The effect of position change on vital signs, back pain and vascular complications following percutaneous coronary intervention.

AIMS AND OBJECTIVES: To determine the effect of position change that is applied after percutaneous coronary intervention on vital signs, back pain and vascular complications. BACKGROUND: In order to minimise the postprocedural complications, patients are restricted to prolonged bed rest that is always accompanied by back pain and haemodynamic instability. DESIGN: Randomised-controlled quasi-experimental study. METHODS: The study sample chosen for this study included 200 patients who visited a hospital in Turkey between July 2014-November 2014. Patients were divided into two groups by randomisation. Patients in the control group (CG, n = 100) were put in a supine position, in which the head of the bed (HOB) was elevated to 15°, the patient's leg on the side of the intervention was kept straight and immobile; positional change was applied to patients in the experimental group (EG, n = 100). RESULTS: After the procedure in the EG, the systolic blood pressure (T4-T6), the rate of postprocedural vascular complications (1%) and the back pain scores were significantly lower (between T5-T6) than the CG, also, the back pain was the lowest level in the standard fowler's position in the 6th hr wherein the HOB was elevated by 45-60°. CONCLUSIONS: It was found that systolic blood pressure and back pain were at the lowest levels in the standard fowler's position in the 6th hr after the procedure when the HOB was elevated 45-60° and the result was clinically significant and the position change decreased back pain without causing any vascular complications. RELEVANCE TO CLINICAL PRACTICE: Low fowler's position was applied in which HOB was elevated 15-30° and standard fowler's position was applied in which the HOB was elevated 45-60° could be safe and applicable in patients by nurses after the procedure.

[Post-dural puncture headache: risk factors, associated variables and interventions]. / La cefalea post-rachicentesi: fattori di rischio, variabili correlate ed interventi. Revisione della letteratura.

AIM: To identify nurses' doubts and questions (about lumbar puncture, related nursing interventions and post-dural puncture headache - PDPH) and to find answers in the available literature. METHODS: 26 nurses were asked to identify open questions and a literature review was conducted searching on Medline, Cochrane database of Systematic Reviews and Cinahl. RESULTS: Atraumatic needles, small gauge, cranial bevel oriented insertion and stylet reinsertion are variables that reduce the risk of PDPH. Bed rest has no efficacy in reducing this complication. On the contrary, it may increase the risk of PDPH. There are not enough evidences about the efficacy of additional fluid intake after the procedure. It's not clear if the risk of PDPH could be affected by the position during lumbar puncture and the volume of cerebrospinal fluid withdrawn. CONCLUSIONS: This literature review clarifies some aspects of lumbar puncture and PDPH: the use of traumatic or atraumatic needles, the bevel orientation and stylet reinsertion, bed rest. More research is needed to study the efficacy of other interventions, still uncertain (patient position during the procedure, volume of cerebrospinal fluid withdrawn, hydration and analgesic drugs' efficacy).

Pain and discomfort in closure of femoral access coronary angiography. The CLOSuredEvices Used in everyday Practice (CLOSE-UP) pain sub study.

BACKGROUND: Pain and discomfort in relation to vascular closure are the predominant patient complaints after coronary angiography (CAG). No large-scale randomized studies have evaluated pain and discomfort after CAG with access site closure by manual compression versus a vascular closure device (VCD). AIM: To compare pain and discomfort after femoral artery closure by manual compression versus FemoSeal® VCD. METHODS: The study is a sub study to the CLOSE-UP study, a randomized, single centre comparison of FemoSeal(®) VCD versus manual compression after CAG. Pain and discomfort score was assessed immediately after the closure procedure, at time for mobilization, at discharge and after 14 days. RESULTS: 1014 patients were included and 1001 patients entered analysis. In-hospital follow-up was obtained for all patients and 14-day follow-up was completed for 96% of patients. The closure procedure lasted 1 (1-1) min in the FemoSeal(®)VCD group and 8 (6-10) min in the manual compression group. Pain and discomfort score at the procedure was significantly higher in the FemoSeal(®)VCD group. No differences in pain and discomfort were detected after leaving the catheterization laboratory. CONCLUSION: Closure of femoral access after CAG by the FemoSeal(®)VCD was associated with significantly more pain and discomfort compared with closure by manual compression. No difference in pain and discomfort was found at follow-up.

[The development of the multifunctional automatic rotating bed with process-monitoring].

We have developed a new rotating bed for the old and the paralised people. This rotating bed is composed of two bed heads at front and at end, bed boards, guardrails, an electric motor, a reducer, an induction locator and a set of electronic controls. With the preestablished program, the angle between the left/right bed board and the middle board is changed by rotating the left/right board around the rotation axis, and the gravity direction between the human body and the ground is changed by the rotation of the middle board as a whole, so that the middle bed board and the left and right ones will act respectively as supporters of weight of the person who is lying on his back or on his side. In this way, a person can turn over automatically, comfortably and naturally when he/she is asleep. This rotating bed meets the physiological needs of a sleeping person, and people with turning over problems can turn over in a comfortable and natural way by means of biotechnology. It can also improve the quality of sleep and help avoid decubitus. In addition, it can be used to promote the rehabilitation of those who are paralysed by reason of its passive exercising function.

