Elsevier

Heart & Lung

Volume 31, Issue 5, September–October 2002, Pages 355-367
Heart & Lung

Issues in Cardiovascular Nursing
The recovery mosaic: Older women's lived experiences after a myocardial infarction*

https://doi.org/10.1067/mhl.2002.127939Get rights and content

Abstract

Objective: The purpose of this study was to examine the experience of recovery in women 65 years of age and older during initial recovery from acute myocardial infarction. Design: The study was designed with Heideggerian phenomenology, purposive sampling, and unstructured interactive interviews. Data were analyzed with interpretive processes of hermeneutics. Setting: The study was set in a Canadian metropolitan teaching hospital and in patient homes. Participants: Seven women who had had a first time myocardial infarction were recruited. Age ranged from 67 to 86 years (mean, 74 years). Results: Analysis revealed that recovery for these women was highly contextual and consisted of life experience resembling a mosaic, in which the women described how they “created a new picture for themselves.” The data were clustered into 4 substantive themes that included: life is scattered; trying to make sense of it; learning to live with it; and getting settled. Conclusion: The older women in this study underestimated their susceptibility to acute myocardial infarction, were avid planners and coordinators of their recovery, equated the loss of the homemaker role to job loss, used their ability to socialize as an indicator of the recovery progress, and lacked support to perform household duties, such as laundry, and those women with fewer symptoms “cheated” in relation to activity and diet. These findings may serve as a basis for the development of healthcare strategies reflective of older women's recovery.(Heart Lung® 2002;31:355-67.)

Section snippets

Purpose of the study

The purpose of this research was to examine the lived experiences of initial recovery (within 4 to 6 weeks) for older women with a first time AMI to gain greater insight into the context and essence of this experience—essentially to learn what this life experience meant to these women. The broad research question was: “I would like to learn from you about your experience since you have been home from the hospital, how you have felt emotionally and physically, and any challenges you may have

Research design

This study used an inductive descriptive method, specifically, Heideggerian phenomenology, as it is “interested in the origin of knowledge embedded in our everyday activities,”30 and aimed to draw from the participants a vivid picture of their lived experiences, as shaped by the context of their situations.31 In keeping with phenomenologic tradition, the interviews were guided by the participants with the assumption that they would describe what was meaningful to them.32

The methodologic

Findings: The mosaic of recovery

Each participant's account of the recovery experience was unique and highly contextual. Analysis of the transcripts unveiled a multidimensional framework called a “mosaic of recovery,” which came from the words of 1 participant who described her recovery as, “I find it's been like a jigsaw puzzle and all the pieces are falling into place.” The mosaic captures the essence of what these women experienced in their initial recovery as they tried to regain a pattern to their lives and create a new

Discussion

Findings detailed how each of these women described daily reflection on the experience of having had an AMI. By week 5, all of the participants appeared to accept that they had had an AMI and were subsequently making changes in their lives. Similar to Sutherland and Jensen,24 who found that elderly women used the AMI experience as an opportunity to grow, the participants in this study used the challenge of learning to live with their disease to create a new picture for themselves.

The findings

Implications for nursing practice

This study underscores the need for health promotion campaigns to target the specific needs of older women. Women in this study underestimated their susceptibility for having MIs and were confused as to the presentation of symptoms that resulted in delays in seeking medical help. Informational pamphlets should include more information in regards to the specific differences women have in relation to precipitating factors, nature of the pain, and associated symptoms.54 In addition, subsequent

Conclusion

This study shows what other investigators have found with older women as they recover with AMI: that recovery was cyclical in nature,22 that women measured their progress through symptom comparison,22, 24 with fatigue and weakness being prevalent symptoms,16, 17, 22 and that the women had difficulty with role adjustment, particularly in relation to their loss of the homemaker role.46, 48 All women had small but effective support networks including family and friends. Older women in this study

References (56)

  • AG Rosenfeld et al.

    Meaning of illness for women with coronary heart disease

    Heart Lung

    (2000)
  • S Wellard

    Constructions of chronic illness

    Int J Nurs Stud

    (1998)
  • B Riegel et al.

    Gender differences in adjustment to acute MI

    Heart Lung

    (1995)
  • J Stokes et al.

    Major causes of death and hospitalization in Canadian seniors

    Chronic Dis Can

    (1996)
  • JF Murphy et al.

