Cynthia Arslanian-Engoren

• PhD, RN, ACNS-BC, FAHA, FAAN
• Professor (Full) at University of Michigan

Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. The development of coronary care units is often credited for a dramatic decline in mortality rates afte...

Few studies have compared cardiovascular disease (CVD) risk factors in sexual minority and heterosexual adults. It remains unclear whether changes in sexual identity over time are associated with increased CVD risk. The purposes of this longitudinal study were to (a) compare sex differences in CVD risk factors across sexual identity subgroups, (b)...

Cardiovascular risk assessment traditionally includes biological (e.g., blood pressure, serum cholesterol) and behavioral (e.g., tobacco use, alcohol consumption, high saturated fat diet, physical inactivity) measures, as well as the presence of chronic conditions known to increase cardiovascular disease (CVD) risk (e.g., diabetes mellitus, obesity...

Background Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision. Methods To ensure that the intervention re...

Background Lesbian, gay, bisexual, transgender and queer (LGBTQ) people, also commonly referred to as sexual and gender minorities (SGMs), live in every part of the United States and encompass all races and/or ethnicities, religions, and social classes. Major reports from various sources document higher rates of health issues (e.g., substance abuse...

Background Studies of sepsis evaluating sex- and race-related disparities in treatment and outcome have been limited by using administrative databases, which may not adequately capture sepsis diagnosis, used limited number and types of races, or not included both sex and race in the analyses. Objective To determine if patients of different races a...

Background: Hypertension is a leading cause of cardiovascular disease (CVD) and affects nearly one in two adults in the United States when defined as a blood pressure of at least 130/80 mm Hg or on antihypertensive medication (Virani et al., 2021, Circulation, 143, e254). Long-standing disparities in hypertension awareness, treatment, and control...

Dementia cases are expected to grow for African Americans and surrogate decision makers (SDMs) will have a significant role at the end of life (EOL). This qualitative exploratory case study used Cognitive Task Analysis and an integrated conceptual framework to understand the EOL decision experience of African American SDMs for patients with advance...

Objective To determine the proportion of informed choices women made about donating their newborns’ blood samples for research. Design A quantitative analysis of informed choice using data on women’s knowledge and attitudes from a descriptive, cross-sectional survey. Setting The state of Michigan. Participants Women (N = 69, ≥18 years old) who h...

Background: Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses' overall health affects the occurrence of medical errors. Objective: To examine the associations among critical care nurses' physical...

Purpose: Parents who face goals-of-care tracheostomy decisions may lack an understanding of challenges affecting their child's and family's long-term quality of life (QOL) to accurately forecast possible outcomes for decision making. We sought to examine whether and how parents' narratives of the child's and family's long-term QOL influence parent...

Although there are a number of transitions of care initiatives that address specific needs as patients move across healthcare settings, adverse events still occur during handoffs. Transitions of care create periods of vulnerability for populations with complex needs that include communication gaps, medication changes, and poorly coordinated treatme...

Background: Cognitive dysfunction contributes to poor learning and impaired self-care (SC) for patients with heart failure. Objectives: The aims of this study were to (1) evaluate the feasibility and acceptability of a nurse-led, virtual home-based cognitive training and SC education intervention to support SC and (2) evaluate the relationship b...

Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complic...

This paper seeks to open a dialogue concerning the current trend in hiring non-nurse faculty (NNF) to tenure track positions in schools/colleges of nursing. The evolution of non-nurses as faculty, including a review of contemporary papers in affecting this trend, is offered. Three means of involving non-nurses in advancing our discipline are presen...

Background: Surrogate decision makers of stroke patients are often unprepared to make critical decisions on life-sustaining treatments. We describe the development process and key features for the Understanding Stroke web-based decision support tool. Methods: We used multiple strategies to develop a patient-centered, tailored decision aid. We be...

Patients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CN...

Introduction Hypertension is a significant modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. Evidence is emerging showing disparities in CVD risk between sexual minorities and heterosexuals. Engagement in CVD risk reduction behaviors may account for differences. We examined CVD risk reduction...

Aiding end-of-life medical decision-making: A Cardinal Issue Perspective - Haoyang Yan, Stephanie K. Kukora, Cynthia Arslanian-Engoren, Patricia J. Deldin, Kenneth Pituch, J. Frank Yates

Context: Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients following hematopoietic cell transplantation (HCT). Yoga is an approach with supportive evidence to improve CRF in different cancer populations, but to our knowledge, has not been tested in an adult HCT population. Objectives: The aim of this...

