Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study.

BACKGROUND: Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD: This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS: Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION: A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.

Faith community nursing scope of practice: extending access to healthcare.

The role of the Faith Community Nurse (FCN) is a multifaceted wholistic practice focused on individuals, families, and the faith and broader communities. The FCN is skilled in professional nursing and spiritual care, supporting health through attention to spiritual, physical, mental, and social health. FCNs can help meet the growing need for healthcare, especially for the uninsured, poor, and homeless. The contribution of FCNs on, primary prevention, health maintenance, and management of chronic disease deserves attention to help broaden understanding of the scope of FCN practice.

Contribuição do cuidado clínico de enfermagem para o conforto psicoespiritual de mulheres com infarto agudo do miocárdio / Contribution of nursing clinical care for psycho-spiritual comfort of women with acute myocardial infarction

Objetivou-se analisar a contribuição do cuidado clínico de enfermagem para o conforto psicoespiritual de mulheres com Infarto Agudo do Miocárdio (IAM), mediado pela pesquisa-cuidado com base na Teoria do Conforto. Os sujeitos foram nove mulheres admitidas com IAM no período de abril a junho de 2011 em um hospital de Cardiologia em Sobral - Ceará, Brasil. O primeiro encontro ocorreu na admissão e durou em média seis horas; depois ocorreram mais três encontros. Para coleta e análise das informações, foram empregados entrevista individual semiestruturada, diário de campo, observação participante e análise temática categorial de conteúdo. Os cuidados implementados no contexto psicoespiritual foram: fortalecer a espiritualidade, esclarecer sobre o adoecimento, ajudar no enfrentamento da nova condição de saúde e nas situações de confusão mental e desorientação. A percepção do conforto psicoespiritual ocorreu por meio da implementação de cuidados clínicos neste contexto, utilizando-se pesquisa-cuidado com base na Teoria do Conforto.

The objective was to analyze the contribution of nursing clinical care for psycho-spiritual comfort of women with acute myocardial infarction (AMI), mediated by research-care based on the Comfort Theory. The subjects were nine women admitted with AMI from April to June 2011 in a Cardiology hospital in Sobral, Ceará, Brazil. The first meeting took place at the admission and lasted around six hours, after that there were three more meetings. For data collection and analysis we used individual semi-structured interviews, field diary, participant observation and thematic category content analysis. The cares implemented in the psycho-spiritual context were: strengthen the spirituality; clarify the illness; help in coping with new the health condition and situations of mental confusion and disorientation. The perception of psycho-spiritual comfort was present through the implementation of clinical cares in this context, using research-care based on the Comfort Theory.

El objetivo del estudio fue analizar la contribución de la atención clínica de enfermería para el confort psicoespiritual de mujeres con Infarto Agudo del Miocardio (IAM), mediada por la investigación-atención basada en la Teoría del Confort. Participaron nueve mujeres que ingresaron con IAM entre abril y junio de 2011 en el hospital de Cardiología de Sobral, Ceará, Brasil. El primer encuentro ocurrió en la admisión y duró alrededor de seis horas, después ocurrieron más tres encuentros. Para recolección y análisis de las informaciones, se utilizaron entrevista semi-estructurada, diarios de campo, observación participante y análisis temático categorial de contenido. Las atenciones psicoespirituales fueron: fortalecer la espiritualidad, aclarar las dudas sobre la enfermedad, ayudar a enfrentarse el nuevo estado de salud y las situaciones de confusión mental y desorientación. La percepción de confort psicoespiritual fue presente a través de la implementación de la atención clínica en este contexto, usándose de investigación-atención basada en la Teoría del Confort.

Associations of dietary calcium intake and calcium supplementation with myocardial infarction, stroke, and overall cardiovascular mortality.

Calcium supplements have been associated with elevated risk of myocardial infarction, whereas dietary calcium intake has not.

Comparison of case fatality rates for acute myocardial infarction in weekday vs weekend admissions in South Korea.

