Respuesta emocional de pacientes cardiológicos en estado crítico durante la higiene en cuidados intensivos: estudio prospectivo y descriptivo / Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study / Resposta emocional de pacientes cardiológicos críticos durante a higiene em cuidados intensivos: um estudo prospectivo e descritivo

Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.

Objective: to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. Method: a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. Results: 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. Conclusion: the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Objetivo: analisar a resposta emocional de pacientes críticos conscientes durante a higiene diária em uma unidade de terapia intensiva cardíaca e compará-la considerando ou não as experiências prévias. Método: estudo prospectivo e descritivo. Foi aplicado questionário ad hoc de 30 itens a 148 pacientes, com base na higiene do primeiro dia. Foram feitas perguntas sobre sentimentos durante a higiene e aspectos positivos e negativos da experiência. Os pacientes foram comparados considerando o fato de terem sido higienizados anteriormente. Resultados: 67,6% eram homens e a idade média foi de 67±15 anos. 45,9% apresentavam conformismo, 27% se sentiram envergonhados e 86,3% estavam gratos por terem conversado com eles durante a higiene; 33,1% dos pacientes acamados nunca haviam recebido cuidados de higiene no leito, eram significativamente mais jovens e solteiros, e tinham um senso de limpeza mais baixo; 32% expressaram que gostariam que um membro da família ajudasse na higiene. Conclusão: os pacientes não se sentiram invadidos em sua intimidade quando receberam os cuidados de higiene e apreciaram a comunicação com o pessoal de saúde durante o procedimento. Os pacientes que não tinham recebido cuidados de higiene no leito anteriormente são mais jovens, sentem-se mais constrangidos e mais incomodados pelas interrupções, sendo mais conscientes delas.

Complicaciones intrahospitalarias del infarto agudo de miocardio. Incidencia y momento de aparición / In-hospital complications of acute myocardial infarction. Incidence and timing of their occurrence

Resumen Aunque la mortalidad del infarto de miocardio con elevación del segmento ST (IAMCEST) ha disminuido con el progreso de la reperfusión, la incidencia de sus complicaciones no ha cambiado. El objetivo del estudio es conocer la incidencia de las complicaciones hospitalarias del IAMCEST, su cronología de aparición e identificar sus predictores. Se realizó un análisis prospectivo de todos los pacientes consecutivos con IAMCEST ingresados en una unidad coronaria de un Hospital público de la ciudad de Buenos Aires desde septiembre de 2017 a marzo de 2020. De 263 pacientes con IAMCEST, el 47.2% (124) presentó complicacio nes siendo la insuficiencia cardíaca (IC) la más frecuente. El paro cardiaco previo al ingreso (PCR) (OR: 9.8; IC: 1.2-81.9; p = 0.03), la fracción de eyección del ventrículo izquierdo (Fey VI) < del 40% (OR: 2.3 IC: 1.3-3.9; p = 0.004) y la edad > de 68 años (OR: 2.2; IC: 1.2-4,0; p = 0.01) fueron sus predictores. La reperfusión exitosa (OR: 0.2 IC: 0.005-0.7; p = 0.02) y la presentación de Killip y Kimball (KK) A (OR: 0.0002 IC: 0.00001-0.003; p = < 0.00001) fueron factores protectores. El 88.7% (110) se complicó el primer día de internación y todos (con excepción de un solo paciente) dentro de las 48 horas. Las complicaciones post IAMCEST son muy frecuentes, suceden dentro de los primeros dos días de internación y la IC es la más prevalente. Detectamos un grupo con menor riesgo que podría tener una internación abreviada de solo 48 horas.

Abstract Although ST-segment elevation myocardial infarction (STEMI) mortality decreased with the progress of reperfusion, the incidence of hospital complications has not changed. We aimed to describe the incidence of STEMI complications in the coronary unit, the timing of their occurrence and to identify their predis posing and protective factors. This is a prospective analysis of all consecutive patients with STEMI admitted to a coronary care unit of a third level reference hospital from September 2017 to March 2020. Of the 263 STEMI, 124 developed complications (47.2%), and the most frequent was heart failure. In the multivariate analysis, pre-admission cardiac arrest (CA) (OR: 9.8; CI: 1.2-81.9; p = 0.03), left ventricular ejection fraction (Fey VI) < 40% (OR: 2.3 CI: 1.3-3.9; p = 0.004) and age > 68 years (OR: 2.2; CI: 1.2-4.0; p = 0.01) were predictors of complica tions. Successful reperfusion (OR: 0.2 CI: 0.005-0.7; p = 0.02) and the presentation of Killip and Kimball (KK) A (OR: 0.0002 CI: 0.00001-0.003; p = < 0.00001) were protective factors. Most complications occurred on the first day (88.7%) and in all but one patient within the first 48 hours. Acute complications of STEMI occurred very frequently and the most prevalent was heart failure. KKA and successful reperfusion are low risks predictors, while 6 out of 10 patients with Fey VI < 40%, Cardiac arrest before admission or age >68 years suffered an event. Almost all complications happened within the first 48 hours.

