Humanização do cuidado ao paciente e familiares frente as doenças e complicações cardíacas / Humanization of care for patients and families in front of heart diseases and complications / Humanización de la atención a pacientes y familias ante enfermedades y complicaciones del corazón

Introdução: Pacientes com patologias cardiovasculares apresentam comprometimento nas dimensões física, emocional e sócio espiritual devido a alterações patológicas, podendo repercutir cotidianamente no processo saúde-doença. Diante das fragilidades e possíveis complicações, cabe à equipe de enfermagem o domínio de conhecimento técnico e científico, bem como de humanização. Assim, por meio da assistência humanizada a equipe de enfermagem buscará estratégias adequadas para tratar os aspectos emocionais, sociais, psicológicos e físicos, os quais deverão ser avaliados continuamente. Objetivo: Descrever as principais práticas da equipe de enfermagem relacionadas a humanização junto aos pacientes portadores de doenças cardiovasculares e seus familiares. Material e Método: Estudo de revisão bibliográfica, descritivo, qualitativo, cuja coleta de dados foi realizada no banco de dados LiLACS, acessado por meio do portal eletrônico da Biblioteca Virtual em Saúde. Resultados: Foram utilizados cinco artigos das 2843 publicações localizadas, guiados pelos descritores que contemplavam o tema abordado e criadas pelo cruzamento das palavras-chave estabelecidas. Duas categorias temáticas: Práticas humanizadas realizadas pela equipe de enfermagem ao paciente cardíaco e Percepção do familiar em relação as práticas humanizadas realizadas pela equipe de enfermagem ao paciente cardíaco. Conclusão: A assistência, bem como bons resultados no tratamento, decorrem e tem relevância nas práticas humanizadas oferecidas pela equipe de enfermagem no atendimento de pacientes com afecções cardíacas e seus familiares.

Introduction: Patients with cardiovascular pathologies present impairment in the physical, emotional and socio-spiritual dimensions due to pathological changes, which may have daily repercussions on the health-disease process. Faced with weaknesses and possible complications, it is up to the nursing team to master technical and scientific knowledge, as well as humanization. Thus, through humanized care, the nursing team will seek appropriate strategies to deal with emotional, social,psychological and physical aspects, which should be continuously evaluated. Objective: To describe the main practices of the nursing team related to humanization with patients with cardiovascular diseases and their families. Material and Method: Bibliographic review, descriptive, qualitative study, whose data collection was carried out in the LiLACS database, accessed through the electronic portal of the Virtual Health Library. Results: Five articles from the 2843 publications located were used, guided by the descriptors that contemplated the topic addressed and created by crossing the established keywords. Two thematic categories: Humanized practices performed by the nursing team to the cardiac patient and Perception of the family member in relation to the humanized practices carried out by the nursing team to the cardiac patient. Conclusion: Assistance, as well as good treatment results, derive from and are relevant to the humanized practices offered by the nursing team in the care of patients with cardiac conditions and their families.

Introducción: Los pacientes con patologías cardiovasculares presentan afectaciones en las dimensiones física, emocional y socioespiritual debido a cambios patológicos, que pueden repercutir en el día a día del proceso salud-enfermedad. Frente a las debilidades y posibles complicaciones, corresponde al equipo de enfermería dominar los conocimientos técnicos y científicos, así como la humanización. Así, a través del cuidado humanizado, el equipo de enfermería buscará estrategias adecuadas para el enfrentamiento de los aspectos emocionales, sociales, psicológicos y físicos, que deben ser evaluados continuamente. Objetivo: Describir las principales prácticas del equipo de enfermería relacionadas con la humanización con pacientes con enfermedades cardiovasculares y sus familias. Material y Método: Revisión bibliográfica, estudio descriptivo, cualitativo, cuya recolección de datos se realizó en la base de datos LiLACS, accedida a través del portal electrónico de la Biblioteca Virtual en Salud. Resultados: Se utilizaron cinco artículos de las 2843 publicaciones localizadas, guiados por los descriptores que contemplaban el tema abordado y creados a partir del cruce de las palabras clave establecidas. Dos categorías temáticas: Prácticas humanizadas realizadas por el equipo de enfermería al paciente cardíaco y Percepción del familiar en relación a las prácticas humanizadas realizadas por el equipo de enfermería al paciente cardíaco. Conclusión: La asistencia, así como los buenos resultados del tratamiento, se derivan y son relevantes para las prácticas humanizadas ofrecidas por el equipo de enfermería en el cuidado de los pacientes con condiciones cardíacas y sus familias.

