Myocardial Infarct Stress-of-Transfer Inventory

Abstract

The Myocardial Infarct Stress-of-Transfer Inventory is a set of measures composed of grouped variables related to patients' perceptions of external support, perceived attitudes and behaviors, and physiological (cardiovascular and autonomit) responses commonly assessed by nurses in typical hospital settings. These measures were designed to evaluate changes in patients' status as a result of transfer from the coronary care unit to a general care ward at the time the patient is presumably out of danger. Direction of change of all parameters is a measure of patient response to transfer as well as a measure of effectiveness of nursing care. The tool consists of observational and nurse questionnaire data collected and averaged for pre- and posttransfer items. Of 48 total items of the tool, 20 are designated “change scores.” Interrater reliability was obtained for 20 percent of the tests with 80 percent agreement. A score of less than 22 is associated with poor transfer outcome; a score of more than 25 is associated with better-than-expected transfer outcome. Midrange from 22 to 25 is the average total score expectation for change as a result of transfer. The instrument was tested on 177 transfers of patients in six hospital settings in five western states (Arizona, Montana, Nevada, Utah, and Washington). The six hospital populations were found to be homogeneous as to patient age, sex, race, diagnosis, and patterns of nursing care. Individual total scores for the tool ranged from 18 to 27 with a mean of 23.175 and S.D. of 1.754. Change scores were adjusted to accommodate the influence of prescores on postscores for the behavioral variables. Factor analysis Indicated 17 factors in the tool with eigen values greater than 1.00. Significant findings were: 1) Cardiovascular signs and symptoms are unstable and arrhythmias are likely to occur in the two-hour period following transfer. Nursing care needs to accommodate this finding. 2) Nurses equated patient acceptance of disconnection of the cardiac monitor with patient “readiness for transfer.” 3) Because family visits had significant effect on patients—sometimes negative, sometimes positive—families should be taught how to visit the patient in order to avoid negative effects. 4) Nursing care plans are associated with patients who are out of danger and are usually not available or not written for patients who are critically ill. 5) The tool proved easy to use. It may lend itself to evaluation of other transfer situations such as transfer front hospital to nursing home.