Living the healthy heart path. Rehabilitation after a cardiac event.

Although cardiac rehabilitation has traditionally been linked to specific programs in which patients participate after having a cardiac event, the concept of cardiac rehabilitation has expanded to many domains of nursing. Not only are critical care nurses the initiators of cardiac rehabilitation through thorough and accurate teaching of the cardiac event but all nurses should be attuned to the modifiable risk factors to direct patients at high risk for possible prevention of a cardiac event. It is a critical care nurse who is knowledgeable about the focus and goals of cardiac rehabilitation, who incorporates the patient's family in the early rehabilitation stages, and who considers cultural variations who can provide optimal care to the patient, helping him or her lead a healthy and productive life.

Orthopedic trauma. Managing secondary medical problems.

Caring for the multiply injured orthopedic trauma patient is a challenge. Managing secondary medical problems associated with injury is enhanced when rehabilitation clinical nurse specialists, orthopedic advanced practice nurses, and the interdisciplinary team are consulted immediately following trauma. Educating the public on actions and behaviors that reduce the likelihood of accidents is an important role of the RN. Nurses play a key role in restoring the patient to the preinjury level of functioning or assisting the patient in adapting to temporary/permanent disability. Early intervention may result in shortened length of hospital stay, earlier return to work, restoration of family role function, and healthier psychologic and physical recovery. All RNs must be actively involved in educating the public on injury prevention, which includes teaching responsible behavior and the adverse effects of alcohol use.

Managing the stress of caring for rehabilitation patients.

Dealing with stress is stressful! Evaluation is important to determine whether your plan for overpowering stress is working. Do you feel less stress as a result of what you have tried? Nurses use creativity every day in caring for their patients; applying that same spirit of creativity for stress reduction becomes personally meaningful. Stress is a universal condition, so friends and colleagues are good sources of ideas for stress management. Although stress is a human condition, unlikely to be totally eliminated, decreasing it as much as possible is important. Efforts in a stress reduction program can be met with great success. Recognizing the problem, assessing its magnitude, and then implementing selected strategies are all that is required. Overpowering stress in their lives is possible for nurses who are then healthier, happier, and even better caregivers.

Using nurse-sensitive outcomes to improve clinical practice.

With the many uncertainties in the current health care milieu and continuing movement from general guidelines to ensure an optimal practice approach, it is especially vital that critical care nurses facilitate a research culture in their workplace and strive to improve clinical practice through understanding and evaluating research. Outcomes research helps to identify discipline-specific accountability in patient care. Through understanding the basic aspects of outcomes research and the issues that influence nurse-sensitive outcomes, the critical care nurse is informed and can make clearer and appropriate choices in patient care. Outcomes research continues to be instrumental in defining a base for nursing practice. Although it is not necessary or even desirable that all nurses conduct research, nurses are accountable for providing scientific and appropriate care to ensure the optimal outcome for the patient.

The evolution of heart transplantation.

Now that heart transplantation is a common therapeutic modality, it has lost much of its earlier mystique. Numerous issues related to donor allocation, immunosuppression, quality-of-life of the recipient, patient selection, cost-effectiveness, and a myriad of ethical considerations remain. Current policies, procedures, legislation, and techniques are the result of a long progression of experimental and clinical advances and public reaction. Current practices and legislation are a part of heart transplantation's evolutionary process. The process can change and advance as rapidly as it did on December 3, 1967, with the announcement of the first successful human-to-human heart transplantation.

Journey to holism.

The journey to holism is the result of a grounded theory study of 18 members of the American Holistic Nurses' Association. Participants were prompted to "Tell me about holistic nursing" and replies revealed a seven-step process to becoming a holistic nurse. The process is an expansion of Van Gennep's three-stage theory of rites of passage, which involves separation, marginality/liminality, and reintegration. The expanded process begins with separation from mainstream nursing and concludes with reintegration into nursing as a holistic nurse. The marginality/liminality step shows five active steps: gathering information to quell the distress of the separation, applying that information to others, changing focus to self-care, applying the information to self, and increasing self-knowledge. This article describes the process and presents data to support the conclusion that the growth of a holistic nurse follows a recognizable course.

Successfully weaning the intra-aortic balloon pump patient: an algorithm.

Guiding a patient safely through the process of weaning from an intra-aortic balloon pump (IABP) requires knowledge that goes beyond understanding the device's purpose and mechanisms. Critical care nurses are responsible for coordinating multidisciplinary care throughout the patient's IABP therapy, assessing and supporting the patient throughout the weaning process, and making determinations about the rate of--and the patient's response to--weaning. This article presents an algorithm for critical care nurses who must make decisions before and during the weaning process.

Selecting and managing fluid therapy. Colloids versus crystalloids.

The critical care nurse is responsible for monitoring the effects of parenteral therapy. If the nurse is to collaborate with the physician on the type of solution appropriate for the patient, it is imperative that the nurse understand how the solution will impact the patient. Only through comprehending the effects and properties of each solution can the nurse provide quality care and ensure desirable patient outcomes.