Unit-based research in critical care nursing.

This article describes the characteristics of unit-based nursing research, highlighting the experiences of staff nurses on two critical care units. On both units, study findings facilitated changes in practice. The authors evaluate their experience and offer suggestions to critical care nurses interested in unit-based research.

Impact of protection isolation on the incidence of infection after heart transplantation.

Infection is a major cause of morbidity and mortality in heart transplantation. Therefore protective isolation has been an inherent part of our postoperative regimen. For retrospective review we selected patients before and after modification of protective isolation. The intensity of protective isolation appeared to have no impact on incidence, morbidity, or mortality resulting from infection in these study groups.

Introduction to hemodynamic monitoring.

This article discusses nursing care of the patient who requires hemodynamic monitoring. This will include care of the patient who requires intra-arterial pressure monitoring, central venous pressure (CVP) monitoring, left atrial pressure (LAP) monitoring, and monitoring of left heart pressures, cardiac output, and systemic vascular resistance using a pulmonary artery (PA) catheter.

Left ventricular assist device as a bridge to heart transplantation: a case study.

Stanford University Medical Center has successfully utilized a left ventricular assist device as bridge support for 9 days in a 52-year-old man awaiting heart transplantation. During this time he developed a pericardial tamponade, but no other serious medical complications occurred. Major nursing care issues focused on pain control, vigorous pulmonary toilet, and left ventricular assist device timing. This article outlines the responsibilities of critical care nurses and what was learned from the experience. The recipient was discharged home 106 days after heart transplantation.

Self-reported change in physical symptoms from cyclosporine-based therapy to azathioprine-based therapy in heart transplant recipients.

Since the introduction of cyclosporine, 183 heart transplants have been performed at Stanford University Medical Center. Although cyclosporine has improved survival rates, it is also associated with progressive renal dysfunction. Seventeen of these recipients have been converted from cyclosporine-based therapy to azathioprine-based therapy because of significant nephrotoxicity. Fourteen of these recipients participated in a study to examine change in physical symptoms since immunoconversion. Most reported little change in physical symptoms following conversion, although 79% experienced rejection following the drug change. Overall, the change in immunosuppressive medications had little impact on perceived symptoms.

Life satisfaction following heart transplantation.

This study investigated perceived life satisfaction and quality of life reported by heart transplant recipients. The impact of life change following transplantation and problems associated with side-effects of the immunosuppressive therapy were also examined. Questionnaires were mailed to one hundred heart transplant recipients. All had survived at least six months after the operation. Seventy-five completed the questionnaire. Eighty-nine percent of those reported good to excellent quality of life. Life satisfaction was reported as good to very satisfactory by 82%. The considerable change in life style following transplantation was mostly perceived as positive. All recipients experienced some side-effects from the immunosuppressive therapy. However, these physical symptoms had little impact upon the overall positive evaluation of life quality and life satisfaction.