Showing papers in "Progress in Cardiovascular Nursing in 1994"

Functional status, mood disturbance and quality of life in patients with heart failure.

Abstract: Patients with chronic heart failure are known not only for exceptionally high mortality rates, but also for having the highest reported hospital readmission rates for all patient groups. Analysis of preliminary descriptive data from 24 patients currently enrolled in an experimental study to examine the effects of a nursing model upon reducing readmission rates and improving quality of life are reported in this paper. Results indicate that heart failure patients experience significant mood disruption that appears to be greater than that reported by other cardiac patients; mood disruption is also related to reported quality of life. Reported exercise tolerance was unrelated to ejection fraction; this finding underscores the importance of psychosocial interventions in improving the quality of life and care outcomes for patients with heart failure.

Burden and stress associated with spousal caregiving for individuals with heart failure.

Abstract: The purpose of this study was to examine the level of caregiver burden and stress experienced by spouses of patients with heart failure. The population of those afflicted with heart failure is growing, and the home management regimen is becoming more complex. A nonprobability sample of 11 male and 30 female spouses participated in this descriptive survey. Participation included the completion of the Caregiving Demands Scale, the Brief Symptom Inventory and a demographic form. Results revealed that caregiving in this sample was burdensome and stressful. There was a significant correlation (r = 0.32), p = 0.04) between the number of helping behaviors performed and level of stress. Also, there was a significant relationship (r = 0.43, p = 0.01) between perceived difficulty in performing caregiving activities and level of stress. Female subjects reported performing more helping behaviors and more difficulty in performing them than the men. Women also identified items related to social participation and the relationship with spouse as most burdensome, whereas men reported activities related to supervision and responsibility as most difficult to manage. Future research on the demands and stressors for those caring for heart failure patients should include a qualitative component to assess the burden and strain in more depth.

The psychosocial effects of support group intervention on AICD recipients and their significant others.

Abstract: The automatic implantable cardioverter defibrillator (AICD) is one treatment method employed for patients with actual or potential malignant ventricular tachyarrhythmias. Support group intervention has been shown to be of value in promoting adaptation and coping skills. This exploratory pilot study compared the psychosocial effects of support group intervention on 11 AICD recipients who regularly attended support group, ten spouses, or significant others who also attended and five AICD recipients who were unable to attend. The Spielberger State Anxiety Inventory, The Anxiety Visual Analogue Study (VAS), the Medical Outcome Study (MOS) Short Form General Health Survey, and anecdotal reports were used. Results showed that quantitative data were not significantly changed by support group interventions. Qualitative data demonstrated improved ability to cope and increased satisfaction with life in group participants, however, it was difficult to ascertain whether this was a result of passage of time.

The educational needs of myocardial infarction patients.

Abstract: Over the last 20 years, the educational needs of myocardial infarction (MI) patients have been addressed from the points of view of health care providers and patients. However, most teaching is based on the health care providers' perceptions of patients' educational needs. Little emphasis has been placed on patients' perception of educational needs. This article identifies the MI patients' perceived learning needs in the coronary care unit, in the post-coronary care unit, and at home, and evaluates the extent of the effectiveness of various types of cardiac rehabilitation programs. Recommendations for educating first-time MI patients during each phase of cardiac recovery and for conducting future research studies are discussed.

Women and coronary heart disease.

Abstract: Research in the diagnosis and treatment of coronary heart disease has largely excluded women despite an increasing incidence, morbidity and mortality in women. This article outlines gender differences in cardiac anatomy and physiology; identifies risk factors in women; reviews primary prevention trials; discusses diagnostic techniques and therapeutic interventions in women. Understanding the strengths and weaknesses of the current knowledge of coronary heart disease in women is essential to planning effective, individualized nursing care.

T wave alternans.

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Electrocardiographic changes in critically ill adults during intrahospital transport.

Abstract: Critically ill patients are frequently transported out of the intensive care unit (ICU) for diagnostic tests and procedures. Advanced diagnostic testing and increased patient acuity have influenced the level of nursing care required during intrahospital transport. Previous studies have documented deleterious patient outcomes during intrahospital transport, but none have evaluated twelve lead electrocardiograms (ECGs). Using a prospective design, this study sought to describe ECG changes during intrahospital transport. A secondary purpose was to describe the nursing implications of transporting the patients in this sample. A convenience sample of 29 critical care patients (14 cardiac, 8 neurological, 5 medical, 2 transplant) was selected from three ICUs at a university hospital. In addition to the standard, single bipolar lead monitor, patients were monitored with a portable, interpretative electrocardiograph with continuous 12 lead ST segment analysis. Results of this study indicate that cardiac events during intrahospital transport may go undetected because of current monitoring practices and the mechanics of transport.

Do not resuscitate (DNR) orders.

Abstract: In Ohio there are several legally recognized ways for you to give doctors and other health care providers instructions about the medical treatment you wish to receive (or do not wish to receive)—before you actually need the care. You may have heard about advance directives such as living wills and health care powers of attorney . Ohio law also recognizes another tool to help you and your doctor do effective health care planning for the end of life. It is called a DNR order. Unlike a living will or health care power of attorney, a DNR order is a medical order that must be written by a physician or other authorized person.

Cardiac nurses' perceptions of nursing research.

Abstract: Nurses' perception of nursing research is an important variable affecting the successful development of a clinical nursing research program. The objectives of this study were to: examine the perceived value, role, interest, support and experience of cardiac nurses in nursing research; to determine the effects of age and level of education on their perceptions; and to analyze the reliability of Alcock et al.'s questionnaire. The survey was administered to 313 nurses with a response rate of 46%. Frequency distributions were obtained on individual survey items. MANOVAs were performed as a function of age group and education level, followed by post hoc ANOVAs. Findings showed nurses valued nursing research particularly as it related to clinical practice decisions and solutions to patient care problems. They saw a participatory role in the first stages of the research process. Age was not a factor in nurses' perceptions of nursing research with the exception of perceived support. Diploma nurses indicated higher levels of perceived value (p = 0.000), role (p = 0.034), interest (p = 0.000) and support (p = 0.017) for nursing research than baccalaureate nurses. The Cronbach reliability coefficient of each area indicated high internal consistency (> 0.72). When 5 items in the questionnaire are deleted, the tool exhibits high level of reliability and evidence of construct and discriminant validity.

Aging and heart failure.

Abstract: The prevalence of heart failure increases as individuals age. The causes of heart failure in the older adult are essentially the same as in the general adult population. However, clinical presentation is altered in older adults because symptoms and physical findings may not be those classically described and taught. This article addresses the pathophysiology and clinical presentation, diagnostic evaluation, and therapy of heart failure in the older adult.

Management of an elderly, multi-center cohort: strategies for conducting longitudinal research.

Abstract: This paper describes a longitudinal study in which a cohort of cardiac surgery elders from several hospital sites has been followed. Issues related to retention of the cohort over time are identified. Low-cost and reliable strategies for cohort management are suggested.

Development of a hospital-based cardiovascular risk factor reduction program for the community: Beyond Heart Disease.

Abstract: The current and future trend of the health care delivery system is prevention and health promotion Long-term viability of hospitals depends on meeting community health education needs With heart disease as the leading cause of death among adults nationwide, hospitals have an opportunity to offer appropriate lifestyle theory and guidance beyond conventional medical and interventional practices Sequoia Hospital in Redwood City is one of the first hospitals in Northern California to develop a comprehensive outpatient program to complement its world renowned cardiovascular services This paper details the Beyond Heart Disease (BHD) program designed by nurses The goal of this program is to effectively help people reduce their risk of coronary events via successful long-term risk factor interventions BHD, a unique medical and business venture, spans a six-week period Group members meet in the evening for two hours, twice a week The program includes lipid testing, a complete program syllabus, didactic lectures, small group discussion, support and goal-setting, nutritional analysis, and experiential stress reduction sessions

Pseudoaneurysm of the femoral artery following cardiac intervention: identification and management.

Abstract: Pseudoaneurysm of the femoral artery following cardiac intervention is a complication requiring intuitive assessment and prompt intervention. The risk of femoral arterial injury from a cardiac catheterization is estimated at 0.6% to 17%, and should always be suspected when hematoma exists. Several factors contribute to the development and severity of vascular pseudoaneurysms following a transarterial intervention. Atherosclerotic occlusive disease at the site of arterial catheterization is a leading cause of pseudoaneurysms. Passage of large sheaths, particularly 8FR or greater contribute to more prevalent vascular complications. The associated use of multiple anticoagulation drugs before and after the cardiac procedure may result in difficulty in maintaining hemostasis allowing for the development of pseudoaneurysm. Once femoral pseudoaneurysm is detected clinical management includes ultrasonic guided compression or surgical repair. Optimal patient care requires careful assessment of the hematoma following invasive cardiac procedures and timely treatment.