Nursing home nurses conceptualize how to care for residents with cardiac vulnerability.

BACKGROUND: With ageing, older people face cardiovascular problems as the major cause of disability and death. Although immediate medical attention is a major factor in determining outcomes of cardiac problems, lack of personnel (i.e. registered nurse, certified nursing assistant and home care aide) in nursing homes without residing doctor limits the awareness of such problems, thus making it difficult to initiate timely and appropriate intervention. AIM: The aim of this study was to conceptualize critical care for nursing home residents with cardiac vulnerability and develop practical knowledge in nursing practice. METHODS: Conventional content analysis was performed on date from interviews with 30 nurses from 10 nursing homes in South Korea between July and November 2010. RESULTS: The analysis revealed three major cardiac problems resulting from residents' cardiac vulnerability: angina, myocardial infarction (MI) and cardiogenic shock. Through content analysis, we extracted 6 themes and 21 subthemes for nurses' conceptualization of critical care for nursing home residents with cardiac vulnerability. In nursing homes without a residing doctor, nurses assessed the physical, functional and cognitive conditions along with the responses and symptoms of residents when emergency situations related to the cardiac problems occurred. Moreover, with a lack of infrastructures of a hospital, nurses provided critical care to the elderly by using personal practice strategies based on their personal experience in facilities along with practical knowledge of nurses while following the management principles of emergencies. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: We found that nurses conceptualized critical nursing care for cardiac problems at nursing homes, which are different from those of general hospitals. The results of this study will provide basis for the development of care guidelines and educational materials that can be used by novice nurses or nursing students.

An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial.

BACKGROUND: Most people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention. METHODS: This was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale. RESULTS: Two hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms. CONCLUSIONS: A larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN60618114 (assigned 27.05.2011).

The effects of topical heat therapy on chest pain in patients with acute coronary syndrome: a randomised double-blind placebo-controlled clinical trial.

AIMS AND OBJECTIVES: To investigate the effects of local heat therapy on chest pain in patients with acute coronary syndrome. BACKGROUND: Chest pain is a very common complaint in patients with acute coronary syndrome. It is managed both pharmacologically and nonpharmacologically. Pharmacological pain management is associated with different side effects. DESIGN: This was a randomised double-blind placebo-controlled clinical trial conducted in 2013. METHODS: A convenience sample of 66 patients with acute coronary syndrome was selected from a coronary care unit of a local teaching hospital affiliated to Gonabad University of Medical Sciences, Gonabad, Iran. Patients were randomly assigned to either the experimental or the placebo group. Patients in the experimental and the placebo groups received local heat therapy using a hot pack warmed to 50 and 37 °C, respectively. We assessed chest pain intensity, duration and frequency as well as the need for opioid analgesic therapy both before and after the study. The study instrument consisted of a demographic questionnaire, the McGill Pain Questionnaire, and a data sheet for documenting pain frequency and duration as well as the need for analgesic therapy. FINDINGS: The placebo heat therapy did not significantly decrease the intensity, the duration and the frequency of pain episodes. However, pain intensity, duration and frequency in the experimental group decreased significantly after the study. Moreover, the groups differed significantly in terms of the need for opioid analgesic therapy neither before nor after the intervention. CONCLUSION: Local heat therapy is an effective intervention for preventing and relieving chest pain in patients with acute coronary syndrome. RELEVANCE TO CLINICAL PRACTICE: Effective pain management using local heat therapy could help nurses play an important role in providing effective care to patients with acute coronary syndrome and in minimising adverse effects associated with pain medications.

Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life.

BACKGROUND: Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients. AIMS: The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP. METHODS: This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up. RESULTS: Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment. CONCLUSION: Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

Randomized controlled trial of a lay-facilitated angina management programme.

AIMS: This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). BACKGROUND: Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. DESIGN: A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. METHODS: Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. RESULTS: There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: anxiety; depression; and angina misconceptions. The intervention was considered cost-effective. CONCLUSION: The angina management programme produced some superior benefits when compared to advice from a specialist nurse.

Effectiveness of music interventions for women with high anxiety during coronary angiographic procedures: a randomized controlled.

The purpose was to investigate if women with high pre-procedural anxiety reported higher degree of relaxation and comfort if listening to music during coronary angiographic procedures. A prospective randomized controlled trial was used included 68 patients undergoing coronary angiography and/or PCI. The women were allocated to receive calming music and standard care or standard care only. Relaxation, environmental sound and discomfort associated with lying still were assessed. There was significantly more positive impression of the sound environment and less discomfort associated with lying still in women listening to music in comparison to women who received only standard care. No effect in relaxation was found.

