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Research

Research Orientation

Dr. Sheila O’Keefe-McCarthy embraces a social justice equity lens and uses mixed methods (quantitative and qualitative and arts-based approaches) to conduct patient-focused research in women’s and men’s cardio/vascular health.  As Primary Investigator within her Heart Innovation Research Program (HIRP) and as Co-Primary Investigator in the Health, Art and Justice Lab provides research, education opportunities for patients, healthcare providers and student trainees and actively creates awareness, and mobilizes knowledge to improve the promotion, prevention, treatment and understanding of the human experience of health and illness.

The Heart Innovation Research Program- Knowledge Mobilization: HIRP is dedicated to active knowledge mobilization of the research and uses an arts-based platform to promote all science and art related presentations and products (sokeefemccarthy.ca). Active knowledge dissemination provides arts-based educational and knowledge translation based on current heart health research that transcends typical forms of education. We use an arts-based method to conduct research and educate people and provide opportunities to create art that leaves a lasting presence in the hearts and minds of our audiences.  We layer three different creative genres, building on each other, for example: (literary techniques of poetry; visual art of paintings, sculpture/photography and use exhibit and/or performance of theatre or music to provide meaningful education on heart health and illness.   Using art in this way helps to transform what we once thought about illness, pain or health and health care delivery and challenges our often taken-for-granted assumptions exposing or our blind spots (implicit biases) of the experience. Providing invitation and entrance into an individual’s (heart) health-related or other healthcare related experience through qualitative inquiry with use of arts-based approaches makes visible the multiple meanings of an illness experience as lived and felt by the individual.

Focus 1: Heart Health; Early and Acute Symptom Recognition

Detection, screening and examination of pre-hospital cardiac prodromal symptoms in men and women with coronary artery disease.

Cardiac–related prodromal symptoms (PS) experienced days to months prior to an acute cardiac event, are defined as sensations/symptoms that are new, vary with intensity and frequency and are absent after the acute event. Men and women have reported varied descriptions of prodromal symptoms that have included unusual chest and arm pain, shortness of breath, unexpected or unusual fatigue, sleep disturbances, dizziness, and increasing levels of anxiety. Dr. O’Keefe-McCarthy’s earlier work in this area resulted in the development of the original Prodromal Symptoms-Screening Scale. Originally an eight-item scale, developed and based on scientific literature, and clinical practice. This screening tool was used to examine the prevalence and influence of pre-hospital prodromal symptoms on patients’ baseline cardiac pain intensity, state and trait anxiety. Results indicated that men and women equally exhibited PS prior to their hospital admission for a heart attack. This new knowledge has not been widely captured in the existing prodromal literature as most prodromal research has been conducted on women. This study was one of the first to demonstrate that prodromal symptoms were predictive of the level of cardiac pain intensity a person may have during a heart attack. Overall, increased cardiac pain intensity was significantly associated with prodromal headaches, sleep disturbance and anxiety. Dr. O’Keefe-McCarthy’s research in this area has expanded into further development of the PS-SS tool, creating new knowledge to disseminate about the predictive value of the tool in detecting heart disease and innovative methods to get this critical information into the hands of patients and healthcare professionals who can use it. [The Prodromal Symptom Screening Scale; catchheartdiseaseearly.ca]

Infographic of the 13 unique symptoms thar may be experienced months, weeks, or days before a cardiac event.

Infographic of the 13 unique symptoms that may be experienced months, weeks, or days before a cardiac event.

Research Focus 1:

The development and testing of innovative, mobile health technology (m-health) interventions for individuals suffering from acute and palliative cardiovascular diseases.

Acute coronary syndromes (ACS) (unstable angina and myocardial infarction) are leading causes of increased morbidity and mortality and impose significant economic burden on health care systems worldwide. ACS pain is typically severe and anxiety-provoking. Accumulating evidence indicates that unresolved ACS pain and anxiety contribute to immediate and long-term major adverse cardiac events (i.e., re-infarction, lethal dysrhythmia, development of persistent cardiac pain, decreased health–related quality of life (HRQL), increased anxiety, hospital length of stay, health service burden, morbidity and mortality). With the advancement in technology, mobile health (m-health) applications are being used across different pain populations as an intervention for symptom management. Within cardiovascular populations m-health technologies have been limited to aspects of disease prevention and risk factor modification that include weight loss, smoking cessation, physical activity/exercise, diabetes mellitus, blood pressure control, and cholesterol monitoring. Unique to Dr. O’Keefe-McCarthy’s program of research, is to develop, design and test symptom treatment interventions that are informed and designed by patients living with heart disease and health care professionals who treat individuals that suffer with cardiovascular disease.

