Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation.

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.

Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery: Protocol for a Systematic Review.

BACKGROUND: Many patients report moderate to severe pain in the acute postoperative period. Enhanced recovery protocols recommend multimodal analgesics, but the optimal combination of these is unknown. PURPOSE: The aim of this study was to synthesize the best available evidence about effectiveness of multimodal analgesics on pain after adult cardiac surgery. METHODS: A systematic review to determine the effect of multimodal postoperative analgesics is proposed (International Prospective Register of Systematic Reviews Registration CRD42022355834). Multiple databases including the Cochrane Library, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association, the Education Resources Information Centre, the Excerpta Medica database, the Medical Literature Analysis and Retrieval System Online, Scopus, Web of Science, and clinical trials databases will be searched. Screening in Covidence and quality assessment will be conducted by 2 authors. A grading of recommendations, assessment, development, and evaluation summary of findings will be presented if meta-analysis is possible.

Psychological Distress and Unmanaged Negative Emotions: Examining Resilience Among Nurses Working on COVID-19 Designated Inpatient Units.

Anecdotal evidence suggests nurses are engaging in resilience-based strategies to mitigate increased levels of psychological distress and unmanaged negative emotions they have been experiencing. Nurses' levels of resilience during the coronavirus disease 2019 (COVID-19) pandemic have not been clearly articulated, specifically in relation to psychological distress and negative emotions. The purpose of the current mixed-methods non-experimental descriptive study was to examine nurses' resilience during the pandemic. Sixty RNs working in acute care hospitals on inpatient units designated to care for patients with COVID-19 completed the study survey and 20 of these RNs completed an interview. Findings indicate moderate levels of resilience among participants, with the need to increase resources and support emerging as a common theme among the qualitative data. Suggestions for integration of resilience-based strategies into the clinical setting, such as creation of a dedicated space for nurses to engage in mindfulness, relaxation, and meditation, were put forward. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 24-28.].

Support during pregnancy for women at increased risk of low birthweight babies.

BACKGROUND: Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programmes offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programmes, collectively referred to in this review as additional social support, may include emotional support, which gives a person a feeling of being loved and cared for, tangible/instrumental support, in the form of direct assistance/home visits, and informational support, through the provision of advice, guidance and counselling. The programmes may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or a combination of lay and professional workers. This is an update of a review first published in 2003 and updated in 2010. OBJECTIVES: The primary objective was to assess the effects of programmes offering additional social support (emotional, instrumental/tangible and informational) compared with routine care, for pregnant women believed to be at high risk for giving birth to babies that are either preterm (less than 37 weeks' gestation) or weigh less than 2500 g, or both, at birth. Secondary objectives were to determine whether the effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay person). SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 5 February 2018, and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials of additional social support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional social support as some form of emotional support (e.g. caring, empathy, trust), tangible/instrumental support (e.g. transportation to clinic appointments, home visits complemented with phone calls, help with household responsibilities) or informational support (advice and counselling about nutrition, rest, stress management, use of alcohol/recreational drugs). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: This updated review includes a total of 25 studies, with outcome data for 11,246 mothers and babies enrolled in 21 studies. We assessed the overall risk of bias of included studies to be low or unclear, mainly because of limited reporting or uncertainty in how randomisation was generated or concealed (which led us to downgrade the quality of most outcomes to moderate), and the impracticability of blinding participants.When compared with routine care, programmes offering additional social support for at-risk pregnant women may slightly reduce the number of babies born with a birthweight less than 2500 g from 127 per 1000 to 120 per 1000 (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.86 to 1.04; 16 studies, n = 11,770; moderate-quality evidence), and the number of babies born with a gestational age less than 37 weeks at birth from 128 per 1000 to 117 per 1000 (RR 0.92, 95% CI 0.84 to 1.01, 14 studies, n = 12,282; moderate-quality evidence), though the confidence intervals for the pooled effect for both of these outcomes just crossed the line of no effect, suggesting any effect is not large. There may be little or no difference between interventions for stillbirth/neonatal death (RR 1.11, 95% CI 0.88 to 1.41; 15 studies, n = 12,091; low-quality evidence). Secondary outcomes of moderate quality suggested that there is probably a reduction in caesarean section (from 215 per 1000 to 194 per 1000; RR 0.90, 95% CI 0.83 to 0.97; 15 studies, n = 9550), a reduction in the number of antenatal hospital admissions per participant (RR 0.78, 95% CI 0.68 to 0.91; 4 studies; n = 787), and a reduction in the mean number of hospitalisation episodes (mean difference -0.05, 95% CI -0.06 to -0.04; 1 study, n = 1525) in the social support group, compared to the controls.Postnatal depression and women's satisfaction were reported in different ways in the studies that considered these outcomes and so we could not include data in a meta-analysis. In one study postnatal depression appeared to be slightly lower in the support group in women who screened positively on the Edinbugh Postnatal Depression Scale at eight to 12 weeks postnatally (RR 0.74, 95% CI 0.55 to 1.01; 1 study, n = 1008; moderate-quality evidence). In another study, again postnatal depression appeared to be slightly lower in the support group and this was a self-report measure assessed at six weeks postnatally (RR 0.85, 95% CI 0.69 to 1.05; 1 study, n = 458; low-quality evidence). A higher proportion of women in one study reported that their prenatal care was very helpful in the supported group (RR 1.17, 95% CI 1.05 to 1.30; 1 study, n = 223; moderate-quality evidence), although in another study results were similar. Another study assessed satisfaction with prenatal care as being "not good" in 51 of 945 in the additional support group, compared with 45 of 942 in the usual care group.No studies considered long-term morbidity for the infant. No single outcome was reported in all studies. Subgroup analysis demonstrated consistency of effect when the support was provided by a healthcare professional or a trained lay worker.The descriptions of the additional social support were generally consistent across all studies and included emotional support, tangible support such as home visits, and informational support. AUTHORS' CONCLUSIONS: Pregnant women need the support of caring family members, friends, and health professionals. While programmes that offer additional social support during pregnancy are unlikely to have a large impact on the proportion of low birthweight babies or birth before 37 weeks' gestation and no impact on stillbirth or neonatal death, they may be helpful in reducing the likelihood of caesarean birth and antenatal hospital admission.

