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 that may be experienced months, weeks, or days before a cardiac event.

Back of infographic, that provides more information about using the scale

Cardiac Prodromal Symptoms Screening Scale [PS-SS]. Developed and validated the online application of the PS-SS, a screening tool of the possible 13 early signs of developing obstructive heart disease. Each item is assessed for occurrence, intensity, and frequency. Total scale scores can range from 0 to 234, with higher scores being indicative of increased prodromal symptomology.  Individual item scores of 0-7; 8-12 and 13-18 indicate mild, moderate and severe levels of symptom severity. Coupled with sex specific differences in individual modifiable and non-modifiable risk factor profile, the scale offers recommendations based on research to contact a health care provider for cardiovascular health risk assessment and follow up. https://prodromalsymptomscreeningscale.ca/

Current Prodromal Research Projects:

Indigenous Heart Health

Early Warning Signs of Heart Disease: An Indigenous Research Creation [Qualitative study, Arts-based analysis, Interpretation, Representation, Knowledge Moblization]

Abstract: First nations people (FNP) are three times more likely to develop cardio/vascular diseases (Heart or Diabetes) compared to non-indigenous people. FNP have higher rates of heart attack, angina, heart related disability and death. In FNPs the premature death rate from heart disease far exceeds non-indigenous Canadians. Recent Canadian statistics indicate that every 40 seconds a person dies because they do not recognize early (prodromal symptoms [PS]) and acute symptoms of heart disease. Prodromal Symptoms are defined as intermittent, vague, singular sensations or a combination of symptoms felt together with varying intensity and frequency before a heart attack strikes. We conducted conversations with women and men with heart disease to explore the early warning signs and symptoms of heart disease/illness they experienced.  In partnership with Six Nations of the Grand River we worked with community, Thru The Red Door film production company, and local artists at Six Nations to develop heart health awareness and arts-based education materials and videos to use within community.  Conducting knowledge mobilization presentations and art exhibits provide opportunities to gain heart health awareness and education through engaging in Indigenous arts-based knowledge practices.

The Indigenous Informed Research Knowledge Creations

Indigenous Heart Health Educational Drum.

Acrylic Painting- Journey to a heart healthy life.

Artist: Sydnie Thomas (2024),

Group of Six; Six Nations

Associated Online Resources

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. Early Warning Signs of Heart Disease: An Indigenous Research Creation (Educational Videos).

Video 1: Introduction to the Early Warning Signs of Heart Disease Project

https://youtu.be/L4zi-gI-Aek

Video 2 Early Warning Signs: An Indigenous Research Creation- The findings

https://youtu.be/bWrrsMpEWD8

Video 3 Early Warning Signs: An Indigenous Research Creation- The Artists Inspirations: https://youtu.be/Jan6kri5VGk

Associated Publications/Presentations

O’Keefe-McCarthy, S., Metz, M.M., & Kahnert, B. (2022). He-ART-istic Journeys-Transformative Experiential Learning through Applied Theatre. Learning Landscapes Spring, 2022/ 15(1): 283-298.

O’Keefe-McCarthy, S., Taplay, K., Flynn-Bowman, A., Keeping-Burke, L., Sjaarda, V., McCleary, L., Abernethy, J., Prentice, M., Tyrer, K., & Salfi, J. (2020). Recognizing Pain as an Early Warning Symptom of Ischemic Cardiovascular Disease: A Qualitative Artistic Representation of the Journey, The Canadian Journal of Pain, 4(3); 71-86. https://doi.org/10.1080/24740527.2020.1801339

Presentations:

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. Symptoms and Signs of Cardiovascular Disease: An Indigenous Knowledge Creation. Brantford Region Indigenous Support Centre: Friendship Centre July, 2024, Brantford, Ontario [Oral/Exhibit].

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. Symptoms and Signs of Cardiovascular Disease: An Indigenous Knowledge Creation- Report to Six Nations Ethics Committee. July 2024, Virtual

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. Symptoms and Signs of Cardiovascular Disease: An Indigenous Knowledge Creation- Six Nations, Silver Fox Fish Fry Event, Six Nations of the Grand River, Ohsweken, Ontario, 2024

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. Symptoms and Signs of Cardiovascular Disease: An Indigenous Research Creation. Canadian Council of Cardiovascular Nurses Spring Conference, May 24-26th, 2024, Calgary Alberta. [Oral].

