Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry.

BACKGROUND: Wide interhospital variations exist in cardiovascular intensive care unit (CICU) admission practices and the use of critical care restricted therapies (CCRx), but little is known about the differences in patient acuity, CCRx utilization, and the associated outcomes within tertiary centers. METHODS: The Critical Care Cardiology Trials Network is a multicenter registry of tertiary and academic CICUs in the United States and Canada that captured consecutive admissions in 2-month periods between 2017 and 2022. This analysis included 17 843 admissions across 34 sites and compared interhospital tertiles of CCRx (eg, mechanical ventilation, mechanical circulatory support, continuous renal replacement therapy) utilization and its adjusted association with in-hospital survival using logistic regression. The Pratt index was used to quantify patient-related and institutional factors associated with CCRx variability. RESULTS: The median age of the study population was 66 (56-77) years and 37% were female. CCRx was provided to 62.2% (interhospital range of 21.3%-87.1%) of CICU patients. Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST-elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. The unadjusted in-hospital mortality (median, 12.7%) was 9.6%, 11.1%, and 18.7% in low, intermediate, and high CCRx tertiles, respectively. No clinically meaningful differences in adjusted mortality were observed across tertiles when admissions were stratified by the provision of CCRx. Baseline patient-level variables and institutional differences accounted for 80% and 5.3% of the observed CCRx variability, respectively. CONCLUSIONS: In a large registry of tertiary and academic CICUs, there was a >4-fold interhospital variation in the provision of CCRx that was primarily driven by differences in patient acuity compared with institutional differences. No differences were observed in adjusted mortality between low, intermediate, and high CCRx utilization sites.

Moral distress among critical care nurses before and during the COVID-19 pandemic: A systematic review.

Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.

Respuesta emocional de pacientes cardiológicos en estado crítico durante la higiene en cuidados intensivos: estudio prospectivo y descriptivo / Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study / Resposta emocional de pacientes cardiológicos críticos durante a higiene em cuidados intensivos: um estudo prospectivo e descritivo

Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.

Objective: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. Method: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. Results: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. Conclusion: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Objetivo: analisar a resposta emocional de pacientes críticos conscientes durante a higiene diária em uma unidade de terapia intensiva cardíaca e compará-la considerando ou não as experiências prévias. Método: estudo prospectivo e descritivo. Foi aplicado questionário ad hoc de 30 itens a 148 pacientes, com base na higiene do primeiro dia. Foram feitas perguntas sobre sentimentos durante a higiene e aspectos positivos e negativos da experiência. Os pacientes foram comparados considerando o fato de terem sido higienizados anteriormente. Resultados: 67,6% eram homens e a idade média foi de 67±15 anos. 45,9% apresentavam conformismo, 27% se sentiram envergonhados e 86,3% estavam gratos por terem conversado com eles durante a higiene; 33,1% dos pacientes acamados nunca haviam recebido cuidados de higiene no leito, eram significativamente mais jovens e solteiros, e tinham um senso de limpeza mais baixo; 32% expressaram que gostariam que um membro da família ajudasse na higiene. Conclusão: os pacientes não se sentiram invadidos em sua intimidade quando receberam os cuidados de higiene e apreciaram a comunicação com o pessoal de saúde durante o procedimento. Os pacientes que não tinham recebido cuidados de higiene no leito anteriormente são mais jovens, sentem-se mais constrangidos e mais incomodados pelas interrupções, sendo mais conscientes delas.

Family Engagement in the Adult Cardiac Intensive Care Unit: A Survey of Family Engagement Practices in the Cardiac Critical Care Trials Network.