Background Compelling evidence indicates that gaps in quality, safety, and experiences occur when patients encounter transitions across the care continuum. Differences in the organization of healthcare services as well as disparities in health across the globe, may have a unique impact on processes associated with transitions of care for client pop...

Objective: To compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. Methods: Secondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). Results: Rates of eligibility for low-dose hel...

Residual dried blood spots from millions of newborns are being stored and used for research. The state of Michigan proactively developed a broad consent process for research use of newborns' blood spots. However, the extent to which mothers make informed choices about this research is unclear. A descriptive, qualitative study was conducted examinin...

Myocardial infarction in the absence of obstructive coronary artery disease is found in ≈5% to 6% of all patients with acute infarction who are referred for coronary angiography. There are a variety of causes that can result in this clinical condition. As such, it is important that patients are appropriately diagnosed and an evaluation to uncover t...

Aim This article describes the development of a middle‐range theory of symptom self‐care management for adults with cancer. Background Current evidence indicates that patients with cancer may benefit from engagement in self‐care management behaviors, one of which is symptom management. A middle‐range theory that explains and guides symptom self‐ca...

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabiliti...

Introduction: Differences in tobacco/nicotine use by sexual orientation are well documented. Development of interventions requires attention to the etiology of these differences. This study examined associations among sexual orientation discrimination, cigarette smoking, any tobacco/nicotine use, and DSM-5 tobacco use disorder (TUD) in the U.S. M...

Background: Therapeutic hypothermia can improve neurological recovery after cardiac arrest when implemented quickly. Objective: To determine whether outcomes are improved among patients undergoing therapeutic hypothermia by adding advanced practice registered nurses to a therapeutic hypothermia response team. Methods: A pilot quality improveme...

Background: Approximately three million U.S. adult women have heart failure (HF), increasing their risk of adverse perioperative outcomes. While gender and racial differences are reported in surgical outcomes, less is known about 30-day perioperative outcomes in HF patients. Objectives: To characterize and compare gender and racial differences i...

Objective: To describe: (1) nurses' physical and mental health; (2) the relationship between health and medical errors; and (3) the association between nurses' perceptions of wellness support and their health. Methods: A cross sectional descriptive survey was conducted with 1,790 nurses across the U.S. Results: Over half of the nurses reported...

Background: Minimizing the time from myocardial infarction (MI) symptom onset to the implementation of lifesaving interventions decreases morbidity and mortality of women who experience an MI. However, not all women seek timely evaluation and treatment for their MI symptoms. Objectives: The aim of this article is to describe reasons for decision...

Nurses are increasingly asked to obtain consent from participants for biobanking studies. Biobanking has added unique complexities to informed consent. The purpose of this systematic review was to evaluate participants’ level of understanding of the information presented during the informed consent process unique to the donation of biological speci...

Incorporating meaningful interprofessional education (IPE) into curricula to better equip students to enter and shape clinical practice can be challenging. Faculty from dentistry, medicine, nursing, pharmacy and social work taught a semester-long IPE course where interprofessional teams of students collaborated in case-based decision making to lear...

Background: Frailty is a debilitating condition in older adults that is associated with increased risks for adverse outcomes. However, the issue of quantifying frailty remains elusive. There is a lack of consistency in the frailty components and the corresponding indicators used to quantify these components. Objective: 1) to describe the compone...

Psychological conditions such as depression can have a greater impact on morbidity and mortality outcomes than traditional risk factors for these outcomes. Despite their importance, it is rare for clinicians to assess patients for these conditions and rarer still for them to consistently and adequately manage them. Illumination of the phenomena of...

Background: Barriers to recruiting and retaining acutely ill older adults in clinical research include complexity of illness, fatigue, and early discharge. Objective: To describe recruitment and retention challenges of examining cognitive dysfunction in older adults hospitalized for acute heart failure. Methods: An examination of the reasons f...

Biobanking may include research procedures that violate the religious values and preferences of some patients. This integrative literature review evaluated the influence of religious values on participants' decisions to donate biospecimens to biobanks for research. The review followed the method of Whittemore and Knafl (2005). PubMed, CINAHL, and G...

Objective: To examine women's perceptions of their emergency department (ED) cardiac triage experience for myocardial infarction (MI). Background: Prompt ED recognition and rapid triage of women is a key component of implementing life-saving interventions for acute MI. Women perceive their symptoms are often ignored by health care providers and...

Meeting the expectation for scholarly productivity can be challenging for nursing faculty, especially in the absence of grant or other funding. Secondary data analysis is one strategy to address this challenge. The use of existing data to test new hypotheses or answer new research questions has several advantages. It typically takes less time and r...

