Instrumentos de valoración en enfermería cardiovascular / Assessment Tools in Cardiovascular Nursing

RESUMEN Introducción: Las enfermedades cardiovasculares son la mayor causa de muerte e incapacidad en el mundo. La enfermera, en su práctica, debe contribuir desde su quehacer al bienestar, seguimiento y control de las personas que experimentan enfermedades cardiovasculares, pero desde intervenciones que estén orientadas a los fenómenos propios de la disciplina, como la adaptación o el autocuidado. Para lograr su propósito, debe disponer de instrumentos validados y orientados a estos fenómenos. Objetivo: Describir los instrumentos de enfermería validados para la valoración de fenómenos propios de la disciplina en las personas que experimentan enfermedades cardiovasculares. Métodos: Revisión integrativa de la literatura. Se realizó una búsqueda de artículos primarios durante los meses de abril a septiembre de 2017 en Lilacs/BIREME, EBSCO, Pubmed/MEDLINE y Science Direct con los términos "enfermería", "cardiovascular", "instrumento", "escala" o "herramienta", en idioma español, inglés y portugués, y publicados entre el año 2000 y el 2016. Se construyó una base de datos con información de los estudios incluidos y se integró la información de forma narrativa. Conclusiones: Se identificaron 14 instrumentos de enfermería validados que permiten valorar los fenómenos de autocuidado, adherencia a tratamientos y calidad de vida. Se utilizaron técnicas de validación de contenido y de constructo y medición de la confiabilidad. Los instrumentos identificados favorecen la práctica diaria de los profesionales de enfermería, contribuyen con la valoración de fenómenos que pueden ser intervenidos por la enfermera de manera independiente para dar respuesta a las necesidades específicas de las personas con enfermedades cardiovasculares(AU)

ABSTRACT Introduction: Cardiovascular diseases are the leading cause of death and disability worldwide. Nurses, in their practice and with their work, should contribute to the well-being, monitoring and control of people who experience cardiovascular diseases, but from interventions oriented to the phenomena of the discipline, such as adaptation or self-care. To achieve its purpose, it must have tools validated and oriented to these phenomena. Objective: To describe the nursing instruments validated for the evaluation of phenomena characteristic of the discipline in people experiencing cardiovascular diseases. Methods: Comprehensive literature review. A search of primary articles was carried out during the months from April to September 2017 in Lilacs/BIREME, EBSCO, Pubmed/MEDLINE, and Science Direct, using the terms enfermería [nursing], cardiovascular [cardiovascular], instrumento [instrument], escala [scale] or herramienta [tool], in Spanish, English and Portuguese, and published between 2000 and 2016. A database was built with information about the included studies, which was integrated narratively. Conclusions: 14 validated nursing instruments were identified that allow to assess the phenomena of self-care, adherence to treatments and quality of life. Content and construct validation techniques and reliability measurement were used. The instruments identified favor the daily practice of nursing professionals, and contribute to the assessment of phenomena that can be intervened independently by the nurse in order to respond to the specific needs of people with cardiovascular diseases(AU)

Association of nurse staffing grade and 30-day mortality in intensive care units among cardiovascular disease patients.

After the implementation of a policy differentiating inpatient nursing fees, no study is found in the nursing literature for intensive care unit (ICU) patients admitted with cardiovascular (CV) disease exclusively in Korea. This study investigates the relationship between ICU nurse staffing and 30-day mortality using large representative claim database.National Health Insurance Service-Senior (NHIS-Senior) claim database from 2002 to 2013, which was released by the Korean National Health Insurance Service (KNHIS), was used in this study. We included CV disease inpatients as a primary diagnostic code (I20-I25) who had their ICU utilization records from differentiating inpatient nursing fees code, resulting in 17,081 subjectsAfter adjusting for confounders, the hazard ratio (HR) for 30-day mortality after discharge (HR: 1.177; P: .018) and in-hospital 30-day mortality (HR: 1.145; P: .058) were higher in general hospital (GH) than in tertiary hospital (TH). In GH setting, HR for 30-day mortality after discharge (HR: 1.499; P: .010) and in-hospital 30-day mortality (HR: 1.377; P: .042) were higher in grade 7 to 9 than grade 1 to 2, but not in TH setting.This study shows that ICU nurse staffing related to improved mortality risk in GHs. Therefore, adequate nurse staffing to provide safe and high-quality care can be ensured by continuous monitoring and evaluation of nurse staffing.

Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial.

BACKGROUND: Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. METHODS: MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. DISCUSSION: The MODERN trial will provide evidence for the potential benefit of independent nurse-run clinics in the community and their cost-effectiveness in adults with MetS. Findings will enable more nurse-led clinics to be adopted outside of major cities and encompassing other chronic diseases as a key primary preventative initiative. TRIAL REGISTRATION: MODERN is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000229471 ) on 19 February 2016 (retrospectively registered). Secondary identifiers: MODERN is an investigator-initiated trial funded by the National Health and Medical Research Council of Australia from 2014 to 2017 via a Project Grant (ID No. APP1069043) and was approved by the Australian Catholic University Human Research Ethics Committee (Project No: 2014 244 V) and the Department of Health Human Research Ethics Committee (Project No:38/2014) for the release of Medicare claims information.

Evaluación del riesgo cardiovascular en el personal de enfermería de un Hospital de Cardiología / Assessment of cardiovascular risk in the nursing staff of a cardiology hospital

Objetivo: Identificar los factores de riesgo cardiovascular (FRC) en el equipo de enfermería y comparar el riesgo cardiovascular a través de la puntuación de Framingham entre los profesionales de los niveles medio y superior que actúan en un hospital de referencia en cardiología. Material y métodos: Estudio transversal, cuantitativo, efectuado en 2014, en un Hospital de Nivel Terciario, referencia en cardiología, en Recife/Pernambuco, Brasil. Recopilamos datos acerca de factores de riesgo cardiológico de 82 profesionales del equipo de enfermería, técnicos, auxiliares de enfermería y enfermeros, con edades comprendidas entre los 30 y los 74 años. Se utilizó la puntuación de Framingham para evaluar el grado de riesgo cardiovascular. Los datos fueron procesados y analizados en el Statistical Package for the Social Sciences, a través de estadística descriptiva y t de Student para variables continuas. Resultados: Los factores de riesgo del historial familiar, estrés y sedentarismo fueron los más frecuentes y presentes en más de la mitad de los profesionales de los niveles medio y superior. En el análisis de la estratificación de riesgo en consonancia con la puntuación de Framingham, el alto riesgo del corazón estuvo presente en sólo el 5.23% de los profesionales del nivel medio y en ningún profesional del nivel superior. Conclusión: Los datos indicaron un bajo riesgo cardiovascular en los profesionales de enfermería y la presencia de factores de riesgo cambiantes. La vigilancia de la salud de estos profesionales es necesaria para evitar el cambio del riesgo para una mayor vulnerabilidad.

Objective: Cardiovascular diseases are the most commoncauses of morbidity and the leading cause of mortality in the world scenario, accounting for about 20% of all deaths in individuals over 30 years. It has attributed this to the increase in the company's exposure to risk factors. Identify cardiovascular risk factors in the nursing team and compare the cardiovascular risk by Framingham score among professionals of middle and upper working in a referral hospital in cardiology. Material y methods: Cross-sectional quantitative study conducted in 2014, in a reference hospital in cardiology located in Recife/Pernambuco, Brazil. Data of cardiologic risk factors were collected from 82 nursing team members, comprised of technical, auxiliary nurses, and nurses between 30 and 74 years of age. The cardiovascular risk level was evaluated by the Framingham Score. Data were organized and analyzed by means of the SPSS, with descriptive statistics and Student-t test for the continuous variables. Results: Family history, stress and sedentary life style were the prevalent risk factors in more than half of the professionals. Only 5.23% of the technical and auxiliary nurses had a high risk score for cardiovascular event. Conclusion: The data indicates a low cardiovascular risk for these professionals and the presence of risk factors that can be modified. Health surveillance of these professionals is necessary in order to avoid a change to a risk of greater vulnerability.

