Effect of Hierarchical Nursing Management in Patients with Hypertension Complicated with Cardiovascular and Cerebrovascular Risk Factors.

Hierarchical management is an essential component of nurse post management and an unavoidable tendency in nursing education. According to their existing condition, various hospitals around the country have actively tested the hierarchical usage and management model of clinical nurses, with some success. The application impact of hierarchical nursing care in patients with hypertension complicated by cardiovascular and cerebrovascular risk factors is the focus of this research. In a hospital, 300 patients with hypertension complicated by cardiovascular and cerebrovascular risk factors were chosen. All patients were split into two groups using the coin-throwing random method: the observation group received hierarchical nurse management and the control group received regular nursing management, with 150 cases in each group. The two groups' blood pressure, blood lipids, blood glucose, poor habits, rehospitalization rate, and cardiovascular and cerebrovascular problems were also examined. At the same time, the patients' poor mood and quality of life were assessed before and after the intervention. In the control group followed up for 1 year, the blood pressure compliance rate was 44.88%, the blood lipid compliance rate was 28.65%, the blood glucose compliance rate was 45.00%, the smokers with bad lifestyle habits were 26.57%, the overweight and obese were 23.5%, the high sodium was 31.67%, the rehospitalization rate was 15.48%, and the incidence of cardiovascular and cerebrovascular complications was 43.00%. The observation group's blood pressure, blood lipids, and blood sugar compliance rates rose substantially (P = 0.05) as compared to the control group. The occurrence of poor luck living habits, the rate of rehospitalization, and the incidence of cardiovascular and cerebrovascular complications were significantly reduced (P < 0.05). Before nursing intervention, there was no significant difference in the bad mood scores SAS, SDS, and quality of life between the two groups of patients (P > 0.05); after nursing intervention, compared with the control group, the observation group's bad mood scores were significantly reduced, physical factors, psychological factors, and total scores all increased significantly, and the difference was statistically significant (P < 0.05).

Admission criteria for a cardiovascular short stay unit: a retrospective analysis on a pilot unit.

Rapid intensive observation (RIO) units have been created to guarantee high standards of care in a sustainable health-care system. Within short stay units (SSUs), which are a subgroup of RIOs, only rapidly manageable patients should be admitted. Physicians are unable to predict the length of stay (LOS) as objective criteria to make such a prediction are missing. A retrospective observational study was carried out to identify the objective criteria for admission within a cardiovascular care-oriented SSU. Over a period of 317 days, 340 patients (age 69.4 ± 14.7 years) were admitted to a pilot SSU within our internal medicine department. The most frequent diagnoses were chest pain (45.9%), syncope (12.9%), and supraventricular arrhythmias (11.2%). The median LOS was 4 days (quartile 1:3; quartile 3:7). Predictors of LOS ≤ 96 h were age < 80, hemoglobin > 115 g/L, estimated glomerular filtration rate > 45 mL/min/1.73 m2, Charlson Comorbidity Index < 3, Barthel Index > 40, diagnosis of chest pain, syncope, supraventricular arrhythmias, or acute heart failure. The HEART (history, ECG, age, risk factors, troponin) score was found to be excellent in risk stratification of patients admitted for chest pain. Blood tests and anamnestic variables can be used to predict the LOS and thus SSU admission. The HEART score may help in the classification of patients with chest pain admitted to an SSU.

Vascular Nursing and Vascular Surgery.

BACKGROUND: Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities. METHODS: For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. RESULTS: From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. CONCLUSIONS: Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.

Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.

