Introduction One in two cardiac patients fear having another heart event or their heart condition getting worse. Research in other chronic illnesses demonstrates that screening for fear of progression and recurrence is vital for adequately addressing such concerns in clinical care. The current project aims to develop and validate a measure for fear of progression and recurrence in cardiac patients. Methods The Fear of Cardiac Recurrence and Progression Scale (FCRP) will be developed through a multistep process. An initial item pool will be generated through a review of the literature and existing measures and consultation with and feedback from key informants. The item pool will be tested in a sample of over 250 adults who have ever had an acute coronary event, undergone cardiac surgery, or a chronic cardiac condition. Exploratory factor analysis will be used to identify the underlying factors, and Rasch analysis will be used to reduce the number of items. A short form version of the FCRP will be developed for use as a brief screening tool, informed by clinical relevance and Rasch psychometric indices. Discussion While many cardiac patients experience fears related to the progression or recurrence of their illness, there remains the need for a validated tool with which these concerns can be identified and measured. It is expected that the design and validation of the FCRP will aid identification of cardiac patients suffering from clinically significant levels of fear of progression and recurrence and facilitate the design of tailored psychological interventions to target these fears.

BACKGROUND & AIMS:Survivors of spontaneous coronary artery dissection (SCAD) often struggle to resume exercise to previous levels, heightened by a fear of recurrence. Cardiac rehabilitation is recommended after SCAD, however its specific role in supporting or hindering patient engagement with exercise remains unclear. This study aimed to examine how cardiac rehabilitation influences SCAD survivors' engagement in exercise. METHODS:Participants with an angiographically confirmed SCAD within the previous 3 years were purposively recruited from a larger clinical study. Focus groups were conducted via Zoom, recorded and transcribed. Thematic analysis followed an iterative approach with themes finalised through consensus. RESULTS:Twenty-eight SCAD survivors (mean age 54.8±9 years; 71% female; mean time since SCAD 18.1±6.4 months) participated in one of eight 90-minute focus groups. Six themes emerged: safety; validation and belonging; knowledge and education; sense of achievement; motivation; and empowerment. Within each theme, participants described how cardiac rehabilitation could either facilitate or hinder post-SCAD exercise engagement. CONCLUSIONS:Cardiac rehabilitation can either facilitate or hinder post-SCAD exercise engagement. For SCAD survivors, cardiac rehabilitation should be individualised and address exercise fear and avoidance, using informed clinical support, education, and reassurance.

Cardiac distress is common, yet minimal support is available for nurse assessment of patients. We translated the Cardiac Distress Inventory (CDI) into Thai (CDI-Thai) and evaluated its psychometric properties. This was a cross-sectional study of 250 adults who experienced an acute cardiac event in the past year in southern Thailand. The CDI was translated into Thai using forward-backward translation and expert review. The CDI-Thai achieved translation equivalence to the original version. An eight-factor structure was confirmed by factor analysis, with excellent fit. The CDI-Thai was shown to be culturally relevant and psychometrically robust as a measure of cardiac distress.

Background: The escalating prevalence of moral harassment in the high-stress environment of the intensive care unit is impacting the overall health of nurses, ultimately putting patient health, safety, and even lives at risk. This issue is becoming increasingly significant. One common form of moral harassment is the misuse of authority within the treatment system. This study aims to determine the relationship between resilience and moral and power harassment in critical care nurses. Methods: This cross-sectional study was conducted in 2022-23. The study included a sample size of 106 critical care nurses in hospitals affiliated with Tehran University of Medical Sciences in Tehran, Iran. Sampling was carried out using a stratified random method. Data collection involved demographic, moral harassment, power harassment and resilience questionnaires. Analysis was performed using SPSS software version 19, with descriptive statistics and the Pearson correlation test. Results: The study revealed that the mean±SD resilience score for nurses overall was 89.01±19.50, with mean±SD for moral harassment at 16.99±14.54 and power harassment at 66.9±9.31. Spearman’s correlation coefficient test showed a significant and poor relationship between power harassment and moral harassment among nurses (p<0.001, r=0.647), as well as a significant and negative relationship between power harassment and resilience (p<0.001, r=-0.357), and moral harassment and resilience (p<0.001, r=- 0.387). Conclusion: Resilience plays a crucial role in mitigating the negative effects of power and moral harassment in the workplace, impacting the perceived health of individuals. Resilience helps explain the distress caused by power harassment and moral harassment in the workplace.