O’Keefe-McCarthy, S., Bomberry, M., Taplay, K., Patterson, C., Flynn-Bowman, A. The Early Warning Signs of Heart Disease-An Indigenous Research Creation: Preliminary Teachings. “Healing Circles of Engagement, Weaving Relationships in Research.”  CIHR Scientifique Café. Brock University, August 23, 2023.

Bomberry, M. & O’Keefe-McCarthy, S. Walking the two row: A Research Relationship.  “Healing Circles of Engagement, Weaving Relationships in Research.”  CIHR Scientifique Café. Brock University, August 23, 2023.

O’Keefe-McCarthy, S. Bomberry, M. [Invited Panel] Early Warning Signs of Heart Disease: An Indigenous Research Creation. An Indigenous Research Panel, Indigenous Week – Brock University, June 21, 2023.

Gallery

Figure  a and b reflect Indigenous knowing that Heart Health is connected to Mother Earth. Digital Art created by Artist Jean Abernethy.

Symptom Story- Hand Clutching Aching Heart- Digital Art] Artist Frankie Warner- Group of Six: Six Nations

Healing the Heart-Acrylic Painting- Artist Lillian Maracle- Group of Six: Six Nations

Walk in an Indigenous Heart Healthy Path-Beaded, laced, red running shoes- Artist- Mya Warner- Group of Six: Six Nations

He-art-istic Journey Series I

Recognizing Pain as an Early Warning Symptom of Ischemic Cardiovascular Disease: A Qualitative Artistic Representation of the Journey

Abstract: Understanding the experience of prodromal ischemic cardiac pain and associated symptoms through use of literary and visual art evokes heightened awareness of the emotional journey. Aims: The aim of this study was to describe the initial early prodromal pain-related symptoms and feelings associated with adjusting to this new cardiac health concern and explore the subjective experience of coming to the realization and awareness of developing heart disease.

Materials and Methods: This study is a secondary supplemental qualitative analysis, using an arts-based embodied layered exploration assisted to translate the experiences of 23 individuals’ journeys through symptom recognition. The analytic process involved three iterative layers: qualitative descriptive analysis of participant pain narratives, interpretation with thematic poetry, and representation via visual art to evoke an aesthetic, heightened level of understanding of the data.

Results: Denial and disbelief, encroaching pain and symptoms of heart disease, and self-recrimination were three themes that emerged from the data. Pain described by participants

brought forward the emotional dimensions of the experience. Participants described their process of realization as a tumultuous time, fraught with feelings of vulnerability and uncertainty, where anger and self-effacing ridicule permeated their thoughts that were tempered with profound

gratitude at survival.

Conclusion: Bridging the connection between science and art to disseminate awareness of the

nature of living with cardiac-related prodromal pain and disease is novel. Providing invitation and entrance into an individual’s pain experience through qualitative inquiry with use of arts-based approaches makes visible the emotional meaning of pain.

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

Presentations:

O’Keefe-McCarthy, S, Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., & Salfi, J. The He-art-istic Journey, Series 1: Recognition of the Early Warning Signs of Heart Disease- An Arts-Based Encounter. Legacy 2021 Research Conference, Western University, London, Ontario, May 3,10 25,31, 2021

O’Keefe-McCarthy, S. Recognizing Pain as an Early Warning Symptom of Ischemic Cardiovascular Disease: A Qualitative Artistic Representation of the Journey. Canadian Journal of Pain-Webinar-Special Qualitative Edition Media Release. October 2, 2020

O’Keefe-McCarthy, S. Pain Presentations by Men and Women with Acute Coronary Syndromes: A Complex Pain Presentation. The Canadian Council of Cardiovascular Nurses- Fall Virtual Conference, Oct. 1, 2020.

