Evaluation of 3 quality of life measurement tools in patients with chronic heart failure.

OBJECTIVE: The objectives of this study are to (1) Address issues related to selecting a quality of life (QOL) measuring tool; and (2) Present data from a pilot test comparing 3 QOL tools (Medical Outcomes Study Short Form-36 [SF-36], the Minnesota Living with Heart Failure Questionnaire [LHFQ], and a visual analogue scale). DESIGN: Descriptive comparative. SETTING: A Southern university-affiliated tertiary medical center outpatient heart failure clinic. PATIENTS: Thirty adults, randomly selected from those treated in a multidisciplinary, nurse practitioner-managed heart failure clinic. RESULTS: Significant correlations were found among the global or broader measures of QOL (visual analog scale and LHFQ Total score) and the component scores (LHFQ Emotional, LHFQ Physical, SF-36 Mental [MCS], and SF-36 Physical [PCS]), with the only exception being that of the LHFQ Total and the SF-36 PCS. Mental and physical components of QOL were not related within the SF-36 or between the SF-36 PCS and the LHFQ Emotional score. However, the emotional and physical scores were highly and significantly related within the LHFQ and between the SF-36 MCS and the LHFQ Physical score. CONCLUSIONS: The SF-36 was better able to differentiate physical and emotional aspects of QOL in this sample. The LHFQ subscales may be less useful in QOL assessment than the total score.

Influences of a relaxation intervention on perceived stress and power spectral analysis of heart rate variability.

This study was designed to determine whether power spectral analysis (PSA) of heart rate variability (HRV) can detect change in autonomic tone following a relaxation intervention called therapeutic touch (TT). Thirty healthy subjects underwent TT by one of three TT practitioners using the steps developed by Krieger and Kunz (The Therapeutic Touch, Prentice-Hall, 1979). Both subjects and TT practitioners were monitored by continuous electrocardiographic monitoring (Holter) before (15 minutes), during, and after (15 minutes) TT was administered. Subjects and TT practitioners completed a visual analogue scale (VAS) of perceived stress before and after TT. Change scores for VAS and PSA of high-frequency/low-frequency (HF/LF) ratios were compared for the 2-minute interval before TT began and the end of TT and the end of the recovery period, using t tests. VAS scores decreased (less stress) from before to after TT for both subjects (p < 0.0005) and TT practitioners (p < 0.0005). Mean HF/LF ratios increased significantly to reflect greater parasympathetic dominance from before TT to the end of treatment for subjects (p = 0.006), but not for TT practitioners. However, further analysis revealed that this change was due to an exaggerated HF/LF response from four outliers (p < 0.0005). Data collected in this study did not reveal differences between these four subjects and the rest of the sample. There were no significant changes in HF/LF ratios from the end of TT to end of recovery for either group. Further research is needed to determine why some subjects may have greater change in autonomic tone in response to relaxation in order to be able to predict who will demonstrate physiologic response to relaxation interventions.

The experience of therapeutic touch for novice recipients.

This study explored the experience of receiving Therapeutic Touch (TT) from the point of view of recipients with no prior experience with TT. Eleven female graduate students who were part of a larger study were interviewed after the second of two TT sessions and statements from the transcripts were analyzed for words, phrases, or sentences that fell into one of five categories: (a) relaxation, (b) physical sensations, (c) cognitive activity, (d) emotional (feelings), and (e) spiritual/transcendent. All participants reported feeling relaxed and had physical sensations and cognitive activity during the TT sessions, and most of the statements fit into these categories. Fewer statements reflected emotional or spiritual experiences and not all participants had these experiences. The sensations associated with TT may occur developmentally. Initially, physical and cognitive experiences are identified. The deeper, meaningful sensations may occur after an individual has more experience with the intervention.

The effect of psychosocial nursing intervention on the mood state of patients with implantable cardioverter defibrillators and their caregivers.

This study sought to determine whether mood state and psychosocial adjustment four months after implantable cardioverter defibrillator (ICD) placement were better for patients and caregivers who received a program of psychosocial interventions than for those who received usual postoperative care and follow-up. Thirty-four adult ICD recipients (17 experimental and 17 control) and their significant other (SO) caregivers were randomly assigned to an experimental or control group. The intervention consisted of weekly, postoperative telephone follow-up, evaluation and counseling by a psychiatric liaison nurse, and participation in an ICD support group. There were no significant differences between treatment and control groups on the outcome measures of adjustment (Profile of Mood States, Psychosocial Adjustment to Illness Scale). Outcomes were not associated with age, ejection fraction, length of hospital stay or family income, and there were no differences in outcomes based on gender, employment status, thoracotomy versus non-thoracotomy procedure, or shocked versus unshocked status. The results do not indicate that the extra time spent to provide individualized attention to these ICD recipients and their SOs was advantageous for the outcomes measured. Adaptation to the device may occur over time regardless of intervention.

