El cuidado desde la visión sensible en la unidad de choque / Cuidados com a visão sensível na unidade de choque / Care from the sensitive vision in the shock unit

Objective: To understand the perception of the nurses who work in the Shock Unit about care during fibrinolytic therapy. Method: Qualitative study, Ethnographic approach, according to ethno-nursing, of Leininger's theory. Thirty-four nurse practitioners participated in a shock unit for adults of a Mexican general hospital. The data were obtained through a semi-structured interview, participant observation, it opted for the content analysis that allowed the elaboration of the categories that facilitated the understanding the data. Results: The analysis revealed the themes: An experience in the time of the other, the scientific and humanistic with a light on the paradigmatic path; opportunity from the nature of life and care from the sensitive vision of my human side. Conclusion: human care is perceptible by belief, motivated from the experiences lived in intensive care units, in this scenario it is necessary to promote hospital cross-cultural studies, due to the scientific wealth of nursing interventions in the shock unit, that strengthens cares like a light on the road.(AU)

Objetivo: comprender la percepción de las enfermeras que actúan en la Unidad de choque en relación a cuidado durante la terapia fibrinolítica. Método: Estudio cualitativo, de aproximación Etnográfico, según la etnoenfermería, de la teoría de Leininger. Participaron 34 enfermeras actoras en una unidad de Choque para adulto de un hospital general mexicano. Los datos se consiguieron a través de entrevista semi-estructurada, observación participante, se optó por el análisis de contenido que permitió la elaboración de las categorías que facilitaran la comprensión de los datos. Resultados: El análisis reveló los temas: Una experiencia en el tiempo del otro, lo científico y humanístico con una luz en el camino paradigmático; oportunidad desde la naturaleza de la vida y el cuidado desde la visión sensible mi lado humano. Conclusión: es perceptible el cuidado humano por la creencia, motivada desde las experiencias vividas en las unidades de terapia intensiva, en este escenario se requiere impulsar estudios transculturales hospitalarios, por la riqueza científica de las intervenciones de enfermería en la unidad de choque, eso fortalece los cuidados como una luz en el camino.(AU)

Objetivo: compreender a percepção dos enfermeiros que atuam na Unidade de Choque em relação aos cuidados durante a terapia fibrinolítica. Método: estudo qualitativo, abordagem etnográfica, segundo aetnoenfermagem, da teoria de Leininger. 34 enfermeiras atores participaram de uma unidade de choque para adultos de um hospital geral mexicano. Os dados foram obtidos por meio de entrevista semiestruturada, observação participante, optou-se pela análise de conteúdo que permitiua elaboração das categorias que facilitaram a compreensão dos dados. Resultados: A análise revelou os temas: Uma experiência no tempo do outro, o científico e o humanístico com uma luz no caminho paradigmático; oportunidade da natureza da vida e cuidado da visão sensível do meu lado humano. Conclusão: o cuidado humano é perceptível pela crença, motivado a partir das experiências vividas em unidades de terapia intensiva, neste cenário é necessário promover estudos transculturais hospitalares, devido à riqueza científica das intervenções de enfermagem na unidade de choque, o que fortalece se preocupa como uma luz na estrada.(AU)

Implementation of a Telecardiology Service in a Health Unit in the City of Porto Alegre, Brazil: A Pilot Study

Abstract Background: The implementation of Telecardiology in primary care in the city of Porto Alegre, Brazil, is a viable and promising strategy. It would decrease the distance between patient and specialized professional services by reducing unnecessary referrals and improving the quality of primary care and satisfaction of patients and health professionals. Objective: To implement a Telecardiology service and assess user satisfaction using the CARDIOSATIS scale. Methods: This was a pilot study developed by a partnership between the Institute of Cardiology and the Telehealth Center of Rio Grande do Sul. The study was carried out at Eri Flores-Vila Vargas health center in the city of Porto Alegre, from May to October 2019, and included 21 patients attending the health center. The descriptive analysis of data was performed using the SPSS program (Statistical Package for the Sciences) version 23. Data normality was checked using the Kolmogorov-Smirnov test. Statistical significance was set at 10%. Results: Mean age of participants was 43.8 ± 16.1 years. The most common risk factors in the sample were physical inactivity (81%) and smoking (43%). Most patients had normal electrocardiogram (ECG) readings. The time elapsed from the performance of the ECG test, transmission of the ECG traces to Telehealth, and return of the final ECG report to the health center was 0-7 days. The CARDIOSATIS scale revealed a high prevalence of "very satisfied" users for the general satisfaction domain, and only 14.3% of patients were dissatisfied with their health. Conclusions: Telecardiology reduced the distance between patient and the specialized professional, with a high level of patient and health professional satisfaction. Our study can serve as a basis for the implementation of a telecardiology network in the city of Porto Alegre in the future.

