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Fatigue in Chronic Heart Failure – Does Gender Make a Difference?
Abstract
The primary aim of this study was to describe and compare the experience of fatigue in a group of elderly women and men with severe chronic heart failure. A sample of 158 patients (66 women and 92 men, with a mean age of 83 and 78 years, respectively) was invited to participate in a study on admission to a hospital outpatient heart failure clinic. A registered nurse interviewed patients using a modified version of the Fatigue Interview Schedule (FIS). Descriptions of the experiences of fatigue generally showed good agreement between men and women; however, some gender differences were found. Women expressed a clear role to fulfil because they were engaged in maintenance activities of their household. Although we still have only limited knowledge about the impact of gender on the experiences and coping strategies in disease and aging, it is important for care providers to consider gender differences when planning caring interventions.
... The response to fatigue differed between men and women. Whereas men became restless, angry and depressed, women felt guilt for not having the strength to manage expected duties in the domestic domain (Ekman & Ehrenberg, 2002c). Lack of energy, leading to limited working capacity and social activities, resulted in resignation in men, whereas feelings of anxiety and worthlessness were reported in women (Mårtensson et al., 1997;Mårtensson et al., 1998). ...
... With the exception of the DUFS, none of these instruments was recognized to be used in measuring fatigue in patients with CHF. A modifi ed version of Fatigue Interview Schedule (Schaefer & Shober,1993), containing ten characteristics of fatigue from the North American Nursing Diagnosis Association (NANDA), has been used in several studies, supplemented with a 10-point visual analog scale (VAS) to measure the severity of fatigue (Schaefer & Shober, 1993;Ekman & Ehrenberg, 2002a;Ekman & Ehrenberg, 2002c). ...
... There are few qualitative studies describing fatigue and its consequences in the daily life of patients with CHF (Schaefer, 1990;Schaefer & Shober, 1993;Ekman & Ehrenberg, 2002c). The few numbers make it diffi cult to know to what extent the fi ndings can comprise all dimensions of fatigue in patients with CHF. ...
... De Geest et al., 2003 Older patients admitted to geriatric wards are significantly less knowledgeable about their condition and have more functional disability compared with older patients admitted to cardiology wards. Ekman & Ehrenberg, 2002 More women express limitations in performing socially defined roles within the contexts of home and family than men. Both sexes rate their global well-being and sense of coherence as equally high compared with controls, regardless of their level of disability. ...
... Being female was found to be an important factor related to fatigue in this age group Hagglund, Boman, Stenlund, Lundman, & Brulin, 2008). In older patients with fatigue, Ekman and Ehrenberg (2002) found that more women than men expressed limitations in performing socially defined roles within the contexts of home and family, leading to dependency in carrying out activities important to independent living. Riegel and colleagues (2010) showed that, compared with younger age groups, older patients had more difficulty in detecting and interpreting symptoms of dyspnea, and they were twice as likely to report a different level of shortness of breath than that noted by the healthcare professional. ...
... Symptom intensity was found to be strongly associated with general perceived health and satisfaction with life in older patients with HF (Stephen, 2008). In contrast, Ekman and Ehrenberg (2002) found that older patients rated their global well-being and sense of coherence as equally high compared with controls, regardless of their level of disability. Brodie and colleagues (2008) showed that motivational interviewing, that is, a personcentered approach for eliciting behavior change by facilitating essential motivation within the person (Miller & Baca, 1983;Rogers, 1959), increased selected aspects of HRQoL pertaining to physical functioning, social functioning, and perceived health status. ...
Purpose:
Several literature reviews have been published summarizing objective knowledge about older patients with heart failure (HF). Although of vital importance to the treatment and diagnosis of HF, these reviews fail to explicate and summarize older patients' subjective and lived experience of the condition, which restrains us from providing a complete picture of the illness trajectory. The purpose of this integrative review was to explore and summarize the current literature examining self-reported symptoms, illness experience, and self-care management in older patients with HF.
Design and methods:
Combinations of search terms related to illness experience, symptoms, and self-care management in HF were used to search three electronic databases. Inclusion criteria were empirical studies, published in English between 2001 and 2011, in populations of older patients (≥ 75 years) investigated in relation to a self-reported subjective experience of HF. The search initially yielded 279 results; 23 qualitative and qualitative studies met the inclusion criteria.
Findings and conclusions:
Older patients with HF have poor health-related quality of life compared with controls and experience severe and frequent symptoms of fatigue and dyspnea that limit several aspects of their life, making them dependent on others for survival. The variety of ways in which older patients cope with these consequences is determined by how they understand their illness, with the majority showing poor health literacy in relation to HF. Neither self-management nor symptom monitoring is ideal in older patients with HF, although person-centered interventions such as motivational interviewing show promising results in improving self-efficacy in this age group. Studies examining older patients' personal experiences of HF and the relationships between symptoms, situational antecedents, and social ties will fill a gap in the literature.
Clinical relevance:
Older patients have special care needs caused by their HF and other chronic conditions, coupled with those of great age. When symptoms of HF exacerbate, older patients are predominantly admitted to geriatric care rather than cardiac care units, implying restricted access to specialized treatment. Little is still known about the basis for self-care abilities from both healthcare provider and patient perspectives.
... Fatigue is a subjective complaint and is usually stated as a sense of constant hatred or exhaustion (1)(2)(3). The term fatigue may be experienced as a general phenomenon by both healthy and sick individuals (4), yet the term fatigue should be distinguished with a sense of tiredness since there is no balance between activity and rest in fatigue (in the other words, fatigue is not completely removed through common ways of restoring energy) (4)(5)(6). Although its exact mechanism is not clear, researchers believe that fatigue includes multiple dimensions (7,8); physiologic and psychological dimensions could be pointed out as two examples (9). ...
... In the study of Zambroski et al. (37), 85% of the patients felt energy loss, which can be equal to fatigue. Fatigue can be considered as a debilitating factor in heart failure patients and it is commonly involved; it can lead to loss of social-physical ability (5) and it also influences self-care behavior to a high extent (25). In terms of rehabilitation process, fatigue is an activity restrictive factor, therefore, daily routines will be affected and patients including youth and adults are not satisfied with their physical activity (9). ...
... Viktigt är också att utgå från patientens egen beskrivning av fatigue/trötthet, eftersom studier har visat på bristande överensstämmelse mellan hur patienter och vårdare uppfattar patientens trötthet (Ekman & Ehrenberg, 2002a, Tiesinga m.fl., 1999. Ekman och Ehrenberg (2002a, 2002b intervjuade äldre patienter med hjärtsvikt utifrån en modifierad version av frågeformuläret The Fatigue Interview Schedule (FIS) med både öppna frågor och slutna frågor som mäter graden av fatigue. Patienternas egna beskrivningar om vad fatigue innebar för dem uttrycktes vanligast som slöhet, håglöshet och behov av vila. ...
... Patienternas egna beskrivningar om vad fatigue innebar för dem uttrycktes vanligast som slöhet, håglöshet och behov av vila. Män och kvinnor beskrev fatigue tämligen lika, men kvinnor graderade oftare fatigue som svår medan männen oftare som mild (Ekman & Ehrenberg, 2002b). När patienterna ombads ta ställning till frågeformulärets beskrivningar av fatigue angavs oftast beskrivningar som var av fysisk karaktär, som nedsatt förmåga till aktivitet och behov av mer energi, samt nedsatt libido (Ekman & Ehrenberg, 2002a). ...
... Utöver andfåddhet och trötthet förekommer en del andra besvär, såsom bröstsmärtor och hosta, och bieffekter av medicinering såsom rethosta, muntorrhet, nedsatt aptit och förändringar i smakupplevelser [3-6]. Trötthet vid kronisk hjärtsvikt har beskrivits som en känsla av irritation, brist på energi, slöhet och koncentrationssvårigheter och upplevs som ett av de svåraste symtomen, framför allt i livets slutskede [4,5,[7][8][9]. Tröttheten är svårvärderad och har bl a visat sig vara relaterad till anemi, men kan också ha sin förklaring i sömnsvårigheter på grund av nattliga andningsbesvär eller täta toalettbesök [10, 11]. Tröttheten innebär ibland nedstämdhet och oro [7] och kopplingen till depression har rapporterats vara hög vid hjärtsvikt, och den tycks vara relaterad till försämrad fysisk funktion [12][13][14]. ...
... Tröttheten är svårvärderad och har bl a visat sig vara relaterad till anemi, men kan också ha sin förklaring i sömnsvårigheter på grund av nattliga andningsbesvär eller täta toalettbesök [10, 11]. Tröttheten innebär ibland nedstämdhet och oro [7] och kopplingen till depression har rapporterats vara hög vid hjärtsvikt, och den tycks vara relaterad till försämrad fysisk funktion [12][13][14]. Dyspné är det vanligaste symtomet, men de bakomliggande mekanismerna är ofullständigt kända [15][16]. ...
... However, it has not been established whether physical fatigue creates a barrier to physical activity, or whether alleviating fatigue through physical activity acts as an incentive to exercise adherence (Dishman, 1991). Women generally report more fatigue than men (Ekman & Ehrenberg, 2002;Nelson & Burke, 2002;Tang, Yu, & Yeh, 2010;Verdonk, Hooftman, van Veldhoven, Boelens, & Koppes, 2010), and it could be that such greater fatigue might differentially influence exercise adherence in women versus men. However, there is a relative paucity of studies examining physical activity interventions for cardiovascular risk reduction in women (Krummel et al., 2001). ...
... Studies do indicate, however, potentially relevant gender differences in fatigue. Studies of healthy individuals as well as individuals with congestive heart failure have shown that women report more fatigue than men (Ekman & Ehrenberg, 2002;Nelson & Burke, 2002;Tang et al., 2010;Verdonk, Hooftman, van Veldhoven, Boelens, & Koppes, 2010). To our knowledge this is the first study whereby women reporting high physical fatigue prior to an exercise intervention spent more time exercising during the intervention than men. ...
To investigate predictors of exercise adherence to a 12-week exercise intervention for sedentary women and men with elevated blood pressure (BP).