The co-occurrence of frailty and heart failure (HF) in older adults (65 years or older) can adversely affect the ability to engage in self-care management behaviors, which may alter self-concepts and decrease quality of life. Little is known about how frailty and HF influence older adults' self-concepts or how these self-concepts affect exercise be...

Background:: The American Heart Association created Go Red Heart Match, a free and secure online program that enables women to connect with each other to fight heart disease either personally or as a caregiver for someone with heart disease. Through these connections, participants have an opportunity to develop a personal, private, and supportive...

Background Decision regret is a negative cognitive emotion associated with experiences of guilt and situations of interpersonal harm. These negative affective responses may contribute to emotional exhaustion in critical care nurses (CCNs), increased staff turnover rates and high medication error rates. Yet, little is known about clinical decision r...

Background: Few studies have measured cognitive dysfunction in older adults during acute exacerbations of heart failure (HF), even though 25% of patients are readmitted within 30 days. The aims of this study were to examine cognitive dysfunction and acute HF symptoms in older adults hospitalized for HF and to evaluate the relationship between cogn...

Acute kidney injury after cardiac surgery is associated with increased operative and late mortality. The objective was to determine if short and long term mortality are systematically improved with completeness of postoperative acute kidney injury reversal or with amount of residual renal function. Retrospective, single center study. Tertiary care...

Background: The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual o...

To conduct an analysis of the concept of chronic unexplained orchialgia. Chronic unexplained orchialgia is a concept unique to men's health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. Walker and Avant's framework was used to guide this concept analysis. Literature sources included bibl...

Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men's health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. Thi...

health-related quality of life (HRQOL) is markedly impaired in patients with heart failure (HF). Despite worse prognosis and physical status, older patients have better HRQOL than younger patients. to determine reasons for differences in HRQOL in older compared with younger HF patients. a mixed methods approach was used. HRQOL was assessed using th...

Introduction: Acute coronary syndromes (ACS) are the leading cause of death in older adults, aged 65 years or older. The clinical presentation varies, and the absence of chest pain may occur. Our purpose was to synthesize the published literature (2000-2012) to (1) examine the initial ED presentation of older adults with confirmed ACS, (2) identif...

Background:Memory and executive function may be associated with poorer self-care management behaviors (indicators of self-care decision making). Dysfunction of self-care decision making processes often results in worsening of heart failure symptoms that necessitates hospitalization for acute management.Aims:The purposes of this literature review ar...

Background: Perceived control has been suggested as a modifiable factor associated with health-related quality of life (HRQOL). However, the relationship between perceived control and HRQOL has not been evaluated in patients with heart failure (HF). The purpose of this study was to determine whether perceived control independently predicts HRQOL i...

Hemoglobin A1c (HbA1c) levels are used as a measure of glycemic control, with greater levels indicating poorer control and a greater risk of death. However, recent studies have found a U-shaped association between the HbA1c levels and mortality in patients with heart failure, with the lowest risk of death associated with elevated HbA1c levels, usua...

Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. Th...

The objective of the present study was to revise 3 clinical nurse specialist (CNS) educational tracks with current National Association of Clinical Nurse Specialist core competencies and educational expectations. National curricula recommendations include core competencies by the 3 spheres of influence. Advanced practice registered nurses consensus...

Mortality from acute coronary syndromes has decreased. This achievement is based on the rapid recognition of possible acute coronary syndrome, obtaining an electrocardiogram for diagnosis, and the prompt initiation of therapy, including aspirin, oxygen, thrombolytics, and cardiac catheterization. The importance of rapid diagnosis and therapy is emp...

Age, race, poverty, hypertension, diabetes mellitus, hyperlipidemia, obesity, smoking, and sedentary lifestyle are risk factors for coronary heart disease (CHD) in women. Menstrual cycle irregularity, preeclampsia, and decreasing levels of sex hormones in postmenopausal women are also implicated. The U.S. Preventive Services Task Force does not rec...

Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest-posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage...

With a prevalence of 5 800 000 (≈2% of the entire populace) in 2009 and an estimated yearly incidence of 550 000, the burden of heart failure (HF) in the United States is tremendous.1 Although HF is largely a condition defined by chronic debility, virtually all patients experience, at some point, acute symptoms that trigger a visit to the emergency...

Acute coronary syndromes (ACS) are common in both men and women. Studies show that women have longer times before diagnosis and treatment in the Emergency Department and worse outcomes than men, which may be related to the differing symptom presentations of men and women. Men are more likely to have chest pain, whereas women are more likely to have...

