First Place Winner: Geriatric Patient Management

ALLOSTATIC LOAD: AN APPROACH TO INVESTIGATE GERIATRIC CARDIOVASCULAR HEALTH DISPARITIES

Authors: Sarah L. Szanton, MSN, CRNP, Jessica S. Gill, MSN, CRNP, Jerilyn K. Allen, ScD, RN, Johns Hopkins University School of Nursing

Older Americans of low socioeconomic status (SES) suffer from increased cardiovascular morbidity and mortality compared to those of high SES. Objective: To describe the construct of allostatic load as a tool to investigate geriatric cardiovascular health disparities. Allostatic load is a multisystem construct theorized to quantify stress-induced biological risk. Quantifying the physiologic stamp of stress for each individual, allostatic load is measured with markers of the sympathetic nervous system, hypothalamic pituitary axis, and neuroendocrine system. Differences in allostatic load may reflect differences in lifetime exposure to stressors and thus provide a mechanistic link to studying health disparities in cardiovascular disease (CVD) in elders. Methods: Systematic electronic review of research on allostatic load in MEDLINE, CINAHL, and EMBASE as well as reference tracking in journal articles and book chapters. Results: The published literature shows four conclusions relating to allostatic load: it marginally predicts heart disease, is affected by psychological stress, is elevated in those of low compared to high SES, and increases with age. Both increased psychological stress and low SES have been associated with CVD in previous research. No studies examined possible differences in allostatic load among racial groups. Conclusions: Allostatic load may be a fruitful construct in health disparities research and may contribute to the explanation of biological causes of increased mortality and morbidity from CVD, especially in lower-SES groups. Future research using allostatic load would benefit from longitudinal studies and the analysis of possible differences based on ethnicity, SES, and age.

Second Place: FIT OVER FIFTY: A COMMUNITY PILOT PROJECT

Authors: Barbara L. Forbes, MSN, GNP, James Groves, EDD, Kim Dayani Center/Vanderbilt University Medical Center

First Place Winner: Clinical Patient Management

WINNING WITH WELLNESS: IMPROVING EMPLOYEES' HEALTH WITHIN A CARDIOLOGY PRACTICE

Authors: Lisa A. Dugger, RN-CS, FNP, University of Tennessee, Teresa L. Wild, PharmD, Pfizer, Clinical Education Consultant, Claudia H. Wild, PharmD, Pfizer, Clinical Education Consultant

Purpose: Cardiovascular disease is the number one killer in the United States affecting over 60 million Americans, which equates to nearly one in five Americans. Tennessee has the second largest cardiovascular death rate in the nation. A cardiology practice in Tennessee developed a wellness program for employees to provide an opportunity to improve overall health and reduce cardiovascular risk. Methods: A wellness program was developed for the employees of a university-based cardiology practice and initiated during February 2003. Employees are not required nor pressured to participate. Screenings (or "progress checks") are performed quarterly for enrollees measuring lipid levels, blood pressure, waist circumference, weight, and calculations of Framingham Risk Score and body mass index. The Wellness Coordinator is a nurse practitioner who actively participates and motivates. The NP partnered with Pfizer Clinical Education Consultants to implement and regularly measure the success of the Wellness Program entitled "Winning With Wellness." Summary: Since February 2003, 50 (or 79%) employees have enrolled to date. In addition to the screenings, each employee earns Activity Points, also called Wellness Points, for physical and health activities accomplished during the review period (quitting smoking etc). Successes include weight loss, waist circumference reductions, blood pressure and cholesterol reductions, and an overall increase in physical activity and improvement in well-being. To date, 88% have achieved optimal blood pressure measurements, 80% are at LDL cholesterol goals, and 62% have ideal body mass indexes, but only 44% meet waist circumference recommendations. The poster will discuss details of the program, and results will be reported in both aggregate and quarterly formats. Implications: This information may facilitate more practitioners to become involved in wellness activities within their own practice environment. Healthcare professionals must set positive examples to further motivate patients to reduce cardiovascular risk. This report may be used to assist others in establishing their own wellness programs.