Research on Diagnosis Architecture of Cardiovascular Diseases Based on Multimedical Images.

OBJECTIVE: To study the effect of a multi-image source 3D modeling imaging examination system on the diagnosis of cardiovascular diseases in cardiac surgery. METHODS: The data of 680 confirmed patients and 1590 suspected patients in the cardiac surgery department of all hospitals of a large chain hospital management group were selected. All patients gave the examination results of multiple image sources and independent examination results of multiple image sources, respectively, their examination sensitivity, specificity, and reliability were compared, and the treatment efficiency and nursing satisfaction of the virtual reference group were deduced in MATLAB. Perform the bivariate t-test and comparative statistics in SPSS. RESULTS: The multi-image source 3D modeling examination system had higher examination sensitivity, specificity, and reliability and higher examination sensitivity in the early stage of the disease. It was deduced that the clinical efficiency and nursing satisfaction based on the examination results were significantly improved (t < 10.000, p < 0.01). CONCLUSION: The multi-image source 3D modeling imaging examination system is suitable for the diagnosis of cardiovascular diseases in cardiac surgery.

Effect of Hierarchical Nursing Management in Patients with Hypertension Complicated with Cardiovascular and Cerebrovascular Risk Factors.

Hierarchical management is an essential component of nurse post management and an unavoidable tendency in nursing education. According to their existing condition, various hospitals around the country have actively tested the hierarchical usage and management model of clinical nurses, with some success. The application impact of hierarchical nursing care in patients with hypertension complicated by cardiovascular and cerebrovascular risk factors is the focus of this research. In a hospital, 300 patients with hypertension complicated by cardiovascular and cerebrovascular risk factors were chosen. All patients were split into two groups using the coin-throwing random method: the observation group received hierarchical nurse management and the control group received regular nursing management, with 150 cases in each group. The two groups' blood pressure, blood lipids, blood glucose, poor habits, rehospitalization rate, and cardiovascular and cerebrovascular problems were also examined. At the same time, the patients' poor mood and quality of life were assessed before and after the intervention. In the control group followed up for 1 year, the blood pressure compliance rate was 44.88%, the blood lipid compliance rate was 28.65%, the blood glucose compliance rate was 45.00%, the smokers with bad lifestyle habits were 26.57%, the overweight and obese were 23.5%, the high sodium was 31.67%, the rehospitalization rate was 15.48%, and the incidence of cardiovascular and cerebrovascular complications was 43.00%. The observation group's blood pressure, blood lipids, and blood sugar compliance rates rose substantially (P = 0.05) as compared to the control group. The occurrence of poor luck living habits, the rate of rehospitalization, and the incidence of cardiovascular and cerebrovascular complications were significantly reduced (P < 0.05). Before nursing intervention, there was no significant difference in the bad mood scores SAS, SDS, and quality of life between the two groups of patients (P > 0.05); after nursing intervention, compared with the control group, the observation group's bad mood scores were significantly reduced, physical factors, psychological factors, and total scores all increased significantly, and the difference was statistically significant (P < 0.05).

