Contribution of transpersonal care to cardiac patients in the postoperative period of heart surgery. / Contribuição do cuidado transpessoal ao ser-cardiopata no pós-operatório de cirurgia cardíaca.

OBJECTIVE: To know the contribution of Watson's theory to nursing care for cardiac patients in the postoperative period of cardiac surgery. METHODS: This is a qualitative study based on the research-care method conducted with ten patients who underwent cardiac surgery in a specialised hospital from June to August 2013, in the city of Fortaleza, Ceará, Brazil. Data were submitted to content analysis based on the Clinical Caritas Process. RESULTS: The results led to four thematic categories: Awareness of being cared for by another being, System of beliefs and subjectivity, Relation of support and trust, and Expression of feelings. Surgery transformed the lives of the patients related to the process of being cared for by other people. FINAL CONSIDERATIONS: The application of Watson's theory to care for cardiac patients after heart surgery shed valuable light on the importance of transpersonal care for the expansion of nursing care.

Contribuição do cuidado transpessoal ao ser-cardiopata no pós-operatório de cirurgia cardíaca / Contribución del cuidado transpersonal al ser-cardiopata en el post operatorio de cirugía cardíaca / Contribution of transpersonal care to cardiac patients in the postoperative period of heart surgery

Resumo OBJETIVO Conhecer a contribuição da teoria de Watson para o cuidado de enfermagem dirigido ao ser com cardiopatia no pós-operatório de cirurgia cardíaca. Métodos: Pesquisa qualitativa, por meio do método de pesquisa-cuidado, realizado com dez pessoas que realizaram cirurgia cardíaca em um hospital especializado, de junho a agosto de 2013, no município de Fortaleza-CE. Os dados foram submetidos à análise de conteúdo, com base no processo Clinical Caritas. RESULTADOS Foram construídas quatro categorias temáticas: Consciência de ser cuidado por outro ser, Sistema de crenças e subjetividade, Relação de ajuda-confiança e Expressão dos sentimentos. Compreendeu-se que a realização da cirurgia acarretou transformações na vida dos pesquisados-cuidados, as quais foram relacionadas ao processo de serem cuidados por outras pessoas. CONSIDERAÇÕES FINAIS Concluiu-se que, ao utilizar a teoria de Watson no cuidado ao ser com cardiopatia no pós-operatório, foi possível compreender a importância do cuidado transpessoal para expansão dos cuidados da enfermeira.

Resumen OBJETIVO Conocer la contribución de la teoría de Watson para el cuidado de enfermería dirigido al ser con cardiopatía en el postoperatorio de cirugía cardíaca. MÉTODOS Investigación cualitativa, por medio del método de investigación-cuidado, realizado con diez personas que realizaron cirugía cardiaca en un hospital especializado, de junio a agosto de 2013, en el municipio de Fortaleza-CE. Los datos fueron sometidos al análisis de contenido, con base en el proceso Clinical Caritas. RESULTADOS Se construyeron cuatro categorías temáticas: Consciencia de ser cuidado por otro ser, Sistema de creencias y subjetividad, Relación de ayuda-confianza y Expresión de los sentimientos. Se comprendió que la realización de la cirugía acarreó transformaciones en la vida de los encuestados-cuidados, las cuales fueron relacionadas al proceso de ser cuidados por otras personas. CONSIDERACIONES FINALES Se concluyó que, al utilizar la teoría de Watson en el cuidado al ser con cardiopatía en el postoperatorio, fue posible comprender la importancia del cuidado transpersonal para la expansión del cuidado de la enfermera.

Abstract OBJECTIVE To know the contribution of Watson's theory to nursing care for cardiac patients in the postoperative period of cardiac surgery. METHODS This is a qualitative study based on the research-care method conducted with ten patients who underwent cardiac surgery in a specialised hospital from June to August 2013, in the city of Fortaleza, Ceará, Brazil. Data were submitted to content analysis based on the Clinical Caritas Process. RESULTS The results led to four thematic categories: Awareness of being cared for by another being, System of beliefs and subjectivity, Relation of support and trust, and Expression of feelings. Surgery transformed the lives of the patients related to the process of being cared for by other people. FINAL CONSIDERATIONS The application of Watson's theory to care for cardiac patients after heart surgery shed valuable light on the importance of transpersonal care for the expansion of nursing care.