Current Research Projects:
  1. An End User-Designed Application for Emergent Acute Heart Pain: The ACUTE-♥-PAIN APP! Phase I: Qualitative Needs Assessment. [data analysis and manuscript preparation- in progress]
Associated Publications:
  1. An End User-Designed Application for Emergent Acute Heart Pain: The ACUTE-♥-PAIN APP! Phase I: Qualitative Needs Assessment. [manuscript preparation- in progress].
  2. O’Keefe-McCarthy, S., McGillion, M., Clarke, S., & McFetridge-Durdle, J. (2014). Pain and anxiety in rural acute coronary syndrome patients awaiting diagnostic cardiac catheterization. Journal of Cardiovascular Nursing. DOI: 10: 1097/JCN0000000000000203. 
  3. O’Keefe-McCarthy, M. McGillion, S. Nelson, S. Clarke, J. Jones, S. Rizza, & McFetridge-Durdle (2014). Acute Coronary Syndrome Pain and Anxiety in a Rural Emergency Department- Patient and Nurse Perspectives. Canadian Journal of Nursing Research. 46(2), 80-100.

“I couldn’t even vacuum, the house … by the time I would get up to the top of the stairs, I had to really stop so that I could catch my breath and I’d have to wait it out a little bit.”

Female, age 67

Research Focus 2:

Examination of cardiac pain-related anxiety.

A growing body of evidence indicates that the presence of anxiety in ACS, places patients at increased risk for myocardial ischemia, adverse complications immediately post ACS event and poor long-term prognosis. Little empirical evidence is available, specific to cardiovascular patients, which describe ACS-related anxiety during the initial hours of an emergent ACS onset. In previous work Dr. O’Keefe-McCarthy for her PhD thesis examined the influence of pain management practices on rural acute coronary syndrome (ACS) patients’ pain intensity and state anxiety in the first acute hours of an ACS onset. Pain was well managed but patients experienced high levels of anxiety over the first 8 hours of an emergency hospital visit. An urgent need identified in her PhD work was the development of innovative, patient-informed interventions for cardiac related symptoms that people experience while having a heart attack.

Associated Publications:
  1. O’Keefe-McCarthy, S., McGillion, M., Victor, C.J., Rizza., S., McFetridge-Durdle, J. (2017). Nociceptive and Neuropathic Pain Qualities in Men and Women with Acute Coronary Syndromes: A Complex Pain Presentation. Open Journal of Nursing 7(3) DOI: 10.4236/ojn.2017.73027.
  2. O’Keefe-McCarthy, S., McGillion, M., Clarke, S., & McFetridge-Durdle, J. (2014). Pain and anxiety in rural acute coronary syndrome patients awaiting diagnostic cardiac catheterization. Journal of Cardiovascular Nursing. DOI: 10: 1097/JCN0000000000000203.
  3. O’Keefe-McCarthy, M. McGillion, S. Nelson, S. Clarke, J. Jones, S. Rizza, & McFetridge-Durdle (2014). Acute Coronary Syndrome Pain and Anxiety in a Rural Emergency Department- Patient and Nurse Perspectives. Canadian Journal of Nursing Research. 46(2), 80-100.
collage of early warning signs heart disease
Artist #2

“Warning Signs Interrupt Us” is the title of a poem that directly comes from the thoughts, feelings and words of women and men when realizing they had heart disease.  This collage represents this.

“I don’t feel myself. I feel like crap…… and I had Googled heart symptoms, … and what concerned me, was that you could have had similar feelings in the past. And I can go back, maybe 9 months from that episode. I had a little bit of heart burn or something, popped a few Tums; it went away….Then I don’t remember when the second squeezy pain was, but again, it didn’t last very long. Brushed it off. And this — this one’s not going away”.

Female, age 45.

Research Focus 3:

Detection, screening and examination of pre-hospital cardiac prodromal symptoms in men and women with coronary artery disease.

Cardiac–related prodromal symptoms (PS) experienced days to months prior to an acute cardiac event, are defined as sensations/symptoms that are new, vary with intensity and frequency and are absent after the acute event. Men and women have reported varied descriptions of prodromal symptoms that have included unusual chest and arm pain, shortness of breath, unexpected or unusual fatigue, sleep disturbances, dizziness, and increasing levels of anxiety. Dr. O’Keefe-McCarthy’s earlier work in this area resulted in the development of the original Prodromal Symptoms-Screening Scale. An eight-item scale developed based on scientific literature, and clinical practice. This screening tool was used to examine the prevalence and influence of pre-hospital prodromal symptoms on patients’ baseline cardiac pain intensity, state and trait anxiety. Results indicated that men and women equally exhibited PS prior to their hospital admission for a heart attack. This new knowledge has not been widely captured in the existing prodromal literature as most prodromal research has been conducted on women. This study was one of the first to demonstrate that prodromal symptoms were predictive of the level of cardiac pain intensity a person may have during a heart attack. Over all, increased cardiac pain intensity was significantly associated with prodromal headaches, sleep disturbance and anxiety. Dr. O’Keefe-McCarthy’s research in this area has expanded into further development of the PS-SS tool, creating new knowledge to disseminate about the predictive value of the tool in detecting heart disease and innovative methods to get this critical information into the hands of patients and healthcare professionals who can use it.

