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.

Identifying subgroups: Part 2: Trajectories of change over time.

Methods to identify multiple trajectories of change over time are of great interest in nursing and in related health research. Latent growth mixture modeling is a data-centered analytic strategy that allows us to study questions about distinct trajectories of change in key measures or outcomes of interest. In this article, a worked example of latent growth mixture modeling is presented to help expose researchers to the use and appeal of this analytic strategy.

Cardiovascular nurses' adherence to practice standards in in-hospital telemetry monitoring.

BACKGROUND: Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards. AIM: The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time. STUDY DESIGN: A comparative study design was applied, and data were obtained by survey methodology. METHODS: Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively). RESULTS: In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P < .001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P = .001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P < .001). Overall, 64% always informed patients of the purpose of cardiac monitoring. CONCLUSION: A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required. RELEVANCE TO CLINICAL PRACTICE: Improved in-hospital telemetry practice is required to ensure patient safety and better care outcomes.

Risk prediction tools in cardiovascular disease prevention: A report from the ESC Prevention of CVD Programme led by the European Association of Preventive Cardiology (EAPC) in collaboration with the Acute Cardiovascular Care Association (ACCA) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP).

Risk assessment and risk prediction have become essential in the prevention of cardiovascular disease. Even though risk prediction tools are recommended in the European guidelines, they are not adequately implemented in clinical practice. Risk prediction tools are meant to estimate prognosis in an unbiased and reliable way and to provide objective information on outcome probabilities. They support informed treatment decisions about the initiation or adjustment of preventive medication. Risk prediction tools facilitate risk communication to the patient and their family, and this may increase commitment and motivation to improve their health. Over the years many risk algorithms have been developed to predict 10-year cardiovascular mortality or lifetime risk in different populations, such as in healthy individuals, patients with established cardiovascular disease and patients with diabetes mellitus. Each risk algorithm has its own limitations, so different algorithms should be used in different patient populations. Risk algorithms are made available for use in clinical practice by means of - usually interactive and online available - tools. To help the clinician to choose the right tool for the right patient, a summary of available tools is provided. When choosing a tool, physicians should consider medical history, geographical region, clinical guidelines and additional risk measures among other things. Currently, the U-prevent.com website is the only risk prediction tool providing prediction algorithms for all patient categories, and its implementation in clinical practice is suggested/advised by the European Association of Preventive Cardiology.

Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey.

BACKGROUND: Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart's inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. OBJECTIVE: To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. METHODS: An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children's hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. RESULTS: The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. CONCLUSIONS: Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.

[Nursing workload in a coronary unit according to the Nursing Activities Score]. / Carga de trabalho em unidade coronariana Segundo o Nursing Activities Score.

OBJECTIVE: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument. METHOD: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012. RESULTS: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts. CONCLUSION: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.

Nursing workload in a coronary unit according to the Nursing Activities Score / Carga de trabajo en unidad coronaria según la Nursing Activities Score / Carga de trabalho em unidade coronariana segundo o Nursing Activities Score

Objective: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument.Method: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012.Results: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts.Conclusion: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.

Objetivo: verificar la carga de trabajo de enfermería medida por la Nursing Activities Score en una unidad coronaria, su relación con los turnos de trabajo y comparar el cuadro de enfermería existente en la unidad con lo proyectado según los dados del instrumento.Método: estudio longitudinal realizado en un hospital universitario de la región sur de Brasil en el periodo de abril a junio de 2012. Resultados: se realizaron 604 medidas por turnos, en una muestra de 61 pacientes. La carga de trabajo fue del 47% (±12) en el análisis por turnos, con promedios más elevados en el turno de la tarde.Conclusión: se observó la necesidad de en promedio dos y hasta 2,4 profesionales de enfermería, estando consistente con el cuantitativo real de la unidad. El instrumento posibilito medir la carga de trabajo de enfermería e delinear la variabilidad de las demandas en los diferentes turnos de trabajo.

Objetivo: verificar a carga de trabalho de enfermagem aferida pelo Nursing Activities Score em uma unidade coronariana, analisar sua relação com os turnos de trabalho e comparar o quadro de enfermagem existente na unidade com o projetado segundo os dados do instrumento.Método: estudo longitudinal conduzido em um hospital universitário da região sul do Brasil no período de abril a junho de 2012. Foram realizadas 604 medidas por turnos, em uma amostra de 61 pacientes. A carga de trabalho foi de 47% (±12) na análise por turnos, com média mais elevada no turno da tarde.Resultados: observou-se a necessidade de em média dois e até 2,4 profissionais de enfermagem, estando condizente com o quantitativo real da unidade.Conclusão: o instrumento possibilitou mensurar a carga de trabalho de enfermagem e delinear a variabilidade das demandas nos diferentes turnos de trabalho.

