A Web-Based Education Program About Primary Palliative Care for Heart Failure: A Study Protocol of Wait-Listed Randomized Controlled Trial.

BACKGROUND: The number of patients with heart failure (HF) is rapidly increasing as palliative care is being integrated into HF management and the need for a nursing workforce to meet these demands grows. To address this, we have developed a Web-based educational program on primary palliative care for HF among general registered nurses caring for patients with HF in Japan. OBJECTIVE: The aim of this study was to evaluate the program's effectiveness on nurse-reported palliative care practice, difficulty, and knowledge. METHODS: In this open-label, individual-level, wait-listed randomized controlled trial, 150 Japanese general registered nurses, with experience in caring for patients with HF and clinical ladder level ≥ 2 in inpatient, outpatient, and home-visiting care settings, will be randomly divided (1:1 ratio) into a Web-based educational program group and a wait-list control group. The follow-up period is 6 months after the intervention. The primary outcome is the nurse-reported practice score in primary palliative care, and the secondary outcomes are the nurse-reported difficulties score and knowledge score. CONCLUSIONS AND CLINICAL IMPLICATIONS: We herein describe the study protocol of a wait-listed randomized controlled trial regarding a Web-based educational program, which is a novel approach for these nurses. If the results of this study support our hypothesis, they could help expand primary palliative care, including daily nursing practices, such as symptom management and interdisciplinary collaboration, in the field of cardiovascular nursing.

Factors Associated with Japanese Nurses' Support on End-of-life Decision-making: A Cross-sectional Study.

PURPOSE: This study aimed to clarify the factors associated with Japanese nurses' end-of-life decision-making support. DESIGN: Cross-sectional study. METHODS: An online survey was conducted among 278 nurses. FINDINGS: Significantly associated factors included visiting nursing, nursing experience duration, female sex, workshop participation, and time spent on end-of-life care. CONCLUSION: Visiting nursing was the most significant factor associated with nurses' end-of-lifedecision-making support. CLINICAL EVIDENCE: Consideration should be given to the curriculum in basic nursing education related to visiting nursing. It shouldinclude end-of-life care as well as resources for end-of-life decision-making to increase the number of patients who die in their preferred setting.

Advance care planning experiences of patients with heart failure and their families: a qualitative systematic review protocol.

OBJECTIVE: This review aims to synthesize advance care planning experiences of patients with heart failure at stage C or D, and the experiences of their families. INTRODUCTION: The high incidence rates worldwide and the health burdens associated with heart failure indicate a need to implement end-of-life care for people with cardiovascular disease. Advance care planning is a core process in effective end-of-life cardiovascular care. Since the trajectory of heart failure is unique, it is necessary to establish patient-specific interventions focusing on their experiences, and develop effective advance care planning interventions. However, no previously published systematic reviews have integrated knowledge of the patient's or the family's experience. Therefore, more comprehensive analyses of the experiences of patients with heart failure and their families are required to conduct better interventions. INCLUSION CRITERIA: This review will consider qualitative studies on the experiences of adult patients with stage C or D heart failure who participated in advance care planning, and the experiences of their families. Studies conducted in all settings that accommodate patients with heart failure will be considered. METHODS: PubMed, CINAHL, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, PsycINFO, ProQuest Dissertations and Theses Global, Google Scholar, and gray literature will be searched for articles that meet the inclusion criteria. Studies published in English from the inception of the database to the present will be considered. Eligible studies will be critically appraised using standardized JBI tools for qualitative synthesis. The findings will be pooled using a meta-aggregation approach. The final synthesized findings will be assessed according to the ConQual approach to establish confidence in qualitative research synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021229096.

Intravenous acetaminophen reduces the length of intubation and rescue analgesics in intensive care unit patients after cardiovascular surgery in Japan: A retrospective analysis.

OBJECTIVE: After cardiovascular surgery, analgesic and sedative management in the intensive care unit (ICU) significantly affects short- and long-term outcomes of patients. This study aimed to clarify the impact of opioid reduction after acetaminophen administration on the length of intubation and rescue analgesic use after cardiovascular surgery. DESIGN: This was a case-control study. SETTING: This study was conducted in the ICU of a cardiovascular hospital. PARTICIPANTS: Datasets of 556 post-cardiac surgery participants were collected; for final analyses, 266 participants were selected by propensity score matching. Equality between the intervention and comparison groups was ensured by calculating the standardized difference and difference test. INTERVENTIONS: The intervention group was treated with the multimodal analgesic sedation protocol. MAIN OUTCOME MEASURE: The primary outcomes were the length of intubation and use of rescue analgesics. RESULTS: The intervention group demonstrated a decreased total opioid consumption (460.0 vs 580.0 mcg, effect size [ES] = -0.178), opioid administration time (1,130.0 vs 2,070.0 minutes, ES = -0.306), and sedative administration time (955.0 vs 1,577.0 minutes, ES = -0.354). Moreover, the protocol resulted in decreased duration of ventilation (990.0 vs 1,057.5 minutes, ES = -0.140) and reduced need for rescue analgesics, including flurbiprofen axetil (3.5 vs 34.5 percent, ES = -0.392) and loxoprofen sodium (19.5 vs 48.1 percent, ES = -0.284). CONCLUSION: This study suggested that acetaminophen reduces opioid use and improves patient outcomes after cardiovascular surgery. Moreover, this research provides essential information for developing analgesic management strategies to reduce opioid consumption in patients after cardiovascular surgery.

Suffering and Attitudes Toward Death of Patients With Heart Failure in Japan: A Grounded Theory Approach.

Early palliative care is needed for patients with heart failure (HF). However, little is known about the suffering and attitudes toward death of these patients before they reach end-stage HF. This study aimed to identify the suffering and attitudes toward death of patients with early- and intermediate-stage HF. Our qualitative research process was guided with a grounded theory approach and consolidated criteria for reporting qualitative research. Participants were selected through theoretical sampling. Data were collected through semistructured interviews, participant observations, and medical records examination. The study included 10 patients. Analysis of the data revealed the core category of "evaluating whether HF hinders the current and future self." From this core category, 6 categories of causal conditions and 3 categories of consequences emerged. Participants with HF evaluated the causal conditions and suffering in the context of how they hindered the ideal state. After recognizing their own suffering, they expressed specific attitudes toward death. The 10 categories revealed in this study elucidate the process by which patients with HF form their attitudes toward death based on suffering. Health care professionals should consider these findings to help facilitate early palliative care interventions.