Comparison of comfort and local complications after cardiac catheterization.

The purpose of this study was to compare the effects of 4 hours of bed rest versus 6 hours of bed rest on patients' safety, comfort, and satisfaction levels. Using a quasi-experimental design, the authors studied 118 left-heart catheterization patients who were randomly assigned to 4 hours or 6 hours of bed rest. Among the study participants, only 1 in the 6-hour group had significant bleeding. There were no complications in the 4-hour group. There were no statistically significant differences between the two groups on any of the other study variables. Given the lack of significant complications for the 4-hour group and similar comfort levels for both study groups, these findings suggest the feasibility of reducing the standard period of postcatheterization bed rest from 6 hours to 4 hours, thereby possibly lowering the cost of the outpatient procedure.

Sleep in acute care settings: an integrative review.

PURPOSE: To report an integrative review about sleep patterns, factors that influence sleep, and sleep interventions in acutely ill hospitalized adults; discuss methodological challenges associated with studying sleep in this population; and propose future research. ORGANIZING FRAMEWORK: Research literature on sleep patterns of acutely ill hospitalized adults, obtained using computerized searches of Medline and CINAHL, was reviewed. Studies of patients on intensive care and medical-surgical units conducted in a range of health disciplines over a span of almost 30 years were included. Studies were organized into the following categories: descriptive studies of sleep using objective and subjective measures; correlational studies of personal, health status, and environmental variables and sleep; and intervention studies. FINDINGS: Sleep disturbance is a common but highly variable experience during acute care hospitalization. Multiple personal, health status, and environmental factors are related to sleep disturbance. Behavioral interventions show promise as a means to modify factors related to sleep. Few studies have shown the outcomes of sleep disturbance in acute care settings. CONCLUSIONS: More systematic research is needed to determine correlates of sleep disturbance in acutely ill hospitalized adults. Such studies can help investigators to identify patients who are most at risk for sleep disturbance and to provide the theoretical and conceptual bases for sleep-promoting interventions. Methodological challenges include characteristics of acute care patients and hospital environments, as well as the complexity of measuring sleep.

Reproductive decision making in mothers with HIV-1.

Eighty percent of women with human immunodeficiency virus (HIV) are of childbearing age and the incidence of HIV in women is rapidly increasing. Despite the risk of perinatal transmission and The Centers for Disease Control's (CDC) recommendation that HIV-positive women delay pregnancy, HIV-infected women continue to become pregnant and have children. To gain insight into reproductive decision-making of women with HIV, 25 mothers who participated in a natural history study of perinatal HIV transmission were interviewed using open-ended questions based on Fishbein's Theory of Reasoned Action. Three major themes emerged from the content analysis of transcripts from interviews with HIV infected women: (1) motherhood viewed as a joy and a means of meeting their own needs, (2) concerns about their children's well-being, and (3) the minor role of HIV infection in their lives. Women reported negative reactions to providers who focused exclusively on their HIV status, and not on the need to view the women's lives as a whole.

Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy.

The purposes of this study were to examine: (a) the relationships between the symptoms of insomnia and fatigue and the psychological factors of anxiety and depression, and; (b) the relationships between these psychological and symptom variables and quality of life in cancer patients who were receiving chemotherapy. The Theory of Unpleasant Symptoms was the framework for the study. A descriptive correlational design was used in a secondary analysis of data obtained from a sample of 263 cancer patients who were undergoing chemotherapy. Insomnia, fatigue, depression, and anxiety were positively correlated with one another (r = .26 to r = .69, p < .001) and negatively correlated with quality of life (r = -.28 to r = -.63, p < .001). Women had more anxiety and fatigue and poorer quality of life than did men. Older age was associated with better quality of life and less insomnia, fatigue, anxiety, and depression. Multiple regression analysis revealed that the symptoms and psychological variables explained 47% of the variance in quality of life, with the largest proportion of the variance explained by depression. Fatigue and insomnia explained only 4% of the variance in quality of life in excess of that contributed by the psychological factors. Although overall depression levels were low in this sample, these findings suggest that insomnia and fatigue are related to depression and that depression is more closely associated with quality of life than are insomnia and fatigue.

