Women´s Experience of a myocardial infarction
Author
Summary, in English
Background: Coronary heart disease (CHD) is the sleading cause of mortality in men
and women in Western society. Few studies of CHD have been performed on women
or with a focus on cardiac risk factors in women’s lives. Results from studies of men
have been generalized to women, which may be inappropriate or even dangerous.
Aim: The overall aim of this thesis was to describe women’s experience of a
myocardial infarction and to explore and describe important factors associated with
this. Furthermore, to describe women’s daily life five years later and the long-term
follow-up resources in primary care.
Method: The first study (I) described women’s (n=19) symptoms and reasons for
delay in seeking medical care at the time of a first myocardial infarction. A content
Sanalysis method was used. The second study (II) looked at how women perceive
stress in their daily lives at the time of (n=20) and after (n=14) the MI. The third
study (III) examines how women cope with stress at the time of (n=20) and after
(n=14) an MI. In study four (IV) the women (n=12) were interviewed five years after
the MI. Studies II, III and IV used a phenomenographic method with contextual
analysis. Study five (V) describes the results of a questionnaire sent to primary health
care centres in Skåne, elucidating resources and cardiac rehabilitation possibilities.
Findings: The women had difficulties interpreting the symptoms or did not recognize
the symptoms at all until they experienced their first MI (I). They had problems
making the final decision to seek medical care. The women wanted support and help
from a family member or a friend. Some women found it difficult to call for
ambulance transportation and often first consulted the PHCC (I). Study II resulted in
two description categories: the women conceived the stress as a personal trait and as
a response to their immediate surroundings. The women had experienced being under
enormous pressure at the time of the MI, which they found stressful. Furthermore,
they had to assume a great deal of responsibility for their family and work. After the
MI the stress continued to increase. Study III resulted in three description categories
regarding the women’s coping strategies with stress at the time of and after the MI:
cogitative actions, social belonging and emotional diversion. The women became
aware that they needed to make plans for their needs and it was essential for them to
be confirmed. By talking to someone they trusted they received emotional support.
Avoidance was used because they did not take their cardiac events seriously and tried
just to resume their lives as if nothing had happened. Study IV showed that the
women changed their lifestyle immediately and some needed time for reflection
before they could make the prescribed lifestyle changes. The women found it
difficult to continue with all the changes. Even five years after the MI they still
needed support from health care professionals. A minority of the PHCCs (V) had
nurses with special education in coronary heart disease and cardiac rehabilitation, and
5% of the PHCCs had nurses with a special position to take care of these patients. Of
all centres 76% had access to a physiotherapist whereas there were significantly more
8
public PHCCs compared to private centres that had access to a physiotherapist. The
same relation was found regarding access to a dietician.
Conclusions and implications: The women had difficulties interpreting the symptoms
or did not recognize the symptoms at all until they experienced their first MI. For
women it is important to recognize the role of stress as an essential risk factor for MI.
The women described how they felt stress over a long period and how it affected
them. They mentioned different strategies to cope with stress in their personal and
professional lives related to MI. Even five years after the MI, that event had a
significant impact on the women An understanding of this phenomenon can assist
primary healthcare, coronary care and rehabilitation nurses in supporting women, as
well as their partners, to adapt their daily lives both before and after an MI. This
thesis points out that patients suffering an MI need long-term support. Well-educated
staff with adequate resources in primary health care can be of great importance.
and women in Western society. Few studies of CHD have been performed on women
or with a focus on cardiac risk factors in women’s lives. Results from studies of men
have been generalized to women, which may be inappropriate or even dangerous.
Aim: The overall aim of this thesis was to describe women’s experience of a
myocardial infarction and to explore and describe important factors associated with
this. Furthermore, to describe women’s daily life five years later and the long-term
follow-up resources in primary care.
Method: The first study (I) described women’s (n=19) symptoms and reasons for
delay in seeking medical care at the time of a first myocardial infarction. A content
Sanalysis method was used. The second study (II) looked at how women perceive
stress in their daily lives at the time of (n=20) and after (n=14) the MI. The third
study (III) examines how women cope with stress at the time of (n=20) and after
(n=14) an MI. In study four (IV) the women (n=12) were interviewed five years after
the MI. Studies II, III and IV used a phenomenographic method with contextual
analysis. Study five (V) describes the results of a questionnaire sent to primary health
care centres in Skåne, elucidating resources and cardiac rehabilitation possibilities.
Findings: The women had difficulties interpreting the symptoms or did not recognize
the symptoms at all until they experienced their first MI (I). They had problems
making the final decision to seek medical care. The women wanted support and help
from a family member or a friend. Some women found it difficult to call for
ambulance transportation and often first consulted the PHCC (I). Study II resulted in
two description categories: the women conceived the stress as a personal trait and as
a response to their immediate surroundings. The women had experienced being under
enormous pressure at the time of the MI, which they found stressful. Furthermore,
they had to assume a great deal of responsibility for their family and work. After the
MI the stress continued to increase. Study III resulted in three description categories
regarding the women’s coping strategies with stress at the time of and after the MI:
cogitative actions, social belonging and emotional diversion. The women became
aware that they needed to make plans for their needs and it was essential for them to
be confirmed. By talking to someone they trusted they received emotional support.
Avoidance was used because they did not take their cardiac events seriously and tried
just to resume their lives as if nothing had happened. Study IV showed that the
women changed their lifestyle immediately and some needed time for reflection
before they could make the prescribed lifestyle changes. The women found it
difficult to continue with all the changes. Even five years after the MI they still
needed support from health care professionals. A minority of the PHCCs (V) had
nurses with special education in coronary heart disease and cardiac rehabilitation, and
5% of the PHCCs had nurses with a special position to take care of these patients. Of
all centres 76% had access to a physiotherapist whereas there were significantly more
8
public PHCCs compared to private centres that had access to a physiotherapist. The
same relation was found regarding access to a dietician.
Conclusions and implications: The women had difficulties interpreting the symptoms
or did not recognize the symptoms at all until they experienced their first MI. For
women it is important to recognize the role of stress as an essential risk factor for MI.
The women described how they felt stress over a long period and how it affected
them. They mentioned different strategies to cope with stress in their personal and
professional lives related to MI. Even five years after the MI, that event had a
significant impact on the women An understanding of this phenomenon can assist
primary healthcare, coronary care and rehabilitation nurses in supporting women, as
well as their partners, to adapt their daily lives both before and after an MI. This
thesis points out that patients suffering an MI need long-term support. Well-educated
staff with adequate resources in primary health care can be of great importance.
Publishing year
2011
Language
English
Publication/Series
Lund Univeristy, Faculty of Medicine Doctoral Dissertation Series
Volume
2011:39
Full text
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Document type
Dissertation
Publisher
Department of Cardiothoracic Surgery, Clinical Sciences, Lund University
Topic
- Cardiac and Cardiovascular Systems
- Surgery
Keywords
- myocardial infarction
- women
- content analysis
- phenomenographicmethod
- stress
- coping
- rehabilitation
- primary health care
Status
Published
Research group
- Child and Family Health
Supervisor
- Trygve Sjöberg
- Bodil Ivarsson
ISBN/ISSN/Other
- ISSN: 1652-8220
- ISBN: 978-91-86671-87-7
Defence date
10 May 2011
Defence time
09:15
Defence place
Segerfalksalen, BMC
Opponent
- Ekman Inger (Professor)