Constructing a predictive risk score for the needs of coronary care unit care in patients with ST-segment elevation myocardial infarction / 中国医师进修杂志

Objective:To construct a risk prediction score for the needs of coronary care unit (CCU) care in stable condition acute ST-segment elevation myocardial infarction (STEMI) patients who receive percutaneous coronary intervention (PCI) treatment.Methods:The clinical data of 805 STEMI patients who accepted PCI in the First Hospital of Jilin University from November 2017 to October 2018 were retrospectively analyzed. Among the patients, 654 patients from November 2017 to July 2018 were served as the modeling group, the patients with needs of CCU had 125 cases, and the patients without needs of CCU had 529 cases; 151 patients from August 2018 to October 2018 were served as the validation group, the patients with needs of CCU had 28 cases, and the patients without needs of CCU had 123 cases. Binary Logistic regression analysis was used to establish the risk prediction model and determine the score standards. The critical value was determined according to the best Youden index of receiver operating characteristic (ROC) curve.Results:Among 805 patients with STEMI, 153 cases (19.01%) had the needs of CCU, and the most common reason was pump failure (heart failure and cardiogenic shock, 113 cases). In the modeling group, age (60 to 74 years old, OR = 1.513, 95% CI 0.945 to 2.424, P = 0.085; ≥75 years old, OR = 2.740, 95% CI 1.371 to 5.478, P = 0.004), total ischemic time>4 h ( OR = 1.701, 95% CI 1.022 to 2.831, P = 0.041), admission shock index ≥0.8 ( OR = 1.910, 95% CI 1.178 to 3.099, P = 0.009), multi-vessel disease ( OR = 2.090, 95% CI 1.272 to 3.432, P = 0.004), preoperative diseased vessels thrombolysis in myocardial ischemia (TIMI) blood flow grade 0 ( OR = 2.099, 95% CI 1.313 to 3.353, P = 0.002), acute anterior myocardial infarction ( OR = 3.696, 95% CI 2.347 to 5.819, P<0.001) and previous history of stroke ( OR = 3.927, 95% CI 2.057 to 7.500, P<0.001) were independent risk factors for CCU needs in STEMI patients undergoing PCI. The scoring criteria were as followings: age<60 years old was given 0 score, 60 to 74 years old 1 score, ≥75 years old 2 score; total ischemic time>4 h in 1 score, admission shock index ≥0.8 2 scores, multi-vessel disease 2 scores, preoperative diseased vessels TIMI blood flow grade 0 2 scores, acute anterior myocardial infarction 3 scores, previous history of stroke 3 scores, and the total score was 15 scores. The patients with 0 to 6 scores were low-risk, and the patients with 7 to 15 scores were high-risk. ROC curve analysis result showed that, in modeling group, the area under curve (AUC) of risk prediction score for predicting the needs of CCU in STEMI patients was 0.740 (95% CI 0.692 to 0.788, P = 0.580); in validation group, the AUC of risk prediction score for predicting the needs of CCU in STEMI patients was 0.755 (95% CI 0.658 to 0.853, P = 0.755). Conclusions:A predictive risk score based on seven risk factors such as age, total ischemic time, admission shock index, multi-vessel disease, preoperative diseased vessels TIMI blood flow grade, acute anterior myocardial infarction and previous history of stroke is constructed in order to predict the needs of CCU in STEMI patients with stable condition who receive PCI treatment. It can be used to help doctors to identify high-risk patients before the admission to CCU, thus providing simple and practical clinical tool for rational allocation of limited CCU resources.

Disturbed sleep pattern (000198): content analysis in patients with acute coronary syndrome / Patrón de sueño perjudicado (000198): análisis de contenido en pacientes internados con síndrome coronario agudo / Padrão de sono prejudicado (000198): análise de conteúdo em pacientes internados com síndrome coronariana aguda

ABSTRACT Objective: to analyze the content of the defining characteristics of the Disturbed Sleep Pattern Nursing Diagnosis (00198) in patients with Acute Coronary Syndrome. Method: content analysis performed by specialists who achieved a score equal to or greater than five, according to established criteria: clinical experience, teaching and/or research; participation in research groups; doctorate degree; master's degree; specialization and/or residency in cardiology and/or sleep and/or nursing classifications. Eight defining characteristics were evaluated for their relationship to population, relevance, clarity and accuracy. Descriptive statistics were performed to characterize the sample, binomial statistical test to establish if there is agreement between the experts and chi-square and Fisher's exact to establish associations between the evaluated items and the experts' variables. Results: 54 experts participated in the study. The defining characteristics validated by the experts were the following: dissatisfaction with sleep, feeling unrested, sleep deprivation, alteration in sleep pattern, unintentional awakening, difficulty initiating sleep and daytime sleepiness. There was a statistically significant association between evaluated items and the variables time of training, time of operation and punctuation. Conclusion: seven of the eight defining characteristics were considered valid after the application of binomial test. This study will contribute to the refinement of the Disturbed Sleep Pattern Nursing Diagnosis (000198) and may enable the improvement of the quality of care of patients hospitalized with Acute Coronary Syndrome regarding changes in sleep pattern. The content analysis stage will support the next stage of the validation process of the present diagnosis, the clinical validation.

RESUMEN Objetivo: analizar el contenido de las características definidoras del Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (00198) en pacientes con Síndrome Coronario Agudo. Método: análisis de contenido realizado por especialistas que obtuvieron una puntaje mayor o igual a cinco, de acuerdo con los criterios establecidos: experiencia clínica, en docencia y/o en investigación; participación en grupos de investigación; doctorado; maestría; especialización y/o residencia en cardiología y/o en clasificaciones de enfermería. Se evaluaron ocho características definidoras en cuanto a su relación con la población, relevancia, claridad y precisión. Se realizó un análisis estadístico descriptivo para caracterizar la muestra, una prueba estadística de binomios para establecer si había concordancia entre los especialistas y las pruebas de chi-cuadrado y exacto de Fisher para establecer asociaciones entre los puntos evaluados y las variables de los especialistas. Resultados: del estudio participaron 54 especialistas. Las características definidoras que evaluaron los especialistas fueron las siguientes: insatisfacción con el sueño, no sentirse descansado, privación del sueño, alteración en el patrón de sueño, despertar no intencional, dificultad para iniciar el sueño y somnolencia diurna. Se registró una asociación estadística significativa entre los puntos evaluados y las siguientes variables: tiempo de formación, tiempo de ejercicio en la profesión y puntuación. Conclusión: siete de las ocho Características definidoras se consideraron válidas después de aplicar la prueba de binomios. El presente estudio contribuirá a perfeccionar el Diagnóstico de Enfermería de Patrón de Sueño Perjudicado (000198) y podrá hacer posible que se mejore la calidad de la atención de pacientes internados con Síndrome Coronario Agudo en lo referente a alteraciones en el patrón de sueño. La etapa del análisis de contenido servirá de ayuda para la próxima etapa del proceso de validación del presente diagnóstico: la validación clínica.

