[The Role of a Nurse Practitioner in Cardiovascular Surgery at a Japanese Private Hospital].

Since 2020, our hospital has introduced nurse practitioners( NP) into cardiovascular surgery with the aim to improve labor efficiency. A cardiovascular surgery NP has both pre- and postoperative roles. An NP is not only involved in a necessary intervention but also in an intervention as the first assistant regardless of regular or emergency surgery. By having an NP perform the work normally performed by doctors, a labor burden on doctors is reduced and care administered by the medical team is smoothened. This study reports the role of NPs in the field of cardiovascular surgery in private hospitals.

Advanced Resuscitation Guidelines Improve Mortality Rates Among Cardiovascular Surgery Patients.

In this month's Magnet® Perspectives column, Melanie Roberts, DNP, RN-BC, CNS, CCNS, CCRN, critical care clinical nurse specialist at Medical Center of the Rockies (MCR) and Poudre Valley Hospital, discusses her efforts to implement the state-ofthe-art European Resuscitation Council (ERC) guideline for resuscitation of cardiovascular (CV) surgery patients. Her evidence-based initiative has improved quality of care and mortality rates among the CV surgery population at MCR. Dr Roberts' pioneering work earned her the 2017 National Magnet Nurse of the Year Award for Empirical Outcomes. She shares details of her innovative program and examines the value of implementing practice enhancements in a Magnet environment. She describes the importance of an interdisciplinary team effort to achieve success.

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature.

Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

Evaluation of an Intervention With Nurses for Delirium Detection After Cardiac Surgery.

BACKGROUND: Completion of a delirium detection tool allows rapid management, which alleviates complications. However, these tools are often underused. AIMS: To assess the effect of a knowledge transfer (KT) intervention on the completion of a delirium detection tool by nurses working with cardiac surgery patients. Secondary aims included describing completion rates per work shift, and patient characteristics associated with higher rates. METHODS: In a pre-post study, the intervention included a survey and focus groups to identify barriers to use of a delirium detection tool (Intensive Care Delirium Screening Checklist [ICDSC]). Nurses' suggestions for a KT activity and its implementation were also included. Using chi-square analysis and medical charts from 242 patients, we compared the pre- and postintervention rates of completion of the ICDSC. RESULTS: The majority of nurses who completed the survey (n = 30) felt they had the knowledge, skills, and intention to complete the ICDSC. During the focus groups (n = 4), a need for information on delirium symptoms and its management was raised as a barrier. This barrier was addressed with the selected KT activity (clinical capsule and aide-memoire handed out to nurses [n = 24]). Across all work shifts, the completion rate was similar pre- and postintervention. Overall, the completion rate was lower during the day shift than the night and evening shifts. A higher rate was associated with the first three postoperative days, and longer hospital and intensive care unit stays. LINKING EVIDENCE TO ACTION: A tailored intervention based on preidentified barriers and facilitators, using the Determinants of Implementation Behavior Questionnaire, and in collaboration with participants, has the potential to promote evidence-based practice.

Simulation training for continuing professional development of nurses in cardiology and cardiovascular surgery.

BACKGROUND:   Nurses play a key role in cardiac arrest management, especially those assigned to cardiac intensive care units, where they are often actively involved in cardiopulmonary resuscitation. AIM: To evaluate the effect of simulation training in in continuing professional development of nurses in this setting. METHODS: A comparative study using paired samples (where the candidate was his own control with repeated measures before and after intervention), was conducted among nurses working in the cardiology and cardiovascular surgery division of our institution. The primary endpoint was the change in skills judged on the basis of competency score of 20 assessed before and after simulation training. RESULTS: 32 nurses participated in the training session. Despite a median job seniority of 8.5 years [4.0 - 12.5], only 44% of nurses had already participated in a simulation session. Although most of the candidates (84%) had previously performed chest compressions, only 34% had delivered an electrical defibrillation during their exercise. We showed a significant increase in overall scores from 8.0 [5.0 - 9.8] to 17.5 [17.0 - 19.0] after the simulation training session (p<0.0001). All the criteria judged in the evaluation grid (basic life support, manual electrical defibrillation) were significantly improved and the most positive effect was observed in the manual defibrillation where the prior experience of the participants was limited. CONCLUSIONS: Simulation learning had a major positive impact on the development of nurses' skills in terms of cardiopulmonary resuscitation.

