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When time matters: Patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0002-7097-392X
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase. A descriptive survey study was conducted to identify various factors influencing patient delay in 381 patients with suspected myocardial infarction hospitalised at a Coronary Care Unit (I) and ambulance utilisation among 110 myocardial infarction patients (II). In order to obtain a deeper understanding of the myocardial infarction patients’ own conceptions about the event, an interview study with a phenomenographic approach was conducted with 15 strategically selected myocardial infarction patients (III), within 72 hours after admission to hospital. Finally, the pre-hospital experiences of 15 spouses of myocardial infarction patients were also studied through interviews with a phenomenographic approach, within 48 hours after the affected partner’s admittance to hospital (IV). The results showed that 59% of the patients with suspected acute myocardial infarction delayed > 1 hour after onset of symptoms. The most common reasons given for delay in seeking hospital admittance were: (1) Did not consider the symptoms as to be severe enough that they warranted hospital care, (2) thought the symptoms to be temporary and that they would disappear, (3) the chest pain was more of a dull pain, (4) or, as one third of the patients chose to do, contacted the general practitioner instead of going directly to the hospital (I). Furthermore, as a first action, 59% consulted their spouse for advice about what to do henceforth. The most common reason for additional delay when the decision to go to hospital had already been taken was that the myocardial infarction patients stated that they were unaware of the advantages of a rapid decision-making process. Sixty percent went by ambulance, but it was the spouse (40%) or the personnel at the general practitioner’s office (32%) who called the emergency service number, rather than the patient him/her self (5%). The most frequently given reasons for not choosing ambulance, were that the patients did not perceive their symptoms as being serious enough to require ambulance transportation (43%), followed by that they had not thought about ambulance as an alternative at all (38%). As a third reason for not going by ambulance, the patients stated that it was unnecessary to call an ambulance when being affected by symptoms related to a myocardial infarction (26%). The patients who called an ambulance differed in some respects from those who went by private alternatives; patients with large infarctions (ST-Elevation Myocardial Infarction) went by ambulance more frequently, as did patients suffering from nausea and severe chest pain (II). The patients expressed in the interviews how the interaction with others, described as the need for supportive environment, worries for the family and the utilisation of the health-care resources, was of great importance in the pre-hospital phase. Likewise, symptom awareness, with earlier experiences of a similar situation to compare with, denying the seriousness of the situation and the use of different self-care strategies, were important in order to manage the situation. Vulnerability, expressed as anxiety and a lack of control, also influenced the decision-making process in the pre-hospital phase (III). Spouses seemed to have a strong influence on the course of events when their partner suffered an acute myocardial infarction and it emerged from the interviews how the spouses in many cases were influenced into sharing the denial of the affected partner by respecting his/her independence. The spouses accepted the partner’s need for control; took earlier marital roles and experiences into account; restraining own emotions and seeking agreement with their partners, contributing to delay. However, being resourceful by sharing the experience; having knowledge; understanding the severity; being rational and consulting others when needed, seemed to have a positive influence on the decision time in the pre-hospital phase (IV).

Conclusion: The reasons for delaying or not in the pre-hospital phase, as well as the reasons for utilising the ambulance services or not, varied considerably between individuals. Earlier experiences of MI did not influence what actions to take; instead patients’ feelings, emotional attitudes to MI symptoms, inadequate coping strategies, and spouses’ influences were important components in the pre-hospital phase.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 941
Keyword [en]
acute coronary syndrome, acute myocardial infarction, pre-hospital phase, symptom interpretation, decision-making, spouses, patient delay, ambulance utalisation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-6748ISBN: 91-85497-74-6 (print)OAI: oai:DiVA.org:liu-6748DiVA: diva2:21976
Public defence
2006-04-21, Elsa Brändströms sal, Universitetssjukhuset, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2006-06-13 Created: 2006-06-13 Last updated: 2013-09-12
List of papers
1. Factors related to delay times in patients with suspected acute myocardial infarction
Open this publication in new window or tab >>Factors related to delay times in patients with suspected acute myocardial infarction
2004 (English)In: Heart & Lung: The Journal of Acute and Critical Care, ISSN 0147-9563, Vol. 33, no 5, 291-300 p.Article in journal (Refereed) Published
Abstract [en]

Objective

The study’s objective was to describe symptoms, symptom management, and patient delay times in patients seeking treatment for suspected acute myocardial infarction (AMI), and to find explanatory factors influencing the decision time.