Current Cardiac Prodromal Research Projects:
  1. Predictive Value of Prodromal Symptoms on Major Adverse Cardiac Events: [In process].
  2. Item Generation of the Prodromal Symptoms-Screening Scale: A Focus Group Study [Data Collection Complete; Analysis and Manuscript in preparation].
  3. Development and Dissemination of a User-Centered Design of a multi-media Educational Strategy Targeting Cardiac Prodromal Symptoms: Dispelling the Mystery- the Difference Between Women and Men. Phase 1: Exploring the Educational Needs and Preferences of Women and Health Care Providers: Designing a Knowledge Dissemination Strategy of Cardiac Prodromal Warning Symptoms[Data Collection and Data Analysis completed.  Manuscript development in process]. Research informed- Educational Products- for heart patients and health care professionals available on the Heart Health Research Site here].
  4. Predictive Value of Prodromal Symptoms on Major Adverse Cardiac Events: [Manuscript preparation].
  5. Development and Dissemination of a User-Centered Design of a multi-media Educational Strategy Targeting Cardiac Prodromal Symptoms: Dispelling the Mystery- the Difference Between Women and Men. Phase 1: Exploring the Educational Needs and Preferences of Women and Health Care Providers: Designing a Knowledge Dissemination Strategy of Cardiac Prodromal Warning Symptoms. [Manuscript in Review].
  6. Research informed- Educational Products- for heart patients and health care professionals available on the Heart Health Research Site here under resources].
Associated Publications:
  1. O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Ostrowski, L., Flynn-Bowman, A., Vasilaki, M., Vigo, J., Hoelzli, J., Salfi, J., O’Leary, D. (2019). Revision of the Cardiac Prodromal Symptoms-Screening Scale [PS-SS]: A Qualitative Exploration. Canadian Journal of Cardiovascular Nursing, 29(2), 15-22.
  2. O’Keefe-McCarthy, S., Yost, J., Taplay, K., Yates, E., Vasilaki, M., Romas, S., Flynn-Bowman, A., McPherson, M., & Keeping-Burke, L. (2018). The Predictive Value of Prodromal Symptoms on Major Adverse Cardiac Events: A Systematic Review Protocol. Canadian Journal of Cardiovascular Nursing, 28 (1).
  3. O’Keefe-McCarthy, S., Keeping-Burke, L., Taplay, K., Vigo, J., Crawford J. & Salfi, J., (2017). Revision of the Cardiac Prodromal Symptoms Screening Scale: A Qualitative Exploration of Ischemic Symptomology. Canadian Journal of Cardiovascular Nursing, 27(3): 6.[Abstract]
  4. O’Keefe-McCarthy, S., Ready, L., & Francis, S-L. (2017). Cardiac related prodromal symptoms- A Complicated Clinical Challenge. The Nurse Practitioner, 42(1), 1-3. DOI:10.1097/01.NPR.0000511010.36961
  5. O’Keefe-McCarthy, S., Guo, S-L. (2016). Development of the Prodromal Symptoms-Screening Scale [PS-SS]: Preliminary Validity and Reliability. The Canadian Journal of Cardiovascular Nursing 26(2). ISSN: 2368-8068
  6. O’Keefe-McCarthy, S., McGillion, M., Victor, J.C., Jones, J. & McFetridge-Durdle, J. (2015). Prodromal symptoms associated with acute coronary syndrome acute symptom presentation. European Journal of Cardiovascular Nursing. DOI: 10: 1177/1474515115580910.
  7. O’Keefe-McCarthy, S., & Ready, L. (2014). Impact of Prodromal symptoms on future cardiac-related events: A systematic review. Journal of Cardiovascular Nursing. DOI: 10: 1097/JNC0000000000000207.
  8. O’Keefe-McCarthy. (2008). Women’s Experiences of Cardiac Pain: A Review of the Literature. Canadian Journal of Cardiovascular Nursing, 18(3), 18-25.
collage of early warning signs heart disease
Artist #2

“Warning Signs Interrupt Us” is the title of a poem that directly comes from the thoughts, feelings and words of women and men when realizing they had heart disease. This collage represents this.

