Stress is a risk factor for coronary heart disease (CHD); which is found in women before and after myocardial infarction (MI). Unfortunately, very little is known about the insight of women’s daily life. This study aims at explaining and investigating women’s awareness of stress before, and after an MI. The study uses two interviews with women suffering an MI; where the first is conducted at the hospital with a sample size of twenty participants, and the second takes place 4-10 months after the MI with a sample size of 14 respondents. The respondents’ responses are tape-recorded and the data obtained from the two interviews analyzed using a phenomenography approach.
From the findings, the stress came from within (personal traits) or from the environment. The stress before MI is a result of the roles the women have to play in their daily life where they have no control over their daily life. After being discharged from the hospital they lacked the strength they had before, in carrying out their daily activities and hence needed support. Greater emphasis is needed on stress as a risk factor and at the same time imparting knowledge to the nurses in the coronary care unit, and primary health care on how to help these women to be accustomed to their daily life before and after the MI
Introduction and purpose of the study
Challenging, harmful and threatening events bring about stress in life depending on how an individual evaluates them. Myocardial infarction (MI) included in coronary heart disease (CHD); has been a health hazard that leads to premature morbidity and mortality. Long-term gains of health are attributed to advancement in health styles but unfortunately; most women do not maintain an advocated lifestyle change, which leads to their stressful life. Women recognize stress as the main cause of MI, hence needs to be prevented since they develop cardiac suffering symptoms after MI more than men. MI is viewed as a disruption to women’s family and social commitment; and therefore, nurses running women’s clinics should recognize that CHD further leads to death in women. The purpose of this study was targeted to give a description and exploration of women’s awareness of stress, before and after MI (Polit & Beck, 2009).
Women’s own insight of their daily life as far as stress before and after MI is concerned, has not been largely known from the literature reviewed. The sample of women studied was from coronary care unit in southern Sweden, where a University Hospital was studied (Polit & Beck, 2009).
The qualitative analysis of stress was described by an approach stirred by phenomenography which was developed to portray, examine and understand human being’s experiences of different occurrences in their surrounding world. This shows how something is experienced; and is an awareness that symbolizes something implied, which needs to be said or not as it has never been revealed (Polit & Beck, 2009).
The Interview method used; involved where women were sampled from the coronary care unit with respect to age, social status, education and the number of children they had. On the first occasion, twenty women were interviewed on their second or third day in the hospital. Out of these twenty women, fourteen of them participated during the second interview which was performed roughly 4 to 10 months after the MI. Out of the six who did not participate in the second interview, two had died and four were rejected to be interviewed. To ease the interview the researchers constructed an interview guide which was based on the experiences they had as cardiac nurses; and also, from the literature review. Women were given confidence in explaining their situations, by using their own words when answering the questions. The tape recording was another method used by the researchers since they tape-recorded the explanations of the women; when they were answering the interview questions (Polit & Beck, 2009).
Sampling and data collection
A broad sample with a maximum variation was employed by strategic selection; which was done in relation to age, social status, education and the number of children the women had. The sampling size was manageable making it easier during data analysis. Sampling was conducted twice with the first one comprising of twenty participants, and the second one having fourteen participants in order to come up with the required information. The data regarding stress in women before and after MI was collected through the interview method; where interview guide questions were formulated to be answered by the participants. Two sets of interviews were performed one to the women on their second day of hospitalization and the other one carried out after 4, 6, and 10 months after the MI. The questions asked were simple and consistent with the topic of study. These interview questions showed how explicitly the researcher’s assumptions and biases were treated. The participants were informed of the confidentiality of information given, and participation was voluntary where participants could withdraw at any time (Polit & Beck, 2009).
Phenomenographic procedures were used in data analysis which comprised seven steps. The researcher familiarized himself with the whole text in order to have an overall recognition of the experienced occurrence. The researcher read the participants’ responses in order to get the perception of stress among women. There was a comparison of how the participants experienced the occurrence, in identifying the sources of variation or agreement. Statements with similarities were clustered into suitable patterns within the overall structure of the awareness. Similarities within each cluster of statements were described as a preliminary group, and the center of concentration moved from the relationship within awareness to relationships between the groups. The groups were named differently as an expression of the essence from their consent. The groups were hence compared in terms of similarities and differences in the levels of understanding, articulated by the respondents (Polit & Beck, 2009).
The findings were described in different categories. The descriptive category showed how the respondents recognized stress from an individual viewpoint. Stress in women was found to be present a long time before the MI; as was indicated by the four perceptions that showed women’s stress before and after the MI. On the other hand, only the fifth perception showed women’s stress after the MI. Conflicts and pressures in life were the common reasons for stress. After the MI, women wanted to experience the same daily life as it was before the MI that made them become stressed because they lacked control over their daily life. As the women were trying to have their daily life organized, there were instances of restlessness, prolonged anxiety, and worry which emanated from within them as they felt that their lives were meaningless. This stressful life was indicated as resulting in their MI which triggered their ill health. These diseases include diabetes, rheumatoid arthritis and severe headaches (Polit &Beck, 2009).
On the other hand, when the women returned home from the coronary care unit, they lacked enough strength for carrying out their daily activities; hence instances of tiredness were indicated as stress after the MI. The women were also preoccupied with thoughts about the MI; especially the younger ones who thought that only the elderly women would suffer an MI (Polit & Beck, 2009).
The descriptive category illustrated the women’s perception of stress in relation to the environment, with five insights indicating that stress is found both before and after the MI. The women were having responsibilities to do with the whole family, another person, or work which was considered as resulting in the MI. After the MI, they wanted to take the same responsibilities they would; before the MI but on realizing that they lacked the strength they had before, their daily lives turned to be stressful (Polit & Beck, 2009).
This study indicated that stress is a primary and relevant topic to be discussed as it can be seen that these Swedish women; were stressed as far as the roles they were to play in their daily life were concerned. Experiences of women regarding stress to do with an MI; had not been addressed before. Therefore, to prevent CHD and evade stress in women’s daily life, more concentration needs to be centered on stress as an important risk factor. Supporting the women after their discharge from the hospital is needed since stress originates from the women themselves, or the immediate environment. The study implies the necessity of understanding women’s experiences, both before and after the MI in order to appraise, arrange, execute and assess nursing care. Information on the prevention of CHD and second MI should be provided to the general public, and employees of nursing care (Polit & Beck, 2009).
Polit, D., & Beck, C. (2009). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, seventh Edition. Philadelphia: Lippincott Williams & Wilkins Press.