[The importance of outcome indicators for pain control and their relationship to nursing actions]. / Skausmo kontroles slaugos rezultatu kriteriju reiksmingumas ir sasajos su slaugytoju veikla.

UNLABELLED: Pain control is an aspect of patient care directly related to nursing competency and actions. Effective pain control, objectively evaluated according to nursing outcomes, is evidence of humane and high-quality care. The value of nursing outcome assessment increases when important and nursing-related outcome indicators are applied. The aim of this study was to analyze nursing outcomes and their indicators for pain control, investigating the importance and relationship of indicators to nursing actions in nursing and supportive treatment. Content validity and nursing sensitivity of pain control nursing outcomes were additionally measured. MATERIAL AND METHODS: The study was performed in 13 nursing and supportive treatment hospitals; 128 nurses were enrolled. The response rate was 63.3%. Three nursing outcomes of pain control were analyzed: Pain: Adverse Psychological Response, Pain: Disruptive Effects, and Pain Level. A list of 53 indicators for pain control outcomes was made from the Nursing Outcomes Classification, 2004. Cronbach alfa was estimated for each class of indicators. Importance of indicators and their relationship with nursing actions were measured using the Likert scale. Content validity and nursing sensitivity were estimated with a modified Fehring technique (Fehring, 1987). For ethical considerations, approval of the National Committee on Bioethics was obtained. The Center for Nursing Classification and Clinical Effectiveness in the University of Iowa (USA) provided permission to use the 3rd edition of the NOC Use survey. RESULTS: The importance of each indicator of pain control nursing outcome was significant, i.e., ≥0.6. Out of the 53 studied indicators, 38 (71.7%) were strongly related to nursing action, and the remaining indicators were moderately related. There was a strong positive correlation (Pearson r=0.835; P=0.000) between the content validity and nursing sensitivity of pain control nursing outcomes. CONCLUSIONS: The study revealed the three most important indicators for pain control nursing outcome assessment that are directly related to nursing competency and actions in nursing and supportive treatment.

[Impact of duration and treatment of arterial hypertension on health-related quality of life]. / Arterines hipertenzijos trukmes ir gydymo itaka su sveikata susijusiai gyvenimo kokybei.

UNLABELLED: Arterial hypertension (AH) is one of the most important risk factors for development of ischemic heart disease; thus, control of AH and effective treatment are of great importance. Since arterial hypertension is commonly referred as asymptomatic condition, the question whether hypertensive condition is associated with the change of well-being and health-related quality of life is still debatable. THE AIM OF THE STUDY: To evaluate the impact of duration and treatment of AH on health-related quality of life. MATERIAL AND METHODS: The contingent of the study consisted of patients who arrived for a cardiologist's consultation at the Clinic of Cardiology, Hospital of Kaunas University of Medicine. The patients were randomly selected for the study. The inclusion criteria were as follows: diagnosed arterial hypertension, diabetes mellitus, and the metabolic syndrome. Diagnosed ischemic heart disease (chronic and acute coronary syndromes and their complications) and severe concomitant diseases were exclusion criteria. A total of 101 patients (19 males and 82 females) met the inclusion criteria and consented to participate in the study. Their mean age was 58.03+/-5.63 years. The patients' quality of life was evaluated using the Medical Outcomes Study short form 36-item questionnaire (SF-36 questionnaire), which comprises 36 questions grouped into eight domains. The questionnaire was filled in by the subjects independently. Other methods applied to the study were inquiry (for the evaluation of risk factors, lifestyle, and medical history), analysis of medical documents (cholesterol levels and glycemia in blood), and objective examination (height, weight, waist circumference, and arterial blood pressure). RESULTS: The subjects with AH showed lower values compared to normotensive patients in the following domains: physical functioning (P=0.014), role limitations due to physical health (P=0.012), energy/vitality (P=0.016), and general health evaluation (P=0.023). We have not determined the differences in quality of life of the patients whose AH was regulated if compared to those patients without AH. The patients whose treatment of AH was not effective reported lower quality of life in the following SF-36 domains: physical functioning (P=0.003), role limitations due to physical health (P=0.003), general evaluation of health (P=0.017), energy/vitality (P=0.008), and emotional status (P=0.015), if compared to the patients without AH. CONCLUSIONS: Patients with AH reported lower quality of life in the following domains: physical functioning, role limitations due to physical health, energy/vitality, and general evaluation of health. Compared to patients without AH, the quality of life of the patients who had the effective treatment did not differ, whereas patients with ineffective treatment had the lower quality of life. Functioning is more statistically significantly limited due to physical health in patients with AH.