Coronavírus: pacientes cardíacos fazem parte do grupo de alto risco?

www.saopaulo.sp.gov.br/coronavirus

Identifying subgroups: Part 2: Trajectories of change over time.

Methods to identify multiple trajectories of change over time are of great interest in nursing and in related health research. Latent growth mixture modeling is a data-centered analytic strategy that allows us to study questions about distinct trajectories of change in key measures or outcomes of interest. In this article, a worked example of latent growth mixture modeling is presented to help expose researchers to the use and appeal of this analytic strategy.

Diabetes-associated cardiac autonomic neuropathy.

Cardiac autonomic neuropathy (CAN) is an underdiagnosed cardiovascular complication associated with diabetes. NPs are in a pivotal position to screen patients for CAN. As the incidence of diabetes increases in an aging population, NPs can help prevent complications associated with diabetes and CAN.

Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease.

OBJECTIVE: Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment. METHODS: Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18). RESULTS: The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality. CONCLUSIONS: Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents' overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.

Heart disease: from living to living well.

Aysha Mendes, Editor, British Journal of Cardiac Nursing, aysha.freelance@gmail.com, discusses support for patients living with heart disease.

Operationality of concepts in Heideggerian phenomenological investigation: epistemological reflection on Nursing.

OBJECTIVE: To describe the investigative path of analysis and the operationality of concepts based on Martin Heidegger's theoretical and philosophical framework. METHOD: Theoretical reflection on the phenomenon of pregnancy in a woman with heart disease. RESULTS: Stages of the investigative movement were evidenced based on the pre-reflection related to the object of study and to the search for the phenomenal meaning, using the existential and analytical Hermeneutics as the approach and resulting in the reach of the phenomenal totality. CONCLUSION: The worldview of the researcher, who considered the subjectivities of the person in a health or disease situation, favored the announcement of the referential by the object of study. Knowledge production in the light of Martin Heidegger's phenomenology unveiled phenomena lived and experienced in the Health and Nursing field, provided of epistemological rigor that demanded appropriation of concepts inherent to the existential analytics.

Advance care planning for patients and their relatives.

BACKGROUND: Advance care planning (ACP) has been suggested to improve the quality of life (QoL) and mental wellbeing in severely ill patients and their relatives. AIM: To investigate the effects of ACP among patients with lung, heart and cancer diseases with an estimated life-span of up to 12 months. METHODS: Patients and relatives were randomised into two groups: one receiving usual care and one receiving ACP and usual care. Themes from the ACP discussion were documented in patients' electronic medical file. Participants completed self-reported questionnaires four to five weeks after randomisation. FINDINGS: In total, 141 patients and 127 relatives participated. No significant differences were found according to outcomes. However, patients with non-malignant diseases had the highest level of anxiety and depression; these patients seemed to benefit the most from ACP, though not showing statistically significant results. CONCLUSION: No significant effects of ACP among patients with lung, heart, and cancer diseases and their relatives regarding HRQoL, anxiety, depression, and satisfaction with healthcare were found.

Nursing Management for Patients Postoperative Cardiac Implantable Electronic Device Placement.

As cardiac implantable electronic devices (CIEDs) continue to evolve and patients continue to live longer, the use of these devices increases. CIEDs include permanent pacemakers, implanted cardioverter-defibrillators, and cardiac resynchronization therapy devices. Over the last 2 decades, the functionality of these devices has increased and can be complex. Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative CIED placement and for patients admitted to critical care units with CIEDs already in place. Patients with CIEDs are a vulnerable population with special needs and considerations for management.

