Saturday, November 3, 2007

This presentation is part of : Acute and Chronic Adult Healthcare Issues
The Lived Experience of Acute Myocardial Infarction in Urban African-Americans
Mary Anne Peters, DNSc, RN, School of Nursing and Health Sciences, La Salle University, Philadelphia, PA, USA and Patti Rager Zuzelo, EdD, APRN-BC, CS, School of Nursing & Health Sciences, La Salle University, Philadelphia, PA, USA.
Learning Objective #1: comprehend the experience of an acute myocardial infarction implicit in accounts of urban African American clients.
Learning Objective #2: integrate understanding of the lived experience of an acute myocardial infarction from the perspective of the urban African American client into personal practice.


This phenomenological study describes the lived experience of acute myocardial infarction (AMI) of African American men and women living in a large, northeastern city. Institutional Review Board approval was secured. The study setting was a tertiary care, urban medical center. Inclusion criteria included English-speaking patients with a confirmed diagnosis of AMI and ability to converse in an organized fashion. Patients requiring mechanical ventilation or experiencing physical instability, extreme anxiety, dyspnea at rest or with conversation, or unresolved chest pain were excluded. Interviewing time frames were dependent upon the course of hospitalization events including invasive therapies for advanced diagnosis, therapeutic intervention, and patient fatigue. Purposively selected African American men (n = 5) and women (n = 6) had multiple co-morbidities, including diabetes. One of the investigators conducted participant interviews using open-ended questions with intermittent prompters and cues within 72 hours of hospital admission. Participants were encouraged to describe their initial symptom experience and to describe their reactions to these symptoms. They were asked to share their recollections of symptom experience up to the point of symptom resolution. Interviews were audiotape recorded. Recordings were transcribed verbatim and thematically analyzed using the framework of van Manen (1991). Major themes included: Interpreting symptoms in my customary way; Working through the symptoms on my own; Delaying requests for help; Being ill at ease; Becoming gradually aware of the gravity of my circumstances; and, Asking for help. Participants did not initially relate signs and symptoms with the heart. None contacted primary care providers for symptom evaluation. Many attributed the distress to gastrointestinal problems. The symptoms were frightening and participants intervened with prayer, self-medication, and activity modifications. Many symptoms differed from those that participants identified as classic heart attack symptoms. Findings are consistent with a recently published study exploring AMI treatment delays in African Americans.