BACKGROUND: Around 19% of people screened by UK cardiac rehabilitation programmes report having moderate or severe symptoms of depression. These individuals are at an increased risk of cardiac mortality and morbidity, reduced quality of life and increased use of health resources compared with their non-depressed counterparts. Maximising psychological health is a goal of cardiac rehabilitation, but psychological care is patchy. OBJECTIVE(S): To examine the feasibility and acceptability of embedding enhanced psychological care (EPC) within cardiac rehabilitation, we tested the feasibility of developing/implementing EPC and documented the key uncertainties associated with undertaking a definitive evaluation. DESIGN: A two-stage multimethods study; a feasibility study and a qualitative evaluation, followed by an external pilot cluster randomised controlled trial (RCT) with a nested qualitative study. SETTING: UK comprehensive cardiac rehabilitation teams. PARTICIPANTS: Adults eligible for cardiac rehabilitation following an acute coronary syndrome with new-onset depressive symptoms on initial nurse assessment. Patients who had received treatment for depression in the preceding 6 months were excluded. INTERVENTIONS: The EPC intervention comprised nurse-led mental health-care co-ordination and behavioural activation within cardiac rehabilitation. The comparator was usual cardiac rehabilitation care. MAIN OUTCOME MEASURES: Measures at baseline, and at the 5- (feasibility and pilot) and 8-month follow-ups (pilot only). Process measures related to cardiac team and patient recruitment, and participant retention. Outcomes included depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Interviews explored participant and nurses' views and experiences. RESULTS: Between September 2014 and May 2015, five nurses from four teams recruited participants into the feasibility study. Of the 203 patients screened, 30 were eligible and nine took part (the target was 20 participants). At interview, participants and nurses gave valuable insights into the EPC intervention design and delivery. Although acceptable, the EPC delivery was challenging for nurses (e.g. the ability to allocate sufficient time within existing workloads) and the intervention was modified accordingly. Between December 2014 and February 2015, 8 out of 20 teams approached agreed to participate in the pilot RCT [five were randomised to the EPC arm and three were randomised to the usual-care (UC) arm]. Of the 614 patients screened, 55 were eligible and 29 took part (the target was 43 participants). At baseline, the trial arms were well matched for sex and ethnicity, although the EPC arm participants were younger, from more deprived areas and had higher depression scores than the UC participants. A total of 27 out of 29 participants were followed up at 5 months. Interviews with 18 participants (12 in the EPC arm and six in the UC arm) and seven nurses who delivered EPC identified that both groups acknowledged the importance of receiving psychological support embedded within routine cardiac rehabilitation. For those experiencing/delivering EPC, the intervention was broadly acceptable, albeit challenging to deliver within existing care. LIMITATIONS: Both the feasibility and the pilot studies encountered significant challenges in recruiting patients, which limited the power of the pilot study analyses. CONCLUSIONS: Cardiac rehabilitation nurses can be trained to deliver EPC. Although valued by both patients and nurses, organisational and workload constraints were significant barriers to implementation in participating teams, suggesting that future research may require a modified approach to intervention delivery within current service arrangements. We obtained important data informing definitive research regarding participant recruitment and retention, and optimal methods of data collection. FUTURE RESEARCH: Consideration should be given to the delivery of EPC by dedicated mental health practitioners, working closely with cardiac rehabilitation services. TRIAL REGISTRATION: Current Controlled Trials ISRCTN34701576. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 30. See the NIHR Journals Library website for further project information.

Making collaboration work.

The Children's Hospitals Network (CHN) was formed in 2012 following a review of national specialist services. Oxford University Hospitals NHS Foundation Trust (OUH) and the University Hospital Southampton NHS Foundation Trust (UHS) collaborated in its formation, with the CHN hosting clinical and operational networks across more than 20 district general hospitals in the Thames Valley and Wessex regions.

Using interactive voice response to improve disease management and compliance with acute coronary syndrome best practice guidelines: A randomized controlled trial.

BACKGROUND: There is evidence from large clinical trials that compliance with standardized best practice guidelines (BPGs) improves survival of acute coronary syndrome (ACS) patients. However, their application is often suboptimal. PURPOSE: In this study, the researchers evaluated whether the use of an interactive voice response (IVR) follow-up system improved ACS BPG compliance. METHOD: This was a single-centre randomized control trial (RCT) of 1,608 patients (IVR=803; usual care=805). The IVR group received five automated calls in 12 months. The primary composite outcome was increased medication compliance and decreased adverse events. RESULTS: A significant improvement of 60% in the IVR group for the primary composite outcome was found (RR 1.60, 95% CI: 1.29 to 2.00, p <0.001). There was significant improvement in medication compliance (p <0.001) and decrease in unplanned medical visits (p = 0.023). At one year, the majority of patients ( 85%) responded positively to using the system again. Follow-up by IVR produced positive outcomes in ACS patients.

Using outdoor activities in cardiac recovery.

Evidence suggests that green spaces next to hospitals can be used to promote health. This article reports on a pilot study to determine how hospital green spaces can be used for patients with cardiac problems and their rehabilitation programmes. Over a six-week period, patients spent one hour per week taking part in activities, including tai chi, photography and willow sculpting, as part of their rehabilitation programme. Patients showed improved physical health, less social isolation, a better overall mood and increased positivity. They were also more likely to choose to exercise than at the start of the rehabilitation programme, and valued the new skills and knowledge that they gained.