Operationality of concepts in Heideggerian phenomenological investigation: epistemological reflection on Nursing / Operación de los conceptos en investigación fenomenológica heideggeriana: reflexión epistemológica en la enfermería / Operacionalidade de conceitos em investigação fenomenológica heideggeriana: reflexão epistemológica na enfermagem

ABSTRACT Objective: To describe the investigative path of analysis and the operationality of concepts based on Martin Heidegger's theoretical and philosophical framework. Method: Theoretical reflection on the phenomenon of pregnancy in a woman with heart disease. Results: Stages of the investigative movement were evidenced based on the pre-reflection related to the object of study and to the search for the phenomenal meaning, using the existential and analytical Hermeneutics as the approach and resulting in the reach of the phenomenal totality. Conclusion: The worldview of the researcher, who considered the subjectivities of the person in a health or disease situation, favored the announcement of the referential by the object of study. Knowledge production in the light of Martin Heidegger's phenomenology unveiled phenomena lived and experienced in the Health and Nursing field, provided of epistemological rigor that demanded appropriation of concepts inherent to the existential analytics.

RESUMEN Objetivo: Describir el camino investigativo de análisis y la operación de los conceptos sostenidos en el referencial teórico-filosófico y metodológico de Martin Heidegger. Método: Reflexión teórica del fenómeno de gestar siendo mujer portadora de cardiopatía. Resultados: Se evidenciaron las etapas del movimiento de investigación a partir del pre-reflexivo relativo al objeto de estudio y de la búsqueda del sentido fenomenal hacia la hermenéutica como analítica existencial, culminando en el alcance de la totalidad fenoménica. Conclusión: La visión de mundo del investigador, que consideró las subjetividades de la persona en situación de salud o enfermedad, favoreció que el objeto de estudio anunciara el referencial. La producción de conocimiento a la luz de la fenomenología de Martin Heidegger desveló fenómenos vividos y vivenciados en el campo de la salud y de la enfermería, mediante rigor epistemológico que exigió apropiación de conceptos inherentes a la analítica existencial.

RESUMO Objetivo: Descrever o caminho investigativo de análise e a operacionalidade de conceitos sustentados no referencial teórico-filosófico e metodológico de Martin Heidegger. Método: Reflexão teórica do fenômeno de gestar sendo mulher portadora de cardiopatia. Resultados: Evidenciaram-se as etapas do movimento de investigação a partir do pré-reflexivo relativo ao objeto de estudo e da busca do sentido fenomenal na direção da hermenêutica como analítica existencial, culminando no alcance da totalidade fenomênica. Conclusão: A visão de mundo do investigador, que considerou as subjetividades da pessoa em situação de saúde ou doença, favoreceu que o objeto de estudo anunciasse o referencial. A produção de conhecimento à luz da fenomenologia de Martin Heidegger desvelou fenômenos vividos e vivenciados no campo da saúde e da enfermagem, mediante rigor epistemológico que exigiu apropriação de conceitos inerentes à analítica existencial.

Effectiveness of early identification and electronic interventions for teens with risk factors for the development of heart disease and diabetes: Phase II findings.

BACKGROUND AND PURPOSE: Serum and physical risk factors for the development of heart disease and diabetes are detectable long before adulthood. The purpose of this two-part study was to assess the prevalence and associations of these risk factors in teens and determine the effectiveness of a customizable two-part electronic education program on minimizing identified risks. METHODS: Data were collected from teens (n = 168) from two high schools (one urban and one rural) in the mid-Atlantic region. After baseline data were collected, the two-part electronic education program was initiated. Serum and physical risk factors were rechecked at 12-week intervals, and results were analyzed. CONCLUSIONS: Significant serum and physical risk factor associations were identified and remained present among teens over the course of the study. High-density lipoproteins showed significant, steady improvement. Low-density lipoproteins were positively associated with body mass index, diastolic blood pressure, and thyroid-stimulating hormone level. IMPLICATIONS FOR PRACTICE: Although serum and physical risk factors are identifiable in teens, routine screening of this age group and younger is not an established standard of care. Health care providers need effective, innovative methods to counteract these risks. Through increased awareness of the presence of risk factors in young patients, advanced nurse practitioners may implement earlier interventions to counteract these risks.

Editor's Choice-Prospective registry of cardiac critical illness in a modern tertiary care Cardiac Intensive Care Unit.