Os cuidados do enfermeiro-acupunturista ao paciente com angina estável: uma relação rumo a integralidade da assistência: [revisão] / Cuidados del enfermero acupuntor al paciente con angina estable: una relacion hacia la integralidad de la atencion: [revisión] / Acupuncturist nurse care to the patient with stable angina: a relationship towards an integral care: [review]

Uma das atribuições do enfermeiro é prestar assistência global ao paciente, com vista à promoção e à recuperação da saúde nas esferas física, mental e emocional. No tratamento da angina estável, essa abordagem é essencial. Sua terapêutica requer um cuidado amplo e contínuo na busca da estabilidade clínica e da melhora da qualidade de vidado paciente. A inserção da acupuntura, que reduz o estresse, a ansiedade e aumenta o bem-estar físico e emocional, é uma alternativa. Pesquisas científicas demonstram que sua ação no organismo induz a liberação de neurotransmissores que atuam no tônus vascular e nas doenças cardiovasculares, como a angina pectóris. O objetivo com este estudo foi identificar as relações da acupuntura com os cuidados do enfermeiro-acupunturista ao paciente com angina estável,buscando uma correlação entre o tratamento tradicional e complementar para essa patologia. Espera-se, também,contribuir para a reflexão dos profissionais de saúde, em especial do enfermeiro-acupunturista, sobre as novas perspectivas de tratamento da angina estável. Trata-se de uma revisão teórica realizada em bancos de dados do BVS,LILACS, SCIELO, BIREME e MEDLINE, com quinze artigos, sete livros, uma tese, quatro manuais e uma resolução. Em face dos resultados obtidos e da abordagem terapêutica integral da acupuntura, foi possível associá-la aos cuidados do enfermeiro no campo da integralidade da atenção. A inserção da acupuntura nos cuidados do enfermeiro requer capacitação para sua aplicação.

One of the nurse’s attributions is to give global assistance to the patient, having in mind the promotion and recovery of their physical, mental and emotional health. This approach is essential when treating stable angina pectoris. Its therapeutic requires a wide and continuous care that aims to maintain clinical stability and improve the patient’s quality of life. An alternative is the use of acupuncture to reduce stress and anxiety and to increase emotional and physical well being. Scientific researches demonstrate that this therapy encourages the release of neurotransmitters that act in the vascular tone and cardiovascular illnesses such as angina pectoris. This study tries to identify the relationship between the acupuncture practiced by an acupuncturist nurse and the patient with stable angina and attempts an association between the traditional and complementary treatments to this pathology. It also aims to make a contribution to the discussion and reflection of health professionals specially the acupuncturist nurses, about the perspectives of the new treatment to the stable angina. It is a theoretical review paper performed on BVS, LILACS, SCIELO, BIREME and MEDLINE,with fifteen articles, seven books, a thesis, four manuals and a resolution. According to the obtained results and the acupuncture integral therapeutic approach, it was possible to associate this treatment to the nursing care in the field of the integral medical care. Introducing acupuncture therapy into the nursing care requires qualification.

Una de las atribuciones del enfermero es ofrecer atención integral al paciente con el objeto de promover y recuperar su salud física, mental y emocional. Tal enfoque es esencial en el tratamiento de la angina estable. Su terapéutica exige cuidados amplios y continuos con miras a mantener la estabilidad clínica y mejorar la calidad de vida del paciente.La inserción de la acupuntura, que disminuye el estrés y la ansiedad y aumenta el bienestar físico y emocional, es una alternativa. Investigaciones científicas demuestran que su acción sobre el organismo induce a la liberación deneurotransmisores que actúan en el sistema cardiovascular y en enfermedades como la angina de pecho. El objetivo de este trabajo ha sido identificar las relaciones de la acupuntura con los cuidados del enfermero acupuntor al pacientecon angina estable, buscando la relación entre el tratamiento tradicional y el complementario para esta patología.Además, se espera contribuir a la reflexión de los profesionales de salud, en especial del enfermero acupuntor, sobre las nuevas perspectivas del tratamiento de la angina estable. Se trata de una revisión teórica de quince artículos, siete libros, una tesina, cuatro manuales y una resolución realizada en bancos de datos de BVS, LILACS, SCIELO, BIREME y MEDLINE. Como consecuencia de los resultados obtenidos y del enfoque terapéutico integral de la acupuntura, se laha podido asociar a los cuidados del enfermero en el campo de la integralidad de la atención. Se requiere capacitación para aplicar la acupuntura dentro de los cuidados del enfermero.

Angina following percutaneous coronary intervention: in-stent restenosis.