Fifty-one otherwise healthy and unmedicated adults (27 women and 24 men) with elevated BP (≥120/80 mmHg but <179/109 mmHg) participated in a 12-week exercise intervention involving cardiovascular and strength training. Participants kept weekly exercise logs detailing minutes spent exercising each week. The following were assessed before and after the intervention: cardiorespiratory fitness (in mL/kg/min), body mass index (BMI), level of habitual physical activity, physical fatigue, self-efficacy for exercise habits, and social support.
Regression analysis revealed that mean exercise minutes/week were predicted by higher age (p < .05), higher cardiorespiratory fitness (p < .05), and a gender by physical fatigue interaction (p < .01; R2 = 0.34, F = 3.248, p < .01). Women who reported higher physical fatigue prior to the intervention spent more time exercising during the 12-week intervention than those with lower levels of physical fatigue. This relationship persisted after controlling for age, BMI, cardiorespiratory fitness, level of habitual physical activity prior to the intervention, self-efficacy for exercise habits, and social support (p < .01). The gender by physical fatigue interaction explained 13.9% of the variance in mean minutes exercised/week above and beyond the effects of covariates.
Both gender and fatigue should be considered when developing exercise interventions, such that more initial physical fatigue in women is associated with a tendency to devote greater amounts of time to exercising.
... It was determined that the mean total and subscale scores of fatigue of men were lower compared to those of women and there was a statistically significant difference between them. Ekman and Ehrenberg reported that women stated that they were mostly involved in physical activity due to their active role in the care of the household in their studies on fatigue in women and men with chronic heart failure (25). In another study, it was stated that, unlike men, women have menstrual cycles and also have more than one responsibility, such as home and work life, making women feel more tired (26). ...
Purpose: This study aimed to determine the kinesiophobia and fatigue levels of patients who underwent open heart surgery. Methods: The study was conducted with 176 patients who underwent traditional open heart surgery in the cardiovascular surgery clinic of a hospital located in Trabzon, Turkey. The data were gathered using a personal information form, the Tampa Kinesiophobia Scale, and the Piper Fatigue Scale. Result: It was determined that patients had high levels of kinesiophobia and moderate levels of fatigue. A statistically meaningful difference was found between mean total Tampa Kinesiophobia Scale scores and age and employment status and between the mean total Piper Fatigue Scale scores and subscale scores of patients according to gender, body mass index, and employment status. There was a statistically significant positive and moderate correlation between patients’ Tampa Kinesiophobia Scale scores and the behavioral, affectivity, and sensory subscales and total score of the Piper Fatigue Scale while there was significant, positive, and weak correlation with the cognitive subscale of the Piper Fatigue Scale. Conclusion: Considering the kinesiophobia and fatigue levels of patients undergoing open heart surgery in the nursing care process before and after surgery may be useful for the performance of physical activities that will contribute to recovery.
... Finally, we did not use gender stratification when recruiting. Based on previous studies that have compared fatigue between elderly women and men, there is no significant difference in gender (Hicks and McCartney, 1996;Ekman and Ehrenberg, 2002). Thus, we consider that gender differences are not a significant interfering factor in our study. ...
The strength of lower extremity is important for individuals to maintain balance and ambulation functions. The previous studies showed that individuals with Parkinson's disease suffered from fatigue and strength loss of central origin. The purpose of this study was to investigate the effect of lower extremities' cycling training on different components of force and fatigue in individuals with Parkinson's disease. Twenty-four individuals (13 males, 11 females, mean age: 60.58 ± 8.21 years) diagnosed with idiopathic Parkinson's disease were randomized into training and control groups. The maximum voluntary contraction (MVC) force, voluntary activation level (VA), and twitch force of knee extensors were measured using a custom-made system with surface electrical stimulation. The general, central, and peripheral fatigue indexes (GFI, CFI, and PFI) were calculated after a fatiguing cycling protocol. Subjects received 8 weeks of low resistance cycling training (training group) or self-stretching (control group) programs. Results showed that MVC, VA, and twitch force improved (p < 0.05) only in the training group. Compared to the baseline, central fatigue significantly improved in the training group, whereas peripheral fatigue showed no significant difference in two groups. The cycling training was beneficial for individuals with Parkinson's disease not only in muscle strengthening but also in central fatigue alleviation. Further in-depth investigation is required to confirm the effect of training and its mechanism on central fatigue.
... The questionnaire used in the study was divided into three parts; Part 1 comprised questions on respondents' demographic background, Part 2 comprised questions on factors of workstation ergonomics and Part 3 consisted of questions on physiological (body health level complaints). The questions for Part 2 was adapted from four previous studies (Brief & Aldag, 1976;Tate et al., 1997;Hedge & Erickson, 1997;Makhbul & Hasun, 2007) while the questions for Part 3 was adapted from three previous studies (Karasek, 1979;Ekman & Ehrenberg, 2002;Makhbul & Hasun, 2007). All the questions for Part 2 and 3 are in a 5-point Likert-scale format that ranges from 1 (strongly disagree) to 5 (strongly agree). ...
... Fatigue is also seen in more than half of the patients with HF, although the exact mechanism of these symptoms still remains unidentified. 45,46 This study discovered that single supplementation or their combination has an effect on FSI score. There are inadequate data for the effects of BCAAs and melatonin on fatigue. ...
Background: Cardiac cachexia (CC) adversely affects the lifestyle of heart failure (HF) patients. The current study examined the impact of melatonin cosupplementation and branched-chain amino acids (BCAAs) on quality of life (QoL), fatigue, and nutritional status in cachectic HF patients. Methods: In this trial, 84 CC patients were randomized to melatonin, BCAAs, or coadministration (both) as intervention groups and a control group over 8 weeks. At baseline and postintervention, QoL, fatigue, and nutritional status were assessed. Results: After intervention, improvement in the overall and physical dimensions of QoL and appetite score were found to be statistically significant in the BCAAs (P < .001) and the melatonin+BCAAs (P < .001) groups compared with the placebo group. The emotional dimension score was significantly lower in the BCAAs group compared with the placebo group (P = .001). There was a statistically significant improvement in fatigue severity in all 3 intervention groups compared with the placebo group. The nutrition risk index (NRI) score increased significantly only in the melatonin group (P = .015), and there was no significant difference between the other groups (P = .804). Conclusions: Cosupplementation with BCAAs and melatonin improved QoL, fatigue status, and appetite in cachectic HF patients but did not affect NRI.
... This finding is similar to findings in prior studies showing insufficient knowledge regarding HF symptoms (Patel et al., 2007;Reeder et al., 2015). In one HF study (Ekman & Ehrenberg, 2002), patients reported illness, age, other symptoms, loneliness, and physical condition as the causes of fatigue. The most common causes of fatigue reported in the study were illness (47%) and age (9%), which are nonmodifiable factors. ...
Patients’ perceptions of the causes and consequences of heart failure (HF) symptoms may impact effective self-management. The purpose of this study was to describe and explore patients’ perceptions of HF symptom status and the causes and consequences on their daily lives in patients with HF. Descriptive and qualitative data were obtained from 20 patients using a semistructured interview guide. Data were analyzed using content analysis and descriptive statistics. Participants reported 15 symptoms (median = 4). Five themes were (a) multiple causes and multiple symptoms; (b) knowing some causes, but still unclear; (c) not being able to live life as previously did; (d) facing emotional distress due to HF symptoms; and (e) development of new priorities and lifestyles. The findings demonstrate that all participants perceived considerable difficulties living with HF symptoms. More comprehensive interventions need to be delivered to patients to manage multiple causes and symptoms effectively.
... Gender differences are also not consistently controlled for, which may contribute to varying degrees of fatigue in OSA (Chotinaiwattarakul, O'brien, Fan, & Chervin, 2009;Lee et al., 2014;Quintana-Gallego et al., 2004) and HF patients (Ekman & Ehrenberg, 2002). ...
Patients with both heart failure and obstructive sleep apnea often have poor, repeatedly disrupted sleep, and yet they frequently do not complain of excessive daytime sleepiness. Understanding this lack of perceived sleepiness is crucial for the case identification and treatment of obstructive sleep apnea in the heart failure population at high risk of this disease, especially given the association between untreated obstructive sleep apnea and mortality among patients with heart failure. In this review, we present epidemiologic evidence concerning the lack of sleepiness symptoms in heart failure and obstructive sleep apnea, explore possible mechanistic explanations for this relationship, assess the benefits of treatment in this population, discuss implications for clinical practice and explore directions for future research.
... 31 However, previous research has shown that women tend to have more symptoms related to HF, and they experience higher distress levels of fatigue, anxiety, and feeling depressed, compared with men. [32][33][34][35][36] The strength of this study was the use of growth modeling, as it has advantages over the more traditional data analytic approach with repeated-measures ANOVA; for example, missing data values do not cause a given subject to be dropped. 20,22,37 Moreover, the linear mixed analysis has sufficient power to detect group differences in a moderate or small sample size. ...
Background
Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients’ characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression).
Patients and methods
In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after discharge. Thirst intensity (visual analog scale, 100 mm) and distress (Thirst Distress Scale-HF, score 9–45) were used. Trajectories were examined using growth modeling.
Results
Trajectory of the thirst intensity was significantly different, for patients with low and high thirst intensity levels (median cut-off 39 mm), from admission to 4 weeks follow up (thirst increased and decreased, respectively). Patients with high level of thirst distress (median score >22) at admission, having fluid restriction and women continued to have higher thirst distress over time. Patients feeling depressed had higher thirst intensity over time. There were no differences in the trajectories of thirst intensity and distress by age, BMI, plasma urea, and anxiety.
Conclusion
Intensity and distress of thirst, having fluid restriction, and feeling depressed at the admission were critical in predicting the trajectory of thirst intensity and distress after discharge to home in patients with HF. Effective intervention relieving thirst should be provided before their discharge to home.
... Furthermore, women may feel as if they are a burden to families or friends or even worthless (Mårtensson et al., 1998). More women than men express feelings of guilt and loneliness (Ekman & Ehrenberg, 2002), and younger women experience more mood disturbance, especially anxiety and depression than older women, whose expectations may be more consistent with their condition (Strö mberg & Mårtensson, 2003). Younger women are also not satisfied with their general or social life (Riedinger, Dracup & Brecht, 2000). ...
