AN ABSTRACT OF THE DISSERTATION OF GREGORY STEINSDOERFER, for the Doctor of Philosophy degree in PSYCHOLOGY, presented on December, 12, 2014, at Southern Illinois University Carbondale. TITLE: BURNED OUT FROM HEALING THE BROKEN HEARTED: THE EXPERIENCES OF CARDIAC NURSES MAJOR PROFESSOR: Kathleen Chwalisz, Ph.D. It has been well documented that prevalence of cardiovascular disease has become a major global healthcare problem. In the United States, healthcare expenditures have dramatically increased as more and more people are requiring cardiovascular treatment. Treatment outcomes (e.g., mortality rates, readmission rates) for cardiovascular disease related illnesses can vary drastically from one hospital to another. Researchers have recently attempted to understand why these drastic differences in performance exist from hospital to hospital. It has been suggested, that one important avenue for improving cardiovascular care is to improve hospital staff performance. Of all hospital staff, nurses spend the most time working directly with cardiac patients and their families. Nurses also frequently report high levels of occupational stress, burnout, and turnover rates. This study was a qualitative investigation of the lived work experiences of cardiac nurses. Qualitative research methodology was utilized as it provided the best opportunity to understand the individual experiences of nurses working with cardiac patients. In-person, semi-structured individual interviews were conducted with seven cardiac nurses. Through the analysis process, seven major categories and 24 sub-level categories emerged. More specifically, grounded theory methodology (Strauss & Corbin, 1998) was used to analyze the interview data. Participants described their experience working with cardiac patients as complex and multidimensional. The core theme of this study, revolved around the concept of cardiac nurses serving as bridges for their patients. Participants described feeling stuck in the middle between having a strong desire to help their patients improve their health, but also working with a high percentage of unmotivated patients who were not accepting of this help. This study also identified the unique stressors of working in a cardiac environment, and the resources that were utilized to help decrease or prevent symptoms of burnout.

Introdução e Objetivos: Este estudo teve como objetivos: caracterizar um grupo de pessoas com Insuficiência Cardíaca (IC) acompanhado em ambulatório de um hospital de alta complexidade em cardiologia, segundo perfil sócio-demográfico, perfil de saúde e de tratamento; identificar o conhecimento das pessoas com IC sobre o tratamento farmacológico e não farmacológico e analisar o conhecimento e o significado que atribuem à doença. Metodologia: Trata-se de uma pesquisa qualitativa. Foram entrevistados 42 pacientes que atenderam aos critérios de inclusão, utilizando-se um questionário semiestruturado, cujos dados foram analisados por meio da análise de conteúdo e discutidos à luz do referencial teórico da educação em saúde e da aprendizagem significativa. O projeto de pesquisa foi aprovado pela Comissão de Ética do HCFMUSP. Resultados: Da análise de conteúdo das entrevistas emergiram três categorias que evidenciaram o Conhecimento da Doença, o Conhecimento do Tratamento e o Significado de Ter e Viver com a IC. Do conhecimento sobre a doença emergiram uma gama de significados atribuídos à doença que extrapolaram o conhecimento, uma vez que o fato de serem perguntados sobre a doença foi o canal necessário para poderem expressar o significado da IC em suas vidas. Em relação ao conhecimento do tratamento as respostas são permeadas por uma disponibilidade interna para se cuidar, para evitar a descompensação da doença e manter a vida motivada pela fé, pela família e pelos profissionais. O significado de ter e viver com a IC trouxe modificações na vida dos entrevistados de ordem física, emocional e social, o que gera incertezas e projeto de vida interrompido. Em geral, essas modificações são carregadas de sentidos e de emoções geradas pelas mudanças do hábito e estilo de vida, caracterizadas por limitações relacionadas às manifestações clínicas da IC, depressão, medo da morte e mudanças no convívio social e trabalho. Considerações Finais: Os resultados da pesquisa abrem perspectivas para a ressignificação da prática do enfermeiro no acompanhamento de pessoas com IC, uma vez que intervenções educativas feitas de forma sistematizada a partir do conhecimento e do significado da doença expresso pelas pessoas com insuficiência cardíaca poderão contribuir para melhor enfrentamento e manejo da doença pelos sujeitos envolvidos, profissionais e pacientes. / Introduction and Objectives: The objective of this study was to characterize a group of people with Heart Failure (HF), followed in an outpatient hospital of high complexity in cardiology, according to socio-demographic profile, health profile and treatment; to identify peoples knowledge about HF regarding pharmacological and non-pharmacolocical treatment and analyze this knowledge and meaning that they attribute to the disease. Methods: This was a qualitative study where forty two (42) patients were interviewed who each met the inclusion criteria, using a semi-structered questionairre, and data was analyzed using content analysis