A review of research into the experience of patients suffering from coronary thrombosis

Abstract

There is now a substantial volume of literature on how patients respond to a heart attack, to admission to a coronary care unit (CCU), transfer to a hospital ward and their subsequent recovery at home. The issue of what factors in the early stages in this illness affect degrees of rehabilitation has also been explored and there are suggestions that anxiety generated in the CCU determines a pattern of cardiac invalidism and debility. However, the relationship is difficult to test and research in this whole area has often produced conflicting results. This subject is mainly discussed in medical journals, yet it is of utmost importance to nurses who have the potential ability to prevent anxiety and therefore influence rehabilitation. For this reason a review of the research on this subject should emphasise its relevance to nursing practice. Many factors obviously influence a patient’s responses to and recovery from myocardial infarction (Ml). Miller and Brewer’s (1969) discussion included the full range of medical, psychological and social factors which are operative in rehabilitation. Severity of the MI, age of onset, previous history and other illnesses may all act against a speedy recovery whereas supportive relationships with staff and from the family can have a very positive effect. When considering psychological factors, the lack of motivation to recover or gain from illness behaviour and an inflexible personality are considered to be major difficulties. Patients’ perception of their illness, influenced by community opinion, can also influence recovery. Misconceptions about heart attacks are very prevalent and usually pessimistic, but iatrogenic disturbances are equally destructive. In their paper Miller and Brewer (1969) considered that “over treatment”, particularly prolonged rest with restrictions on many personal activities such as washing and feeding, demonstrated to the patient that he was desperately ill. Misdiagnosis of stabbing chest pain as angina is apparently frequently made. These pains which do not radiate and are not indicative of cardiac pathology are non-specific muscular pains often brought on by anxiety, but cause many doctors to advise bed rest “for safety”. Caution on advising