Recovering from an acute cardiac event--the relationship between depression and life satisfaction.

AIMS: This study sought to measure the rates and trajectory of depression over six months following admission for an acute cardiac event and describe the relationship between depression and life satisfaction. BACKGROUND: Co-morbid depression has an impact on cardiac mortality and is associated with the significant impairment of quality of life and well-being, impairments in psychosocial function, decreased medication adherence and increased morbidity. DESIGN: This was a descriptive, correlational study. METHOD: The study was undertaken at a large public hospital in Melbourne. Participants were asked to complete a survey containing the cardiac depression scale (CDS) and the Personal Well-being Index. RESULTS: This study mapped the course of depression over six months of a cohort of patients admitted for an acute cardiac event. Significant levels of depressive symptoms were found, at a level consistent with the literature. A significant correlation between depressive symptoms as measured by the CDS and the Personal Well-being Index was found. CONCLUSIONS: Depression remains a significant problem following admission for an acute coronary event. The Personal Well-being Index may be a simple, effective and non-confrontational initial screening tool for those at risk of depressive symptoms in this population. RELEVANCE TO CLINICAL PRACTICE: Despite the known impact of depression on coronary heart disease (CHD), there is limited research describing its trajectory. This study makes a compelling case for the systematic screening for depression in patients with CHD and the importance of the nursing role in identifying at risk individuals.

The impact of an ICU liaison nurse service on patient outcomes.

OBJECTIVE: To determine the effect an intensive care unit liaison nurse service had on ICU patient discharges, readmissions and outcomes. METHODS: We evaluated the impact of our ICU liaison nurse service in a 36-month before-and-after study on ICU and hospital length of stay (LOS) and mortality, and ICU step-down days (time spent in ICU in a 1 : 2 nurse to patient ratio). RESULTS: There was a 13% increase in patient throughput after the introduction of the ICU liaison nurse service (835 ICU admissions in the 18 months before v 943 in the 18 months after). Despite trends to an improvement, there was no significant change in median ICU LOS (2.2 days before v 2.1 days after) or median hospital LOS (12.0 days before v 11.5 days after), or in ICU or hospital mortality (ICU, 15% before v 14% after; hospital, 23% before v 22% after). ICU step-down days were significantly decreased by 48% (71 +/- 14.2 days v 37 +/- 15.5 days; P < 0.001). In the patient group readmitted to the ICU (49 patients before v 55 patients after), there was a 25% (1 day) decrease in median ICU LOS (4.0 v 3.0 days), and a trend to decreased mortality in both the ICU (18% before v 16% after) and hospital (35% before v 26% after). CONCLUSIONS: The introduction of our ICU liaison nurse service was associated with a trend towards more efficient ICU discharges (increased throughput, decreased ICU step-down days and ICU readmission LOS) and improved survival for ICU patients requiring readmission, but overall ICU and hospital LOS and mortality, and ICU readmission rates were unchanged.