T'ai Chi Chih as an intervention for heart failure.

A program of T'ai Chi Chih, a modified T'ai Chi exercise, was piloted in a study comprised of a small sample of individuals with heart failure. A conceptual framework guided the study design, integrating theories of the neurohormonal dynamics of heart failure with mind-body holistic perspectives of health. Comparisons of pre- and post-measures of heart failure symptoms, general health, mental health, functional capacity, and energy perceptions support the potential of T'ai Chi Chih in managing heart failure symptoms and improving quality of life. In this article, quantitative interviews capture the meaning of experiencing a complementary therapy as an intervention for chronic illness. Participation in T'ai Chi Chih by individuals with heart failure is a cost-effective, noninvasive alternative strategy that warrants continued investigation.

The energy costs of a modified form of T'ai Chi exercise.

BACKGROUND: Alternative strategies for exercises that provide both training and relaxation benefits are optimal for persons with very low functional capacities who also are at high risk for complications. T'ai Chi C'hih, a modified form of traditional T'ai Chi, is a series of slow balanced movements and breathing promoted to increase energy levels and induce relaxation. OBJECTIVES: To estimate the energy costs and cardiovascular effects of T'ai Chi C'hih. Measured energy costs of specific activities can assist with safe exercise prescription for individuals with very low energy reserves. METHODS: A convenience sample (n = 26) of healthy adults participated in this study, which involved completion of surveys to estimate functional capacity and exercise participation, training in a select series of nine T'ai Chi C'hih movements, and oxygen consumption testing while movements are performed. Movements involving front to back and lateral moves of the lower extremity, full shoulder range of motion of upper extremity, and deep forced inhalation and stepped exhalations were performed at slow to fast cadences in sitting and standing positions. The Human Activity Profile was used to estimate lifestyle energy consumption. Exercise participation was quantified as Kcal/Kg(1) expended per week. RESULTS: Metabolic equivalents (METs) for sitting T'ai Chi C'hih movements were estimated to be 1.5 +/- 0.17 and 2.3 +/- 0.34 for slow standing, and 2.6 +/- 0.47 for fast standing. Mean maximum heart rates ranged from 43% to 49% of predicted maximum heart rates. Mean increases in both systolic and diastolic blood pressures over resting were 8%. Mean METs of breathing exercises ranged from 3 to 3.6. There were no differences in responses to the movements by gender or experience with T'ai Chi exercise. CONCLUSION: The movements used to perform T'ai Chi C'hih require energy expenditure comparable with that for activities of daily living and for low level exercises currently recommended for persons with low exercise tolerance. Therefore, T'ai Chi C'hih may be an alternative approach to health promotion in many populations with chronic disease.

An exploratory study of developmental growth in adults with heart failure.

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.

Care and safety of pacemaker electrodes in intensive care and telemetry nursing units.

BACKGROUND: Temporary pacing leads with electrodes are a potential risk, because microshock inadvertently transmitted across the catheter or wire can paradoxically cause lethal dysrhythmias. Much attention has been paid to this complication in clinical guidelines, but little is known about actual practices used to protect patients. OBJECTIVES: A national survey was done to describe current practices related to the care of patients with temporary epicardial or transvenous pacing catheters. The survey focused on environmental factors that affect generation of static electricity, equipment used with temporary pacing, and nursing practices used when handling temporary pacing electrodes. METHODS: The Pacemaker Electrical Care and Safety Survey was developed, validated, and pilot tested before it was mailed to all 895 hospitals that perform cardiac surgery. Surveys were sent to the coronary care unit, cardiac surgical ICU, and telemetry units of each hospital. RESULTS: Responses were received from 476 units representing 388 (43%) of the 895 institutions. Most respondents reported using gloves, although few hospitals had policies mandating this practice. The insulating materials used most often, in order, were a glove or finger cot, tape, and gauze. Few units (25%) use any measure to reduce static electricity generated by movement over carpeting. Little attention was paid to insulating exposed epicardial temporary pacing electrodes at the generator. CONCLUSIONS: Temporary pacing electrodes were usually handled in an electrically safe manner; however, little attention was paid to environmental sources of microshock or connections between the generator and the cable. Although the respondents reported using a variety of insulating materials, the ideal cover for the exposed tips of the electrodes has not yet been determined.

Relationships between self-care resources and the quality of life of persons with heart failure: a comparison of treatment groups.

