Pain and Anxiety in Rural Acute Coronary Syndrome Patients Awaiting Diagnostic Cardiac Catheterization
| Autor: | Sheila O'Keefe-McCarthy, Sean P. Clarke, Michael McGillion, Judith McFetridge-Durdle |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
Canada Cardiac Catheterization medicine.medical_specialty Acute coronary syndrome Attitude of Health Personnel Vasodilator Agents medicine.medical_treatment Analgesic Pain Context (language use) Anxiety Nursing Staff Hospital Nitroglycerin Internal medicine Humans Medicine Prospective Studies Myocardial infarction Acute Coronary Syndrome Prospective cohort study Aged Pain Measurement Cardiac catheterization Advanced and Specialized Nursing Analgesics business.industry Unstable angina Middle Aged medicine.disease Anesthesia Female Clinical Competence Rural Health Services medicine.symptom Emergency Service Hospital Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Nursing. 30:546-557 |
| ISSN: | 0889-4655 |
| DOI: | 10.1097/jcn.0000000000000203 |
| Popis: | Context In rural areas of Canada, people with acute coronary syndromes (ACS) can wait up to 32 hours for transfer for diagnostic cardiac catheterization (CATH). While awaiting CATH, it is critical that pain and anxiety management be optimal to preserve myocardial muscle and minimize the risk of further deterioration. Objectives The aim of this study was to examine the relationship between clinical management, cardiac pain intensity, and state anxiety for rural ACS patients awaiting diagnostic CATH. Methods In a prospective, descriptive-correlational repeated-measures design involving 121 ACS rural patients, we examined the associations of analgesic and nitroglycerin administration with cardiac pain intensity (numeric rating scale) and state anxiety (Spielberger State Anxiety Inventory) and also nurses' pain knowledge and attitudes (Toronto Pain Management Inventory-ACS Version and Knowledge and Attitudes Survey Regarding Pain) using linear mixed models. Results The mean age of patients was 67.6 ± 13, 50% were men, and 60% had unstable angina and the remainder had non-ST-elevated myocardial infarction. During follow-up, cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. State anxiety ranged from 44.0 ± 7.2 to 46.2 ± 6.6. Cumulative analgesic dose was associated with a reduction in cardiac pain by 1.0 points (numeric rating scale, 0-10) (t108 = -2.5; SE, -0.25; confidence interval, -0.45 to -0.06; P = .013). Analgesic administration was not associated with state anxiety. Over the course of follow-up, ACS patients reported consistently high anxiety scores. Conclusions Whereas cardiac pain declines in most patients in the early hours after admission, many patients experience a persistent anxious state up to 8 hours later, which suggest that development and testing of protocols for anxiety reduction may be needed. More urgently, the development and examination of a treatment intervention, early on in the ACS trajectory, are warranted that targets pain and anxiety for those for whom immediate angioplasty is not possible and who continue to experience cardiac pain and persistent high levels of anxiety. Moreover, a larger prognostic study is required to determine whether high levels of anxiety in rural ACS patients are predictive of major adverse cardiac events. |
| Databáze: | OpenAIRE |
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