BACKGROUND: Cardiovascular and critical care professional societies recommend incorporating family engagement practices into routine clinical care. However, little is known about current family engagement practices in contemporary cardiac intensive care units (CICUs). METHODS: We implemented a validated 12-item family engagement practice survey among site investigators participating in the Critical Care Cardiology Trials Network, a collaborative network of CICUs in North America. The survey includes 9 items assessing specific engagement practices, 1 item about other family-centered care practices, and 2 open-ended questions on strategies and barriers concerning family engagement practice. We developed an engagement practice score by assigning 1 point for each family engagement practice partially or fully adopted at each site (max score 9). We assessed for relationships between the engagement practice score and CICU demographics. RESULTS: All sites (N=39; 100%) completed the survey. The most common family engagement practices were open visitation (95%), information and support to families (85%), structured care conferences (n=82%), and family participation in rounds (77%). The median engagement practice score was 5 (interquartile range, 4). There were no differences in engagement practice scores by geographic region or CICU type. The most commonly used strategies to promote family engagement were family presence during rounds (41%), communication (28%), and family meetings (28%). The most common barriers to family engagement were COVID-related visitation policies (38%) and resource limitations (13%). CONCLUSIONS: Family engagement practices are routinely performed in many CICUs; however, considerable variability exists. There is a need for strategies to address the variability of family engagement practices in CICUs.

Development of the sleep quality scale for coronary care patients (SQ-CC).

OBJECTIVES: In this study, it was aimed to develop a valid and reliable measurement instrument to measure sleep quality in coronary care patients. RESEARCH METHODOLOGY/DESIGN: This is a methodological study that was carried out with 201 patients at the coronary care unit of a university hospital. The validity and reliability of the scale were tested using exploratory and confirmatory factor analyses, Cronbach's alpha analysis, and Pearson's correlation analysis. RESULTS: The scale's Cronbach's alpha coefficient was found to be 0.816. There were significant positive relationships between the overall scale and its dimensions. The Pearson's correlation analysis showed a significant negative relationship between the Sleep Quality Scale for Coronary Care Patients and the Richards-Campbell Sleep Questionnaire. CONCLUSION: The Sleep Quality Scale for Coronary Care Patients was determined to be a valid and reliable measurement instrument for assessing the sleep quality of patients who are receiving care in coronary care units. IMPLICATIONS FOR CLINICAL PRACTICE: The scale that was developed in this study can be applied to coronary care patients because it is easy to implement and specific to intensive care settings. This way, the sleep quality levels of patients can be assessed quickly, and nursing interventions for potential problems can be defined. Hence, the emergence of sleep-related health problems can be prevented. Although RCSQ is the most commonly used scale to evaluate the sleep quality of patients treated in the intensive care unit, SQ-CC is thought to be more inclusive in considering noise-, environment-, and patient-related subjective factors. The evaluation of environmental factors can also provide objective data for improvements to be made to eliminate these factors in clinics. Furthermore, the use of this scale in national and international scientific studies where the sleep quality of coronary care patients is evaluated will contribute to not only our colleagues but also the relevant scientific field.

Association of Multiple Cardiovascular Risk Factors with Musculoskeletal Function in Acute Coronary Syndrome Ward Inpatients.

This study explored the association of multiple risk factors with musculoskeletal function in adults hospitalized for acute coronary syndrome. Sixty-nine inpatients (55 ± 6 years; 67% male) admitted to the cardiology ward within <12 h were assessed regarding stress, smoking, alcoholism, hypertension, diabetes mellitus, and obesity. The musculoskeletal function was assessed by predicted values of handgrip strength of the dominant hand (HGS-D%) and maximal inspiratory and expiratory pressures (MIP% and MEP%, respectively). After adjustment by age and sex, drinking habits showed the strongest linear association with the total number of cardiovascular disease risk factors [standardized ß, p-value] (ß = 0.110, p < 0.001), followed by smoking load (ß = 0.028, p = 0.009). Associations were also observed for HGS-D% with mean blood pressure (ß = 0.019 [0.001; 0.037], p = 0.048); MIP% with mean blood pressure (ß = 0.025 [0.006; 0.043], p = 0.013); and MEP% with drinking habits (ß = 0.009 [0.002; 0.016], p = 0.013) and body mass index (ß = 0.008 [0.000; 0.015], p = 0.035). Peripheral and respiratory muscle strength must be interpreted in the context of its association with cardiovascular disease risk factors in adults hospitalized for acute coronary syndrome.

