Nurses' Competence Caring for Hospitalized Patients With Ventricular Assist Devices.

BACKGROUND: Nursing care is an essential component of the delivery of high-quality patient care for advanced heart failure patients with ventricular assist devices (VADs). However, there is little information about how VAD patient care competence is formed, and there are no empirical data regarding the bed nurses' competence. OBJECTIVES: The aim of this study was to explain how nurses perceived their competence related to VAD technology and how they utilized resources to equip themselves for the management of patients with implantable VADs. METHODS: An exploratory correlational research design was used in this study. Online surveys including demographic and work characteristics questionnaires as well as VAD Innovation in Nursing Appraisal Scale (knowledge, adoption, and communication) were completed by 237 critical-care unit and progressive care unit (PCU) nurses. RESULTS: Ventricular assist device knowledge, adoption, and communication of innovation mean scores were 3.9 ± 0.6, 3.9 ± 0.8, and 3.7 ± 0.9, respectively, indicating moderate/high levels. Critical-care unit nurses reported higher levels of knowledge (3.7 vs 3.6) and adoption (4.0 vs 3.8; P < .05) of innovation than did the PCU nurses, with no differences in communication. Compared with PCU nurses, critical-care unit nurses were more likely to seek VAD competence-related information using mass media. Innovation and adoption were associated with years of nursing experience and some hospital characteristics. CONCLUSION: Critical-care unit nurses have higher self-reported VAD care competence than PCU nurses. Further research is needed to confirm the findings and link nurse competence with VAD patient outcomes.

Self-reported adjustment to implanted cardiac devices.

BACKGROUND AND RESEARCH OBJECTIVE: Although implantations of devices to support cardiovascular function are increasing, little is known about the factors involved in adjusting psychologically to having an implanted device. This study provides factor analysis of the Implanted Device Adjustment Scale (IDAS) and self-reported data on quality of life, mood states, and global adjustment. SUBJECTS AND METHODS: This cross-sectional correlational design study included 174 subjects (46 women and 128 men). A convenience sample was recruited from electrophysiology practices in 2 large Midwestern cities. Subjects completed the IDAS, the SF-36 quality-of-life measure, the Profile of Mood States, and a device adjustment visual analog scale. RESULTS AND CONCLUSIONS: The factor analysis produced 4 subscales for the IDAS: fear/anxiety, attitude, preparation, and body awareness. Perceived adjustment was "good" for 89% of persons and was unrelated to age, sex, type of device, and whether a shock was received. All 4 subscales of the IDAS correlated negatively with adjustment (higher IDAS score means poorer adjustment). The overall IDAS was internally consistent with a Cronbach alpha = .89. Adjustment, as measured by the overall IDAS, had a weak but significant relationship with measures of quality of life including the mental component summary scale of the SF-36 (r = 0.19), but not the physical component summary scale of the SF-36. All the Profile of Mood States subscales correlated positively with the IDAS subscale anxiety/fear with the exception of vigor/activity which had a negative correlation. No sex differences in total adjustment were seen in this group of patients, although there were differences in body awareness, physical functioning, and fatigue. Although patients with implanted cardioverter defibrillator were more fearful/anxious than patients with pacemaker only, no differences in total adjustment were seen between the 2 groups. A better understanding of the experience of adjusting to an implanted device is foundational to the development of appropriate interventions.

Promoting self-care through symptom management: a theory-based approach for nurse practitioners.

PURPOSE: To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. DATA SOURCES: Literature review of relevant theory and associated literature, case studies from clinical practice. CONCLUSIONS: An individual asks several questions when experiencing a physical sensation: "Am I sick, stressed, or is this a sign of aging? If I'm sick, is the symptom connected with a disease label?" After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual's cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. IMPLICATIONS FOR PRACTICE: NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal's CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual's cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient's distress in the management of symptoms.

Illness representations in patients with chronic kidney disease on maintenance hemodialysis.

A sample of patients with chronic kidney disease on maintenance hemodialysis participated in a study to explore the relationship between illness perception and quality of life. Illness perception was examined based on the Common-Sense Model of Illness as described by Leventhal. Forty-two participants completed the Revised Illness Perception Questionnaire (IPQ-R), the Index of Well-being (IWB) and a brief demographic form. All of the subscales of the IPQ-R and the IWB demonstrated adequate reliability (alpha levels > or = .70) except for the treatment control subscale (alpha = .46). More perceived consequences of kidney disease and higher scores on the emotional representation scale were negatively correlated with scores on the IWB. Future research is needed to assess the influence of factors such as coping strategies on illness representations and on well-being. Nephrology nurses are in an optimal position to identify the illness perceptions of patients on chronic hemodialysis and can introduce specific coping mechanisms to enhance overall well-being. As well nephrology nurses can function as part of the overall health care team to identify the resources available to minimize the perceived consequences of chronic kidney disease.

