Use of a Pediatric Cardiovascular Nursing Consortium for Development and Evaluation of Quality Measures: The C4-MNP Experience.

UNLABELLED: The evidence linking nursing care and patient outcomes has been globally demonstrated. Thus, it is time for translation and application of this evidence to robust measurement that uniquely demonstrates the value of nursing care and the characteristics of the nursing workforce that contribute to optimal patient outcomes. OBJECTIVE: The aim of this study was to identify and develop standardized measures representative of pediatric nursing care of the cardiovascular patient for benchmarking within freestanding children's hospitals. METHODS: Using a consensus-based approach, the Consortium of Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) members developed quality measures within working groups and then individually critiqued all drafted measures. Final draft measures were then independently reviewed and critiqued by an external nursing quality measurement committee. The final quality measures were also made available to a national parent support group for feedback. OUTCOMES: The development process used by C4-MNP resulted in 10 measures eligible for testing across freestanding children's hospitals. Employing a collaborative consensus-based method plus implementing the criteria of the National Quality Forum and external vetting period provided a strong framework for the development and evaluation of standardized measures. NEXT STEPS: The Consortium will continue with implementation and testing of each measure in 9 of our 28 collaborating centers. This activity will support initial development of benchmarks and evaluation of the association of the measures with patient outcomes.

Vascular nursing experience, practice knowledge, and beliefs: Results from the Michigan PICC1 survey.

BACKGROUND: Peripherally inserted central catheters (PICCs) are increasingly used in hospitalized patients. Yet, little is known about the vascular access nurses who often place them. METHODS: We conducted a Web-based survey to assess vascular access nursing experience, practice, knowledge, and beliefs related to PICC insertion and care in 47 Michigan hospitals. RESULTS: The response rate was 81% (172 received invitations, 140 completed the survey). More than half of all respondents (58%) reported placing PICCs for ≥5 years, and 23% had obtained dedicated vascular access certification. The most common reported indications for PICC insertion included intravenous antibiotics, difficult venous access, and chemotherapy. Many respondents (46%) reported placing a PICC in a patient receiving dialysis; however, 91% of these respondents reported receiving approval from nephrology prior to insertion. Almost all respondents (91%) used ultrasound to find a suitable vein for PICC insertion, and 76% used electrocardiography guidance to place PICCs. PICC occlusion was reported as the most frequently encountered complication, followed by device migration and deep vein thrombosis. Although 94% of respondents noted that their hospitals tracked the number of PICCs placed, only 40% reported tracking duration of PICC use. Relatedly, 30% of nurses reported that their hospitals had a written policy to evaluate PICC necessity or appropriateness. CONCLUSION: This survey of vascular nursing experiences highlights opportunities to improve practices such as avoiding PICC use in dialysis, better tracking of PICC dwell times, and necessity. Hospitalists may use these data to inform clinical practice, appropriateness, and safety of PICCs in hospitalized patients.

Job satisfaction and work related variables in Chinese cardiac critical care nurses.

AIM: To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. BACKGROUND: Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. METHOD: A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. RESULT: Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. CONCLUSION: Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses.

Perspectiva do futuro da enfermagem em cardiologia / Perspective of the future of nursing in cardiology

No século XX, os avanços na ciência, tecnologia e saúde pública (imunização, condições sanitárias, moradia e educação) levaram a diminuição das doenças agudas e ao aumento da expectativa de vida. O modelo biomédico de diagnóstico foi o vigente à época, havendo negligência quanto aos cuidados da crescente população com condições crônicas. No século XXI, a maior expectativa de vida aumenta a exposição a riscos que promovem condições crônicas. Os determinantes de tais condições são multifatoriais e multisetoriais, como tabagismo, dieta não saudável, sedentarismo e pobreza. As políticas públicas e sociais não promovem de maneira consistente a saúde ou mesmo apoiam estratégias para prevenir o desenvolvimento dessas condições...(AU)

Proceso enfermero en lactante con síndrome de ventrículo izquierdo hipoplásico bajo el enfoque de Henderson / Nursing process for infant with hypoplastic left heart syndrome under Henderson approach", "_i": "

