Nurses' and midwives' experiences and views about responding to out of work emergencies: A constructivist grounded theory study.

AIM: To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required. DESIGN: A constructivist grounded theory study was conducted between 2012 and 2019. METHODOLOGY: In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory. RESULTS: A core enduring in vivo theme, 'The Right Thing to Do', emerged as a central conceptual reality constructed via three key in vivo themes; 'Something I've Heard', 'Am I Covered?' and 'Just Who I Am', each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes. CONCLUSION: The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as 'doing "The Right Thing" in a climate of anxiety'. IMPACT: The study illuminates an area that has previously been the subject of anecdotal debate. The substantive theory, 'doing "The Right Thing" in a climate of anxiety' illustrates the issues and tensions that exist surrounding the off-duty response. Implications and recommendations for practice and education focus on the fostering of knowledge and understanding of professional identity, position in law and scope of practice, together with potential future research directions. This work provides the first in-depth qualitative study contributing a significant new perspective both nationally and globally.

The use of the CR-10 scale to allow self-regulation of isometric exercise intensity in pre-hypertensive and hypertensive participants.

PURPOSE: Isometric exercise (IE) has been shown to lower blood pressure (BP). Using equipment with force output displays, intensity is usually regulated at 30% maximal voluntary contraction (MVC); however, the cost of programmable equipment and their requirement for maximal contractions presents limitations. A simple, cost-effective alternative deserves investigation. The purpose of this study was (1) to explore the relationship between %MVC, change in systolic BP (ΔSBP), and perceived exertion (CR-10) and (2) to assess the validity of self-regulation of intensity during isometric hand-grip exercise. METHODS: Fourteen pre-hypertensive and hypertensive adults completed eight, 2-min isometric hand-grip exercises at randomised intensities; participants estimated their perceived exertion at 30-s intervals (estimation task). Subsequently, on three separate occasions, participants performed four 2-min contractions at an exertion level that they perceived to be equivalent to CR-10 "Level-6" (production task). RESULTS: There were significant linear relationships between the estimated exertion on the CR-10 scale, and ΔSBP (r = 0.784) and %MVC (r = 0.845). Level-6 was equivalent to an average ΔSBP of 38 mmHg (95% CI; 44, 32 mmHg) and a relative force of 33% MVC (95% CI; 36.2, 30%). During the production task, %MVC was not significantly different between the estimation task and each production trial. In at least the first two repetitions of each production trial, ΔSBP was significantly lower than that observed in the estimation task. CONCLUSION: These findings show that CR-10 "Level-6" is an appropriate method of self-regulating isometric hand-grip intensity; its use offers an affordable and accessible alternative for isometric exercise prescription aimed at reducing BP.

Reproducibility of 24-h ambulatory blood pressure and measures of autonomic function.

Determining the number of familiarization sessions required for accurate recordings of ambulatory blood pressure monitoring and autonomic function is a prerequisite for the appropriate design of intervention studies. The benefit of familiarization trials remains largely unexplored. The objective of the current investigation was to assess the reproducibility of 24-h ambulatory blood pressure, 24-h heart rate variability (HRV) and resting measurements of HRV and blood pressure variability (BPV). Eleven prehypertensive and hypertensive adults participated. Ambulatory blood pressure and HRV were measured across 24 h on four occasions. In addition, 5-min resting measures of HRV and BPV were recorded and analysed. Variability between consecutive pairs of trials was calculated. The typical error induced by ambulatory recordings of systolic blood pressure reduced over time (3.8-2.8 mmHg). The greatest effect of familiarization was observed at night. Ambulatory HRV was more reproducible than resting measures. The most reproducible markers were root mean square of successive differences [coefficient of variation (CV): 13.2-10%] and high frequency normalized units (CV: 15.2-6.4%), with the percentage of adjacent NN intervals differing by more than 50 ms showing the poorest reproducibility (CV: 23.9-20.7%). Overall BPV (SD) was more reproducible than the frequency domain low frequency component. Familiarization trials are required for the most accurate recordings of both 24-h ambulatory blood pressure monitoring and HRV. Ambulatory HRV provide superior reproducibility to resting measurements.