Cost Analysis of an Advanced Practice Registered Nurse Transitional Care Model for Cardiac Patients.

Interest in care transitions has intensified in light of emphasis placed on hospital readmissions. This study provides a comparative analysis of the costs of providing transitional care through a program for cardiac patients against hospital readmission costs. The advanced practice registered nurse-managed BRIDGE model reduced health care costs associated with readmissions that were in excess of program costs. On average, there was a per-patient savings of $4,944 in avoided readmissions within 30 days of hospital discharge. Over the duration of the program, this equates to a $306,537 savings in patients with acute coronary syndrome. Nurse practitioners have a unique, holistic, and supportive approach to providing care that may make them ideal for the transitional care setting.

Using outdoor activities in cardiac recovery.

Evidence suggests that green spaces next to hospitals can be used to promote health. This article reports on a pilot study to determine how hospital green spaces can be used for patients with cardiac problems and their rehabilitation programmes. Over a six-week period, patients spent one hour per week taking part in activities, including tai chi, photography and willow sculpting, as part of their rehabilitation programme. Patients showed improved physical health, less social isolation, a better overall mood and increased positivity. They were also more likely to choose to exercise than at the start of the rehabilitation programme, and valued the new skills and knowledge that they gained.

Easier does it.

Nurses at a Belfast hospital have eased the anxiety of cardiac patients attending for day procedures by introducing reclining chairs and a relaxing waiting area. A nurse-led care pathway has also removed delays in care and provided consistency from admission to discharge.

A novel paradigm for providing improved care to chronic patients in cardiac intensive care unit.

OBJECTIVE: Evaluate the impact of chronic cardiac care team (CCCT) on hospital course of patients, their families, and nursing staff. DESIGN: Retrospective observational study in children with hospital stay of ≥6 weeks in a pediatric cardiac intensive care unit (CICU) at a tertiary care children's hospital. Before and after care, survey of the nurses and patients family was also performed. RESULTS: The CCCT provided care for 68 patients of which 44 survived to discharge. Median age at admission was 19 days (range 0-20.6 years); 18 (26%) were admitted at birth. Cardiac diagnosis included single ventricle in 27, heart failure/cardiac transplantation in 37, others in 6. The CCCT was involved in follow-up for vitamin and endocrine deficiencies, updating immunization status, optimizing nutritional intake, growth parameters, assess feeding issues, and providing end-of-life discussions in all those who died. One year after implementation, 85% nurses indicated improved understanding of patient problems, 57% reported improved working relationship with families, and 87% reported improved team communication. Family survey indicated that implementation of the model led to significantly improved opinion of parents in their ability to participate in the plan of care (28% vs. 70%, P = 0.019) and better relationship with the CICU staff caring for their child (57% vs. 100%, P = 0.008). CONCLUSION: The CCCT provides a new team-based paradigm for improving continuity of care in chronic CICU patients by supplementing medical care and facilitates end-of-life discussions. The CCCT bridges communication gap between CICU staff and families.

Intervención tanatológica en la Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata del Instituto Nacional de Cardiología Ignacio Chávez / Thanatological intervention in the Advanced Comprenhensive Care Unit for cardiopathy patient of the National", "_i": "

Los cuidados paliativos (CsPs) surgen por la necesidad de ayudar al enfermo que está cercano a la muerte, por esta razón la Organización Mundial de la Salud los propuso como un componente de toda política sanitaria nacional y los define como: “El enfoque que mejora la calidad de vida de pacientes y familias que se enfrentan a los problemas asociados con enfermedades amenazantes para la vida, a través de la prevención y alivio del sufrimiento por medio de la identificación temprana e impecable evaluación y tratamiento del dolor y otros problemas, físicos, psicológicos y espirituales”. En el año 2011, el Instituto Nacional de Cardiología Ignacio Chávez presenta ante la Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, un plan de trabajo en el cual se otorgarán CsPs, cuyo nombre queda establecido como Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata y su Familia. En el presente escrito se aborda cómo está constituida esta unidad y el tipo de intervenciones tanatológicas que se realizan.