Knowledge Mobilization/Resources:

O’Keefe-McCarthy, S., Gallant, J. He-art-istic Journey I: Virtual Art Exhibit: The He-ART-istic Journey, Series 1: Recognition of the Early Warning Signs of Ischemic Heart Disease – An Arts-Based Encounter May 2021. https://www.youtube.com/watch?v=elXhl4BkB6Y

The He-ART-istic Journey- Digital Wall-Art Presentation Brock University, Library, St. Catharines, Ontario September 9th-30th, 2019.

The HE-ART-ISTIC Journey through Cardiac Pain: An Interpretation through Poetry and Art. The 40th Annual Canadian Pain Society Conference, Toronto, Ontario.

Twitter Event Reach: over 4000 impressions.  April 2-5, 2019.

he HE-ART-ISTIC Journey: View the HE-ART from the inside out. An artistic Interpretation of the Early Warning Signs of cardiac disease through art and poetry. A Canadian Council of Cardiovascular Nurses/Niagara Health Educational Presentation, St. Catharines, Ontario.  February 28, 2019.

Art Symposium: Heart-Informed Representation of Cardiac Illness. Meet and Greet the Artists. Marilyn Walker Centre for the Performing Arts, Brock University, St Catharines, Ontario.  September 12, 201.

He-art-istic Journey II

The Tensions of Time in the Recognition of the Early Prodromal Symptoms of Heart Disease: An Artistic Interpretation through Thematic Photographyouldn’t even

Abstract: Background: Early signs [Prodromal Symptoms], indicators of development of coronary artery disease (CAD) are hard to recognize. Prodromal Symptoms [PS] are often vague in nature, transient as they occur at unexpected times and come and go with such irregularity that one regards them as just odd and not a threat to their heart health.

Purpose: This secondary analysis explored the process of realization of Prodromal Symptoms (PS) leading to diagnosis of coronary artery disease (CAD).  Methods: This secondary analysis was couched within a qualitative descriptive study where our team revised items contained in the Cardiac Prodromal Symptoms Screening Scale. Twenty-three individual experiences of prodromal symptomology were explored through 12 individual and 4 focus group interviews. Data analysis was carried out employing the arts-based embodied layered exploration [ABELE] qualitative approach to analyze, interpret and disseminate the findings. Typically, we layer analysis using creative genres building on each other: qualitative description (coding, themes), literary techniques [i.e., thematic poetry] and visual art [i.e., artistic photography] and disseminate with exhibit and/or presentation.

Results: Women and men, 48 to 78 years of age post myocardial infarction were recruited from cardiac rehabilitation centres in Ontario.  Themes arising from the narratives revealed an uncertain and introspective process that included denial and disbelief, rationalization and self recrimination at not realizing PS were a cardinal sign of CAD. Thematic photography depicted the underlying tensions around “time” prior, during and after participant’s myocardial infarction.  The symptoms of encroaching CAD often denied are depicted in a series of 4 photographs entitled “Borrowed Time”. The actual cardiac event is pictorially displayed as a person who has “Timed Out” and is having a heart attack. The third photo series depicts the themes of self-recrimination, and gratitude at surviving; living through the experience post cardiac event entitled: “Recovered Time.”

Conclusion: Creating knowledge of PS and individuals’ experiences of recognition of CAD requires an environment where mutual understanding and sharing can occur, we do this by uniting research and art in which the meaning of cardiac disease can be fully experienced and remembered.

Publications:

O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., Sjaarda V., Moretti, R., Romas, S., Dinnarr, C., Muraca, V., Bernier, B., Anwar, Y. Tensions of Time-Journeying towards Recognition of Heart Disease: Captured by Thematic Photography [In preparation]

Presentations:

O’Keefe-McCarthy, S, Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., Sjaarda, V, Moretti, R., Dinnarr, C. & Romas S. “Timed Out”-Recognition of the Early Warning Symptoms in the Development of Cardiac Disease: An Artistic Exhibit through Thematic Photography. The Canadian Council of Cardiovascular Spring Conference, Kelowna BC, Canada May 27-28, 2022 (Oral).

