When face-to-face interviews are not possible: tips and tricks for video, telephone, online chat, and email interviews in qualitative research.

Face-to-face interviews have long been the norm for conducting qualitative interviews in healthcare research. However, the Covid-19 pandemic has accelerated the need to explore alternative methods. This, along with the swift digitalization of healthcare, has led to video, telephone, and online interactions becoming increasingly used. The use of new techniques to carry out interviews through video, telephone, and online applications all come with benefits and drawbacks. In this article, three ways of collecting data through qualitative interviews are described and their uses exemplified through a project investigating the impact of a transition program for adolescents with congenital heart disease.

Cuidados intensivos sistematizados ao paciente em pós-operatório cardíaco / Patient systematic intensive care in post-operative cardiac / Patient systematic intensive care in post-operatório cardiac

Objetivo: conhecer o estado da arte atual a respeito da Sistematização da Assistência de Enfermagem nos cuidados intensivos ao paciente em Pós-operatório Cardíaco. Métodos: revisão integrativa de dados indexados a partir de 2012 em conformidade com o Protocolo Reporting of Qualitative Research Studies. Resultados: elegíveis 08 artigos de 40 pré-selecionados com adensamento de evidências capazes de responder ao objetivo de investigação. Discussão: perceber o paciente cirúrgico no escopo de suas necessidades físicas, emocionais, espirituais e sociais, demanda do Enfermeiro Intensivista constante atualização teórica e metodológica para fundamentar uma prática baseada em Diagnósticos e Prescrições das Intervenções de Enfermagem capazes de suprir as demandas do paciente. Conclusão: a estruturação do cuidado no qual a Sistematização da Assistência de Enfermagem alicerça metodologicamente a aplicação dos conhecimentos como viabilizadores do Processo de Enfermagem permite a realização de um cuidado intensivo diferenciado ao Paciente em Pós-operatório cardíaco

Objective: to know the current state of the art regarding the Systematization of Nursing Care in the intensive care to the patient in Post-operative Cardiac. Methods: integrative review of indexed data as of 2012 in accordance with the Protocol Reporting of Qualitative Research Studies. Results: eligible 08 articles from 40 pre-selected with denser evidence capable of responding to the objective in research. Discussion: to perceive the surgical patient in the scope of their physical, emotional, spiritual and social needs, the Intensive Nurse's demand constant theoretical and methodological update to base a practice based on Diagnoses and Prescriptions of Nursing Interventions able to meet the demands of the patient. Conclusion: the structure of care in which the Nursing Assistance Systematization methodologically supports the application of knowledge as an enabler of the Nursing Process allows the performance of an intensive care differentiated to the Patient in the Cardiac Post-operative

Objetivo: Conocer el estado del arte actual respecto a la Sistematización de la Asistencia de Enfermería en los cuidados intensivos al paciente en Post-operatorio Cardiaco. Métodos: Revisión integrativa de datos indexados a partir de 2012 de conformidad con el Protocolo de informes de expertos en investigación. Resultados: Elegibles 08 artículos de 40 preseleccionados con adensamiento de evidencias capaces de responder al objetivo de investigación. Discusión: Percibir al paciente quirúrgico en el alcance de sus necesidades físicas, emocionales, espirituales y sociales, demanda del Enfermero Intensivista constante actualización teórica y metodológica para fundamentar una práctica basada en Diagnósticos y Prescripciones de las Intervenciones de Enfermería capaces de suplir las demandas del paciente. Conclusión: La estructuración del cuidado en el que la Sistematización de la Asistencia de Enfermería fundamenta metodológicamente la aplicación de los conocimientos como viabilizadores del Proceso de Enfermería permite la realización de un cuidado intensivo diferenciado al Paciente en Postoperatorio cardíaco

Nefropatia inducida por contraste: identificación de riesgos para promoción de buenas prácticas / Contrast-induced nephropathy: identification of risks to promote good practices / Nefropatia induzida por contraste: identificação de riscos para promoção de boas práticas