Palliative care, arise from the need to help the patient who is close to death, that is why the World Health Organization, he proposed that they should constitute a component of any national health policy and defined as The approach that improves the quality of life of patients and families facing the problems associated with disease threatening to life, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual. In 2011, the National Institute of Cardiology Ignacio Chavez presented to the Coordinating Commission of National Institutes of Health and Hospitals of High Specialty, the work plan of the service in which the palliative care whose name is established as Advanced Cardiopathy Patient and your Family Comprehensive Care Unit will be awarded. In the present study deals with how it is organized and the interventions of thanatology implemented.

Tai Chi as an adjunct physical activity for adults aged 45 years and older enrolled in phase III cardiac rehabilitation.

BACKGROUND: Cardiac rehabilitation improves physical, cognitive and psychosocial functioning, yet services are greatly underutilized with increasing patterns of attrition over time. Tai Chi has been suggested as a possible adjunct to cardiac rehabilitation exercise training. AIM: To describe differences in physical, cognitive and psychosocial functioning among adults ≥ 45 years old attending phase III cardiac rehabilitation, who have or have not self-selected Tai Chi exercise as an adjunct physical activity. METHODS: A cross-sectional design compared subjects attending group-based Wu style Tai Chi classes plus cardiac rehabilitation, with cardiac rehabilitation only. Subjects had a battery of physical and cognitive functioning tests administered to examine aerobic endurance, balance, strength, and flexibility, verbal retrieval/recall, attention, concentration and tracking. Subjects completed a health survey to ascertain cardiac event information, medical history, and psychosocial functioning (i.e. health-related quality of life, stress, depressive symptoms, social support, and Tai Chi self-efficacy). RESULTS: A total of 51 subjects (75% married, 84% college-educated, 96% White/European-American) participated. Subjects were on average 70 (± 8) years old and had attended cardiac rehabilitation for 45 (± 37) months. Approximately 45% (n = 23) attended Tai Chi classes plus cardiac rehabilitation, while 55% (n = 28) attended cardiac rehabilitation only. Subjects attending Tai Chi plus cardiac rehabilitation had better balance, perceived physical health, and Tai Chi self-efficacy compared to those attending cardiac rehabilitation only (p ≤ 0.03). CONCLUSION: Tai Chi can be easily implemented in any community/cardiac rehabilitation facility, and may offer adults additional options after a cardiac event.

Paediatric cardiac intensive care unit: current setting and organization in 2010.

Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

Importancia del cuidado ante el consumo de cocaína como factor de riesgo cardiovascular / Importance of careful attention in the case of cocaine consumption as a risk cardiovascular factor", "_i": "

La cocaína ocupa el tercer lugar de consumo de drogas en lapoblación de México, su principal vía de administración es esfinaday fumada; actúa directamente sobre las vías del placer y larecompensa en el haz proscencefálico medial. A nivel cardiovascularaumenta el consumo de oxígeno miocárdico y la formaciónde trombos. Por lo tanto, las complicaciones más frecuentesson: hipertensión arterial sistémica, arritmias, angina de pecho,infarto de miocardio, paro cardíaco, hemorragias cerebrales,convulsiones, pérdida de la conciencia y evento vascular cerebral.Por esta razón se analizan los efectos de la cocaína sobreel sistema cardiovascular y la importancia de las intervencionesde enfermería en pacientes con esta dependencia, para lo cualuna vez elegido el tema de investigación bibliohemerográfica, sellevó a cabo una búsqueda sistemática de información en basesde datos nacionales e internacionales y en literatura bibliográ-fica relacionada con el uso de la cocaína, efectos en el organismoy cuidados de enfermería en salud mental, particularmente enadicciones. Se realizó un análisis de la evidencia científica encontrada,llegando a la conclusión de que la dependencia a lacocaína conlleva a serias complicaciones cardiovasculares, porlo que se hace indispensable la formación de profesionales deenfermería con conocimientos en el campo de las adicciones ydel área cardiovascular para otorgar un cuidado holístico encada nivel de atención, lo que implica: proporcionar educaciónpara la salud y llevar a cabo el proceso de atención de enfermeríapara garantizar calidad en el cuidado.