Tailored Web-Based Interventions for Pain: Systematic Review and Meta-Analysis.

BACKGROUND: Efforts have multiplied in the past decade to underline the importance of pain management. For both acute and chronic pain management, various barriers generate considerable treatment accessibility issues, thereby providing an opportunity for alternative intervention formats to be implemented. Several systematic reviews on Web-based interventions with a large emphasis on chronic pain and cognitive behavioral therapy have been recently conducted to explore the influence of these interventions on pain management However, to our knowledge, the specific contribution of tailored Web-based interventions for pain management has not been described and their effect on pain has not been evaluated. OBJECTIVE: The primary aim of this systematic review was to answer the following research question: What is the effect of tailored Web-based pain management interventions for adults on pain intensity compared with usual care, face-to-face interventions, and standardized Web-based interventions? A secondary aim was to examine the effects of these interventions on physical and psychological functions. METHODS: We conducted a systematic review of articles published from January 2000 to December 2015. We used the DerSimonian-Laird random effects models with 95% confidence intervals to calculate effect estimates for all analyses. We calculated standardized mean differences from extracted means and standard deviations, as outcome variables were measured on different continuous scales. We evaluated 5 different outcomes: pain intensity (primary outcome), pain-related disability, anxiety, depression, and pain catastrophizing. We assessed effects according to 3 time intervals: short term (<1 month), medium term (1-6 months), and long term (6-12 months). RESULTS: After full-text review, we excluded 31 articles, resulting in 17 eligible studies. Only 1 study concerned acute pain and was removed from the meta-analysis, resulting in 16 studies available for quantitative assessment. Compared with standard care or a waiting list, tailored Web-based intervention showed benefits immediately after, with small effect sizes (<0.40) for pain intensity (10 randomized controlled trials [RCTs], n=1310, P=.003) and pain-related disability (6 RCTs, n=953, P<.001). No other improvements were observed at follow-up in the medium and long terms. Compared with the active control group, no improvements were found for the primary outcome (pain intensity) or any of the outcomes except for a small effect size on pain catastrophizing (2 RCTs, n=333, P<.001) immediately after the intervention. CONCLUSIONS: Tailored Web-based interventions did not prove to be more efficacious than standardized Web-based interventions in terms of pain intensity, pain-related disability, anxiety, and depression. An interesting finding was that some efficacy was shown on pain catastrophizing compared with active control interventions. Considering the diversity of approaches used in tailored Web-based interventions for chronic pain management, their efficacy is yet to be explored. Moreover, their contribution to acute pain management is embryonic. TRIAL REGISTRATION: International prospective register of systematic reviews (PROSPERO): CRD42015027669; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027669 (Archived by WebCite at http://www. webcitation.org/6uneWAuyR).