    Age and gender differences in health services utilization

    Res Nurs Health

    (1996)
  • M Dishman

    Motivating older adults to exercise

    South Med J

    (1994)
  • American Heart Association

    Heart and stroke facts

    (1998)
  • Heart and Stroke Foundation of Canada

    Heart disease and stroke in Canada

    (1997)
  • Statistics Canada. Health Statistics Division, Health Canada

    Heart disease and stroke in Canada

    (1997)
  • NA Bickell et al.

    Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment?

    Ann Intern Med

    (1992)
  • JZ Ayanian et al.

    Differences in the use of procedures between women and men hospitalized for coronary heart disease

    N Engl J Med

    (1991)
  • RC Becker et al.

    Comparison of clinical outcomes for women and men after acute myocardial infarction

    Ann Intern Med

    (1994)
  • RB Case et al.

    Living alone after myocardial infarction

    JAMA

    (1992)
  • LF Berkman et al.

    Emotional support and survival after myocardial infarction: a prospective, population-based study of the elderly

    Ann Intern Med

    (1992)
  • J Marrugat et al.

    Mortality differences between men and women following first myocardial infarction

    JAMA

    (1998)
  • SS Kahn et al.

    Increased mortality in coronary artery bypass surgery: evidence in referral bias

    Ann Intern Med

    (1990)
  • TJ McLaughlin et al.

    Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for the under-treatment in women and the elderly

    Arch Intern Med

    (1996)
  • JH Gurwitz et al.

    The exclusion of the elderly and women from clinical trials in acute myocardial infarction

    JAMA

    (1992)
  • VS Conn et al.

    Myocardial infarction survivors: age and gender differences in physical health, psychosocial state and regimen adherence

    J Adv Nurs

    (1991)
  • MM Friedman

    Stressors and perceived stress in older women with heart disease

    Cardiovasc Nurs

    (1993)
  • PA Sharpe et al.

    Differences in the impact and management of heart disease between older women and men

    Women Health

    (1991)
  • RF Young et al.

    Gender, recovery from late life heart attack, and medical care

    Women Health

    (1993)
  • NK Janz et al.

    The impact of a disease-management program on symptom experience of older women with heart disease

    Women Health

    (1999)
  • H Helpard et al.

    The “kaleidoscope” experience for elderly women with coronary artery disease

    Can J Cardiovasc Nurs

    (1998)
  • B Tobin

    Getting back to normal

    Can J Cardiovasc Nurs

    (2000)
  • LA LaCharity

    The experiences of postmenopausal women with coronary artery disease

    West J Nurs Res

    (1997)
  • B Sutherland et al.

    living with change: elderly women's perceptions of having a myocardial infarction

    Qual Health Res

    (2000)
  • G MacKenzie

    Role patterns and emotional responses of women with ischemic heart disease 4 to 6 weeks after discharge from hospital

    Can J Cardiovasc Nurs

    (1993)
  • Cited by (23)

    • The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

      2016, International Journal of Nursing Studies
      Citation Excerpt :

      The recovery process made progress towards reorientation enabling a new life focus and a new balance in self and relationships (Hildingh et al., 2006). Participants expressed their desire to ‘get back to normal’ (Sutherland and Jensen, 2000; Tobin, 2000; White et al., 2011) and described spending a great degree of time during the first few weeks planning and initiating a variety of strategies to take care of themselves such as conserving energy in performing household chores and meal preparation (Kerr and Fothergill-Bourbonnais, 2002). By the end of the third week following hospital discharge, participants generally expected to be able to return to work and resume their previous activities (Jackson et al., 2000).

    • Women's experiences of recovery after myocardial infarction: A meta-synthesis

      2007, Heart and Lung: Journal of Acute and Critical Care
      Citation Excerpt :

      Even women who no longer had children at home experienced an internal conflict when implementing necessary changes after the MI. One woman described how she lost her normal status in her son’s household, in which she regularly babysat, cooked, ironed, and cleaned.37 She was sad to not be permitted to perform these activities as mother and grandmother anymore because she wanted to protect those nearest to her.

    View all citing articles on Scopus
    *

    Reprint requests: Evelyn E. Kerr, RN, The Ottawa Hospital, Nursing Professional Practice Dept, 501 Smyth Rd, Ottawa, Ontario, Canada K1H 8L6.

    View full text