BACKGROUND:Spontaneous coronary artery dissection (SCAD) is associated with substantial psychological sequelae. Although previous studies have identified individual risk factors for poor mental health post-SCAD, none has examined whether protective and vulnerability factors cluster together. This study aimed to identify distinct post-SCAD psychological profiles. METHOD:A cross-sectional survey of 263 SCAD survivors recruited from the Victor Chang Cardiac Research Institute Arteriopathies and SCAD Cohort (VASC). Participants completed measures of anxiety (GAD-7), depression (PHQ-9), cardiac distress (CDI-SF), health-related quality of life (SF-12), resilience (CD-RISC), social support (ESSI), patient activation (PAM-13), and post-traumatic growth (PTGI), and provided sociodemographic and medical data. K-Prototypes cluster analysis identified subgroups. Between-cluster differences were examined using chi-square tests and ANOVAs. RESULTS:Clustering identified three psychological recovery profiles. Cluster 1 (Psychologically Vulnerable; 39%) comprised younger-to-mid-aged survivors characterised by low resilience, low patient activation, financial strain, and limited social support. Cluster 2 (Established Copers; 32%) were older with moderate-to-high resilience, higher cardiac rehabilitation (CR) attendance, and low financial strain. Cluster 3 (High-Resource Recoverers; 29%), the youngest group, exhibited the highest resilience, patient activation, and post-traumatic growth. Cluster solution validity was supported by convergent evidence across five complementary indices. CONCLUSIONS:Psychological recovery after SCAD is heterogeneous and not necessarily age dependent. Younger survivors who are financially strained and socially unsupported are most vulnerable to poor recovery whereas, in a novel finding, those with favourable personal and social conditions cope well. Among older survivors, financial security and CR attendance may be protective. Interventions should prioritise resilience building, patient engagement, and strengthening social support.

Aims Spontaneous coronary artery dissection (SCAD) is a cause of acute myocardial infarction that is marked by a particularly challenging psychosocial recovery period. Survivors commonly experience fear of recurrent events and uncertainty around their condition. These psychosocial challenges may contribute to anxiety, depression, and cardiac distress. This study investigated the relationship between fear of recurrence and progression (FoRP), uncertainty, and psychological outcomes, specifically whether illness uncertainty moderates the relationship between FoRP and mental health outcomes in SCAD survivors.Methods and results Participants were recruited from the Victor Chang Cardiac Research Institute Arteriopathy and SCAD Cohort (VASC). Two hundred and seventy survivors completed an online questionnaire measuring FoRP, illness uncertainty, anxiety, depression, and cardiac distress. Moderation analyses were undertaken to investigate the relationship between these variables. FoRP directly predicted all three mental health variables. Illness uncertainty moderated this relationship in the case of depression and cardiac distress.Conclusion The findings indicate specific intervention targets to meet the support needs of survivors. While fear of recurrent events is common following SCAD, managing illness uncertainty may be a means to reduce the impacts of this fear on survivor's mental health.

The SARS-CoV-2 virus, responsible for COVID-19, was first identified in December 2019 and rapidly became a global pandemic. This health crisis placed unprecedented pressure on healthcare systems, and nurses, as frontline caregivers, bore the brunt of the psychological and physical toll. The burnout from this crisis highlighted the need to focus on nurses’ resilience. To evaluate the effectiveness of the RENEW online educational program in enhancing the resilience of nurses working at Imam Hassan (AS) Hospital in Bojnurd(The capital of North Khorasan Province in northeastern Iran). This randomized clinical trial was conducted in 2023 with the participation of 86 nurses who had a resilience score of ≤ 75. Participants were randomly assigned to either the intervention (RENEW) or the control group. The RENEW program consisted of six weekly online educational sessions. Data were collected using the Connor-Davidson Resilience Scale and the Kessler Psychological Distress Scale and were analyzed using SPSS. The average resilience score in the intervention group showed a significant increase after the program implementation and at the six-month follow-up compared to the control group (P < 0.001). The interaction effect between time and group was also significant (P = 0.019), indicating the sustained effectiveness of the RENEW program in improving resilience. The RENEW educational program significantly improved nurses’ resilience. These findings emphasize the importance of designing structured interventions tailored to nurses’ working conditions to enhance their mental health. Iranian Registry of Clinical Trials (IRCT20240222061081N1). Registered on 19 May 2024.