RESUMO Objetivo: analisar o conteúdo das características definidoras do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (00198) em pacientes com Síndrome Coronariana Aguda. Método: análise de conteúdo realizada por especialistas que atingiram pontuação igual ou maior a cinco, de acordo com critérios estabelecidos: experiência clínica, no ensino e/ou pesquisa; participação em grupos de pesquisa; doutorado; mestrado; especialização e/ou residência em cardiologia e/ou sono e/ou classificações de enfermagem. Oito características definidoras foram avaliadas quanto a sua relação com a população, relevância, clareza e precisão. Realizou-se estatística descritiva para caracterização da amostra, teste estatístico binomial para estabelecer se há concordância entre os especialistas e qui-quadrado e exato de Fisher para estabelecer associações entre os itens avaliados e variáveis dos especialistas. Resultados: 54 especialistas participaram do estudo. As características definidoras validadas pelos especialistas foram: insatisfação com o sono, não se sentir descansado, privação do sono, alteração do padrão de sono, despertar não intencional, dificuldade para iniciar o sono e sonolência diurna. Houve associação estatística significativa entre itens avaliados e as variáveis tempo de formação, tempo de atuação e pontuação. Conclusão: sete das oito características definidoras foram consideradas válidas após aplicação de teste binomial. O presente estudo contribuirá para o refinamento do Diagnóstico de Enfermagem Padrão de Sono Prejudicado (000198) e poderá possibilitar a melhoria da qualidade do atendimento de pacientes internados com Síndrome Coronariana Aguda no que tange a alterações do padrão de sono. A etapa de análise de conteúdo subsidiará a próxima etapa do processo de validação do presente diagnóstico, a validação clínica.

Practical guidance for healthcare professionals during the COVID-19 pandemic; with special emphasis on the care of cardiovascular patients and personal protection

A novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the COVID-19 pandemic. There are concerns regarding the spread of disease by asymptomatic carriers to healthcare workers who continue to see patients and to perform procedures on them. The infection then could be transmitted through them to other patients who eventually, could infect persons in the community. Further, limitations of existing tests to detect new cases that are negative early in the disease; and the inability to use appropriate personal protection equipment (PPE)also contribute to the spread of infection. This document, from the COVID-19 Working Group of Wellness and Radial Intervention Society, describes considerations for management and care of cardiovascular disease (CVD) patients with the concept of COVID 19 `designated` Vs. enabled` centers for those with symptoms of and/ or confirmed COVID-19 disease Vs. asymptomatic suspects. It also provides guidance to healthcare professionals, hospital administrators, and policymakers in general and to those managing patients with CV and other diseases, regarding the concept of `levels of personal protection` for staff; with suggestions for `equivalent innovative alternatives`, and a` protection plan` for patients to prevent the spread of disease. The guidance can also be broadly applied to surgical branches in general and to other specialties involved with invasive, semi-invasive, and non-invasive procedures such as gastroenterology, urology, anesthesiology, otolaryngology, and ophthalmology which carry a higher risk of exposure for healthcare professionals.

Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Abstract Background: Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients. Objetive: To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed. Methods: Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher's exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05. Results: 372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison. Conclusion: After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

Prevalence of elderly patients who refuse to get discharge from coronary intensive care unit in a tertiary care hospital of North India: a pilot study

Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.

Conceptual and operational definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern / Definição conceitual e operacional das características definidoras do diagnóstico de enfermagem Padrão de Sono Prejudicado / Definición conceptual y operacional de las características definidoras del diagnóstico de enfermería Estándar de Sueño Perjudicado

Objective to present the knowledge produced about sleep and Acute Coronary Syndrome in order to assist in the elaboration of the operational and conceptual definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern (00198). Method integrative review in the following databases: COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribbean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (The Excerpta Medical Database). At the end of the search, 2827 studies were found, 43 were selected for reading, and 10 were included in the review. The gray literature was also included. Results important findings related to clinical evidence and contributing factors of sleep were found in the review. However, in order to build definitions of the defining characteristics, it was necessary to use gray literature, such as a Portuguese dictionary and two textbooks about sleep. Conclusion the definitions will help nurses in their practice in the collection of information, in the determination of the nursing diagnosis studied here, and in directing care measures with respect to quantity and quality of sleep of Acute Coronary Syndrome inpatients. They will also assist in the next steps of the validation of this diagnosis to the referred population.

Objetivo apresentar o conhecimento produzido sobre sono e Síndrome Coronariana Aguda a fim de auxiliar na elaboração das definições operacionais e conceituais das características definidoras do diagnóstico de enfermagem Padrão de Sono Prejudicado (00198). Método revisão integrativa nas bases de dados COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) e EMBASE (The Excerpta Medica Database). Ao final das buscas, 2827 estudos identificados, 43 selecionados para leitura e 10 incluídos. A literatura cinzenta também foi incluída. Resultados importantes achados relacionados a evidências clínicas e fatores contribuintes do sono foram encontrados na revisão realizada. Porém, para a construção das definições das características definidoras, fez-se necessário lançar mão de literatura cinzenta, como um dicionário da Língua Portuguesa e dois livros-texto sobre o sono. Conclusão tais definições poderão auxiliar os enfermeiros da prática na coleta de informações, na determinação do referido diagnóstico de enfermagem e, assim, no direcionamento de cuidados ao que tange à quantidade e qualidade do sono de pacientes internados com Síndrome Coronariana Aguda. Também auxiliarão nas próximas etapas do processo de validação desse diagnóstico à população referida.