Facilitators and Barriers of Heart Surgery Discharge: Patients' and Nurses' Narrative Accounts.

BACKGROUND: Optimal patient recovery from open-heart surgery relies on effective discharge planning and education. However, the nature of the discharge experience has not been clearly described. OBJECTIVE: The study purpose is to explore patients' and nurses' narrative accounts of the facilitators and barriers of heart surgery discharge. METHODS: A qualitative study was employed using a narrative methodology that elicited and analyzed stories. This research was conducted in a large, urban hospital in Ontario, Canada. A total of 17 patients and nurses were recruited. Five female and 5 male patients were recruited from a preoperative clinic. Ages ranged from 37 to 80 years. Seven nurses were recruited from inpatient cardiovascular units. They had 2 to 19 years of cardiovascular nursing experience. Semistructured, narrative-based interviews were conducted. Two interviews were conducted with each patient at 1 week after discharge and at 4 to 6 weeks. One interview was conducted with each nurse. RESULTS: Findings indicate that although the preoperative period was identified as an effective time for discharge preparation, the patient's cognitive capacity was limited during the postoperative phase of surgery. Both nurses and patients also found that insufficient time impeded the discharge process and limited individualized discussions. The structured and standardized delivery of discharge information affected patients' capacity to apply it to the particularities in their own lives and homes. The fostering of therapeutic relationships created a space where patients felt comfortable sharing their concerns and nurses learned more about patients and thus could better tailor the discharge approach. CONCLUSIONS: Study recommendations include group and scenario-based education in which patients and nurses brainstorm about how to apply the discharge information to the particularities of patients' lives and homes. Provision of support needs to be bolstered during the home period, where patients have timely opportunities to discuss their concerns and questions with practitioners or possibly peers.

Using knowledge translation as a framework for the design of a research protocol.

Knowledge translation has been defined as the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, resulting in a stronger health-care system. Using KT activities to aid in the adoption of evidence into practice can address current health-care challenges such as increasing organizational practice standards, alleviating the risk for adverse events and meeting practitioner needs for evidence at the bedside. Two general forms of KT have been identified. These being integrated KT and end-of-grant KT. Integrated KT involves the knowledge users in the research team and in the majority of stages of the research process. End-of-grant KT relates to the translation of findings through a well-developed dissemination plan. This paper describes the process of using an integrated knowledge translation approach to design a research protocol that will examine the effectiveness of a web-based patient educational intervention. It begins with a description of integrated knowledge translation, followed by the presentation of a specific case example in which integrated knowledge translation is used to develop a nursing intervention. The major elements of integrated knowledge translation pertain to need for a knowledge user who represents the broad target user group, and who is knowledgeable in the area under investigation and who as authority to enact changes to practice. Use of knowledge users as equal partners within the research team; exploring all feasible opportunities for knowledge exchange; and working with knowledge users to identify all outcomes related to knowledge translation are the other major elements of integrated knowledge translation that are addressed throughout this paper. Furthermore, the relevance of psychosocial or educational interventions to knowledge translation is also discussed as a source of knowledge. In summary, integrated knowledge translation is an important tool for the development of new interventions, as it helps to apply science to practice accurately. It supports the elaboration of the design while enhancing the relevance of the intervention through the validation of feasibility and acceptability with clinicians and patients.

Examining the influence of treatment preferences on attrition, adherence and outcomes: a protocol for a two-stage partially randomized trial.