... Covariates included were demographic factors (eg, age, sex, race or ethnicity, and body mass index), [16][17][18][19] vital signs (eg, blood pressure and heart rate), 17 comorbid conditions (eg, diabetes mellitus, coronary artery diseases, pulmonary disease, renal disease, and cerebrovascular disease), 16,18 results of laboratory tests (eg, serum levels of creatinine, sodium, hemoglobin, and troponin I), 9,18 clinical characteristics (eg, left ventricular ejection fraction and New York Heart Association functional class), 16,18,19 and medications. 16 The results of several studies on heart failure [19][20][21] have suggested that fatigue, depression, hospitalization rates, and the factors associated with these 2 symptoms and hospitalization rates differ between men and women. Therefore, we examined the effects of fatigue and depression on hospitalization, including synergistic effects, and compared the effects of fatigue and depression on hospitalization between men and women with heart failure. ...
Background In patients with heart failure, worsening of signs and symptoms and depression can affect hospitalization and also each other, resulting in synergistic effects on hospitalizations. A patient’s sex may play a role in these effects.
Objectives To determine the effects of fatigue and depression on all-cause hospitalization rates in the total sample and in subgroups of men and women.
Methods A secondary analysis was done of data collected January 1, 2010, through December 31, 2012 (N = 582; mean age, 63.2 years [SD, 14.4]). Data were collected on fatigue, depression, sample characteristics, vital signs, results of laboratory tests, medications, and frequency of hospitalization. Patients were categorized into 4 groups on the basis of the International Classification of Diseases, Ninth Revision: no fatigue or depression, fatigue only, depression only, and both fatigue and depression. General linear regression was used to analyze the data.
Results In both the total sample and the subgroups, the number of hospitalizations in patients with both fatigue and depression was greater than the number in patients without either symptom. Among women, the number of hospitalizations in the fatigue-only group and in the depression-only group was greater than that in the group with neither symptom. In men, the number of hospitalizations in the fatigue-only group was greater than that in the group without either symptom.
Conclusion Fatigue and depression do not have synergistic effects on hospitalization, but men and women differ in the effects of these symptoms on hospitalization.
... In Part II, the questionnaire lists the physiological (somatic complaints), psychological (fatigue and job dissatisfaction), and behavioral (intention to quit) elements. Modifications on the items are based on Karasek (1979), and Ekman & Ehrenberg (2002). Part III contains items to test the moderating variables i.e. ...
Literatures show that work stress has been a major workplace problem now as compared to the past and it has become among the major causes that contribute to workplace accidents. The occurrence of work stress is quite rampant in the manufacturing organizations which involved blue collar workers. The literatures reveal that poor ergonomics workstation environment is among the major contributor to the work stress problems. Thus, this study aims to examine the relationships between ergonomics workstation factors and the work stress outcomes. Five hundred samples of production operators were derived from eleven manufacturing electronics organizations which were registered with Malaysian International Chamber of Commerce and Industry (MICCI) by using proportionate stratified random sampling. Questionnaires were used for the data collections process. The major finding shows that ergonomically designed workstation is an important strategy in minimizing the work stress outcomes in organizations. Through the multiple regression analysis, each ergonomics workstation factor and component collectively have significant relationship with the work stress outcomes. These findings have been supported by the Pearson correlation analysis which shows that all ergonomics workstation factors have high significant correlation with the work stress outcomes. The multiple regression analysis shows health, work area design, shiftwork, humidity system and working hours factors have significant relationship with work stress outcomes. Furthermore, ergonomics workstation components proved that the human and environment factors have significant relationship with the work stress outcomes. The person-environment fit (P-E fit) and the effectiveness of training program can minimize the work stress outcomes which are caused by poor ergonomics of workstation factors.
... In Part II, the questionnaire lists the physiological (somatic complaints), psychological (fatigue and job dissatisfaction), and behavioral (intention to quit) elements. Modifications on the items are based on work done by Camman et al. (1979), Karasek (1979), Ekman and Ehrenberg (2002) and Mearns et al. (2003). Table 3 displays the items in the questionnaire. ...
The occurrence of work stress is quite rampant in manufacturing organizations which involved blue collar workers. The literature revealed that poor ergonomics workstation environment is among the major contributor to the work stress problems. Thus, this study aims to examine the relationship between ergonomics workstation factors and the work stress outcomes. Five hundred samples of production operators were derived from eleven manufacturing electronics organizations which were registered with Malaysian International Chamber of Commerce and Industry (MICCI) by using proportionate stratified random sampling. Questionnaires were used for the data collections process. The major finding shows that ergonomically designed workstation is an important strategy in minimizing the work stress outcomes in organizations. Through the multiple regression analysis, each ergonomics workstation factor and component collectively have significant relationship with the work stress outcomes. These findings have been supported by the Pearson correlation analysis which show that all ergonomics workstation factors have high significant correlation with the work stress outcomes. The multiple regression analysis shows health, work area design, shiftwork, humidity system and working hours factors have significant relationship with work stress outcomes. Overall, the findings of this research are important to organizations which are in need of healthy and competent human resources in line with the aspiration of a dynamic human capital development.
... These items were adapted from House and Rizzo (1972), Brief and Aldag (1976), Lemasters and Atterbury (1996), Hedge and Erickson (1997), Tate, Whatley and Clugston (1997), Miles (2000), Hilderbrant et al. (2001), Nag and Nag (2004) and Tarcan et al. (2004). Section 2 includes physiological, psychological and behavioral items, which are modified from the works of Karasek (1979), Ekman and Ehrenberg (2002) and Mearns et al. (2003). Table 1 depicts the comprehensive analysis of the respondents' background. ...
The present study explores ergonomic workstation factors to explain work stress outcomes. Proportionate stratified random sampling method is utilized to collect data from 500 production operators. The production operators are employees of 11 manufacturing electronics organizations that joined Malaysian International Chamber of Commerce and Industry (MICCI). The data samples are based upon self-administered questionnaires. Following data analysis, ergonomically designed workstations are proven to be a significant strategy to help organizations minimize work stress outcomes. Additionally, the multiple regression analysis shows that ergonomic workstation element collectively has significant relationship with work stress outcomes.
... Bahagian satu daiam soalselidik inimengandungi 58 soalan yangberkaitan dengan faktor stesen kerja ergonomik dalam sesebuah organisasi' Faktor tersebut ialah kedudukan tubuh badan, kerusi/tempat duduk sewaktu bekerja, rekabentuk ruang kerja, sistem pengudaraan, sistem akustik, pencahayaan' kerja syif dan tempoh masa bekerja. Pengubahsuaian item adalah berdasarkan kajian House dan Rizzo (1g72),Briefdan Atoug (1976), Lemasters and Afferbury (1996) 'Tate et al. (1997) Bahagian dua soal selidik ini mengandungi 2l soalan yang terdiri daripada komponen fisiologi (aduan berkenaan tubuh badan), psikologi (kelesuan/ keletihan dan keidakpuasan kerja) dan gelagat (niat untuk berhenti)' pengubahsuaian item adalah berdasarkan kajian yang dijalankan oleh Karasek (tgig), Ekman & Ehrenberg(2002)dan Meams et al. (2003). ' ...
... In Part II, the questionnaire lists the physiological (somatic complaints), psychological (job dissatisfaction), and behavioural (intention to quit) elements. Modifications on the items are based on work done by Cammann et al. (1979), Karasek (1979), Ekman and Ehrenberg (2002) and Mearns et al. (2003). Table 4 displays the items in the questionnaire. ...
Work stress occurrences largely contribute to job dissatisfaction, burnout and retention ratios in many organizations. As in most literature review, poor ergonomic workstation environment is among the major contributor in stress outcomes such as somatic complaints and intention to leave. Thus, this study aims to examine the relationship between ergonomics workstation factors and the work stress outcomes in the Banking Supervision Department in the ABC Bank. Thirty-one (31) samples of the employees were derived from a population of sixty two (62) staffs in the Department by using proportionate stratified random sampling. Questionnaires were used for the data collections process. Findings from the study shows that the problems of body postures and health factors under the ergonomically designed workstation contributed to the work stress outcomes in the Department. These findings are supported by the multiple regression analysis where it depicts that both the body postures and health factors and component have significant relationship with the work stress outcomes in the Department. These findings however were inconsistent with the Pearson correlation analysis which showed that only the health factor has significant correlation with the work stress outcomes. In conclusion, the findings from this research are significant to the management and the organization as a whole to improve on ergonomic workstation factors on health and other ergonomic policies. Having a competent and healthy workforce will surely contribute to human capital development and the overall organization's success.
... Bahagian 2 dalam soal selidik ini terdiri daripada komponen stres, iaitu fisiologi (aduan berkenaan tubuh badan), psikologi (kelesuan/keletihan dan ketidakpuasan kerja) dan gelagat (niat untuk berhenti). Pengubahsuaian item adalah berdasarkan kajian yang dijalankan oleh Camman et al. (1979), Karasek (1979), Ekman dan Ehrenberg (2002) dan Mearns et al. (2003). Kesemua item dalam soal-selidik ini boleh dilihat dalam Jadual 3. ...
... Fatigue. Fatigue has been described by patients as a multidimensional phenomenon involving physical mental sensations and affecting feelings that influence functional ability (Ekman & Ehrenberg, 2002). The NANDA (2001) Patients with chronic HF may become so accustomed to fatigue as a symptom of HF that they may not mention it unless they are specifically asked. ...
... Bahagian 2 dalam soal selidik ini terdiri daripada komponen stres, iaitu fisiologi (aduan berkenaan tubuh badan), psikologi (kelesuan/keletihan dan ketidakpuasan kerja) dan gelagat (niat untuk berhenti). Pengubahsuaian item adalah berdasarkan kajian yang dijalankan oleh Camman et al. (1979), Karasek (1979), Ekman dan Ehrenberg (2002) dan Mearns et al. (2003). Kesemua item dalam soal-selidik ini boleh dilihat dalam Jadual 3. ...