Objetivo presentar el conocimiento producido sobre sueño y Síndrome Coronario Agudo a fin de auxiliar en la elaboración de las definiciones operacionales y conceptuales de las características definidoras del diagnóstico de enfermería Estándar de Sueño Perjudicado (00198). Método revisión integradora en las bases de datos COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) e EMBASE (The Excerpta Medica Database). Al final de las búsquedas, 2827 estudios identificados, 43 seleccionados para lectura y 10 incluidos. La literatura gris también fue incluida. Resultados importantes hallados relacionados a las evidencias clínicas y factores contribuyentes del sueño fueron encontrados en la revisión realizada. Sin embargo, para la construcción de las definiciones de las características definidoras es necesario usar la literatura gris, como un diccionario de la Lengua Portuguesa y dos libros texto sobre el sueño. Conclusión tales definiciones podrán auxiliar a los enfermeros de la práctica en la recolección de informaciones, en la determinación del referido diagnóstico de enfermería y así, en el direccionamiento de cuidados sobre la cantidad y calidad del sueño de pacientes internados con Síndrome Coronario Agudo. También auxiliarán en las próximas etapas del proceso de validez de ese diagnóstico a la población referida.

Incidence and mortality of acute kidney injury in coronary care unit: a retrospective study from a single center / 中华肾脏病杂志

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU),and to identify the risk factors of the incidence of AKI and the mortality of CCU patients.Methods A total of 414 patients in CCU from January 1,2014 to June 1,2015 at Zhongnan Hospital of Wuhan University were enrolled.Based on the KDIGO-AKI criteria,these patients were classified into two groups:NAKI group (patients without AKI) and AKI group.Clinical characteristics and laboratory data of two groups were compared.The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression,and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors.Results (1) Among 414 patients,136(32.9％) patients fulfilled the criteria for AKI,and 14.0％ patients in AKI stage 1,10.9％ in AKI stage 2 and 8.0％ in AKI stage 3.(2) The total CCU mortality was 15.0％.Mortality of AKI patients in the CCU was 33.3％,higher than 6.1％ in patients without AKI (OR=7.735,95％CI 4.215-14.196,P ＜ 0.001).The mortality worsened with increasing severity of AKI (22.4％ for AKI stage 1 group,37.8％ for AKI stage 2 group,45.4％ for AKI stage 3 group).(3) Anemia (OR=8.274,95％ CI 4.363-15.689),history of chronic illness (OR=2.582,95％ CI 1.400-4.760),APACHE]Ⅱ seores (OR=1.813,95％CI 1.739-1.895),male (OR=3.666,95％CI 1.860-7.226) were the independent risk factors for AKI,while the normal mean arterial pressure (MAP) (OR=0.292,95％CI 0.153-0.556) and normal estimated glonerular filtration rate (eGFR) (OR=0.166,95％CI 0.090-0.306) are the protective factors for AKI (all P ＜ 0.05).(4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050,95％ CI 2.970-16.735,P ＜ 0.001).Other independent risk factors for CCU mortality included history of chronic illness,ejection fraction and APACHE Ⅱ ≥ 15 scores (all P ＜ 0.05),while the normal MAP and normal eGFR were the protective factors (all P ＜ 0.05).(5) For predicting AKI,eGFR displayed an excellent areas under the ROC curve (AUC=0.815,P ＜ 0.001),and for CCU mortality,APACHE Ⅱ scores had the highest overall correctness of prediction (AUC=0.757 P ＜ 0.001).Conclusions CCU patients have high morbidity of AKI,which is the most powerful independent factor associated with the increased CCU mortality.The eGFR is the best predictor for AKI,and then through the evaluation of eGFR for CCU patients,we can evaluate high-risk groups,make early interventions and then improve the prognosis of CCU patients.

Estresse do paciente na terapia intensiva: comparação entre unidade coronariana e pós-operatória geral / Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

Objetivo: Avaliar e comparar os fatores estressantes identificados pelos pacientes de uma unidade de terapia intensiva coronariana com aqueles percebidos pelos pacientes de uma unidade de terapia intensiva pós-operatória geral. Métodos: Estudo transversal, descritivo, realizado na unidade de terapia intensiva coronariana e na unidade de terapia intensiva pós-operatória geral de um hospital privado. Participaram 60 pacientes, sendo 30 de cada unidade de terapia intensiva. Para identificação dos fatores estressantes, utilizou-se a escala de estressores em unidade de terapia intensiva. Foram calculados o escore médio de cada item da escala e, em seguida, o escore total de estresse). Após a comparação entre os grupos, as diferenças foram consideradas significantes quando p < 0,05. Resultados: A idade dos pacientes da unidade de terapia intensiva coronariana foi de 55,63 ± 13,58 e da unidade de terapia intensiva pós-operatória geral foi de 53,60 ± 17,47 anos. Os principais estressores para a unidade de terapia intensiva coronariana foram “sentir dor”, “estar incapacitado para exercer o papel na família” e “estar aborrecido”. Para a unidade de terapia intensiva pós-operatória geral foram “sentir dor”, “estar incapacitado para exercer o papel na família” e “não conseguir se comunicar”. A média do escore total de estresse na unidade de terapia intensiva coronariana foi de 104,20 ± 30,95 e, na unidade de terapia intensiva pós-operatória geral, foi de 116,66 ± 23,72 (p = 0,085). Comparando cada fator estressante separadamente, houve diferença estatisticamente significante apenas entre três itens. “Ter a enfermagem constantemente fazendo tarefas ao redor do leito” foi mais estressante para a unidade de terapia intensiva pós-operatória geral do que para a unidade de terapia intensiva coronariana (p = 0,013). Por outro lado, os itens “escutar sons e ruídos ...