BACKGROUND: Empirical evidence pertaining to the influence of treatment preferences on attrition, adherence and outcomes in intervention evaluation trials is inconsistent. The inconsistency can be explained by the method used for allocating treatment and measuring preferences. The current methodological study is designed to address these factors by implementing the two-stage partially randomized or preference trial design, and administering a validated measure to assess participants' preferences for the treatments under evaluation. It aims to compare attrition, adherence and outcomes for participants allocated randomly or by preference to treatment. The study is in its final stages of data collection; its protocol is presented in this paper. METHODS/DESIGN: A partially randomized clinical or preference trial is used. Eligible participants are randomized to two trial arms. First is the random arm involving random assignment to treatments, and second is the preference arm involving allocation to the chosen treatment. Participants with chronic insomnia are targeted. Two behavioral treatments are offered, stimulus control therapy and sleep restriction therapy, in the same format (small group) and dose (two sessions given over a 4-week period). A participant log is used to collect data on attrition. Adherence is evaluated in terms of exposure and enactment of treatment. Sleep-related outcomes (sleep parameters and perceived insomnia severity) are measured at pretest, posttest, 6 and 12 month follow-up. Treatment preferences, adherence and outcomes are assessed with reliable and valid measures. DISCUSSION: The advantages and limitations of the preference trial design are highlighted. The challenges in implementing the trial are discussed relative to the distribution of participants in the groups defined by treatment received and method of treatment allocation. TRIAL REGISTRATION: ClinicalTrials.gov Registry NCT02513017.

Questioning the efficacy of 'gold' open access to published articles.

AIM: To question the efficacy of 'gold' open access to published articles. BACKGROUND: Open access is unrestricted access to academic, theoretical and research literature that is scholarly and peer-reviewed. Two models of open access exist: 'gold' and 'green'. Gold open access provides everyone with access to articles during all stages of publication, with processing charges paid by the author(s). Green open access involves placing an already published article into a repository to provide unrestricted access, with processing charges incurred by the publisher. DATA SOURCES: This is a discussion paper. REVIEW METHODS: An exploration of the relative benefits and drawbacks of the 'gold' and 'green' open access systems. DISCUSSION: Green open access is a more economic and efficient means of granting open access to scholarly literature but a large number of researchers select gold open access journals as their first choices for manuscript submissions. This paper questions the efficacy of gold open access models and presents an examination of green open access models to encourage nurse researchers to consider this approach. CONCLUSION: In the current academic environment, with increased pressures to publish and low funding success rates, it is difficult to understand why gold open access still exists. Green open access enhances the visibility of an academic's work, as increased downloads of articles tend to lead to increased citations. IMPLICATIONS FOR RESEARCH/PRACTICE: Green open access is the cheaper option, as well as the most beneficial choice, for universities that want to provide unrestricted access to all literature at minimal risk.

Examining the effect of patient-centred care on outcomes.

Within patient-centered care (PCC), the individual is viewed as an active member of the healthcare team. While there has been recent interest in conducting systematic reviews to examine the effectiveness of PCC interventions, various studies fall short in explaining the type of intervention most effective in producing significant changes to desired outcomes. The purpose of this systematic review was to determine the characteristics of PCC interventions that have demonstrated effectiveness in enhancing the quality of care and performance of self-care behaviours. A systematic review of 40 studies that addressed PCC interventions, included samples over the age of 18 years, and were published between 1995 and 2014 was performed. Descriptive statistics were used to delineate study, participant, and intervention characteristics. Results suggest PCC-based interventions are not effective when delivered to individuals living with chronic illnesses.

Preparing for a randomized controlled trial: strategies to optimize the design of an individualized cardiovascular surgical patient education intervention.

Randomized controlled trial (RCT) designs are standardized to control for bias and allow for replication. Conducting RCTs is generally straightforward when dealing with interventions that contain a single component, such as a drug. However, interventions that do not contain single components, such as a patient education programs, are more difficult to standardize, as they contain multiple elements, which may act independently or interdependently of each other. The purpose of this discursive clinical methods paper is to describe and explain a methodology that can be used to optimize the design of a complex intervention prior to its evaluation in a randomized control trial.

The experience of developing a faculty research cluster using the creativity of the narrative reflective process.

Faculty development that builds research capacity is a significant yet challenging expectation in academia. The School of Nursing faculty at Ryerson University established several research clusters to support research collaborations and productivity. This article explicates one cluster's development process, and specifically, its adoption of the narrative reflective process (NRP). Engaging in NRP permitted the group to creatively enter into critical dialogue, address both individual and collective needs, and establish a supportive environment that nurtures the creative process--all of which ultimately enhances scholarship and academic productivity.

Integrating Interactive Digital Content Into Existing Professional Development Programs for Nurses: A Brief Discussion Paper.

Current nursing professional development programs include online education related to caring for COVID-19-positive patients. However, these resources failed to attract significant uptake of knowledge acquisition mainly because of poorly structured web pages. This discussion paper presents a unique perspective to designing professional development programs for frontline nurses working during the COVID-19 pandemic and beyond through the use of interactive digital content (IDC). An overview of IDC is provided, followed by strategies for transforming existing nursing professional development education into IDC.

Creating a social media strategy for an international cardiothoracic research network: a scoping review.

AIMS: A cardiac surgery international nursing and allied professional research network titled CONNECT was created to strengthen collaborative cardiac surgery research through shared initiatives including supervision, mentorship, workplace exchange programs, and multi-site clinical research. As with any new initiative, there is a need to build brand awareness to enhance user familiarity, grow membership, and promote various opportunities offered. Social media has been used across various surgical disciplines; however, their effectiveness in promoting scholarly and academic-based initiatives has not been examined. The aim of this scoping review was to examine the different types of social media platforms and strategies used to promote cardiac research initiatives for CONNECT. METHODS AND RESULTS: A scoping review was undertaken in which a comprehensive and thorough review of the literature was performed. Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. CONCLUSION: Findings from this review will inform the design and evaluation of a targeted Twitter campaign aimed at increasing brand awareness of CONNECT, which will include the use of @CONNECTcardiac Twitter handle, hashtags, and CONNECT-driven journal clubs. In addition, the use of Twitter to disseminate information and brand initiatives related to CONNECT will be evaluated using the Twitter Analytics function. REGISTRATION: Open Science Framework: osf.io/q54es.

Driveline dressings used in heartmate patients and local complications: A retrospective cohort.

BACKGROUND: Patients with long-term ventricular assist devices (VAD) are predisposed to infection, bleeding, and pressure injuries at the insertion of the driveline. There is no consensus on a driveline dressing protocol. Chlorhexidine is often used to clean the driveline exit site and has been associated with lower rates of infection. For driveline coverage, bacteriostatic agents and transparent film have shown good results, but are costly. The same issue was associated with anchorage devices. OBJECTIVES: The purpose of this study was to evaluate the types of dressings used in the driveline of patients using HeartMate (HM) and to describe the incidence density of local complications (infection, bleeding, and pressure injury) within 30 days postoperatively. METHODS: A retrospective cohort study was conducted and included 22 patients admitted to the Intensive Care Unit after implantation of HM II and III in a Brazilian private hospital. RESULTS: Several types of dressings were used in the drivelines. There were 22 different types of dressings. Dressing type 6 (Chlorhexidine, Excilon, Gauze and IV3000) were the most used (45.4%). Subjects using the Flexi-Trak anchoring device had a higher rate of local bleeding (50.0%) and those who used the Hollister device had more infection (61.1%) and pressure injury associated with a medical device (11.1%), compared to others. Infection was the primary complication (45.4%), followed by local bleeding (27.7%). CONCLUSION: Despite the high variability of products used in the driveline of patients using HeartMate, the dressing made with chlorhexidine, silver-impregnated absorbent foam and transparent film, and the use of anchoring devices was the most frequently used. Infection was the most common complication.

Integrated care in cardiovascular disease: a statement of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

In a rapidly changing health and care landscape, there is acknowledgement that the organization of care should be integrated with the patient placed at the centre. In reality, care systems are often fragmented, disjointed, and focused on the condition rather than the patient. The Science Committee of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology recognizes the need for a statement on integrated care to guide health professionals caring for people with cardiovascular disease. This statement outlines the evidence for integrated cardiovascular care, identifies challenges, and offers advice for practice, education, and research.

The influence of country of origin on engagement in self-care behaviours following heart surgery: a descriptive correlational study.

AIM: The aim of this study was to determine whether an individual's country of origin influenced performance of self-care behaviours after heart surgery. BACKGROUND: Patients are required to perform self-care behaviours following cardiovascular surgery. Usual care encompasses a patient education initiative that addresses self-care behaviour performance. Within Canada, current heart surgery patient education efforts have been designed and evaluated using homogenous samples that self-identify their country of origin as England, Ireland or Scotland. However, approximately 42·6% of Canadian cardiovascular surgical patients self-identify their country of origin as India or China. Thus, current cardiovascular surgery patient education initiatives may not be applicable to all patients undergoing heart surgery, which may result in decreased patient outcomes such as performance of self-care behaviours. DESIGN: This descriptive study. METHODS: A convenience sample of 90 patients who underwent heart surgery at one of two university-affiliated teaching hospitals, representing individuals of diverse backgrounds. Point-biserial correlational analysis was conducted to determine the relationship between country of origin and performance of self-care behaviours. RESULTS: Findings indicate individuals who self-identified their country of origin as England or Ireland were associated with a higher score on the number of self-care behaviours performed (p < 0·05) than individuals who self-identified other countries of origin. Self-care behaviours were taught using patient education materials that were designed based on feedback obtained from individuals whose country of origin was England or Ireland. CONCLUSION: This study provides preliminary evidence to suggest country of origin influences the amount of self-care behaviours individuals will perform. RELEVANCE TO CLINICAL PRACTICE: Patient education initiatives should incorporate the values, beliefs, attitudes and customs reflective of an individual's country of origin to enhance the likelihood of producing desired outcomes.

An examination of current patient education interventions delivered to culturally diverse patients following CABG surgery.

The design of current educational initiatives for heart surgery patients is based on feedback from individuals of Western European origin. The relevance of these initiatives is unknown when provided to individuals from non-Western European cultures. This study examined the cultural relevance of heart surgery patient educational initiatives delivered to individuals of diverse backgrounds. It used a non-experimental descriptive design involving 252 participants. Cultural relevance was assessed through self-care behaviours performed as recommended in the educational initiative. The participants of non-Western European origin were found to engage in more work-related activities and fewer self-care behaviours than their Western European counterparts in the first week following hospital discharge, indicating lack of adherence to educational recommendations. The study provides preliminary evidence suggesting that current self-care educational initiatives may not be culturally relevant. Continued evaluation to determine reasons why specific cultural groups engage in specific types of behaviour is needed.

Memory loss following coronary artery bypass graft surgery: a discussion of the implications for nursing.

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.

A cyborg ontology in health care: traversing into the liminal space between technology and person-centred practice.

Person-centred practice indubitably seems to be the antithesis of technology. The ostensible polarity of technology and person-centred practice is an easy road to travel down and in their various forms has been probably travelled for decades if not centuries. By forging ahead or enduring these dualisms, we continue to approach and recede, but never encounter the elusive and the liminal space between technology and person-centred practice. Inspired by Haraway's work, we argue that healthcare practitioners who critically consider their cyborg ontology may begin the process to initiate and complicate the liminal and sought after space between technology and person-centred practice. In this paper, we draw upon Haraway's idea that we are all materially and ontologically cyborgs. Cyborgs, the hybridity of machine and human, are part of our social reality and embedded in our everyday existence. By considering our cyborg ontology, we suggest that person-centred practice can be actualized in the contextualized, embodied and relational spaces of technology. It is not a question of espousing technology or person-centred practice. Such dualisms have been historically produced and reproduced over many decades and prevented us from recognizing our own cyborg ontology. Rather, it is salient that we take notice of our own cyborg ontology and how technological, habitual ways of being may prevent (and facilitate) us to recognize the embodied and contextualized experiences of patients. A disruption and engagement with the habitual can ensure we are not governed by technology in our logics and practices of care and can move us to a conscious and critical integration of person-centred practice in the technologized care environments. By acknowledging ourselves as cyborgs, we can recapture and preserve our humanness as caregivers, as well as thrive as we proceed in our technological way of being.