Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
Background: Even though struggling with similar symptom burden, patients with chronic heart failure (CHF)\nreceive less palliative care than patients suffering from malignant diseases. Researchers have found that this might\nbe related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the\ncyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that\npatients with CHF benefit from palliative care. As there are no studies for the German health care system this study\naimed to assess health care professionals� attitudes regarding palliative care of CHF patients in order to identify\nbarriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF\npatients� access to palliative care in Germany.\nMethod: Problem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses:\nhospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were\nconducted and analysed according to Mayring�s qualitative content analysis.\nResults: Most interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients�,\npublic�s, and professionals� lack of knowledge of palliative care and CHF; shortcomings in communication and\ncooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis\nof course of disease; and patients� concerns regarding palliative care were described. Different attitudes regarding\nappropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better\ncommunication and closer cooperation between different professional groups and medical disciplines as well as\nbetter education about palliative care and CHF for professionals, patients, and public were cited.\nConclusions: Palliative care for CHF patients is a neglected topic in both practice and research and should receive\nmore attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public,\npatients, and professionals, closer cooperation between the different professional groups involved as well as\ndevelopment of a joint agreement regarding the appropriate time to administer palliative care to CHF patients....
Objective: Cardiac surgery due to its-associated stressors has the potential physiological, psychological, emotional, and\nspiritual consequences. Assessment of stressors needs to nurses and patients understanding these factors that are different\nfrom each other. The aim of this study was to determine nurse-patient perception of stressful factors in patients undergoing\ncoronary artery bypass surgery (CABG).\nMaterials and Methods: It was a descriptive comparative study on patients who underwent CABG and were hospitalized\nat cardiac surgery wards between the third and fifth days after operation and also on nursing caregivers of these patients\nworking in these wards. The Revised Cardiac Surgery Stressor Scale (RCSSS) was used for assessing related stressors after\ndetermining its reliability and validity. The data analysis was performed by SPSS and with descriptive statistical methods\n(frequency, percent, mean �± standard deviation) and inferential statistical analysis was performed.\nResults: According to overall mean RCSSS score, the perception of stressors in nurses was significantly higher than patients\n(2.38 �± 0.56 versus 1.65 �± 0.44) and the nurse-patient understanding was different for interpersonal, intrapersonal, and\nextra-personal stressors.\nConclusion: According to the results, nurses can generally assess their patients in terms of interpersonal, intrapersonal, and\nextra-personal stressors and train them according to the needs of patients. It can help them to personal assessment of the\npatients and facilitate their adaptation....
Introduction: Coronary Artery Bypass Surgery (CABG) is one of the\nmain options for treating coronary artery disease.\nObjective: To describe the nursing care in the immediate postoperative\nperiod in CABG surgery in the ICU.\nMethod: This is an integrative review, which seeks to gather and\nsynthesize the information gathered for analysis of the data was performed\na reading in full the findings and discussed later, preserving\nthe ethical and legal principles of each study.\nResults: Nursing care should be developed with quality and competence\nby nurses and all his team, comprising all the POI period in\nICU within 24 hours, it is of utmost importance to prevent possible\ncomplications.\nConclusion: The nurse has the key role in the admission of that\npatient in the ICU, assessing and caring in comprising the SVR postoperative\nICU....
Background: Anxiety and depression are common after heart transplantation. This study aimed to pilot test the\nfeasibility of a clinical model of psychological care for heart transplant recipients. The model of care involved\nnurse-led screening for anxiety and depression followed by referral for a course of telephone-delivered cognitive\nbehaviour therapy as well as co-ordination of communication with on-going specialist and primary care services.\nMethods: A pilot randomised controlled trial was conducted. Heart transplant recipients who self-reported at least\nmild anxiety or depressive symptoms were randomised (defined as a score higher than 5 on the Patient Health\nQuestionnaire-9 or the Generalized Anxiety Disorder-7 [GAD-7], or a score higher than 20 on the Kessler\nPsychological Distress Scale [K10]). The primary outcome was assessment of feasibility of conducting a larger trial,\nwhich included identification of recruitment and attrition rates as well as the acceptability of the intervention.\nFollow-up was conducted at 9 weeks and 6 months.\nResults: One hundred twenty-two of the 126 (97 %) heart transplant recipients assessed on their attendance at\nthe outpatient clinic met the study eligibility criteria. Of these patients, 88 (72 %) agreed to participate. A\nmoderate proportion of participants (n = 20; 23 %) reported at least mild symptoms of anxiety or depression.\nFive participants were excluded because they were currently receiving psychological counselling, two withdrew\nbefore randomisation and the remaining 13 were randomised (seven to intervention and six to usual care). The\nmajority of the randomised participants were male (n = 9; 69 %) and aged over 60 (range 35ââ?¬â??73). Median length\nof time post-transplant was 9.5 years (ranging from 1 to 19 years). On enrolment, 3 randomised participants\nwere taking anti-depressants. One intervention group participant withdrew and a further 3 (50 %) declined the\ntelephone-delivered CBT sessions; all because of restrictions associated with physical illnesses. Attrition was 30 %\nat the 6 month follow-up time-point.\nConclusions: Due to the poor acceptability of telephone-delivered cognitive behavioural therapy observed in our\nsample, changes to intervention components are indicated and further pilot testing is required....
Background: Current research suggests that nurses can influence the outcome for patients with acute coronary\nsyndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can\nimprove ambulance nurses� (ANs�) prehospital care of patients experiencing suspected ACS, related to pain intensity.\nMethods: This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were\nallocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course\nand in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain\nraising suspicion of ACS, and 2/pain score �4 on a visual analogue scale (VAS). The primary outcome was the\nestimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were\nestimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as\nwell as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of\nalertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to\n30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients\nwho fulfilled the inclusion criteria.\nResults: The pain score did not differ significantly between the two groups fifteen minutes after randomisation\n(median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for\npatients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who\nhad not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the\ncourse used higher doses of morphine.\nConclusions: An educational intervention with a CVN course did not relate significantly to more efficient pain relief\nin suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief\nlater on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity\namong patients experiencing suspected ACS. This result needs however to be confirmed in further tria...
Introduction\nHeart failure is a growing public health problem associated with poor quality of life and significant\nmorbidity and mortality. The majority of heart failure care is provided by family caregivers,\nand is associated with caregiver burden and reduced quality of life. Research\nemphasizes that future nursing interventions should recognize the importance of involving\nfamily caregivers to achieve optimal outcomes.\nAims\nThe aims of this study are to explore registered nursesââ?¬â?¢ perceptions about the situation of\nfamily caregivers to patients with heart failure, and registered nursesââ?¬â?¢ interventions, in order\nto improve family caregiversââ?¬â?¢ situation.\nMethods\nThe study has a qualitative design with an inductive approach. Six focus group interviews\nwere held with 23 registered nurses in three hospitals and three primary health care centres.\nData were analysed using qualitative content analysis.\nResults\nTwo content areas were identified by the a priori study aims. Four categories and nine subcategories\nemerged in the analysis process. The content area ââ?¬Å?Family caregivers' situationââ?¬Â\nincludes two categories: ââ?¬Å?To be unburdenedââ?¬Â and ââ?¬Å?To comprehend the heart failure condition\nand its consequencesââ?¬Â. The content area ââ?¬Å?Interventions to improve family caregivers'\nsituationââ?¬Â includes two categories: ââ?¬Å?Individualized support and informationââ?¬Â and ââ?¬Å?Bridging\ncontactââ?¬Â. Conclusions\nRegistered nurses perceive family caregivers' situation as burdensome, characterized by\nworry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent\nhealth care contact was considered an important and sustainable intervention to better care\nfor family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals,\nregistered nurses can provide family caregivers with the opportunity of involvement in their\nrelative's health care and address congruence and relationship quality within the family\nthrough the use of \"Shared care\" and or Family-centred care. Registered nurses consider it\nnecessary to have a coordinated individual care plan as a basis for collaboration between\nthe county council and the municipality....
Background: Counselling on health-related lifestyles is key to the prevention and management of chronic diseases.\nAfter comprehensive study of determinants of its delivery in general practice and strategies to improve, we composed\na tailored improvement program, which included communication skills training, online patient information, and a\nclinical protocol for managing depressive symptoms. Our aim was to assess the effectiveness of this program on\nprofessional performance and outcomes in cardiovascular patients.\nMethods: A two-arm cluster randomized trial in 34 general practices involving 34 nurses was conducted. The primary\noutcome was an aggregated score of a positive score on lifestyle counselling delivered and an appropriate action on\ndepressive symptoms. Secondary outcomes included the various elements of the primary outcome, vascular risk factors\n(extracted from patient records), and patient-reported lifestyle behaviors. Data were collected from medical records and\na written survey among included patients.\nResults: A sample of 1782 patients with recorded cardiovascular disease or high cardiovascular risk was available at\nfollow-up at 6 months. No impact on the primary outcome was found; lifestyle counselling was recorded in a minority\nof patients (11.4 % in the intervention group and 10.3 % in the control group). An effect was found on a secondary\noutcome: patientsââ?¬â?¢ physical activity level increased (B 0.18; 95 % CI 0.02ââ?¬â??0.35) on a seven-point scale.\nConclusions: The tailored improvement program showed no effect on the primary outcome. This challenges the\nmethodology of tailoring. More involvement of the targeted health care professionals might offer ways to develop\nmore effective implementation programs. Physical activity might be the lifestyle issue that can be more easily changed\nthan smoking or dietary habits...
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