Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review.

Workplace bullying in the nursing profession: A cross-cultural scoping review.

https://www.onlinecjc.ca/article/S0828-282X(14)01656-0/pdf

Obesity and Coronary Artery Disease: Evaluation and Treatment

It has been over two decades since the very first robotic cardiac surgery was performed. Over the years, there has been an increase in the demand for less invasive cardiac surgical techniques. Developments in technology and engineering have provided an opportunity for robotic surgery to be applied to a variety of cardiac procedures, including coronary revascularisation, mitral valve surgery, atrial fibrillation ablation, and others. In coronary revascularisation, it is becoming more widely used in single vessel, as well as hybrid coronary artery approaches. Currently, several international centres are specialising in a totally endoscopic coronary artery bypass surgery involving multiple vessels. Mitral valve and other intracardiac pathologies such as atrial septal defect and intracardiac tumour are also increasingly being addressed robotically. Even though some studies have shown good results with robot-assisted cardiac surgery, there are still concerns about safety, cost and clinical efficacy. There are also limitations and additional challenges with the management of cardiopulmonary bypass and myocardial protection during robotic surgery. Implementing novel strategies to manage these challenges, together with careful patient selection can go a long way to producing satisfactory results. This review examines the current evidence behind robotic surgery in various aspects of cardiac surgery.

The Future of Open Heart Surgery in the Era of Robotic and Minimal Surgical Interventions.

The concept and relevance of existential issues in nursing.

Aim
To explore nurses’ experiences of horizontal violence (HV) in three diverse non-affiliated organisations within a single city in the USA.

Background
Horizontal violence, also called workplace bullying or lateral violence, is a long-standing nursing issue.

Method
Content analysis was used to analyse open-format textual responses from 126 registered nurses.

Results
A powerful collective story emerged from nurses’ shared experiences with HV, describing the characters and the setting in which HV and its consequences exist. Nurses’ depictions of HV were consistent despite the different organisational structures of their workplaces suggesting that hospital type is not the explanation for HV, rather the culture of acute care nursing. Nurses want change and asked for tactics to resolve HV within their institutions; some provided specific solutions.

Conclusion
Nurse managers must continue to address HV by using a variety of known tactics, as well as adopting new evidence-based interventions as they are identified. The anti-bullying message should be disseminated through professional nursing organisations as well as in local health-care establishments.

Implications for nursing management
Nurse managers need to be the culture champions who hold individuals accountable for HV and foster professionalism through their leadership.

A cross‐hospital exploration of nurses’ experiences with horizontal violence

Objective: The influence of body mass index (BMI) as a risk factor for isolated off-pump coronary artery bypass (OPCAB) surgery is unknown. We postulated that BMI ≥ 30 kg/m2 would adversely affect outcomes following OPCAB at our institution.



Methods: From 2002 to 2009, we selected 742 patients (primary, N = 709 [95.6%], re-operative, N = 33 [4.45%]) who underwent isolated OPCAB for analysis. Patients were stratified into groups by BMI: non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). Preoperative risk, operative characteristics, and postoperative outcomes were analyzed. Risk-adjusted models evaluated the occurrence of any complication and mortality.



Results: Overall crude mortality was 1.5% (11/742). When compared to non-obese (26.12 ± 2.72 kg/m2) recipients, the obese (35.81 ± 5.69 kg/m2) comprised younger patients (62.46 ± 9.96 years, p < 0.001). Number of diseased vessels, Left ventricular ejection fraction, and baseline renal function was equivalent across groups. Diabetes (53.24%) and hypertension (90.59%) were more prevalent among obese patients (p < 0.001, respectively). Internal mammary artery utilization (p = 0.47), endoscopic vein harvest (p = 0.74), and intra-aortic balloon pump use (p = 0.58) were similar between groups. Interestingly, postoperative blood product requirement was lower in obese versus non-obese recipients (47.35% vs. 56.72%, p < 0.01). Furthermore, intensive care unit stay (p = 0.93), mortality (p = 0.56), and discharge to home (p = 0.09) remained equivalent between groups. Importantly, multivariable logistic regression did not identify BMI ≥ 30 kg/m2 as an independent predictor of any complication (p = 0.21) or mortality (p = 0.74).



Conclusions: Obesity does not influence operative characteristics or effect outcomes after OPCAB. BMI ≥ 30 kg/m2 should not be considered a prohibitive risk factor in isolated off-pump coronary revascularization. (J Card Surg 2011;26:565-571)

Is body mass index a risk factor for isolated off-pump coronary revascularization?

Changes in the causes of death and advances in medical technology are leading nurses today to become more involved with end-of-life care than previously. Yet, terminally ill patients and their families have reported dissatisfaction with end-of-life care. One reason for the dissatisfaction may be attitudes among nurses about end-of-life care and hospice referral. Attitudes about end of life affect nurses' ability to care for and communicate with patients and families facing these issues. For this reason, it is important to examine nurses' attitudes about end-of-life care, specifically hospice referral, to improve care to patients and families facing death.

Nurses' attitudes about end-of-life referrals.

OBJECTIVE Left ventricular (LV) resynchronization with epicardial lead placement after failed coronary sinus cannulation can be achieved with minimally invasive robotic-assisted (RA) or minithoracotomy (MT) incisions. We evaluated early outcomes and costs after RA and MT epicardial LV lead implantation at our academic center. METHODS From 2005 to 2010, 24 patients underwent minimally invasive RA or MT epicardial LV lead placement for resynchronization. Patient characteristics, electrophysiologic features, outcomes, and costs were analyzed. RESULTS Ten patients underwent RA and 14 underwent MT minimally invasive LV lead placement, with no 30-day mortality in either group. Younger patients underwent RA epicardial lead placement (63.8 ± 15.4 vs 75.6 ± 10.0 years; P = 0.03). In addition, although both groups had comparable body surface areas, RA patients had significantly higher body mass index versus MT patients (44.4 ± 17.5 vs 26.9 ± 7.1 kg/m, respectively; P = 0.003). Premorbid risk and cardiovascular profiles were similar across groups. Importantly, pacing threshold, impedance, and postoperative QRS interval were equivalent between groups. Significantly, both operating room and mechanical ventilation durations were higher with RA epicardial placement (P < 0.001). Despite equivalent outcomes, incision-to-closure interval was 48 minutes shorter with MT (P = 0.002). Absolute differences in direct costs between groups were negligible. Despite these differences, resource utilization and lengths of stay were equivalent. CONCLUSIONS Epicardial LV lead placement is efficacious with either approach. Early outcomes and mortality are equivalent. Greater tactile feedback during operation and equivalent short-term outcomes suggest that MT minimally invasive LV lead placement is the more favorable approach for epicardial resynchronization.

Robotic-assisted or minithoracotomy incision for left ventricular lead placement: a single-surgeon, single-center experience.

Rural nurses typically fill several roles as needed from acute and extended care settings and to the emergency room. The nurse’s role with aggressive curative efforts involves an intense clinical focus; while end-of-life care entails an intense psychosocial focus. Emergency room (ER) nurses commonly experience these two intense foci of care in succession. Purpose: With the limited resources in rural hospitals, it was necessary to explore the rural influence on rural ER nurses transitioning from curative to end-of-life care. The goal was to capture areas of need to best support rural nurses caring for dying patients and their families in the rural communities. Method: A secondary analysis using deductive content analysis incorporated Rural Nursing Theory to identify rural influences with rural ER nurses transitioning from curative to end-of-life care.  In a primary study, Grounded Theory was used  to explore ER nurses’ personal transitioning when the focus of patient care changes from curative to end-of-life. Registered nurses (N=10; rural n=6, urban n=4) from four hospitals (2 rural and 2 urban) in four different counties in Upstate New York participated in semi-structured interviews. Analysis yielded 29 concepts and producing five categories: preparing caring, immersion, making sense, changing gears, and reflecting. Three sub-processes, focus, feelings, and conflict were identified as common threads with conflict as a moderating factor influencing nurses transitioning from curative to end of life care. Findings: The concepts of distance, resources, and familiarity had the greatest influence on rural ER nurses transitioning from curative to end-of-life care. The strongest characteristic of rural nurses was self-reliance. For this reason, adequate support and resources are essential to care for dying patients and their families in rural communities. Conclusions: Implications for rural ER nursing include strategies to improve staff resources, access to education, and mentoring. Keywords : Rural, End-of-life, Transition, Emergency, Nurse DOI: http://dx.doi.org/10.14574/ojrnhc.v16i2.396

Roberta Rolland

Papers

A cross‐hospital exploration of nurses’ experiences with horizontal violence

Is body mass index a risk factor for isolated off-pump coronary revascularization?

Nurses' attitudes about end-of-life referrals.

Robotic-assisted or minithoracotomy incision for left ventricular lead placement: a single-surgeon, single-center experience.

Emergency Room Nurses Transitioning from Curative to End-of-Life Care: The Rural Influence