Nursing patients with ventricular assist devices: an interpretive description.

CONTEXT-Although researchers have studied the experience of caring for patients with ventricular assist devices from the perspective of family caregivers, few reports address the experience of nursing patients with such devices. OBJECTIVE -To investigate the experience of nursing patients who have a ventricular assist device. DESIGN -A qualitative approach called interpretive description was used to conduct semistructured, 1-on-1 interviews. PARTICIPANTS-Six registered nurses with a range of clinical experiences were interviewed in a 1-year period from 2009 to 2010. Data were transcribed and analyzed by the researcher in conjunction with a research team. RESULTS-Four distinct themes were interpreted from the interview data: exclusive knowledge, human connection, ethics, and interdisciplinary stress and technology. CONCLUSION -Nursing patients who have a ventricular assist device is a complex experience. Nurses develop expert knowledge that is related to direct exposure to patients; this unique knowledge should be formally considered in team decision making. Nursing care of patients who have a ventricular assist device also has features that might result in overconnected nurse-patient relationships. Closely connected nurse-patient relationships intensified the emotional difficultly of experiences of exposure to illness or suffering, or exposure to an unpredictable dying trajectory. Nursing patients with ventricular assist devices can be difficult, and nursing leaders should be aware of the emotional reactions that can result from direct exposure to patients who might be perceived as very ill or suffering. Institutions with ventricular assist device programs should consider providing emotional support for health care workers who find this type of work emotionally difficult.

The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study.

BACKGROUND: Post-operative delirium after cardiac surgery is an adverse event that affects patients' recovery and complicates the delivery of nursing care. Numerous risk factors for delirium are uncontrollable; however, nurses' pro re nata drug administration of sedatives may be a controllable risk factor. OBJECTIVES: This study examined the relationship between nurses' pro re nata administration of midazolam hydrochloride to cardiac surgery patients and the development of post-operative delirium. DESIGN: Observational study. SETTING: Cardiac surgery intensive care and nursing units of a tertiary care center in Vancouver, Canada. PARTICIPANTS: 122 male and female patients requiring non-emergent surgery for coronary artery disease or valvular heart disease who did not have pre-existing cognitive impairment, severe hearing or visual impairment, substance misuse, alcohol intake exceeding 7 drinks per week, or renal impairment requiring hemodialysis. METHODS: Patients were assessed for delirium, on three occasions, with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 h after surgery and through reviews of physicians' notes. Risk factor and midazolam dosage data were collected from medical records. RESULTS: 77.9% of the patients in this sample received midazolam hydrochloride post-operatively. The prevalence of delirium ranged from 37.7% to 44.3%. Almost all of the dosages of midazolam (85-87%) were given before the first indication of delirium; that is, most of the patients had received their entire dosage before the first signs of delirium were detected. Bivariate analysis with logistic regression models revealed that for every additional milligram of midazolam administered, the patients were 7-8% more likely to develop delirium. Multivariate logistic regression models demonstrated that the magnitude of the association between midazolam dosage and delirium was not confounded by established risk factors including age and peripheral vascular disease. CONCLUSION: Nurses play an important role in the prediction, assessment and prevention of post-operative delirium. Sedatives should be administered with caution because they increase a patient's risk of developing delirium. Nurses' decisions regarding sedation administration must be informed by empirical knowledge, accurate assessment data and clear rationale with consideration of how these actions may contribute to the development of delirium.

Nurse Educator Pathway Project: a competency-based intersectoral curriculum.

In this paper, we begin by providing an overview of the Educator Pathway Project (EPP), an education infrastructure that was developed in response to emerging critical nursing workplace issues, and the related demand for enhanced workplace education. We then describe the EPP competency-based curriculum designed to prepare nurses as preceptors, mentors, and educators to lead learning with diverse learner groups. This competency-based curriculum was developed through a collaboration of nurse leaders across practice, academic, and union sectors and drew from a widely embraced curriculum development model (Iwasiw, Goldenberg, & Andrusyzyn, 2005). The goal of the curriculum was to prepare nurses through a four-level career pathway model that contextualized practice and education theory to various education-related roles and levels of experience within the practice setting. Over 1,100 nurses participated in this innovative intersectoral nursing initiative.

Individuals' descriptions of living with fibromyalgia.

Fibromyalgia (FM) is a chronic pain syndrome with no known etiology, cure, prognosis, or clear diagnostic criteria. This interpretive descriptive study was focused on the experience of living with FM. Using a constant comparative inductive analytic method, the researcher collected and analyzed data from in-depth, semistructured interviews with eight participants. This study's findings offer insights into the experience of living with and managing FM and identify social, policy, and health care issues that profoundly affect those suffering from it. Participants believe that people with FM would benefit if more health care professionals, as well as family and friends, would validate their condition and provide them with better support. More research could clarify ways in which health care providers may provide more effective interventions, appropriate care, and ongoing support for those affected with FM.

Assessing and addressing inappropriate sexual behavior in brain-injured clients.

Inappropriate sexual comments and behaviors from clients with brain injuries can be frustrating, awkward, and time consuming for the nurses who are caring for them. Understanding the meaning of these comments and behaviors, as well as receiving direction concerning ways to handle the situation can help nurses overcome their frustration and improve the quality of nursing care. This article examines potential underlying causes of inappropriate sexual behavior, explains the behaviors from client, family, staff, and organizational perspectives, and begins to look at ways to respectfully and sensitively address the behaviors using a model and framework developed by the Sexual Health Service (SHS) at Vancouver Hospital and Health Sciences Centre (VHHSC), in British Columbia, Canada.

Chronic illness experience: insights from a metastudy.

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and metasynthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.