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In 2010, K Reeder, PhD, RN, Research Assistant Professor, received the five-year, K99/R00, Pathway to Independence award from the National Institutes of Health (NIH) – National Institute of Nursing Research (NINR). Up to 200 K99/R00 competitive applications are awarded each year by NIH to outstanding postdoctoral candidates. After completing the two-year, K99 training phase of the award in 2012, Dr. Reeder transitioned the three-year, R00 phase to the Goldfarb School of Nursing at Barnes-Jewish College.

This research project is focused on the timeliness of symptom recognition, interpretation and reporting in heart failure. Patients with heart failure are at heightened risk for acute decompensation and hospitalization. While timely reporting of symptoms can often expedite outpatient treatment and avoid the need for hospitalization, few patients recognize and respond to symptoms until acutely ill. Thus, patients hospitalized for acute decompensated heart failure were interviewed about their symptom experience before hospitalization, how they managed their symptoms and the timeliness of seeking professional treatment for symptoms.

Using an investigator-developed questionnaire, semi-structured patient interviews were conducted during hospitalization or within seven days of discharge. Questionnaire interviews addressed 6 domains, including 1) symptom recognition; 2) symptom interpretation; 3) self-care strategies used to relieve symptoms; 4) social interactions (i.e., lay consultations) to aid in symptom evaluation; 5) timeliness of symptom reporting to healthcare providers; and 6) timeliness of response to patient reports of symptoms by healthcare providers.

Initial findings from this study highlight the need for greater attention to the post-discharge environment, where self-management occurs. In this study, many patients who self-managed their chronic HF failed to recognize and interpret signs and symptoms as being cardiac-related. A variety of self-care strategies were employed for symptom relief by patients, and included resting and elevating legs, as well as taking extra doses of prescription medications such as narcotic pain medications and medication used in type-2 diabetes. Patients also often delayed reporting their symptoms or visiting a health care provider, some delaying for two weeks or more. These findings were published in the Journal of Cardiovascular Nursing, cited below. Dr. Reeder’s ongoing data analyses will (a) examine the role of lay consultations in symptom evaluation, (b) identify possible predictor variables for the 6 questionnaire domains, and (c) explore associations between patients’ symptom experiences and clinical outcomes, hospitalization, and death.

Dr. Reeder’s research interests include symptom management in persons living with chronic cardiovascular conditions, including heart failure, atrial fibrillation, chronic angina, and hypertension. The overall goal of Dr. Reeder’s program of research is to promote independence and effectiveness in self-management of chronic illness and prevent hospital readmissions. Dr. Reeder’s program of research is aligned with research priorities of Healthy People – 2020, as well as the American Heart Association and NINR strategic plan.

Reeder KM, Ercole PM, Peek GM, & Smith CE (2013). Symptom perceptions and self-care behaviors in patients who self-manage heart failure. Journal of Cardiovascular Nursing, Vol. 00, No. 0, pp 00-00 [epub ahead of print]. DOI: 10.1097/JCN.0000000000000117

This project is supported by the National Institute of Nursing Research of the National Institutes of Health under award number R00NR012217. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, National Institute of Nursing Research.

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