Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.085
L Creighton, G Caughers, D Fitzsimons
Background Nurses as health promotors are optimally placed to identify cardiovascular disease risk factors and discuss behaviour change strategies for modifiable risk factors, but most undergraduate curriculums lack detailed content regarding these topics. Unfortunately evidence indicates that student nurses often demonstrate risky behaviours such as smoking, physical inactivity, excessive alcohol consumption and poor nutritional choices. As nursing is a pressurised career with long shifts and often challenging emotional encounters, it can be easy to overlook personal health behaviours. Purpose Given that nursing students are our potential health promotors of the future, we aimed to enhance cardiovascular knowledge and behaviour change awareness in their undergraduate education by implementing a co-designed digital educational resource - ASMOSUS. It sought to embed knowledge and risk assessment of cardiovascular disease risk factors, while motivating and sustaining behaviour change within undergraduates, facilitating them to make healthier lifestyle choices themselves and act as role models for patients. We developed roles of ‘Heart Health Champions’ within university and clinical placements, which is novel for both clinical practice and Higher Education Institutes. Methods Any nursing student who had received the ASMOSUS digital educational resource in the first semester of their undergraduate program and had an interest in further knowledge acquisition and health promotion amongst their peers were invited to become a Heart Health Champion. Alongside the recruitment of Heart Health Champions the cohort received cardiovascular risk factor specific educational sessions on physical exercise, smoking and vaping cessation, nutrition and alcohol consumption. Results We recruited 9 Heart Health Champions from the cohort representing all fields of undergraduate nursing. These students have undertaken 30 hours of required participation, leading to a university recognised qualification- FutureReady on graduation. This included attending cardiac risk and prevention training with cardiac rehabilitation nurses. They have taken the initiative to plan activities such as a sponsored walk, a ‘dancercise' class and support for their peers in harnessing healthy lifestyle behaviours through role modelling and motivational interviewing techniques. Results demonstrate that these sessions and student led activities are well attended and positively evaluated, which shows that including cardiovascular prevention techniques in undergraduates is feasible and acceptable. Conclusion Heart Health Champions are a valuable asset and can promote modifiable risk factor change amongst their peers and may help to maintain a healthy lifestyle. Further Heart Health Champions will be recruited over the next undergraduate nursing cohorts with a planned study to explore their effectiveness.
{"title":"Heart health champions: how to develop student nurses as role models for cardiovascular health","authors":"L Creighton, G Caughers, D Fitzsimons","doi":"10.1093/eurjcn/zvae098.085","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.085","url":null,"abstract":"Background Nurses as health promotors are optimally placed to identify cardiovascular disease risk factors and discuss behaviour change strategies for modifiable risk factors, but most undergraduate curriculums lack detailed content regarding these topics. Unfortunately evidence indicates that student nurses often demonstrate risky behaviours such as smoking, physical inactivity, excessive alcohol consumption and poor nutritional choices. As nursing is a pressurised career with long shifts and often challenging emotional encounters, it can be easy to overlook personal health behaviours. Purpose Given that nursing students are our potential health promotors of the future, we aimed to enhance cardiovascular knowledge and behaviour change awareness in their undergraduate education by implementing a co-designed digital educational resource - ASMOSUS. It sought to embed knowledge and risk assessment of cardiovascular disease risk factors, while motivating and sustaining behaviour change within undergraduates, facilitating them to make healthier lifestyle choices themselves and act as role models for patients. We developed roles of ‘Heart Health Champions’ within university and clinical placements, which is novel for both clinical practice and Higher Education Institutes. Methods Any nursing student who had received the ASMOSUS digital educational resource in the first semester of their undergraduate program and had an interest in further knowledge acquisition and health promotion amongst their peers were invited to become a Heart Health Champion. Alongside the recruitment of Heart Health Champions the cohort received cardiovascular risk factor specific educational sessions on physical exercise, smoking and vaping cessation, nutrition and alcohol consumption. Results We recruited 9 Heart Health Champions from the cohort representing all fields of undergraduate nursing. These students have undertaken 30 hours of required participation, leading to a university recognised qualification- FutureReady on graduation. This included attending cardiac risk and prevention training with cardiac rehabilitation nurses. They have taken the initiative to plan activities such as a sponsored walk, a ‘dancercise' class and support for their peers in harnessing healthy lifestyle behaviours through role modelling and motivational interviewing techniques. Results demonstrate that these sessions and student led activities are well attended and positively evaluated, which shows that including cardiovascular prevention techniques in undergraduates is feasible and acceptable. Conclusion Heart Health Champions are a valuable asset and can promote modifiable risk factor change amongst their peers and may help to maintain a healthy lifestyle. Further Heart Health Champions will be recruited over the next undergraduate nursing cohorts with a planned study to explore their effectiveness.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"45 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.047
J Hanley, M Paterson, R Pollock, R Parker, L Neubeck, I Atherton, S Mchale, A Pearsons, B Mckinstry, B Guthrie
Introduction The effects of COVID-19 on people with hypertension are poorly understood, but potentially severe both due to increased risk of cardiovascular events post covid (1) and by altering the way people accessed healthcare (2). This study aimed to explore the immediate impact of COVID-19 on the hypertensive population in Scotland. Methods The study used linked routine clinical data. Hypertensive patients from five NHS Scotland Health Boards were identified through the Prescribing Information System (PIS) between March 2019 and February 2021. Linked data included Blood Pressure (BP) telemonitoring data from the Connect Me BP service, outcome data (cardiovascular events and mortality) from Scottish Morbidity Records, and National Records of Scotland COVID-19 testing and vaccination records from Public Health Scotland (PHS). Follow up was until February 2022. EDRIS, the research arm of PHS, linked and pseudonymised the data and transferred it to the secure national safe haven analysis platform for access by the research team. The study was approved by the Public Benefit and Privacy Panel for Health and Social Care. Results Almost 450,000 people with hypertension were identified across the whole adult age range, 52% male. Of those, 89% had been diagnosed prior to the study. New diagnoses dropped by over 50% during the first year of the COVID-19 pandemic. The use of long term BP telemonitoring increased rapidly during the pandemic from 5000 to over 10,000. Overall mortality was over 8%. Mortality rates showed a similar pattern to the general population during the pandemic and remained above pre-pandemic levels until the end of the follow up period in February 2022. Discussion BP telemonitoring supported healthcare delivery at a time when normal services were severely disrupted due to COVID-19. However the data suggests that there may be an increase in the number of people with undiagnosed hypertension with associated raised cardiovascular risk. Mortality in this population was increased by the COVID-19 pandemic and remained above pre-pandemic levels.
{"title":"Hypertension management and outcomes during the covid-19 pandemic: diagnosis, blood pressure telemonitoring use and mortality","authors":"J Hanley, M Paterson, R Pollock, R Parker, L Neubeck, I Atherton, S Mchale, A Pearsons, B Mckinstry, B Guthrie","doi":"10.1093/eurjcn/zvae098.047","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.047","url":null,"abstract":"Introduction The effects of COVID-19 on people with hypertension are poorly understood, but potentially severe both due to increased risk of cardiovascular events post covid (1) and by altering the way people accessed healthcare (2). This study aimed to explore the immediate impact of COVID-19 on the hypertensive population in Scotland. Methods The study used linked routine clinical data. Hypertensive patients from five NHS Scotland Health Boards were identified through the Prescribing Information System (PIS) between March 2019 and February 2021. Linked data included Blood Pressure (BP) telemonitoring data from the Connect Me BP service, outcome data (cardiovascular events and mortality) from Scottish Morbidity Records, and National Records of Scotland COVID-19 testing and vaccination records from Public Health Scotland (PHS). Follow up was until February 2022. EDRIS, the research arm of PHS, linked and pseudonymised the data and transferred it to the secure national safe haven analysis platform for access by the research team. The study was approved by the Public Benefit and Privacy Panel for Health and Social Care. Results Almost 450,000 people with hypertension were identified across the whole adult age range, 52% male. Of those, 89% had been diagnosed prior to the study. New diagnoses dropped by over 50% during the first year of the COVID-19 pandemic. The use of long term BP telemonitoring increased rapidly during the pandemic from 5000 to over 10,000. Overall mortality was over 8%. Mortality rates showed a similar pattern to the general population during the pandemic and remained above pre-pandemic levels until the end of the follow up period in February 2022. Discussion BP telemonitoring supported healthcare delivery at a time when normal services were severely disrupted due to COVID-19. However the data suggests that there may be an increase in the number of people with undiagnosed hypertension with associated raised cardiovascular risk. Mortality in this population was increased by the COVID-19 pandemic and remained above pre-pandemic levels.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"31 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.059
T Argyropoulos, A M A L I A Yfanti
Introduction Today, everyone agrees that the best treatment of coronary artery disease is its prevention through understanding the role and, of course, controlling the predisposing factors, i.e. those particular characteristics whose presence predicts the occurrence and progression of the disease. As Health professionals, nurses must know about the predisposing factors, participate in prevention programs, and advise on the Algorithm of Care. Objective To investigate pediatric nurses' knowledge about the predisposing factors of coronary Heart disease and assess the degree of risk of developing coronary heart disease based on the prevention measures they take and their lifestyle. Material and Methods The study sample consisted of 164 working nurses in our Pediatric hospitals, and its duration was four months. A specially designed questionnaire was used for data collection, which was distributed to employees of different departments and was answered by a total of 164 nurses. The questionnaire was weighted to check its validity, and minor adjustments were made for the study. Results Pediatric nurses identify the most important predisposing factors of coronary heart disease as hypertension, smoking, dyslipidemia, and stress as a result of their profession. They have a significantly increased body mass index, poor dietary habits, and appear negligent in preventive cardiac screening. Conclusions The level of knowledge of Greek pediatric nurses regarding the prevention of coronary heart disease is satisfactory. Their working environment, stress, lifestyle, and lack of regular check-ups make them extremely vulnerable to the predisposing factors of coronary heart disease.
{"title":"Pediatric nurses in Greece, investigation of knowledge and attitude towards the predisposing factors of coronary heart disease","authors":"T Argyropoulos, A M A L I A Yfanti","doi":"10.1093/eurjcn/zvae098.059","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.059","url":null,"abstract":"Introduction Today, everyone agrees that the best treatment of coronary artery disease is its prevention through understanding the role and, of course, controlling the predisposing factors, i.e. those particular characteristics whose presence predicts the occurrence and progression of the disease. As Health professionals, nurses must know about the predisposing factors, participate in prevention programs, and advise on the Algorithm of Care. Objective To investigate pediatric nurses' knowledge about the predisposing factors of coronary Heart disease and assess the degree of risk of developing coronary heart disease based on the prevention measures they take and their lifestyle. Material and Methods The study sample consisted of 164 working nurses in our Pediatric hospitals, and its duration was four months. A specially designed questionnaire was used for data collection, which was distributed to employees of different departments and was answered by a total of 164 nurses. The questionnaire was weighted to check its validity, and minor adjustments were made for the study. Results Pediatric nurses identify the most important predisposing factors of coronary heart disease as hypertension, smoking, dyslipidemia, and stress as a result of their profession. They have a significantly increased body mass index, poor dietary habits, and appear negligent in preventive cardiac screening. Conclusions The level of knowledge of Greek pediatric nurses regarding the prevention of coronary heart disease is satisfactory. Their working environment, stress, lifestyle, and lack of regular check-ups make them extremely vulnerable to the predisposing factors of coronary heart disease.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"57 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.035
S D Dimishkovska, M L Lazeska, N A Alii, V T Tasevska, I J Josevska, D Z Zafirovska, M K Klincheva, Z M Mitrev
Introduction A lot of evidence suggests a close link between COVID-19 and cardiovascular diseases. Recent data indicate that COVID-19 may increase the risk of cardiovascular diseases in the future, to an extent similarly observed in reference to the more traditional cardiovascular risk factors. Health practitioners, nurses, and doctors have a hypothesis that, since COVID began, more and more younger patients seek cardiovascular examinations. The Purpose of this study is to compare the number of cardiovascular examinations before and after the beginning of the COVID pandemic, by gender and age. Materials and Methods We examined the total number of cardiovascular examinations performed at the diagnostic center, Zan Mitrev clinic, Skopje, R. Macedonia, for a period of three years before COVID-19, i.e., from January 2017 to March 2020, and three years after the start of the pandemic, i.e. from March 2020 to March 2023. We structured the comparison by gender and age of the patients before and after COVID. Cardiovascular examination in our hospital comprises electrocardiography, echocardiography and cardiologic consultation. All of the collected data came from the Hospital Information System. Results A total of 24,496 cardiovascular examinations were performed between January 2017 and March 2020. The cohort of patients comprised 13,374 men (55%) and 11,121 (45%) women. The average age was 53±30 years. During the period from March 2020 to March 2023 a total of 33,825 cardiovascular examinations were performed, and the patients comprised 18,137 (54%) men and 15,687 (46%) women. The average age was 55±43 years. Conclusions Although there seems to be an upward trend of the number of cardiovascular examinations after the COVID pandemic started, there is no statistically significant difference between the data categorized by age and gender before and after the COVID era.
{"title":"Pre - and post- COVID era: how did the pandemic impact the number of cardiovascular examinations?","authors":"S D Dimishkovska, M L Lazeska, N A Alii, V T Tasevska, I J Josevska, D Z Zafirovska, M K Klincheva, Z M Mitrev","doi":"10.1093/eurjcn/zvae098.035","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.035","url":null,"abstract":"Introduction A lot of evidence suggests a close link between COVID-19 and cardiovascular diseases. Recent data indicate that COVID-19 may increase the risk of cardiovascular diseases in the future, to an extent similarly observed in reference to the more traditional cardiovascular risk factors. Health practitioners, nurses, and doctors have a hypothesis that, since COVID began, more and more younger patients seek cardiovascular examinations. The Purpose of this study is to compare the number of cardiovascular examinations before and after the beginning of the COVID pandemic, by gender and age. Materials and Methods We examined the total number of cardiovascular examinations performed at the diagnostic center, Zan Mitrev clinic, Skopje, R. Macedonia, for a period of three years before COVID-19, i.e., from January 2017 to March 2020, and three years after the start of the pandemic, i.e. from March 2020 to March 2023. We structured the comparison by gender and age of the patients before and after COVID. Cardiovascular examination in our hospital comprises electrocardiography, echocardiography and cardiologic consultation. All of the collected data came from the Hospital Information System. Results A total of 24,496 cardiovascular examinations were performed between January 2017 and March 2020. The cohort of patients comprised 13,374 men (55%) and 11,121 (45%) women. The average age was 53±30 years. During the period from March 2020 to March 2023 a total of 33,825 cardiovascular examinations were performed, and the patients comprised 18,137 (54%) men and 15,687 (46%) women. The average age was 55±43 years. Conclusions Although there seems to be an upward trend of the number of cardiovascular examinations after the COVID pandemic started, there is no statistically significant difference between the data categorized by age and gender before and after the COVID era.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"18 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.005
L Pina Astete, M L Buelga Suarez, M I Munoz Gomez, P Rodriguez Sanchez, A Tur Sainz, N Penaranda Romero, J Garcia Montalvo, A Rebolleda Sanchez, G L Alonso Salinas
Background 12-lead electrocardiogram (ECG) is the gold standard for detecting ventricular arrhythmias. In cardiac critical care units (UCC), monitoring systems are used to detect transient events such as arrhythmias or ST-segment acute changes. The discomfort caused in the patient by the need for 10 electrodes to obtain the 12 leads continuously means that complete monitoring is not routine. The EASI monitoring system, based on vector electrocardiography, is an alternative that uses only 5 electrodes (4 thoracic and 1 ground) and theoretically allows obtaining a complete standard ECG. Objectives The main endpoint of this study was to evaluate the diagnostic accuracy of the EASI monitoring system in patients with ventricular tachycardia (VT), compared with conventional ECG. Methods Seven cases of patients admitted to the CCU due to episodes of VT are presented. The patients were monitored with the EASI system upon arrival, and the conventional ECG and the one derived from the EASI system were taken simultaneously for VT events for comparison. The 4 electrodes of the EASI system were placed, as recommended, on the sternal manubrium (S), lower sternum at the level of the 5th intercostal space (E), at the level of the 5th intercostal space, and on the right and left midclavicular lines (I and A). Results Analysing case by case, the axis of the tachycardia was similar in 5 patients, being able to assess the origin of the tachycardia in them. In 2 patients it was different. These cases of patients that differ, one episode has its origin in the right ventricular outflow tract (endocardial) and the other in the area of the left ventricular summit (epicardial). Two patients with different tachycardias and no cardiac characteristics in common. Figure 1. Conclusions EASI monitoring is a feasible alternative for monitoring patients in the CCU, which could give us reliable information (compared with standard ECG) with limitations in some cases in which the cardiac axis differs. For patients admitted for arrhythmic events, a better characterization of the differences would be interesting in order to optimize its use.
{"title":"EASI monitoring in ventricular tachycardia, an alternative to conventional electrocardiography?","authors":"L Pina Astete, M L Buelga Suarez, M I Munoz Gomez, P Rodriguez Sanchez, A Tur Sainz, N Penaranda Romero, J Garcia Montalvo, A Rebolleda Sanchez, G L Alonso Salinas","doi":"10.1093/eurjcn/zvae098.005","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.005","url":null,"abstract":"Background 12-lead electrocardiogram (ECG) is the gold standard for detecting ventricular arrhythmias. In cardiac critical care units (UCC), monitoring systems are used to detect transient events such as arrhythmias or ST-segment acute changes. The discomfort caused in the patient by the need for 10 electrodes to obtain the 12 leads continuously means that complete monitoring is not routine. The EASI monitoring system, based on vector electrocardiography, is an alternative that uses only 5 electrodes (4 thoracic and 1 ground) and theoretically allows obtaining a complete standard ECG. Objectives The main endpoint of this study was to evaluate the diagnostic accuracy of the EASI monitoring system in patients with ventricular tachycardia (VT), compared with conventional ECG. Methods Seven cases of patients admitted to the CCU due to episodes of VT are presented. The patients were monitored with the EASI system upon arrival, and the conventional ECG and the one derived from the EASI system were taken simultaneously for VT events for comparison. The 4 electrodes of the EASI system were placed, as recommended, on the sternal manubrium (S), lower sternum at the level of the 5th intercostal space (E), at the level of the 5th intercostal space, and on the right and left midclavicular lines (I and A). Results Analysing case by case, the axis of the tachycardia was similar in 5 patients, being able to assess the origin of the tachycardia in them. In 2 patients it was different. These cases of patients that differ, one episode has its origin in the right ventricular outflow tract (endocardial) and the other in the area of the left ventricular summit (epicardial). Two patients with different tachycardias and no cardiac characteristics in common. Figure 1. Conclusions EASI monitoring is a feasible alternative for monitoring patients in the CCU, which could give us reliable information (compared with standard ECG) with limitations in some cases in which the cardiac axis differs. For patients admitted for arrhythmic events, a better characterization of the differences would be interesting in order to optimize its use.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"72 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.107
V Micheluzzi, G Casu, G D Sanna, E Vellone, P Iovino
Background To reduce symptoms and improve outcomes in patients with cardiovascular diseases, international guidelines recommend cardiac rehabilitation. However, patients’ adherence to rehabilitation programs remains suboptimal, compromising its beneficial effects. Virtual reality has proven to be effective in enhancing adherence to rehabilitation in different fields (e.g., neurological and post-trauma). In the cardiological field, it has been proven effective in improving functional capacity and several psychological parameters (e.g., anxiety, depression, and emotional stress). Despite the increasing use of this digital technology, there is still a lack of information regarding its underlying mechanism of effectiveness. Purpose This middle-range theory aims to explain the mechanism of effectiveness of virtual reality in cardiac rehabilitation. Methods An inductive-deductive approach was used to develop this middle-range theory. Three steps were conducted including synthesis of key concepts, definition of the relationship between these concepts, and setting up of a hypothetical model. Results This middle-range theory proposes both proximal and distal outcomes of virtual reality. Proximal outcomes are classified as responses at the psychological (i.e., emotional stress, depression, and anxiety) and physical (i.e., exercise capacity) level, which, in turn, influence adherence to rehabilitation (i.e., distal outcome). Mediators of the relationship between virtual reality and outcomes are both at a proximal and distal level. The proximal mediators are activated at the neurological level to generate a multisensory experience of sight, hearing, and touch. This alters perception, by inducing an immersive altered state of consciousness and activating the distal mediators of attention, enjoyment, and sense of presence. The activation of the distal mediators promotes distraction from negative external stimuli related to the disease and healthcare setting and perception of positive emotions by interacting with the virtual world. Consequently, these mediators influence physical and psychological responses that enhance overall adherence to cardiac rehabilitation. Moderators of the relationship between virtual reality and rehabilitation adherence include age, gender, trust in technology, and cognitive status (Figure 1). Conclusions This middle-range theory aims to clarify the mechanism by which virtual reality enhances adherence to cardiac rehabilitation. Further qualitative and quantitative studies are warranted to test its hypothetical model.
{"title":"Virtual reality and cardiac rehabilitation: a new middle-range theory to outline its mechanism of effectiveness","authors":"V Micheluzzi, G Casu, G D Sanna, E Vellone, P Iovino","doi":"10.1093/eurjcn/zvae098.107","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.107","url":null,"abstract":"Background To reduce symptoms and improve outcomes in patients with cardiovascular diseases, international guidelines recommend cardiac rehabilitation. However, patients’ adherence to rehabilitation programs remains suboptimal, compromising its beneficial effects. Virtual reality has proven to be effective in enhancing adherence to rehabilitation in different fields (e.g., neurological and post-trauma). In the cardiological field, it has been proven effective in improving functional capacity and several psychological parameters (e.g., anxiety, depression, and emotional stress). Despite the increasing use of this digital technology, there is still a lack of information regarding its underlying mechanism of effectiveness. Purpose This middle-range theory aims to explain the mechanism of effectiveness of virtual reality in cardiac rehabilitation. Methods An inductive-deductive approach was used to develop this middle-range theory. Three steps were conducted including synthesis of key concepts, definition of the relationship between these concepts, and setting up of a hypothetical model. Results This middle-range theory proposes both proximal and distal outcomes of virtual reality. Proximal outcomes are classified as responses at the psychological (i.e., emotional stress, depression, and anxiety) and physical (i.e., exercise capacity) level, which, in turn, influence adherence to rehabilitation (i.e., distal outcome). Mediators of the relationship between virtual reality and outcomes are both at a proximal and distal level. The proximal mediators are activated at the neurological level to generate a multisensory experience of sight, hearing, and touch. This alters perception, by inducing an immersive altered state of consciousness and activating the distal mediators of attention, enjoyment, and sense of presence. The activation of the distal mediators promotes distraction from negative external stimuli related to the disease and healthcare setting and perception of positive emotions by interacting with the virtual world. Consequently, these mediators influence physical and psychological responses that enhance overall adherence to cardiac rehabilitation. Moderators of the relationship between virtual reality and rehabilitation adherence include age, gender, trust in technology, and cognitive status (Figure 1). Conclusions This middle-range theory aims to clarify the mechanism by which virtual reality enhances adherence to cardiac rehabilitation. Further qualitative and quantitative studies are warranted to test its hypothetical model.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.069
T A Marcos, S Kulnik, R Crutzen
Introduction Regular physical activity is important in the secondary prevention of cardiovascular disease. But many cardiac patients have difficulty establishing lifelong physical activity habits, even after completion of an exercise-based cardiac rehabilitation programme. There is a need for effective interventions to support cardiac patients' physical activity. Such interventions are often complex behaviour change interventions whose design should be grounded in programme theory, i.e., a description of how the intervention is expected to lead to its effects and under what conditions. A logic model is often used to communicate programme theory [1]. Purpose The purpose of this work was to describe a generic logic model for behaviour change interventions to increase and maintain physical activity among patients who have had an acute cardiac event. Methods We applied the Intervention Mapping approach [2] to develop a generic logic model that is both data- and theory-driven, i.e. informed by research evidence and behaviour change theory. The at-risk behaviour for the individual cardiac patient was defined as "insufficient independent long-term maintenance of heart-healthy physical activity", compounded by the environmental factor "lack of support provision for long-term independent physical activity" from the healthcare providers and people in the patient’s interpersonal environment. We defined performance objectives by asking the questions: "What do people who had an acute cardiac event need to do to increase and maintain their heart-healthy physical activity?" and "What do the healthcare providers and people in the patient’s interpersonal environment need to do to encourage and support the patient in being physically active?" The performance objectives specify what actions are required of the individuals targeted in the intervention. We selected determinants corresponding to performance objectives based on empirical evidence from systematic reviews and based on behaviour change theory such as the Reasoned Action Approach (RAA) and the Health Action Process Approach (HAPA). Results Central elements of the logic model are presented in table 1. The logic model includes 18 performance objectives and 13 determinants, supported by empirical evidence from 40 scientific publications. Conclusion The generic logic model serves as a collection of current knowledge regarding increasing and maintaining physical activity among the cardiac population and can be used for a number of purposes: as a foundation for developing new interventions; as a blueprint against which to compare and/or solidify the programme theory of existing interventions; as a conceptual framework for designing evaluations of interventions; as a current evidence map from which to identify research gaps; and as a point of reference for reflecting on one’s own health behaviour.Table 1.Elements of the logic model.
{"title":"A generic logic model for physical activity interventions for the cardiac population using intervention mapping","authors":"T A Marcos, S Kulnik, R Crutzen","doi":"10.1093/eurjcn/zvae098.069","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.069","url":null,"abstract":"Introduction Regular physical activity is important in the secondary prevention of cardiovascular disease. But many cardiac patients have difficulty establishing lifelong physical activity habits, even after completion of an exercise-based cardiac rehabilitation programme. There is a need for effective interventions to support cardiac patients' physical activity. Such interventions are often complex behaviour change interventions whose design should be grounded in programme theory, i.e., a description of how the intervention is expected to lead to its effects and under what conditions. A logic model is often used to communicate programme theory [1]. Purpose The purpose of this work was to describe a generic logic model for behaviour change interventions to increase and maintain physical activity among patients who have had an acute cardiac event. Methods We applied the Intervention Mapping approach [2] to develop a generic logic model that is both data- and theory-driven, i.e. informed by research evidence and behaviour change theory. The at-risk behaviour for the individual cardiac patient was defined as \"insufficient independent long-term maintenance of heart-healthy physical activity\", compounded by the environmental factor \"lack of support provision for long-term independent physical activity\" from the healthcare providers and people in the patient’s interpersonal environment. We defined performance objectives by asking the questions: \"What do people who had an acute cardiac event need to do to increase and maintain their heart-healthy physical activity?\" and \"What do the healthcare providers and people in the patient’s interpersonal environment need to do to encourage and support the patient in being physically active?\" The performance objectives specify what actions are required of the individuals targeted in the intervention. We selected determinants corresponding to performance objectives based on empirical evidence from systematic reviews and based on behaviour change theory such as the Reasoned Action Approach (RAA) and the Health Action Process Approach (HAPA). Results Central elements of the logic model are presented in table 1. The logic model includes 18 performance objectives and 13 determinants, supported by empirical evidence from 40 scientific publications. Conclusion The generic logic model serves as a collection of current knowledge regarding increasing and maintaining physical activity among the cardiac population and can be used for a number of purposes: as a foundation for developing new interventions; as a blueprint against which to compare and/or solidify the programme theory of existing interventions; as a conceptual framework for designing evaluations of interventions; as a current evidence map from which to identify research gaps; and as a point of reference for reflecting on one’s own health behaviour.Table 1.Elements of the logic model.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"77 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.038
M Farrugia, D J Foulkes
Background/ Introduction Aortic stenosis (AS) is a calcific disease which affects the aortic valve leaflets and is commonly prevalent in people who are 65 years and older. The global burden of AS is expected to keep on increasing due to the longer life expectancy as well as the morbidity and mortality associated with the disease. Transcatheter aortic valve implantation is utilised for the management of AS. Currently, TAVI is recommended as a first-line treatment for patients who are 75 years and older and those who are at an intermediate to high surgical risk, with the aim of becoming the first treatment option for patients who are 65 years and older. However, one of the concerns of TAVI is the need of ionising radiation during valve placement. The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation. Purpose Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose. Methods Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes. Results In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2. The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = <0.001). DAP was not significantly related only to age category and the operator’s combination. Generalised linear models (GLM) showed that prosthetic valve size, body surface area (BSA) and aortic valve gradient are statistically significant predictors of DAP. Conclusion This study shows that the local TAVI patients receive a radiation dose which is within acceptable European limits and that valve size and patient’s BSA are the variables that impacted the radiation dose.
{"title":"Radiation exposure of patients undergoing transcatheter aortic valve implantation and factors contributing to it","authors":"M Farrugia, D J Foulkes","doi":"10.1093/eurjcn/zvae098.038","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.038","url":null,"abstract":"Background/ Introduction Aortic stenosis (AS) is a calcific disease which affects the aortic valve leaflets and is commonly prevalent in people who are 65 years and older. The global burden of AS is expected to keep on increasing due to the longer life expectancy as well as the morbidity and mortality associated with the disease. Transcatheter aortic valve implantation is utilised for the management of AS. Currently, TAVI is recommended as a first-line treatment for patients who are 75 years and older and those who are at an intermediate to high surgical risk, with the aim of becoming the first treatment option for patients who are 65 years and older. However, one of the concerns of TAVI is the need of ionising radiation during valve placement. The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation. Purpose Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose. Methods Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes. Results In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2. The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = &lt;0.001). DAP was not significantly related only to age category and the operator’s combination. Generalised linear models (GLM) showed that prosthetic valve size, body surface area (BSA) and aortic valve gradient are statistically significant predictors of DAP. Conclusion This study shows that the local TAVI patients receive a radiation dose which is within acceptable European limits and that valve size and patient’s BSA are the variables that impacted the radiation dose.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"42 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.092
S Cilluffo, B Bassola, E Vellone, G Pucciarelli, C S Lee, M Lusignani
Background An estimated 64.3 million people live with heart failure (HF) worldwide and most are older adults. HF patients often use emergency services, and unplanned hospitalizations represent 20-25% of all hospital admissions in those over 65 years of age. During these frequent hospitalizations, patients with HF may experience adverse clinical events, such as falls, pressure ulcers, and infections. Furthermore, during these hospitalizations, patients with HF can develop a good mutuality(i.e., good quality in the relationship)with nurses, characterized by empathy, trust, reciprocity, equality, shared goals, shared decision making, and sharing of care. It is unknown whether mutuality is associated with hospital admissions, and adverse clinical events. Purpose The aim of this study was to investigate whether nurse-patient mutuality is associated with reduced hospital admission(i.e., use of emergency services and unplanned hospitalizations) and adverse clinical events(i.e., falls, pressure ulcers, and infections). Method A multicenter cross-sectional study was conducted in Italy. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness Scale, which includes three dimensions: "Developing and going beyond"(score ranges 3-15),"Being a point of reference"(score ranges 8-40)and "Deciding and sharing care"(score ranges 9-45). Higher scores mean better mutuality. Adverse clinical events were obtained from medical records. Data were analyzed with descriptive statistics and logistic regression. Covariates in the tested models were age, sex, education, living conditions, number of diseases, and number of medications. Results A sample of 167 patients with HF participated in the study (mean age 66.6, SD ±13.9; 58.1 % male). The mutuality average scores were 12.8(±2.4), 35.4(±5.0) and 32.0(±8.7) for "Developing and going beyond", "Being a pointof reference" and "Deciding and sharing care",respectively. Logistic regression showed that higher "Developing and going beyond" scores were associated with lower odds of pressure ulcers(OR=.49, 95%CI[.27-.87])and infections(OR=.75, 95%CI[.59-.96]); higher "Being a point of reference" scores were associated with lower odds of pressure ulcers(OR=.56, 95%CI[.37-.84]); higher "Deciding and sharing care" scores were associated with lower odds of infections(OR=.86, 95%CI[.80-.92]), of uses of emergency services(OR=.92, 95%CI[.87-.97]), of unplanned hospitalizations(OR=.94, 95%CI[.89-.99]),and of falls(OR=.90, 95%CI[.84-.97]). Among the covariates, patients living alone were 3.01(95%CI [1.06-.8.54])times as likely to have emergency access than those living with a family. Conclusions Our study showed that nurse-patient mutuality has an important role in predicting either hospital admissions or adverse clinical events. These results, if supported by further studies, may be useful to guide future interventions for patients with HF in order to reduce their hospitalizations and improve their clinical outcomes.
{"title":"A better quality in the relationship between patients with heart failure and nurses reduces hospital admissions and adverse clinical events","authors":"S Cilluffo, B Bassola, E Vellone, G Pucciarelli, C S Lee, M Lusignani","doi":"10.1093/eurjcn/zvae098.092","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.092","url":null,"abstract":"Background An estimated 64.3 million people live with heart failure (HF) worldwide and most are older adults. HF patients often use emergency services, and unplanned hospitalizations represent 20-25% of all hospital admissions in those over 65 years of age. During these frequent hospitalizations, patients with HF may experience adverse clinical events, such as falls, pressure ulcers, and infections. Furthermore, during these hospitalizations, patients with HF can develop a good mutuality(i.e., good quality in the relationship)with nurses, characterized by empathy, trust, reciprocity, equality, shared goals, shared decision making, and sharing of care. It is unknown whether mutuality is associated with hospital admissions, and adverse clinical events. Purpose The aim of this study was to investigate whether nurse-patient mutuality is associated with reduced hospital admission(i.e., use of emergency services and unplanned hospitalizations) and adverse clinical events(i.e., falls, pressure ulcers, and infections). Method A multicenter cross-sectional study was conducted in Italy. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness Scale, which includes three dimensions: \"Developing and going beyond\"(score ranges 3-15),\"Being a point of reference\"(score ranges 8-40)and \"Deciding and sharing care\"(score ranges 9-45). Higher scores mean better mutuality. Adverse clinical events were obtained from medical records. Data were analyzed with descriptive statistics and logistic regression. Covariates in the tested models were age, sex, education, living conditions, number of diseases, and number of medications. Results A sample of 167 patients with HF participated in the study (mean age 66.6, SD ±13.9; 58.1 % male). The mutuality average scores were 12.8(±2.4), 35.4(±5.0) and 32.0(±8.7) for \"Developing and going beyond\", \"Being a pointof reference\" and \"Deciding and sharing care\",respectively. Logistic regression showed that higher \"Developing and going beyond\" scores were associated with lower odds of pressure ulcers(OR=.49, 95%CI[.27-.87])and infections(OR=.75, 95%CI[.59-.96]); higher \"Being a point of reference\" scores were associated with lower odds of pressure ulcers(OR=.56, 95%CI[.37-.84]); higher \"Deciding and sharing care\" scores were associated with lower odds of infections(OR=.86, 95%CI[.80-.92]), of uses of emergency services(OR=.92, 95%CI[.87-.97]), of unplanned hospitalizations(OR=.94, 95%CI[.89-.99]),and of falls(OR=.90, 95%CI[.84-.97]). Among the covariates, patients living alone were 3.01(95%CI [1.06-.8.54])times as likely to have emergency access than those living with a family. Conclusions Our study showed that nurse-patient mutuality has an important role in predicting either hospital admissions or adverse clinical events. These results, if supported by further studies, may be useful to guide future interventions for patients with HF in order to reduce their hospitalizations and improve their clinical outcomes.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"9 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.127
A Faraci, G Coppola, E Corrado, G Novo
Introduction The treatment of cardiac pathologies with devices has led to an exponential increase in patients with CIED, who need more frequent, more careful check-ups, with a consequent increase in the number and clinical complexity of patients who refer to cardiac stimulation centers. Aim The use of remote monitoring makes it possible to have a continuous flow of information relating not only to the performance of the device but also to clinical events such as arrhythmias and heart failure without the need for direct contact, drastically reducing hospital accesses and at the same time promptly detecting any critical issues that require intervention in a more or less short time. The benefits of remote monitoring, as we have seen over the years, intervene at multiple levels, economic, social and clinical. Materials and methods Numerous studies have shown how remote monitoring can replace outpatient check-ups without compromising patient safety, reducing resource consumption, while scheduling at least one outpatient follow-up per year as recommended by international guidelines. With the introduction of telecardiology and remote monitoring in clinical practice, new organizational models have been implemented, which harmonize and codify the activity of the various professionals involved in the diagnostic and therapeutic process. This model must guarantee a precise definition of roles and responsibilities, traceability of actions, continuity of care, low consumption of resources, patient satisfaction and acceptance, integration with traditional hospital and out-of-hospital diagnosis and treatment pathways. A model that encompasses all these peculiar features is the PRIMARY NURSE MODEL. Primary nursing is a relationship based and resource driven system of care delivery, the building blocks are: attribution and acceptance by each individual of personal responsibility in making decisions; assignment of day to day care according to the case method; direct person to person communication; a person operationally responsible for the quality of care provided to patients. The decentralised decision making approach is based on three basic concepts: the nurse's decision making authority, responsibility and accountability. Results and conclusions The real CORE of this model is represented by the responsibility for the decisions made by a single nurse. Then each patient is assigned to a nurse responsible for continuity of care, whose duties include patient and caregiver education and training, website data entry, review of critical case transmissions and assessments, and submission of critical cases to the physician.
{"title":"The primary nursing model of remote monitoring in patients with implantable cardiac devices (CIED)","authors":"A Faraci, G Coppola, E Corrado, G Novo","doi":"10.1093/eurjcn/zvae098.127","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.127","url":null,"abstract":"Introduction The treatment of cardiac pathologies with devices has led to an exponential increase in patients with CIED, who need more frequent, more careful check-ups, with a consequent increase in the number and clinical complexity of patients who refer to cardiac stimulation centers. Aim The use of remote monitoring makes it possible to have a continuous flow of information relating not only to the performance of the device but also to clinical events such as arrhythmias and heart failure without the need for direct contact, drastically reducing hospital accesses and at the same time promptly detecting any critical issues that require intervention in a more or less short time. The benefits of remote monitoring, as we have seen over the years, intervene at multiple levels, economic, social and clinical. Materials and methods Numerous studies have shown how remote monitoring can replace outpatient check-ups without compromising patient safety, reducing resource consumption, while scheduling at least one outpatient follow-up per year as recommended by international guidelines. With the introduction of telecardiology and remote monitoring in clinical practice, new organizational models have been implemented, which harmonize and codify the activity of the various professionals involved in the diagnostic and therapeutic process. This model must guarantee a precise definition of roles and responsibilities, traceability of actions, continuity of care, low consumption of resources, patient satisfaction and acceptance, integration with traditional hospital and out-of-hospital diagnosis and treatment pathways. A model that encompasses all these peculiar features is the PRIMARY NURSE MODEL. Primary nursing is a relationship based and resource driven system of care delivery, the building blocks are: attribution and acceptance by each individual of personal responsibility in making decisions; assignment of day to day care according to the case method; direct person to person communication; a person operationally responsible for the quality of care provided to patients. The decentralised decision making approach is based on three basic concepts: the nurse's decision making authority, responsibility and accountability. Results and conclusions The real CORE of this model is represented by the responsibility for the decisions made by a single nurse. Then each patient is assigned to a nurse responsible for continuity of care, whose duties include patient and caregiver education and training, website data entry, review of critical case transmissions and assessments, and submission of critical cases to the physician.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":"47 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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