1Ulster Hospital, South Eastern Trust, UK.
Eur J Cardiovasc Nurs. 2014 Jun;13(3):270-6. doi: 10.1177/1474515113491649. Epub 2013 Jun 3.
There are considerable differences in the type of treatments offered to patients presenting with acute myocardial infarction (AMI), in terms of the speed and urgency with which they are admitted, treated and discharged from hospital. The impact of these different treatment experiences on patients' illness perception and motivation for behavioural changes is unknown.
The aim of this study was to explore and compare patients' illness perception and motivation for behavioural change following myocardial infarction (MI) treated by different methods.
Semi-structured, domiciliary interviews (n=15) based on the common sense model of self regulation, were conducted with three groups of MI patients within four weeks of diagnosis: (a) primary percutaneous coronary intervention (PPCI) (n=5); (b) thrombolysis (n=5); (c) non ST elevation MI (NSTEMI) (n=5). Framework analysis was used to identify and compare themes between groups.
Patients presenting with a ST-elevation MI (STEMI) receiving either PPCI or thrombolysis had similar perceptions of their illness as a serious, life-threatening event and were determined to make lifestyle changes. In contrast, patients with a NSTEMI experienced uncertainty about symptoms and diagnosis, causing misconceptions about the severity of their condition and less determination for lifestyle changes.
Patients with NSTEMI in this study expressed very different perceptions of their illness compared to those experiencing STEMI. Patients' clinical presentation and treatment experience during an AMI can impact on their illness perception, motivation for behavioural change and uptake of cardiac rehabilitation. Nurses should consider the patients' illness experience and perception when planning secondary prevention interventions.
在急性心肌梗死（AMI）患者的治疗方式上存在很大差异，表现在他们入院、治疗和出院的速度和紧迫性方面。这些不同的治疗经验对患者的疾病认知和行为改变的动机的影响尚不清楚。
本研究旨在探讨和比较不同治疗方法治疗心肌梗死（MI）后患者的疾病认知和行为改变的动机。
采用基于自我调节常识模型的半结构式家庭访谈（n=15），在诊断后 4 周内对三组 MI 患者进行了访谈：（a）直接经皮冠状动脉介入治疗（PPCI）（n=5）；（b）溶栓治疗（n=5）；（c）非 ST 段抬高型心肌梗死（NSTEMI）（n=5）。采用框架分析方法对组间主题进行识别和比较。
接受直接经皮冠状动脉介入治疗（PPCI）或溶栓治疗的 ST 段抬高型心肌梗死（STEMI）患者对其疾病的认知相似，认为这是一种严重的、危及生命的疾病，并决心改变生活方式。相比之下，NSTEMI 患者对症状和诊断存在不确定性，导致对其病情严重程度的误解，改变生活方式的决心较小。
与 STEMI 患者相比，本研究中 NSTEMI 患者对其疾病的认知截然不同。AMI 患者的临床表现和治疗经验会影响他们的疾病认知、行为改变的动机和心脏康复的参与。护士在计划二级预防干预时应考虑患者的疾病体验和认知。