Objective: To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods: This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results: The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). ...

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit / Avaliação da satisfação profissional e carga laboral das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas / Evaluación de la satisfacción profesional y de la carga laboral del personal de enfermería en las Unidades Griegas de Cuidados Coronarios

ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

RESUMO Objetivo Explorar as potenciais associações entre a carga laboral e a satisfação profissional das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas. Método Estudo transversal com 66 membros das equipes que desenvolvem suas atividades em seis diferentes unidades, selecionadas aleatoriamente. A satisfação no trabalho foi avaliada pelo Index of Work Satisfaction (IWS) e a carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Antervention Score (CNIS) e Therapeutic Intervention Scoring System-28 (TISS-28). Resultados A taxa de resposta foi de 77.6%. A confiabilidade do IWS foi de α=0.78 e a média 10.7 (±2.1,intervalo:0.5-39.7). O componente de satisfação mais valorizado foi “Remuneração”, seguido por “Requisitos da Tarefa”, “Interação”, “Status Profissional”, “Políticas Organizacionais” e “Autonomia”. NAS, CNIS e TISS-28 foram correlacionados negativamente (p≤0.04) com os seguintes componentes de trabalho: “Autonomia”, “Status Profissional”, “Interação” e “Requisitos da Tarefa”. O trabalho no turno noturno definiu independentemente o índice de IWS. Conclusão Os resultados mostraram níveis baixos de satisfação no trabalho, que estão relacionados com a carga laboral e influenciados pelos turnos rotativos.

RESUMEN Objetivo Explorar las asociaciones potenciales entre la carga laboral y la satisfacción profesional del personal de enfermería en las Unidades Griegas de Cuidados Coronarios. Método Estudio transversal en 66 miembros das equipes, seleccionados al azar, que están empleados en 6 diferentes unidad griegas. La satisfacción en el trabajo se evaluó por el Index of Work satisfaction (IWS) y la carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Intervention Score (CNIS) y Therapeutic Intervention Scoring System-28 (TISS-28). Resultados La tasa de respuesta fue del 77,6%. La fiabilidad del IWS fue de α=0,78 y la media 10,7(±2,1, rango de escala:0,5-39,7). El componente de la satisfacción más valorado fue “Salario”, seguido de “Requisitos de la tarea”, “Interacción”, “Estatus Profesional”, “Políticas Organizacionales” y “Autonomía”. NAS, CNIS y TISS-28 se correlacionaron negativamente (p≤0.04) con los siguientes componentes de trabajo:”Autonomía”, “Estatus Profesional”, “Interacción” y “Requisitos de la tarea”. El trabajo en el turno nocturno definió independientemente el índice de IWS. Conclusión Los resultados muestran bajos niveles de satisfacción en el trabajo del personal de enfermería que están relacionados con la carga laboral e influenciados por los turnos rotativos.

Influence of CCU nursing pathway on quality of life in patients undergoing coronary artery bypass grafting / 心血管康复医学杂志

Objective:To explore influence of critical care unit (CCU)clinical nursing pathway (CCU-CNP)in de-partment of cardiology on quality of life in patients undergoing coronary artery bypass grafting (CABG).Methods:A total of 128 patients undergoing CABG,who hospitalized in our CCU from Jun 2012 to Jun 2014,were selected. According to random number table,patients were equally divided into CCU-CNP group and routine nursing group. Changes of quality of life and disease knowledge level were compared and analyzed between two groups before and after intervention.Results:Compared with routine nursing group,after intervention,there were significant rise in scores of anginal stability [(60.12±4.36)scores vs.(77.36±5.46)scores],physical limitation [(68.02±3.98) scores vs.(86.98±4.58)scores],anginal frequency [(60.28±5.12)scores vs.(78.47±3.45)scores],disease per-ception [(61.89±4.36)scores vs.(82.58±5.89)scores]and treatment satisfaction [(63.38±5.23)scores vs. (83.92±6.21)scores],P <0.05 or <0.01;and significant reductions in CCU time [(6.98±1.32)d vs.(3.32± 1.22)d],mean hospitalization time [(12.87±2.66)d vs.(6.36±2.45)d]and incidence rate of adverse cardiac events (14.06% vs.3.13%)in CCU-CNP group,P <0.05 or <0.01. Conclusion:CCU clinical nursing pathway can effectively raise disease knowledge and quality of life,reduce the incidence of adverse cardiac events,shorten CCU time and improve patient′s prognosis in CABG patients.

The Pattern of Cardiac Disease at Coronary Care Unit of Dhaka Medical College Hospital.