and discussed in light of the theoretical framework of health education and meaningful learning. This research project was approved by the HCFMUSP Ethics Commission. Results: The following three (3) categories emerged during content analysis of the interviews: the Knowledge of the disease, the Knowledge of the Treatment and the Meaning of Having and Living with HF. In the category, the Knowledge about the Disease, a range of meanings emerged, attributed to the disease, that had surpassed the knowledge, since the fact of being asked about the disease was the channel required in order to express the meaning of HF in their lives. With respect to, the Knowledge about the Treatment, responses are suffused with an inner necessity to be careful, to avoid decomposition of the disease and sustain life motivated by faith, family and the professionals. And finally, the Significance of Having and Living with HF, has brought changes in the lives of the respondents from physical, emotional and social development , which creates uncertainty and projects an interrupted life. In general, these changes are laden with meanings and emotions generated by changes of habits and lifestyle, characterized by the limitations related to the clinical manifestations of heart failure, depression, fear of death and changes in social life and work. Final Considerations: The results of this study open perspectives for the reframing of nursing practices in monitoring patients with HF, since educational interventions performed in a systematic way, beginning with the Knowledge and the Meaning of the Disease, expressed by people with HF, may contribute to better coping and managment of the disease by the individuals involved, professionals and patients.

The diploma thesis deals with non-invasive and invasive monitoring of the cardiovascular system, focusing on non-medical health workers. The aim of the work was to analyze the knowledge of non-medical health workers in selected areas of cardiovascular monitoring. The data was obtained in the form of a non- standardized questionnaire created by myself. For the research were selected non-medical health workers working in Prague hospitals in coronary units and postoperative cardiac surgery units. The total number of respondents who participated in the research was 108. The results of the survey revealed that non-medical staff are relatively well versed in the issue of cardiovascular monitoring. A rather surprising finding was that most respondents did not use foreign literature to study cardiovascular monitoring. As part of the comparison of the respondents, the better knowledge of cardiovascular monitoring was presented in non-medical staff of the Department of Postoperative Cardiac Surgery. Compared in relation to the highest educational attainment, university graduates have demonstrated a higher level of knowledge than others. Based on achieved data, it was created a study text for newcomers, which contains basic information for better orientation in the given issue. keywords: cardiovascular...

Cardiovascular diseases are the leading cause of death in the Czech Republic. An increasing number of its inhabitants become cardiac patients who require a nursing intervention. Nursing in cardiology has an irreplaceable position in the cardiovascular care provision. The health care costs are rising, nursing has been undergoing many changes. Training of cardiology nurses gets changed, as well as the image and role of cardiology nurses in society. Cardiology nurses are much more independent, educated and organized. In cardiovascular facilities nursing care is being standardized and the quality of care is improving. In this thesis, focus is given to nursing in cardiology. In the introduction the issue of cardiovascular diseases is outlined, the major part is devoted to the concept of Czech nursing in cardiology. Individual stages of the system of care for cardiac patients in the Czech Republic and the status of cardiology nurses involved in the system are surveyed. Attention is also paid to the structure of cardiovascular facilities and expert companies in our country and abroad. The thesis has the title: Survey of continuity of care for cardiac patients in the Czech Republic with focus on nursing care. In total five goals, seven research questions and four hypotheses were stated. We surveyed the cardiology nurses´ attitude to lifelong learning, if they are building their own specific image, and if they ensure the continuity of care. Our objective was also to identify the role of nurses in education of cardiac patients and the level of cardiac patients´ knowledge. The research section is elaborated on the basis of a qualitative and quantitative investigation. The qualitative part was carried out by semi-structured interviews with cardiology nurses working in comprehensive cardiovascular centers. The quantitative part of the survey was conducted with patients of comprehensive cardiovascular centers. Seventy domestic and foreign sources of literature devoted not only to the issueof cardiovascular diseases were quoted. The research results are supposed to serve as a basis for coordinated efforts of all participating nurses and institutions to build a well-functioning and technically and economically efficient system of nursing care for cardiac patients in CR.