Las actuales guías en el manejo de las dislipidemias europeas y estadounidenses no están de acuerdo en sus objetivos y recomendaciones / Current guidelines on the management of European and American dyslipidemias do not agree on their objectives and recommendations

La prevención de la enfermedad cardiovascular (ECV) constituye una prioridad fundamental en la práctica clínica diaria, tanto en Enfermería como en Medicina. Para conseguirla, el control de la dislipidemia es fundamental y la elaboración de guías por expertos, basadas en la evidencia disponible, el modo más racional de su abordaje. Pero en ocasiones, la producción científica llega a ser tan abundante que seleccionar la calidad de los estudios puede generar controversias. Este es el caso que se presenta en este estudio, donde las guías estadounidenses, basadas en ensayos clínicos aleatorizados y controlados, han establecido un nuevo paradigma frente a las guías europeas que además han considerado los diseños de estudios observacionales. Se exponen los puntos fundamentales de ambos casos, la controversia generada y el posterior acercamiento entre ambas guías, valorando la importancia que aporta la evidencia científica.(AU)

Prevention of cardiovascular disease (CVD) constitutes a critical priority of daily clinical practice, for both nurses and doctors. In order to achieve this, it’s essential to control dyslipidemia by using guides created by experts, based on available research. Occasionally, however, the amount of scientific research can be so abundant that choosing which studies to include can generate controversy. This study analyzes cases in which guides created in the United States, using evidence from randomized controlled clinical trials, have established a new paradigm compared to European guides, which have considered the designs of the American guides to be observational studies. The fundamental arguments of both sides will be discussed, as well as the resulting controversy and the subsequent reconciliation between both guides, which now place more value on scientific evidence.(AU)

Nursing Teleconsultation for the Outpatient Management of Patients with Cardiovascular Disease during COVID-19 Pandemic.

Introduction: During the COVID-19 outbreak, non-urgent clinic visits or cardiac interventional procedures were postponed to a later date, and the implementation of telemedicine has guaranteed continuity of care for patients with chronic diseases. The aim of our study was to describe the medical interventions following nursing teleconsultation for the outpatient management of patients with cardiovascular diseases during the COVID-19 pandemic. Materials and Methods: All patients who did not attend the follow-up visit from 4 to 15 April 2020 at our institution and who were re-scheduled due to the COVID-19 lockdown were selected to be enrolled in the study. Each patient was followed by a semi-structured telephonic interview performed by a nurse. The outcomes of our study were to assess the patients' adherence to nursing teleconsultation and the usefulness of nursing teleconsultation to detect clinical conditions in need of medical intervention. Results: In total, 203 patients (81%) underwent nursing teleconsultation in a mean time of 7 ± 3 days from the outpatient visit lost due to the COVID-19 lockdown. Furthermore, 53 patients (26%) showed poor adherence to nursing teleconsultation. Among the 150 patients (mean age 67 ± 10 years; 68% male) who completed the telephonic interview, the nursing teleconsultation revealed the need of medical intervention in 69 patients (46%), who were more likely at very high cardiovascular risk (77% vs. 48%; p < 0.0003) and who showed a higher prevalence of dyslipidemia (97% vs. 64%; p < 0.0001) and coronary artery disease (75% vs. 48%, p < 0.0008) compared to those not in need of any intervention. The up-titration of the lipid-lowering drugs (n: 32, 74%) was the most frequent medical intervention following the nursing teleconsultation. The mean time between the nursing teleconsultation and the date of the rescheduled in-person follow-up visit was 164 ± 36 days. Conclusions: Nursing teleconsultation is a simple and well-tolerated strategy that ensures the continuity of care and outpatient management for patients with cardiovascular diseases during the COVID-19 pandemic.

Geriatric co-management for cardiology patients in the hospital: A quasi-experimental study.

BACKGROUND/OBJECTIVES: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. DESIGN: A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. SETTING: Two cardiac care units of the University Hospitals Leuven. PARTICIPANTS: One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. INTERVENTION: A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS: The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS: The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION: This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes.

Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study.