Modeling and role-modeling provided the theoretical basis for this exploratory pilot quality of life study. Thirty-eight individuals undergoing three different treatment regimens for chronic heart failure were surveyed regarding various dimensions of quality of life. No differences were found in resources needed or available, physical or emotional symptoms, total activity, or global quality of life among the three groups. The health-related outcome of activity was predicted by physical symptoms and the mental composite score from the Short Form-36 Health Survey. Regression analysis provided an equation for global quality of life in which internal and external resources accounted for 43% of the variance in scores on the Index of Well-Being. Results suggest that MRM theory-based nursing interventions may enhance resources that improve the quality of life of persons with chronic heart failure.

Medical devices and attachment: holistic healing in the age of invasive technology.

The environment is filled with wonderful examples of medical technology that provide emergency life support, improve well-being, and offer the possibility of a longer and more productive life. But these devices are no longer only a part of the external environment. As technology advances, more devices are becoming a part of the internal environment (i.e., our bodies) as well. For some people an implanted mechanical device, such as a cardiac pacemaker or a cardioverter defibrillator, is readily accepted; for others it may be seen as an encroachment. It may be a symbol of loss and debilitation or of independence and resilience. What makes the difference? How can nurses facilitate a healthy adjustment and healing in an era permeated with technology? A discussion of the symbolism, related theory, and nursing implications is provided.

Infection precautions with temporary pacing leads: a descriptive study.

OBJECTIVE: To describe infection precautions used by nurses when caring for patients with temporary epicardial and transvenous pacemakers. DESIGN: Descriptive, nation-wide survey. SETTING: All U.S. hospitals performing cardiac surgery. RESPONDENTS: Nurse managers and clinical specialists from cardiac and thoracic intensive care, coronary care, and telemetry units at all U.S. hospitals performing cardiac surgery. INTERVENTION: The Pacemaker Electrode Care and Safety Survey. RESULTS: Responses came from 43% (388) of the 895 hospitals. Most respondents indicated that they wore gloves when handling electrodes (approximately 96%); usually the gloves were nonsterile (73%). A sterile procedure was often used to perform site care (37% for epicardial and 65% for transvenous). The most common agent used for site cleansing was povidone-iodine. Concern has been expressed in the literature about use of this agent. Gauze was the most common type of dressing (used by 60% for epicardial dressings and 31% for transvenous). CONCLUSION: There is diversity in clinical practice. Further study is recommended to establish the safety, efficacy, and cost-effectiveness of identified infection precautions.

Bringing nursing informatics into the undergraduate classroom.

Nursing informatics is not formally addressed in most undergraduate nursing education programs. Nurses usually rely on their employer and/or device vendors to provide this education. Few nurses are able to capitalize on the potential of computer technology because they have not been sufficiently exposed to nursing informatics during their nursing education. Biomedical computer technology/informatics needs to be brought into the classroom, away from the pressures of the work environment. Informatics training needs to be incorporated into undergraduate nursing education through an integrated systems approach, combining elements of nursing, systems analysis, and engineering. In this article, a university-based state-of-the-art classroom and education plan using an integrated approach to educate nurses in nursing informatics is described.

An analysis of the writings of Janet Geister and Mary Roberts regarding the problems of private duty nursing.

Fifty years ago there were two widely circulated nursing journals, each with a unique purpose and style. The Trained Nurse and Hospital Review was the privately owned older journal, and the American Journal of Nursing was the voice of the professional organization. Each journal was edited by a strong nursing leader, Janet Geister and Mary Roberts, respectively. Each editor had many years of service to the nursing profession in varied capacities. Naturally, each had distinctly different interests, visions, and styles of communication. These editors witnessed and commented on the change in the sphere of nursing practice from a private duty and public health orientation to one that eventually became dominated by the hospital. Although their approaches differed, both recognized the need for organization, versatility, and creative problem solving. However, the legacy of these leaders must be considered in view of the gap that continues to exist between practicing nurses and the American Nurses' Association leadership.

Temporary cardiac pacing.

The use of temporary cardiac pacing in critical care and stepdown units has grown tremendously over the past 10 years. While the concept of artificial pacing is simple, improvements in generator technology and lead design, along with broader clinical applications, have made temporary cardiac pacing more complex. Consequently, the critical care nurse is required to maintain an advanced level of knowledge regarding modes and complications of temporary pacing, and assessment skills related to recognizing pacemaker hemodynamic effects and pacemaker problems.

Memory error. Developing a new nursing diagnosis.

It is recommended that memory error, the inability to encode, maintain, or retrieve information, be identified as a nursing diagnosis. Two different types of memory error, forgetting to take a medication at the scheduled time and being unable to remember whether a medication has already been taken, are discussed in terms of nursing diagnosis and intervention.