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

The social determinants of health (SDH) are recognized as a prominent influence on health outcomes across the lifespan. Racism is identified as a key SDH. In this article, the authors describe the concept of racism as an SDH, its impact in discriminatory actions and inactions, and the implications for cardiovascular nurses. Although research in Canada on the links among racism, stress, and cardiovascular disease is limited, there is growing evidence about the stress of racism and its long-term impact on cardiovascular health. The authors discuss how cardiovascular nursing could be enhanced through an understanding of racism-related stress, and race-based differences in cardiovascular care. The authors conclude with strategies for action to address this nursing concern.

Background: High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role.

Purpose: To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital.

Methods: Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction.

Results: Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p < or = 0.01), and had undergone more complicated surgical procedures (p < or =0.01). After discharge, more patients in the hospitalist-led group had visited their family doctor within a week (p < or =0.02) and measures of satisfaction relating to teaching, answering questions, listening and pain management were higher in the ACNP-led group.

Conclusion/implications: Although challenges in recruitment yielded a lower than anticipated sample size, this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.

Rapid surgical recovery (RSR) is a bundle of multimodal, preventive, best and promising practices based on available evidence that simplify care and treatment processes. When performed together, the synergy has real potential for improving patient safety, quality care, and access. RSR is an aggressive, goal-directed, and outcome-driven approach that seeks to rapidly return patients to their functional baseline. This is achieved through humanizing, normalizing, preventive and restorative strategies designed to make patients feel remarkably well soon after surgery. Reimer-Kent's postoperative wellness model is a conceptual framework that provides strong support for attaining RSR. The results from program evaluations have demonstrated the positive impact of RSR on both the patient and the health care system. An overview of the model and the importance of RSR are provided in this article.

Aim: The aim of this discursive paper is to present nursing interventions that address memory loss following heart surgery and that can be incorporated into patients' overall plan of care.

Background: Coronary artery bypass graft (CABG) is the most frequent surgical treatment for cardiovascular disease. Despite the advantages, reports indicate CABG procedures significantly increase the risk of cerebral impairment and/or injury, which can present itself in the form of memory loss. Older individuals tend to be at higher risk for memory loss than other age groups. Age combined with the effects of the surgical procedure increases the likelihood that individuals over the age of 65 years will experience some form of memory loss following surgery. In this paper, the author presents a discussion of the relevance and implications of memory loss to clinical nursing practice with particular attention to strategies nurses should use when caring for patients experiencing this symptom.

Relevance to clinical practice: Memory loss is a common symptom present in at least 25% of all patients following CABG. Screening for memory loss following CABG using reliable and valid instruments, revisions to current patient education initiatives to include calling patients following hospital discharge to review education and delivering education over multiple sessions, creating supportive reality-oriented relationships, and engaging in memory oriented training are suggested as nursing strategies that should be incorporated into existing nursing care for patients following CABG.

Conclusion: Currently, nursing practice does not routinely incorporate assessment and management of memory loss into the overall plan of care for patients following heart surgery. Specific nursing strategies that centre on the assessment and management of memory loss need to be implemented into the standard of nursing practice.

Understanding qualitative research is an important component of cardiovascular nurses' practice and allows them to understand the experiences, stories, and perceptions of patients with cardiovascular conditions. In understanding qualitative research methods, it is essential that the cardiovascular nurse understands the process of saturation within qualitative methods. Saturation is a tool used for ensuring that adequate and quality data are collected to support the study. Saturation is frequently reported in qualitative research and may be the gold standard. However, the use of saturation within methods has varied. Hence, the purpose of this column is to provide insight for the cardiovascular nurse regarding the use of saturation by reviewing the recommendations for which qualitative research methods it is appropriate to use and how to know when saturation is achieved. In understanding saturation, the cardiovascular nurse can be a better consumer of qualitative research.

Patients living with chronic heart failure (CHF) often have poor quality of life and similar symptoms as patients with cancer. Despite this, these patients receive less specialist palliative care. Some of the major barriers in providing high-quality care for end stage CHF patients are the conflicting conceptualization of palliative care among health care professionals as a system of care delivery at the terminal phase of the illness versus philosophy of care introduced early in conjunction with life-prolonging treatments, the unpredictable nature of the illness trajectory, lack of knowledge among acute care nurses about palliative care and lack of communication with patients and their families. The aim of this article is to identify evidence-based strategies and frameworks that would aid nurses and other health care professionals in the integration of palliative care into the care path of CHF patients.

The ventricular assist device (VAD) is a mechanical device that is used to provide long term support either as a bridge or as an alternative to transplantation for patients suffering from end stage heart failure. While in hospital, patients with a VAD have traditionally been taught by an educator nurse with VAD expertise in preparation for discharge. In 2004, our centre implemented a successful competency-based patient education program in post-heart transplant patients and thought that a similar program may provide increased confidence for bedside nurses to actively participate in VAD patient education prior to discharge. The purpose of this quality improvement project was to create a competency-based education program that would provide consistency in patient teaching. A questionnaire was developed and completed by 13 bedside nurses. This pre-test questionnaire indicated the need for a systematic and organized approach to VAD patient teaching. Furthermore, adequate resources, consistency in teaching methods, and feedback were seen to be essential. A pilot competency-based program was designed to lead bedside nurses and patients through a series of learning phases and has successfully been implemented. Since its implementation, the questionnaire has been repeated with results reflecting satisfaction with the revised competency-based program. Our findings and evaluation of the program through pre- and post-testing reflect an increase in organization in our teaching methods and has led to improved confidence and satisfaction for bedside nurses using this program. By redeveloping the current method of VAD education, our goal has been to improve the ways in which we deliver teaching to our patients. It is thought that, as with our experience in the post-heart transplant population, bedside nurses and team members will feel more empowered to provide teaching to patients with a VAD.

Adherence to physical activity is low among persons with cardiac disease. To influence this behaviour positively, it is suggested clinicians adapt the recommendations to each patient. Besides estimating needs and the values and the preferences of the person, professionals need to measure the physical activity. This measure also allows clinicians to follow the evolution of the behaviour further to the interventions. Subjective methods (questionnaire, logbook) and objective methods (pedometer, accelerometer, and heart rate monitor) can be used. There are advantages and inconveniences to each of these methods. This clinical column provides a review of these various methods to choose the one that is the most suited to the clinical context.