A Qualitative Study

[Posted 7/Jun/2022]

AUDIENCE: Nursing

KEY FINDINGS: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women.

BACKGROUND: Aimed to identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient.

DETAILS: Conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. During the study carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. Identified an overarching theme, ‘factors that influenced participants’ decision to be vaccinated or not’, which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants’ decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Maranon, A. A., Fernandez-Cano, M. I., Montero-Pons, L., et al. (2022). Understanding Factors That Influence The Decision To Be Vaccinated Against Influenza And Pertussis In Pregnancy: A Qualitative Study. J Clin Nurs. Published: May 6, 2022. DOI: 10.1111/jocn.16006.

The Association Of Education Level With Autonomy Support, Self-Efficacy And Health Behaviour In Patients With Cardiovascular Risk Factors

[Posted 14/Jun/2022]

AUDIENCE: Nursing

KEY FINDINGS: The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated.

BACKGROUND: The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors. Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association.

DETAILS: A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines. The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Yenom, H. and Lee, J. (2022). The Association Of Education Level With Autonomy Support, Self-Efficacy and Health Behaviour In Patients With Cardiovascular Risk Factors. J Clin Nurs. 2022; 31(11-12): 1547-1556. Published: June, 2022. DOI: 10.1111/jocn.16008.

Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients

[Posted 2/Jun/2022]

AUDIENCE: Cardiology, Emergency Medicine

KEY FINDINGS: B-lines identify the pulmonary congestion phenotype at rest, and more frequently, during ESE in ischemic and heart failure patients. Stress B-lines may help to refine risk stratification in these patients.

BACKGROUND: Lung ultrasound detects pulmonary congestion as B-lines at rest, and more frequently, during exercise stress echocardiography (ESE).

DETAILS: Performed ESE plus lung ultrasound (4-site simplified scan) in 4392 subjects referred for semi-supine bike ESE in 24 certified centers in 9 countries. B-line score ranged from 0 (normal) to 40 (severely abnormal). Five different populations were evaluated: control subjects (n=103); chronic coronary syndromes (n=3701); heart failure with reduced ejection fraction (n=395); heart failure with preserved ejection fraction (n=70); ischemic mitral regurgitation >= moderate at rest (n=123). In a subset of 2478 patients, follow-up information was available. During ESE, B-lines increased in all study groups except controls. Age, hypertension, abnormal ejection fraction, peak wall motion score index, and abnormal heart rate reserve were associated with B-lines in multivariable regression analysis. Stress B lines (hazard ratio, 2.179 [95% CI, 1.015-4.680]; P=0.046) and ejection fraction <50% (hazard ratio, 2.942 [95% CI, 1.268-6.822]; P=0.012) were independent predictors of all-cause death (n=29 after a median follow-up of 29 months).

Copyright © American Heart Association, Inc. All rights reserved.

Source: Merli, E., Ciampi, Q., Scali, M. C., et al. (2022). Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients. Circulation: Cardiovascular Imaging.. 2022; 15(5): e013558. Published: May 17, 2022. DOI: 10.1161/CIRCIMAGING.121.013558.

[Posted 17/May/2022]

AUDIENCE: Nursing

KEY FINDINGS: Perceived pressure to breastfeed may be an important psychosocial factor to consider when aiming to improve women's breastfeeding experiences. Reducing perceived pressure may be beneficial for promoting breastfeeding outcomes.

BACKGROUND: Purpose of the study is to develop a measure to quantitatively assess perceived pressure to breastfeed and examine associations between perceived pressure, emotional distress, and the breastfeeding experience and self-efficacy among women with 2- to 6-month-old infants.

DETAILS: A cross-sectional study using an online survey to assess perceived pressure to breastfeed, emotional distress, and the breastfeeding experience and self-efficacy was conducted. Participants were recruited through ResearchMatch, a national online service that matches potential participants to research studies, and online community forums (e.g., Facebook). Women (n = 187) reported themselves and society as the greatest sources of pressure. Pressure to breastfeed was negatively associated with the breastfeeding experience (r = -.34, p < .01) and self-efficacy (r = -.39, p < .01), but not emotional distress. Pressure to breastfeed remained a significant explanatory factor, even when considering demographic covariates, with the final models accounting for 16% and 20% of the variance in the breastfeeding experience and self-efficacy, respectively.

Copyright © Wolters Kluwer Health, Inc. All rights reserved.

Source: Korth, C. X., Keim, S. A., Crerand, C. E. et al. (2022). New Mothers' Perceptions of Pressure to Breastfeed. MCN, The American Journal of Maternal/Child Nursing. 2022: 47(3): 160-167. Published: May/June, 2022. DOI: 6307642.

[Posted 10/May/2022]

AUDIENCE: Nursing

KEY FINDINGS: Among patients younger than 21 years of age who have provoked venous thromboembolism, anticoagulant therapy for six weeks compared with three months met noninferiority criteria based on the trade-off between recurrent venous thromboembolism risk and bleeding risk.

BACKGROUND: Clinical practice guidelines suggest a six-week course of anticoagulant therapy for pediatric venous thromboembolism instead of the three-month course recommended for adults, but there is a need for definitive evidence to support this recommendation. A randomized clinical trial was designed to test the hypothesis that a six-week course of anticoagulant therapy in patients younger than 21 years of age who had a provoked venous thromboembolism is noninferior to a three-month course of therapy.

DETAILS: The multinational trial enrolled patients younger than age 21 who had radiologically confirmed acute provoked venous thromboembolism. The main exclusion criteria were prior venous thromboembolism and clinically significant anticoagulant deficiencies. At six-week follow-up, patients with venous flow evident in the involved vessel segments and without persistent antiphospholipid antibodies were randomized to discontinuation of anticoagulants or continuation for a total of three months after diagnosis. Among the 297 patients in the per-protocol population (median age, 8.3 years), the primary efficacy outcome (adjudicated symptomatic recurrent venous thromboembolism within one year) occurred in one patient (0.65%) in the six-week treatment group and in two patients (1.40%) in the three-month group. The primary safety outcome (adjudicated clinically relevant bleeding events within one year) occurred in one patient (0.65%) in the six-week group and one patient (0.70%) in the three-month group. Based on the absolute risk differences between groups, noninferiority was demonstrated. Adverse events occurred in 26% of patients in the six-week treatment group and in 32% of those in the three-month group. The study population was characterized by a small proportion of people who had cancer or pulmonary embolism, so the results may not apply to these patient populations. Also, although most patients received low-molecular-weight heparin, direct oral anticoagulants are increasingly used for pediatric venous thromboembolism. The study points out that the low rates of recurrent venous thromboembolism they observed support shortening the duration of anticoagulant therapy for provoked venous thromboembolism in patients younger than age 21.

Copyright © Wolters Kluwer Health, Inc. All rights reserved.

Source: Rosenberg, K. (2022). Duration of Anticoagulant Therapy for Pediatric Venous Thromboembolism. AJN, American Journal of Nursing. 2022; 122(5): 49-49. Published: May, 2022. DOI: 6307900.

[Posted 3/May/2022]

AUDIENCE: Nursing

KEY FINDINGS: This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors.

BACKGROUND: This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD). Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors.

DETAILS: A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used. The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (β = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033).

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Aldan, G., Helvaci, A., Ozdemir, L., et al. (2022). Multidimensional Factors Affecting Medication Adherence Among Patients With Chronic Obstructive Pulmonary Disease. J Clin Nurs. 2022; 31(9-10): 1202-1215. Published: May, 2022. DOI: 10.1111/jocn.15976.