The effect of a family-based participatory care program on anxiety in patients with acute coronary syndrome in coronary care units: A randomised controlled clinical trial.

BACKGROUND: Admission to the coronary care units (CCUs) and the patient's reduced interaction with family are regarded as important sources of anxiety. Family participation in care programs is pivotal to patient outcomes. OBJECTIVES: The present study was conducted to determine the effect of a care program based on family participation on anxiety in patients with acute coronary syndrome. METHODS: This randomised controlled trial was conducted on 90 patients in CCUs and their families. The patients were randomly assigned to one of the following three groups: routine care, control, and intervention. Routine care measures were provided to the routine care group, increased participation of the family was ensured in the control group, and a family-based participatory care program was implemented in the intervention group with the interaction of the nurse, patient, and family based on five principles, including presence, determination of needs, communication, participation in decision-making, and cooperation in care. The patients' anxiety was measured in the three groups on day 1 and 3 days after the admission to the CCU using the Spielberger State-Trait Anxiety Inventory. RESULTS: The patients' mean state anxiety score before the intervention was 44.4 ± 12.7, 46.6 ± 12.4, and 45.5 ± 12.1 in the routine care, control, and intervention groups, respectively, with no significant differences between them (P = 0.81). After adjusting for anxiety before the intervention and study hospital, the mean (before-after) changes in anxiety score in the three groups showed that anxiety was significantly lower in the intervention group than in the other groups (P < 0.05). CONCLUSION: Increased family presence alone has no effect on the patients' anxiety, but the family's participation and interaction with the care team can affect anxiety levels in cardiac patients in CCUs and improve the care processes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, Trial No. IRCT201105146481N1.

[Adherence to the Clinical Practice Guidelines for the hospital management of patients with decompensated heart failure in a Coronary Care Unit in Colombia]. / Adherencia a la guía de práctica clínica para el manejo hospitalario de pacientes con insuficiencia cardíaca descompensada en una unidad de cuidados coronarios de Colombia.

Objective: To assess adherence to the recommendations for the diagnosis and management of hospitalized patients with Decompensated Heart Failure issued by the European Society of Cardiology in 2021 at a Coronary Care Unit at a fourth-level hospital in the city of Bogotá. Materials and Methods: A descriptive cross-sectional study was conducted, including hospitalized patients in the Coronary Care Unit at Hospital San José in Bogotá, with a primary diagnosis of Decompensated Heart Failure, from September 2021 to January 2023. Patient data were collected from medical records. Adherence to the Decompensated Heart Failure guidelines was described in the study. Results: High adherence was observed for laboratory tests and medication prescriptions recommended by the 2021 European Society of Cardiology guidelines. However, there was low adherence to the request for thyroid function tests, troponin, and iron studies. The cause of heart failure and decompensation was adequately recorded. The most common cause of decompensation was acute coronary syndrome. Regarding the hemodynamic profile on admission, the majority presented as Stevenson B. Pharmacological adherence to Class I recommendations showed high compliance in prescribing beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and Angiotensin Receptor-Neprilysin Inhibitors. However, lower adherence was observed for Sodium-glucose co-transporter two inhibitors and Mineralocorticoid receptor antagonists. Conclusions: Variable adherence rates were recorded, emphasizing satisfactory compliance with class I recommendations for certain medications and laboratory tests. It is necessary to improve adherence in the request for paraclinicals, especially in thyroid function tests and ferrokinetic profiles.

The effects of earplugs and eye masks on sleep quality of patients admitted to coronary care units: A randomised clinical trial.

