Relationships among patient characteristics, comorbidities, and vascular complications post-percutaneous coronary intervention.

BACKGROUND: The incidence of vascular complications (VCs) after femoral sheath removal following a percutaneous coronary intervention procedure (PCIP) occurs variably (5%-30%) depending on gender, body size, and comorbidities. VCs after a PCIP are distressful for subjects and increase costs and nursing care. Evidence on which subject characteristics contribute to VCs is inconsistent. OBJECTIVES: The study objective was to determine which subject characteristics and comorbidities contribute to VCs post-PCIP. METHODS: This correlational study included 306 subjects. Groin areas were assessed for the presence of VCs before, immediately after compression released, and 12 and 24 hours after femoral sheath removal for the presence of VCs. Subject characteristics and comorbidities were recorded. RESULTS: The most frequently occurring VCs were ecchymosis, hematoma, and oozing. Age was significantly associated with ecchymosis, whereas hypertension was associated with a decreased level of ecchymosis. Body surface area significantly influenced hematoma formation. CONCLUSIONS: Nurses caring for subjects' post-PCIP who are older and have a smaller body surface area may require extra vigilance and tailoring of nursing care to prevent development of VCs.

The Densford Clinical Scholars Program: improving patient care through research partnerships.

The Densford Clinical Scholars Program at the University of Minnesota School of Nursing partners advanced practice nurses and faculty members to design and conduct clinical studies for improving patient care. Benefits have included changes in nursing practice and, on occasion, the practice of other members of the healthcare team; enhanced research skills for clinicians; an enriched professional practice environment; access to clinical facilities for faculty; funding for research; and an expanded network for professional development. The authors describe this innovative partnership.

Effects of three groin compression methods on patient discomfort, distress, and vascular complications following a percutaneous coronary intervention procedure.

BACKGROUND: Incidence of vascular complications (VCs) after sheath removal following a percutaneous coronary intervention procedure (PCIP) vary widely by the compression method used to achieve femoral artery hemostasis. OBJECTIVE: To determine if one groin compression method causes the least discomfort and distress for patients and results in fewer VCs. METHODS: Patients (n = 306, mean age = 62.3 years, 77% male, 96.4% Caucasian) undergoing PCIPs at a tertiary care center in the urban Midwest participated in this three-group experimental design study. They were randomly assigned to Femostop, C-clamp, or manual compression and rated level of groin discomfort and distress on a 0-10 Numeric Rating Scale (NRS) prior to, during, and after arterial compression was released. The groin area was assessed for any VCs (oozing, ecchymosis, hematoma) prior to sheath removal, after compression released, and 12 and 24 hr after sheath removal. RESULTS: No significant differences were found by compression method for discomfort, distress, or VCs. Regardless of method, not having a VC prior to femoral sheath removal contributes to less oozing (z = -3.1, p = .0019), hematoma (z = -9.4, p < .0001), and ecchymosis(z = -10.1, p < .0001). C-clamp contributes to less oozing when hemostasis time is < 30 min (z = -2.2, p = .03), and Femostop is superior when time to hemostasis is >30 min (z = -2.3, p = .02). Not receiving eptifibatide (Integrilin) contributes to less ecchymosis (z = -2.9, p = .004). CONCLUSIONS: Nurses need to be vigilant when caring for patients who have a VC prior to femoral sheath removal and have received antiplatelet medications. Further research is needed to identify patient characteristics that may contribute to VCs.

Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction.

OBJECTIVE: To conduct an investigation similar to a landmark study that investigated the association between nurse-to-patient ratio and patient mortality, failure-to-rescue, emotional exhaustion and job satisfaction of nurses. METHODS: Cross-sectional analysis of 2709 general, orthopedic, and vascular surgery patients, and 140 staff nurses (42% response rate) caring for these patients in a large Midwestern institution. The main outcome measures were mortality, failure-to-rescue, emotional exhaustion, and job dissatisfaction. RESULTS AND CONCLUSIONS: Staffing was not a significant predictor of mortality or failure-to-rescue, nor did clinical specialty predict emotional exhaustion or job dissatisfaction. Although these findings reinforce adequate staffing ratios at this institution, programs that support nurses in their daily practice and positively impact job satisfaction need to be explored. The Nursing Research Council not only has heightened awareness of how staffing ratios affect patient and nurse outcomes, but also a broader understanding of how the research process can be used to effectively shape nurse's practice and work environments.

Developing an outcome-based multidisciplinary care planning tool: process and outcomes.

Multidisciplinary care planning is required for patients in acute care settings. A task force was charged by the Vice President of Patient Care to develop and implement a multidisciplinary care planning tool. This article outlines the process used and includes examples of the tool and outcomes to date. This major change project resulted in the development of a successful tool, a successful Joint Commission on Accreditation of Healthcare Organization survey, and new opportunities for outcome-based care planning.

Interdisciplinary rounds: impact on patients, families, and staff.

Interdisciplinary rounds are a new care coordination strategy in several healthcare settings. This article describes the process used by clinical nurse specialists in one institution to broaden existing discharge planning rounds to interdisciplinary rounds. In addition, a survey queried advanced practice nurse subscribers to two listserves, the ANPACC and CNS-L, to determine how other institutions conducted interdisciplinary rounds, including structure, membership, and leadership. As a result of the changed focus in rounds, the target institution noted greater participation by all disciplines in achieving patient and family outcomes, increased early recognition of patients at risk, and improved communication among members of the healthcare team. These findings were supported by participants in the Internet survey. It was determined that interdisciplinary rounds are a valuable mechanism for improved patient outcomes and increased staff professionalism.

Operationalizing advanced practice registered nurse legislation: perspectives from a clinical nurse specialist task force.

Many state boards of nursing are currently examining advanced nursing practice and determining a process to recognize and regulate it appropriately. In 1999, Minnesota state law was altered to define and provide title protection for advanced practice registered nurses. After passage of the new law, the Minnesota Board of Nursing convened 4 task forces, representing each of 4 advanced practice nursing groups, to develop recommendations regarding issues of certification, criteria for determining acceptable certifying organizations, procedures in the event of examination failure, and a process for communicating this information to the nursing community. This article provides an overview of the legislation and describes the process used to obtain and operationalize the new law. The process undertaken in the clinical nurse specialist task force is also described, including the key issues that emerged and lessons that were learned.