The first 12 weeks following discharge from hospital: The experience of Gujarati South Asian survivors of myocardial infarction and their families
Rosemary A Webster
Clinical Nurse Specialist, Coronary Care Unit
Leicester General Hospital, Leicester, United Kingdom
David R Thompson
Faculty of Health Sciences, Australian Catholic University, Melbourne VIC
Patricia M Davidson
Centre of Cardiovascular and Chronic Care, School of Nursing and Midwifery, University of Technology Sydney, Sydney NSW; Curtin University, Perth WA
PP: 288 - 299
Abstract
The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs.
Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience.
Keywords
Gujarati; acute myocardial infarction; recovery; cultural competence
References
Annells M. & Koch T (2001): 'The real stuff': implications for nursing of assessing and measuring a terminally ill person' quality of life. Journal of Clinical Nursing 10(6): 806-812.
Bunker SJ, Colquhoun DM, Esler MD, et al. (2003): Stress and coronary heart disease: psychosocial risk factors. Medical Journal of Australia 178 (6): 272-276.
Cappuccio FP, Oakeshott. P, Strazzullo P, Kerry SM (2002): Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice: cross sectional population based study. British Medical Journal 325 (7375):1271.
Chaturvedi N, Rai H, Ben-Shlomo Y (1997): Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans. Lancet 350 (9091):1578-83.
Chaturvedi N (2003): Ethnic differences in cardiovascular disease. Heart 89: 681-686.
Conn VS, Taylor SG & Wiman P (1991): Anxiety, depression, quality of life and self-care among survivors of myocardial infarction. Issues in Mental Health Nursing 12: 321-331.
Daly J, Elliott D, Cameron-Traub E, Salamonson Y, Davidson P, Jackson D, Chin C, Wade V (2000): Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction. American Journal of Critical Care 9: 62-69.
Daly J, Jackson D, Davidson PM, Wade V, Chin C, Brimelow V (1998): Illuminating the experiences of female spouses of survivors of acute myocardial infarction (AMI): A pilot study of Lebanese-born women in South Western Sydney, Australia. Journal of Advanced Nursing 28: 1199-1206.
Daly J, Sindone A, Thompson D, Hancock K, Chang E, Davidson PM. (2001): Barriers in participation and adherence to cardiac rehabilitation programs: a critical literature review. Progress in Cardiovascular Nursing 17 (4): 8-17.
Davidson PM, Daly J, Meleis AM, Douglas M (2003): Globalization as we enter the 21st Century: reflections and directions for nursing research, science and practice. Contemporary Nurse (in press).
Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo A, Braslow A. (1995): Causes if delay in seeking treatment for acute myocardial infarction. Soc Sci Med 40:379-92.
Gerrish K (2001): The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers. Journal of Advanced Nursing; 33:566-74.
Gujarati Language Resources. Accessed at http://is.rice.edu/~riddle/play/guju.html 9 July 2003.
Gujarat Indian Government. Accessed at http://www.gujaratindia.com/Statistics/1558new.htm 9 July 2003.
Jackson D, Daly J, Davidson P, Elliott D, Cameron-Traub E, Wade V, Chin C, Salamonson Y (2000): Women recovering from first-time myocardial infarction: a feminist qualitative study. Journal of Advanced Nursing 32: 1403-1411.
Johnson JL & Morse JM (1990): Regaining control: The process of adjustment after myocardial infarction. Heart & Lung 19: 126-135.
Knight TM, Smith Z, Whittles A, Sahota P, Hogg G, Bedford A (1992): Insulin resistance, diabetes, and risk markers for ischemic heart disease in Asian men and non-Asian men in Bradford. British Heart Journal 67:343-350.
Kulkarni KR, Markovitz JH, Nanda NC, Segrest JP (1999): Increased prevalence of smaller and denser LDL particles in Asian Indians. Arteriosclerosis, Thrombosis & Vascular Biology 19: 2749-2755.
Miles, M. & Hubermann, M. (1994). Qualitative Data Analysis. (2nd Ed) California: Sage.
McKeigue PM, Miller GJ, Marmot MG (1989): Coronary heart disease in South Asians overseas - a review. Journal of Clinical Epidemiology 42: 597-609
McKeigue PM., Shah B, Marmot MG (1991): Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 337: 382-386.
Meleis AI (1996): Culturally competent scholarship: substance and rigor... based on a keynote speech given at the 11th research conference 'Toward Culturally Competent Health Care,' Rutgers State University. Advances in Nursing Science 19(2):1-16.
Meleis AI & Im E (1999): Transcending marginalization in knowledge development. Nursing Inquiry 6(2): 94-102.
Messias DKH (2001): World Health. Globalization, nursing and health for all. Journal of Nursing Scholarship 33(1): 9-11.
National Heart Foundation of Australia (2003): Reducing risk in heart disease; guidelines for preventing cardiovascular events in people with coronary heart disease. Accessed at http://www.heartfoundation.com.au/prof/index_fr.html, 10 July 2003.
Preston RM. (1997) Ethnography: studying the fate of health promotion in coronary families. Journal of Advanced Nursing 1997; 25(3):554-61.
Stewart, M., Davidson, K., Meade, D., Hirth, A., & Makrides, L. (2000). Myocardial infarction: survivors' and spouses' stress, coping and support. Journal of Advanced Nursing, 31(6): 1351-1360.
Thompson DR, Ersser SJ, Webster RA (1995): The experiences of patients and their partners one month after a heart attack. Journal of Advanced Nursing 22: 707-714.
Venkatramana P & Reddy PC (2002): Association of overall and abdominal obesity with coronary heart disease risk factors: comparison between urban and rural Indian men. Asia Pacific Journal of Clinical Nutrition 11(1):66-71.
Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P, Timmis AD: (1996) Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. British Medical Journal 312(7042):1330-3.
Webster R (1997): The experiences and health care needs of Asian coronary patients and their partners. Methodological issues and preliminary findings. Nursing in Critical Care 2: 215-223.
Webster RA, Thompson DR, Mayou RA (2002): The experiences and needs of Gujarati Hindu patients and their partners in the first month after a myocardial infarction. European Journal of Cardiovascular Nursing 1:69-76.
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