Percutaneous coronary intervention (PCI) represents a technical advance in the treatment of coronary artery disease. However, it is not without risks both during and after the procedure. In-stent restenosis (ISR) is the most common complication following PCI. Individuals who experience angina associated with ISR often fail to recognize its seriousness and, therefore, do not respond appropriately to the situation. Individuals with ISR are vulnerable to the consequences of angina, including increased morbidity and mortality, as well as a decreased health-related quality of life. In this article, the authors review the risks for developing ISR, the pathophysiology of angina related to ISR, and the challenges that face patients who develop recurrent angina post-PCI. Cardiovascular nurses play a critical role in the clinical management and education of patients following PCI. The provision of post-PCI follow-up care is key to identifying, managing, and supporting patients with recurrent angina.

Heart felt approach.

Although a comparatively common condition, there is only one unit in the country which specialises in care of patients with angina.

The effect of music intervention in relation to gender during coronary angiographic procedures: a randomized clinical trial.

Several studies have evaluated music interventions prior and after coronary angiography and percutaneous coronary intervention (PCI), but there is no clear evidence showing that music has an effect on patients during these procedures. The purpose was to investigate the effects of music on anxiety, angina, pain, relaxation, and comfort in patients during angiographic procedures and to evaluate gender differences. The study was a four-armed, prospective randomized controlled trial included 240 patients undergoing coronary angiography and/or PCI. Patients were allocated to receive relaxing music, MusiCure or standard care during the procedure. Outcome measures were; puncture pain and the discomfort related to it, angina and the discomfort related to it, anxiety, experience of the sound environment, discomfort of lying still, and the doses of anxiolytics and analgesics during the procedure. No differences were found between the music and control groups regarding any of the trial endpoints or gender-related differences. The overall rating of the sound environment and feeling of relaxation was high. In conclusion, music intervention in patients undergoing angiographic procedures was highly feasible, but not effective in this study though the delivery of music went smoothly and did not disturb the examination and patients and staff alike looked favorably on it.

Metabolic therapeutics in angina pectoris: history revisited with perhexiline.

The ever-increasing burden of ischaemic heart disease and its common manifestation chronic angina pectoris calls for the exploration of other treatment options for those patients who despite the maximum conventional pharmacological and surgical interventions continue to suffer. Such exploration has led to the increasing use of new metabolically acting antianginal agents and the re-emergence of an old and somewhat forgotten pharmacological agent, perhexiline maleate. This review aims to update the cardiac nurse with knowledge to manage the care a patient receiving perhexiline maleate treatment and provide a brief review of three new metabolic agents: trimetazidine, ranolazine and etomoxir.

Relationship between illness representation and self-efficacy.

AIM: This paper reports a patient survey exploring the possible relationship between illness perception and self-efficacy following a cardiac event, and the implications this could have for nursing practice. BACKGROUND: Cardiac rehabilitation guidelines endorse the need to improve psychological care; suggesting that individualized support will improve the effectiveness of cardiac rehabilitation. Surveys, however, continue to identify that psychosocial factors are poorly assessed. Illness representation and self-efficacy are two prominent research approaches that have been developed as separate foci for the treatment of patients. METHOD: A cross-sectional survey with patients diagnosed with either myocardial infarction or angina over an 8-month period in two hospitals. The Illness Perception Questionnaire, General Self-Efficacy Questionnaire, Cardiac Diet Self-efficacy Instrument and Cardiac Exercise Self-efficacy Instrument were used, alongside two specifically-designed scales: the Diet Outcome Expectation and Exercise Outcome Expectation Scales. RESULTS: The results indicate that there is a significant relationship between illness perception and self-efficacy. The greater patients' perceived consequences of the heart condition, the lower was the general self-efficacy available to cope with the condition. Further, the longer the perceived time the condition will affect the patient, the higher the specific self-efficacy to maintain a change of diet or exercise regime. CONCLUSION: The findings identify that, in the initial phase of recovery, nursing practice needs to focus on the key variables of "consequence" and "timeline" in order to increase patients' confidence in their ability to cope (self-efficacy).

The nursing assessment and management of patients with angina.

Coronary heart disease (CHD) is a growing problem in the UK. Angina is just one way that CHD manifests itself in the patient, thus challenging the approach that healthcare professionals use to manage these patients. With approximately 2-4% of all accident and emergency admissions presenting with chest pain, it is important that nurses, who are often the first healthcare professionals to assess the patient, have the appropriate knowledge and expertise to distinguish the aetiology of the chest pain. With CHD being the main cause for illness and death in the UK, it is inevitable that nurses at some point in their career will need to assess and manage patients with this presentation.