BACKGROUND: The changing landscape of care in the Cardiac Intensive Care Unit (CICU) has prompted efforts to redesign the structure and organization of advanced CICUs. Few studies have quantitatively characterized current demographics, diagnoses, and outcomes in the contemporary CICU. METHODS: We evaluated patients in a prospective observational database, created to support quality improvement and clinical care redesign in an AHA Level 1 (advanced) CICU at Brigham and Women's Hospital, Boston, MA, USA. All consecutive patients (N=2193) admitted from 1 January 2015 to 31 December 2017 were included at the time of admission to the CICU. RESULTS: The median age was 65 years (43% >70 years) and 44% of patients were women. Non-cardiovascular comorbidities were common, including chronic kidney disease (27%), pulmonary disease (22%), and active cancer (13%). Only 7% of CICU admissions were primarily for an acute coronary syndrome, which was the seventh most common individual diagnosis. The top three reasons for admission to the CICU were shock/hypotension (26%), cardiopulmonary arrest (11%), or primary arrhythmia without arrest (9%). Respiratory failure was a primary or major secondary reason for triage to the CICU in 17%. In-hospital mortality was 17.6%. CONCLUSIONS: In a tertiary, academic, advanced CICU, patients are elderly with a high burden of non-cardiovascular comorbid conditions. Care has shifted from ACS toward predominantly shock and cardiac arrest, as well as non-ischemic conditions, and the mortality of these conditions is high. These data may be useful to guide cardiac critical care redesign.

Recomendações da prática de enfermagem no manejo de anticoagulantes em unidade hospitalar: um direcionamento para o cuidado / Recommendations for nursing practice in the management of anticoagulants in a hospital unit: a guide for care

Introdução: Os anticoagulantes estão inseridos na classe de medicamentos com alto risco de eventos adversos e de acordo com suas características exigem extremo cuidado no seu manuseio. Nesse contexto, o enfermeiro torna-se fundamental no gerenciamento clínico aos pacientes em uso de anticoagulantes, com o objetivo do planejamento necessário para seu tratamento, acompanhamento e uso adequado de recursos no ambiente hospitalar. Objetivo Geral: discutir a prática de Enfermagem no cuidado aos pacientes cardiovasculares em uso de anticoagulantes em unidade hospitalar. Específicos: identificar as características epidemiológicas e clínicas dos pacientes cardiovasculares que utilizam anticoagulantes em unidade hospitalar, discutir as boas práticas de enfermagem relacionadas à anticoagulação de pacientes cardiovasculares em uso de anticoagulantes em unidade hospitalar e propor estratégias para o manejo de Enfermagem no cuidado aos pacientes cardiovasculares em uso de anticoagulantes em unidade hospitalar. Metodologia: Trata-se de um estudo com abordagem qualitativa. A obtenção dos dados foi mediante análise documental de prontuários através de um roteiro estruturado dos pacientes cardiovasculares que fizeram uso de alguma categoria anticoagulante durante a internação hospitalar. Foi realizada busca e estratificação em bases de dados de evidências científicas além de realização de entrevistas semiestruturadas aos enfermeiros de um hospital privado situado na cidade do Rio de Janeiro. Resultados: Quanto às características dos enfermeiros entrevistados, houve diferença significativa entres os sexos, sendo 78% (67) para o sexo feminino e 22% (19) para o sexo masculino. O número mais representativo de enfermeiros (29) esteve concentrado nos Centros de Terapia Intensiva. Quanto ao perfil dos prontuários de pacientes analisados, não houve diferença significativa entres os sexos embora o sexo feminino seja mais prevalente. A média de idade foi de 67,4 anos e o tempo médio de internação dos pacientes foi de 6 dias. Grande parte dos clientes tinha mais de duas comorbidades. Foi possível evidenciar práticas clínicas de enfermagem em relação aos anticoagulantes orais e subcutâneos. Os prontuários evidenciaram monitoramento laboratorial dos pacientes em uso desta classe medicamentosa com a observação de coleta de exame para analisar o fator anti-Xa. Quanto aos anticoagulantes intravenosos foi possível observar que os enfermeiros possuem autonomia para controlarem protocolo de heparinização venosa, realizando cálculos de dosagem para início e manutenção da terapia 97% (32), administram o anticoagulante em via exclusiva 91% (30), utilizam cateteres venosos mais calibrosos 85% (28), realizam monitoramento laboratorial 100% (33), através do Tempo de Tromboplastina Parcial ativado a cada 6 horas. E obtivemos resultados em relação a orientações aos pacientes e familiares quanto os principais riscos desta terapia, sangramentos e surgimento de hematomas. Conclusão: Destaca-se a importância dos enfermeiros na assistência qualificada, integral e individualizada à pacientes em uso de anticoagulantes, enfatizando a relevância do cuidado seguro e qualificado para a melhoria das condições de saúde do indivíduo.