Objetivo: Identificar factores de riesgo para nefropatía inducida por contraste (NIC) en pacientes sometidos al procedimiento de angioplastia coronaria transluminal percutánea (ACTP) y discutir los cuidados de enfermería en la perspectiva de las buenas prácticas para minimizarla. Método: Estudio transversal, retrospectivo, cuantitativo, realizado de enero a diciembre de 2015, utilizando análisis documental mediante registros médicos. Resultados: Se seleccionaron 87 registros. El sexo masculino prevaleció con el 67,8% (59), con un promedio de edad de 58,8 +/- 10,4. Se notó que 6 (6,8%) utilizaron inyecciones de contraste entre 100 ml o más y 32 (36,8%) presentaron cambios en los valores de hematocrito. Sobre el riesgo para nefropatía, 24 (27,6%) presentaron de moderado a altísimo. Conclusión: Factores de riesgo para NIC son frecuentes en pacientes que realizan ACTP. Así, discutir cuidados de enfermería que puedan colaborar en la identificación y prevención del problema renal es estratégico y contribuye a buenas prácticas

Objective: To identify the risk factors for contrast-induced nephropathy (CIN) in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and discuss the nursing care from the perspective of good practices in order to minimize it. Method: Cross-sectional, retrospective, quantitative study carried out from January to December 2015, using documentary analysis through medical records. Results: Eighty-seven medical records were selected. The male sex prevailed with 67.8% (59), with a mean age of 58.8 +/- 10.4. It was seen that 6 patients (6.8%) used contrast injections between 100 ml or more and 32 (36.8%) presented alterations in hematocrit values. Concerning the risk for nephropathy, 24 (27.6%) presented moderate to very high risk. Conclusion: Risk factors for CIN are common in patients who undergo PTCA. Thus, discussing nursing care that can collaborate in the identification and prevention of kidney injury is strategic and contributes to good practices

Objetivo: Identificar os fatores de risco para nefropatia induzida por contraste (NIC) nos pacientes que se submeteram ao procedimento de angioplastia coronária transluminal percutânea (ACTP) e discutir os cuidados de enfermagem na perspectiva das boas práticas para minimizá-la. Método: Estudo transversal, retrospectivo, quantitativo, realizado de janeiro a dezembro de 2015, que utilizou análise documental através de prontuários. Resultados: foram selecionados 87 prontuários. O sexo masculino prevaleceu com 67,8% (59), com uma média de idade de 58,8 +/-10,4. Verificou-se que 6 pacientes (6,8%) utilizaram injeções de contraste entre 100 ml ou mais e 32 (36,8%) apresentaram alterações nos valores de hematócrito. Quanto ao risco para nefropatia, 24 (27,6%) apresentaram de moderado a altíssimo. Conclusão: Fatores de risco para NIC são frequentes nos pacientes que realizam ACTP. Assim, discutir cuidados de enfermagem que possam colaborar na identificação e prevenção da injúria renal é estratégico e contribui para boas práticas

Instrumentos de valoración en enfermería cardiovascular / Assessment Tools in Cardiovascular Nursing

RESUMEN Introducción: Las enfermedades cardiovasculares son la mayor causa de muerte e incapacidad en el mundo. La enfermera, en su práctica, debe contribuir desde su quehacer al bienestar, seguimiento y control de las personas que experimentan enfermedades cardiovasculares, pero desde intervenciones que estén orientadas a los fenómenos propios de la disciplina, como la adaptación o el autocuidado. Para lograr su propósito, debe disponer de instrumentos validados y orientados a estos fenómenos. Objetivo: Describir los instrumentos de enfermería validados para la valoración de fenómenos propios de la disciplina en las personas que experimentan enfermedades cardiovasculares. Métodos: Revisión integrativa de la literatura. Se realizó una búsqueda de artículos primarios durante los meses de abril a septiembre de 2017 en Lilacs/BIREME, EBSCO, Pubmed/MEDLINE y Science Direct con los términos "enfermería", "cardiovascular", "instrumento", "escala" o "herramienta", en idioma español, inglés y portugués, y publicados entre el año 2000 y el 2016. Se construyó una base de datos con información de los estudios incluidos y se integró la información de forma narrativa. Conclusiones: Se identificaron 14 instrumentos de enfermería validados que permiten valorar los fenómenos de autocuidado, adherencia a tratamientos y calidad de vida. Se utilizaron técnicas de validación de contenido y de constructo y medición de la confiabilidad. Los instrumentos identificados favorecen la práctica diaria de los profesionales de enfermería, contribuyen con la valoración de fenómenos que pueden ser intervenidos por la enfermera de manera independiente para dar respuesta a las necesidades específicas de las personas con enfermedades cardiovasculares(AU)