A prospective study of early ambulation 90 minutes post-left heart catheterization using a retrospective comparison group.

BACKGROUND: Despite a trend toward a reduction in bedrest time after left heart catheterization (LHC) in many Canadian centres, an evidence-based standard of practice has not been established. Canadian bedrest times range from two to four hours post-LHC. Two recent prospective non-randomized studies (n = 1,000) indicate safety of ambulation at 60 and 90 minutes post-LHC. PURPOSE: The purpose of this study was to determine safety of ambulating patients at 90 minutes post-LHC sheath removal compared to the current practice of ambulation at three to four hours post-sheath removal. DESIGN: The study was a prospective non-concurrent design with a retrospective control. METHOD/SAMPLE: Retrospective data from the APPROACH database and chart reviews were analyzed for a period of six months for the control group on the traditional three- to four-hour ambulation protocol (n = 402). Prospective data were gathered for six months for the experimental group (n = 193). RESULTS: There was no difference in complication rates for the two groups. CONCLUSIONS: The results suggest that early ambulation for selected patients at 90 minutes is safe and has the potential to increase both patient comfort and quality of care.

Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial.

AIM: To evaluate the effect of bed rest with music on relaxation for patients who have undergone heart surgery on postoperative day one. BACKGROUND: Music intervention has been evaluated as an appropriate nursing intervention to reduce patients 'pain, stress and anxiety levels in several clinical settings, but its effectiveness in increasing patients' subjective and objective relaxation levels has not been examined. DESIGN: A randomised controlled trial. METHOD: Forty patients undergoing open coronary artery bypass grafting and/or aortic valve replacement surgery were randomly allocated to either music listening during bed rest (n = 20) or bed rest only (n = 20). Relaxation was assessed during bed rest the day after surgery by determining the plasma oxytocin, heart rate, mean arterial blood pressure, PaO2 SaO2 and subjective relaxation levels. RESULTS: In the music group, levels of oxytocin increased significantly in contrast to the control group for which the trend over time was negative i.e., decreasing values. Subjective relaxation levels increased significantly more and there were also a significant higher levels of PaO2 in the music group compared to the control group. There was no difference in mean arterial blood pressure, heart rate and SaO2 between the groups. CONCLUSION: Listening to music during bed rest after open-heart surgery has some effects on the relaxation system as regards s-oxytocin and subjective relaxations levels. This effect seems to have a causal relation from the psychological (music makes patients relaxed) to the physical (oxytocin release). RELEVANCE TO CLINICAL PRACTICE: Music intervention should be offered as an integral part of the multimodal regime administered to the patients that have undergone cardiovascular surgery. It is a supportive source that increases relaxation.

The Clinical Scholar Model: Evidence-based practice at the bedside.

The Clinical Scholar Model serves as an effective framework for investigating and implementing evidence-based practice (EBP) changes by direct care providers. The model guides one in identifying problems and issues, key stakeholders, and the need for practice changes. It provides a framework to critique and synthesize the external and internal evidence. Three EBP projects conducted at a large tertiary care facility in northern New England illustrate the process of using the Clinical Scholar Model.

Nurses' knowledge, attitudes, and confidence regarding preventing and treating deconditioning in older adults.

BACKGROUND: This article examines nurses' knowledge, beliefs, attitudes, and confidence regarding providing care to prevent and treat deconditioning in hospitalized older adults. METHODS: Data were collected from 157 registered nurses enrolled in a post-registered nurse, bachelor of science in nursing program using a descriptive cross-sectional survey. RESULTS: Nurses' responses reflected substantial gaps in their knowledge and theoretical understanding of deconditioning, and a strong belief in the need for more education on the prevention of it. Levels of confidence in preventing deconditioning in older adults were modest, but participants expressed positive attitudes toward nurses' role in deconditioning care. Barriers to deconditioning care included lack of education, low staffing levels, and a lack of valuing prevention efforts. CONCLUSION: This study suggests that it is important to establish gerontology continuing education programs with a core component on deconditioning treatment and prevention to enhance nurses' knowledge and confidence levels in providing care to older adults.

Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of the literature.

Survivors of critical illness often undergo an extended recovery trajectory. Reduced functional ability is one of several adverse outcomes of prolonged bed rest and mechanical ventilation during critical illness. Skeletal muscle weakness is known to be one of the major phenomena that account for reduced functional ability. Although skeletal muscle weakness is evident after prolonged mechanical ventilation (PMV), few studies have tested the benefits of various types of mobility interventions in this population. The purpose of this article is to review the published research on improving mobility outcomes in patients undergoing PMV. For this review, published studies were retrieved from MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews from January 1990 to July 2007. A total of 10 relevant articles were selected that examined the effect of whole body physical therapy, electrical stimulation (ES), arm exercise, and inspiratory muscle training (IMT). Overall, there is support for the ability of mobility interventions to improve outcomes in patients on PMV but limited evidence of how to best accomplish this goal. Generating more data from multicenter studies and randomized controlled trials is recommended.

Therapeutic positioning of the multiply-injured trauma patient in ICU.

Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author's own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.