O’Keefe-McCarthy, S, Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., Sjaarda, V., Moretti, R., & Dinnarr, C. The He-ART-istic Journey Series II: The Tension of Time in the Recognition of the Early Prodromal Symptoms of Heart Disease: An Artistic Interpretation through Thematic Photography. Legacy 2021 Research Virtual Conference, Western University, London, Ontario, May 3,10,25,31, 2021. [Research/Art, Virtual-Exhibit]

Knowledge Mobilization/Resources: would get up to the top of the s

He-art-istic Journey II: Virtual Art Exhibit: He-ART-istic Journey, Series II: The Tensions of Time in the Recognition of the Early Prodromal Symptoms of Heart Disease: An Artistic Interpretation through Thematic Photography. Western University, Legacy Conference May 10, 2021. https://www.youtube.com/watch?v=m-F_okaBxe8

The He-ART-istic Journey, Series II- Time Series, ABELE interpretation of the Early Warning Signs of Heart Disease as told through Thematic Photography, Brock University, Rodman Hall St. Catharines, Ontario, February 20, 2020.

He-art-istic Journey III

The Heart DIS-Ease PlaY  https://www.youtube.com/watch?v=r0ZxHuczgKU

Abstract: The creation of the Heart DIS-ease PlaY was generated through a secondary qualitative arts-based analysis, interpretation and representation of men and women’s experiences of the early warning signs of heart disease. Using an integrated arts-based embodied layered exploration approach [ABELE approach] we developed scenes that depict the lived experiences described in the qualitative interviews.  The Heart DIS-ease PlaY includes 10 different scenes that dramatize the lived experiences of 23 individuals who have lived with heart disease. It is their cumulative story of how they became aware of their early warning symptoms leading to a heart attack. This is presented as a video play with scenes depicting the internal and external journeys people face when they are diagnosed with heart disease.

Heart Event 2023, Brock University- The Heart DIS-ease Play- Scene: The Moment. [Pictured Dr. Sheila O’Keefe-McCarthy (Centre), Mirror Theatre Cast: L to R: Kevin Hobbs, Mike Metz and Nadia Ganesh]

Research: Using Reflexivity to DIS-rupt Implicit Bias in Cardiovascular Care: An Applied Theatre Workshop-The Heart DIS-Ease PlaY

Abstract: Experiential, arts-based learning workshops for healthcare students are an innovative approach to promote dialogue, reflexivity, and disrupt implicit biases. Educational opportunities in different formats immerse students in their learning, challenging individuals to be critical and engaged thinkers. The objective of this study is to understand the impact of an arts-based theatrical workshop to educate future health professionals in the Niagara region about heart disease and promote reflexivity to understand health care provider implicit biases and patient perspectives.  Nursing and medical undergraduate students were recruited by purposive sampling and engaged in the Heart DIS-Ease PLAY workshop at Brock University. The participatory, dialogic theatrical workshop incorporates recorded and live theatrical adaptations, focusing on individuals’ experiences of heart disease. Students were guided through scenes with prompted reflection and dialogue and engagement with actors and peers in discussion. A post-workshop mixed qualitative and quantitative survey was used for data collection and analysis. The survey collected demographic data, Likert-scale ranking of aspects of the workshop, and qualitative questions that captured the students perceived impression of the learning experience. Follow-up qualitative interviews were conducted with interested participants that focused on the impact on their learning and use of reflexivity to unpack implicit bias in clinical practice.   

Publications:

O’Keefe-McCarthy, S., Keeping-Burke. L., Taplay, K. Hobbs, K., Metz, M.M., Okhuakhua, O.J., Morris S., Dullius, W., Dunn, S., Macdonald, V., Ells, G.  Using Reflexivity to DIS-rupt Implicit Bias in Cardiovascular Care: An Applied Theatre Workshop-The Heart DIS-Ease PlaY. [Manuscript Development]

Presentations:

O’Keefe-McCarthy, S., Keeping-Burke. L., Taplay, K. Hobbs, K., Metz, M.M., Okhuakhua, O.J., Morris S., Dullius, W., Dunn, S., Macdonald, V., Ells, G.  The Heart DIS-Ease PlaY: An Artistic Way to Mobilize Research.  Canadian Council of Cardiovascular Nurses, Spring Conference, May 24th 25th, 2024, Calgary, Alberta [Plenary-Oral].

