Families and hospitalized elders: A typology of family care actions.

The extensive care provided by families to their elderly relatives in the home is well documented. Although family caregiving is likely to be continued during hospitalization of elderly relatives, limited research has been conducted to address the nature of family care for hospitalized elders. The main purpose of this qualitative study was to refine the content domain of family care for hospitalized elders. Altogether 25 interviews were done. Of the 16 participants, 6 were family members, 6 were patients, and 4 were nurses; 7 participants were interviewed once and 9 participants were interviewed twice. Qualitative analysis based on Lofland and Lofland's (1984, 1995) approach resulted in the identification of three major content domains: family members providing care to the patient, working together with the health care team, and taking care of themselves. This typology suggests a shift of research in this area from its current focus on family needs to a view of family caregivers as partners with the health care team.

Patient-environment interactions in critical care.

This article examines patient-environment interactions in critical care from the perspective of chronobiology. Critically ill patients have reduced control over an environment that they cannot leave voluntarily. These patients have endogenous biologic rhythms that were synchronized to their prehospitalization environment. They exhibit transient physiologic responses to environmental stimuli, and their biologic rhythms may be re-entrained by patterns of stimuli that are different from their customary environment. Nursing interventions based on principles of chronobiology may optimize patient-environment interactions in critical care settings.

Temporal patterns of heart rate and selected arrhythmias for 48 hours after cardiac surgery.

OBJECTIVE: To describe the temporal patterns of heart rate and arrhythmias in the immediate postoperative period following cardiac surgery. Six postoperative cardiac surgical patients with a mean age of 48.3 years were studied. DESIGN: Descriptive longitudinal design. SETTING: Cardiac surgical ICU. METHODS: Heart rate and arrhythmias were recorded continuously for 48 hours from a cardiac monitor using a Holter tape recorder. Environmental and treatment data were noted throughout data collection by trained nonparticipant observers. RESULTS: Mean heart rate and incidence of arrhythmias were different between the 2 study days; therefore, data were divided into two segments (A and B). These differences coincided with extubation in most cases. Individual subject cosinor analysis revealed 24-hour rhythms of heart rate in both segments in all subjects except segment B for one subject. Rhythms of shorter periods were also found. In segment A individual subjects' acrophases (peak times of fitted curves) occurred later than expected for subjects' prehospitalization sleep-wake schedule, whereas in segment B they occurred earlier. Cosinor analysis of arrhythmias revealed significant 24-hour rhythms in both segments in one of the three subjects with premature atrial complexes, two of the four subjects with premature ventricular complexes and both subjects with ventricular couplets. Four-hour rhythms were found in premature atrial complexes (n = 1), atrial tachycardia (n = 1) and premature ventricular complexes (n = 3). Acrophases for arrhythmias varied among patients. During segment B the 4-hour-rhythm acrophases in heart rate and arrhythmias were related to the timing of respiratory therapy. CONCLUSIONS: Temporal variations in heart rate could be identified in these six critically ill adults. Rhythm parameters changed during the first 48 hours after cardiac surgery. In those who had arrhythmias, some patients demonstrated temporal patterns in the incidence of selected arrhythmias. Further study is needed to describe the temporal patterns of heart rate and arrhythmias in varied groups of critically ill persons in a variety of settings.