The cocaine is in third place inside of consume in Mexico, theprincipal route of administration are sniffed and smoked, whichacts directly on the means of pleasure and reward in the medialprosencephalon beam. On cardiovascular area increases myocardialoxygen consumption and thrombus formation. Therefore,some of the most frequent complications are: high bloodpressure, arrhythmias, angina pectoris, myocardial infarction,stroke, intracerebral hemorrhage, seizures and loss of consciousness.For this reason is analyzed the effects of cocaine on thecardiovascular system and the importance of nursing care inpatients with these problem, is carried out a systematic searchfor information in national and international databases andbibliographic literature related to cocaine use, effects on thebody and care of mental health nursing, particularly on addictions.An analysis of scientific evidence found, to conclude thatthe cocaine dependence leads to serious cardiovascular complicationsas it is essential training for nursing professionals withknowledge about addictions and cardiovascular area to provideholistic care, which involves: health education and carry out thenursing process to ensure quality care.

Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation.

OBJECTIVES: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes. METHODS: This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses. RESULTS: Significant increases in RR practice time (75 min/week, effect size/ES=1.05) and spiritual well-being scores (ES=0.71) were observed after participants completed the program (P<.0001). Patients also improved on measures of depression, anxiety, hostility and the global severity index with medium effect sizes (0.25 to 0.48, P<.0001). Greater increases in RR practice time were associated with enhanced spiritual well-being (beta=.08, P=.01); and enhanced spiritual well-being was associated with improvements in psychological outcomes (beta=-0.14 to -0.22, P<.0001). CONCLUSION: Our data demonstrated a possible dose-response relationship among RR practice, spiritual and psychological well-being. Furthermore, the data support the hypothesis that spiritual well-being may serve as a pathway of how RR elicitation improves psychological outcomes. These findings might contribute to improved psychological care of cardiac patients.

Sexual problems in cardiac patients: how to assess, when to refer.

It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using appropriate language. Second, we present different styles and approaches that can be used to start the assessment, differing between settings, persons, or disciplines. The PLISSIT (permission, limited information, specific suggestion, and intensive therapy) model can be helpful to initiate discussion about sexuality with the cardiac patient and his/her partner. This model is a stepwise approach using various levels of discussion or treatment. Open-ended question can facilitate discussion about sexual concerns, and validated questionnaires or diaries can be used to assess sexual problems. Patients with sexual concerns and problems should be counseled and/or treated appropriately, and adequate follow-up is needed. Additional training and research are needed to further improve the quality of sexual assessment and counseling in cardiac patients.

Blood conservation in a congenital cardiac surgery program.

Bloodless surgery programs are being instituted because of increasing public concerns about blood transfusions and the need to accommodate some patients' religious beliefs. Patients' desires to forego transfusion must be identified during the preoperative screening process and subsequently reflected on the surgical consent. Patients are managed preoperatively with erythropoietin and dietary supplements. The surgical team employs a variety of intraoperative and postoperative blood conservation techniques to help avoid the need for transfusion. A retrospective review of congenital cardiac procedures in a blood conservation program confirmed that bloodless cardiac surgery is effective.

"There's just something about Ron": one nurse's healing presence amidst failing hearts.

Chronic disease can be devastating to the patient, family, and nurses who care for them. Patients and family members struggle with the debilitating effects and uncertainties that abound in living with a chronic disease, such as heart failure. The nurse has a unique opportunity to foster a therapeutic relationship through the use of nursing presence. The phenomenon of nursing presence has been defined in the literature by six features: uniqueness, connecting with the patient's experience, sensing, going beyond the scientific data, knowing (what will work and when to act), and being with the patient. Nursing presence, when exhibited, may facilitate healing, promote comfort, and improve patient satisfaction. The story in the article depicts how one professional nurse in a heart failure clinic exemplified the nurse as a healing presence. Through his example, nurses may better understand the significance that their presence may have when caring for patients diagnosed with a chronic illness.

Mending broken hearts: the role of spirituality in cardiac illness: a research synthesis, 1991-2004.

This research synthesis analyzed research on spirituality in cardiac illness from 1991 to 2004 to identify progress, gaps, and priorities for research. Articles were retrieved from PubMed and CINAHL. Twenty-six studies met inclusion criteria. Moody's Research Analysis Tool, Version 2004, was used to analyze studies. Lack of conceptual model and universal definition of spirituality are major knowledge gaps. A proposed conceptual model is presented.