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

Background: Acute care nurse practitioners (ACNPs) provide advanced nursing care to patients and families who are experiencing a complex acute, critical or chronic health condition. A clear understanding of ACNP activities may facilitate the deployment of ACNP roles in health care teams. Time and motion studies represent the gold standard to measure clinician work time.

Methods: A time and motion tool to measure cardiology ACNP activities was developed and pilot-tested in two organizations.

Findings: The researcher produced a valid and reliable tool. The inter-observer agreement was 0.94 following the pilot study. A training guide and a training schedule were produced to support the use of the time and motion tool. Each activity was defined to facilitate the coding of ACNP activities.

Conclusion: A validated tool can contribute to our knowledge of ACNP activities and role components, and identify the ACNPs' contributions to patient care and the functioning of the health care team.

The need for quality nursing research to promote evidence-based practice and optimize patient care is well recognized. This is particularly pertinent in cardiovascular nursing, where cardiovascular disease continues to be the leading cause of morbidity and mortality worldwide (World Health Organization, 2007). Across the spectrum of academic, clinical, and health care administration nursing roles, research remains fundamental to bridging theory, practice, and education (LoBiondo-Wood, Haber, Cameron, & Singh, 2009). Despite recognition of the importance of nursing research, the gap between research and practice continues to be an ongoing issue (Funk, Tornquist, & Champagne, 1995; Pettengill, Gillies, & Clark, 1994; Rizzuto, Bostrom, Suterm, & Chenitz, 1994; Rolfe, 1998). Nurses are appropriately situated to contribute to research that improves clinical outcomes and health service delivery. However, the majority of nurses in clinical practice do not have a significant research component structured into their nursing role. In this research column, the authors outline the importance of nurses being engaged in research and present some different levels of involvement that nurses may assume. A continuum of nursing research involvement includes asking researchable questions, being a savvy consumer of research evidence, finding your own level of research involvement, and aspiring to lead.

Cold agglutinins are particular cold-reactive antibodies that react with red blood cells when the blood temperature drops below normal body temperature causing increased blood viscosity and red blood cell clumping. Most individuals with cold agglutinins are not aware of their presence, as these antibodies have little effect on daily living, often necessitating no treatment. However, when those with cold agglutinins are exposed to hypothermic situations or undergo procedures such as cardiopulmonary bypass with hypothermia during cardiac surgery, lethal complications of hemolysis, microvascular occlusion and organ failure can occur. By identifying those suspected of possessing cold agglutinins through a comprehensive nursing assessment and patient history, cold agglutinin screening can be performed prior to surgery to determine a diagnosis of cold agglutinin disease. With a confirmed diagnosis of cold agglutinin disease, the plan of care can be focused on measures to maintain the patient's blood temperature above the thermal amplitude throughout their hospitalization including the use of normothermic cardiopulmonary bypass with warm myocardial preservation techniques to prevent these fatal complications. Using a case report approach, the authors review the mechanism, clinical manifestations, detection and nursing management of a patient with cold agglutinins undergoing scheduled cardiac surgery. Cold agglutinin disease is rare. However, the risk to patients warrants an increased awareness of cold agglutinins and screening for those who are suspected of carrying these antibodies.

Dual antiplatelet therapy with aspirin and clopidogrel is among the most efficacious treatment for patients after acute coronary syndromes and for those who have had a percutaneous coronary intervention and coronary stent implantation. Patients who are treated with dual antiplatelet therapy are usually also ordered medications that reduce the secretion of gastric acid (such as H2 receptor blockers or proton pump inhibitors [PPIs]) in order to decrease the risk of gastrointestinal bleeding and dyspepsia. Numerous observational studies reported that omeprazole (a PPI) attenuates the antiplatelet activity and clinical effectiveness of clopidogrel and causes adverse cardiovascular events. Based on these findings, several medical agencies in the world have issued communications regarding the negative interaction between clopidogrel and PPIs, urging clinicians to evaluate the need for starting treatment with a PPI in patients taking clopidogrel. There are studies that reported contradicting findings, suggesting that there is no significant interaction between clopidogrel and PPIs. Only one prospective, randomized, double-blind, placebo-controlled clinical trial examined the interaction between clopidogrel and omeprazole and did not demonstrate cardiovascular harm among the patients who were treated with clopidogrel and omeprazole, as compared to those who were treated with clopidogrel and placebo. In this article, the authors review the current studies that reported a possible drug-drug interaction between clopidogrel and PPIs, particularly omeprazole.