Telephone interviews: a cost-effective way to select faculty.

The telephone interviewing process was a very positive experience for the interviewers. It gave us the opportunity to collaborate together to determine how best to represent our own peers and find future peers. With minimal expense, it expedited the process of filling our positions. The efficiency and thoroughness of the interview process allowed us to fill the positions by holding only three on-campus interviews which were shorter (less than one day in length in one case) and within budgetary allotments.

Driving with an internal defibrillator: legal, ethical, and quality-of-life issues.

Patients with internal cardioverter-defibrillators experience many issues after implantation. One issue is operating a motor vehicle. This issue has many ethical, legal and quality-of-life concerns that must be addressed by the patient, health care providers, and society. The legal and ethical issues surrounding patients with internal cardioverter-defibrillators will be explored using an ethically based theoretical framework.

Dissemination and use of research findings in nursing practice.

This study built on two previous studies (Brett, 1987; Coyle & Sokop, 1990) that found no significant relationships between use of nursing research and nursing education level. These two studies had fewer than 5 per cent of their subjects with master's degrees in nursing. The new population studied had 49 per cent master's prepared nurses, which provided the necessary foundation to expand the examination of the relationship of higher education and use of research findings among nurses. Whereas the overall extent of dissemination and use of research findings among nurses in the sample was similar to that of the two previous studies, it was found that nurses with a master's degree reported higher utilization than those with a bachelor's degree. This finding suggests a unique and critical role for the master's-prepared nurse in the dissemination and use of research findings in the practice setting.

Appointment, promotion, and tenure criteria to meet changing perspectives in healthcare.

With anticipated changes in healthcare delivery systems, nursing faculty members need to redefine the faculty role and scholarship as a product of that role. The authors describe the development of appointment, promotion, and tenure criteria that value scholarly outcomes generated from both practice and research within the educational model.

The impact of device recall on patients and family members of patients with automatic implantable cardioverter defibrillators.

BACKGROUND: Patients often depend on life-saving technology as a permanent part of their lives. Sometimes these devices become defective and are recalled. OBJECTIVES: To investigate how the urgent device recall of three models of the Automatic Implantable Cardioverter Defibrillator (AICD) affected confidence in the device and the psychosocial responses of patients and their family member caregivers. METHODS: All patients (N = 31) and caregivers (N = 21) affected by the recall at one heart center completed a survey instrument consisting of a series of visual analog scales designed to measure confidence before and after learning of the recall, fear, anger, depression, anxiety, helplessness, loss of control, uncertainty, and confusion associated with having a recalled AICD. Surveys were completed immediately after being told of the recall and 1 month later. RESULTS: Confidence of patients decreased significantly from a mean of 87% to 74% when comparing perceptions of before learning of the recall to those immediately after (t30 = 3.65, p < 0.0005). For caregivers, mean confidence dropped from 92% to 73% (t19 = 5.0, p < 0.0005). Confidence remained significantly lower 1 month later. Caregiver scores were consistently, although not significantly, higher (less favorable) on the measures of emotional response than patient scores. Caregivers of patients who had received shocks from the AICD and those of patients who had the device for more than a year were generally more affected. CONCLUSIONS: Patient and caregiver confidence in the AICD was significantly reduced. Further research is needed to investigate the trends in the data from caregivers.

Accuracy of heart rate assessment in atrial fibrillation.

OBJECTIVE: To determine the most accurate technique to measure the heart rate during atrial fibrillation by use of three counting intervals, 15, 30, and 60 seconds, and two methods, apical and radial pulse measurement. DESIGN: A quasi-experimental, repeated measures factorial design was used to determine absolute error (amount of error ignoring direction of error) between heart rates obtained from six randomly ordered pulse measurements taken of one man in chronic atrial fibrillation by the 94 nurses in the sample and the heart rate recorded by simultaneous electrocardiographic (ECG) and plethysmographic (pleth) recordings. SUBJECTS: Nurses in four groups comprised the sample; registered nurses (N = 29), licensed practical nurses (N = 23), nursing students (N = 21), and registered nurses with advanced degrees who are clinical specialists and in faculty positions. RESULTS: The heart rate of the man varied from 57 to 111 beats/min (mean 81 beats/min). The mean absolute error rates for the six measurements ranged from 8 beats/min to 20 beats/min, all considered to be important when a 10% error was used as the criteria for clinical significance. The apical method was significantly more accurate than the radial method regardless of whether the ECG or pleth standard was used (ECG--F1.90 = 72.91, p less than 0.0001; pleth--F1.144 = 4.68, p = 0.036). The 60-second counting interval was significantly more accurate regardless of the standard (ECG--F2.180 = 5.19, p = 0.006; pleth--F2.88 = 3.95, p = 0.02). CONCLUSIONS: Atrial fibrillation occurs in 2% to 4% of people over 60 years of age and is one of the most difficult dysrhythmias to count. Accurate counts are important when making clinical decisions, yet measurement of heart rate in this study was quite inaccurate. The 60-second count and the apical method were the most accurate statistically, although differences in counting interval error rates were not clinically significant.