“Using an arts-informed approach to analyze and disseminate data has the ability to change perceptions of our understanding of the early warning signs of heart disease,” O’Keefe-McCarthy

Research Focus 4:

Arts-based Research

Arts-based analysis, interpretation and dissemination within in healthcare research as a qualitative methodological approach is evolving and within cardiovascular populations is fairly new.

..

The Heart Innovation Research Program deliberately employs an arts-based integrated approach to analysis, interpretation and dissemination, that we call the arts-based, embodied, layered exploration [The ABELE approach] of an experience. This qualitative, arts-based approach permits a unique view into the narrative stories of women and men living with cardiovascular disease.

Using an arts-based approach with artistic creations helps to transform what we once thought about illness, pain or health and challenges our often taken-for-granted assumptions of the experience. Providing invitation and entrance into an individual’s health-related experience through qualitative inquiry with use of arts-based approaches makes visible the multiple meanings of an illness experience as lived and felt by the individual with cardiovascular disease.

 

Publications:

  1. O’Keefe-McCarthy, S., Taplay, K., Flynn-Bowman, A., Keeping-Burke, L., Sjaarda, V., McCleary, L., Abernethy, J., Prentice, M., Tyrer, K., & Salfi, J. (In Press, 2020). Recognizing Pain as an Early Warning Symptom of Ischemic Cardiovascular Disease: A Qualitative Artistic Representation of the Journey. The Canadian Journal of Pain. https://doi.org/10.1080/24740527.2020.1801339

Knowledge Dissemination

He-art-isitic Journeys Series I- Recognizing Pain as an Early Warning Sign of Ischemic Heart Disease

Sheila holding artwork

 

 

 

Other Research Activities:

Development and Psychometric Evaluation of Measurement Tools.

The Toronto Pain Management Inventory-Acute Coronary Syndrome Version [TPMI-ACS]

During Dr. O’Keefe-McCarthy’s PhD, she was able to work with the original developer Dr. Judy Watt-Watson to revise the Toronto Pain Management Inventory to reflect current ACS assessment and management in order to measure nurses’ pain knowledge and attitudes.

The revised Toronto Pain Management Inventory-ACS Version is a disease specific tool that contains 24 items dealing with patients’ experiences of ACS pain and anxiety, nurses’ chest pain assessment, and also pharmacologic ACS pain management strategies, including antianginal medications and opioids. Items are scored using an 11-point rating scale (range, 0-100) in 10-unitincrements. To decrease acquiescence bias and avoid use of negative items, half of the scale items are phrased so that higher scores indicate greater knowledge. To generate the final score, the remaining items (ie, 1, 2, 4 & 7, 9, 10, 12, 14, 16, 18, and 20) were reverse scored (ie, subtracted from 100) and all items were summed. The overall summary score range is 0 to 2400; score ranges were further categorized in to low, medium, and high levels of knowledge: low, 0 to 800; medium, 801 to 1600; and high, 1601 to 2400 points. A score of 1601 or higher indicates a superior knowledge level. Preliminary content validity index was established at 0.90, and test-retest reliability, with an interclass correlation of 0.78.

Toronto Pain Management Inventory- ACS Version Permission Form: Download here

Current Research Related to Psychometric Development and Evaluation:

  1. International colleagues in Brazil are collaborating with Dr. O’Keefe-McCarthy to translate the TPMI-ACS version into Portuguese, with a subsequent validation study in a sample of Brazilian nurses. [Study completed; manuscript in progress]
  2. Future collaborative research and translation is planned for the TPMI-ACS into French, Spanish, Greek and Chinese languages.

Associated Publications:

  1. de Souza Felício, AC., de Lucena Ferretti-Reubustini, RE., Murata-Murakami, B., de Andrade Coelho, FU., Takao Lopes, C., O’Keefe-McCarthy, S., Ribeiro dos Santos, E. (2020). VERSÃO BRASILEIRA DO TORONTO PAIN MANAGEMENT INVENTORY -ACUTE CORONARY SYNDROME [BRAZILIAN VERSION OF THE TORONTO PAIN MANAGEMENT INVENTORY – ACUTE CORONARY SYNDROME]. Reme Revista Mineira de Enfermagem, 24:e-1320. DOI: 10.5935/1415-2762.20200057
  2. O’Keefe-McCarthy, M. McGillion, S. Nelson, S. Clarke, J. McFetridge-Durdle, & J. Watt-Watson. (2014). Content Validity of the Toronto Pain Management Inventory-Acute Coronary Syndrome. Version. The Canadian Journal of Cardiovascular Nursing, 24(2), 11-18.
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