Nursing_Research

Running head: Angioplasty for heart attack Research Summary Primary angioplasty for heart attack: Mismatch between expectations and reality' Grand Canyon University NRS 433V Intro to Nursing Research February 18, 2011 Angioplasty for Heart attacks, expectations and reality The expectations and reality can be mismatched depending on the persons experience during a heart attack and the treatment received. The purpose of this paper is to provide a summary on the recent article in the Journal of Advanced Nursing, Primary angioplasty for heart attack: mismatch between expectations and reality (Astin, Closs, McLenachan, Hunter, & Priestley, 2009), in which nursing researchers documented an evaluation patient’s experience with primary angioplasty and assess their perception of their illness during early recovery. Percutaneous coronary intervention (PCI) has transformed the way we treat coronary artery disease. PCI is used to describe balloon angioplasty, which is where a catheter is inserted peripherally and directly into the coronary circulatory under x-ray fluoroscopy to restore coronary blood flow. PCI has taken the place of bypass surgery as treatment for revascularization in patients with coronary artery disease. Primary PCI (P-PCI) is used to treat evolving ST elevation myocardial infarctions. There are several advantages to using P-PCI including mortality is reduced by one-third, reinfarction by half, and stroke by two-thirds. The patient’s hospital stay is shorter by two days compared to other treatment options. There is little known about patients’ experiences of this treatment option. Recent policy’s call for clinical practice and management to be patient centered, to achieve this we need to understand their hospitalization experiences and how features of the experience influence how they make sense of their condition. The purpose of this study was to see how patient’s expectations compared to reality. There is not much research documenting patient’s experiences with percutaneous coronary intervention. The method used was qualitative because they used in-depth interviews and an illness perception questionnaire to collect data. The research was done in a large specialist UK cardiac center that provides twenty-four hour PCI service to a population of about 3.1 million people. The participants of the study were first-time PCI recipients and spoke English fluently. The participants could not have any history of cardiac illness. Research nurses identified and recruited participants based on the criteria set forth for the study. The data was collected in 2006-2007. There was one research not involved in the recruitment of participants and did face -to -face interviews in the participants at home. The demographic of all participants was collected prior to interview. All participants were asked the same questions to insure consistency through out the study. The illness perception questionnaire (IPQ-R) was developed to assess the participant’s perceptions and beliefs about their illness. They used a 5- point Likertype scale to assess the patient’s level of agreement there was 38 statements about their condition on the form. There were 29 participants in the study, ages ranged from thirty-eight to eighty-three. Over half were male with a small percentage that lived alone. (Astin, et al. 2009) The three key themes that characterized the participant’s experience was the speed of events, expectations and reality: mismatch and emotional reactions. Because of the speediness the majority of the participants felt normal right after the procedure; which made them question the seriousness of everything. There are several examples of how their expectations and reality were mismatched. Pain was another indicator of the seriousness of what they went through. The patients used the level of pain from the procedure as an indicator of the severity of their heart attack. Because there is no scar left also influence how the patients interpreted the seriousness of their condition. Most of the patients had an unexpected feeling of energy after the procedure which lead them to feel like they didn’t have a heart attack and that the level of physical activity didn’t match level of energy they felt. These are all examples of the mismatch between reality and expectations. When it comes to the emotional reactions patient’s talked about having a sense of being in a surreal environment. It has been described as a feeling of looking from the outside in. They also experienced shock and disbelief. These affected their ability to recall events and information about the procedure. Fear, was reported by women more than the men and affected activities like sleeping and walking. The last emotion is denial, which happened in the early stages influenced health information seeking behavior. The IPQ-R showed that the participants viewed their illness as acute, with serious consequences. They had a strong belief in their treatment and ability to control their illness. The highest score was in illness coherence, which showed a lack of understanding of their illness. They blamed cigarette smoking (38%), unhealthy diet (31%), and heredity (10%) as the main cause of their illness. The remaining 14% was made up of obesity, stress, previous chest infection, and consumption of alcohol; a small percentage said they were unsure of the cause. (Astin, et al, 2009) The ethical considerations for this study are participants right to privacy, which is protected by anonymity or another confidentiality procedure. All participants were given an information packet about the study prior to participating in the study. Also protecting the participants right to self-determination, this was done by having the participants sign an informed consent. (Polit &Beck, 2010) It also had to be approved by the appropriate research ethics committee. This study brought to light how one can have a mismatch between expectations and reality. This is based on the person’s experience during and after a heart attack. When taking care of patients after a heart attack education is a key to recovery. More so when doing education you need to have discussions that focus on the mismatch between what they expected and reality. This will help to promote a better understanding of what happened and what to expect. It will also bring a greater awareness to the patients about heart disease as a long -term condition that will require self -management. References Astin,F., Closs, S.J., McLenachan, J., Hunter, S., & Priestley, C. (2009). Primary angioplasty for heart attack: mismatch between expectations and reality'. Journal of Advanced Nursingl, 65(1), 72-83. Polit, D. F., & Beck, C. T. (2010). Essentials of Nursing Research Appraising Evidence for Nursing Practice (7th ed.). Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins.