Canadian journal of cardiovascular nursing = Journal canadien en soins infirmiers cardio-vasculaires最新文献

Background: Coughing has been identified as the most painful experience post cardiac surgery.

Methods: Participants (n = 32), in a randomized crossover trial, applied a frozen gel pack to their sternal incision dressing before performing deep breathing and coughing (DB & C) exercises. Pain scores from 0 to 10 at rest were compared with pain scores post DB & C with and without the gel pack. Participants were also asked to describe their sensations with the frozen gel pack, as well as their preferences for gel pack application.

Results: The repeated measures analysis of variance revealed a significant reduction in pain scores between pre- and post-application of the gel pack (F = 28.69, p < .001). There were 22 (69%) participants who preferred the application of the gel pack compared with no gel pack. All 32 (100%) participants would reapply the gel pack in the future.

Conclusion: This study demonstrates that cold therapy can be used to manage sternal incisional pain when DB & C.

Over recent decades, qualitative research has become accepted as a uniquely valuable methodological approach for generating knowledge, particularly in relation to promoting understanding of patients' experiences and responses to illness. Within cardiovascular nursing such qualitative approaches have been widely adopted to systematically investigate a number of phenomena. Contemporary qualitative research practice comprises a diverse range of disciplines and approaches. Computer-aided qualitative data analysis software represents an important facet of this increasingly sophisticated movement. Such software offers an efficient means through which to manage and organize data while supporting rigorous data analysis. The increasing use of qualitative data analysis software has stimulated wide discussion. This research column includes a review of some of the advantages and debates related to the use and integration of qualitative data analysis software.

Arrhythmogenic right ventricular cardiomyopathy is a cardiac disorder manifested by the replacement of the ventricular myocardium by fibro fatty tissue and has been known to cause sudden cardiac death in young adults. In 30% to 50% of cases, the disease has familial links, which can have implications for the patients and families involved. Achieving a diagnosis can be taxing on all involved, and for the patient, it can mean having to go through a battery of tests. Once diagnosis has been confirmed, treatment for the disease includes implantation of an implantable defibrillator and/or pharmacotherapy to control the ventricular tachyarrhythmias.

According to the Canadian Hypertension Society (Canadian Hypertension Education Program, 2008), hypertension remains a significant health problem that is projected to become a greater global burden in the next 20 years. Internationally, the estimated total number of adults with hypertension in 2000 was 972 million; 333 million in economically developed countries. Current trends suggest that the number of adults with hypertension will increase by about 60% to a total of 1.56 billion by 2025. Despite the availability of effective treatment, more than half of patients treated for hypertension drop out of care entirely within a year of diagnosis. Fifty per cent of patients who remain under medical supervision take only 80% of their prescribed medications. As a result, 75% of patients with a diagnosis of hypertension do not achieve optimum blood pressure control due to poor adherence to anti-hypertensive treatment. Nurses represent a formidable force in improving adherence and care outcomes by understanding the dynamics of compliance, and employing techniques in assessing and monitoring the problems of nonadherence. Nurses are well positioned to effectively use sustained strategies to improve adherence, thereby decreasing the global burden of hypertension. Using a case study approach, this author explores the dynamics of adherence and reviews techniques for assessing, monitoring, and improving compliance in hypertension therapy.

Percutaneous coronary intervention (PCI) is a safe, effective, non-surgical treatment for coronary artery disease (CAD). The demand for PCI has increased exponentially since the 1980s and it has become the treatment of choice for many individuals with CAD. Since PCI is not a cure, secondary prevention strategies are critical to prevent disease progression. Unfortunately, current strategies ignore the specific needs of the elective PCI population. In this article, the authors highlight the unique characteristics of these patients, which may contribute to their lack of engagement in healthy lifestyles. Elective PCI patients are vulnerable due to limited knowledge and follow-up, and lack of enrolment in secondary prevention programs. Exercise is a central component of any cardiac prevention strategy. Individualized exercise programs that incorporate physical activity and counselling can potentially improve the clinical outcomes of these patients. Advanced practice cardiovascular nurses play a key role in developing, implementing, and evaluating exercise programs in this population.