El síndrome de ventrículo izquierdo hipoplásico (SVIH) es una cardiopatía congénita que engloba varios grados de hipodesarrollo de las estructuras del lado izquierdo del corazón. Quien lo padece necesita de cuidados especializados y personalizados. Objetivo: Identificar las necesidades alteradas y determinar los cuidados específicos del paciente con SVIH con base en la metodología del proceso de atención de enfermería (PAE) y las Guías de Práctica Clínica Cardiovascular del Instituto Nacional de Cardiología Ignacio Chávez (INCICh). Metodología: El PAE se aplicó a un paciente pediátrico masculino de 34 días de edad, hospitalizado en el Servicio de Cardiopediatría en el Área de Aislados del INCICh, utilizando el formato de valoración elaborado con base en el modelo de Virginia Henderson e implementado por la Dirección de Enfermería de este instituto. Las variables de estudio fueron las 14 necesidades, se identificaron las más alteradas y posteriormente se formularon los diagnósticos en el formato: problema, etiología, signos y síntomas (PESS), así como etiquetas diagnósticas de la North American Nursing Diagnosis Association (NANDA), se plantearon cuidados con base en las Guías de Práctica Clínica Cardiovascular. Conclusión: El PAE como instrumento en la aplicación del modelo de Virginia Henderson favoreció la identificación de necesidades reales y potenciales para mejorar la calidad de vida y la satisfacción de todas las necesidades estableciendo la priorización y aplicación de cuidados, lo que permitió otorgar atención efectiva y eficiente.

The hypoplastic left heart syndrome (SHIV) is a congenital heart defect that includes various degrees of hypodevelopment structures of the left heart, who has this defect needs specialized and personalized care. Objective: Identify altered needs and determine specific care for patients with SHIV based on the methodology of the nursing process and the Cardiovascular Clinical Practice Guidelines of the National Institute of Cardiology Ignacio Chavez (INCICh). Methodology: The Process of Nursing Care (PNC) was applied to a male pediatric patient 34 days of age, hospitalized in Pediatric-Cardiology service in the isolated area from INCICh using evaluation format developed based on the model of Virginia Henderson and implemented by the nursing management and physical examination, the study variables were the 14 needs, from them were identified the most affected and then made ​​the diagnoses in the format PESS and the NANDA diagnostic labels were raised, the care was determined based on the Cardiovascular Clinical Practice Guidelines. Conclusions: The PNC as a tool in implementing the model of Virginia Henderson favored the identification of real and potential needs to improve the quality of life and the satisfaction of all the needs by stablishing the application and the prioritization of care, enabling effective and efficient care giving.

Lactante menor con alteración de las necesidades básicas secundario a cardiopatía congénita / Nursling babies with alteration of basic needs secondary to congenital pathology", "_i": "

Introducción: Los cuidados de enfermería y el concepto de salud-enfermedad han evolucionado en el tiempo por factores sociales, políticos, económicos y religiosos; demandando la profesionalización de enfermería y una transición hacia la mejora de sus intervenciones con la perspectiva bio-psicosocial y espiritual de la persona; basadas en el conocimiento teórico, científico y humano que garantice la atención de calidad y calidez del cuidado enfermero especializado. Objetivo: Identificar las necesidades básicas alteradas de un lactante menor con cardiopatía congénita y elaborar un proceso enfermero con el enfoque de Virginia Henderson. Metodología: Se realizaron las siguientes acciones; elección del lactante en el servicio de cardiotórax del Instituto Nacional de Pediatría (INP); solicitud del consentimiento informado de la madre; revisión bibliográfica extensa para la construcción del marco teórico; valoración de enfermería con el formato para evaluación de las necesidades básicas en los menores de 0 a 5 años del INP; jerarquización de necesidades basada con el Modelo de Virginia Henderson, elaboración de diagnósticos enfermeros, planeación y ejecución de intervenciones especializadas de enfermería bajo el rigor ético pertinente, y la evaluación del resultado. Conclusiones: El proceso enfermero es el método ideal para la detección oportuna de las necesidades humanas alteradas, permite establecer intervenciones especializadas que garantizan una atención segura y cálida en el entorno del ser humano.

Introduction: Nursing cares and the concept of health-disease have evolved along time because of social, political, and religious factors. There is a demand for nursing professionalization and a transition towards improvement in its interventions with human beings under a bio-psychosocial and spiritual perspective. The aforementioned fact should be based upon a theoretical, scientific and human fact which may assure quality attention and warm care from the specialized nursing care. Objective: To identify altered basic needs in a nursling baby and create a nursing process following Virginia Henderson’s approach. Methodology: It was performed the following actions: election of the nursling infant at the Cardiothoracic Service in the National Institute of Pediatrics (NIP); requirement of mother’s informed consent; extensive literature review for the construction of the theoretical frame; nursing evaluation with the form for the evaluation of basic needs in infants from zero to five years old at the NIP; need hierarchy ranking based upon Virginia Henderson’s Model, creation of nursing diagnosis, planning and execution of specialized interventions under appropriate medical strictness, and the evaluation of results. Conclusions: The nursing process is the ideal method for the timely detection of altered human necessities, which allows establishing specialized interventions that guarantee safe and warm attention in human background.

