, and lack of options. After ICD-AT, themes included positive perceptions of the device because of AF symptom relief, ability to resume normalcy, and medication tolerance; incorporation of shock experiences into life routines; and patient suggestions regarding preparation and social support. IMPLICATIONS: Symptoms of AF have a major negative impact on overall quality of life. Treatment with the ICD-AT confers a sense of security and reduced symptom distress. Greater provider attention to patient preparation and facilitating social support are important for future ICD-AT patient care.

Adult↗

PubMedDate not supplied

The Seattle angina questionnaire: reliability and validity in women with chronic stable angina.

Angina pectoris causes substantial psychological and functional disability and adversely effects health-related quality of life, particularly in women. Studies of cardiac disease-specific quality of life in women with coronary artery disease and angina are limited because little reliability and validity data for these instruments exist for women. Therefore, the purpose of this study was to examine reliability and validity of the Seattle Angina Questionnaire (SAQ), a cardiac disease-related quality-of-life measure, in a sample of women with chronic stable angina. A secondary analysis was performed on SAQ data from 175 women with a confirmed diagnosis of CAD and angina pectoris. The majority of the women were older, white, living with their spouse, had a previous acute myocardial infarction, and had undergone revascularization. The Cronbach alpha was used to assess reliability of the SAQ's five subscales, and factor analysis was used to assess the SAQ's validity. Results suggest that the SAQ is a reliable and valid quality-of-life measure in women with CAD. The physical limitations subscale factored into two separate factors, suggesting that the subscale measures two domains of physical function: self-care and exercise tolerance/mobility. Future research is needed to determine whether examining different combinations of SAQ items might provide a more sensitive assessment of cardiac disease-specific quality of life in women.

Adult↗

PubMedDate not supplied

Personal characteristics that influence exercise behavior of older adults.

Long-term exercise participation among older adults will result in healthier lifestyles and reduced need for health care. A better understanding, therefore, of what influences older individuals to start and maintain exercise plans would be beneficial. The twofold purpose of this study was (1) to create a knowledge base of determinants that influence exercise behavior in older adults and (2) to have health professionals prioritize determinants that affect exercise initiation and adherence in older adults. The expert panel examined nine determinants within the category of personal characteristics: age, gender, ethnicity, occupation, educational level, socioeconomic status, biomedical status, smoking status, and past exercise participation. The experts rated the determinants on importance for influencing exercise behavior of older adults. This expert panel concluded that older adults who are in good health and have a history of exercise activity might be more likely to participate in long-term exercise programs.

Aged↗