There is little consensus on the optimal components of gambling psychological treatments. This study aimed to identify clinical consensus statements regarding the perceived effectiveness of gambling intervention content (change techniques, participant/recruitment characteristics, delivery characteristics, and evaluation characteristics) from a panel of researchers with psychological gambling treatment expertise across 11 countries. A two-round modified Delphi study was conducted. Thirty-five panellists rated the perceived effectiveness of 96 gambling intervention components for achieving clinically helpful change, which was defined as “reduction in gambling severity, expenditure, and frequency”. Consensus criteria on effectiveness and ineffectiveness were defined a priori. Consensus statements were identified for four of 19 change techniques (motivational enhancement, relapse prevention, cognitive restructuring, and plan social support), five of 23 participant/recruitment characteristics (e.g. eligibility screening took place), 17 of 47 delivery characteristics (e.g. the therapy goal was to reduce time and/or money spent gambling), and three of seven evaluation characteristics (e.g. specific process or mediators are targeted by the intervention). These statements, when interpreted with consideration of contextual factors, can inform the selection of likely effective components to employ in gambling treatment programs and indicate where future research efforts may be most beneficial.

BACKGROUND:Spontaneous coronary artery dissection (SCAD) is a highly distressing cause of acute myocardial infarction. No SCAD-specific distress measure currently exists, with researchers relying on generic measures of anxiety, depression, and distress that fail to capture the psychological impacts unique to SCAD. We developed and validated the SCAD Distress Inventory (SDI) to provide a condition-specific distress measure. METHODS:The SDI was developed through a multistep process. First, 48 SCAD-related distress items were generated from focus groups with SCAD survivors (N=30) and relevant literature. Items were administered online to survivors of SCAD (N=293, angiography-confirmed), who also provided sociodemographic and medical data and completed validated psychological instruments. Exploratory factor analysis identified underlying dimensions within the item pool and Rasch analysis confirmed dimensionality and refined the scale. Psychometric properties were assessed, including internal consistency (McDonald's ω), construct and discriminant validity (correlations with other validated psychological instruments), and clinically significant cutoff scores. RESULTS:The final SDI comprised 33 items across 4 subscales: challenges to sense of self, fear of recurrence, concerns about reduced capacity, and lack of support and validation. All subscales met required statistical and conceptual criteria. The SDI demonstrated excellent internal consistency (ω=0.88-0.92) and good construct and discriminant validity (correlations significantly higher with cardiac distress and lower with posttraumatic growth). Clinically significant cutoff scores were identified for the scale and subscales. CONCLUSIONS:The 33-item SDI was successfully codesigned and validated. It can be used in both research and clinical settings, enabling comprehensive assessment of the unique and multifaceted psychological distress experienced after SCAD.

This cross-sectional study, conducted in 2023 on 386 ICU nurses from hospitals affiliated with Tehran University of Medical Sciences, investigated the relationships between moral resilience, moral distress, and second victim syndrome. Participants were selected through simple random sampling, and data were collected using Rushton’s Moral Resilience Scale, Hamric’s Moral Distress Questionnaire, and Burlison’s Second Victim Scale. Analysis was performed using descriptive statistics and Pearson’s correlation in SPSS v24. The results showed a significant positive correlation between second victim syndrome and moral distress, indicating that increased second victim experiences were associated with higher moral distress. There was also a significant negative correlation between moral resilience and second victim syndrome, confirmed by regression and structural equation modeling. However, no significant correlation was found between moral resilience and moral distress. Overall, the study highlights that second victim syndrome contributes to moral distress, while moral resilience acts as a protective factor. It is recommended that targeted interventions – such as resilience training, peer support groups, professional debriefing, and organizational mental health.initiatives -be implemented to mitigate these psychological challenges in high-stress ICU environments.

Purpose: Cardiac rehabilitation (CR) is standard care for patients after a heart event, including acute myocardial infarction. However, the uptake and relevance of traditional CR after acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) has not been extensively investigated. The present study investigated attitudes toward CR, identified the rate and correlates of CR attendance, and examined the reasons for CR non-attendance after SCAD. Methods: Online focus groups (n = 30) explored attitudes toward and experiences of CR of survivors of SCAD, with data analyzed thematically according to recommended guidelines. An online survey (n = 310) then investigated rates of CR attendance and reasons for non-attendance. Correlates of CR attendance were identified using bivariate and multivariable analyses. Results: Thematic analysis revealed 5 themes in the perceptions of CR of survivors of SCAD: (1) lack of relevance of CR educational content; (2) lack of identification with typical CR attendees; (3) lack of CR health professional knowledge and skills; (4) preference for SCAD-specific CR; and (5) benefits of CR. The survey demonstrated a CR attendance rate of 63% (73% among those referred). The correlates of CR attendance were mid-level education and self-reported lifetime anxiety. Among attendees, the correlates of attending fewer sessions were having a more recent SCAD, not having lifetime anxiety, and not knowing other survivors of SCAD. Reported reasons for non-attendance mirrored qualitative themes identified. Conclusion: While the survey demonstrated high CR attendance, perceptions that CR was unnecessary and irrelevant after SCAD were evident, often based on health professional advice. The findings add to the growing literature highlighting a need for appropriate support for survivors of SCAD.