Introduction: Anticoagulants are included in the class of drugs with a high risk of adverse events and, according to their characteristics, require extreme care in their handling. In this context, nurses become fundamental in the clinical management of patients using anticoagulants, with the objective of planning necessary for their treatment, monitoring and adequate use of resources in the hospital environment. General Objective: to discuss the Nursing practice in the care of cardiovascular patients using anticoagulants in a hospital unit. Specific: to identify the epidemiological and clinical characteristics of cardiovascular patients using anticoagulants in a hospital unit, discuss good nursing practices related to anticoagulation of cardiovascular patients using anticoagulants in a hospital unit and propose strategies for Nursing management in the care of cardiovascular patients in use of anticoagulants in a hospital unit. Methodology: This is a study with a qualitative approach. Data collection was performed through documental analysis of medical records through a structured script of cardiovascular patients who used some anticoagulant category during hospital stay. A search and stratification of scientific evidence databases was carried out, as well as semi-structured interviews with nurses from a private hospital located in the city of Rio de Janeiro. Results: Regarding the characteristics of the nurses interviewed, there was a significant difference between the sexes, with 78% (67) for females and 22% (19) for males. The most representative number of nurses (29) was concentrated in the Intensive Care Centers. Regarding the profile of the medical records of the analyzed patients, there was no significant difference between the sexes, although females are more prevalent. The mean age was 67.4 years and the mean length of hospital stay for patients was 6 days. Most of the clients had more than two comorbidities. It was possible to evidence clinical nursing practices in relation to oral and subcutaneous anticoagulants. The medical records showed laboratory monitoring of patients using this drug class with the observation of exam collection to analyze the anti-Xa factor. Regarding intravenous anticoagulants, it was possible to observe that nurses have autonomy to control venous heparinization protocol, performing dosage calculations for initiation and maintenance of therapy 97% (32), administer the anticoagulant exclusively 91% (30), use venous catheters more caliber 85% (28), carry out laboratory monitoring 100% (33), through activated Partial Thromboplastin Time every 6 hours. And we obtained results in relation to guidelines for patients and families regarding the main risks of this therapy, bleeding and the appearance of hematomas. Conclusion: The importance of nurses in qualified, comprehensive and individualized care for patients using anticoagulants is highlighted, emphasizing the importance of safe and qualified care for the improvement of the individual's health conditions.

Cardiac Disease in Pregnancy.

In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.

Focused Cardiac Ultrasound by Nurses in Rural Vietnam.

