Postoperative management and nursing care after implantation of a total artificial heart: Scoping review.

INTRODUCTION: End-stage heart failure (HF) is a condition whose only successful long-term treatment, with a survival of more than 10 years, is heart transplantation. However, limited organ availability and the progressive increase in the number of patients with advanced HF have served as an impetus for the development of implantable mechanical assistive devices. AIM: To provide an overview of postoperative management and nursing care after the implementation of a Total Artificial Heart (TAH). METHODS: A scoping review was carried out by consulting the PUBMED, CINAHL, and COCHRANE databases. From all the documents located, information was extracted on the date of publication, country of publication, type of study, and results of interest to answer the research question. In addition, the degree of recommendation was identified. RESULTS: Twenty-three documents were included in the scoping review. Results were classified in relation to: 1) description of the CAT SynCardia®; 2) nursing care in the immediate postoperative period (management of the device and management of hematological, infectious, nephrological, nutritional complications, related to immobilization, sleep-rest disturbances, psychological disorders, and patient and family education); and 3) follow-up at home. CONCLUSIONS: The complexity of implantation of the TAH, the multiple related complications that can arise during this process, both in the immediate post-operative and late, require a standardised and multidisciplinary management. The absence of standardised protocols raises the need for future studies to measure the effectiveness of care in patients with TAH. A multidisciplinary approach is crucial. Nurses must acquire autonomy and involvement in decision-making and develop competencies to address the patient's and family's physiological and psychosocial needs.

Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico / Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: Clinical case

Objetivo Presentar y analizar un caso clínico con el que se aborde el plan de cuidados de un paciente con asistencia ventricular permanente en una unidad de cuidados intensivos (UCI).Presentación del caso clínico Varón de 65 años de edad que ingresa en la UCI de un hospital universitario de nivel terciario en septiembre de 2011, tras implantarle el dispositivo de asistencia ventricular permanente (Heartmate II®).Discusión e implicaciones para la práctica El análisis del caso se estructura según las categorías que se identifican en la revisión de la literatura médica: prevención de riesgos y complicaciones, manejo del dispositivo y educación para la salud. Conclusión Este trabajo evidencia la importancia de instaurar un plan de cuidados protocolizado para los pacientes portadores de asistencia ventricular permanente en la UCI, lo que evitaría complicaciones en el post-operatorio inmediato, reduciría los costes y el tiempo de hospitalización (AU)

Objective To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU).Clinical case presentation A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II®).Discussion and implications for practice The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. Conclusion This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time (AU)

[Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: clinical case]. / Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico.

OBJECTIVE: To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU). CLINICAL CASE PRESENTATION: A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II). DISCUSSION AND IMPLICATIONS FOR PRACTICE: The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. CONCLUSION: This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time.

[Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses]. / Cuidados del paciente al final de la vida: ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos.

BACKGROUND: The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. AIMS: To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. METHOD: A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand and Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. FINDINGS: Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x = 4.46); whereas ethics committee constantly involved in the unit as the least supportive one (x = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant differences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. CONCLUSIONS: Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority.

Cuidados del paciente al final de la vida: ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos / Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses

Introducción. La muerte es una realidad que con frecuencia ocurre en las Unidades de Cuidados Intensivos (UCI). El ambiente de la UCI por su alta tecnología, el enfoque de los cuidados, centrado en la curación y en medidas para salvar la vida, hacen que no sea el entorno más natural para que se dé el proceso del final de la vida. Actualmente, un objetivo de los profesionales que trabajan en estas Unidades es el de crear un clima que favorezca una «buena muerte». Objetivos. Los objetivos de esta investigación son: a) conocer las ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos en la atención del paciente al final de la vida y b) analizar si existe relación entre las ayudas y obstáculos percibidos por las enfermeras y las variables sociodemográficas. Método. Estudio descriptivo correlacional realizado en 5 hospitales terciarios de dos Comunidades Autónomas de España. La muestra de conveniencia estuvo formada por 151 enfermeras de Cuidados Intensivos. El cuestionario de Beckstrand y Kirchhoff de 2005, con 6 grados de respuesta (0 = no ayuda, no obstáculo; 5 = máxima ayuda, máximo obstáculo) se utilizó para conocer las ayudas y los obstáculos que perciben las enfermeras en la atención del paciente al final de la vida. Resultados. La edad media de las enfermeras fue de 35 años (mínimo 22 - máximo 57; DE = 7,6) con una experiencia en UCI de 9,2 años (mínimo 1-máximo 30; DE = 6,9). El ítem percibido como máxima ayuda para proporcionar un buen cuidado al paciente al final de la vida fue «que todos los médicos estén de acuerdo con el enfoque de los cuidados» (x­ = 4,46). La mínima ayuda corresponde al ítem «tener un miembro del comité de ética en los pases de visita diarios» (x­ = 2,93). El máximo obstáculo correspondió al ítem «que el paciente tenga dolor difícil de controlar» (x­ =4,38) y el mínimo, a «que la enfermera/o conozca el mal pronóstico del paciente antes de que lo sepa la familia» (x­ = 1,37). Al relacionar la edad y los años de experiencia en UCI con las variables de interés, ayudas y obstáculos, se han encontrado algunas correlaciones estadísticamente significativas. De igual modo, existen diferencias estadísticamente significativas entre las enfermeras que tienen formación postgrado y las que no la tienen con la percepción de ciertas ayudas y obstáculos. Con respecto al número de pacientes atendidos al final de la vida se han encontrado también diferencias estadísticamente significativas con algunas ayudas y obstáculos. Conclusiones. Las enfermeras perciben como prioritario el adecuado control del dolor, que entre el equipo médico haya unanimidad de criterios en la toma de decisiones y que se favorezca, tanto al paciente como a la familia, un entorno digno durante todo el proceso

Background. The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. Aims. To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. Method. A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand & Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. Findings. Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x­ = 4.46); whereas ethics committee constanly involved in the unit as the least supportive one (x­ = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x­ = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x­ = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant diferences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. Conclusions. Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority