Patient perception of cardiovascular surgical patient education.

After surgery, 100 adult cardiac surgical patients participated in a study to determine what information was important to them and how well prepared they were. Questionnaires were administered 5 to 10 days after surgery and 1 to 4 weeks after discharge. In general patients received information that they perceived to be important, and they believed that preparation was more than adequate. Patients indicated a need to know more information about medication side effects than they received, and they did not desire as much information about emotional changes or sexual activity as the literature suggested.

Traumatic descending thoracic aneurysms: discussion and nursing care.

Traumatic aneurysms of the descending thoracic aorta are a rare but lethal event, having a mortality of 85-90%. Mortality of this population remains high due to the occurrence of aortic rupture. The isthmus of the aorta, just distal to the left subclavian artery is the most frequent site of injury. Acute traumatic injury to the aorta is characterized by hemorrhagic shock symptoms due to the tear in the layers of the aortic wall. Chronic traumatic injury with aneurysmal formation may not surface with symptoms for months or years after initial trauma. Patients who have formed a chronic aneurysm after a trauma incident can experience dysphagia, chest pain, dyspnea, or cough. Surgical repair involves placing a dacron graft in the area of aneurysmal formation. Protection of the lower extremities during the surgical procedure may prevent paraplegia. In a review of ten cases of chronic traumatic aneurysms at Loyola University Medical Center during the past twenty (20) years, all patients underwent surgical repair. There was no incidence of paraplegia. Post-operative nursing care focuses on monitoring hemodynamic stability, preventing respiratory complications and controlling pain.

Development of a program to manage costly outliers.

The advanced practice nurse group devised a method to identify clinical variables of the elderly patients with multisystem failure requiring complex nursing care referred to as outlier. Outliers in this program were defined as patients whose hospital charges were greater than $50,000 with a length of stay greater than the primary diagnostic related group designated. Once criteria were identified, nursing strategies were developed to monitor the elderly patient, implement interventions, and evaluate patient outcomes. The goals of this program were to identify who the outliers might be prior to becoming outliers and to manage their nursing care early in their hospital course, attempting to match resource requirements with resource availability.

Informed consent: an ethical dilemma.

Health care today involves complex decisions. How these decisions are made and by whom are the concerns of consumers, healthcare providers, ethicists, third-party payers, and the legal community. The authors explore the question of whether hospitalized clients participate in informed decision making and they use a case study to demonstrate application of Curtin's model for ethical decision making.