Validação de um protótipo de metodologia da assistência de enfermagem para o cuidado do idoso hospitalizado com doença arterial coronariana

Estudo descritivo, retrospectivo, realizado no setor de cardiologia do Hospital UniversitárioClementino Fraga Filho (HUCFF), no Rio de Janeiro, para identificar o perfil clínico deidosos com doença coronariana atendidos no nível terciário em hospital especializado doRio de Janeiro; descrever as necessidades humanas básicas (NHB) de idosos com doençacoronariana no nível terciário em um hospital especializado do Rio de Janeiro; construir umprotótipo de metodologia de assistência de enfermagem de idosos com doença coronarianano nível terciário atendidos em hospital especializado a luz das NHB e validar um protótipode metodologia de assistência de enfermagem junto a um painel de juízes. Trata-se de umapesquisa metodológica baseada na extração de dados provenientes do registro deenfermagem eletrônico em prontuário de idosos com doença arterial coronariana,complementado por evidências de sinais e sintomas da literatura. Tal caminho foi norteadopelas proposições conceituais de Wanda de Aguiar Horta (1979) no que se refere aoreconhecimento de NHB do idoso com doença arterial coronariana e baseado numaterminologia padronizada de enfermagem NANDA-I (Associação Norte-Americana deDiagnósticos de Enfermagem), NIC (Classificação das Intervenções de Enfermagem), eNOC (Classificação dos resultados de enfermagem). Primeira etapa se deu a partir de ummapeamento de termos que subsidiaram a construção de uma versão inicial de protótipo demetodologia de enfermagem. Numa segunda etapa foi realizada uma validação de conteúdodessa versão inicial: um painel de juízes composto por enfermeiros expertises e umsegundo composto por pesquisadores de Processos de Enfermagem. A autorização doestudo se deu através do portal da Plataforma Brasil e diante do aceite foi cadastrada noSISNEP com o número de aprovação parecer n. 257.765. A amostra foi composta de 60prontuários de idosos no período de janeiro a agosto de 2012...

Descriptive, retrospective study in cardiology sector of Hospital Universitário ClementinoFraga Filho (HUCFF), in Rio de Janeiro, to identify the clinical profile of elderly patientswith coronary artery disease treated at the tertiary level in a specialized hospital of Rio deJaneiro; describe the basic human needs of elderly patients with coronary artery disease atthe tertiary level in a specialized hospital of Rio de Janeiro; build a prototype of elderlynursing care methodology with coronary disease at the tertiary level attended in specializedhospital in line with the NHB and validate a prototype of nursing care methodologytogether with a panel of judges. It is a methodological research based on data extractionfrom electronic nursing medical records of elderly patients with coronary artery disease,supplemented by evidence of signs and symptoms of literature. This path was guided by theconceptual propositions of Wanda de Aguiar Horta (1979) with regard to the recognition ofNHB elderly patients with coronary artery disease and based on a standardized terminologynursing NANDA-I, NIC and NOC. The first stage was built mapping the terms thatsupported the construction of an initial version of the nursing methodology prototype. Thesecond step was a content validation of this initial version: a panel of judges composed ofnurses‟ knowledge‟s and a second composed of researchers, which works focus in nursingprocess line. The authorization of the study was obtained through the portal of PlatformBrazil and, once accepted, was registered in SISNEP with the approval number of opinionn. 257,765. The sample consisted of 60 medical records of elderly...

New cardiac models of care reduce patient access to specialist nurses: a Victorian cross-sectional pilot study.

BACKGROUND: Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown. AIM: To describe the workforce and workplace resources of adult CCUs in Victoria, Australia. METHOD: This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010. RESULTS: A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met the international standards for a nursing workforce with critical care qualifications. The CCU/day procedure/HDU models had 24% of critical care qualified staff followed by CCU/cardiology ward model with 35% compared to an average of 54-80% of qualified staff in the other models of care of CCU. CONCLUSIONS: This pilot study has highlighted the heterogeneity in models of CCU and a shortage of qualified critical care nurses, particularly in the CCU/cardiology ward model. This may have implications for the quality of care delivered in CCUs.

Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation.

AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care. METHODS AND RESULTS: A cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual. CONCLUSION: The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.

Acidente vascular cerebral em paciente de pós operatório de cirurgia cardíaca de Revascularização do miocárdio: avaliação diagnóstica preditiva

O objeto deste estudo está pautado na avaliação diagnóstica de enfermagem na predição para o acometimento do acidente vascular cerebral no cliente em pós-operatório de Revascularização do Miocárdio. Os objetivos são estratificar os sinais e sintomas sugestivos do Acidente Vascular Cerebral em clientes de pós-operatório de Revascularização do Miocárdio descritos em prontuário; Analisar a aproximação entre a descrição dos sinais e sintomas sugestivos do Acidente Vascular Cerebral em clientes pós-operatório de Revascularização do Miocárdio e os diagnósticos de enfermagem com suas respectivas características definidoras segundo a Taxonomia NANDA II; Discutir a avaliação diagnóstica na predição para o acometimento de acidente vascular cerebral no cliente em pós-operatório de revascularização do miocárdio. Trata-se de um estudo Epidemiológico, transversal, de prevalência, tipo retrospectivo. O cenário institucional deste estudo foi constituído por um hospital público universitário. Os clientes que foram submetidos à revascularização do miocárdio e selecionados para a pesquisa corresponderam a um total de 76 prontuários, num recorte temporal de 2009 a 2010...