[Risk management in the operating room in cardiovascular and thoracic surgery; from the nursing point of view].

The primary risk management, on the side of a nurse, in the operating room includes prevention of misidentificatin of both the patient and the site of operation. Leaving of a foreign body in the patient, falling of the patient from the operating table, incidence of deep venous thrombosis and mismatch of blood transfusion should also be prevented with utmost care. The long operating time in cardiovascular surgery and the lateral position of the patient on the operating table in chest or esophageal surgery require additional risk management. Risks of pressure sore as well as nervous injury can be prevented by fixing the patient securely with soft pads to maintain comfortable posture. Above all, careful watching of the patient's condition is most important.

Use of a telehealth device to deliver a symptom management intervention to cardiac surgical patients.

A variety of approaches can provide cardiac patients with needed follow-up care. However, with the explosion of telehealth capabilities, clinicians are more ready to explore other methods to integrate the use of telehealth devices into the delivery of effective nursing interventions. This article summarizes the development of a symptom management intervention for coronary artery bypass graft patients using the Health Buddy to deliver a nursing intervention in the early recovery period after hospital discharge. Considerations used to design the symptom management intervention and selection of this telehealth modality are discussed. This overview can help clinicians and researchers gain perspective on how to evaluate telehealth modalities to aid in the delivery of interventions for cardiac and other clinical populations.

Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients.

Cardiothoracic surgical patients are at high risk for complications related to immobility, such as increased intensive care and hospital length of stay, intensive care unit readmission, pressure ulcer development, and deep vein thrombosis/pulmonary embolus. A progressive mobility protocol was started in the thoracic cardiovascular intensive care unit in a rural academic medical center. The purpose of the progressive mobility protocol was to increase mobilization of postoperative patients and decrease complications related to immobility in this unique patient population. A matched-pairs design was used to compare a randomly selected sample of the preintervention group (n = 30) to a matched postintervention group (n = 30). The analysis compared outcomes including intensive care unit and hospital length of stay, intensive care unit readmission occurrence, pressure ulcer prevalence, and deep vein thrombosis/pulmonary embolism prevalence between the 2 groups. Although this comparison does not achieve statistical significance (P < .05) for any of the outcomes measured, it does show clinical significance in a reduction in hospital length of stay, intensive care unit days, in intensive care unit readmission rate, and a decline in pressure ulcer prevalence, which is the overall goal of progressive mobility. This study has implications for nursing, hospital administration, and therapy services with regard to staffing and cost savings related to fewer complications of immobility. Future studies with a larger sample size and other populations are warranted.

Stress during mechanical ventilation: benefit of having concrete objective information before cardiac surgery.

BACKGROUND: Negative emotional reactions and difficulty in communicating are common in patients receiving mechanical ventilation and may adversely affect recovery from cardiac surgery. OBJECTIVE: To determine the effect of providing concrete objective information about emotional stress and difficulty in communicating related to mechanical ventilation to Korean cardiac surgery patients. METHODS: A quasi-experimental 2-group design was used. The 22 subjects in the control group received the usual information; the 21 in the experimental group received concrete objective information in addition to the usual information. State anxiety, negative affect, use of sedative and analgesic medications, and difficulty communicating were compared between the 2 groups after surgery. RESULTS: Patients who received concrete objective information experienced less anxiety and negative mood during mechanical ventilation, less difficulty in communicating, and a shorter intubation time than did patients in the control group. The 2 groups did not differ in the amount of sedative or analgesic medication used per hour during mechanical ventilation. CONCLUSIONS: Nursing interventions that include concrete objective information help cardiac patients cope with the stresses associated with surgery and mechanical ventilation.