Background: Care-seeking delay represents a major cause of death and disability for cardiac patients. With more than 70,000 new and recurrent acute myocardial infarctions (AMI) in Canada each year, recognizing symptoms as heart-related and seeking prompt medical care is essential for increasing the likelihood of successful treatment and survival. However, little is known about the factors associated with whether or not individuals attribute their symptoms to the heart (i.e., adopt a cardiac symptom attribution).

Purpose and design: Secondary analyses were conducted on data from a sample of 135 patients from four North American hospitals to identify the predictors of correct symptom attribution (CSA) during AMI.

Results and conclusions: Logistic regression investigations revealed that patients with a prior diagnosis of coronary heart disease and patients whose AMI experience paralleled their pre-existing symptom expectations were associated with greater odds of adopting a CSA. Results suggest that patient education and a clearer understanding of patients' beliefs about AMI can help nurses in acute care and community settings identify and manage misconceptions that may interfere with correctly attributing symptoms to a cardiac cause.

Exercise training in heart failure is safe, useful and effective therapy in the management of heart failure patients. Contrary to the old belief, it does not worsen cardiac function. Smaller studies also reported reduction in mortality and morbidity associated with exercise training. The available data support training HF patients to improve exercise tolerance and symptoms. Patients should be properly reviewed by their physicians prior to engaging in exercise training. It is highly recommended that patients be referred to a cardiac rehabilitation program, especially those with severe or advanced heart failure.

Tailoring discharge teaching information to the unique learning needs of cardiac surgery patients and their caregivers may improve information acquisition and retention and positively influence the transition home for these individuals. Two questionnaires were developed, one for adult cardiac surgery patients, and one for their caregivers, to explore their self-identified information needs regarding discharge teaching information. The questionnaires were adapted from the Patient Learning Needs Scale of Bubela et al. (1990). The content of the questionnaires was based on informal discussions with patients and their caregivers and nurses of the cardiac surgery department of a university teaching hospital. In addition, previous research exploring discharge teaching content post cardiac surgery and perceived discharge information needs of this population was reviewed. Preliminary testing of the tools indicated content validity. The questionnaires may enhance the efficiency and quality of discharge teaching, as they enable nurses to address the unique information needs of patients and caregivers. This, in turn, may assist patients and caregivers to cope with the transition home. Formal piloting and evaluation of the tools with all stakeholder groups is indicated, in order to determine the effectiveness of the questionnaires and to evaluate and validate their content and format.

Many patients experiencing ST segment elevation myocardial infarction (STEMI) are currently treated with primary percutaneous intervention (PCI). This relatively new procedure has reduced the time patients with the diagnosis of STEMI spend in hospital. In this literature review we explore patients' perceptions of their experience of receiving primary percutaneous intervention (PCI) as a treatment for STEMI. We critiqued and graded for relevance 10 papers that included original research and other sources. Key findings indicate that there is considerable variability in how patients treated for STEMI perceive the experience of PCI. Further, there is a misalignment between some patients' perceptions and health professionals' perceptions of this experience related to the event as well as the language used to speak of it. Thus, we recommend that nurses assess patients' perception of the experience and patients' health literacy level, then tailor the content and language of patient and family education to ensure an effective educative intervention.

Background: Completion of a cardiac rehabilitation (CR) program post cardiac disease event promotes successful recovery and subsequent cardiovascular health. Attrition rates for CR programs have been reported as high as 65%. Little is known about the attrition population.

Purpose: The purpose of this study was to describe demographic and clinical variables associated with non-completion of CR and to identify factors that led to attrition.

Methods: A comparative retrospective survey design was used to identify differences in demographic and clinical variables between patients who completed CR and those who did not. Prospectively, CR participants who dropped out received follow-up calls to identify reasons for program cessation.

Results: Demographic variables were not significantly different between the attrition group and the control group. Having a normal ECG during a pre-program stress test and having higher levels of pre-program stress were significant for the attrition group. The most common reason for dropping out was physical health problems. Other influential factors included patients' perception that the exercise component of the program was too difficult and personal perceptions and reactions to the program.

Implications: Patients entering CR who present in better physical risk categories with higher home or occupational stress levels may be at risk for dropping out. CR staff should monitor patients early for personal reactions to the program along with their response to physical exercise in order to address issues that promote program attrition.