Cirurgia de revascularização do miocárdio: características da internação e alterações relacionadas ao tempo de internação / Myocardial revascularization surgery: hospitalization characteristics and changes related to hospitalization time

O estudo teve como objetivo identificar as características da internação e alterações apresentadas por indivíduos submetidos à Cirurgia de Revascularização do Miocárdio e sua associação com tempo de internação para cirurgia. Estudo epidemiológico observacional e transversal, realizado entre março de 2013 a março de 2014, com 99 indivíduos submetidos à Cirurgia de Revascularização do Miocárdio. Verificou-se que dor no peito e angina/dor torácica identificados no pré-operatório e insuficiência respiratória, hipertermia, Hipertensão Arterial Sistêmica e arritmias apresentadas no pós-operatório foram preditores para maior tempo de internação. A associação entre as características da internação e as alterações clínicas com o tempo de Internação de indivíduos submetidos à Cirurgia de Revascularização do Miocárdio fornecem subsídios para atuação do enfermeiro e demais profissionais de saúde e gestores, a fim de criar estratégias para detecção precoce de intercorrências relacionadas à Cirurgia de Revascularização do Miocárdio.

The study objective was to identify the hospitalization characteristics and changes presented by individuals submitted to Myocardial Revascularization Surgery and its association with hospitalization time for the surgery. We conducted a cross-sectional observational and epidemiological study, between March of 2013 and March of 2014, with 99 individuals submitted to Myocardial Revascularization Surgery. We verified chest pain and angina/thoracic pain pre-surgery and respiratory insufficiency, hypertermia, hypertension and arrythmias post-surgery as predictors for a longer hospital stay. The association between hospitalization characteristics and clinical changes with hospitalization time of individuals submitted to Myocardial Revascularization Surgery provides subsidies for nurses, all health professionals, and managers, to create early detection strategies for complications related to Myocardial Revascularization Surgery.

Using Mobile-Health to Connect Women with Cardiovascular Disease and Improve Self-Management.

Background/Introduction: Self-management approaches are regarded as appropriate methods to support patients with cardiovascular disease (CVD) and to prevent secondary complications and hospitalizations. Key to successful self-management is the ability of individuals to enlist peer supports to help sustain motivation and efforts to manage their condition. The purpose of this study was to investigate the proof of concept of a peer-support mobile-health (m-health) program, called Healing Circles, and explore the program's effect on self-management, social support, and health-related quality of life in women with CVD. MATERIALS AND METHODS: Healing Circles is a consumer m-health solution developed to facilitate peer support and self-management by connecting people with CVD in groups of five to nine people. Women with CVD (obstructive coronary artery disease) were included in this single group, pre/post study if they owned an iPhone/iPad with at least iOS 7.0. Participants (n = 21) used the Healing Circles program for a 10-week period. Self-management, social support, and health-related quality-of-life outcomes were assessed before and after the use of the program. User experiences and satisfaction were obtained during an exit interview. RESULTS: After 10 weeks of using the Healing Circles program, statistically significant improvements were observed in the participants' health behaviors (p = 0.04), self-monitoring (p = 0.04), social support (p = 0.01), and social integration (p = 0.002). As well, many women had a level of high satisfaction with the concept of using m-health for the delivery of peer support. CONCLUSION: The delivery of peer and self-management support using m-health technologies is well received and may improve self-management and social support. More research is needed to test hypotheses of the effect of the Healing Circles program on clinical outcomes.

A gerência de enfermagem nos serviços de cardiologia / The management of nursing in the cardiology services

O objeto do estudo foi a gerência de enfermagem dos serviços de cardiologia da Região Metropolitana da Grande Vitória. O estudo teve como objetivo geral: analisar a gerência de enfermagem em alta complexidade cardiovascular. Específicos: descrever a estrutura dos serviços de cardiologia na perspectiva da Política Nacional de Atenção Cardiovascular de Alta Complexidade nos hospitais da Região Metropolitana da Grande Vitória; caracterizar o processo de gerência de enfermagem em serviços cardiologia da Região Metropolitana da Grande Vitória; identificar os fatores facilitadores e os limitantes na organização de enfermagem nos serviços de cardiologia em hospitais da Região Metropolitana da Grande Vitória. Metodologia: estudo transversal do tipo descritivo exploratório com análise estatística descritiva, realizado em três hospitais da Grande Vitória. Foram utilizados como fundamentação teórica os conceitos de Donabedian de estrutura e processo. Para caracterizar a estrutura foram utilizadas as recomendações da Política Nacional de Atenção Cardiovascular de Alta Complexidade. Para analisar o processo de gerência foram utilizadas bases conceituais de gerência de enfermagem nos eixos de gerência de pessoas, gerência de informação, gerência da assistência de enfermagem, gerência de equipamentos e gerência administrativa. Os resultados mostraram que a maioria da estrutura estava organizada conforme a Política, entretanto existia a falta de algumas recomendações, de enfermeiras especialistas em cardiologia para alguns serviços e de alguns recursos diagnósticos especializados. A unidade hospitalar exclusiva do Sistema Único de Saúde tinha o menor número de cirurgia e de leitos de Centro de Terapia Intensiva da Região Metropolitana da Grande Vitória. Foi identificado que todas as unidades hospitalares trabalhavam com as variáveis investigadas nos eixos de gerência de enfermagem, todavia em percentuais variados. As facilidades e limitações estavam presentes e equilibradas, com exceção para recursos humanos de enfermagem, que teve a maior limitação. Conclusão: O estudo possibilitou visualizar que as unidades hospitalares de alta complexidade cardiológica contemplavam a maioria das recomendações da política enquanto estrutura, e enquanto processo as unidades hospitalares trabalhavam com as variáveis investigadas nos eixos de gerência, todavia existiam particularidades que precisam ser melhoradas.(AU)