Reducing the incidence of nosocomial pneumonia in cardiovascular surgery patients.

Outcomes management provides a mechanism to foster development of patient-driven services through revision of practice and measurement of outcomes. Because nosocomial pneumonia is the most common hospital-acquired infection in intensive care units, reducing the rate of nosocomial pneumonia became on area of intense scrutiny at our institution. This article shares an outcome initiative that focused on reducing the incidence of nosocomial pneumonia in a hospital setting. Strategies used such as multidisciplinary team formation, case/control study, quality improvement activities, risk tool development, and protocol implementation, are discussed. Process and outcome data are provided to demonstrate the initiative's positive impact. The benefits of this outcome effort are easily identified and well-illustrated. The backbone of the initiative--proactive identification of problems and the methodical, reasoned search for answers--is universally applicable.

The standard of suction for patients undergoing endotracheal intubation.

The purpose of this study was to determine whether using a standard method of endotracheal suctioning, to ensure consistent use of available knowledge, had any impact on patient care. Using experimental study design, the results of two different methods of suctioning in a cardiovascular surgery intensive care unit were compared. One method was the suctioning procedure applied by the nurses working in the intensive care unit. The other one, standard suctioning procedure, was developed based on the related literature and applied to the patients assigned to the experimental group by the researcher herself. Mean arterial blood pressure (MAP), heart rate (HR), and arterial blood gases (ABGs) were measured before the procedure, immediately after, 5 and 15 minutes after the procedures for both control and experimental group. The majority of the nurses suctioning the control group did not evaluate the ABGs after endotracheal suctioning, none of these patients was given oxygen both before and after the suctioning, and suctioning took longer time than recommended. To compare the results of the two different methods, the values of MAP, HR, PO2 (arterial oxygenation), PCO2 (arterial carbondioxide), and HCO3- (hydrogen carbonate) 15 minutes after the procedure were used, and the differences between the two methods were statistically significant (P < 0.05).

Postoperative outreach care for cardiac patients.

Cardiac patients' length of hospital stay has greatly decreased in recent years. Rapid discharge programmes following routine post-cardiac surgery are thought to be safe and cost-effective. A programme of postoperative outreach care can monitor problems and prevent readmission.

Causas de readmissão hospitalar após cirurgia cardíaca / Causes of hospital readmission after heart surgery

Objetivou-se identificar o perfil e as causas de readmissão de pacientes submetidos à cirurgia cardíaca. Estudo retrospectivo, descritivo, realizado por meio de revisão de prontuários de pacientes submetidos à cirurgia de revascularização do miocárdio ou implante de prótese valvar com readmissão posterior. A amostra foi constituída por 62 pacientes. A taxa de readmissão foi de 5,9%. A infecção do sítio cirúrgico foi a principal causa de readmissão em 87,5% dos pacientes submetidos à revascularização do miocárdio e em 12,5% dos implantes de prótese valvar (p˂0,001) e esteve associada às variáveis obesidade (p=0,05) e dislipidemia (p=0,007). A identificação dos pacientes em risco para o desenvolvimento de infecção do sítio cirúrgico pode minimizar as taxas de readmissão e diminuir os custos associados ao cuidado, e, merece um planejamento diferenciado de ações multiprofissionais

The objective was to identify readmission's profile and causes of heart surgery patients. A retrospective, descriptive study, through the revision of records from patients submitted to myocardial revascularization surgery or valvar prosthesis implantation with posterior readmission. Sixty-two patients composed the sample. The readmission rate was 5.9%. Surgical site infection was the main cause for readmission in 87.5% of patients submitted to myocardial revascularization surgery and in 12.5% of valvar implantation (p<0.001) and, it was associated with obesity (p=0.05) and dyslipidemia (p=0.007). To identify patients at risk of surgical site infection can minimize readmission rates and decrease care costs and, it deserves a special planning of multi-professional actions.

