DOI QR코드

DOI QR Code

Self-care in Patients with Atrial Fibrillation Based on the Theory of Unpleasant Symptoms

불쾌 증상 이론을 적용한 심방 세동 환자의 자가관리

  • Kim, Min Young (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Lee, Sun Hee (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Park, Han Jong (College of Nursing, The Catholic University of Korea)
  • 김민영 (가톨릭대학교 서울성모병원) ;
  • 이선희 (가톨릭대학교 서울성모병원) ;
  • 박한종 (가톨릭대학교 간호대학)
  • Received : 2021.11.24
  • Accepted : 2022.02.24
  • Published : 2022.04.30

Abstract

Purpose: This study aimed to identify the relationships among disease severity, anxiety, depression, social support, unpleasant symptoms and self-care among patients with atrial fibrillation based on the unpleasant symptom theory, and to examine the mediating effects of unpleasant symptoms. Methods: A cross-sectional study was conducted. The participants were 216 patients with atrial fibrillation who were being followed up on an outpatient basis at a university hospital in Seoul. Data were collected from November 1, 2020 to June 30, 2021, using self-report questionnaires. Data were analyzed using IBM SPSS/WIN 27.0 and PROCESS macro with 95% bias-corrected bootstrap confidence interval(CI). Results: The average age of participants in this study was 66.0years. Disease severity (β=10.19, p<.001) and depression (β=1.53, p<.001) had significant positive relationships with unpleasant symptoms. Also, unpleasant symptoms (β=-0.03, p=.006) had a negative relationship with physical activity, which is a subscale of self- care. Social support (β=0.06, p<.001) was positively related with physical activity. Unpleasant symptoms showed a mediation effect in the relationship between disease severity and physical activity (Bias corrected bootstrap CI -0.65, -0.04). Depression had an indirect effect on physical activity that was mediated by unpleasant symptoms (Bias corrected bootstrap CI -0.11, -0.00). Conclusion: The findings of this study suggest that integrated strategies including physical, psychological, and social factors should be considered to promote self-care in patients with atrial fibrillation.

Keywords

Acknowledgement

본 연구는 2020년 가톨릭대학교 서울성모병원에서 연구비를 지원받아 진행한 연구임.