Sleep is an essential need for patients admitted to coronary care units. The present clinical trial aimed to determine the effect of using eye masks and earplugs on the sleep quality of patients with coronary heart disease (CHD). A total of 68 eligible patients with CHD were randomly allocated into four groups of 17 (control, eye masks, earplugs, and eye masks with earplugs). All three interventions were performed during the night from 10:00 p.m. to 7:00 a.m. the next day. The outcomes were the quality of sleep, measured by the Verran and Snyder-Halpern (VSH) Sleep Scale, and the urinary levels of nocturnal melatonin and cortisol, measured by urine samples taken during the night (from 10:00 p.m. to 7:00 a.m.). The study outcomes were measured on the third and fourth days. Sleep disturbance was statistically significantly lower in patients with earplugs (visual analogue scale mean difference [MD]: 74.31 mm, SE: 11.34, p = 0.001). Sleep effectiveness was statistically significantly higher in patients with eye mask (MD: 36.88 mm, SE: 8.75, p = 0.001). The need for sleep supplementation was statistically significantly lower in patients with eye masks (MD: 39.79 mm, SE: 7.23, p = 0.001). There was a significant difference in melatonin levels between eye masks and the control group (p = 0.03). For urinary cortisol levels, there were significant differences between eye masks and the control group (p = 0.007), earplugs and the control group (p = 0.001), and eye masks with earplugs and the control group (p = 0.006). The mean scores for comfort, effectiveness, and ease of use were highest for the group that used eye masks (2.88, 2.94, and 3.18, respectively). As a result, all three interventions improved the sleep quality of patients. However, the interventions had different effects on the three dimensions of the VSH Sleep Scale, as well as the urinary levels of cortisol and melatonin.

Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study.

Background: Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses. Materials and Methods: Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self-efficacy. Conclusion: There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses' CR skills.

Effective strategies for implementing patient-centered care in cardiac care unit: An opportunity for change.

BACKGROUND: Patient-centered care (PCC) is a cornerstone for health-care professionals to improve the quality of care they provide to patients with cardiac disease. However, implementation of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore, the present study was conducted to determine effective strategies for the implementation of PCC from the perspective of patients and healthcare providers. MATERIALS AND METHODS: The present research was a qualitative study using conventional content analysis method in one of the university hospitals of Abadan University of Medical Sciences during 2019-2020. Purposive sampling was performed until data saturation was achieved. Data were collected through four focused group discussions and 24 in-depth semi-structured interviews with 22 health-care providers and seven cardiac patients. Depending on the interview process and the responses of each individual, the sequencing of questions was different from one participant to another. Data analysis was performed continuously and concurrently with data collection, using a comparative method. RESULTS: After data analysis, seven subcategories and three main categories were extracted. The main categories included structural, process, and outcome strategies. The category of structural strategies included subcategories of nursing care organization, application of appropriate motivational mechanisms, and expansion of team coordination. Process strategies included three subcategories, namely, promoting communication, respectful and compassionate care, and the development of holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment. CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed in this study were at structural, process, and outcome levels. Health-care managers and administrators can avail themselves of the findings of the present study to promote the quality care for cardiac care unit patients and improve patient satisfaction.