Dunn, S., O’Keefe-McCarthy, S., Keeping-Burke. L., Taplay, K., Hobbs, K.,  Metz, M.M., Okhuakhua, O.J.,  Morris, S., Dullius, W., Macdonald, V., Ells, G. The Utility of the Heart DIS-Ease PLAY – An Applied Theatre Workshop for Medical and Nursing Students. Norman Education Research Day, June 5, 2024, McMaster University, Hamilton, Ontario [Poster Presentation].

Dunn, S., O’Keefe-McCarthy, S., Keeping-Burke. L., Taplay, K., Hobbs, K., Morris, S., Dullius, W., Macdonald, V., Ells, G. The Utility of the Heart DIS-Ease PLAY – An Applied Theatre Workshop for Medical and Nursing Students-Disrupting Bias in Clinical Practice. Niagara Health Research Day, May 2, Niagara College, Daniel J. Patterson Campus, Niagara-on-the-Lake [Poster Presentation]

O’Keefe-McCarthy, S., Keeping-Burke. L., Taplay, K. Hobbs, K., Morris S. Dullius, W., Dunn, S., Macdonald, V., Ells, G.  Using Reflexivity to DISrupt Implicit Bias in Cardiovascular Care: An Applied Theatre Workshop-The Heart DIS-Ease PlaY. Canadian Associations of Schools of Nursing Conference, May 27th 28th, 2024 Calgary, Alberta [Oral].

Knowledge Mobilization

HeArt Event and Art Exhibit- 2023. He-art-sitc Journeys Heart Dis-ease PlaY. Sean O’Sullivan Theatre, Brock University, St. Catharines Ontario, February 8, 2023.

Emotional Burden of Heart Disease

Abstract: Background/Aims A diagnosis of ischaemic heart disease may cause the individual

to enter a state of emotional uncertainty. The authors aimed to provide an arts-based

account of the emotional burden experienced by people with ischaemic heart disease.

Methods: A secondary qualitative analysis of 35 individuals with ischaemic heart disease

was conducted; the results from the interview transcripts were analysed and depicted

using an arts-based approach, in the form of poetry, musical lyrics and visual art.

Results: Participants described an overwhelming sense of loss following a diagnosis of

ischaemic heart disease, including feeling a loss of control in their lives, loss of self, loss

of agency in managing the illness and a loss of hope for the future. The emotional burden

that patients carried was likened to going through a grieving process. Three poems,

one song and two visual art pieces were created by the authors to depict the emotional

burden experienced by the participants.

Conclusions: Supportive interventions that apply arts-based approaches to practice are

needed to target the psychological needs and emotional burden of patients following

diagnosis of ischaemic heart disease.

Publications.

O’Keefe-McCarthy, S., Mussie, I., Taplay, K. Michaelson, H., Faleiro, R. (2023). The Emotional Burden of Living with Ischemic Heart Disease: An Artistic Approach. British Journal of Cardiac Nursing, 18(9), 1-12. https://doi.org/10.12968/bjca.2022.0134

Presentations:

O’Keefe-McCarthy, S. Mussie, I., Taplay, K. The Emotional Burden of Cardiovascular Disease-Represented through Poetry and Lyrics. Kingston Virtual Nursing Conference, Queen’s University, Kingston, Ontario, March 3, 2022 [Primary Investigator] [Oral/Poster].

O’Keefe-McCarthy, S. [Invited Plenary] Embodying your Research through Arts-based Approaches: Mobilizing Knowledge in Impactful Ways. Mapping New Knowledges Graduate Conference, Brock University, April 12th 2023. https://www.youtube.com/watch?v=pXoz6-2cxsM (Ascendancy)

https://www.youtube.com/watch?v=YfPxqgxQ9Ac(The DIS-ease of my Disease)

O’Keefe-McCarthy, S., Taplay, K., [Invited Plenary and Art Exhibit]. Arts-based Research: Creating Tools for Meaningful Knowledge Translation. St. Bartholomew’s Hospital, London, England, March 23, 2023.

O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Flynn-Bowman. A., McCleary, L., Abernethy, J., Prentice, M., Tyrer, K., Salfi, J. Recognizing Pain as an Early Warning Sign of Ischemic Heart Disease: A Qualitative Artistic Representation of the Journey. St. Bartholomew’s Hospital, 900th Anniversary, London, England. March 23, 2023.