References

  1. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2014;64(21):e1-e76. https://doi.org/10.1016/j.jacc.2014.03.022
  2. Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, et al. 10-year nationwide trends of the incidence, prevalence, and adverse outcomes of non-valvular atrial fibrillation nationwide health insurance data covering the entire Korean population. American Heart Journal. 2018;202:20-26. https://doi.org/10.1016/j.ahj.2018.04.017
  3. Kishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: A systematic review and meta-analysis. Stroke. 2014;45(2):520-526. https://doi.org/10.1161/strokeaha.113.003433
  4. Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009;373(9658):155-166. https://doi.org/10.1016/s0140-6736(09)60040-4
  5. Ro YM, Shim WJ, Yoo SH. Relation between left atrial size and atrial fibrillation. Korean Circulation Journal. 1985;15(2):285-290. https://doi.org/10.4070/kcj.1985.15.2.285
  6. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the Manitoba follow-up study. American Journal of Medicine. 1995;98(5):476-484. https://doi.org/10.1016/s0002-9343(99)80348-9
  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Revista Espanola de Cardiologia. 2017;70(1):50. https://doi.org/10.1016/j.rec.2016.11.033
  8. Kang YH. The Relationships among uncertainty, appraisal of uncertainty, depression, anxiety and perceived health status in patients with atrial fibrillation. Korean Journal of Adult Nursing. 2005;17(2):230-238.
  9. Kang YH. Correlates of depression and perceived health status in patients with atrial fibrillation. Korean Journal of Adult Nursing. 2009;21(1):86-94.
  10. McCabe PJ. Psychological distress in patients diagnosed with atrial fibrillation: The state of the science. Journal of Cardiovascular Nursing. 2010;25(1):40-51. https://doi.org/10.1097/JCN.0b013e3181b7be36
  11. Baek KH, Son YJ. Relationships between symptom experience and quality of life in patients with atrail fibrillation. Journal of Korean Academy of Fundamentals of Nursing. 2008;15(4): 485-494.
  12. McCabe PJ, Schumacher K, Barnason SA. Living with atrial fibrillation: A qualitative study. Journal of Cardiovascular Nursing. 2011;26(4):336-344. https://doi.org/10.1097/JCN.0b013e31820019b9
  13. Lenz ER, Pugh LC, Milligan RA, Gift A, Suppe F. The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science. 1997;19(3):14-27. https://doi.org/10.1097/00012272-199703000-00003
  14. Yang IS. A structural model for self-management of heart failure patients based on the theory of unpleasant symptoms [dissertation]. Seoul: Ewha Womens University; 2013. p. 1-129.
  15. Hansen C, Zinckernagel L, Schneekloth N, Zwisler AO, Holmberg T. The association between supportive relatives and lower occurrence of anxiety and depression in heart patients: Results from a nationwide survey. European Journal of Cardiovascular Nursing. 2017;16(8):733-741. https://doi.org/10.1177/1474515117715761
  16. Kang HC, Yeon KP, Han ST. A review on the use of effect size in nursing research. Journal of Korean Academy of Nursing. 2015;45(5):641-649. https://doi.org/10.4040/jkan.2015.45.5.641
  17. Wynn GJ, Todd DM, Webber M, Bonnett L, McShane J, Kirchhof P, et al. The European Heart Rhythm Association symptom classification for atrial fibrillation: Validation and improvement through a simple modification. EP Europace. 2014;16(7):965-972. https://doi.org/10.1093/europace/eut39519
  18. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal FMedicine. 2006;166(10):1092-1097. https://doi.org/10.1001/archinte.166.10.1092
  19. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  20. Park SJ, Choi HR, Choi JH, Kim KW, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety and Mood. 2010;6(2):119-124.
  21. Zimet GD, Dalhlem NW, Zimet SG, Farley GK. The multi-dimensional scale of perceived social support. Journal of Personality Assessment. 1988;52(1):30-41. https://doi.org/10.1207/s15327752jpa5201_2
  22. Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean Journal of Social Welfare. 1999;37:241-269.
  23. Bubien RS, Kay GN, Jenkins LS. Test specifications for symptom checklist: Frequency and severity. Milwaukee (WI): University of Wisconsin-Milwaukee; 1993.
  24. Jeon HR, Park JS. Development and application of a self-management program based on prothrombin INR monitoring for patients with cardiac valve replacement. Journal of Korean Academy of Nursing. 2015;45(4):554-564. https://doi.org/10.4040/jkan.2015.45.4.554
  25. Oh YH. Effect of individualized education intervention for self-management enhancement in patients with atrial fibrillation [dissertation]. Seoul: Hanyang University; 2018. p. 1-90.
  26. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Lee HG, translator. Seoul: Shinyoungsa; 2015.
  27. Kim KH, Song JH, Shin SY. The level of knowledge related to disease in patients with atrial fibrillation. Journal of the Korea Convergence Society. 2021;12(6):249-258. https://doi.org/10.15207/JKCS.2021.12.6.249
  28. Mulligan K, Mehta PA, Fteropoulli T, Dubrey SW, McIntyre HF, McDonagh TA, et al. Newly diagnosed heart failure: change in quality of life, mood, and illness beliefs in the first 6 months after diagnosis. British Journal of Health Psychology. 2012;17(3):447-462. https://doi.org/10.1111/j.2044-8287.2011.02047.x
  29. Choi SY, Ko IS. The Influence of self-care agency and social support on self-care practice among spinal cord injured pati ents. Korean Journal of Adult Nursing. 2017;29(6):569-578. https://doi.org/10.7475/kjan.2017.29.6.569
  30. Choi SM, Ko IS, Choi MN, Jang YS. The Relationship among menopausal symptoms, competency of self-care agency and social support in middle-aged woman. Journal of Korean Clinical Nursing Research. 2015;21(1):105-115. https://doi.org/10.22650/JKCNR.2015.21.1.105