Although gambling disorder is a widespread problem among Chinese communities across the globe, coping by Chinese female spouses of problem gamblers is under-researched. AIM: To explore the lived experiences of Chinese female spouses of problem gamblers. Semi-structured interviews were held with 23 Chinese female spouses of problem gamblers in Hong Kong. Interviews were audio-recorded, transcribed, and coded in NVivo. Grounded theory method was used to build categories, themes and model. A total of 17 coping strategies, and three distinct coping paradigms are identified. The three coping paradigms emerged are compared with existing themes of coping identified in other coping studies. Implications on couple counselling to facilitate coping with adaptive paradigm shifts are discussed.

Spontaneous coronary artery dissection (SCAD) is a major medical event with a high burden of psychosocial sequelae. SCAD survivors require psychological support to facilitate recovery. This pilot study involved feasibility testing of an online group support program for SCAD survivors, co-designed by clinicians, survivors and researchers. The SCAD Online Support Program uses the principles of Acceptance and Commitment Therapy. The four-session-manualized program, facilitated by a registered psychologist and a SCAD survivor, was delivered to 33 SCAD survivors (6-7 per group). Participant and Project Advisory Group feedback led to iterative program refinements. Qualitative and quantitative acceptability data were evaluated. Participants completed pre- and post-program questionnaires to assess engaged living (life fulfilment and valued living), enrichment, self-efficacy, anxiety, depression and cardiac distress. Changes in proportions classified as anxious, depressed and distressed were identified. Qualitative comments highlighted the support, camaraderie and skills gained through the program. There were improvements in levels of life fulfilment, valued living, enrichment, self-efficacy, anxiety, depression, and cardiac distress, and reductions in proportions classified as anxious, depressed and distressed. The SCAD Online Support Program was successfully co-designed, implemented and modified, shown to be acceptable to SCAD survivors, and demonstrates potential for improving mental health outcomes.

Background:This article has examined the possibility of communicating with conscious intubated patients using an application and its effect on anxiety and satisfaction. Methods:This clinical trial study was conducted from March 5, 2021, to August 8, 2023, with the target population of conscious intubated patients hospitalized in intensive care units (ICUs) of hospitals affiliated with Qom University of Medical Sciences in Iran. Patients who met the inclusion criteria were randomly assigned to groups using a randomized block method with blocks of four (27 people in each group). Subjects completed the Hamilton Anxiety Rating Scale questionnaire along with a researcher-made questionnaire to assess satisfaction levels. After 4 days, the questionnaires were re-administered and the results were analyzed using descriptive and analytical statistics, as well as Kruskal-Wallis and t-tests with SPSS version 16. Results:Both the control and intervention groups had similar demographic characteristics. Postintervention, the satisfaction levels in the intervention group (mean 92.13 ± 16.25) significantly increased compared to the control group (mean 70.50 ± 6.06) (P = 0.001). In addition, anxiety levels after the intervention were lower in the intervention group (mean 29.12 ± 6.51) than in the control group (mean 88.49 ± 46.31) (P = 0.001). Conclusion:These results have significant implications for patients in ICU who may struggle to communicate their needs. In addition, this communication tool has the potential to enhance the quality of communication between patients and nurses, boost adherence to care plans, lower rates of re-hospitalization, and ultimately improve patient health.

