Point-of-care examinations using handheld ultrasound devices performed by intensive care nurses in a cardiac intensive care unit.

AIMS: Having nurses to perform point-of-care ultrasound (POCUS) when physically examining patients to assess for early signs of decompensation and fluid overload has been proven to be feasible, provide extra information, and improve quality of care. To date, few studies have analyzed whether it is feasible for intensive care nurses to perform POCUS on critically ill patients. This study aimed to evaluate whether the findings of briefly trained intensive care nurses' ultrasound examinations agreed with conventional examinations performed by physicians. METHODS AND RESULTS: This comparative cross-sectional inter-rater agreement study comprised 50 patients admitted to a cardiac intensive care unit (CICU), with signs and symptoms of acute dyspnoea and suspected cardiac disease. After a brief training session, the study nurses performed standardized examinations of each patient's inferior vena cava (IVC) and the pleural and pericardial cavities using a handheld ultrasound device. A blinded physician repeated the same examinations using conventional ultrasound. Analysis using Gwet's agreement coefficient with quadratic weights showed moderate agreement for the IVC respiration variation [0.60; 95% confidence interval (CI): 0.38-0.82], and substantial agreement for the IVC diameter (0.70; 95% CI: 0.50-0.90) and right-sided pleural effusion (0.70; 95% CI: 0.52-0.88). For left-sided pleural effusion (0.85; 95% CI: 0.75-0.95) and pericardial effusion (0.95; 95% CI: 0.90-1.01), the agreement was almost perfect. CONCLUSIONS: Briefly trained intensive care nurses in a CICU can perform POCUS examinations of the IVC and pleural and pericardial cavities with moderate to almost perfect agreement with identical examinations performed by physicians.

Perceptions of healthcare professionals' support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients.

AIMS: To investigate the extent to which perceived support from healthcare professionals and shock anxiety is related to device acceptance among implantable cardioverter defibrillator recipients. BACKGROUND: Device acceptance can be influenced by several factors, one of which is shock anxiety associated with poor device acceptance. Reduced shock anxiety, as well as increased device acceptance, has been reported after psycho-educational programmes. As healthcare professionals appear to play a significant role in providing support and education during regular follow-up visits, they may constitute an important social support system that could be another factor influencing device acceptance. However, little is known about the relationship between perceived support from healthcare professionals and device acceptance among recipients. DESIGN: A cross-sectional survey design. METHODS: A sample comprising implantable cardioverter defibrillator recipients completed questionnaires assessing perceived support from healthcare professionals, shock anxiety and device acceptance. Demographic and clinical data were collected by self-report and from medical records in September-October 2010. RESULTS: The descriptive results indicated that approximately 85% of the recipients experienced high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance and moderated the negative relationship between shock anxiety and device acceptance. Non-constructive support and shock anxiety had a negative statistical association with device acceptance. CONCLUSIONS: Healthcare professionals may represent a valuable constructive support system that can enhance device acceptance among implantable cardioverter defibrillator recipients, partly by preventing shock anxiety from leading to poor device acceptance. Non-constructive communication on the part of healthcare professionals could hinder device acceptance.

Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients.

AIMS AND OBJECTIVES: To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease (PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. BACKGROUND: Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. DESIGN: Cross-sectional survey design. METHODS: Recipients (n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. RESULTS: The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. CONCLUSIONS: The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out.

Shock anxiety among implantable cardioverter defibrillator recipients with recent tachyarrhythmia.

BACKGROUND: Shock anxiety has been documented irrespective of shock exposure in implantable cardioverter defibrillator (ICD) recipients. The presence of tachyarrhythmia may lead to an anticipation of receiving a shock and thereby give rise to shock anxiety. The aims were to assess: (1) the level of shock anxiety in a sample of ICD recipients, (2) the relationship between such anxiety and shock exposure, and (3) the relationship between recent tachyarrhythmia and shock anxiety. METHODS: ICD recipients (n = 167) completed the Florida Shock Anxiety Scale measure of shock anxiety. The recipients were divided into three groups: (1) Recipients with no documented tachyarrhythmia over the previous 12 months (n = 56), (2) recipients with documented tachyarrhythmia over the previous twelve months (n = 54), and (3) recipients with any history of shocks (n = 57). RESULTS: Of the recipients, 44% experienced some form of shock anxiety, whereas 15% reported general shock anxiety. Analyses of covariance revealed that recipients with recent tachyarrhythmia (F = 7.675 df = 9/100, P = 0.007) as well as recipients with a shock history (F = 9.976, df = 9/103, P = 0.002) reported higher levels of shock anxiety than recipients with no recent tachyarrhythmia. CONCLUSION: This study indicates that although a substantial proportion of the ICD recipients experienced some form of shock anxiety, only a relatively small proportion reported general shock anxiety. ICD recipients with recent tachyarrhythmia, in addition to recipients with shock history, appear to be at greater risk for development of shock anxiety. This implies that these recipients may profit from clinical-based strategies and interventions targeting shock anxiety.