Effects of age on activity patterns after coronary artery bypass surgery.

OBJECTIVE: To examine the effect of age on activity patterns, including circadian rhythms and levels, after coronary artery bypass surgery (CABS). DESIGN: Repeated measures, correlational. SETTING: Northeastern university-affiliated tertiary coronary care center. SUBJECTS: Eight middle-aged (mean age = 57 years) and 14 older (mean age = 72 years) adults who had undergone first, isolated CABS. OUTCOME MEASURES: Wrist actigraph measures of levels (daytime activity) and circadian patterns of activity (acrophase, amplitude, percent rhythm, mesor), self-reported postoperative clinical activity milestones, and Sickness Impact Profile subscales of ambulation dysfunction and sleep-rest. INTERVENTION: Measurement of activity over postoperative days 2 through 5, including wrist actigraphy, Sickness Impact Profile ambulation and sleep-rest subscales, and daily clinical activity milestones. RESULTS: Repeated measures ANOVA was used in the data analysis. Statistically significant increases were found in percent rhythm (P <.001), amplitude (P <.001), activity level (P <.001), and clinical activity milestones (P <.001) over postoperative days 2 through 5. Significant effects of age were found on amplitude (P =.02) and percent rhythm (P =.008). Significant age-by-time effects were found for circadian amplitude (P =.03) and percent rhythm (P =.02). There was a nonstatistically significant (P =.07) age by time interaction effect on daytime activity. Trends in amplitude, percent rhythm, and daytime activity indicated that these activity parameters increased more slowly in older adults, compared with middle-aged adults, after initially similar levels on postoperative days 2 and 3. CONCLUSION: Both middle-aged and older adults increase daily activity and the strength of circadian activity pattern over days 2 through 5. However, these variables increase more rapidly in middle-aged adults after essentially identical levels on postoperative days 2 and 3.

Prehospital correlates of sleep in patients hospitalized with cardiac disease.

The purpose of this study was to examine relationships among selected endogenous factors and sleep patterns during hospitalization in patients with cardiac disease. Participants included 33 male and female patients with myocardial infarction and unstable angina. Wrist actigraph recordings and a computerized sleep algorithm demonstrated that the participants slept for a mean of 424.55 min (SD = 114.52), had a mean sleep efficiency of 77.30% (SD = 15.80), and experienced from 5 to 32 awakenings each night (M = 13.94, SD = 6.29). The mean duration of nighttime awakenings was 9.24 min (SD = 5.60). Self-reports of sleep efficiency, sleep supplementation, and sleep disturbance, using the Verran and Snyder-Halpern (1990) sleep scale, were better than normative data reported for hospitalized patients. The combination of age, gender, New York Heart Association Functional Classification scores (NYHA Criteria Committee, 1964), and prehospitalization sleep loss explained 29% of the variance in objectively measured sleep efficiency and 46% of the variance in duration of nighttime awakenings. These findings suggest the importance of prehospitalization variable as predictors of sleep patterns in hospitalized cardiac patients and provide baseline data for future study.

Health patterns of cardiac surgery clients using home health care nursing services.

The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.

Sleep patterns in women after coronary artery bypass surgery.

Sleep patterns were examined over a 6-month time period after coronary artery bypass graft surgery (CABG) using a wrist-worn actigraph and the Sleep-Rest subscale of the Sickness Impact Profile. The sample included 22 women during the first postoperative week (T1), and 13 of these women during the first posthospitalization week (T2) and the sixth (T3) and twenty-fourth postoperative weeks (T4). Nighttime sleep became less fragmented and, over time, total sleep became more consolidated during nighttime hours, as shown by significant decreases in day, evening, and total sleep and increases in the percentage of total sleep occurring at night during T1. There were also increases in nighttime sleep and percentages of total sleep and the mean sleep interval and decreases in day sleep and evening sleep and nighttime awakenings during T1 through T4. Decreases in the Sleep-Rest subscale indicated perceived improvement in sleep consistent with changes in objective sleep measures over 6 months. These data can be used to help women anticipate changes in sleep patterns over the course of recovery. They suggest the importance of interventions to improve sleep during hospitalization and posthospitalization recovery.