Protección ocular al paciente en estado crítico bajo efectos de sedación / Eye protection for the patient in critical condition under sedation effect", "_i": "

Considerando la tendencia mundial sobre la seguridad del paciente y la calidad del cuidado se hace indispensable diseñar, proponer e implementar procedimientos que lleven a satisfacer tales objetivos. El paciente en estado crítico requiere de cuidados especializados que garanticen la integridad física durante su estancia hospitalaria, a fin de prevenir y/o limitar las complicaciones que en la convalecencia resulten trascendentales para su rehabilitación y reintegración a su rol social. Por lo tanto se propone el procedimiento de protección ocular al paciente en estado crítico bajo efectos de sedación en cuatro etapas que pueden aplicarse de manera universal en toda instancia hospitalaria en la que se proporcione cuidado enfermero a pacientes con deficiencia en la oclusión natural de los ojos.

Considering the world-wide tendency on the security of the patient and the quality of the care it is made indispensable design, propose and implement procedures that take to satisfy such objectives. The patient in critical state requires of specialized cares that guarantee physical integrity during their hospital stay, in order to prevent and/or to limit the complications that in the rehabilitation are transcendental for their rehabilitation and reintegration to their social roll. Therefore the procedure of ocular protection to the patient in critical state under effects of sedation in four stages sets out that can be applied of universal way in all hospitable instance in which well-taken care of nurse to patients with deficiency in the natural occlusion of the eyes provides itself.

Impacto del apoyo familiar en la adherencia terapéutica de los pacientes hipertensos / Impact of family support on the therapeutic adherence of hypertensive patients", "_i": "

La hipertensión arterial es un problema de salud pública a nivelmundial, una de sus causas radica en la baja adhesión altratamiento. Se desea conocer si existe asociación entre adherenciaterapéutica y apoyo familiar en personas hipertensas.Se realizó un estudio descriptivo, transversal, correlacionalaplicado a personas hipertensas de la consulta externa del InstitutoNacional de Cardiología Ignacio Chávez (INCICH). Seaplicaron los Instrumentos para medir el estilo de vida (IMEVID)(α = 0.81) y la Escala de Efectividad en el Funcionamiento Familiar(E-EFF), (α = 0 .83). El α del instrumento fue de 0.82.Se observó que la mayoría tienen más de 55 años, son casadosy padecen hipertensión arterial desde hace más de 30 años.Más de la tercera parte combina medicamentos, ejercicio y dietapara controlar su enfermedad, pero algunos utilizan sólomedicamentos. Asimismo, el 46.7% tiene un nivel socioeconó-mico bajo y el 33.3% sólo tienen primaria. El 73% de la poblacióntiene alta adherencia terapéutica y el 63.3% alto apoyo familiar.La r de Spearman obtenida para estas variables fue de0.643 (p = 0.000). No existe ninguna asociación entre las variablesdemográficas y la adherencia terapéutica. El apoyo familiares un factor importante para el éxito del tratamiento,destacando que ni las cuestiones económicas, edad, nivel académicoo estado civil actúan como limitantes para ello.

Hypertension is a public health problem worldwide, a causelies in the low adherence to treatment. You want to know ifthere is an association between therapeutic adherence and familysupport in hypertensive persons. We performed a descriptive,cross-correlation applied to hypertensive individualsin the outpatient LTD. IMEVID instruments wereapplied (α = 0.81) and E-EFF (α = 0 .83). The α instrumentwas 0.82. It was noted that most are over 55 years, are marriedand have high blood pressure for over 30 years. Morethan a third of combining medications, exercise and diet tocontrol their disease, but some use only medicines. Also,46.7% have a low socioeconomic level and 33.3% have onlyprimary education. 73% of the population has high adhesiontherapy and 63.3% high family support. Spearman’s r for thesevariables was obtained from 0,643 (p = 0.000). There is noassociation between demographic variables and therapeuticadherence. Family support is an important factor in treatmentsuccess, noting that neither the economic, age, educationallevel and marital status act as constraints for this.