BACKGROUND: According to recent reports, reduced weekend staffing in hospitals may lead to a lower intensity of management of patients with acute conditions such as acute myocardial infarction (AMI). The present study evaluated differences in the case fatality rate of Korean patients admitted with AMI on weekdays vs those admitted on weekends. METHODS AND RESULTS: The dataset was constructed from the Korea National Health Insurance Claims Database. The study population was 97,466 patients who were admitted to a hospital in Korea from 2003 to 2007 with AMI. Patients admitted on weekends had a higher 30-day fatality rate (20.1% vs 17.3%) than did those admitted on weekdays. Differences in the 30-day fatality rate were significant after adjusting for baseline characteristics and the severity of disease (odds ratio (OR), 1.21; 95% confidence interval (CI), 1.16-1.26). However, the 30-day fatality rate was insignificantly different after additional adjustment for medical or invasive management (OR 1.05; 95%CI 0.99-1.11). CONCLUSIONS: Differences in the case fatality rate of AMI patients admitted on weekdays and on weekends in Korea are caused by differences in the rate of performance of medical or invasive procedures.

Identifying and managing patients with acute coronary conditions.

In 2004, the then National Institute for Clinical Excellence (NICE) published a technology-appraisal guideline on the treatment of patients with unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI). This article reports the results of a study in which triage and treatment for this patient group in one emergency department (ED) was assessed against this NICE guideline. The study found that patients were triaged by ED staff successfully but that there had been a lack of awareness of prognostic risk groupings and that compliance with guidelines on early antiplatelet therapy had not been ideal. The authors conclude, therefore, that the introduction of an ED pathway for patients with UA or NSTEMI would improve clinicians' compliance with the NICE guideline.

Nurses' perceptions and experiences of initiating thrombolysis: a qualitative study.

Nurse-initiated thrombolysis has become established in some trusts for patients presenting to the accident and emergency department or coronary care unit with an acute myocardial infarction. A limited approach to the exploration of this multidimensional expansion in nursing practice is noted in the literature. The aims of this study were to explore the experiential dimensions of nurses who have initiated thrombolysis, if nurses perceive themselves prepared for the role, and whether they consider role expansion a positive or negative experience. A qualitative approach was used. The sample included 12 nurses organizationally sanctioned to autonomously administer a thrombolytic agent, who completed a self-administered, predominantly open-ended questionnaire. Data were analysed using the method described by Giorgi (1997). Two major themes emerged: 'perceived pressure to deliver best practice' and 'developing patient care within a holistic framework', these themes are discussed and underpinned with supporting narratives. Nurses initiating thrombolysis have a desire to engage with delivery of a treatment proven to have a positive impact on individual patient outcomes; they express an overwhelming desire 'to do good' for their patient. Despite struggling with the possibility of adverse patient outcomes, all the nurses felt that their experiences overall were positive and all supported this with examples of practice.

Nursing competencies for spiritual care.

AIM AND OBJECTIVES: The aim of this paper is to reveal the main nursing competencies for spiritual care, which emerged from data collecting from qualified nurses in Malta. BACKGROUND: For nurses to deliver spiritual care, they must be competent to provide care on a physical, mental, social and spiritual level. As spiritual care may be influenced by culture, this study explored the competencies for spiritual care from the Maltese nurses' perspective. METHODS: A descriptive exploratory study investigated nurses' competencies in the delivery of spiritual care to patients with myocardial infarction. Data were collected by means of an open-ended questionnaire on qualified nurses (n=77) followed by an in-depth interview on a stratified random sample (n=14) of nurses from the same respondents. RESULTS: The four main nursing competencies identified were associated with the role of the nurse as a professional and as an individual person; delivery of spiritual care by the nursing process; nurses' communication with patients, inter-disciplinary team and clinical/educational organizations and safeguarding ethical issues in care. CONCLUSION: This study demonstrated the complexity of spiritual care, which requires nurses to increase their awareness of the uniqueness of each individual patient with regard to the connection between mind, body and spirit; the assessment of the spiritual status of patients during illness and the implementation of holistic care as recommended by the Nursing Code of Ethics. RELEVANCE TO CLINICAL PRACTICE: These findings will enable nurses to consider the importance of spiritual care, which may allow them to help empower patients find meaning and purpose during times of illness. More emphasis should be put on spiritual care in the pre- and postregistration education. Further research to translate these main competencies into specific competencies will guide spiritual care.