[The burnout syndrome among nurses working in Lithuanian cardiac surgery centers]. / 'Perdegimo" sindromas tarp Lietuvos kardiochirurgijos centruose dirbanciu slaugytoju

UNLABELLED: The burnout syndrome may be defined as a complex phenomenon which is characterized by three components: emotional burnout (physical and psychical exhaustion, incapability to carry on requirements), depersonalization (cynical attitude towards performed work, duties, cold or negative reaction to the patients), and lowered efficiency (reflected by the sense of incompetence, the lack of efficiency and achievements). This process is progressing slowly for a long time and is characterized individually by various psychical and physical symptoms of different intensity. The aim of this study was to examine the manifestation of burnout syndrome and to estimate the influence of the syndrome on the behavior and practice of the nurses in cardiac surgery units of Lithuania (to evaluate physiological and psychological symptoms of the burnout). METHODS: The study was performed using a questionnaire. A total of 180 questionnaires completed by nurses in Lithuanian cardiac surgical centers (Vilnius, Kaunas, and Klaipeda) were analyzed. RESULTS: The study revealed that 72.8% of nurses had an excess of workload (exceeding full-time job). Most of the respondents (84.4%) pointed out the emotional stress, unevaluated work and underpayment. Three-fourths of the nurses (75%) indicated that they felt physical fatigue after their work. More than half of nurses (67.2%) felt general fatigue, 63.3% reported the leg pains after the work, and 32.2% feel splitting headaches. Psychological fatigue was stressed by 86.1% of specialists. The main causes of psychological stress are as follows: the communication with the doctors in 57% of the cases, communication with the patient's relatives in 52% of cases, communication with the nursing administration in 49% of cases, and communication with the patients in 40% of cases. CONCLUSIONS: The majority of the nurses working in the centers of cardiac surgery experience physical and psychological fatigue, emotional stress. All this determinates the dissatisfaction in the work, conflicts rising between the nurse and job environment. Above-mentioned symptoms show the progression of the burnout syndrome.

Extrapotentials and allorhythmias as an expression of experimental parasystole.

UNLABELLED: The aim of the study was to investigate the dynamics of experimental parasystole taking into consideration the peculiarities of recurrent arrhythmias recorded in clinical settings. MATERIAL AND METHODS: The experiments were conducted on isolated right atria of seven chinchilla rabbits. Parasystolic arrhythmias using periodical one-site electrostimulation were provoked in one atrium, where the sinus node was not affected, and in two atria with the spontaneous low value activity of pacemakers. The parasystolic arrhythmias by the dual-site periodical pacing were provoked in four atria, in which the spontaneous activity had disappeared, while the membrane potential of cardiomyocytes remained at the level of 70 to 80 mV. RESULTS: The parasystolic arrhythmias of the shape of single extrapotentials were obtained in atria when the periods of excitation impulses were within the limits of 0.9-1.2 s, and the differences between these periods being relatively small (0.04-0.2 s). The increase of these differences resulted the various allorhythmias. In cases of single extrapotentials, the recurrence periods of arrhythmias reached 5.6-29 s; while in cases of allorhythmias they shortened to 2.4-4.8 s. CONCLUSION: The parasystoles in isolated atria of rabbits can be induced by two competitive excitation sources. They may manifest themselves through single extrapotentials or allorhythmias, whose form depends on the duration of the periods of excitation impulses, the difference between these durations, as well as on effective refractory periods of atrial cardiomyocytes. The determination and evaluation of the recurrence period of these arrhythmias can serve in any given clinical situation as a supplementary criterion.