title: 'Betwixt and between health and illness' - women's narratives following acute coronary syndrome.
abstract: OBJECTIVE
  This study investigated experiences of women with a primary diagnosis of ACS (NSTEMI and Unstable Angina) in the 6-8 week period following discharge from hospital. The aim was to report the experience of the mediating impact of a newly-diagnosed disease.
  
  
  BACKGROUND
  Cardiovascular disease is the main cause of mortality in women. Treatment modalities have improved health outcomes and survival rates, however, quality of life and ongoing morbidity after discharge is not clearly understood from a gender specific perspective.
  
  
  METHODS
  A naturalistic case study design guided this study.
  
  
  METHODS
  Thirty women participated (n = 30); a within-case followed by a cross-case analysis provided meticulous knowledge of each case. Data collection included participant diaries and face to face interviews. Data were analysed using modified analytic induction which allowed the emergence of theoretical insights. The theoretical concepts, liminality and transitioning were used to inform the analysis. Within-methods triangulation captured the depth and breadth of the women's experiences.
  
  
  RESULTS
  The data provide an insight into women's experiences following ACS and highlight a need for support structures and services after discharge. Many women reported a period of disrupted normality following discharge from hospital. While a number of women had transitioned towards recovery, many remained in a liminal space 'betwixt and between' health and illness. Cardiac rehabilitation was reported as a positive experience for those who were attending.
  
  
  CONCLUSIONS
  The findings provide a platform for a wider discourse on the needs of women with ACS in the immediate period after discharge from hospital. Women may benefit from gender-specific, appropriately timed, and targeted interventions to facilitate recovery and adaptation to living with CHD.
  
  
  CONCLUSIONS
  It is essential that secondary prevention services are modelled and tailored to meet the needs of women and evaluated appropriately to ensure positive outcomes. Nursing could have a key role to play in managing and providing this support.
authors.affiliation: UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Rita
authors.identifier: http://orcid.org/0000-0002-9090-9642
authors.initials: R
authors.lastname: Smith
authors.affiliation: UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Kate
authors.initials: K
authors.lastname: Frazer
authors.affiliation: Irish Heart Foundation, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hall
authors.affiliation: UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Abbey
authors.initials: A
authors.lastname: Hyde
authors.affiliation: UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Laserina
authors.initials: L
authors.lastname: O'Connor
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D011788:Quality of Life; D016387:Women's Health
keywords: acute coronary syndrome; case study research; coronary heart disease; primary/secondary care interface; women's health