[The amount of nursing care for patients with myocardial infarction--a descriptive study]. / Die Erfassung des Pflegeaufwands bei Patienten mit der medizinischen Diagnose Myokardinfarkt. Eine deskriptive Studie.

In Germany nurses have no evidence-based data about the amount of nursing care for patients with specific medical diagnosis. These data are necessary for the demanded appropriate consideration of criteria of nursing care in a German-DRG. The pilot study "The amount of nursing care for patients with myocardial infarction", which was part of a students research project at the University of Witten/Herdecke, can provide a basis for this consideration. The amount of nursing care for a convenience sample of 26 patients during their stay at a university hospital in Munich is the focus of a cross-sectional descriptive study. A standardized instrument measuring the amount of care was developed by the project group. The nursing intervention system LEP was used to determine the nursing care hours. The patients' average length of stay is 9.5 days. 73 percent spent 2.4 days in the intensive care unit. The average amount of nursing care is 32.2 hours per patient or 3.4 hours per patient and day, respectively. Typical nursing activities as well as an amount of nursing care pattern in the course of the stay can be seen. Variations of nursing care and length of stay show the inhomogeneity of the investigated group. Older patients and patients with associated diagnoses show an increase of the amount of nursing care and length of stay. The amount of nursing care of old patients in the category "motion and transfer" increases drastically compared to younger ones. The results of this pilot study confirm the assumption that just the diagnosis myocardial infarction is not sufficient to predict and describe the amount of nursing care. Based on this study, further research with larger samples and a longer investigation time is necessary.

Evidence-based care of a patient with a myocardial infarction.

Quality nursing care of the patient with a myocardial infarction is realized in accordance with evidence-based practice and by the willingness of nurses to adjust nursing practice as new evidence emerges. The framework for the holistic care of the patient following a myocardial infarction encompasses a comprehensive assessment, planning, intervention and evaluation process. The intention of this case study is to illustrate the rationale and evidence base underpinning the holistic approach to the care of this patient group.

Spirituality and life-threatening illness: a phenomenologic study.

PURPOSE/OBJECTIVES: To examine the lived experience of individuals when confronted with a life-threatening disease. RESEARCH APPROACH: Qualitative, phenomenologic using Giorgi's approach. SETTING: Patients' homes in the Midwest. PARTICIPANTS: Five women and two men, aged 44-74 years, who had a variety of diagnoses, including breast cancer, colorectal cancer, prostate cancer, pulmonary fibrosis, and myocardial infarction. METHODOLOGIC APPROACH: Subjects were recruited through flyers posted at support groups and religious establishments and by word of mouth. MAIN RESEARCH VARIABLES: Willingness to volunteer to share their stories. FINDINGS: Participants described how their spirituality provided comfort throughout their journey, strength in facing the life-threatening illness, many blessings despite the hardship of the illness, and trust in a higher power to see them through the journey. All participants described a sense of meaning in their lives throughout their experience. CONCLUSIONS: Spirituality greatly affected patients' journeys through a life-threatening illness and provided a sense of meaning despite the illness. INTERPRETATION: Nurses need to acknowledge patients' spirituality and, in turn, assist patients in meeting their spiritual needs. By understanding the study participants' experiences, nurses can better support their patients, provide time and space for spiritual practices, and honor patients' spiritual journeys.

The development of Partners for Health's integrated community pathway for postmyocardial infarction patients.

Partners for Health convened an interdisciplinary team to evaluate the quality of care received by cardiac patients. The team detailed the suboptimal postacute care of patients with ischemic heart disease. To solve the quality problems, a cross-sectoral team, using an approach that is in accordance with the American Heart Association's Scientific Statement on Pathways, systematically developed and implemented an integrated community pathway for myocardial infarction patients. The paper contributes to the literature on pathways by presenting the lessons learned from the authors' first-hand experience. The paper concludes with recommendations based on those lessons.

Cardiovascular chronobiology: do you know what time it is?