The effect of melatonin on quality of sleep in patients with sleep disturbance admitted to post coronary care units: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: Patients with cardiovascular disease who required to be admitted in coronary care units (CCU) would have sleep deprivation. During the admission some factors such as continuous ambient light exposure can suppress melatonin release, in consequence sleep deprivation will be occurred and hinder the progress of patients' treatment. The aim of study was to evaluate the effect of melatonin on the sleep quality of patients admitted to post-CCU. MATERIALS AND METHODS: This randomized clinical trial was carried out on 110 patients admitted to post-CCU at SayyadeShirazi Hospital, Gorgan, Iran. Patients with a poor sleep quality (Pittsburgh sleep quality index (PSQI) global score>5) were randomly allocated into two intervention and placebo groups. Patients in the intervention group received melatonin (3 mg; 30 minutes before bedtime), and the placebo group received placebo for 2 weeks, and their sleep quality was re-evaluated after the end of intervention. Data were analyzed using paired t test, Wilcoxon, and Chi-square tests by SPSS version 21. RESULTS: The results showed that mean of the patients' PSQI scores decreased significantly in intervention group (from 14.95 ± 1.48 to 11.65 ± 1.50, P < 0.001), while in placebo group the difference was not significant (from 15.48 ± 1.47 to 15.24 ± 1.71, P = 0.129). Post-intervention score of patients in intervention group was also lower than the placebo group (P < 0.001). CONCLUSION: The melatonin can improve the sleep quality of the patients admitted to post-CCU who suffer from sleep disturbance.

Constructing a predictive risk score for the needs of coronary care unit care in patients with ST-segment elevation myocardial infarction / 中国医师进修杂志

Objective:To construct a risk prediction score for the needs of coronary care unit (CCU) care in stable condition acute ST-segment elevation myocardial infarction (STEMI) patients who receive percutaneous coronary intervention (PCI) treatment.Methods:The clinical data of 805 STEMI patients who accepted PCI in the First Hospital of Jilin University from November 2017 to October 2018 were retrospectively analyzed. Among the patients, 654 patients from November 2017 to July 2018 were served as the modeling group, the patients with needs of CCU had 125 cases, and the patients without needs of CCU had 529 cases; 151 patients from August 2018 to October 2018 were served as the validation group, the patients with needs of CCU had 28 cases, and the patients without needs of CCU had 123 cases. Binary Logistic regression analysis was used to establish the risk prediction model and determine the score standards. The critical value was determined according to the best Youden index of receiver operating characteristic (ROC) curve.Results:Among 805 patients with STEMI, 153 cases (19.01%) had the needs of CCU, and the most common reason was pump failure (heart failure and cardiogenic shock, 113 cases). In the modeling group, age (60 to 74 years old, OR = 1.513, 95% CI 0.945 to 2.424, P = 0.085; ≥75 years old, OR = 2.740, 95% CI 1.371 to 5.478, P = 0.004), total ischemic time>4 h ( OR = 1.701, 95% CI 1.022 to 2.831, P = 0.041), admission shock index ≥0.8 ( OR = 1.910, 95% CI 1.178 to 3.099, P = 0.009), multi-vessel disease ( OR = 2.090, 95% CI 1.272 to 3.432, P = 0.004), preoperative diseased vessels thrombolysis in myocardial ischemia (TIMI) blood flow grade 0 ( OR = 2.099, 95% CI 1.313 to 3.353, P = 0.002), acute anterior myocardial infarction ( OR = 3.696, 95% CI 2.347 to 5.819, P<0.001) and previous history of stroke ( OR = 3.927, 95% CI 2.057 to 7.500, P<0.001) were independent risk factors for CCU needs in STEMI patients undergoing PCI. The scoring criteria were as followings: age<60 years old was given 0 score, 60 to 74 years old 1 score, ≥75 years old 2 score; total ischemic time>4 h in 1 score, admission shock index ≥0.8 2 scores, multi-vessel disease 2 scores, preoperative diseased vessels TIMI blood flow grade 0 2 scores, acute anterior myocardial infarction 3 scores, previous history of stroke 3 scores, and the total score was 15 scores. The patients with 0 to 6 scores were low-risk, and the patients with 7 to 15 scores were high-risk. ROC curve analysis result showed that, in modeling group, the area under curve (AUC) of risk prediction score for predicting the needs of CCU in STEMI patients was 0.740 (95% CI 0.692 to 0.788, P = 0.580); in validation group, the AUC of risk prediction score for predicting the needs of CCU in STEMI patients was 0.755 (95% CI 0.658 to 0.853, P = 0.755). Conclusions:A predictive risk score based on seven risk factors such as age, total ischemic time, admission shock index, multi-vessel disease, preoperative diseased vessels TIMI blood flow grade, acute anterior myocardial infarction and previous history of stroke is constructed in order to predict the needs of CCU in STEMI patients with stable condition who receive PCI treatment. It can be used to help doctors to identify high-risk patients before the admission to CCU, thus providing simple and practical clinical tool for rational allocation of limited CCU resources.