Cardiovascular surgeon and acute care nurse practitioner: collaboration on postoperative outcomes.

Changes occurring in the healthcare environment require healthcare delivery systems to provide high quality care services with increased efficiency and cost-effectiveness. Healthcare systems are encouraged to use less expensive care providers for medical management responsibilities while maintaining or increasing quality of patient care. Accompanying the changes in healthcare delivery modes is the parallel rise in patient acuity levels related to chronic illnesses of patients admitted for cardiac services such as cardiovascular surgeries. This retrospective, 2-group comparison study examined patient and economic outcomes between 2 groups of adult patients for whom postoperative cardiovascular care was directed by either cardiovascular surgeons alone or cardiovascular surgeons in collaboration with acute care nurse practitioners. Outcome measures included length of stay and cost for an episode of care. Findings revealed that when cardiovascular surgeons, in collaboration with acute care nurse practitioners, directed postoperative care, the length of stay decreased 1. 91 days and total cost decreased 5,038.91 dollars per patient.

Déficit de Auto-cuidado en un agente con alteración de la perfusión cardíaca / Deficit of Self-care in an agent with alteration in the cardiac perfusion", "_i": "

La cardiopatía isquémica, en el año 2007 representó la segundacausa de mortalidad general y la tercera causa de muerte en elgrupo de edad entre los 15 a 64 años de edad. La enfermedadisquémica, representa un área de oportunidad para el trabajoprofesional de Enfermería y obliga la participación a través deun proceso enfermero especializado, con el objetivo de generarel Auto-cuidado. El modelo de atención de Enfermería empleadoen este estudio de caso fue el Déficit de Auto-cuidado de DoroteaOrem, con aplicación metodológica del proceso de atenciónde Enfermería en cada una de sus cinco etapas. Resultadode este estudio se lograron diferenciar dos líneas de trabajo: 1)la construcción de intervenciones especializadas y 2) la trascendenciade la participación del profesional de enfermería en elmanejo del paciente con enfermedad cardíaca isquémica.

Ischemic heart disease in the year 2007 represented the second cause of mortality and the third leading cause of death in the age group between 15 to 64 years of age. Ischemic heart disease represents an area of opportunity for the professional work of nursing and requires participation by a specialized nursing process with the objective of generating Self-Care. The nursing care model used in this case study was the Self-Care Deficit of Dorothea Orem, with methodological application of nursing process in each of its five stages. Results of this study could distinguish two main lines of work, 1) the construction of specialist and 2) the importance of nurse participation in the management of patients with ischemic heart disease.

Triangulation in nursing research: issues of conceptual clarity and purpose.

The controversy concerning the value of qualitative, quantitative and triangulation approaches to nursing research for understanding human behaviour and increasing nursing knowledge has been an increasing source of debate among nurse scholars. However, the differences and similarities of these three perspectives have not been fully compared as either philosophies or methodologies. The purposes of this paper are to provide an understanding of the origin and development of the triangulation research method, clarify major sources of confusion in the presentation of a triangulation study, and discuss the problems and possible solutions of a triangulation study. Finally, an example of multiple triangulation in a nursing research within a Taiwanese cultural context -- turning points of recovery from cardiac surgery during the intensive care unit transition -- is presented. In the course of the paper, suggestions are also given to help nurse researchers recognize when it is most appropriate to use a certain research method, whether that be qualitative, quantitative or triangulation.

Outcomes measurement.

Patient outcomes have been referred to as the "ultimate definition of effectiveness and efficiency," and there is an increasing emphasis on identifying and measuring the results of interventions and practice. This new department will focus on issues surrounding patient outcomes such as definitions, measurement, sources of data, nurse-sensitive versus multidisciplinary outcomes, and determining the evidence on which to base practice. The goal of the department is to stimulate questions and encourage discussion that will contribute to the necessary knowledge for defining, measuring, and ultimately improving cardiovascular patient outcomes.