Cardiovascular indices, such as blood pressure, heart rate, cardiac output, and fibrinolytic factors, vary over a 24-hour period. For example, nocturnal blood pressure may decrease to 30-50 mm Hg and heart rate to 25 beats per minute. In addition, these cardiovascular rhythms interact and may trigger a cardiovascular catastrophe, such as a myocardial infarction, sudden cardiac arrest, or stroke, with the highest risk during the first 6 hours after awakening and arising. Understanding the fluctuations in cardiovascular indices and the rhythmic increase in risk is crucial in assessing patients and developing a protective plan of care. This article discusses the cardiovascular rhythms and the rhythmic increase in risk for cardiovascular catastrophes. A framework demonstrating the interaction of these rhythms provides the basis for the development and exploration of interventions, including modification of activity and medications, and nursing actions to protect patients during periods of high cardiovascular risk.

Envisioning a network of care for at-risk patients after myocardial infarction.

Myocardial infarction (MI) continues to be a significant health care issue because of its prevalence. As treatment options improve the survival rate, an increasing number of individuals have to learn how to adjust to this major life event and prevent recurrence. Recovery can be difficult. Many patients experience emotional distress, fear of dying, and family turmoil, fail to return to work when physiologically capable of doing so, are unable to return to their previous levels of sexual activity, and are not capable of making the necessary diet and exercise changes. Acute management strategies continue to be aimed at limiting the infarct size, whereas holistic approaches to the patient and family adjustment must target seeking prompt treatment when symptoms present, psychologic adjustment, stress reduction, and patient and family education for self-care and risk reduction. As hospital length of stay for acute MI decreases, health care professionals must provide an interdisciplinary, collaborative approach to ensure that the at-risk MI patient is provided all of the information and support needed to lead a satisfying, productive, healthy life. An excellent way for nurses to not only address this challenge, but to lead the effort, would be to develop a network of care for the at-risk MI patient.

Spirituality of patients recovering from an acute myocardial infarction. A grounded theory study.

The purposes of this study were to discover what spirituality means to patients recovering from an acute myocardial infarction and to identify patients' perceptions of how spirituality influences recovery. Using the Glaserian method, spiritual concepts were used for theory building. Spirituality was described as a life-giving force nurtured by receiving presence of the divine, family, friends, health care providers, and creation (core category). Supporting categories were: developing faith, discovering meaning and purpose, and giving the gift of self. Five phases to discovering meaning and purpose were: (a) facing mortality, (b) releasing fear and turmoil, (c) identifying and making lifestyle changes, (d) seeking divine purpose, and (e) making meaning in daily life. Spirituality influenced recovery by providing the participants with inner strength, comfort, peace, wellness, wholeness, and enhanced coping. This substantive theory can be used by holistic nurses to facilitate spirituality in patients recovering from an acute myocardial infarction.

Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP). The SHIP Collaborative Group.

OBJECTIVE: To assess the effectiveness of a programme to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina. DESIGN: Randomised controlled trial; stratified random allocation of practices to intervention and control groups. SETTING: All 67 practices in Southampton and south west Hampshire, England. SUBJECTS: 597 adult patients (422 with myocardial infarction and 175 with a new diagnosis of angina) who were recruited during hospital admission or attendance at a chest pain clinic between April 1995 and September 1996. INTERVENTION: Programme to coordinate preventive care led by specialist liaison nurses which sought to improve communication between hospital and general practice and to encourage general practice nurses to provide structured follow up. MAIN OUTCOME MEASURES: Serum total cholesterol concentration, blood pressure, distance walked in 6 minutes, confirmed smoking cessation, and body mass index measured at 1 year follow up. RESULTS: Of 559 surviving patients at 1 year, 502 (90%) were followed up. There was no significant difference between the intervention and control groups in smoking (cotinine validated quit rate 19% v 20%), lipid concentrations (serum total cholesterol 5.80 v 5.93 mmol/l), blood pressure (diastolic pressure 84 v 85 mm Hg), or fitness (distance walked in 6 minutes 443 v 433 m). Body mass index was slightly lower in the intervention group (27.4 v 28.2; P=0.08). CONCLUSIONS: Although the programme was effective in promoting follow up in general practice, it did not improve health outcome. Simply coordinating and supporting existing NHS care is insufficient. Ischaemic heart disease is a chronic condition which requires the same systematic approach to secondary prevention applied in other chronic conditions such as diabetes mellitus.