Abstrak Penyelidikan ini bertujuan mengkaji perhubungan di antara faktor stesen kerja ergonomik dan akibat stres. Sampel seramai lima ratus operator pengeluaran telah dipilih daripada sebelas organisasi perkilangan elektronik yang berdaftar dengan Malaysian International Chamber of Commerce and Industry (MICCI) dengan menggunakan kaedah persampelan rawak berstrata berkadaran. Kaedah soal selidik telah digunakan dalam proses pengumpulan data kajian ini. Penemuan utama menunjukkan reka bentuk stesen kerja ergonomik merupakan strategi penting dalam meminimumkan akibat stres dalam organisasi. Analisis korelasi Pearson mengukuhkan kenyataan ini dengan menunjukkan kesemua faktor stesen kerja ergonomik mempunyai kekuatan hubungan yang signifikan dengan akibat stres. Analisis regresi linear berbilang menunjukkan faktor kesihatan, reka bentuk ruang kerja, kerja syif, sistem pengudaraan dan tempoh masa bekerja mempunyai hubungan signifikan dengan akibat stres. Komponen stesen kerja ergonomik pula membuktikan bahawa faktor manusia dan persekitaran mempunyai hubungan yang signifikan dengan akibat stres.
Kata kunci :
Ergonomik; stres; operator pengeluaran; stesen kerja; organisasi multinasional
Abstract. This study aims to examine the relationship between ergonomics workstation factors and the work stress outcomes. Five hundred samples of manufacturing operators were derived from eleven manufacturing electronics organizations which were registered with Malaysian International Chamber of Commerce and Industry (MICCI) by using proportionate stratified random sampling. Questionnaires were used for the data collection process. The major finding shows that ergonomically designed workstation is an important strategy in minimizing the work stress outcomes in organizations. These findings have been supported by the Pearson correlation analysis which shows that all ergonomics workstation factors have high significant correlation with the work stress outcomes. The multiple regression analysis shows health, work area design, work shift, humidity system and working hours factors have significant relationship with work stress
outcomes. Furthermore, ergonomics workstation components proved that the human and environment factors have significant relationship with the work stress outcomes.
Keywords :
Ergonomics, stress, manufacturing operator, workstation, multinational organization .
... Female sex, education, GCS score, and alcohol use at the time of injury were reported to have no associative value for fatigue severity in a study of mild TBI (Kempf et al., 2010). Differences in severity and frequency of fatigue between men and women have been observed after stroke (Lerdal et al., 2011), depression (Khan et al., 2002), obstructive sleep apnea (Chervin, 2002 ), heart disease (Ekman and Ehrenberg, 2002), and cancer (Miaskowsky, 2004), with females more often reporting fatigue than their male counterparts . Sex-related differences in fatigue were investigated in just one reviewed study, and further research is warranted. ...
OBJECTIVES:
To review the number and characteristics of self-reported sleep measures used to evaluate impaired sleep/wakefulness in traumatic brain injury (TBI) populations.
METHODS:
We conducted a comprehensive peer-reviewed literature search of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. Only standardized self-report measures for evaluating sleep dysfunction and its signs were taken into consideration.
RESULTS:
Sixteen self-report measures used in TBI research and clinical practices were identified. Five were generic, five symptom-related, and six were condition-specific measures. The Pittsburgh sleep quality index and Epworth sleepiness scale were partially validated in post-acute TBI.
CONCLUSION:
Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using the existing measures. However, additional research is needed to examine their applicability to the TBI population. The design and introduction of a new instrument able to triage sleep-related complaints between depressive, other medical, and primary sleep disorders-with a section for caregiver reports-might assist in the identification of the etiology of sleep dysfunction in persons with TBI. In choosing or developing a sleep measure, researchers and clinicians must consider the specific domains they want to screen, diagnose, or monitor. Polysomnography is recommended for diagnosing specific sleep disorders that cannot be diagnosed solely using a self-report measure.
... Female sex, education, GCS score, and alcohol use at the time of injury were reported to have no associative value for fatigue severity in a study of mild TBI . Differences in severity and frequency of fatigue between men and women have been observed after stroke (Lerdal et al., 2011), depression (Khan et al., 2002), obstructive sleep apnea (Chervin, 2002), heart disease (Ekman and Ehrenberg, 2002), and cancer (Miaskowsky, 2004), with females more often reporting fatigue than their male counterparts. Sex-related differences in fatigue were investigated in just one reviewed study, and further research is warranted. ...
Background:
Fatigue is common after traumatic brain injury (TBI). Its risk factors, natural history and consequences are uncertain. Best-evidence synthesis was used to address the gaps.
Methods:
Five databases were searched for relevant peer-reviewed studies. Of the 33 articles appraised, 22 longitudinal studies were selected. Results were reported separately based on their timing of baseline assessment.
Results:
All studies document changes in fatigue frequency and severity with time, irrespective of setting or TBI severity. There is limited evidence for certain clinical and psychosocial variables as predictors of fatigue severity at follow-up. Early fatigue severity predicted persistent post-concussive symptoms and Glasgow outcome score at follow-up.
Conclusions:
Fatigue is present before and immediately following injury, and can persist long term. The variation in findings supports the idea of fatigue in TBI as a nonhomogeneous entity, with different factors influencing the course of new onset or chronic fatigue. To decrease the heterogeneity, we emphasize the need for agreement on a core set of relevant fatigue predictors, definitions and outcome criteria. PROSPERO registry number: CRD42013004262.
... It is a common and complex symptom with wide-ranging implications for the fatigued patients lives (Ream & Richardson 1996) and is reported to be distributed continuously in the general population (Loge et al. 1998). Fatigue is associated with diseases such as MI Appels et al. 1995;Pedersen & Middel 2001), chronic heart failure (Ekman & Ehrenberg 2002;Falk et al. 2007), multiple sclerosis (Flensner et al. 2003), chronic fatigue syndrome (Larun & Malterud 2007), and depression (Pedersen et al. 2007, Lee et al. 2000. It is also a common side effect of various cancer treatments (Smets et al. 1998;Stone et al. 2001;Ahlberg et al. 2005;Browall et al. 2008). ...
... In order to examine the effects of the 24-week physical training on the patients' subjective experience with fatigue, we applied the Fatigue Impact Scale (FIS) [21,22]. The FIS consists of 40 items which evaluate the impact of fatigue on three aspects of daily life: physical (10 items), cognitive (10 items) and psychosocial (20 items) functions. ...
BACKGROUND AND DESIGN:In this study we set out to determine the effects of long-term physical training on hemorheological, laboratory parameters, exercise tolerability, psychological factors in cardiac patients participating in an ambulatory rehabilitation program. METHODS:Before physical training, patients were examined by echocardiography, tested on treadmill by the Bruce protocol, and blood was drawn for laboratory tests. The enrolled 79 ischemic heart disease patients joined a 24-week cardiac rehabilitation training program. Blood was drawn to measure hematocrit (Hct), plasma and whole blood viscosity (PV, WBV), red blood cell (RBC) aggregation and deformability. Hemorheological, clinical chemistry and psychological measurements were repeated 12 and 24 weeks later, and a treadmill test was performed at the end of the program. RESULTS:After 12 weeks Hct, PV, WBV and RBC aggregation were significantly decreased, RBC deformability exhibited a significant increase (p
... Although the relationship between fatigue and depression in COPD patients has not been extensively studied, there are data suggesting that men are more likely to express somatic complaints (such as fatigue) 32 rather than emotional concerns. Further, there is evidence that relationships between fatigue and emotions differ by gender in heart failure patients 33 . Our post-hoc analysis showing a higher correlation between depressed mood and fatigue in men than in women suggests that similar differences may exist among COPD patients. ...
As many as 30% of patients who start pulmonary rehabilitation (PR) fail to complete it, and depressed mood has been associated with PR non-completion. Depression is more common in women than men with COPD and historically women with COPD have been under studied. However, no studies to date have investigated gender-specific predictors of PR completion.
The study included 111 patients with COPD who enrolled in a community based outpatient PR program in Providence, RI. Patients who attended 20 or more sessions were designated "completers". Depression was measured using the CES-D. Logistic regression models were evaluated to test depressed mood as a predictor of PR completion. Analyses controlled for demographic and health variables found to differ between completers and non-completers.
Patients were 95% white and 49.5% women, and 74% had a GOLD stage ≥3. Sixty-eight percent of patients were PR completers. A logistic regression model, showed that lower depressed mood independently predicted PR completion across all patients (adjusted OR = 0.92, p = .002). In gender-stratified analyses, lower depressed mood was an independent predictor of PR completion for women (adjusted OR = .91, p = .024) but not men (adjusted OR = .97, p = .45). Greater 6-min walk test distance was also an independent predictor of PR completion among women.
Depressed mood is an important predictor of completion of community based PR among women. Screening and brief treatment of depression should be considered in practice.
... Furthermore, women may feel as if they are a burden to families or friends or even worthless (Mårtensson et al., 1998). More women than men express feelings of guilt and loneliness (Ekman & Ehrenberg, 2002), and younger women experience more mood disturbance, especially anxiety and depression than older women, whose expectations may be more consistent with their condition (Strö mberg & Mårtensson, 2003). Younger women are also not satisfied with their general or social life (Riedinger, Dracup & Brecht, 2000 ). ...
To reformulate and adjust to their life-situation, women living with heart failure (HF) need help and support. However, the actual meaning of the phenomenon of support is not yet well described. The aim of the study was to uncover the meaning of the phenomenon of support as experienced by women living with HF in middle age. A reflective lifeworld approach within the perspective of caring science was used. Six women (aged 33Á61 years) were interviewed. The findings show that the essence of support can be understood as safety, depicted by understanding. However, there is tension between what is supportive and what is not, meaning that even though intentions are good, intended support may involve limitations, uncertainties or insecurity. The meaning of support is further illuminated in the following constituents: ''knowledge and understanding'', ''finding balance'', ''ambiguity of relationships'' and ''support and formal care*a matter of trust and mistrust''. Findings demonstrate the need for carers to find an approach that ensures both good quality medical care and, at the same time, acknowledges the uniqueness of each individual.
... Though people with HF tend to be at risk for poor psychosocial health with 40% having depression or depressive symptoms [46], women are particularly vulnerable to adverse psychosocial health and support. This may be because women with HF tend to have more symptoms than men [47,48]. However, it may also be related to the lower psychosocial and family support identified in the studies in this review or to a reluctance of men to voice being isolated or fearful. ...