BACKGROUND: Multiple studies investigating the use of focused cardiac ultrasound (FCU) in lower and middle-income countries and in medically underserved areas of the United States have demonstrated utility in echocardiographic screening algorithms performed by a variety of operators at different levels of training. No study to date has employed previously untrained nurses in a medically underserved setting to identify older adults with cardiac disorders. The aim of this study was to assess the accuracy of nurse-performed FCU to screen adult subjects at a village health center in Vietnam. METHODS: Vietnamese nurses (N = 8) underwent structured training conducted by sonographers and physicians during an outreach event sponsored by the American Society of Echocardiography Education and Research Foundation. The nurses were trained to detect abnormalities from a single echocardiographic view (parasternal long-axis) with a laptop-sized device and underwent pre- and posttraining testing. Following training, cardiac ultrasound examinations were performed on subjects >50 years of age at a village health center. First, the nurses performed focused cardiac ultrasound using two-dimensional and color Doppler imaging in the parasternal long-axis view using the M7 device and recorded their assessments. Two-dimensional color and spectral Doppler echocardiography was thereafter performed using the same machine by a sonographer (n = 5) or a Vietnamese echocardiography-trained cardiologist (n = 1). Interviews and electrocardiography were performed at the time of FCU. RESULTS: Each nurse improved from pre- to posttraining (average improvement in correct answers, 21%; range, 2%-31%). During the scanning phase, nurses' sensitivity, specificity, and accuracy for identifying subjects with any abnormality were 51.5% (85 of 165), 78.1% (82 of 105) and 61.9%, respectively. There were 60 subjects with significant findings (22.2%); all of these subjects had significant abnormalities visible on parasternal long-axis images. Overall sensitivity, specificity, and accuracy for identifying subjects with major abnormalities were 83.3% (50 of 60), 78.1% (164 of 210), and 78.6%, respectively. Nurse-performed FCU demonstrated much higher sensitivity with lower specificity than electrocardiography alone. The combination of nurse-performed FCU plus ECG identified all of the significant findings on echocardiography and increased accuracy to 91.5%. CONCLUSIONS: Nurses with no prior echocardiographic experience and with limited training can identify patients with significant cardiac abnormalities using FCU with acceptable accuracy. Screening strategies involving FCU may play a role in improving access to health care and triage in underserved areas.

The Patient's Perspective of the Intensive Care Unit Diary in the Cardiac Intensive Care Unit.

BACKGROUND: Many patients who survive an intensive care unit admission develop post-intensive care syndrome and face significant long-term physical, cognitive, and mental health impairments. The intensive care unit diary is a reality-sorting tool that is effective in aiding patients to connect their flashbacks and delusional memories to actual events. OBJECTIVES: To describe implementation of an intensive care unit diary in the cardiac intensive care unit and to describe the patient's perspective of the diary. METHODS: Consent for participation in the study was given by the patient health care proxy or a family member. The study consisted of 3 phases: writing in the diary about the patient's events in the cardiac intensive care unit, a follow-up visit with the patient within 1 week of cardiac intensive care unit transfer, and a follow-up telephone call 2 months after hospital discharge. RESULTS: Of 26 patients, 13 completed all phases of the study. Four themes were identified from the transcripts of the patients' responses: (1) The diary allowed patients to correlate memories to actual events, (2) it enabled patients to read about their families' experiences during their critical illness, (3) recovery was an emotional process that affected the patient's readiness to read the diary, and (4) patients expressed a desire for more entries by caregivers. CONCLUSIONS: The intensive care unit diary can help patients gain clarity of their time in the cardiac intensive care unit. Additional research on the use of the diary and long-term patient follow-up is warranted.

Low health literacy: Implications for managing cardiac patients in practice.

There are limited data on racial and ethnic disparities related to quality of life (QoL) and health literacy in adults with multiple cardiac conditions. This article evaluates the relationship between health literacy and QoL among patients with cardiac conditions in a multiethnic community in New York City.

Contribution of transpersonal care to cardiac patients in the postoperative period of heart surgery. / Contribuição do cuidado transpessoal ao ser-cardiopata no pós-operatório de cirurgia cardíaca.

OBJECTIVE: To know the contribution of Watson's theory to nursing care for cardiac patients in the postoperative period of cardiac surgery. METHODS: This is a qualitative study based on the research-care method conducted with ten patients who underwent cardiac surgery in a specialised hospital from June to August 2013, in the city of Fortaleza, Ceará, Brazil. Data were submitted to content analysis based on the Clinical Caritas Process. RESULTS: The results led to four thematic categories: Awareness of being cared for by another being, System of beliefs and subjectivity, Relation of support and trust, and Expression of feelings. Surgery transformed the lives of the patients related to the process of being cared for by other people. FINAL CONSIDERATIONS: The application of Watson's theory to care for cardiac patients after heart surgery shed valuable light on the importance of transpersonal care for the expansion of nursing care.

The cardiac care bridge program: design of a randomized trial of nurse-coordinated transitional care in older hospitalized cardiac patients at high risk of readmission and mortality.

BACKGROUND: After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation. METHODS: In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden. DISCUSSION: This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care. TRIAL REGISTRATION: NTR6316 . Date of registration: April 6, 2017.