O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., Vanessa Sjaarda, V., Moretti, R., Dinnarr, C., Romas, S., Bernier, B., Muraca, V., Anwar, Y. Tensions of Time: Journeying towards Recognition of Heart Disease: Captured by Thematic Photography. St Bartholomew’s Hospital, 900th Anniversary, London, England. March 23, 2023.

O’Keefe-McCarthy, S., Taplay, K., Mussie, I., Michaelson, H. Faleiro, R. The Emotional Burden Living with Ischemic Heart Disease: An Artistic Understanding. St Bartholomew’s Hospital, 900th Anniversary, London, England. March 23, 2023.

O’Keefe-McCarthy, S., Norris, J., Hobbs, K., Metz M.M., Ganesh, N., Moreno, R. He-art-istic Journeys III: Heart DIS-ease PlaY- [The Moment-]. St Bartholomew’s Hospital, 900th Anniversary, London, England. March 23, 2023.

O’Keefe-McCarthy, S. [Invited Plenary] Opening up the heart through ART. The Society of Cardiovascular Thoracic Surgery, The Royal College of Surgeons of Edinburgh, University Day/Conference, Birmingham, England. March 19-21st, 2023.

O’Keefe-McCarthy, S., Taplay, K., Mussie, I., Michaelson, H. Faleiro, R. The Emotional Burden Living with Ischemic Heart Disease: An Artistic Understanding. The Society of Cardiothoracic Surgery Annual Conference, Birmingham, United Kingdom, March 21, 2023.

O’Keefe-McCarthy, S. [Invited Plenary and art exhibit]. Translating Research Data into Art. The Society of Cardiovascular Thoracic Surgery, The Royal College of Surgeons of Edinburgh, University Day/Conference, Birmingham, England. March 19-21st, 2023.

O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Flynn-Bowman. A., McCleary, L., Abernethy, J., Prentice, M., Tyrer, K., Salfi, J . Recognizing Pain as an Early Warning Sign of Ischemic Heart Disease: A Qualitative Artistic Representation of the Journey. Society of Cardiothoracic Surgery- University Day, Annual Conference, Birmingham, England, March 19, 2023.

O’Keefe-McCarthy, S., Taplay, K., Keeping-Burke, L., Flynn-Bowman, A., Vanessa Sjaarda, V., Moretti, R., Dinnarr, C., Romas, S., Bernier, B., Muraca, V., Anwar, Y. Tensions of Time: Journeying towards Recognition of Heart Disease: Captured by Thematic Photography. SCTS University Day, Birmingham, United Kingdom, March 19th, 2023.

O’Keefe-McCarthy, S., Taplay, K., Mussie, I., Michaelson, H. Faleiro, R. The Emotional Burden Living with Ischemic Heart Disease: An Artistic Understanding. SCTS University Day, Birmingham, United Kingdom, March 19th 2023.

O’Keefe-McCarthy, S. [Invited presentation] Introduction to Qualitative Methods. The Society of Cardiovascular Thoracic Surgery, The Royal College of Surgeons Of Edinburgh. Virtual Core Research Skills Educational Course. November 19, 2022.

Lyrics: Losing Control is an alternative soul rendition based on the cumulative

narratives of the participants that reflect the themes of loss of control and temporary loss of self while adjusting to having ischaemic heart disease. Performed by Isaac Mussie.

https://www.youtube.com/watch?v=Yzgu0Vlaljg

For associated publications of other studies conducted in this focus see the publications tab.

Other Arts-Based Projects

1. 1. Breaking through the Brokenness: An arts-based qualitative study of pregnant womens’ experiences of intimate partner violence.