Anxiety in Relatives of Patients Admitted to Cardiac Care Units and its Relationship with Spiritual Health and Religious Coping.

OBJECTIVES: This work sought to determine the level of anxiety in relatives of patients admitted to CCUs and its relationship with spiritual health and religious coping. METHODS: This cross-sectional study was conducted on 300 relatives of Cardiac Care Units patients in Jahrom, Iran. Required data was collected using the Spielberger State-Trait Anxiety Inventory (STAI), the Paloutzian-Ellison Spiritual Well Being Scale (SWBS), and the Pargament Brief RCOPE questionnaire. RESULTS: The results showed that both levels of state and trait anxiety were moderate and the level of total spiritual health was high. Anxiety score had an inverse relationship with spiritual health (r=-0.52) and a direct relationship with negative religious coping score (r=0.25). However, no significant relationship was found between total anxiety score and positive religious coping (p < 0.05). There was a direct relationship between spiritual health and positive religious coping (r=0.19), and an inverse relationship between spiritual health and negative religious coping (r=-0.36). CONCLUSIONS: According to the findings of the study, it is suggested to paying attention to the reinforcement of spiritual attitudes, beliefs, and religious coping strategies to reduce their anxiety in CCU patients.

Disturbed sleep pattern (000198): content analysis in patients with acute coronary syndrome / Patrón de sueño perjudicado (000198): análisis de contenido en pacientes internados con síndrome coronario agudo / Padrão de sono prejudicado (000198): análise de conteúdo em pacientes internados com síndrome coronariana aguda

ABSTRACT Objective: to analyze the content of the defining characteristics of the Disturbed Sleep Pattern Nursing Diagnosis (00198) in patients with Acute Coronary Syndrome. Method: content analysis performed by specialists who achieved a score equal to or greater than five, according to established criteria: clinical experience, teaching and/or research; participation in research groups; doctorate degree; master's degree; specialization and/or residency in cardiology and/or sleep and/or nursing classifications. Eight defining characteristics were evaluated for their relationship to population, relevance, clarity and accuracy. Descriptive statistics were performed to characterize the sample, binomial statistical test to establish if there is agreement between the experts and chi-square and Fisher's exact to establish associations between the evaluated items and the experts' variables. Results: 54 experts participated in the study. The defining characteristics validated by the experts were the following: dissatisfaction with sleep, feeling unrested, sleep deprivation, alteration in sleep pattern, unintentional awakening, difficulty initiating sleep and daytime sleepiness. There was a statistically significant association between evaluated items and the variables time of training, time of operation and punctuation. Conclusion: seven of the eight defining characteristics were considered valid after the application of binomial test. This study will contribute to the refinement of the Disturbed Sleep Pattern Nursing Diagnosis (000198) and may enable the improvement of the quality of care of patients hospitalized with Acute Coronary Syndrome regarding changes in sleep pattern. The content analysis stage will support the next stage of the validation process of the present diagnosis, the clinical validation.

RESUMEN Objetivo: analizar el contenido de las características definidoras del Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (00198) en pacientes con Síndrome Coronario Agudo. Método: análisis de contenido realizado por especialistas que obtuvieron una puntaje mayor o igual a cinco, de acuerdo con los criterios establecidos: experiencia clínica, en docencia y/o en investigación; participación en grupos de investigación; doctorado; maestría; especialización y/o residencia en cardiología y/o en clasificaciones de enfermería. Se evaluaron ocho características definidoras en cuanto a su relación con la población, relevancia, claridad y precisión. Se realizó un análisis estadístico descriptivo para caracterizar la muestra, una prueba estadística de binomios para establecer si había concordancia entre los especialistas y las pruebas de chi-cuadrado y exacto de Fisher para establecer asociaciones entre los puntos evaluados y las variables de los especialistas. Resultados: del estudio participaron 54 especialistas. Las características definidoras que evaluaron los especialistas fueron las siguientes: insatisfacción con el sueño, no sentirse descansado, privación del sueño, alteración en el patrón de sueño, despertar no intencional, dificultad para iniciar el sueño y somnolencia diurna. Se registró una asociación estadística significativa entre los puntos evaluados y las siguientes variables: tiempo de formación, tiempo de ejercicio en la profesión y puntuación. Conclusión: siete de las ocho Características definidoras se consideraron válidas después de aplicar la prueba de binomios. El presente estudio contribuirá a perfeccionar el Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (000198) y podrá hacer posible que se mejore la calidad de la atención de pacientes internados con Síndrome Coronario Agudo en lo referente a alteraciones en el patrón de sueño. La etapa del análisis de contenido servirá de ayuda para la próxima etapa del proceso de validación del presente diagnóstico: la validación clínica.

RESUMO Objetivo: analisar o conteúdo das características definidoras do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (00198) em pacientes com Síndrome Coronariana Aguda. Método: análise de conteúdo realizada por especialistas que atingiram pontuação igual ou maior a cinco, de acordo com critérios estabelecidos: experiência clínica, no ensino e/ou pesquisa; participação em grupos de pesquisa; doutorado; mestrado; especialização e/ou residência em cardiologia e/ou sono e/ou classificações de enfermagem. Oito características definidoras foram avaliadas quanto a sua relação com a população, relevância, clareza e precisão. Realizou-se estatística descritiva para caracterização da amostra, teste estatístico binomial para estabelecer se há concordância entre os especialistas e qui-quadrado e exato de Fisher para estabelecer associações entre os itens avaliados e variáveis dos especialistas. Resultados: 54 especialistas participaram do estudo. As características definidoras validadas pelos especialistas foram: insatisfação com o sono, não se sentir descansado, privação do sono, alteração do padrão de sono, despertar não intencional, dificuldade para iniciar o sono e sonolência diurna. Houve associação estatística significativa entre itens avaliados e as variáveis tempo de formação, tempo de atuação e pontuação. Conclusão: sete das oito características definidoras foram consideradas válidas após aplicação de teste binomial. O presente estudo contribuirá para o refinamento do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (000198) e poderá possibilitar a melhoria da qualidade do atendimento de pacientes internados com Síndrome Coronariana Aguda no que tange a alterações do padrão de sono. A etapa de análise de conteúdo subsidiará a próxima etapa do processo de validação do presente diagnóstico, a validação clínica.

Effect of Programmed Family Presence in Coronary Care Units on Patients' and Families' Anxiety.

Introduction: Hospitalization of patients in the intensive care units always has negative consequences such as anxiety and concern for patients and their families. This study aimed to investigate the effect of programmed family presence in intensive care units on patients' and families' anxiety. Methods: This was a quasi-experimental study conducted in Iran. The eligible patients and a member of their families were assigned into two groups (N = 80) through convenience sampling. The family members in the experimental group were allowed to attend twice a day for 15 minutes in a planned way beside the patient and contribute to their clinical primary care. In the control group, the family members had a strict limitation to visit their patients based on the usual policy. Anxiety in both groups at the beginning and on the third day of patient's admission was measured, using Spielberger's questionnaire. The data were analyzed with SPSS version13. Results: The mean score of anxiety in the control group did not show significant difference in patients and in families, however it had decreased significantly in the experimental group after the intervention for both patients and families. The results showed that mean differences between the two groups was statistically significant in patients and families. Conclusion: The planned presence of the family of patients in coronary care unit (CCU) played a crucial role in reducing the anxiety of patients and their family. Furthermore, it is recommended that strategies of visiting policy in intensive care units (ICUs) should be revised and the possibility be provided for the families' planned presence and participation in the patient care.

Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Abstract Background: Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients. Objetive: To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed. Methods: Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher's exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05. Results: 372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison. Conclusion: After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

Specialty cardiac nurses' work satisfaction is influenced by the type of coronary care unit: A mixed methods study.

BACKGROUND: Many dedicated Coronary Care Units (CCUs) in Victoria, Australia, have been decommissioned and replaced with larger combined generic medical/cardiac precincts called hybrid units. Hybrid units are staffed with a low proportion of specialist critical care nurses. These changes may pose risks to nurse satisfaction and retention, and quality of patient care. The aims of this study were to explore specialist cardiac nurses' perceived work satisfaction across four CCUs, and differences in satisfaction between dedicated and hybrid CCUs. METHODS: This concurrent mixed methods study comprised two Phases in four Victorian CCUs (2 dedicated, 2 hybrid). In Phase 1, 74 specialist cardiac nurses completed the Professional Practice Environment (PPE) Scale. In Phase 2, 17 specialist cardiac nurses were interviewed to further explore elements of the PPE subscales. Descriptive, inferential (Phase 1), and content analyses (Phase 2) were performed. RESULTS: Survey participants' median age was 38 years (IQR 30, 45). The median PPE Scale score was 3.10 (IQR 2.90, 3.10) indicating high levels of satisfaction with their workplaces. Specialist cardiac nurses in one hybrid unit were significantly less satisfied compared with each of the other three units (p < 0.05). There were no significant differences in overall satisfaction or in any subscale of the PPE Scale between dedicated and hybrid units. Qualitative data revealed nurses in hybrid units felt they had less control over practice, lacked autonomy, had poor relationships with physicians, and experienced inadequate nurse leadership. CONCLUSIONS: Specialist cardiac nurses' workplace satisfaction overall is high, with no significant differences between dedicated and hybrid CCUs. However, the structure of specialist cardiac units and NUM leadership skill level can impact nurses' satisfaction with their workplace and collegial relationships. Strong nursing leadership that is respectful of nursing expertise and places patient safety foremost positively impacts nurses' satisfaction. Further studies should assess the impact of the types of CCUs and NUM leadership on workforce factors such as nurse retention rates and patient outcomes such as adverse events.

The effect of aerobic physical rehabilitation on the quality of life in patients with chronic atrial fibrillation; A randomized controlled clinical trial study.

BACKGROUND: Management of atrial fibrillation (AF), besides prevention of stroke, mainly stresses symptom control and improvement of quality of life (QOL). In patients with permanent AF, exercising may improve QOL, rhythm, and symptoms. The purpose of this study was to determine the impact of aerobic physical rehabilitation on the QOL of patients suffering from AF and admitted to a coronary care unit (CCU). METHODS: This randomized controlled clinical trial study was conducted on 50 patients who were hospitalized with chronic AF in the CCU of Montazeri Hospital, Najafabad, Iran, and had the inclusion criteria. The participants were selected using convenience sampling method, and were randomly divided into experimental (n = 25) and control (n = 25) groups. The experimental group received a rehabilitation program in the form of an educational package and scheduled physical activity of aerobics for 8 weeks, and the control group received CCU routine care. The researcher measured the patients' QOL before and after the intervention using the 36-Item Short Form Health Survey (SF-36). RESULTS: There was no significant difference in the mean score of total QOL between the control and experimental groups before the intervention (P > 0.050). However, the comparison of the mean score of total QOL after the intervention showed a significant increase in the experimental group (P < 0.050). CONCLUSION: Aerobic rehabilitation activities are effective on the QOL of patients with chronic AF.