Despite the benefits of prompt treatment of myocardial infarction, gender disparities exist in emergency department (ED) nurses' cardiac triage decisions. To determine the feasibility and utility of the aid to cardiac triage (ACT) intervention designed to improve ED nurses' cardiac triage decisions for women with myocardial infarction. A prospectiv...

Although heart failure (HF) is equally prevalent in men and women, women with HF are more likely to report decreased quality of life and are more likely to die of the disease compared with men. Moreover, HF has been studied less extensively in women and no study has specifically addressed women with New York Heart Association (NYHA) class III HF us...

Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival. To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival. Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to A...

Although nurses frequently determine patient priority and urgency status for emergency evaluation and treatment of symptoms suggestive of myocardial infarction (MI), surprisingly few studies have specifically examined the cardiac triage decisions of emergency department (ED) nurses. Therefore, the purpose of this study was to explicate the decision...

Because rapid therapy can improve the unfavorable prognosis of individuals with acute coronary syndromes (ACSs), it is critical that nurses accurately associate the cues of ACS and quickly and aggressively initiate interventional strategies that reduce mortality. To determine if genetic algorithms (GAs) can be used to decipher the prediction rules...

Understanding why women delay seeking treatment for symptoms suggestive of an acute myocardial infarction remains elusive. Thirty individual semistructured interviews were conducted to determine black (n=10), Hispanic (n=10), and white (n=10) women's perception of heart disease risk and whether differences existed based on participant's race or eth...

This study evaluated symptom similarities and differences between men and women presenting with acute coronary syndromes (ACSs) and determined whether differences in presentation are intrinsic to patient gender or to other factors. This study was a subgroup analysis of patients from an ACS registry. We compared differences in symptom presentation b...

Despite the great advances in treating coronary heart disease (CHD) and increasing survival rates, heart disease remains the #1 killer of women. But women who experience myocardial infarction (MI) may not have the same presenting symptoms as men, even though they share many of the same risk factors for CHD, such as obesity, elevated serum lipid lev...

To examine Black, Hispanic, and White women's knowledge of the symptoms of acute myocardial infarction. Descriptive, nonexperimental design. Detroit, Michigan, and San Antonio, Texas, metropolitan areas. A convenience sample of 78 ethnically diverse women. Hispanics (n = 26) were recruited from San Antonio, Texas; Blacks (n = 26) were recruited fro...

The purpose of this study was to determine the patient cues that emergency department (ED) nurses use to triage male and female patients with complaints suggestive of acute coronary syndromes (ACSs) and to determine if cues used by ED nurses to make clinical inferences varied by patient sex or nurses' demographic characteristics. Using clinical vig...

Studies of tracheostomy for respiratory failure have suggested a poor prognosis, however, trauma patients may have a better outcome. Data from 113 trauma patients were retrospectively analyzed for comorbidities, laboratory values, and hospital course. Long-term survival was determined from the Social Security Death Index. Trauma patients were young...

The purpose of this study was to determine hospital and postdischarge survival and functional status at follow-up in elderly patients receiving tracheostomy for respiratory failure and to determine if these outcomes differed between the younger elderly (65-74 years) and the older elderly (= 75 years). This was a retrospective chart review with pros...

The decision to care is often mandated by unavoidable alterations within the family, requiring a primary caregiver. One population that often requires complex community-based care is survivors of prolonged mechanical ventilation (PMV). This investigation explored the choices and challenges of eight family caregivers of PMV survivors. Using content...

Women who experience symptoms of an acute myocardial infarction (MI) are less likely than men to seek medical attention after the onset of initial symptoms. The purpose of this study was to facilitate a better understanding of the treatment-seeking decisions of women who seek emergency evaluation for symptoms suggestive of MI. A qualitative, semi-s...

Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may...

Coronary heart disease is the number 1 killer of adults in the United States, affecting 1 in 5 men and women. However, women are more likely than men to die after an acute coronary event and are less likely to receive prompt or aggressive treatment. Few studies have examined the role of emergency nurses' triage decisions in these disparities, even...

To determine the patient characteristics, hospital course, hospital cost, posthospital survival, and functional outcome in a group of patients with tracheostomy for respiratory failure. Retrospective chart review combined with prospective evaluation of functional status. An urban, tertiary-care medical center. Adult patients with tracheostomy for r...

Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. This article serves to describe the experience of patients who survived PMV and to identify salient factors that contrib...

To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery. Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years. One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who under...

Feminist poststructuralism: a methodological paradigm for examining clinical decision-making Aim. To present the philosophical framework of feminist poststructuralism, discuss its use as an innovative research approach and its implications for nursing knowledge development and practice. Background. This perspective examines the construction of mean...