Patient- and family-centred care on an acute adult cardiac ward.

This paper outlines a service improvement project undertaken in one acute cardiac ward within a regional NHS trust in the east of England that explored the impact of advancing patient- and family-centred care within an acute adult setting. The project was implemented and evaluated over a 9-month period between March and December 2012 and data collected via a pre and post-intervention survey. The results demonstrated that the majority of family carers wanted to be involved in patient care. The provision of flexible family visiting,facilitated and supported family carer involvement in care provision and improved partnership working between family carers and the multidisciplinary team, had a positive impact on the patient and family carer experience. This project has demonstrated the value of involving family carers in acute adult inpatient care provision and the importance of flexible family visiting to enable this to be successful.

Preventing cardiovascular disease in women.

The Women's Healthy Heart Initiative clinic was launched in 2009 at the McGill University Health Centre to provide women with comprehensive primary prevention care. The mission of this nurse-led clinic is to increase awareness among women of their risk of heart disease and to empower them to be proactive in achieving heart health. In this article, the author discusses the findings from an analysis of clinical measures in the clinic's first three years of operation. The clinic has helped patients reduce their blood pressure, cholesterol levels and weight. The clinic's nurses have gained insights into the importance of self-referral and family history in preventive care. The results demonstrate the effectiveness of this collaborative care model in heart disease prevention.

Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities.

BACKGROUND: Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers. METHODS: A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes. RESULTS: The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol. CONCLUSIONS: The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.

Nurse-led Early Triage (NET) study of chest pain patients: a long term evaluation study of a service development aimed at improving the management of patients with non-ST-elevation acute coronary syndromes.

BACKGROUND: Patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) are at risk of early death. This may be reduced by timely assessment and treatment. OBJECTIVES: The purpose of this study was to evaluate if Nurse-led Early Triage (NET) in the coronary care unit (CCU) can improve time to assessment and management of NSTE-ACS patients. METHODS: Data on 79 consecutive chest pain patients admitted pre-NET to the acute admissions unit (AAU) and on 103 patients admitted in the first six months of the NET service in CCU, was re-examined and compared to subsequent data obtained on 92 patients admitted via NET five years later, in order to re-evaluate the service. RESULTS: NET resulted in significant improvements in: the number of patients with chest pain who had their 12-lead electrocardiogram (ECG) performed within 10 min of admission (94% vs 32%, p<0.001); the number of high-risk NSTE-ACS patients prescribed clopidogrel (72% vs 42%, p<0.01); and the number being managed in CCU (82% vs 34%, p<0.01). Comparison of the NET service at five years with the pre-NET service demonstrated measurable benefits were sustained (p<0.01) for the same comparative end points. There were no significant differences in these end-points of time to ECG, clopidogrel prescription nor management in CCU for high-risk patients between the NET groups at six months and five years, demonstrating that current triage is as effective as when first introduced. CONCLUSIONS: This study demonstrated the positive impact of nurse-led early triage for NSTE-ACS patients and that initial benefits have been sustained.

Effectiveness of structured patient education on the knowledge level of adolescents and adults with congenital heart disease.

BACKGROUND: Patients with congenital heart disease (CHD) have poor understanding of their heart condition, treatment and prevention of complications. To improve their level of health-related knowledge, a structured education program was implemented in the adult congenital heart disease program. This study aimed (a) to evaluate the level of knowledge of patients who received structured CHD education as compared to patients who did not receive this education; (b) to explore if the provision of structured education is an independent determinant of knowledge; and (c) to evaluate whether patients who received structured education reached the educational target (>80% correct answers). METHODS AND RESULTS: A total of 317 patients were included: 226 in the education group, and 91 in the comparison group. Knowledge was assessed using the 'Leuven Knowledge Questionnaire for Congenital Heart Disease'. The mean total knowledge score in the education group (57%) was significantly higher as compared to the comparison group (43%) (p<0.001). However, only 24 patients (11%) in the education group reached the educational target of the program. After adjusting for patient's age, educational level and disease complexity, hierarchical multivariable linear regression analysis showed that the provision of structured CHD education was an independent determinant of higher levels of knowledge. CONCLUSION: A structured education program was associated with a higher level of knowledge. However, the educational target for sufficient knowledge was reached in a very limited number of patients. Hence, continuous efforts in educating patients and developing alternative education methods are needed.