The hypertensive elder: a review for the primary care provider.

Hypertension, the most prevalent cardiovascular disorder in America, affects over 50% of the older adult population. Management of hypertension in the elder is influenced by numerous age-related factors, including physiological changes, co-morbid conditions, functional or cognitive impairments, and polypharmacy issues. As data on the damaging effects of untreated hypertension increase, practice guidelines are increasingly focused on early detection and successful management of blood pressure in the primary care setting. The primary health care provider, having an advanced knowledge base and excellent communication skills, can make effective management of hypertension a reality. This article presents a comprehensive review of assessment, diagnosis, and treatment of hypertension in the older adult. Lifestyle modification and pharmacologic therapy are discussed. Elements of patient education are described, with special emphasis on promoting adherence to a long-term treatment regimen.

Women's patterns of activity over 6 months after coronary artery bypass surgery.

OBJECTIVE: To examine the relationships between objectively measured activity patterns over 6 months after coronary artery bypass surgery (CABS) and their relationship to self-reported functional recovery at 6 weeks and 6 months after CABS. DESIGN: Time series, descriptive-correlational, convenience sample. SETTING: Hospital and home environment. PATIENTS: Thirteen women who had undergone CABS. The mean age was 62 years (SD 10.76, range, 43 to 78). The mean preoperative New York Heart Association Functional Classification was 2.08 (SD 1.26, range, 1 to 4). MEASURES: Wrist-worn accelerometers and the Sickness Impact Profile (SIP). INTERVENTION: Women wore the accelerometers for 4 week-long intervals: the first postoperative week (T1), the first week after hospitalization (T2), the sixth postoperative week (T3), and the first week of the sixth postoperative month (T4). The SIP was administered at the end of each week of data collection. RESULTS: Circadian rhythms and linear trends in activity were examined with spectral, cosinor, and least squares regression analyses. Repeated measures ANOVA over T1 through T4 demonstrated statistically significant increases in the strength of the circadian rhythms and means levels of activity over T1 to T4. There were no statistically significant relationships between activity parameters at T1, T3, or T4 and SIP scores at T3 or T4. CONCLUSIONS: This study is the first to report changes in circadian rhythms and levels of objectively measured activity over 6 months after CABS. The findings suggest that women's levels of activity and the strength of the circadian rhythm of activity increase between the early postoperative period and the sixth postoperative month. More research is needed to further explore the trajectory of activity patterns after CABS, their relationships to recovery and to determine the need for and effectiveness of interventions designed to promote recovery through activity patterning.

A framework of trauma and trauma recidivism in adolescents and young adults.

Trauma resulting from violence and unintentional causes has reached epidemic proportions in the United States, particularly among urban adolescents and young adults. Many of these injuries can be predicted because of participation of adolescents and young adults in risky behaviors. In addition, subsequent injuries to survivors can be predicted because of their return to risk taking behavior. This paper presents a model that addresses risk-taking behaviors, antecedents to risk taking, and the possible outcomes, including trauma and trauma recidivism. It focuses attention on the growing problem of trauma and trauma recidivism among adolescents and young adults and identifies implications for research and practice for trauma nurses.

Risk factors of adolescent and young adult trauma victims.