Background: Epidemiological transition which is taking place in every part of the world, among all races, ethnic groups and cultures has resulted in the global rise in cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality throughout the world. We tried to assess the pattern of cardiac disease at coronary care unit (CCU) of tertiary care hospital. Methods: A cross sectional study conducted among the patients admitted at CCU of Dhaka Medical College Hospital (DMCH) during the period of 1st January 2010 to 31st December 2010. A total of 2415 patients were included in the study. Results: A total 2415 patients in the year 2010, were admitted at CCU of DMCH, among them 56% (n=1346) were male and 44% (n=1069) were female. Out of total admitted patients 220 (9%) were below 30 years of age and 588 ( 24%) & 1607 (67 %) were the age group of 31 to 44 years and 45 years and above age group respectively. Among the disease group ischemic heart disease( IHD) (45%) was the most common cause of hospitalization followed by heart failure (HF) (16%) valvular heart disease (9%), hypertension (7%) and arrhythmia (2%). Acute myocardial infarction (30 %) was the leading cause of IHD followed by unstable angina (15%). Conclusion: This study has found that almost three-quarters of cardiac disease were due to IHD, HF and valvular heart disease in decreasing order of frequency. Countries like Bangladesh can be able to spend very little resources to address those cardiovascular diseases. Along with public as well as private sector efforts, public awareness about the risk factors for cardiovascular diseases should be improved to reduce this sort mortality and morbidity.

Patient Dignity in Coronary Care: Psychometrics of the Persian Version of the Patient Dignity Inventory.

Aim: The Patient Dignity Inventory (PDI) is a valid and reliable questionnaire. This questionnaire was created by Chochinov in 2002 and is used to measure various sources of distress related to the dignity of patients. The present study investigated the characteristics of items, reliability and validity measurements, and the application of the PDI for Persian-speaking cardiac patients. Place and Duration of Study: The study was performed in Kerman, Iran in 2014. Methodology: The PDI was translated into Persian. Then, it was distributed among 220 cardiac patients along with another 4 questionnaires related to anxiety, depression, hopelessness, and quality of life. Cronbach’s coefficient alpha was calculated and principal component analysis and correlation analysis were performed. Construct validity was assessed using these validated questionnaires: the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and SF-36 Health Survey. Results: Factor analysis supported 4 dimensions, including the loss of human dignity, emotional distress and uncertainty, changes in ability and mental image, and loss of independence. The loading factors ranged between 0.5 and 0.83. The Cronbach's alpha of the questionnaire was high at 0.85, and those of the 4 dimensions were also high, ranging between 0.80 and 0.91. A desirable correlation was found between the Persian version of the Patient Dignity Inventory (PDI-P) and the 4 other questionnaires. Conclusion: This tool can be useful in measuring coronary patients' dignity and the distress associated with dignity that these patients comprehend, and it can be used in Persian-speaking countries.

A quantitative study on work-related stressors of night shift nurses’in coronary care unit / 现代临床护理

Objective To explore the work-related stressors of night shift nurses’in coronary care unit(CCU).Method Semi-structured interviews were conducted among 6 night shift nurses in CCU with phenomenological method to analyze work experience of night shift.Result CCU night shift nurses’work-related stressors were found to be horror,frustration,overwork,interpersonal communication stress and shortage of work experience.Conclusion Strengthening psychological communication and emergency training to nurses,adopting incentive mechanism and organization support can relieve nurses’physical and psychological stress and improve work initiative.

Significados de la experiencia de una enfermera con su madre hospitalizada en una unidad intensiva coronaria / Meanings of the experience of a nurse with her mother hospitalized in an intensive coronary unit

El ingreso de un paciente a una Unidad de Cuidados Intensivos (UCI), es un acontecimiento estresante para los miembros de la familia y las experiencias que viven al separarse resultan traumáticas, pero pocas veces son acogidas por los profesionales del staff clínico. Se realizó un estudio de caso para develar la experiencia de una enfermera cuya madre estuvo hospitalizada en una unidad de cuidados intensivos coronaria, para contribuir a generar conocimiento comprensivo en enfermería sobre este fenómeno y aportar a la humanización del cuidado de los familiares. Metodología: Para ello, se aplicó el método de investigación cualitativa de aproximación fenomenológica de Husserl. Se entrevistó en profundidad a una enfermera, quien firmó previamente un consentimiento informado. El proceso de análisis fue realizado basado en Streubert & Carpenter y triangulado con investigadores expertos. Resultados: Se develaron cuatro grandes unidades de significado. La experiencia de tener a su madre hospitalizada en una UCI significa: (1) vivir como un divagar de sentimientos en torno a la muerte, (2) significa, también, una incapacidad de desvincularse del rol de enfermera y tener conciencia de gravedad, (3) significa contar con diferentes apoyos y, por último, significa un (4) cambio de roles al interior de la familia. Conclusión: Se evidencian los aspectos más importantes para realizar intervenciones de cuidados de enfermería personalizados considerando los aspectos emocionales y psicológicos de acuerdo a las singularidades de la enfermera como familiar de paciente hospitalizado en una unidad de paciente crítico.

A patient admitted in an Intensive Care Unit (ICU) is a stressful event for the members of a family, the experiencesbe separated can be traumatic, but rarely are understood by clinical staff. A case study was conducted to reveal the experience of a nurse whose mother was in a Coronary Intensive Care Unit in order to contribute to the construction of comprehensive knowledge in Nursing about this phenomenon, and make a contribution in the humanization of caring for family. Methodology: was applied a qualitative investigation method of approximation phenomenological from Husserl In depth was interviewed a nurse who previously signed an informed consent. The process of analysis was performed based on Streubert & Carpenter and triangulated with expert researchers. Results: Four major units of meaning were unveiled. The experience of having her mother hospitalized in an ICU means: (1) live as a ramble from feelings about death, (2) also means an inability to disengage from the role of nurse and be aware of gravity, (3) means having diff erent supports and fi nally, means a (4) Change of roles within the family. Conclusion: The results indicated the most important interventions of nursing care considering the custom and human emotional and psychological aspects according to the singularities of the nurse as a relative of an ill patient in a critical inpatient unit.

Características clínico epidemiológicas de pacientes con infarto miocárdico agudo / Clinical-epidemiological characteristics of acute myocardial infarction patients

Introducción: la cardiopatía isquémica, y entre estas el Infarto Agudo del Miocardio con elevación del segmento ST, es la primera causa de muerte a nivel mundial. Objetivo: describir las características clínico epidemiológicas de pacientes con infarto agudo del miocardio de la unidad de cuidados coronarios del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río, en 2011 y 2012. Material y Método: estudio observacional, descriptivo, retrospectivo transversal; universo 644 pacientes ingresados con elevación del ST. Los datos se tomaron de las historias clínicas. Resultados: 62% tenían entre 60- 79 años. 84.5% de los pacientes entre 30 y 49 años eran hombres. 81,6% fumaba y el 45,5% era diabético. La localización topográfica del infarto fue: inferior el 70,8%, anterior el 22,9% y anterior extensa el 6,2% de los pacientes. Como complicación, la arritmia se presentó en el 34% de los pacientes, la insuficiencia cardiaca en el 14,9% y la muerte en 7,7%. El 68,5% de los pacientes con arritmias tuvo fibrilación auricular. La trombolisis se empleó en el 55,2% de los pacientes apareciendo, entre las complicaciones, la hipotensión en el 30,7%. Conclusiones: el infarto miocárdico agudo fue más frecuente en pacientes de mayor edad, siendo antes de los 50 años cinco veces más frecuente entre los hombres. Los factores de riesgo más representados fueron el hábito de fumar y la diabetes mellitus. La localización más frecuente fue la inferior y la complicación las arritmias y dentro de estas la fibrilación auricular. La trombolisis se complica principalmente con hipotensión, pudiendo ser más empleada.

Introduction: ischemic cardiopathologies, and particularly high ST-segment acute myocardial infarction, constitute the first death cause in the world. Objective: to describe the clinical-epidemiological characteristics of acute myocardial infarction patients from the coronary care unit at Abel Santamaría Cuadrado Teaching General Hospital, in 2011 and 2012. Material and method: observational, descriptive, retrospective cross-sectional study; target group of 644 admitted patients with ST elevation. The data was taken from clinical records. Results: 62% of the patients were at ages 60-79 years, while 84.5% at ages 30-49 years were male. 81.6% were smokers, and 45.5% were diabetics. Topographical localization of the infarctions was: 70.8% of patients with inferior, 22.9% with anterior, and 6.2% with extended anterior. As complications, arrhythmia occurred in the 20% of patients, myocardial insufficiency in 14.9%, and death in 7.7%. 68.5% of patients with arrhythmias had atrial fibrillation. Thrombolysis was used in the 55.2% of patients; low blood pressure occurred as a complication in 30.7% of the cases. Conclusions: acute myocardial infarction was more frequent in older patients, being, at ages under 50 years, five times more frequent in male. The most represented risk factors were smoking and diabetes mellitus. The interior localization was the most frequent, as were arrhythmias among complications and atrial fibrillation in turn among them. Thrombolysis was complicated chiefly by high blood pressure; it would otherwise have been more used.

Expressão não verbal do paciente no cuidado: percepção do enfermeiro em unidade cardiointensiva / No verbal expression from the patient in care: perception of the nurse in cardio intensive care unit

Este estudo trata da percepção de enfermeiros relativa à observação, à identificação e à análise da comunicação não verbal para traduzir a reação e o sentimento do paciente. Realizado em 2009 em um hospital no Rio de Janeiro com quatorze enfermeiros. RESULTADOS: A comunicação não verbal foi citada no banho no leito (12%), pré-operatório (12%), pós-operatório (12%), admissão (12%), punção venosa (12%), visita familiar (8%), preparo de material (3%), dissecção venosa (3%), aspiração (3%), cardioversão (3%); 18% das enunciações não atendidas referem-se a situações de medo da morte (pré-operatório) e à incapacidade diante do abandono familiar. Os autores destacam que 7% dos pensamentos são representados por palavras, 38%, pela paralinguagem e 55%, pelos sinais corporais. CONSIDERAÇÕES: O enfermeiro observa, identifica e analisa a CNV para traduzir a reação, o sentimento do paciente e as necessidades a serem atendidas pelo cuidado.

That is the perception of nurses related to observation, identification and analysis of non-verbal communication to translate the patient's reaction and feelings during the care provided. Method: Qualitative approach through creative dynamics with fourteen nurses in cardio intensive unit, in Rio de Janeiro's Hospital, in 2009. RESULTS: The non-verbal communications is presented in the bath in bed (12%) preoperative (12%), postoperative (12%), admission (12%), venous puncture(12%), family visit (8%), preparation of material (3%), venous dissection (3%), aspiration (3%), cardio version (3%), 18% of statements missed refer to situations of fear death (preoperative) and the inability against family abandonment. DISCUSSION: There is a validation that 7% of the thoughts are represented by words and 93% by body signals. Considerations: the nurse observes, identifies and analyses the NCV to translate the reaction, the patient's feeling and needs to be met by care.

El estudio trata de la percepción de los enfermeros sobre la observación, identificación y análisis de la comunicación no verbal del paciente para traducir la reacción y el sentimiento durante el cuidado prestado. Método: Abordaje cualitativo, a través de dinámicas creativas con catorce enfermeros de la unidad cardio-intensivista, en un hospital de Rio de Janeiro, en 2009. RESULTADOS: La comunicación no verbal se presenta en el baño en la cama (12%), preoperatorio (12%), postoperatorio (12%), admisión (12%), punción venosa (3%), aspiración (3%), cardioversión (3%), 18% de no atendidas se refiere a situaciones de miedo frente la muerte (preoperatorio) y la incapacidad frente al abandono familiar. DISCUSIÓN: Ha validación de que 7% de los pensamientos son representados por palabras, y un 93% por los señales corporales. Consideraciones: el enfermero observa, identifica y analiza la CNV para traducir la reacción, el sentimiento del paciente y las necesidades que sean atendidas por el cuidado.

Drug utilization study in intensive coronary care unit of a tertiary care teaching hospital.

Background: Critically ill patients are admitted in Intensive coronary care unit. The intensive coronary care unit (ICCU) is a setting where a large number of drugs are administered to patients. Information on drug utilization in intensive coronary care units (ICUs) are lacking in India. Objectives: To identify pattern of drug use and suggest measures. Methods: Prospective drug utilization study was conducted in patients admitted in ICCU for six months. Data was collected in previously prepared case record form. Data was recorded from the admission of patient in ICCU to discharge from ICCU. Analysis was done by using drug use indicators, age and sex wise distribution, morbidity pattern of disease, frequency of drug use, cost of drug therapy and length of stay. Data analysed using Microsoft Excel. Total 605 cases were analysed. Results and Interpretation: Mean ± SD6 of age of all patients being admitted in ICCU is 57.05 ± 11.92 years. Most frequent morbidity found is myocardial infarction. Average number of drugs per encounter is 14.85. Percentage of encounters with an antibiotic and injection prescribed is 27.44% and 98.68% respectively. 34.46% drugs are prescribed by generic name and 43.75% drugs were prescribed from WHO essential drug list. Most commonly prescribed drug is Tablet Aspirin. Frequent injections used are promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metoprolol, Pentazocin and frusemide. Average drug cost per encounter is 867.84 Rs. 65.38% cost is spent on fibrinolytics. Conclusion: Average number of drugs per encounter is high it should be kept low whenever possible. From all drugs prescribed 42.66% drugs were parenteral. Percentage of drug prescribed by generic name is less. Drugs should be prescribed by generic name. Cost of drugs spend by patient is high. Antibiotics are less frequently prescribed. The mortality rate is low. Essential drug list for ICCU should be prepared. Seminar or group discussion can be done with health professionals working in ICCU to discuss drug utilization pattern for further improving prescribing pattern.

Gerenciamento de enfermagem: situações que facilitam ou dificultam o cuidado na unidade coronariana / Administración de la enfermería: aspectos que facilitan o dificultan el cuidado en unidad coronaria / Nursing administration: aspects that can facilitate and hinder care in a coronary unit

A assistência de enfermagem na Unidade Coranariana requer uma equipe de saúde especializada, equipamentos de alta tecnologia e uma liderança atenta as facilidades e dificuldades do cotidiano do cuidado de enfermagem. Objetivo: discutir os aspectos que facilitam ou dificultam o gerenciamento de enfermagem na unidade coronariana. Métodos: realizou-se pesquisa bibliográfica na base de dados Scielo e coleta de dados, utilizando um roteiro de entrevista semi-estruturada com 6 enfermeiras líderes do setor de unidade coronariana do Hospital Universitário da Universidade Federal do Rio de Janeiro. Resultados: quanto aos aspectos facilitadores do gerenciamento de enfermagem, os estudos selecionados e as enfermeiras apontaram fatores objetivos e subjetivos, respectivamente, como a utilização de instrumentos de distribuição da equipe e boa comunicação e relacionamento interpessoal. Sobre os aspectos dificultadores, concordaram quanto à mecanização da enfermeira, à complexidade de uma unidade de cuidados críticos e à escassez de recursos materiais. Conclusões: diante disso, cabe à gerência de enfermagem identificar estes fatores, a fim de possibilitar melhor desempenho dos profissionais e, conseqüentemente, uma assistência mais eficaz e segura ao paciente e sua família.

Nursing care in a coronary unit requires a team of specialized health-care professionals, high-tech equipment and leadership that is alert to the daily possibilities and difficulties of nursing care. Objective: To discuss the aspects that can facilitate and hinder nursingadministration in a coronary care unit. Methods: This is a bibliographic study based on SciELO and data collection, using semi-structured interviews with six head nurses from the Coronary Care Unit at the Universidade Federal do Rio de Janeiro University Hospital. Results:As to the aspects that facilitate nursing administration, the selected studies and the nurses interviewed point to objective and subjective factors, respectively, such as the use of instruments, distribution of the team and good communication and interpersonal relations. Concerning the aspects that hinder nursing administration, they were in agreement with respect to the mechanization of nursing, the complexity of a critical care unit and the shortage of material resources. Conclusions: It is, therefore, the duty of nursing administration to identify these factors in order to help nursing professionals perform better. This will result in safer and more effective care for patients and their families.

La asistencia de enfermería en la Unidad Coranariana requiere un equipo de cuidados de salud especializado, equipamientos de alta tecnología y un liderazgo atento a las facilidades y dificultades diarias del cuidado de enfermería. Objetivo: discutir los aspectos que facilitan y dificultan la administración de enfermería en la unidad coronariana. Métodos: se realizó una investigación bibliográfica en labase de datos SciELO y recolección de datos, utilizando un plan de entrevista semiestructurada con 6 enfermeras líderes del sector de la unidad coronaria del Hospital Universitario de la Universidad Federal de Río de Janeiro. Resultados: acerca de los aspectos que facilitan la administración de enfermería, los estudios seleccionados y las enfermeras apuntaron factores objetivos y subjetivos, respectivamente,como el uso de instrumentos de la distribución del equipo y la buena comunicación y relación interpersonal. Sobre los aspectos que la dificultan, han señalado la mecanización de la enfermera, la complejidad de una unidad de cuidados críticos y la escasez de recursos materiales. Conclusiones: es deber de la administración de enfermería identificar estos factores, para permitir mejor desempeño de losprofesionales y, en consecuencia, asistencia más eficaz y segura para los pacientes y sus familias.