OBJECTIVE:Increased negative moods such as anxiety, depression and fear of recurrence of cardiac events after a cardiac event, make it difficult to comply with lifestyle recommendations and drug therapy. Conducting screenings for cardiac distress and ensuring appropriate referrals are made constitute a crucial aspect of maintaining a healthy lifestyle post-illness. The Cardiac Distress Inventory has made it possible to assess cardiac patients psychologically and emotionally. The objective of this study was to provide a validity and reliability assessment of the original form Cardiac Distress Inventory (CDI) and short form (CDI-SF), in Turkish. METHOD:The inventory was administered face to face to a total of 417 participants (336 CDI/81 CDI-SF) who were hospitalized with the diagnosis of acute coronary syndrome and volunteered to participate in the study. Validity data was assessed using Exploratory Factor Analysis (EFA), Rasch, Confirmatory Factor Analysis (CFA), reliability by McDonald's Omega (ω), Pearson correlation coefficient and discriminability by Receiver operating characteristic (ROC) analysis. RESULTS:The two CDI were a high level of reliability. The factor structure and factor loadings of the CDI were not compatible with the original. The goodness of fit estimated by validity (CFA-EFA) was also not confirmed. The values of RMSEA, χ2/df and CFI indices suggest that it is not suitable for Türkiye. However, in the cross-cultural adaptation, validity and reliability study of the CDI-SF, it was concluded that the construct validity and internal consistency were high and could be used as a unidimensional scale. The inventory will be made freely available to clinicians and researchers. CONCLUSION:CDI-SF provides a specific, pragmatic and reliable measurement of cardiac distress, adapted to common heart diseases. It serves as an effective screening tool in cardiac clinical management by demonstrating strong psychometric properties.

Cardiovascular diseases are the leading cause of mortality worldwide, contributing to one-third of global deaths. Beyond physical health, heart disease is associated with cardiac distress, an emotional response that can negatively impact recovery and well-being. Understanding the psychological and social mechanisms underlying cardiac distress is crucial for improving patient outcomes. This study examines how social health (social support and social isolation) influences cardiac distress, with loneliness and repetitive negative thinking as mediators. To evaluate a theoretical model linking social health to cardiac distress, mediated by loneliness and repetitive negative thinking in patients with heart disease. A cross-sectional, correlational study was conducted in 2024 with 400 cardiac patients from two hospitals and one private clinic in Amol, Iran. Participants completed validated questionnaires assessing cardiac distress, social support, social isolation, loneliness, and repetitive negative thinking. Structural equation modeling was used for data analysis. Social isolation (r = 0.47, p < 0.001) and repetitive negative thinking (r = 0.50, p < 0.001) were significantly associated with greater cardiac distress. Social support negatively predicted both loneliness (β = - 0.32, p < 0.001) and cardiac distress (β = - 0.25, p < 0.01). Indirect effects showed that social support reduced cardiac distress by decreasing loneliness and repetitive negative thinking (β = - 0.23, p < 0.01), while social isolation increased cardiac distress through its influence on loneliness and repetitive negative thinking (β = 0.18, p = 0.05). The model explained 47.4% of the variance in cardiac distress. These findings highlight the importance of social health in managing cardiac distress among heart disease patients. Strengthening social support may alleviate loneliness and reduce repetitive negative thinking, ultimately improving emotional well-being and health outcomes. Future research should explore targeted interventions addressing these psychosocial factors to effectively reduce cardiac distress.

Approximately one in three patients with cardiovascular disease experience psychological distress, often with an associated poor prognosis. Early detection and intervention can improve patients' heart and mental health, yet minimal guidance on psychological screening is offered for clinicians working in cardiovascular care. This paper describes a pragmatic approach to conducting psychological screening during routine clinical care, including when and how to screen and what to do in the case of a positive screen. A psychological screening protocol is proposed to enable clinicians to assess and, where necessary, intervene or refer for further evaluation.

BackgroundGiven the high-stakes environment of intensive care units, understanding how nurses navigate moral challenges and engage in ethical decision-making is critical for maintaining patient safety and care quality. One important process in this field is moral disengagement, which is growing in the nursing literature. However, there is a lack of foundational and qualitative studies addressing this issue. This study presents a qualitative content analysis aimed at exploring moral disengagement among nurses working in intensive care units.MethodThis qualitative study employed conventional content analysis from June to December 2024 in Tehran, Iran. Purposive sampling was used to recruit participants. Data were collected using in-depth, unstructured interviews at the beginning, followed by semi-structured interviews. Sampling continued until data saturation was reached, resulting in 30 interviews with 25 eligible intensive care unit nurses. The conventional qualitative content analysis approach developed by Graneheim and Lundman was employed.ResultsThree main categories with eight subcategories were identified from the initial 765 codes. The findings revealed three main categories: "cognitive justification of unethical behavior," "protective strategies for personal security," and "normalization of unconventional practices." These categories include subcategories such as "externalization of responsibility," "moral-cognitive justification," "positive reframing of the event," "preservation of job position and security," "psychological stabilization," "strategic violation of regulations for survival," "reduction of emotional and psychological pressure," and "protective framing of behavior."ConclusionThis study reveals various aspects of moral disengagement among critical care nurses, which can pave the way for future studies to better understand the phenomenon, its related factors, and help with the development of preventive measures.