The object of this study is guided by the diagnostic evaluation of nursing in the prediction forthe onset of stroke on the client in the postoperative period of myocardial revascularization.The objectives are stratifying suggestive signs and symptoms of stroke in patients inpostoperative period of myocardial revascularization described in medical records; analyzethe rapprochement between the description of the suggestive signs and symptoms of stroke inclients in post-operative myocardial revascularization and nursing diagnoses with theirdefining characteristics according to NANDA Taxonomy II; discuss the diagnostic evaluationfor predicting the onset of stroke on the client in the postoperative period of CABG. This is anepidemiological study, cross-sectional prevalence, retrospective type. The institutional settingof this study consisted of a public hospital. Patients who underwent CABG and selected forthe study corresponded to a total of 76 records in a time frame from 2009 to 2010...

L'objet de cette étude est guidée par l'évaluation diagnostique des soins infirmiers dans laprédiction de la survenue de l'AVC sur le client dans la période post-opératoire de larevascularisation myocardique. Les objectifs sont de stratifier les signes et symptômesévocateurs d'AVC chez les patients en période postopératoire de la revascularisationmyocardique décrit dans les dossiers médicaux, d'analyser le rapprochement entre ladescription des signes et des symptômes évocateurs d'un AVC dans les clients post-opératoireet une revascularisation myocardique diagnostics infirmiers avec leurs caractéristiques quidéfinissent en fonction de la taxonomie NANDA II, discuter de l'évaluation diagnostique pourprédire la survenue de l'AVC sur le client dans la période post-opératoire de pontageaortocoronarien. Il s'agit d'une étude épidémiologique, la prévalence transversale, de typerétrospectif. Le cadre institutionnel de cette étude consistait en un hôpital public. Les clientsqui ont subi un PC et sélectionnés pour l'étude correspondait à un total de 76 dossiers dans unlaps de temps de 2009 à 2010...

Prevalencia de úlceras por presión en pacientes atendidos en el Instituto Nacional de Cardiología Ignacio Chávez / Prevalence of pressure ulcers in patients treated at the Instituto Nacional de Cardiología Ignacio Chávez", "_i": "

Introducción: Las úlceras por presión (UPP) son lesiones producidaspor tensión sobre la piel al permanecer largos períodosen una sola posición, éstas representan un problema asistencialdada su prevalencia, el impacto sobre la salud y calidad de vidadel paciente. Objetivos: Identificar la prevalencia de UPP deacuerdo a su clasificación, localización y evolución de la heridaen los pacientes atendidos en el Instituto Nacional de CardiologíaIgnacio Chávez (INCICh). Metodología: Se realizó unestudio descriptivo, transversal y retrospectivo de los pacientesatendidos en el INCICh que presentaron UPP en el periodo deenero del año 2007 a diciembre del 2008, se revisaron los expedientesclínicos para obtener datos como: edad, sexo, grado deúlcera, tipo de tratamiento y evolución. Se realizó el análisiscon estadística descriptiva. Resultados: 173 pacientes presentaronUPP; el 47.3% fueron mayores de 60 años, la prevalenciafue de 1.4%; el 58.3% se estratificó en grado II y las zonas delocalización fueron sacro, glúteos y talones; el 73.4% se presentaronen Unidades de Cuidados Intensivos; el tratamiento seaplicó de acuerdo a las características individuales del paciente,por lo que varió el tiempo de resolución en cada uno de ellos.Conclusión: Evidenciar la prevalencia de UPP permite difundirel trabajo que realiza el profesional de enfermería en elINCICh y evaluar la efectividad de las medidas empleadas enla prevención de las UPP en el paciente cardiópata, a quien sele proporciona atención integral y de calidad para evitar complicacionesdurante su hospitalización.

Introduction: Pressure ulcers (PU) are lesions that are produced due to tension on the skin when staying in one position during too long. These lesions represent an assistential problem because of their prevalence, besides their impact over the patient’s life quality. Objectives: To identify the prevalence of pressure ulcers (PP) according to their classification, localization and evolution of the lesions in the patients who have been attended at the Instituto Nacional de Cardiología Ignacio Chávez (INCICh). Methodology: It was performed a descriptive, transversal and retrospective study of the patients attended at the INCICh who presented PP during the period going from January 2007 to December 2008. The clinical records were reviewed in order to obtain the following data: age, sex, grade of ulcer, type of treatment and evolution. An analysis applying de scriptive statistics was carried out. Results: One hundred and seventy-three patients presented PP. The 47.3% of these patients were elder than 60 years old. The prevalence was of the 1.4%; the 58.3% of the cases was stratified in grade II and the localization areas were as follows: sacrum, gluteus area (buttocks), and heels. The 73.4% of the cases appeared at the Intensive Care Unit (ICU). The treatment was applied according to the patient’s particular characteristics; therefore, the resolution time differs among patients. Conclusion: To put the prevalence into evidence allows to spread the work performed by the infirmary staff of professionals at the INCICh and evaluate the effectiveness of the measures used in the prevention of PP in cardiopathy patients, who are given integral and quality attention in order to avoid complications during their hospitalization.