ABSTRACT Introduction: Cardiovascular diseases are the leading cause of death and disability worldwide. Nurses, in their practice and with their work, should contribute to the well-being, monitoring and control of people who experience cardiovascular diseases, but from interventions oriented to the phenomena of the discipline, such as adaptation or self-care. To achieve its purpose, it must have tools validated and oriented to these phenomena. Objective: To describe the nursing instruments validated for the evaluation of phenomena characteristic of the discipline in people experiencing cardiovascular diseases. Methods: Comprehensive literature review. A search of primary articles was carried out during the months from April to September 2017 in Lilacs/BIREME, EBSCO, Pubmed/MEDLINE, and Science Direct, using the terms enfermería [nursing], cardiovascular [cardiovascular], instrumento [instrument], escala [scale] or herramienta [tool], in Spanish, English and Portuguese, and published between 2000 and 2016. A database was built with information about the included studies, which was integrated narratively. Conclusions: 14 validated nursing instruments were identified that allow to assess the phenomena of self-care, adherence to treatments and quality of life. Content and construct validation techniques and reliability measurement were used. The instruments identified favor the daily practice of nursing professionals, and contribute to the assessment of phenomena that can be intervened independently by the nurse in order to respond to the specific needs of people with cardiovascular diseases(AU)

Using Patients and Their Caregivers Feedback to Develop ENABLE CHF-PC: An Early Palliative Care Intervention for Advanced Heart Failure.

OBJECTIVE:: Models of early, community-based palliative care for individuals with New York Heart Association (NYHA) class III/IV heart failure and their families are lacking. We used the Medical Research Council process of developing complex interventions to conduct a formative evaluation study to translate an early palliative care intervention from cancer to heart failure. METHOD:: One component of the parent formative evaluation pilot study was qualitative satisfaction interviews with 8 patient-caregiver dyad participants who completed Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare For Patient and Caregivers (ENABLE CHF-PC) intervention. The ENABLE CHF-PC consists of an in-person palliative care assessment, weekly telehealth coaching sessions, and monthly follow-up. Subsequent to completing the coaching sessions, patient and caregiver participants were interviewed to elicit their experiences with ENABLE CHF-PC. Digitally recorded interviews were transcribed and analyzed using a thematic approach. RESULTS:: Patients (n = 8) mean age was 67.3, 62.5% were female, 75% were married/living with a partner; caregivers (n = 8) mean age was 56.8, and 87.5% were female. Four themes related to experiences with ENABLE CHF-PC included "allowed me to vent," "gained perspective," "helped me plan," and "gained illness management and decision-making skills." Recommendations for intervention modification included (1) start program at diagnosis, (2) maintain phone-based approach, and (3) expand topics and modify format. CONCLUSION:: Patients and caregivers unanimously found the intervention to be helpful and acceptable. After incorporating modifications, ENABLE CHF-PC is currently undergoing efficacy testing in a large randomized controlled trial.

Effectiveness of interventions involving nurses in secondary stroke prevention: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Among members of the health care team, nurses play a large role in actively engaging stroke survivors in secondary stroke prevention programs. This systematic review and meta-analysis examines the effectiveness of interventions in which nurses have a primary role on modification of risk factors among stroke survivors. METHODS: We systematically searched for randomized controlled trials in relevant databases investigating the role of nurses in secondary stroke prevention. Meta-analyses were conducted using Cochrane Review Manager Software. The mean pooled effect size, a 95% confidence interval (CI), and I-squared ( I2) for heterogeneity were calculated. RESULTS: Sixteen randomized controlled trials were included with a total of 3568 stroke and transient ischemic attack patients. After removing one outlier, the models demonstrated a statistically significant effect on reducing systolic blood pressure (SMD = -0.14 (95% CI = -0.23, -0.05), I2 = 0%; p = 0.002, six studies, n =1885) and diastolic blood pressure (SMD = -0.16 (95% CI = -0.27, -0.05), I2 = 0%; p = 0.003, four studies, n =1316). The interventions also significantly improved physical activity (five studies, n=1234), diet (three studies, n=425), medication adherence (two studies, n=270), and knowledge of risk factors (three studies, n=516). However, there was no effect on smoking cessation or reduction in use of alcohol. CONCLUSION: We found that interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors, as well as knowledge of risk factors as part of secondary prevention of stroke.

