Implantable cardioverter defibrillators: physical and psychosocial outcomes.

BACKGROUND: The long-term outcomes of living with an implantable cardioverter defibrillator are an important consideration in recovery. However, little is known about physical and psychosocial outcomes beyond 1 year after implantation. OBJECTIVE: To describe the long-term physical and psychosocial adaptation of persons who have had an implantable cardioverter defibrillator for approximately 2 years or more. METHODS: This nonexperimental cross-sectional study used telephone interviews to ascertain the responses of 80 recipients of implantable cardioverter defibrillators to physical and psychosocial questionnaires to explore the long-term outcomes of living with the devices. Subjects eligible for inclusion were selected from the files of an arrhythmia clinic. RESULTS: Hierarchical regression analysis showed that subjects who are not emotional are likely to be more physically active, especially if they are young and male, and that subjects who tend to be emotional are likely to be psychologically distressed and have poorer social and domestic adaptation. Furthermore, use of emotions was a positive predictor of psychological distress and poor social and domestic adaptation. Subjects reported the use of both emotion- and problem-focused coping. Subjects' scores on physical and psychosocial functioning were comparable to scores reported in the literature for patients who have had myocardial infarction or dysrhythmia. CONCLUSIONS: Emotional responses to distress were predictive of little physical activity and psychological distress. Furthermore, young recipients of implantable cardioverter defibrillators and men were predicted to be physically active. Persons who have had an implantable cardioverter defibrillator for approximately 2 years or more can anticipate that their physical and psychosocial functioning will be similar to that of patients who have myocardial infarction or dysrhythmia.

A randomized clinical trial of the effect of bed position after PTCA.

BACKGROUND: After percutaneous transluminal coronary angioplasty, prolonged supine bedrest with the bed flat frequently causes back pain. This study was conducted to examine whether percutaneous transluminal coronary angioplasty patients could adjust their bed position to make themselves comfortable without increasing the frequency or severity of bleeding complications. OBJECTIVES: To determine whether the risk of bleeding increased in patients who were allowed to use their bed controls to make themselves comfortable, and if the difference in comfort was significant between patients who controlled and elevated their bed position and patients who remained flat in bed. METHOD: A randomized clinical trial was conducted; 54 patients undergoing percutaneous transluminal coronary angioplasty were randomly assigned to either the control group, in which patients remained flat in bed, or the experimental group, in which they controlled their bed position. Outcome measures included amount of bleeding at the catheter sites and patient comfort. RESULTS: No difference in the amount of bleeding at catheter insertion sites was found between the two groups. Few subjects reported pain at any time. Back pain at dinner and bedtime was higher in the control group, but only the bedtime difference was statistically significant. CONCLUSION: We conclude that patients may be allowed to adjust their bed position to 30 degrees for comfort without incurring increased risk of catheter entry site bleeding and that requiring patients to remain flat in bed has no scientific basis.

Survey of nursing practice related to decanting intravenous solutions.

A survey instrument was mailed to a stratified random sample of 1000 nurses from the membership list of the American Association of Critical-Care Nurses to determine whether there are generally accepted standards for decanting intravenous (IV) solutions before the addition of medication. Four hundred seventy-eight surveys were returned from 47 states and the District of Columbia. Of those, 475 were usable. Seventy-one percent of the respondents did not decant. Of those who did decant (29%), 79% used a needle and syringe to withdraw a volume equal to that of the medication to be added. The results of this study indicate that no generally accepted standards of practice exist for the preparation of IV solutions. Patients may not, therefore, be receiving the dose prescribed by the physician. Nurses need to develop standards for accurate administration of IV solutions.

A shortened version of an instrument measuring bereavement.

The purpose of the study was to develop a tool to measure the grief experience. The Grief Experience Inventory (GEI) [Sanders et al., A Manual for the Grief Experience Inventory. C. M. Sanders, Charlotte, NC (1979)] was revised according to the Parkes [Bereavement: Studies of Grief in Adult Life. International Universities Press, New York (1972)] framework. Four hundred and eighteen subjects who had been primary care givers for significant others prior to the loss of the person through death completed Revised Grief Experience (RGEI) questionnaires. The internal consistency reliability (coefficient alpha) for the RGEI was 0.93. A principal components factor rotation was performed yielding a four factor solution consistent with the theoretical structure (Parkes, 1972). Results demonstrated that the RGEI is a concise, valid, and reliable measure sensitive to the grief experience.

Promoting enthusiasm for research among undergraduate students.

Methods for increasing the undergraduate nursing student's awareness and appreciation of nursing research are presented. Faculty members are asked to examine their own attitudes towards research as well as the factors contributing to the students' developing attitudes. Ways of assisting students to identify researchable problems are discussed and suggestions made for the involvement of the students in ongoing research.

The success of non-BSNs in graduate nursing programs.

Although there is a great need to increase the number of master's prepared nurses, admissions criteria often limit the pool of possible applicants to those with a bachelor's degree in nursing (BSN), and/or require that non-BSN applicants complete special requirements to compensate for their lack of a degree in nursing. One of the few schools that admits RNs without the BSN, and does not require make-up of undergraduate nursing courses, is Yale University School of Nursing (YSN). Yale also has a program for preparing college graduates at the master's level for entry into nursing practice. Those individuals spend the first of three years in prespecialty basic nursing and the last two in the regular master's program. To determine if there was any difference in success among the groups at YSN, the three groups of individuals admitted to the two-year master's program at Yale--Non-Nurse College Graduates, BSNs, and nurses with a non-nursing baccalaureate degree were compared on their theoretical and clinical grades at the end of the first and second years of the specialty programs. Data were gathered from 435 students who had attended Yale over a ten-year period. No significant differences were found among these groups on clinical or theoretical grades at either the end of the first or second year of the program. This study indicates that although careful selection of candidates for graduate study is essential, intelligent, motivated individuals are able to acquire skills through self-learning and professional experience that are usually provided in baccalaureate nursing programs.

Measuring the effectiveness of nursing practice.

This article examines the importance of outcomes as indicators of quality of care. The appropriateness of selected traditional and emerging outcomes in measuring the effectiveness of nursing interventions is addressed.

Factors that influence CNSs' decision about specialization.

Few studies have explored nurses' decision making relative to advanced practice. The purposes of this study were to determine when the decision to prepare as a CNS in a particular specialty is made and to identify the factors that influence that decision. A survey was completed by 257 CNSs. Results indicated that more than half (69%) decided on their specialty after graduation from a basic nursing program. The factors that influenced choice of specialty included experience in first position (47%), clinical role model (37%), and student experience (35%). Critical care was rated the most desirable specialty and psychiatric nursing the least preferred.