To improve patient support, it is important to understand how people view and experience Heart Failure (HF) self-care. This systematic review of qualitative studies included all published studies that examine the influence of sex and gender on HF self-care. A systematic search was done for papers (1995-2010) indexed in Ovid MEDLINE, Ovid Medline, Ovid EMBASE, Ovid PsycINFO, CSA Sociological Abstracts, OVID AARP Ageline, EBSCO Academic Search Complete, EBSCO CINAHL, EBSCO SocINDEX, ISI Web of Science: Social Sciences Citation Index and Science Citation Index Expanded, and Scopus. After screening of 537 citations, six qualitative studies identified that differences existed in perceptions of symptoms with women having less family involvement and psychosocial support around self-care. Moreover, women had considerably more negative views of the future, themselves and their ability to fulfill social self-care roles. Women with HF represent a highly vulnerable population and need more support for psychosocial wellbeing and self-care.
Background
Fatigue in heart failure (HF) is a burdensome symptom with profoundly negative effects on quality of life and an association with worsening prognosis and mortality. Despite its deleterious outcomes, HF-related fatigue remains poorly understood with limited treatment modalities.
Objective
The objective of this study was to identify correlates of HF-related fatigue.
Methods
A scoping review was completed using the Arksey and O'Malley framework. The theory of unpleasant symptoms was used as a basis for organizing key findings into concepts related to HF-related fatigue. Published, primary studies in English that explored correlates or predictors of fatigue in adult patients with HF were included.
Results
The search identified 655 articles, of which 38 were retained. An additional 4 articles were included for final review (N = 42). Nineteen concepts were identified as having a relationship with HF-related fatigue: age, sex, disease severity, inflammation, anemia, volume status, dyspnea, pain, body weight, depression, anxiety, perception of symptoms/health, sleep disturbances, poor social support, poor self-care, polypharmacy, reduced quality of life, risk for hospitalization, and mortality. Concepts were grouped into 4 categories: physiologic, psychologic, situational, and outcome.
Conclusions
Heart failure–related fatigue is a complex symptom that has physiologic, psychologic, and situational antecedents that influence the symptom and patient outcomes, all of which should be addressed when developing treatment modalities. Cultural and societal norms, racial disparities, and the co-occurrence of multiple symptoms should also be considered. Inconsistent or weak relationships with multiple physiologic correlates suggest the presence of unrecognized influencing factors.
Background
Fatigue is a common and distressing symptom of heart failure and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in heart failure.
Objective
To synthesize existing literature on fatigue in heart failure through a systematic literature review guided by the biopsychosocial model of health.
Methods
A systematic search of the literature was performed on March 18th, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of heart failure were included.
Results
The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness/isolation. Few non-pharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue.
Conclusions
Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to 1) define the relationships between fatigue and both psychological and social factors, 2) better describe the prognostic implications of fatigue, and 3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
Background:
Fatigue is a symptom experienced by 40%-74% of older individuals in the United States. Despite its significance, clinicians face challenges helping individuals to manage or reduce fatigue levels. Some management issues are attributable to the ambiguity around the risk factors, consequences, and the effect of fatigue management strategies.
Methods:
A literature review was conducted using four databases to identify themes in relation to risk factors, consequences, and management strategies from research studies about fatigue in older individuals with chronic diseases.
Results:
Findings on fatigue risk factors, such as age, body mass index, and marital status, were contradictory. There was a positive association between fatigue and comorbidities, depression, and anxiety and a negative relationship between fatigue and physical activity, sleep, educational status, and socioeconomic status. Fatigue was perceived as a state of "feebleness" and negatively impacted individuals' quality of life. Consequences of fatigue included tiredness, sleepiness, depression, anxiety, worse sense of purpose in life, poor self-care, and an increased β-amyloid load. Predictors of worse fatigue consequences included functional health, symptom burden, subjective health, and self-acceptance. Fatigue management strategies included physical activity, rest, sleep, maintaining normal hemoglobin levels, and acetyl-L-carnitine supplementation.
Conclusion:
This systematic review is of value to older individuals with chronic illnesses, researchers, and clinicians who strive to improve the quality of life of individuals experiencing fatigue. To prevent undesirable consequences of fatigue, older individuals should be screened for the discussed modifiable risk factors of fatigue. The inconsistencies in the studies reviewed can guide researchers to potential research areas that require further inquiry and exploration to ground future practice on best scientific evidence.
Background: Mucositis is a common side effect in children with cancer experienced chemotherapy. Levine’s Conservation Theory views children as open individuals who always respond to the environment. Children with cancer undergoing chemotherapy are seen as individuals who adapt to threats from the internal-external environment. The threat from the internal environment is the presence of cancer cells that threaten normal cells, while the external environment is the side effects of chemotherapy and environmental exposure. The nurse is responsible for carrying out a series of nursing processes to prevent the occurrence of mucositis due to chemotherapy. Objectives: Thisstudyaimedtoexplorethenursingprocessthatwasgiventochildrenexperiencing chemotherapy-induced mucositis using Levine’s Conservation Theory. Methods: This study was conducted with a case study. Ten children with cancer who experienced chemotherapy due to mucositis was participated in this study. Nursing process was applying by Levine Conservation Theory for one month at National Referal Hospital in Jakarta. Case studies are carried out by applying the nursing process according to Levine’s Conservation Theory, which consists of trophicognosis, hypothesis, nursing intervention and evaluation. Data analysis within cases and across cases is conducted by content analysis related to Levine’s evaluation model. Results: The results of the case study show that eight clients experienced energy conservation imbalances, ten clients experienced structural integrity disorders and eight clients experienced impaired social integrity. The results of the application of the Levine Conservation Theory for one month showed only two clients who could not achieved energy conservation and structural integrity. Conclusion/Importance: This case study shows that the Levine conservation model can be used in the nursing process in children with mucositis to maintain energy conservation and structural integrity. Nurses are expected to understand the application of Levine’s conservation theory to clients who are prone to conservation problems.
This study was conducted to determine the prevalence of fatigue and identify its demographic, clinical, and psychological correlates in 150 heart failure (HF) patients (73% men, 66% Caucasian, mean age 55.0 years, mean ejection fraction 26.7%±11%), from a single HF center, using the Profile of Mood States-Fatigue Subscale, the Minnesota Living With Heart Failure Questionnaire, and the Beck Depression Inventory. Sociodemographic and clinical data were obtained through self-report and chart abstraction. High levels of fatigue were reported in 50.4% of men and 51.2% of women. In a multivariate model, maximal workload, physical health, emotional health, and depression explained 51% of the variance in fatigue (P<.001). Fatigue in patients with HF is associated with both clinical and psychosocial variables, offering a number of targets for intervention. These findings suggest the need for multiple risk factor intervention strategies that improve physical and emotional health to decrease fatigue. Patients with depression warrant particular scrutiny.
Literature review indicated that a gap exists between how different stakeholders understand the
universal values espoused in the rights of the child and the place of local values. This affects
discipline in primary and secondary schools in Malawi in that school managers are unsure of
which set of values they should promote. Guided by the theoretical lens of the theory of
incompatibilities and culturally responsive methodology, this conceptual article examines how
the gap between some rights of the child and the local values can be bridged. Having examined
theories of deliberative pedagogy and democracy, global citizenship education, transformative
pedagogy, multiculturalism, and democratic education, negotiation between stakeholders was
considered an appropriate approach to analysing the compatibility of the local and universal
values with the purpose of adopting values they agree with and rejecting/adapting those that are
questionable. In this connection, a model that involves key stakeholders has been developed to
guide negotiations. It is hoped that integrating local and universal values will reduce conflict
between the stakeholders and therefore improve discipline in schools in Malawi.
Keywords: Incompatibility; integrate; rights of the child; values; learner discipline, culture.
Fatigue is a symptom experienced almost universally by people living with a chronic illness. People diagnosed with heart failure have described experiencing significant levels of fatigue. The family experience of fatigue, that is, how families perceive, respond to, and manage fatigue, is unknown. Semistructured family group interviews with 22 families (N = 62 family members) were conducted. Thematic analysis was undertaken to explore the family experience of fatigue. Fatigue was described as a significant symptom that affected physical, emotional, and social functioning at a family level. Fatigue was described as difficult to manage, and while most family members interviewed had developed a shared understanding of fatigue, some family members found acceptance of this invisible symptom more difficult. Spouses were more likely to express concern that fatigue, and especially increased fatigue, represented a decline in health. The study highlighted the importance of a shared understanding of fatigue from a family perspective.
Background:
Fatigue, a common and distressing symptom of heart failure, is a non-specific, invisible and subjective experience, which is difficult to describe and for which there are no effective interventions. Fatigue negatively impacts on patients' everyday life, prognosis and quality of life, therefore it is important that patients can manage, monitor and respond to changes in fatigue. To cope with fatigue patients may need or seek advice on self-management strategies.
Objectives:
To synthesize the best available evidence on the experiences and management of fatigue in everyday life among adult patients with stable heart failure.
Inclusion criteria types of participants:
Adults with confirmed and stable heart failure.
Phenomena of interest:
Studies exploring the experiences and management of fatigue in everyday life among adults with heart failure.
Types of studies:
Qualitative studies focusing on qualitative data, including, but not limited to, designs within phenomenology, grounded theory or ethnography.
Search strategy:
A three-step search strategy was used to identify published and unpublished qualitative studies from 1995 to 2014.
Methodological quality:
Studies that met the inclusion criteria were assessed by two independent reviewers for methodological validity using the standardized critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).
Data extraction:
Data was extracted from the five included studies using JBI-QARI.
Data synthesis:
Findings were identified and arranged according to the three research questions: patients' experiences of fatigue, impact of fatigue on everyday life and how patients' managed fatigue and its consequences in everyday life. Findings were pooled using JBI-QARI.
Results:
From the five included studies, 108 findings were derived and subsequently aggregated into 24 categories, which were finally meta-synthesized into five syntheses: "A pervasive and unignorable bodily experience" captured the patients' descriptions of fatigue experiences; "Limited performance of daily living and social activities" and "Loss of self-esteem, identity and intellectual function" aggregated the impact of fatigue on patients' everyday life; "Using protecting and restoring strategies according to the body barometer" and "A dynamic balance between accepting and struggling against fatigue" captured how patients managed fatigue and its consequences.
Conclusion:
Three different types of bodily fatigue challenge patients with heart failure. Decreased physical capacity, unpredictability and fluctuating intensity are dominant features of fatigue experiences, which cause limitations in performing daily and social activities, increased dependency of others, and loss of self-esteem, identity and intellectual function. Patients' management of fatigue and its consequences is an ongoing process involving use of protective and restorative activities to handle the specific bodily fatigue. However it also relates to living constructively with fatigue by striking a balance between adjusting to and struggling against fatigue.