Cardiovascular Implications of Preeclampsia.

Cardiovascular disease (CVD) is the leading cause of death of women in the United States. Many healthcare providers are unaware of sex-specific factors that affect the development of CVD. Nursing care for women with a history of preeclampsia and their children is presented. Preeclampsia affects 4% to 8% of all pregnancies. Rates have increased by 25% over the past 2 decades. Research supports the link between preeclampsia and risk of future CVD in women and the children of affected pregnancies. Appropriate preconception, prenatal and postpartum education, and surveillance are necessary to improve the long-term health of both mother and infant. Currently, there are no evidence-based interventions specific to the prevention of CVD for women and their children who have been affected by preeclampsia. However, women who have had preeclampsia may require yearly risk factor assessment and education regarding cardiovascular prevention strategies such as smoking cessation, increased physical activity, importance of a healthy diet, and maintenance of a healthy weight. Preeclampsia should be acknowledged by healthcare providers as a CVD risk factor. Appropriate monitoring, education, and CVD preventive strategies need to be implemented with this population and their children.

A expansão da estratégia saúde da família e as internações por condições cardiovasculares sensíveis à atenção município do Rio de Janeiro de 2008 a 2013

A atenção primária à saúde (APS) compreende não só a promoção à saúde e a prevençãode agravos a partir de um cuidado constante, como também um conjunto de serviços desaúde direcionados para as necessidades do indivíduo e de uma coletividade. Comoproblematização de estudo discute-se o município do Rio de Janeiro com a ampliação daESF, esta reduzindo as internações por condições cardiovasculares sensíveis à atençãoprimária. Tema de estudo: A expansão da Estratégia Saúde da Família reduz o número deinternações por condições cardiovasculares sensíveis à atenção primária no município doRio de Janeiro? Objetivo: Apresentar a taxa das Internações Cardiovasculares Sensíveis àAtenção Primária (ICSAP) e a relação com a cobertura da ESF no município do Rio deJaneiro no período de 2008 a 2013. Método: Trata-se de um estudo quantitativo, do tipoecológico, considerando como unidade de análise a população pertencente ao município doRio de Janeiro, adotando-se o período entre janeiro de 2008 e dezembro de 2013. Tendocomo variáveis: idade, sexo, AP de residência, cobertura da ESF, cobertura populacionalda ESF e número de habitantes por AP e o indicador de saúde, que envolve as internaçõeshospitalares sensíveis à atenção primária, optou-se pelos grupos de causascardiovasculares: hipertensão arterial (I10, I11), angina pectoris (I20), insuficiênciacardíaca congestiva (I50, J81) e doenças cerebrovasculares (I63 a I67, I69, G45 e G46).Resultado: Aumento da cobertura, saindo de 8,1% para 39,41% em dezembro de 2013.Ampliação do número de equipes habilitadas de 266 em dezembro de 2010 para 734equipes habilitadas em dezembro de 2013. Na AP 5.3 observa-se redução para o grupo dehipertensão. Nas APs 2.1, 3.1, 3.2 e 4.0 foi apresentada redução para o grupo deinsuficiência cardíaca. No grupo das doenças cerebrovasculares as APs que apresentaram redução foram...