Experiences of patients and significant others with automatic implantable cardioverter defibrillators after discharge from the hospital.

Sudden cardiac death (SCD) is a leading cause of mortality in this country. The automatic implantable cardioverter defibrillator (AICD) is a technology which has proven successful in reducing the risk of SCD in patients who qualify for it. However, little is known about how individuals adjust to living with the device. This field study used a focus group technique to investigate the question "What are the experiences of patients and their significant others (S.O.) in the time since being discharged from the hospital with an AICD?" Fifteen AICD recipients and 14 S.O.s each attended one of three focus groups which were tape recorded. Data from the transcriptions were analyzed by a combination of content analysis and ethnographic summary. The major concerns of the patients were [Physiologic], the sensations of being shocked, medications, trouble sleeping, dizziness (accompanied by heat intolerance at times), physical awareness of the device; [Psychosocial], fear, including fear of death and preparation for death, changes in mental functioning, changes in lifestyle including clothing not fitting, loss of control, driving an automobile, and spousal overprotectiveness. The primary psychosocial concerns of the S.O.s were fears, including fear of death and preparation for death, family and role changes, being overprotective and driving an automobile. Mental changes and heat intolerance have not been addressed in the literature previously.

Adjustment of gynecological and breast cancer patients to the cancer diagnosis: comparisons with males and females having other cancer sites.

Newly diagnosed cancer patients (N = 133) were studied to determine gender-based differences in initial adjustment and whether, within the female population, women with gynecological or breast cancer adjust differently. The Brief Symptom Inventory (BSI) and the Rand Health Insurance Study-General Well-Being Schedule (HIS-GWB) were used to measure anxiety, depression, hostility, somatization, and general psychological distress or psychological well-being. There were no gender differences on any of the measures when men were compared with women. However, when gynecological/breast cancer patients were analyzed separately from women with other forms of cancer, they were significantly less depressed, anxious, and hostile; they had less somatization, less psychological distress, and greater psychological well-being. These findings may be related to the perception of their illness as being less serious than that of other females with cancer.

Power: its use and potential for misuse by nurse consultants.

The purpose of this article is to examine the concept of power as it relates to human relationships, and the consultant-client relationship as a power relationship, which may be inherently one of unequal power. The types of power available to the consultant are examined, as well as how to get power, how to use it, and the potential for its misuse.

Clinical evaluation of a critical path for coronary artery bypass surgery patients.

The critical path, one component of the case management model, was examined to determine its accuracy in describing patient recovery following coronary artery bypass surgery and to determine if variations from the path influenced postoperative length of stay. One hundred ninety-five (195) postoperative days were analyzed on 28 subjects. Data about patient characteristics, daily progress, and recovery following transfer from intensive care until hospital discharge were compared to expected patient progress and recovery as delineated by the critical path. Fifty-seven percent (57%) of the patients (n = 28) were discharged within the time frames designated by the critical path. Significant correlations (p less than or equal to .01) were found between postoperative length of stay and the variables of activity progression (r = -.46), telemetry usage (r = -.56), inspirometer use (r = -.35), and adherence to the critical path (r = -.48). Using step-wise multiple regression analysis, overall adherence to the critical path in the areas of telemetry usage and activity progression were found to be significant predictors of postoperative length of stay (combined R2 = .65).

Treating ununited fractures with electricity: nursing implications.

Not only are the elderly more susceptible to fractures because of a decrease in total bone content from osteoporosis, but the regeneration of injured bone may be prolonged as well. When a long bone fracture occurs in the elderly person, weightlessness and immobility result in further acceleration of bone loss. Because the success of pulsing electromagnetic field treatments depends on adherence to the treatment protocol, patient education is a key in nursing care. Although all fractures are a serious setback for the elderly person, those that do not heal properly require special considerations and the mobilization of many resources if the patient is to remain out of an institution.