Implications for practice:
Healthcare providers should be accountable to their patients, recognizing and taking into consideration patients' fatigue experiences and the meaning of fatigue, in order to provide optimal and individual care to their patients.
Implications for research:
Further qualitative research is needed to consider cultural factors of importance for managing fatigue in everyday life among patients with heart failure. Furthermore research should explore and test different kinds of physical and mind-body activities on the patients' functional capacity and wellbeing.
Abstrak Tinjauan literatur menunjukkan bahawa persekitaran stesenkerja yang tidak ergonomik merupakan antara penyebab utama kepada masalah stres di tempat kerja. Penyelidikan ini bertujuan mengkaji perhubungan di antara faktor stesenkerja ergonomik dan akibat stres. Sampel seramai lima ratus operator pengeluaran telah dipilih daripada sebelas organisasi perkilangan elektronik yang berdaftar dengan Malaysian International Chamber of Commerce and Industry (MICCD dengan menggunakan kaedah persampelan rawak berstrata berkadaran. Kaedah soal selidik telah digunakan dalam proses pengumpulan data kajian ini. Penemuan utama menunjukkan rekabentuk stesenkerja ergonomik merupakan strategi penting dalarn meminimumkan stres dalam organisasi. Analisis Korelasi Pearson menunjukkan kesemua faktor stesenkerja ergonomik mempunyai kekuatan hubungan yang signifikan dengan stres. Di antara kesemua faktor tersebut, faktor kesihatan mempunyai hubungan paling kuat dengan kesan stres di tempat kerja. Ini diikuti oleh faktor sistem pengudaraan, tempoh masa bekerja, kedudukan tubuh badan, rekabentuk ruang kerja, sistem kerja syif, pencahayaan, peralatan, kerusi dan sistem akustik. Secara keseluruhan, penemuan penyelidikan ini amat bermakna kepada organisasi yang ingin memastikan sumber manusia mereka sihat dan berdaya saing sejajar dengan aspirasi pembangunan modal insan yang dinamik. Kata kunci: ergonomik, korelasi, perkilangan, stesenkerja, stres Pendahuluan Stres di tempat kerja dikatakan boleh menjejaskan prestasi keseluruhan organisasi melalui kadar ketidakhadiran yang tinggi, ketidakpuasan hati dikalangan tenaga kerja, pusingganti buruh yang tinggi dan kehilangan pekerja terbaik serta peningkatan besar dalam kos pengambilan dan latihan semula. Isu sebegini bukan sahaja menjadi masalah individu tetapi merupakan masalah organisasi dan negara keseluruhannya (McHugh dan Brennan,1994). Apabila pekerja mendapat kecederaan kesan daripada stres, ia boleh menjejaskan prestasi kerja dan memberi impak terhadap produktiviti organisasi dan negara. Situasi ini jelas ditunjukkan dalam tinjauan literatur bahawa kedua-dua pembolehubah (stesenkerja ergonomik dan stres di tempat kerja) memberi kesan terhadap kos dan produktiviti organisasi (Dwyre dan Ganster, 199 l; Hendrick, 2003; Joseph, 2003). Persekitaran stesenkerja yang ergonomik sebenarnya memberi kesan ke atas sumber manusia sama ada secara psikologi ataupun fisiologi (Hagg, 2003; Piko, 2006). Masalah psikologi dan fisiologi ini meningkatkan tahap stres dan seterusnya menjejaskan produktiviti organisasi. Apabila pekerja berasa stres dan keadaan terus berulang semasa mereka melakukan tugas, maka kecenderungan mereka mendapat kecederaan atau kemalangan adalah tinggi. Manshor et. al. (2003) menegaskan bahawa stres di tempat keda boleh menyebabkan peningkatan kadar kecederaan dan kemalangan di negara-negara yang sedang membangun. Menurut Shahnavaz (1996), aplikasi ergonomik amat diperlukan di negara-negara yang sedang membangun kerana masalah persekitaran kerja yang buruk, kelemahan mengatasi isu kecederaan di tempat kerja dan ketidakselesaan, yang kesemua ini menyebabkan peningkatan kecederaan dan kadar kemalangan. Apa yang boleh diperkatakan di sini ialah persekitaran kerja perlu disesuaikan dengan individu. Kesesryian inilah yang dikenali sebagai kesesuaian persekitaran-individu (trterson-environment fi-P-E rtt). Jika berlaku ketidaksepad anan (misfit) antara persekitaran dengan individu, ia boleh mencetuskan kesan fisiologi, psikologi dan kelakuan negatif yang dikenali sebagai ketegangan (Jamieson dan Graves, 1998). Stres boleh dilihat sebagai kesan daripada ketidaksesuaian antara individu dan persekitaran. Oleh itu, semakin besar jurang antara individu dengan persekitaran, maka lebih signifikan pengalaman stres yang dialami oleh individu (Ivancevich et. al.,1982).
ABSTRAK Para sarjana yang mengkaji stres di tempat kerja bersetuju bahawa stres di tempat kerja merupakan masalah yang serius bagi kebanyakan organisasi. Organisasi kini terdorong untuk mengenalpasti dan membangunkan strategi mengurus dan meminimumkan kesan stres di tempat kerja selari dengan hasil penyelidikan yang banyak mengaitkan antara stres di tempat kerja dengan impak negatif terhadap individu dan organisasi. Penyelidik stres bersetuju bahawa stres yang berterusan dan berlebihan pada masa kini boleh memberi impak yang negatif terhadap kesihatan mental dan fizikal individu. Tinjauan literatur menunjukkan bahawa persekitaran stesenkerja yang tidak ergonomik merupakan antara penyebab utama kepada masalah stres di tempat kerja. Oleh itu, penyelidikan ini bertujuan mengkaji perhubungan di antara faktor stesenkerja ergonomik dan kesan stres. Sampel seramai 1668 kakitangan sokongan telah dipilih dengan menggunakan kaedah persampelan rawak mudah. Kaedah soal selidik telah digunakan dalam proses pengumpulan data kajian ini. Analisis regresi berbilang menunjukkan 59.7 peratus perubahan kesan stres di tempat kerja disebabkan oleh hubungannya dengan faktor kesihatan, peralatan, kerusi, rekabentuk ruang kerja, pengudaraan, pencahayaan dan tempoh masa bekerja. ABSTRACT Work stress scholars appear to agree that stress at the workplace is a serious problem in many organizations globally. Apprehension over the research evidence relating work stress to negative individual and organizational outcomes has impelled in identifying and developing strategies to manage stress and its consequences. It is now generally accepted that prolonged or intense stress can have a negative impact on an individual's mental and physical health. Previous
The occurrence of work stress is quite rampant in manufacturing organizations which involved blue collar workers. The literature revealed that poor ergonomics workstation environment is among the major contributor to the work stress problems. Thus, this study aims to examine the relationship between ergonomics workstation factors and the work stress outcomes. Five hundred samples of production operators were derived from eleven manufacturing electronics organizations which were registered with Malaysian International Chamber of Commerce and Industry (MICCI) by using proportionate stratified random sampling. Questionnaires were used for the data collections process. The Pearson correlation analysis shows that all ergonomics workstation factors have high significant correlation with the work stress outcomes.
Mergers and acquisitions (M&As), which became extremely common in the branded industry in the 1990s, have recently seen a parallel development in the generics medicines industry. However, generics M&As are more susceptible to impact from cultural barriers. These may become apparent post merger, but can also dramatically affect the success of the negotiations. The reasons for this are discussed and several proposals are made for risk reduction through recognising the importance of the culture differences in play and taking adequate measures to reduce their impact.
Because of the widespread nature of chronic fatigue, health care providers need a common understanding of chronic fatigue to enable effective communication. To aid this understanding a concept analysis was undertaken using a modified version of Rodger’s evolutionary method of concept analysis. The literature review yielded many resources focused on defining fatigue and relating it to many diverse chronic conditions. This article also discusses the differences between chronic fatigue and acute episodes of fatigue. Chronic fatigue is a subjective, unpleasant, changeable, and exhausting experience that adversely affects quality of life. Whereas rest or sleep often relieves acute fatigue, chronic fatigue is unrelenting. Chronic fatigue has multiple antecedents and is a component of a diverse array of chronic diseases.
Effective symptom management is a critical component of quality palliative care. For those with heart failure, poorly managed symptoms contribute to frequent rehospitalization and significantly increase the overall burden to patients and families as well as the healthcare system. The purpose of this paper is to review assessment and management strategies for patients with heart failure who remain symptomatic despite guideline-indicated heart failure treatment. Initially, we focus on the Symptom Management Model as a guiding framework consistent with palliative care. Then, we address several specific symptoms commonly reported by heart failure patients, including dyspnea, fatigue, difficulty sleeping, depression and anxiety. Comprehensive, on-going assessment of symptoms and the symptom experience is critical to guide planning, intervention, and evaluation of patients with heart failure. Through targeted assessment and interventions, the burden of symptoms may be reduced to improve quality of life for patients and their families as they face this life-limiting, chronic illness.
Background:
Progression of fatigue in elderly heart failure patients is not well documented.
Aim:
To report on patterns and severity of fatigue in surviving patients (n = 112, mean age 75 years) of a 5 year heart failure programme (HFP).
Methods:
Patients (n = 200 at baseline) participated in a 6 month trial of cardiac rehabilitation (CR versus standard care) followed by the same prescribed maintenance programme (Phase IV and/or independent exercise). Fatigue was rated by the MLHF questionnaire and compared to quality of life (QoL), physical and clinical measures. Patterns of fatigue are described in the whole sample. Data analysis is undertaken on sub-groups based on baseline randomisation, aetiology, gender, co-morbidity and survival. Heart failure patients (n = 29) newly diagnosed at the 5 year follow-up time point provided information on their experience of fatigue.