Purpose: Interactive voice response (IVR) technology was used to increase medication compliance and reduce adverse events (hospitalization and emergency visits) in post-cardiac surgery patients.

Method: Patients randomized to intervention received 11 automated IVR calls in the six months after discharge. A total of 331 patients (164 IVR, 167 usual care) participated.

Results: Findings showed significant differences in the IVR group for the primary composite outcome of compliance and adverse events (relative risk (RR] and 95% confidence interval [CI]: 0.60 [0.37, 0.96), p = 0.041) and the secondary outcome of medication compliance (RR: 0.34 (0.20, 0.56), p < 0.0001). There was no significant impact on emergency room visits (RR: 1.04 (0.63, 1.73J) and hospitalization (RR: 0.77 [0.41, 1.45]). Most patients (93%) preferred IVR follow-up to no follow-up.

The Canadian Hypertension Education Program (CHEP), Canadian Hypertension Society, Blood Pressure Canada, Canadian Diabetes Association, College of Family Physicians of Canada, Canadian Pharmacists Association, Heart and Stroke Foundation of Canada, and the Canadian Council of Cardiovascular Nurses issued a recent call for all health care professionals in Canada to double their efforts to assist patients with diabetes in maintaining target blood pressures (Campbell et al., 2009b). Blood pressure (B/P) in diabetic individuals should be less than 130 mmHg systolic and less than 80 mmHg diastolic (CHEP 2009). Considering recognition and treatment of hypertension in people with diabetes can result in reductions in disability and death, control of hypertension must become an interdisciplinary priority. Maintaining B/P less than 130/80 mmHg requires lifestyle modification as the cornerstone to treatment and often two or more B/P medications (Campbell et al., 2009a). The cost of multiple drugs required for B/P control in diabetic individuals is one of the few treatments estimated to reduce overall health costs and related cardiovascular disease complications (Gillies, Abrams, & Lambert, 2007). Nurses are essential partners in assessing and assisting diabetic patients and all patients with hypertension to reduce overall cardiovascular risks. Nurses may also be key practitioners in assessing and monitoring patient difficulties with adherence to lifestyle or pharmacological interventions (Jayasinghe, 2009; McLean et al., 2008). Individualized lifestyle counselling and treatment modification are recommended to maintain target B/P and treat dysglycemia, dyslipidemia, smoking or any other cardiovascular risks in diabetic individuals.

Background: Stress is an untoward condition in patients with acute myocardial infarction (AMI). Abrupt nicotine withdrawal is associated with increased symptoms of stress. However, little is known about the impact of smoking cessation on the psychological indicators of stress among hospitalized AMI patients.

Purpose: In this pilot study we compared the psychological stressors between non-smoking AMI patients and smoking patients who abruptly ceased smoking following admission to the CCU.

Methods: A cross-sectional survey was piloted on a sample of 57 AMI patients (29 smokers and 28 nonsmokers) on the second day of admission to the CCU. Psychological stress was measured using the Profile of Mood States and the Insomnia Severity Index.

Results: Multivariate analysis of covariance (MANCOVA) suggested that after adjusting for age, smokers experienced significantly higher overall levels of stress than non-smokers (F = 3.13; p = 0.016). Post-hoc analyses suggested that scores of depression (p = 0.033), anxiety (p = 0.007), and anger (p = 0.017) were particularly higher among smokers, as compared to non-smokers. However, the two groups were not different with regard to their scores on fatigue (p = 0.528) and insomnia (p = 0.299).

Conclusions: Abrupt smoking cessation may expose patients admitted with AMI symptoms to higher levels of psychological stress. Given the potential damaging impact of psychological stressors on the physical outcomes of these patients, these findings demonstrate the need for continued assessment and research related to the management of nicotine withdrawal following AMI.