Acute changes in arterial stiffness following exercise in people with metabolic syndrome.

BACKGROUND: This study aims to examine the changes in arterial stiffness immediately following sub-maximal exercise in people with metabolic syndrome. METHODS: Ninety-four adult participants (19-80 years) with metabolic syndrome gave written consent and were measured for arterial stiffness using a SphygmoCor (SCOR-PVx, Version 8.0, Atcor Medical Private Ltd, USA) immediately before and within 5-10min after an incremental shuttle walk test. The arterial stiffness measures used were pulse wave velocity (PWV), aortic pulse pressure (PP), augmentation pressure, augmentation index (AI), subendocardial viability ratio (SEVR) and ejection duration (ED). RESULTS: There was a significant increase (p<0.05) in most of the arterial stiffness variables following exercise. Exercise capacity had a strong inverse correlation with arterial stiffness and age (p<0.01). CONCLUSION: Age influences arterial stiffness. Exercise capacity is inversely related to arterial stiffness and age in people with metabolic syndrome. Exercise induced changes in arterial stiffness measured using pulse wave analysis is an important tool that provides further evidence in studying cardiovascular risk in metabolic syndrome.

Effect of an IT-supported home-based exercise programme on metabolic syndrome in India.

Summary We studied the effectiveness of a home-based exercise programme with information technology (IT) support in people with metabolic syndrome in India. Ninety-four participants with metabolic syndrome (mean age 50 years) were randomized into two groups. Both groups received a 12-week home exercise programme and Group 2 received additional IT support for health education. Before and after the exercise programme, participants were measured for arterial stiffness using applanation tonometry, exercise capacity using an incremental shuttle walk test and quality of life (QoL) using the SF-36 questionnaire. Sixty-one participants completed the post intervention tests. There was a significant reduction in systolic blood pressure, mean pressure and aortic systolic pressure in both groups. Pulse wave velocity, aortic pulse pressure and aortic diastolic pressure showed significant reductions only in Group 2. There were no significant changes in QoL measures, except vitality in Group 2. There was significant improvement in fasting blood glucose in Group 2, cholesterol in Group 1 and triglycerides in both groups. The participants' exercise capacity did not change significantly, although the mean duration of regular exercise was 7.2 weeks for Group 1 and 10.0 weeks for Group 2 (P = 0.019). Metabolic syndrome was reversed in 16% of the participants in both groups. IT support, through mobile text messages and phone calls, may be helpful in metabolic syndrome. Longer-term studies are now required.

Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure.

Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise. These were performed in 54 patients-20 with moderate to severe heart failure, 18 with implanted LVADs, and 16 with explanted LVADs. At rest there was a nonsignificant difference in CPO among groups (p >0.05). Peak CPO was significantly higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 1.90 +/- 0.45 W, implanted LVAD 2.37 +/- 0.55 W, explanted LVAD 3.39 +/- 0.61 W, p <0.01) as was peak cardiac output (heart failure 9.1 +/- 2.1 L/min, implanted LVAD 12.4 +/- 2.2 L/min, explanted LVD 14.6 +/- 2.9 L/min, p <0.01). Peak oxygen consumption was higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 15.8 +/- 4.1 ml/kg/min, implanted LVAD 19.8 +/- 5.8 ml/kg/min, explanted LVAD 28.2 +/- 5.0 ml/kg/min, p <0.05) as was anaerobic threshold (heart failure 11.2 +/- 1.9 ml/kg/min, implanted LVAD 14.7 +/- 4.9 ml/kg/min, explanted LVAD 21.4 +/- 5.0 ml/kg/min, p <0.05). In conclusion, peak CPO differentiates well during cardiac restoration using LVADs and emphasizes the benefits of this therapy. CPO has the potential to be a key physiologic marker of heart failure severity and can guide management of patients with LVAD.