Results:
At baseline and 5 years, 45% patients rated fatigue within the two highest categories of severity, whereas 10% reported no symptoms on assessment. Over 5 years, the fatigue patterns in the sample were unsustained improvement commensurate with the HFP (37%), an adverse pattern from baseline (37%), maintained improvement (18%) or no overall change (8%). Fatigue was higher in patients with joint problems and responded to the intervention. There was a significant increase (p < 0.05) in the proportion of patients with reduced haemoglobin level and severe fatigue at 5 years. Fatigue scores correlated significantly (p < 0.01) with QoL and physical measures.
Conclusions:
Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.
Priestess, Mother, Sacred Sister: Religions Dominated by Women. SUSAN STARR SERED. New York and Oxford: Oxford University Press, 1994. 330 pp., photographs, notes, references, index.
To identify the incidence and prognosis of CHF and the prevalence of diastolic heart failure, we assessed all patients (n = 216) who received a new diagnosis of CHF in Olmsted County, Minnesota, in 1991. Newly diagnosed CHF patients had decreased survival; however, systolic function was preserve in 43% of the cases. Survival was not significantly different in patients having preserved compared with reduced systolic function. We found CHF was a disease of the elderly and that echocardiography and ACE inhibitors were underused.
The purpose of this study was to compare return to physical activity, psychosocial aspects. and family interrelationships in men and women post-myocardial infarction (Ml). Ten men and ten women were interviewed three to six months post-Mi. Women reported slightly higher MET level activities at one and four weeks post-MI. Men and women differed in types of activities performed. Men reported resting and relaxing, whereas women began household work as early as one week post-M1. Women did not perceive household activities as work. Of the employed women. 67% (four) failed to return to work as compared with 10% (1) of the men. All participants returned to normal sexual activity by six months post-MI, although men began sexual activity earlier. Fifty percent (five) of the women reported feeling guilt’; post-M1 as compared with 10 % (one) of the men. Guilt was attributed to being limited in forforming household and family responsibilities. Women with traditional feminine se typings (Bem Sex-Role Inventory) performed at higher MET levels than men sex typed as radilionally masculine. To date, there have not been any data explicitly describing female rehabilitation post-M1. This study demonstrated differences in the rehabilitation of men and women post-MI. It suggests the need for research to further define these differences and to address needs specific to female patients post-M1 in clinical practice.
Coronary artery bypass surgery is one of the most frequently performed surgical procedures for coronary heart disease, which is the leading cause of illness in American men and women over the age of 50. Since perceptions of events have been shown to significantly affect outcomes after major cardiac illness, it is crucial for nurses to understand patients' perceptions of these events. This article explores how perceptions of cardiac surgery differ considerably by gender and role expectations, and how such differences can influence recovery.
Fatigue and malaise (FM) is a frequent, non-specific symptom of cancer patients caused by the disease, its treatment and psychological distress. Since comprehensive quality of life assessment is often not feasible in multicentre clinical trials, short, but clinically relevant, quality of life indicators have to be defined. In a representative subsample of 127 patients in a phase-III randomized small-cell lung cancer trial comparing two different regimens of combination chemotherapy, quality of life was assessed at the beginning of each of the six treatment cycles with a self-rating questionnaire including an early version of the EORTC questionnaire, a mood adjective check list (Bf-S) and a single linear-analogue self-assessment scale (LASA) measuring general well-being. FM, measured with a five-item Likert subscale of the EORTC questionnaire, showed moderate to high intercorrelations with other EORTC subscales assessing disease symptoms, toxicity of treatment, role functioning, personal functioning, restriction of social activity, psychological distress, emotional (Bf-S) and general well-being (LASA). At baseline, FM was one of the most pronounced symptoms. Over the six cycles 43%–31% of the patients complained of moderate to severe fatigue. Over the first two cycles FM tended to decrease, slightly increasing during cycles 3 and 4 and decreasing again before cycle 6. In a multiple regression analysis over the six cycles, 53% of the variance of FM was explained by patient-rated symptoms of disease and toxicity (disease alone: 43%; toxicity alone: 35%). Initial performance status, previous weight loss, treatment arm, cycle number and age predicted the scores of FM over the six cycles. We conclude that, among other disease- and treatment-related scales, FM can be used as a global indicator of quality of life in small-cell lung cancer patients.
Cardiovascular nuclear medicine exercise studies may serve as a screening method to be used in making decisions to refer patients for catheterization and coronary artery bypass surgery. In a study of 390 patients consecutively referred for nuclear exercise testing, abnormal results found in 31% of the women and in 64% of the men affected physicians' decisions to recommend catheterization in men only; 4% of the women with abnormal radionuclide scans were referred for catheterization compared with 40% of the men (p less than 0.001). this 10:1 ratio was independent of age. A multiple logistic regression analysis that controlled for age, previous myocardial infarction, presence of typical and atypical angina, and abnormal test results yielded an odds ratio of 6.3 for men. The male-to-female ratio of patients with coronary artery disease given abnormal results of a cardiovascular nuclear scan is only 2:1. Thus, the sex differential in decisions to refer patients for cardiac catheterization cannot be explained entirely by differences in the sensitivity of tests or the rates of coronary artery disease; it also cannot be explained by differential benefits from surgery. These findings raise the question of whether coronary artery bypass surgery is underused in women.
In relation to research question one: 'How may fatigue and exertion fatigue be conceptualised?', a concept analysis of fatigue is describes in chaper two of this thesis. Altought the interest in studying fatigue is increasing and som models have now been developed, theory development is in its beginning phase. Zie: Summary, general conclusion and discussion
The associations between exercise capacity, symptoms and specific aspects of quality of life were examined in subjects participating in a trial of the treatment of heart failure. Patients were assessed on entry and after three months treatment. The principle symptoms were fatigue, breathlessness and chest pain. These limited the extent and speed of physical activities, restricted social, leisure and family life and were associated with emotional distress. There were associations between baseline exercise capacity and measures of quality of life. Change in exercise capacity during three months treatment was correlated with changes in measures of symptoms, limitation of activity and quality of life. The findings confirm the value of change in exercise capacity as a measure of functional status and suggest that it should be supported by a limited number of specific measures of quality of life.
Congestive heart failure is a complex disease that is complicated by the normal changes that accompany aging. The medical profession has learned a great deal about managing this disease in the past decade. However, the challenge remains for the nursing profession to help individuals and their families live with this chronic, debilitating disease. We must be prepared to coordinate the complex array of services needed, educate the elder to an acceptable level of understanding, counsel regarding end-of-life issues, and encourage all elders to remain active in an effort to help these fragile individuals retain the quality in their life until the end of life. (Geriatr Nurs 1999;20:180-6)
The specific aim of this study is to compare and contrast the biophysical and psychosocial profile of men and women undergoing cardiac surgery (coronary artery bypass graft and valve replacement) during the perioperative and home recovery period. Coronary artery disease appears to be qualitatively worse in women than men although the prevalence in women does not approach that in men until the seventh decade. Valvular disorders also reveal a different profile by sex with the greater valvular problems in women related to the fact that women have more rheumatic heart disease. A prospective, longitudinal design with a convenience sample of 117 patients undergoing cardiac surgery and their spouses (234 subjects) from five Northern California hospitals was used to tap patient response at three critical perioperative data points. Female patients were observed during the perioperative period to have significantly more shortness of breath, poorer cardiac functional status (New York Heart Association), significantly longer intensive care unit stays, and proportionately more deaths. At 1 and 3 months after discharge, however, their recoveries did not differ significantly from men's when they were compared on sexuality, recreation, or return-to-work variables. Surprisingly, female patients had significantly less mood disturbances as measured by the Profile of Mood States than their male counterparts, and they scored higher on measures of family satisfaction than did male patients. Implications of the study involve early recognition of heart disease in women, preparation of families for longer intensive care unit stays, and appreciation of different psychosocial responses to surgery.
Fatigue is a pervasive, protective phenomenon affecting the totality of the individual. Assessment and management involve a wide range of activities to address the total human being's physical, psychological, cognitive, and spiritual dimensions. When elimination or neutralization of the effect of an antecedent condition is not an option, redesigning one's life-style may be the primary avenue of fatigue management. This protective mechanism, fatigue, may in fact herald the return of quality and purpose to one's life.
We examined by medical-record review why long-term digitalis therapy was prescribed in 150 outpatients, the reasons were: supraventricular tachyarrhythmias (35): supraventricular tachyarrhythmias and heart failure (33); and heart failure with sinus rhythm (82). In the patients without supraventricular tachyarrhythmias we scrutinized the diagnosis of heart failure using a clinicoradiographic scoring system and found the diagnosis unlikely in 32 patients. When these 32 patients are combined with the 31 patients who had only one occurrence of supraventricular tachyarrhythmias or heart failure, 42% of the patients were on long-term digitalis therapy for a questionable reason. We conclude that a substantial fraction of general medical outpatients might benefit from digitalis withdrawal, if evidence for heart failure is lacking or if the reason prompting digitalis therapy is isolated to the distant past.
Coronary artery bypass surgery is one of the most frequently performed surgical procedures for coronary heart disease, which is the leading cause of illness in American men and women over the age of 50. Since perceptions of events have been shown to significantly affect outcomes after major cardiac illness, it is crucial for nurses to understand patients' perceptions of these events. This article explores how perceptions of cardiac surgery differ considerably by gender and role expectations, and how such differences can influence recovery.
To compare return to work, participation in cardiac rehabilitation, and sexual activity in women and men recovering from acute myocardial infarction (AMI).
A descriptive survey design was used. Descriptive statistics and chi square analysis were used to compare differences between women and men after an AMI.
The survey was mailed to the subject's home.
A purposive sample of 20 women and 42 men.
Comparing women with men, there were significant differences in the following activities with women evidencing higher percentages in responsibility for household duties before AMI, and cooking, washing dishes, reading, bed making, laundry, dusting and sweeping within 4 weeks after AMI. For those subjects who were sexually active before AMI, all resumed sexual activities after an average of 8 weeks. Women reported a decrease in frequency, less satisfactory relationship, and more reports of chest pain during sexual activity. Subjects reported that nurses gave little or no counseling concerning resumption of household activities, return to work issues, and sexual activity. Women received less counseling than men after AMI.
The findings are not generalizable to the population at large; however, the study indicates a need to investigate further the recovery period for women who experience AMI.