Method

This is a descriptive survey study including 403 Swedish patients with a median age of 64 years with suspected AMI.

Results

Altogether, 84% of the patients suspected that the symptoms emanated from the heart. Despite this fact, 59% delayed going to the hospital more than 1 hour after the onset of symptoms. In the multiple regression analysis, a “dull pain,” the patients’ belief that it was nothing serious, and contact with the general practitioner were associated with prolonged delay. The decision to contact the emergency service shortened the delay time.

Conclusions

The patient’s subjective feeling of the severity of symptoms is an important predictor for delay times. There is still a need for public awareness of the appropriate responses to AMI symptoms, that is, to call for an ambulance instead of contacting the general practitioner.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13864 (URN)10.1016/j.hrtlng.2004.04.002 (DOI)
Available from: 2006-06-13 Created: 2006-06-13 Last updated: 2013-09-12
2. Ambulance use in patients with acute myocardial infarction
Open this publication in new window or tab >>Ambulance use in patients with acute myocardial infarction
2004 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, Vol. 19, no 1, 5-12 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the choice of transportation mode to hospital in patients experiencing acute myocardial infarction.

Method: A descriptive survey study at the Coronary Care Unit of one Swedish University Hospital. The study was carried out between July 2000 and March 2001.

Results: The study population consisted of 114 consecutive patients with acute myocardial infarction. Thirty-two percent stated that they did not know the importance of a short delay when experiencing an acute myocardial infarction. Only 60% called the emergency service number, 112. Patients calling for an ambulance differed from those who did not in several aspects. Medical characteristics associated with ambulance use in a univariate analysis were ST-elevation myocardial infarction and prior history of myocardial infarction. There were no differences regarding gender or age. When looking at the patients' symptom-experience, patients with vertigo or nausea and severe pain chose an ambulance for transport to the hospital. The only significant reasons for not choosing an ambulance were cramping pain and the patient perceiving the symptoms not to be serious. In a multivariate analysis, ST-elevation (OR = 0.30, P = .04), unbearable symptoms (OR = 0.20, P = .03), and nausea (OR = .33, P = .04) appeared as independent predictors of ambulance use and cramping pain (OR = 5.17, P = .01) for not using an ambulance.

Conclusions: Patients with acute myocardial infarction view the ambulance as an option for transportation to hospital only if they feel really sick. For that reason, it needs to be made well known to the public that ambulances are not only a mode of transport, but also provide diagnostics and treatment.

Keyword
acute myocardial infarction, ambulance use, decision-making, prehospital delay
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13865 (URN)
Available from: 2006-06-13 Created: 2006-06-13 Last updated: 2013-09-12
3. Patients' conceptions of suffering an acute myocardial infarction
Open this publication in new window or tab >>Patients' conceptions of suffering an acute myocardial infarction
2006 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13866 (URN)
Available from: 2006-06-13 Created: 2006-06-13 Last updated: 2013-09-12
4. Spouses conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction - A qualitative analysis
Open this publication in new window or tab >>Spouses conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction - A qualitative analysis
2008 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 7, no 3, 182-188 p.Article in journal (Refereed) Published
Abstract [en]

Background: Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse.

Aim: Was to describe spouses conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction.

Method: A phenomenographic approach was applied. Fifteen spouses were interviewed <48 h after the partners hospital admittance.

Findings: Two categories with underlying sub-categories conceptualised the spouses experiences. The category being resourceful contained: sharing the experience, having knowledge, understanding the severity, being rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement.

Conclusion: Our findings suggest that spouses have a strong influence on the course of events. When accepting the partners need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.

Keyword
Acute myocardial infarction, Spouses, Decision-making, Delay, Pre-hospital phase, Phenomenography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16118 (URN)10.1016/j.ejcnurse.2007.11.002 (DOI)
Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2013-09-12

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