Introdução e Objetivos: Este estudo teve como objetivos: caracterizar um grupo de pessoas com Insuficiência Cardíaca (IC) acompanhado em ambulatório de um hospital de alta complexidade em cardiologia, segundo perfil sócio-demográfico, perfil de saúde e de tratamento; identificar o conhecimento das pessoas com IC sobre o tratamento farmacológico e não farmacológico e analisar o conhecimento e o significado que atribuem à doença. Metodologia: Trata-se de uma pesquisa qualitativa. Foram entrevistados 42 pacientes que atenderam aos critérios de inclusão, utilizando-se um questionário semiestruturado, cujos dados foram analisados por meio da análise de conteúdo e discutidos à luz do referencial teórico da educação em saúde e da aprendizagem significativa. O projeto de pesquisa foi aprovado pela Comissão de Ética do HCFMUSP. Resultados: Da análise de conteúdo das entrevistas emergiram três categorias que evidenciaram o Conhecimento da Doença, o Conhecimento do Tratamento e o Significado de Ter e Viver com a IC. Do conhecimento sobre a doença emergiram uma gama de significados atribuídos à doença que extrapolaram o conhecimento, uma vez que o fato de serem perguntados sobre a doença foi o canal necessário para poderem expressar o significado da IC em suas vidas. Em relação ao conhecimento do tratamento as respostas são permeadas por uma disponibilidade interna para se cuidar, para evitar a descompensação da doença e manter a vida motivada pela fé, pela família e pelos profissionais. O significado de ter e viver com a IC trouxe modificações na vida dos entrevistados de ordem física, emocional e social, o que gera incertezas e projeto de vida interrompido. Em geral, essas modificações são carregadas de sentidos e de emoções geradas pelas mudanças do hábito e estilo de vida, caracterizadas por limitações relacionadas às manifestações clínicas da IC, depressão, medo da morte e mudanças no convívio social e trabalho. Considerações Finais: Os resultados da pesquisa abrem perspectivas para a ressignificação da prática do enfermeiro no acompanhamento de pessoas com IC, uma vez que intervenções educativas feitas de forma sistematizada a partir do conhecimento e do significado da doença expresso pelas pessoas com insuficiência cardíaca poderão contribuir para melhor enfrentamento e manejo da doença pelos sujeitos envolvidos, profissionais e pacientes. / Introduction and Objectives: The objective of this study was to characterize a group of people with Heart Failure (HF), followed in an outpatient hospital of high complexity in cardiology, according to socio-demographic profile, health profile and treatment; to identify peoples knowledge about HF regarding pharmacological and non-pharmacolocical treatment and analyze this knowledge and meaning that they attribute to the disease. Methods: This was a qualitative study where forty two (42) patients were interviewed who each met the inclusion criteria, using a semi-structered questionairre, and data was analyzed using content analysis and discussed in light of the theoretical framework of health education and meaningful learning. This research project was approved by the HCFMUSP Ethics Commission. Results: The following three (3) categories emerged during content analysis of the interviews: the Knowledge of the disease, the Knowledge of the Treatment and the Meaning of Having and Living with HF. In the category, the Knowledge about the Disease, a range of meanings emerged, attributed to the disease, that had surpassed the knowledge, since the fact of being asked about the disease was the channel required in order to express the meaning of HF in their lives. With respect to, the Knowledge about the Treatment, responses are suffused with an inner necessity to be careful, to avoid decomposition of the disease and sustain life motivated by faith, family and the professionals. And finally, the Significance of Having and Living with HF, has brought changes in the lives of the respondents from physical, emotional and social development , which creates uncertainty and projects an interrupted life. In general, these changes are laden with meanings and emotions generated by changes of habits and lifestyle, characterized by the limitations related to the clinical manifestations of heart failure, depression, fear of death and changes in social life and work. Final Considerations: The results of this study open perspectives for the reframing of nursing practices in monitoring patients with HF, since educational interventions performed in a systematic way, beginning with the Knowledge and the Meaning of the Disease, expressed by people with HF, may contribute to better coping and managment of the disease by the individuals involved, professionals and patients.