The Primary Healthcare encompasses not only the promotion of Health, and the preventionof damages, by the ongoing care, as well as a set of Health Services directed to the needsof the individual and the colective. As the Study’s Problematization the Municipality ofRio de Janeiro is discussed, with the ampliation of the Family Health Strategy, which isreducing hospitalizations for cardio-vascular conditions sensible to the primary care. Studytheme: Does the expansion of the Family Health Strategy reduces the number ofhospitalizations for cardio-vascular conditions sensible to the primary care? Objective: Topresent the level of Cardio-vascular Hospitalizations Sensible to Primary Care, and therelation to the coverage of the Family Care Strategy in the Municipality of Rio de Janeiro,in the period from 2008 to 2013. Method: This is a Quantitative Study, of the ecologicaltype, considering as it’s analysis unit the population of the Municipality of Rio de Janeiro,and the period from January 2008 to December 2013 was adopted. The variablesconsidered were age, gender, Primary Care unit of residence, coverage of the FamilyHealth Strategy, populational coverage of the Family Health Strategy, and the number ofinhabitants per Primary Care unit, as well as the health indicator, which involves thehospitalizations sensible to primary care. The cardio-vascular causes groups were chosen:high blood pressure (I10, I11), angina pectoris (I20), gongestive heart failure (I50, J81),and cerebro-vascular diseases (I63 a I67, I69, G45 e G46). Results: The broadening ofcoverage, from 8.1% to 39.41% in December, 2013. The growth in the number ofcapacitated staff, from 266 in December, 2010, to 734 in December, 2013. At the PrimaryCare Unit 5.3, a reduction for the hipertension group is observed. At the Primary CareUnits 2.1, 3.1, 3.2, and 4.0, a reduction for the heart failure group was presented. In thecerebro-vascular group, the Primary Units that presented reductions were...

Primary care of women who have sex with women. Recommendations from the research.

Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.

Shifting cardiovascular care to nurses results in structured chronic care.

OBJECTIVES: To explore nurse involvement in cardiovascular risk management (CVRM) in primary care and how this involvement was associated with the degree of structured chronic illness care. STUDY DESIGN: A cross-sectional observational study in 7 European countries. METHODS: Five aspects of nurse involvement in CVRM and 35 specific components of structured chronic illness care were documented in 202 primary care practices in Austria, Belgium, Germany, the Netherlands, Slovenia, Spain, and Switzerland. An overall measure for chronic care management, range 0 to 5, was constructed, derived from elements of the Chronic Care Model (CCM). Random coefficient regression modeling was used to explore associations. RESULTS: A majority of practices involved nurses for organization of CVRM in administrative tasks (82.2 %), risk factor monitoring (78.5%) and patient education (57.1%). Fewer practices involved nurses in defining protocol and the organization for CVRM (45%) or diagnosis and treatment (34.6%). With an increasing number of tasks handled by nurses, overall median adoption of CCM increased from 2.7 (95% CI, 1.5-3.6) to 4.2 (95% CI, 3.8-4.1). When the number of nurse tasks increased by 1, the adoption of CCM increased by 0.13 (P <.05; 95% CI, 0.03-0.22). Some practices with low nurse involvement had high adoption of CCM, while variation of adoption of CCM across practices reduced substantially with an increasing level of nurse involvement. CONCLUSIONS: Nurses were involved in the delivery of CVRM in varying degrees. Higher involvement of nurses was associated with higher degree of structured chronic illness care, with less variation.

Do primary health care nurses address cardiovascular risk in diabetes patients?

AIMS: To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. METHODS: Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. RESULTS: The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001). CONCLUSIONS: Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.

Construction and validation of a data collection tool for the clinical assessment of human responses of outpatients with chronic cardiovascular diseases.

PURPOSE: To develop and test the content validity of a nursing assessment tool for data collection (NATDC) based on NANDA-I for use in outpatients with chronic cardiovascular diseases. METHODS: Construction based on the literature, refinement with a pilot group of hypertensive outpatients and content validation by experts. FINDINGS: The NATDC questions were divided into demographic information of the patient and family, clinical data, physical examination, and interview according to NANDA-I domains. CONCLUSION: The NATDC was constructed and validated. IMPLICATIONS FOR NURSING PRACTICE: This tool can be used in patients with chronic illnesses who experience a variety of human responses seeking nursing care in an outpatient setting because it is based in human responses within a structured framework for nursing assessment.

Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities.

BACKGROUND: Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers. METHODS: A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes. RESULTS: The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol. CONCLUSIONS: The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.

Critical service learning in community health nursing: enhancing access to cardiac health screening.

Critical service learning (CSL) offers promise for preparing community health nursing students to be advocates for social justice and social change. The purpose of this article is to describe a community based CSL project designed to provide cardiac health screening to an underserviced population, wherein nursing's role in social justice is integrated into nursing practice. First, the relationship between social justice and CSL is explored. Then, the CSL approach is examined and differentiated from the traditional service learning models frequently observed in the nursing curriculum. The CSL project is described and the learning requisites, objectives, requirements, and project outcomes are outlined. While not a panacea for system reform, CSL offers nursing students avenues for learning about social justice and understanding the social conditions that underlie health inequalities. Nurse educators may benefit from the new strategies for incorporating social justice into nursing curriculum; this paper suggests that CSL offers one possibility.

Cost-effectiveness of cardiovascular risk management by practice nurses in primary care.

BACKGROUND: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT. METHODS: Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50-75 years, women aged 55-75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education). RESULTS: Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide. CONCLUSIONS: In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity. TRIAL REGISTRATION: Trialregister.nl identifier: http://NTR2188.

Caregiver burden and nonachievement of healthy lifestyle behaviors among family caregivers of cardiovascular disease patients.

PURPOSE: To determine whether caregiver burdens are associated with lifestyle behaviors 1 year following the hospitalization of a family member with cardiovascular disease (CVD). DESIGN: Prospective follow-up study of National Heart Lung and Blood Institute sponsored Family Intervention Trial for Heart Health participants. SETTING: Hospital-based recruitment/baseline visit with 1-year follow-up. SUBJECTS: Family members of hospitalized CVD patients (N  =  423; 67% female; 36% racial/ethnic minority; mean age 49 years). MEASURES: Systematic evaluation at 1 year to determine heart-healthy diet (defined as <10% kcal from saturated fat; Block 98 Food Frequency Questionnaire) and physical activity (defined as ≥4 d/wk; Behavioral Risk Factor Surveillance System Survey) behaviors and caregiver burdens (five domains: employment, financial, physical, social, and time; Caregiver Strain Questionnaire). ANALYSIS: Logistic regression adjusted for covariates. RESULTS: Heart-healthy diet was less frequent among caregivers citing feeling overwhelmed (odds ratio [OR]  =  .50; 95% confidence interval [CI]  =  .26-.97), sleep disturbance (OR  =  .51; 95% CI  =  .27-.96), financial strain (OR  =  .41; 95% CI  =  .20-.86), upsetting behavior (OR  =  .48; 95% CI  =  .25-.92), and/or time demands (OR  =  .47; 95% CI  =  .26-.85) as burdens. Physical activity was less frequent among caregivers reporting financial strain (OR  =  .32; 95% CI  =  .13-.81) or upsetting patient behavior (OR  =  .33; 95% CI  =  .15-.76) as burdens. The most commonly cited caregiver burdens included changes in personal plans (39%), time demands (38%), and sleep disturbance (30%). CONCLUSION: Caregiver burdens were associated with nonachievement of heart-healthy diet and physical activity behaviors among family caregivers 1 year after patient discharge. When developing heart-health promotion interventions, caregiver burden should be considered as a possible barrier to prevention among family members of CVD patients.

Health related quality of life and the support needs of carers of cardiac surgical patients: an exploratory study.

In this descriptive, repeated-measures study, we assessed changes in Health-Related Quality of Life (HRQL) of cardiac surgical patients' caregivers over time and their need for support. Ninety-six primary carers of cardiac patients who had received elective surgery at one tertiary referral hospital were recruited. The majority were female spouses of patients who had undergone bypass and/or cardiac valve surgery. Participants completed a self-administered questionnaire that included the SF-36v2 quality of life health survey and asked about their need for support 6 weeks and 6 months following patient discharge. Carers reported a significant improvement in five out of eight HRQL dimensions (Physical functioning, Physical role, Vitality, Social functioning, Role-emotional) over the study period (P < 0.05). Those who completed the survey at 6 weeks but not 6 months reported higher scores across all dimensions. Carers' need for support need was higher at 6 weeks than 6 months.