Publications:

Jackson, K. T., Mantler, T., O’Keefe-McCarthy, S., Davidson, C. A., Shillington, K. J., & Yates, J. (2024). “Breaking through the Brokenness”: An arts-based qualitative exploration of pregnant women’s experience of intimate partner violence while receiving trauma- and violence-informed antenatal care. Creative Nursing. https://doi.org/10.1177/10784535241256872

Media

Ontario professors and local artists work together to turn stories of intimate partner violence into art. https://www.cbc.ca/listen/live-radio/1-193/clip/16081568

Arts-based research deepens understanding of intimate partner violence in pregnancy. Groundbreaking study led by Western nursing prof used paintings, poetry to show resilience resulting from trauma-and violence-informed care. Western News. Kari Ferguson, June 28, 2024 https://news.westernu.ca/2024/06/arts-based-research-ipv/

2. Nursing caring through COVID-19 in Long-term Care Homes Reflected through Poetry and Art.

Abstract: SARS-CoV-2 virus which led to COVID-19 disease has changed the way we provide health care. An Ontario strategy to assist with COVID-19 management in longterm care (LTC) homes included the implementation of Infection Prevention and Control (IPAC)-Supplemental Work and Transition (SWAT) Teams. This strategy deployed healthcare providers, including nurses from southern Ontario to provide emergent COVID-19 preparedness, education, and support to LTC home personnel. One IPAC SWAT team of three nurses assisted seven LTC homes with their outbreak management during the first wave of the pandemic. We conducted a qualitative-arts-based study of three IPAC-SWAT team nurses to describe and analyze their experiences working in the LTC homes in the Toronto area. Three themes were generated: Controlling the viral load and fear, Self-protection-sustaining practice and the Power of collegial reciprocal trust. We used an integrated arts-based, embodied, layered exploration (ABELE) approach for analysis, interpretation, and representation of the themes in poetry and art; five free verse poems and three pieces of art were created. Nurses reported amidst their fear and witnessing the devastation, that their nursing work provided renewed hope, positivity, and personal and professional growth even in the face of COVID-19. The nurses emerged from the pandemic with a resurgence of honour for nurses and meaning in their nursing work.

Publications:

O’Keefe-McCarthy, S., Volpentesta, K., Adams, D., Michaelson, H., Sawhney, M. (2023). Nurses Caring through COVID-19-in Long Term Care Homes: Reflected through Poetry and Art. Nursing Perspectives, 44(2); 27-42.

Research Creative Scholarship/Literary

Project: Nurses Caring through COVID-19 in Long-Term Care Homes: Reflected through Poetry and Art:

O’Keefe-McCarthy, S. (2023). Theme-Controlling the Viral Load and Fear–“COVID-19 Cascade”. Perspectives 44,(2) p.37. https://www.youtube.com/watch?v=axUouKhfKr8

O’Keefe-McCarthy, S. (2023). Theme- Controlling the Viral Load and Fear-  “Controlling the Curve.“ Perspectives 44,(2) p.38.

O’Keefe-McCarthy, S. (2020). Theme-Self Protecting-Sustaining Practice-“Do’s and Don’ts”.

O’Keefe-McCarthy, S. (2023). Theme-Self Protecting-Sustaining Practice-

“Parking Lot Dance.” Perspectives 44,(2) p.39.

O’Keefe-McCarthy. S. (2023). Theme-Power of Collegial Co-reciprocal Trust-

“Silent Grief.” Perspectives 44,(2) p.40. https://www.youtube.com/watch?v=17T7IIscDDg

O’Keefe-McCarthy. S. (2023). Theme-Power of Collegial Co-reciprocal Trust-

“Humbly we Walk in the Wake.” Perspectives 44,(2) p.41.

Living a “Non-Life” as an LGBTQ2+ Person-Aging in Place: An artistic Understanding [Completed, manuscript development]

Dullius, W.R., O’Keefe-McCarthy, S., Michaelson, H.L, Habib, N., McCleary, L., Alba Scortegagna, S. Living a Non-Life as a LGBTQ2+ Person Aging in Place: An Aesthetic Understanding.

Research Creative Scholarship/Literary

Project: Living a “non-Life” as An LBGTQ2+ Person Aging in Place”.

Dullius, W.R., S., O’Keefe-McCarthy, S. (2023). Theme: Discrimination Kills-

Poem: Marked

Poem: Prejudice Exists

Poem: Being LGBTQ2+

Poem: Fear Of Aging

Poem: Hope-We Look Beyond

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,  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.

