Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
J Clin Nurs. 2009 Dec;18(23):3358-65. doi: 10.1111/j.1365-2702.2009.02911.x. Epub 2009 Sep 4.
To describe the care-seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction.
Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients' initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care-seeking.
Focus group discussions with patients who had had a recent acute myocardial infarction.
The analysis of the transcribed text was inspired by the self-regulatory model of illness behaviour.
Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self-regulatory illness behaviour that seems to cause a considerable delay in care-seeking.
We found indications of a pertinent shift in appraisal and coping-strategy when a patient changes from self-regulative illness behaviour to seeking care - the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients' self-regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly.
Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.
描述急性心肌梗死患者从最初症状的解释到决定寻求医疗护理的就诊过程。
患有急性心肌梗死症状的患者在就诊时远远超过了预期的时间限制，这种情况导致了不必要的生命损失。因此，有必要了解这些患者最初的不适、评估和行为，以便设计可以减少就诊延误的干预措施。
对最近患有急性心肌梗死的患者进行焦点小组讨论。
对转录文本的分析受到疾病行为自我调节模型的启发。
急性心肌梗死患者描述了难以准确识别通常模糊症状的发作时间的问题。他们对症状的体验与预期不符。这些患者表现出自我调节的疾病行为，这似乎导致了就诊的明显延误。
我们发现，当患者从自我调节的疾病行为转变为寻求医疗护理时，即转折点，存在评估和应对策略的明显转变迹象。这种转变似乎受到了几种相互矛盾的影响的影响，而且患者需要相当长的时间才能达到这个阶段。如果我们希望患者更快地寻求医疗护理，就必须考虑患者自我调节疾病行为的所有方面。
我们的发现对于未来设计公共卫生和康复策略以挽救患者生命非常重要。确定转折点是深入了解急性心肌梗死后初始阶段患者行为的有益方法。