The purpose of this study was to evaluate the effectiveness of the nurse-led physical activity (PA) intervention on cardiovascular disease (CVD) risk reduction in individuals with moderate risk. A randomized controlled pilot trial was conducted with 12 individuals who have moderate cardiovascular risk meeting the inclusion criteria. Eleven individuals in the intervention group participated in a 12-week PA program (outdoor group walking with the group 5 days in a week, each lasting for 40 minutes) guided by a nurse. For determining the risk level of CVD, the "HeartScore program" was used. Height, weight, blood pressure, and cholesterol values of individuals in the intervention group were measured. At the end of nurse-led outdoor walking activity with the group for 12 weeks, systolic blood pressure (P = .041) and cholesterol (P = .001) values of individuals in the intervention group decreased based on the baseline levels and accordingly CVD risk levels decreased significantly (P = .019). There was no significant difference in the control group. This study demonstrates that health care professionals working in the family health centers can easily determine the CVD risk with the HeartScore. Outdoor group walking program guided by a nurse is effective in decreasing the CVD risk level.

Needs, Aggravation, and Degree of Burnout in Informal Caregivers of Patients with Chronic Cardiovascular Disease.

This study aimed to answer three main questions with respect to home caregivers for people with cardiovascular disease: (1) Are the needs of home caregivers being met (and at what level)?; (2) what is the level of emotional exhaustion, depersonalization, and personal accomplishment of home caregivers?; (3) what sociodemographic variables of home caregivers are related to unmet needs and level of emotional exhaustion, depersonalization, and personal accomplishment? The study used the Camberwell Modified Needs Assessment questionnaire and the Maslach Burnout Inventory questionnaire. This study reports on 161 informal home caregivers of patients with cardiovascular disease. We found that younger caregivers were less likely to report unmet needs (p = 0.011), and showed lower rates of burnout on depersonalization and emotional exhaustion. In addition, caregivers who worked more often reported higher levels of met needs (p = 0.022), and showed lower rates of burnout on depersonalization (p = 0.005) and emotional exhaustion (p = 0.018). Subjects residing in urban areas were more likely to report unmet needs (p = 0.007), and showed higher rates of burnout on emotional exhaustion (p = 0.006). Older caregivers who are unemployed and reside in cities should be offered programs to determine their unmet needs and to receive support.

The effect of knowledge brokering on nurses' empathy with patients receiving cardiac care: a study protocol.

BACKGROUND: Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care. METHODS: This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant. DISCUSSION: To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.

Calidad de vida relacionada con la salud de los pacientes crónicos complejos / Health-related quality of life in complex chronic patients

OBJETIVO: determinar la calidad de vida relacionada con la salud de los pacientes crónicos complejos (PCC) mayores de 60 años en dos Zonas Básicas de Salud del Área Este de Valladolid, el perfil de las patologías crónicas que padecían y los factores influyentes en la calidad de vida relacionada con la salud (CVRS). MÉTODO: estudio descriptivo transversal entre enero y marzo de 2017. Se incluyó a los PCC con 60 años o más y sin deterioro cognitivo de dos zonas básicas de salud de Valladolid seleccionados mediante muestreo de conveniencia. Se recogieron variables sociodemográficas, clínicas y la variable CVRS (Cuestionario SF-36) mediante cuestionario y revisión de historias clínicas. Se realizaron índices de estadística descriptiva globales y desagregados por sexo y regresión lineal múltiple para la CVRS. RESULTADOS: participaron 73 personas (63% mujeres, edad media 77,4 años). El 71,2% padecía patologías cardiovasculares y osteomusculares. La CVRS global fue de 36,6 puntos, superior en el índice sumatorio mental (40,9) que en el físico (36,6) y menor en las mujeres en todos ellos (p< 0,05). El 24,5% de la variabilidad en CVRS fue explicada por el sexo (coeficiente en hombres 4,94), la presencia de patología mental (coeficiente -5,01) y patología osteomuscular (coeficiente -4,098). CONCLUSIÓN: las enfermedades cardiovasculares, las osteomusculares y la hipertensión arterial fueron los diagnósticos crónicos más prevalentes. Los pacientes crónicos complejos percibían mala CVRS. La CVRS global, física y mental fue inferior en las mujeres que los hombres. La variabilidad en CVRS fue explicada en un 24,5% por el sexo, la patología mental y osteomuscular. No se encontró asociación con la edad ni con otras patologías crónicas

OBJECTIVE: to determine the health-related quality of life in > 60-year-old complex chronic patients (CCPs) in two Basic Health Areas in Valladolid East, the profile of their chronic conditions, and the factors with impact on their HRQoL. METHOD: a descriptive cross-sectional study conducted between January and March, 2017. The study included ≥ 60-year-old CPPs without cognitive impairment from two Basic Health Areas in Valladolid, selected through convenience sampling. Sociodemographical and clinical variables were collected, as well as the HRQoL variable (SF-36 Questionnaire), through questionnaire and clinical record review. Overall descriptive indexes were applied, disaggregated by gender, and multiple linear regression for HRQoL. RESULTS: the study included 73 persons (63% women, mean age 77.4-year-old); 71.2% of them suffered cardiovascular and musculoskeletal conditions. The overall HRQoL score was 36.6, superior in the mental (40-9%) than in the physical summation index (36.6), and lower in women in all of them (p < 0.05). The 24.5% variability in HRQoL was explained by gender (4.94 ratio in men), the presence of mental conditions (-5.01 ratio) and musculoskeletal condition (-4.098 ratio). CONCLUSION: the most prevalent chronic diagnoses were cardiovascular and musculoskeletal conditions and hypertension. Complex chronic patients perceived a bad HRQoL. The variability in HRQoL was explained in 24.5% by gender, mental and musculoskeletal conditions. No association with age or other chronic conditions was found

Update: AHA guidelines for CPR and emergency cardiovascular care.

Continuous review of current research and practice has resulted in updates to the American Heart Association guidelines for CPR and emergency cardiovascular care. This article examines the recommendations and their implementation into current healthcare practice.

Cribado de hipertensión arterial. Variabilidad entre práctica clínica y recomendaciones actuales / Screening of hypertension. Variability between clinical practice and current recommendations

No disponible

Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study.

AIMS AND OBJECTIVES: To explore patients' understanding of the role of an advanced practice nurse (APN). BACKGROUND: The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore. METHODS: An exploratory descriptive qualitative design using semi-structured face-to-face individual interviews was undertaken (November 2017-March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to. FINDINGS: The multi-ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs. CONCLUSION: A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN-led services, they may gain confidence in APNs' skills and knowledge. RELEVANCE TO CLINICAL PRACTICE: When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics.

Stakeholder-informed strategies addressing cardiovascular disease (CVD) burden among people living with HIV (PWH) are needed within healthcare settings. This study provides an assessment of how human-centered design (HCD) guided the adaptation of a nurse-led intervention to reduce CVD risk among PWH. Using a HCD approach, research staff guided two multidisciplinary "design teams" in Ohio and North Carolina, with each having five HCD meetings. We conducted acceptability and feasibility testing. Six core recommendations were produced by two design teams of key stakeholders and further developed after the acceptability and feasibility testing to produce a final list of 14 actionable areas of adaptation. Acceptability and feasibility testing revealed areas for adaptation, e.g. patient preferences for communication and the benefit of additional staff to support patient follow-up. In conclusion, along with acceptability and feasibility testing, HCD led to the production of 14 key recommendations to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.

Escape the Generational Gap: A Cardiovascular Escape Room for Nursing Education.

BACKGROUND: Generation Z college students often prefer individualized, immersive learning experiences. Faculty designed an educational escape room to engage nursing students and improve knowledge in cardiovascular critical care. METHOD: This study evaluated the educational innovation's impact on changes in knowledge and perceptions of the educational innovation with a pre- and postknowledge assessment and a validated perception survey. Students discussed their experiences and reflections in a focus group. RESULTS: Pre- and postknowledge assessment scores showed statistically significant improvements in knowledge (p < .05). Student perceptions were statistically significantly higher than the mean value for the evaluation scale (p < .001). Analysis of focus group transcriptions revealed four themes: Logistics of the Learning Activity, Cognitive Learning, Team Learning, and Professional Practice Skills. CONCLUSION: The cardiovascular escape room increased student knowledge and was positively received by students. The educational innovation encouraged student engagement in learning, content application, peer communication, and nursing practice skills. [J Nurs Educ. 2020;59(2):111-115.].