Second Place: IMPLEMENTING A MULTIPLE CARDIOVASCULAR RISK FACTOR REDUCTION PROGRAM USING AN RN/RD DISEASE MANAGEMENT TEAM

Author: Paulette D. Sharp, DM, MS, APRN, CDE, Kaiser Permanente, Oakland, CA

Third Place: IMPROVING POSTMYOCARDIAL INFARCTION CARE WITH ADMISSION ORDERS, DISCHARGE PROTOCOLS, AND EDUCATIONAL PROGRAMS

Authors: Dorothy Brown, PharmD, Memorial Hospital West, Michelle Quijada, RN, Memorial Hospital West, Rena Coll, PharmD, Clinical Education Consultant, Pfizer, Inc, Venessa Price, PharmD, Clinical Education Consultant, Pfizer, Inc., Jimmy Emmanuel, RPH, Memorial Hospital West

First Place Winner: Data-based Research

ADULT INTERACTIVE INSTRUCTIONAL METHODS IN THE ACHIEVEMENT OF RISK FACTOR LEARNING OUTCOMES

Authors: James Rosneck, MS, BSN, MS, Summa Health System, Donna Waechter, PhD, Summa Health System, Isadore Newman, PhD, University of Akron, Richard Josephson, MS, MD, Summa Health System

Background: Outpatient risk factor education is an important adjunct to cardiovascular disease management programs. Traditional approaches to adult education typically involve an expository, lecture format (LF) in which the facilitator imparts instruction and the learner assumes a passive role. The effectiveness of this method has been questioned in the educational literature. Therefore we evaluated the feasibility and effectiveness of a patient participation (PP), interactive instructional design utilizing electronic response media in the delivery of risk factor education. Methods: 107 subjects were randomly assigned to either LF or PP groups for cholesterol and blood pressure management education sessions. As part of the instructional design, subjects in the PP group were asked to anonymously respond via electronic hand-held transmitters to multiple choice questions projected on a screen. Anonymous aggregate responses were immediately computer analyzed and projected in histogram format for subject and facilitator review. The LF group's lesson was conducted by the same facilitator using identical learning objectives and handout materials. After each instructional treatment a posttest measuring achievement of learning objectives was completed by both groups. Descriptive statistics, analysis of variance and analysis of covariance were performed. Results: PP subjects scored significantly higher on post testing than LF subjects across the two teaching units (P < .005); and when controlling for the covariates of race, age, and gender (P < .05). Conclusions: An interactive instructional approach that incorporated active but anonymous adult participation with immediate audio-visual reinforcement resulted in improved knowledge acquisition of risk factor learning outcomes in this adult outpatient cohort. Patient learning outcomes may be enhanced through the use of innovative instructional methods and media.

Second Place: THE IMPACT OF CARDIOVASCULAR RISK FACTOR CASE MANAGEMENT ON THE METABOLIC SYNDROME IN A LOW-RISK PRIMARY PREVENTION POPULATION: A RANDOMIZED CONTROL TRIAL

Authors: Jody Bindeman, BSN, RN, Tracy A. Perron, BSN, RN, Patrick G. O'Malley, MD, MPH, Allen J. Taylor, MD, Walter Reed Army Medical Center, Courtney Kowalczyk, BA, University of Virginia

Third Place: AGE, ACCULTURATION, AND BARRIERS TO CARE IN HISPANICS LIVING WITH HEART FAILURE

Authors: Viola G. Benavente, MSN, RN, CNS, University of Pennsylvania, School of Nursing; Beverly Carlson, MS, RN, CCRN, CNS, Sharp HealthCare, Barbara J. Reigel, DNSc, RN, CS, FAAN, University of Pennsylvania School of Nursing

Section Description

The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.