Development of the implanted devices adjustment scale.

Advances in microelectronics have resulted in exponential growth in the number of implanted medical devices. Most people do well adjusting to their devices, but others show signs of depression and/or anxiety. The Implanted Device Adjustment Scale (IDAS) was developed to measure how well a person is adjusting to an implanted device. First, a pool of items was generated and reviewed by 2 panels of clinicians and psychometricians for content validity. The revised version was then administered to a small sample that provided information about problematic items. Finally, a convenience sample of 45 persons (66% males) with implanted devices (18 pacemakers only, 37 cardioverter/defibrillators) completed the revised IDAS twice. After deleting weak items, the Cronbach alpha was 0.90. No age, gender, or device differences were found. Test-retest reliability was 0.92. The IDAS may be useful to evaluate how well a person is adjusting to her/his device. This may lead to more timely and appropriate interventions to improve outcomes.

Accuracy of the precordial V-Quick patch in persons with cardiac or pulmonary disease.

The aim of this study was to demonstrate the equivalence of 12-Lead Electrocardiograms (EKG) obtained with the new V-Quick patch and traditional tab-style electrodes. Using a within-subject design, a convenience sample of 100 subjects with either cardiac or pulmonary disease underwent two 12-lead EKGs, one with the traditional tab-style electrodes and one with the precordial patch. Computer-generated measurements of waveform axes and amplitude were obtained for both EKGs. Comparison of mean and 95% confidence intervals revealed no significant differences in Q, R or S wave amplitude across the six precordial leads. Furthermore, a four-factor ANOVA found no significant difference (p > 0.05) in the Q, R and S wave amplitude between the type of electrode, gender and type of disease. A subset of 29 EKGs read by three experts found intra- (.90) and inter-rater (.84) reliability to be strong. In conclusion, the precordial V-Quick patch provided equivalent EKGs to those obtained using standard tab-style electrodes.

Spirituality in persons with heart failure.

Spiritual expression has been proposed as a dimension of quality of life. Persons with chronic diseases such as AIDS or cancer have described the value of spiritual expression in living with their illnesses. The authors examined the role spirituality plays in the lives of 58 people with heart failure being treated medically or by transplant. Instruments used included the Medical Outcome Survey Short Form 36 and Index of Well-Being measures of quality of life, the Spiritual Well-Being Scale, and the Relative Importance Scale. Combined spirituality scores predicted 24% of the variance in global quality of life. There were no significant gender differences in spiritual well-being or quality of life.

Infections in the heart transplant recipient.

The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. Hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population.

Self-care resources and activity as predictors of quality of life in persons after myocardial infarction.

An ex post facto correlational study was conducted to examine predictors of quality of life in persons 3 to 6 months after a myocardial infarction. Self-care resources, self-care knowledge (needs), activity level, and selected demographic variables were examined as predictor variables. A convenience sample of 86 subjects with a mean age of 61 years, was recruited for participation in this study. The study that explained 35% of the variance in quality of life included self-care resources available, activity level, and self-care needs. Modeling and Role Modeling Paradigm provided a useful explanation of how self-care resources and self-care knowledge can be applied to persons recovering from myocardial infarction.

Practice patterns of heart failure nurses.

OBJECTIVE: Little is known about the practice patterns of nurses who work in the specialty of heart failure (HF). This specialty includes inpatient and outpatient sites for practice that incorporate intensive care to rehabilitation. The purpose of this study was to describe the current practice of nurses who are members of the American Association of Heart Failure Nurses (AAHFN). METHODS: A convenience sample of nurses attending the 2010 Annual Meeting of AAHFN was surveyed to determine current practice patterns. RESULTS: The mean age of the nurses completing the survey was 48 years (standard deviation [SD] +10), and the majority were white (85%) and female (98%). Approximately half (48%) completed a Master's degree. The mean time worked as a nurse was 23 years (SD +10), with a mean of 11 years (SD +8.2) caring for patients with HF. Both HF education and physical assessment were reported to be provided frequently. CONCLUSION: This survey provides insight into the practice patterns of HF nurses. Continued monitoring of this role is warranted and can serve to assist the AAHFN in advancing HF knowledge and skills.