This study aimed to refine and extend the findings of an original study which focused on the description of fatigue associated with congestive heart failure. A descriptive approach based on Levine's Conservation Model provided both quantitative and qualitative data. Qualitative data addressed personal integrity and quantitative data measured energy conservation, structural and social integrity. Patients described fatigue as being tired and exhausted and containing both physical and emotional components. Fatigue occurred as a result of stress, physical activity and disease. Patient-identified interventions included rest, distraction, medicine, and physical and spiritual activities. Age, pH and oxygen saturation were significantly related to fatigue. The findings are examined using the concept of adaptation as defined by Levine. Implications for nursing are discussed within the framework of the Conservation Model with emphasis on a holistic approach to patient care.
To examine the relative contribution of psychologic factors and physical symptoms to the variance in fatigue in older women with heart failure.
Eighty women who had been hospitalized in the previous 12 months for heart failure were interviewed. Fifty-seven women completed second interviews 18 months after the first interview.
Fatigue was the most frequently occurring physical symptom at both measurement times, and it significantly increased with time. Other physical symptoms contributed uniquely to the variance in fatigue at both measurement times, but psychologic factors did not. At time 1, sleep difficulties, chest pain, and weakness each explained unique variance in fatigue. At time 2, dyspnea was the only variable that explained unique variance in fatigue (9%). Dyspnea also explained a significant portion of the variance (7%) in time 2 fatigue, when time 1 fatigue was controlled.
Fatigue in older women with heart failure is related more to other physical symptoms than psychologic factors.
To compare women's and men's recovery symptoms during home recovery after coronary artery bypass grafting (CABG).
This secondary analysis used a survey design. Descriptive statistics and content analysis were used to compare women's and men's recovery symptoms.
Subjects were interviewed about physical and emotional symptoms they experienced after CABG at three measurement points: 1 day before discharge, 2 days after being discharged, and 3 weeks after being discharged.
A purposive sample of 20 women and 20 men recovering from their first CABG.
More men than women reported fatigue, chest incision discomfort, and negative emotional symptoms. Unlike men, women described numbness and discomfort in their breasts during the first weeks of recovery. Women's and men's recovery emotions centered on concerns associated with their social circumstances. Women were more likely to be older, unemployed, unmarried, and live alone, and they were anxious about who would care for them during home recovery and where that recovery would take place. Men's anxiety centered first on their immediate physical recovery symptoms and then on long-term issues in regard to return to work and activities.
An understanding of these gender differences in CABG recovery is important so clinicians can tailor discharge planning to the specific needs of women and men.
To describe the psychosocial processes by which women make the decision to seek care for the symptoms of Acute Myocardial Infarction (AMI).
The qualitative method of grounded theory was used to study the prehospital experience of women with symptoms of AMI.
Sixteen women between the ages of 42 and 82 years who were hospitalized in a coronary care unit after AMI.
The women delayed a median of 5.4 hours (range 1.5 to 144 hours). The psychosocial processes by which they made the decision to seek treatment after symptom onset were dynamic and multidimensional. The fundamental structure involved two core categories: (1) maintaining control, and (2) relinquishing control. Within these two core categories there were five subcategories: symptom awareness, perceived insignificance, self-treatment, perceived threat, and lay consultation.
Although these women immediately recognized their symptoms as abnormal, they did not acknowledge their seriousness until after the use of a variety of coping mechanisms and self-treatment behaviors to reduce threat and maintain control over the situation. Interventions to reduce delay should focus on the issue of perceived loss of control during symptom onset and attempt to reduce the sense of threat by describing the benefits of seeking treatment early.
Fatigue is probably the most common symptom of illness affecting sufferers of both acute and chronic conditions. However, confusion surrounds the definition and use of the term fatigue. As with many other nursing concepts, it is a word that is commonly used in colloquial language. This concept analysis aims to identify the attributes that are essential to the concept of fatigue, and to distinguish between its colloquial and its nursing usage by following the strategy suggested by Walker and Avant (1995, Strategies for Theory Construction in Nursing, Appleton Lange, London). A review of the literature identifies nursing uses of the term fatigue which reflect and conflict with colloquial uses. Defining attributes, demonstration cases, antecedents, consequences and empirical referents are identified before a definition of fatigue is developed and proposed for nursing. This clarification of the phenomenon has particular relevance for clinical nursing, future research and the development of fatigue theories.
Patients with congestive heart failure (CHF) are an extensive group in Sweden both with regard to prevalence and number of medical care events. As the age of the population and survival after myocardial infarction are increasing, the incidence of CHF is also on the rise. The aim of this study is to describe, from a nurse's perspective, how male patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: the biophysical, the sociocultural, the emotional, the intellectual, and the spiritual-existential. A qualitative method was used with a phenomenographic approach as it examines aspects of the surroundings as conceived. In the results, six categories emerged: feeling a belief in the future, gaining awareness, feeling support from the environment, feeling limitation, feeling a lack of energy and feeling resignation. The mental and physical lack of energy which patients feel easily leads to limited working capacity and social activities. This limitation may cause patients with CHF to believe that neither they nor their environment can influence their life situation and there is a risk that these patients become resigned. In order to help them get out of this vicious circle of limitation and resignation, it is important that the nurse teaches them self-care and shows them the possibilities that exist in everyday life. With increased awareness of their life situation, patients may adapt to their CHF and see that it is possible to improve their future themselves.
Persons with heart failure (HF) experience impaired quality of life (QOL). However, the majority of research conducted on QOL in persons with HF has been with men. The purpose of this descriptive pilot study was to describe the impact of symptoms of HF and examine the relationships among symptom impact, perceived health status, perceived social support, and overall QOL in 30 women who had recently been hospitalized for HF. The women reported high physical symptom impact, poor perceived physical health status, and impaired QOL. Physical symptom impact, perceived physical health status, and QOL were moderately to highly correlated with one another. Perceived social support was significantly, though not strongly, correlated with physical symptom impact. Emotional symptom impact and mental health status were significantly and negatively correlated with each other but were not significantly correlated with QOL. In this group of 30 chronically ill women, QOL was lower in those women who reported greater physical symptom impact and poorer perceptions of their physical health status.
To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic heart failure.
Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a randomized study to compare the effect of a nurse-monitored, outpatient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Heart Association classes III-IV, age 65 years, and eligibility for an outpatient follow-up programme. The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed. Eighty-nine per cent of all the hospitalized patients (n=1541) were 65 years old. Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigue. The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups.
Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.
Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse's perspective, how female patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: biophysical, socio-cultural, emotional, intellectual and spiritual-existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self-care and existing possibilities. These measures will make it easier for women with CHF to maintain a hopeful perspective and a sense of control, competence, and self-esteem.
A growing interest in the health problem presented by fatigue, both in clinical practice and research, coupled with a decreasing number of reported studies on fatigue in the last decade, make an updated and systematic review of factors related to fatigue necessary. A search of the literature, comprising 53 studies, was therefore undertaken to explore the following research questions: Which significantly social-demographic, cure-related, and care-related factors are significantly correlated with fatigue? And which nursing interventions need priority in experimental research to reduce or eliminate fatigue? Reported factors related to fatigue in analysed studies show that the correlations between the specific cure- and care-related factors and fatigue are similar among the various investigated (patient) populations. This result supports the concept of the non-specific character of fatigue. The intervention of primary effectiveness most suggested in this study is 'energy management'. Interventions of secondary importance which emerge are those of 'emotional support', 'activity therapy' and 'coping enhancement'. This study makes clear that the exploration of a research model for fatigue, with social-demographic, cure- and care-related factors is useful and that care-related factors have their own effects on fatigue not necessarily dependent upon the presence of medical diseases or cure-related factors. In general, multi-related factors could be assessed. Implications and relevant questions for further research on fatigue are also given.
The purpose of this study was to evaluate gender differences in quality of life (QOL) in a large sample of age-matched and ejection fraction (EF)-matched patients with heart failure.
Matched comparisons of secondary data were used.
The setting consisted of multicenter Studies of Left Ventricular Dysfunction trials.
The sample included 1382 patients (691 men and 691 women) who were age-matched and EF-matched. Outcome Measures: Global QOL and the QOL dimensions of physical function, emotional distress, social health, and general health were measured using the Ladder of Life, items from the Profile of Mood States Inventory, the Functional Status Questionnaire, the beta-Blocker Heart Attack Trial instrument, and an item from the RAND Medical Outcomes Study instrument.
Women had significantly worse general life satisfaction, physical function, and social and general health scores than men. There were no significant differences found between gender groups for current life situation or emotional distress. After controlling for New York Heart Association classification, women still had significantly worse ratings for intermediate activities of daily living (a sub-dimension of physical functioning) and social activity.
Despite controlling for age, EF, and New York Heart Association classification, women had worse QOL ratings than did men for intermediate activities of daily living and social activity. Research should focus on identifying why differences exist and developing measures to improve QOL, particularly physical functioning, in women with heart failure.
Almost half of the patients affected with congestive heart failure (CHF) in the United States are women. However, past studies have included predominantly men and generalized results to women. Many women with CHF are older, have hypertension, and have higher ejection fractions. Survival differences have been reported previously with conflicting results. Although treatment for left ventricular dysfunction is somewhat standardized, treatment for diastolic dysfunction is less defined. Clinical trials for this group of patients, many of whom are women, have not been performed. In comparison with men, women have several cardiovascular differences as well as differences in electrical properties. In addition, response to medical (pharmacologic) therapy may differ in men and women.Finally, functional status has been shown to be compromised in both men and women with CHF; however, some studies have shown women to experience more exercise intolerance. This may be because more women than men have diastolic dysfunction. Few women have been included in exercise trials. Future trials must address women with CHF, many of whom are older and have normal (or near normal) left ventricular function or diastolic dysfunction.
The goal of this study was to determine whether gender differences exist in health perceptions, psychosocial adjustment to illness, and concerns related to illness in patients with heart failure (HF).
Thirty-two patients (50% women) from a single outpatient HF clinic were asked to complete standardized tools to assess health perceptions and psychosocial adjustment to illness. Open-ended questions were used to obtain data on concerns related to HF.
The women had higher health perceptions than men did; they also demonstrated better psychosocial adjustment to illness. The qualitative data further suggest that women ascribed more positive meanings to their illness than men did.
The current study underscored the importance of gender differences in health perceptions related to HF. Patient teaching and counseling can be tailored to address the gender-specific concerns of men and women suffering with this condition to improve patient outcomes.
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