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Diseases of the heart have been the number one cause of death in the Native American population for decades and is an adverse health disparity for this population. Heart disease mortality rates are higher in Native Americans than in the U.S. population (American Heart Association, 2015; Veazie et al., 2014). The purpose of this Doctor of Nursing Practice (DNP) project is to describe the acute coronary syndrome (ACS) experience among Native American adults who reside in northern Arizona and diagnosed with an acute myocardial infarction .A qualitative dominant mixed methods design (QUAL→quan) was used to describe the ACS symptom experience among this population. Data was collected from a convenience sample of nine Native American men residing on the Navajo and Hopi reservations in northern Arizona diagnosed with an acute myocardial infarction. The qualitative portion of this study consisted of a semi-structured interview and the quantitative portion consisted of the completion of a demographic questionnaire and the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey. Qualitative description were used to analyze the data and develop codes, subcategories, categories and themes. Descriptive statistics were used to analyze the data from the demographic questionnaire and MAPMISS results. The findings in this study revealed the average age of the first heart attack for these participants was 58 years. The average time from symptom onset to hospital presentation was 7.4 hours. A common prodromal symptom was very tired/unusual fatigue. Common acute symptoms were chest pain, shortness of breath, gastrointestinal symptoms and diaphoresis. Neck/throat, generalized chest, and top of shoulders were most frequently reported areas of acute pain or discomfort. Influences to not seeking treatment included ignoring symptoms or thinking symptoms would go away. Influences to seeking treatment included worsening or non-resolution of symptoms. Accessing health care was difficult for almost all participants and contributed to treatment delay. Findings from this study gave new insight on ACS symptoms and the ACS experience of Native American men, reinforced current knowledge of the health disparities that exist in this population, and will assist in the development of culturally-sensitive, community-based education programs directed toward the Native American population.

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / abstract / Pharmacology / Master / Master of Philosophy

published_or_final_version / abstract / Physiology / Doctoral / Doctor of Philosophy

Strong evidence has been found to link the diagnosis of CHD with depression, and patients with all CHD-related diagnoses and co-morbid depression display higher morbidity and mortality from CHD than those individuals without depression. Screening and treatment of depression by cardiology clinicians continues to be limited due to poor symptom recognition and lack of desire to treat perceived primary care conditions in specialty practice. The American Heart Association has designated timely assessment and treatment/referral of depression as primary goals for high-quality evidenced-based cardiology care to improve patient outcomes in CHD.This study employed a quasi-experimental descriptive pretest-posttest study design for the purposes of (1) understanding diagnostic and treatment practices for depression in the presence of CHD by nurse practitioner and physician cardiology providers (n=35) in a large metropolitan private outpatient cardiology practice and; (2) adaptation of a valid and reliable depression screening tool (Patient Health Questionnaire-9) to an existing electronic medical record system for use in the sample practice.Findings from the study showed that even though all providers (100%) believed that depression inhibited patients' ability to make positive CHD risk-reducing lifestyle changes, and the majority (73.7%) felt that depression contributed to the progression of CHD, no formal screening for depression was being performed. Less than half (42.1%) of providers in the sample treated depression in their clinic practice, and the large majority (89.5%) referred patients back to primary providers for all depression care.Since 2008 guidelines for depression care by cardiology providers were recommended by the American Heart Association (endorsed by the American Psychiatric Association), it is questionable if these recommendations are filtering down to outpatient cardiology practice. Provider education to improve confidence with depression screening and treatment, and provision of concise easy-to-use care templates in outpatient EMR systems may help to improve compliance with recommendations while maximizing patient outcomes for depressed CHD patients.Advanced practice nurses have been consistently instrumental in the development and management of performance-enhancing processes that improve care quality and patient outcomes. As nursing practice leaders, nurse practitioners should be progressive in supporting implementation of best-practice for depression care in outpatient cardiology practice settings.

2 pp. / Heart Disease in Women / How consumers can eat to reduce their risk of heart disease by lowering fat and cholesterol in their diet.

The Purpose of this research was to describe relationships between Murdaugh and Verran's (1987) Preventive Behavior Model Concepts in military-affiliated individuals at risk for coronary artery disease. One hundred forty-three subjects were recruited by their primary care physician and were requested to voluntarily complete questionnaires measuring health beliefs, health locus of control, value orientations, and health care activities. Laboratory values and blood pressure were also evaluated. There were significant positive correlations between health beliefs, health locus of control, and value orientations. However, these PBM concepts explained only 13% of the variance in dietary habits, 9% of smoking behaviors, 16% of habitual physical activity, 4% of cholesterol levels, 2% of diastolic blood pressure, 7% of body mass index, and 21 percent of glucose levels. PBM concepts explained a relatively small amount of the variance in the dependent variables within this sample and the results were not clinically significant.