BACKGROUND: Repeated injury, or recidivism, because of intentional or unintentional injury is a growing chronic health problem among urban adolescents and young adults in the United States. OBJECTIVE: To describe demographic, social, environmental, psychological, and developmental antecedents and risk-taking behaviors, and to examine their relationships to type of trauma and rate of trauma recidivism in adolescent and young adults in an urban trauma center. METHODS: One hundred adolescent and young adult trauma victims in an urban trauma center were interviewed, using the Adolescent Risk-Taking Instrument, the Brief Anger/Aggression Questionnaire, and the Trauma Risk Factor Interview Schedule. Bivariate correlation, multiple regression, and discriminant function analysis were used to examine the data. RESULTS: Of the sample, 89% experienced trauma related to interpersonal violence, including firearm injuries, stab wounds, and blunt trauma. Male gender, unemployment, past arrest, lower levels of spirituality, and higher levels of anger/aggression and thrill-seeking accounted for 25% of the variance in the number of risk-taking behaviors. Factors such as male gender, past arrest, unemployment, having been a crime victim in the past, lower autonomy, use of weapons, fighting, and no psychological counseling distinguished subjects with firearm-related injuries from subjects with other injury sources. Use of alcohol on weekdays, past arrest, and higher education levels were associated with trauma recidivism, explaining 14% of the variance. CONCLUSIONS: Social/environmental and psychological/developmental variables, as well as risk-taking behaviors, are important correlates of trauma and recidivism. These findings suggest the importance of advocacy for social policies conductive to reducing the risks of violence and trauma and risk-reduction interventions as components of posttrauma care.

First postoperative week activity patterns and recovery in women after coronary artery bypass surgery.

The purpose of this study was to examine the relationship between activity-rest patterns and recovery in women during the first week after coronary artery bypass surgery (CABS). Twenty-five women wore wrist actigraphs to measure activity objectively throughout the first postoperative week. The Sickness Impact Profile (SIP) and length of postoperative hospital stay (LOS) were used as measures of recovery. Analysis of the activity data indicated that 21 (84%) of the participants had statistically significant positive linear trends in activity. Spectrum analysis indicated that 18 participants had periods that could be defined as circadian, 1 had a shorter period, and 6 had longer periods. After controlling for the effect of preoperative functional status, the period and linear trend of activity explained 28% of the variance in the SIP score at 1 week and 33% of the variance in length of stay. Positive linear trends in activity and circadian activity periods were related to better functioning and shorter length of stay.

Critical care nursing research: opportunities and resources.

BACKGROUND: As patient needs become more complex in the critical care setting, nurses with increased clinical expertise are needed to expand the research knowledge base and apply existing knowledge in practice settings. PURPOSE: To review opportunities and resources that are available to facilitate nurses' involvement in critical care research: opportunities for participation in research, sources of ideas, human and financial resources, and ideas for the dissemination of research findings. CONCLUSIONS: Opportunities and resources available for critical care research are numerous, varied, and widely available. They should be used to advance the scientific bases for critical care practice.

Perspectives on activity.

Activity is integral to human health, well-being, development, and functioning. Despite its importance to health, there have been few efforts to develop conceptual definitions of activity as a basis for nursing research in this area. The purposes of this paper are to review the major attributes of physical activity found in the nursing and health care literature, to formulate a comprehensive definition of activity based on the literature, and to suggest directions for future research.

Symptoms reported by older and middle-aged adults after coronary bypass surgery.

Knowledge of the most prevalent symptoms after coronary artery bypass surgery (CABS) can be used to assist patients to anticipate recovery. The purposes of this study were to describe the prevalence of symptoms during the first 6 weeks after CABS, to assess changes in the number and types of symptoms, and to compare symptoms in older and middle-aged adults. The most prevalent symptoms during hospitalization (Time 1) were pain, edema, wound drainage, fever, and fatigue. In the third through fifth postoperative weeks (Time 2), the most prevalent symptoms were pain, edema, sleep problems, fatigue, and wound drainage. At 6 weeks (Time 3), sleep problems, edema, pain, fatigue, and shortness of breath were the most common. Number of symptoms decreased significantly between Times 1 and 3. All symptoms were more prevalent at Time 2 than at Time 1 and less prevalent at Time 3, with the exception of sleep problems, which were reported more frequently at Time 3 than at Time 1. The most persistent symptoms were edema, fatigue, sleep problems, pain, and shortness of breath. Significantly more middle-aged adults than older adults reported anxiety at Time 2. No other age-related differences were found. Implications for nursing practice and research are discussed.