“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.

haHealth, Art and Justice Lab.                         

Dr O’Keefe-McCarthy is Co-Primary Investigator in the Health Art and Justice lab. She co-leads an interdisciplinary team drawing on the different areas of research expertise (health sciences, education women and gender, Indigenous knowledge, drama, nursing) along with patients and people with lived experiences in health care system delivery to conduct research projects that are framed from a social justice and equity, diversity, inclusivity lens.

Current Project                   

Using Participatory Theatre to Eliminate discrimination in health service Delivery.

Summary: During the COVID 19 pandemic, discrimination in individual and systemwide decisions and actions has escalated existing inequities. This has rendered people already at risk of poor health outcomes before the pandemic even worse off than before. In response, the UN Research Roadmap has proposed the elimination of discrimination in the health system as a key goal. Though the relationship between discrimination and health disparities is well established, addressing it in ways that lead to behaviour change has proven to be difficult. One reason is that discrimination often stems from unexamined biases and assumptions. When we do not recognize or acknowledge that these biases exist, they hold a great deal of power over our actions and attitudes. Eliminating system wide discrimination is not possible unless leaders at all points of care in the health system do the inner work of examining their own implicit biases.

This project harnesses a novel collaboration between the dramatic arts and allied health sciences. Our objective is to dismantle discrimination by developing a participatory theatre intervention. We will use it to invite health system leaders to examine how implicit biases and assumptions may be shaping decisions and actions in unconscious ways that discriminate and exclude.

Approach: 1) Beginning with a qualitative study, we will gather stories of lived experiences of discrimination (e.g., intersections of race, social class, gender, and age) with the health system from a diverse sample of people; 2) These stories will inform the development of scenes that will ground the participatory theatre intervention; 3) Working in collaboration with our community partners, we will develop the intervention itself and determine appropriate applied theatre techniques for its facilitation; 4) We will pilot, revise, and implement the intervention across health systems regionally, nationally and internationally, and then evaluate its impact.

Significance: In 2015, the Sustainable Development Goals provided a bold vision for addressing discrimination as critical to creating a sustainable world. Progress has been disappointing. Through our innovative project, we will invite leaders to develop the inner capacity to recognize and eliminate discrimination in the health system. Taking responsibility for our own growth in the way that this intervention invites allows us to honour our collective responsibility to create a more equitable world.

Other Research Activities:

Development and Psychometric Evaluation of Measurement Tools.

Revision of the Heart Healthy Schools Program Questionnaire (HHSPQ)

In partnership with Heart Niagara.org, we were able to revise the existing Heart Healthy Schools Program  Questionnaire (created initially by Heart Niagara and used for annual CVD screening and CPR and now AED training to grade nine students in the Niagara Area; See heartniagara.org).

Project 1: Content Validity of the Revised Healthy Heart Schools’ Program Questionnaire (HHSP-Q). [Study completed; manuscript development in progress]

Project 2: Test Re-test Reliability of the Revised Healthy Heart Schools’ Program Questionnaire [HHSP-Q] [Study Completed, Manuscript development in progress]

Project 3: The Pre-Pandemic State of CVD Risk in Adolescents over a 6-year period

[Data analysis completed, Manuscript in preparation.

Publications:

O’Keefe-McCarthy, S., Prentice, D., McPherson, M., Dullius, W., Stearne, K., Gibson, D. The Pre-Pandemic State of CVD Risk in Adolescents over a 6-year period.  (In preparation).

O’Keefe-McCarthy, S., Prentice, D., McPherson, M., Stearne, K., Gibson, D., Kerr, A. Content Validity Index of the Healthy Hearts School Program Revised Questionnaire. [Primary Investigator; data analysis, manuscript development].

O’Keefe-McCarthy, S., Prentice, D., McPherson, M., Stearne, K., Gibson, D., Kerr, A. Test RE-Test Reliability of the Healthy Hearts School Program Revised Questionnaire. (Manuscript development].

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]

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,  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.

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.

Past Research Projects:

1. An End User-Designed Application for Emergent Acute Heart Pain: The ACUTE-♥-PAIN APP! Phase I: Qualitative Needs Assessment.[Completed]

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,  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.