Implementing a Cardiac Skills Orientation and Simulation Program.

Patients with cardiac morbidities admitted for cardiac surgical procedures require perioperative nurses with a high level of complex nursing skills. Orienting new cardiac team members takes commitment and perseverance in light of variable staffing levels, high-acuity patient populations, an active cardiac surgical schedule, and the unpredictability of scheduling patients undergoing cardiac transplantation. At an academic medical center in Boston, these issues presented opportunities to orient new staff members to the scrub person role, but hampered efforts to provide active learning opportunities in a safe environment. As a result, facility personnel created a program to increase new staff members' skills, confidence, and proficiency, while also increasing the number of staff members who were proficient at scrubbing complex cardiac procedures. To address the safe learning requirement, personnel designed a simulation program to provide scrubbing experience, decrease orientees' supervision time, and increase staff members' confidence in performing the scrub person role.

Night-time care routine interaction and sleep disruption in adult cardiac surgery.

AIMS AND OBJECTIVES: To explore the context and the influence of night-time care routine interactions (NCRIs) on night-time sleep effectiveness (NSE) and daytime sleepiness (DSS) of patients in the cardiac surgery critical-care and progressive-care units of a hospital. BACKGROUND: There exists a paucity of empirical data regarding the influence of NCRIs on sleep and associated outcomes in hospitalised adult cardiac surgery patients. METHODS: An exploratory repeated-measures research design was employed on the data provided by 38 elective cardiac surgery patients (mean age 60.0 ± 15.9 years). NCRI forms were completed by the bedside nurses and patients completed a 9-item Visual Analogue Sleep Scale (100-mm horizontal lines measuring NSE and DSS variables). All data were collected during postoperative nights/days (PON/POD) 1 through 5 and analysed with IBM SPSS software. RESULTS: Patient assessment, medication administration and laboratory/diagnostic procedures were the top three NCRIs reported between midnight and 6:00 a.m. During PON/POD 1 through 5, the respective mean NSE and DSS scores ranged from 52.9 ± 17.2 to 57.8 ± 13.5 and from 27.0 ± 22.6 to 45.6 ± 16.5. Repeated-measures ANOVA showed significant changes in DSS scores (p < .05). NSE and DSS were negatively correlated (r = -.44, p < .05), but changes in NSE scores were not significant (p > .05). Finally, of 8 NCRIs, only 1 (postoperative exercises) was significantly related to sleep variables (r > .40, p < .05). CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Frequent NCRIs are a common occurrence in cardiac surgery units of a hospital. Further research is needed to make a definitive conclusion about the impact of NCRIs on sleep/sleep disruptions and daytime sleepiness in adult cardiac surgery. Worldwide, acute and critical-care nurses are well positioned to lead initiatives aimed at improving sleep and clinical outcomes in cardiac surgery.

Consulta de Enfermagem à pessoa com doença cardiovascular: valorizando as habilidades empáticas / Nursing consultation to the person with cardiovascular disease: valuing the empathic abilities

O estudo é integrado a pesquisa "Saberes e práticas criativas em saúde: ampliando fronteiras do conhecimento", CAAE 50683415.2.3001.5279. Tem como objeto a valorização das habilidades empáticas na Consulta de Enfermagem à pessoa que convive doença cardiovascular. Foi definida a seguinte questão de estudo: O modelo de Consulta de Enfermagem baseado na Teoria da Empatia Multidimensional, adotado no ambulatório de Cardiologia, é compreendido pelos usuários como espaço de cuidado, acolhimento e ressignificação da maneira de lidar com a doença cardiovascular e os eventos da vida? Possui os seguintes objetivos: Descrever as diferentes dimensões do Cuidado de Enfermagem que compõe a Consulta de Enfermagem no ambulatório de Cardiologia; identificar a presença das habilidades empáticas na Consulta de Enfermagem baseada na Teoria de Empatia Multidimensional; analisar como as habilidades empáticas são compreendidas pelas pessoas com doença cardiovascular; descrever as motivações dos usuários para frequência e continuidade das Consultas de Enfermagem no Ambulatório de Cardiologia; discutir as contribuições da Consulta de Enfermagem para a saúde das pessoas com doença cardiovascular, na perspectiva dos mesmos. Trata-se de um estudo qualitativo e descritivo. Teve como cenário um ambulatório de Cardiologia de uma Policlínica vinculada a uma Universidade Pública, situada no Município do Rio de Janeiro. Participaram 14 pessoas que convivem com doença cardiovascular a partir dos critérios de inclusão estabelecidos. A coleta de dados foi realizada por meio de Grupo Focal. Para tratamento dos dados, utilizou-se a análise de conteúdo delineado por Bardin e emergiram as categorias: A pessoa além de sua doença cardiovascular: as diferentes dimensões integradoras do ser humano a serem observadas durante a Consulta de Enfermagem; O Processo Empático; Contribuições da Consulta de Enfermagem na perspectiva das pessoas atendidas. Os resultados evidenciaram que a Consulta de Enfermagem atinge as quatro dimensões integradoras do ser humano: emocional, socioeconômica, espiritual e física; que para uma melhor relação interpessoal com a pessoa atendida, o Enfermeiro precisa possuir habilidades empáticas cognitivas, comportamentais e afetivas. Também mostrou que apesar das dificuldades físicas, geográficas e a violência, os participantes vêm à consulta, mantendo continuidade e frequência, pois se sentem acolhidos e compreendidos pelo Enfermeiro, além de terem seus sentimentos, pensamentos e perspectivas reconhecidos e validados. Conclui-se que é possível se utilizar da Consulta de Enfermagem baseada na empatia multidimensional como uma tecnologia de cuidado integral a pessoa, então poderá se constituir em uma estratégia a ser adotada em outros ambulatórios da Policlínica em questão, o que ocorrerá para qualificar o cuidado de enfermagem.

The study is integrated into the research "Knowledge and creative practices in health: broadening the frontiers of knowledge", CAAE 50683415.2.3001.5279. Its objective is the valuation of the empathic skills in the Nursing Consultation to the person who lives cardiovascular disease. The following question of study was defined: The Nursing Consultation model based on the Multidimensional Empathy Theory, adopted in the Cardiology outpatient clinic, is understood by users as a space of care, reception and resignification of the way to deal with cardiovascular disease and events of life? It has the following objectives: Describe the different dimensions of Nursing Care that compose the Nursing Consultation in the Cardiology outpatient clinic; to identify the presence of empathic skills in the Nursing Consultation based on Multidimensional Empathy Theory; analyze how empathic abilities are understood by people with cardiovascular disease; to describe the motivations of the users for frequency and continuity of the Nursing Consultations in the Cardiology Outpatient Clinic; to discuss the contributions of the Nursing Consultation to the health of people with cardiovascular disease from their perspective. This is a qualitative and descriptive study. The scenario was an outpatient clinic of Cardiology of a Polyclinic linked to a Public University, located in the Municipality of Rio de Janeiro. Participants were 14 people living with cardiovascular disease based on established inclusion criteria. Data collection was done through the Focal Group. For data treatment, we used the content analysis outlined by Bardin and the categories emerged: The person besides his cardiovascular disease: the different integrating dimensions of the human being to be observed during the Nursing Consultation; The Empathic Process; Contributions of the Nursing Consultation from the perspective of the people served. The results showed that the Nursing Consultation reaches the four integrating dimensions of the human being: emotional, socioeconomic, spiritual and physical; that for a better interpersonal relationship with the person served, the Nurse must possess empathic cognitive, behavioral and affective skills. It also showed that despite the physical, geographical and violence difficulties, the participants come to the consultation, maintaining continuity and frequency, because they feel welcomed and understood by the Nurse, in addition to having their feelings, thoughts and perspectives recognized and validated. It is concluded that it is possible to use the Nursing Consultation based on multidimensional empathy as a comprehensive care technology for the person, so it can be a strategy to be adopted in other outpatient clinics of the Polyclinic in question, which will occur to qualify the care of nursing.

Specialty Linens and Pressure Injuries in High-Risk Patients in the Intensive Care Unit.

BACKGROUND: The cardiovascular and surgical intensive care units had the highest unit-acquired pressure injury rates at an institution. Patients in these units had multiple risk factors for pressure injuries. Various interventions had been used to minimize pressure injuries, with limited results. OBJECTIVES: To evaluate the effect of specialty linens on the rate of pressure injuries in high-risk patients. The specialty linen was a synthetic silklike fabric that addressed the microclimate surrounding the patient, with the purpose of minimizing friction, shear, moisture, and heat. METHODS: The specialty linen was tried on 24 beds in the cardiovascular intensive care unit and 20 beds in the surgical intensive care unit, including sheets, underpads, gowns, and pillow cases. Data obtained from a retrospective review of electronic health records were compared for 9 months before and 10 months after specialty linens were implemented. RESULTS: Total unit-acquired pressure injury rates for both units combined declined from 7.7% (n = 166) before to 5.3% (n = 95) after the intervention. The intervention was associated with a significant reduction in posterior (coccyx, sacrum, back, buttock, heel, and spine) pressure injury rates, from 5.2% (n = 113) before to 2.8% (n = 51) after specialty linens were implemented (P < .001). CONCLUSION: Addressing the microclimate, friction, and shear by using specialty linens reduces the number of posterior pressure injuries. The use of specialty linens in addition to standard techniques for preventing pressure injuries can help prevent pressure injuries from developing in high-risk patients in intensive care units.

Person-centred discharge education following coronary artery bypass graft: A critical review.

AIMS AND OBJECTIVES: To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery. BACKGROUND: Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation. DESIGN: A critical review of published peer-reviewed literature was conducted. METHODS: Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015. RESULTS: Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews. CONCLUSION: A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft. RELEVANCE TO CLINICAL PRACTICE: Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being.

Challenges in secondary prevention after acute myocardial infarction: A call for action.

Worldwide, each year more than 7 million people experience myocardial infarction, in which one-year mortality rates are now in the range of 10%, but vary with patient characteristics. The consequences are even more dramatic: among patients who survive, 20% suffer a second cardiovascular event in the first year and approximately 50% of major coronary events occur in those with a previous hospital discharge diagnosis of ischaemic heart disease. The people behind these numbers spur this call for action. Prevention after myocardial infarction is crucial to reduce risk and suffering. Evidence-based interventions include optimal medical treatment with anti-platelets and statins, achieve-ment of blood pressure, lipid and blood glucose targets, and appropriate lifestyle changes. The European Society of Cardiology and its constituent bodies are determined to embrace this challenge by developing a consensus document in which the existing gaps for secondary prevention strategies are reviewed. Effective interventions in relation to the patients, healthcare providers and healthcare systems are proposed and discussed. Finally, innovative strategies in hospital as well as in outpatient and long-term settings are endorsed.

Knowledge and practice in cardiovascular disease prevention among hospital registered nurses: a cross-sectional study.

AIMS AND OBJECTIVES: To investigate the knowledge and clinical practices of cardiovascular disease prevention among registered nurses who worked on three major clinical units in Beijing hospitals. BACKGROUND: Health education on cardiovascular disease prevention is an important component of nursing practice; however, Chinese registered nurses' knowledge and practice patterns have been poorly explored in previous studies. DESIGN: A cross-sectional study. METHODS: A stratified random sample of three hundred registered nurses was recruited from two tertiary hospitals in Beijing, China. A validated questionnaire was used to examine nurses' knowledge of cardiovascular disease risk factors, their practices and perceived barriers to cardiovascular disease prevention-related patient education. The differences in knowledge of cardiovascular disease risk factors and the practice pattern associated with cardiovascular disease prevention were compared among nurses who worked on three major clinical units. RESULTS: Questionnaires were completed by 273 registered nurses with a response rate of 91%. More than 75% of the registered nurses knew the cardiovascular disease risk factors; however, less than half knew the right target goals for cardiovascular disease risk factors. Notably, fewer than 70% of registered nurses routinely provided health education for cardiovascular disease prevention during their practice. There was inconsistency between registered nurses' knowledge of target goals for cardiovascular disease risk reduction and their education practices on cardiovascular disease prevention. The three major barriers to providing cardiovascular disease risk factor preventive education were lack of time, patients' reluctance to change lifestyle and lack of physicians' support. CONCLUSIONS: Not all of the registered nurses were motivated to educate and encourage patients to engage healthy lifestyle changes, even though most of them were knowledgeable about cardiovascular disease risk factors. A gap between the knowledge and practice for the prevention of cardiovascular disease was identified. RELEVANCE TO CLINICAL PRACTICE: The findings highlight the need to advocate for knowledge application and address knowledge deficits in the area of cardiovascular disease prevention among registered nurses.

Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses.

BACKGROUND: Patients' knowledge of their atrial fibrillation (AF) and anticoagulation therapy are determinants of the efficacy of thromboprophylaxis. Nurses may be well placed to provide counselling and education to patients on all aspects of anticoagulation, including self-management. It is important that nurses are well informed to provide optimal education to patients. Current practice and knowledge of cardiovascular nurses on AF and anticoagulation in the Australian and New Zealand (ANZ) context is not well reported. This study aimed to; 1) Explore the nurse's role in clinical decision making in anticoagulation in the setting of AF; 2) Describe perceived barriers and enablers to anticoagulation in AF; 3) Investigate practice patterns in the management of anticoagulation in the ANZ setting; 4) Assess cardiovascular nurses' knowledge of anticoagulation. METHODS: A paper-based survey on current practices and knowledge of AF and anticoagulation was distributed during the Australian Cardiovascular Nursing College (ACNC) Annual Scientific Meeting, February 2014. This survey was also emailed to Cardiovascular Trials Nurses throughout New South Wales, Australia and nursing members of the Cardiac Society of Australia and New Zealand (CSANZ). RESULTS: There were 41/73 (56%) respondents to the paper-based survey. A further 14 surveys were completed online via nurse members of the CSANZ, and via an investigator developed NSW cardiovascular trials nurse email distribution list. A total of 55 surveys were completed and included in analyses. Prior education levels on AF, stroke risk, anticoagulation and health behaviour modification were mixed. The CHA2DS2VASc and HAS-BLED risk stratification tools were reported to be underused by this group of clinicians. Reported key barriers to anticoagulation included; fears of patients falling, fears of poor adherence to medication taking and routine monitoring. Patient self-monitoring and self-management were reported as underutilised. ANZ cardiovascular nurses reported their key role to be counselling and advising patients on therapy regimens. Anticoagulant-drug interaction knowledge was generally poor. CONCLUSION: This study identified poor knowledge and practice in the areas of AF and anticoagulation. There is scope for improvement for cardiovascular nurses in ANZ in relation to AF and anticoagulation knowledge and practice.

Evaluation of telehealth service for patients with congestive heart failure in the north of Israel.

AIMS: This research was conducted to evaluate the impact of a telehealth service on re-hospitalization of patients with congestive heart failure at New York Heart Association II-IV. METHODS AND RESULTS: The telehealth service for congestive heart failure patients was designed to follow the patients after their daily weighing and to provide a response in cases of non-compliance or deviation from baseline weight. A weighing scale was installed in the patient's house together with a communication module connected to the telemedicine control centre through a telephone line. The control centre is staffed by skilled nurses whose responses to patients are guided by programmed algorithm. Over a year, we evaluated the changes in the frequency of hospital admission and of primary care visits, and quality of life of 141 individuals who were eligible for the telehealth service for congestive heart failure. A decline was noted in the average number of hospitalizations per patient (from 4.7 to 2.6, p < 0.001). Scores of parameters of quality of life were improved (average score for first through fourth quarterly administration: 64, 50, 16, 16, p < 0.001 by the Minnesota Living with Heart Failure Questionnaire). CONCLUSIONS: During the year of use in telehealth service for congestive heart failure parameters of hospitalization were improved, together with parameters of quality of life.

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.

[A reflective case report applied to pain management in a complex care situation]. / Eine reflexive Fallarbeit bezogen auf das Schmerzmanagement in einer komplexen Pflegesituation.

PROBLEM: This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. METHOD: The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? RESULTS: Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. DISCUSSION: The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

Venous leg ulcers: Summary of new clinical practice guidelines published August 2014 in the Journal of Vascular Surgery.

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) published guidelines for the management of venous leg ulcers in August 2014. The goal of this article (Part 2) is to summarize the guidelines that address diagnosis and treatment recommendations published jointly by the SVS and AVF that may affect the nursing practice of vascular nurses. Specific sections include wound evaluation, therapies used on the wound bed itself, compression, and operative or endovascular management. Part 1, published elsewhere in this issue, addressed the epidemiology and financial impact of ulcers, venous anatomy, pathophysiology of venous leg ulcer development, clinical manifestations, and prevention of venous leg ulcers. These 2 parts together provide a comprehensive summary of the joint SVS and AVF guidelines for care of venous leg ulcers.