Registered nurses' experiences with an evidence-based home care pathway for myocardial infarction clients.

OBJECTIVES: To obtain home health nurses' comments on an evidence-based care pathway for post myocardial infarction. DESIGN: A qualitative design was used. SETTING: Culturally diverse, lower income area of a large city. PARTICIPANTS: All home health nurses from one nursing agency who participated in a comparative study on the impact of the evidence-based care pathway. RESULTS: The largest number of comments made by the nurses were related to the beneficial impact of the pathway on the provision of quality nursing care and on increased job satisfaction. The home health nurses reported that the pathway increased clients' knowledge of medications and diet. In addition, they commented that they were able to use the pathway effectively because of the training they received from the inpatient cardiac nurses. CONCLUSIONS: This qualitative study demonstrates the benefits of investing in the implementation of best practice guidelines by home health nurses. However, nursing associations, such as the Canadian Community Health Nurses Initiatives Group, will need to continue to champion for additional funds to support the additional expenses incurred.

The effect of high frequency oscillatory ventilation on pulmonary stretch receptors in the dog.

High frequency oscillatory ventilation is a form of artificial ventilation where the tidal volume is less than the anatomical dead space. The efficacy of gas exchange depends upon the oscillatory frequency, volume, bias flow and the airway pressure. The present study was undertaken to determine the influence of oscillatory frequency, oscillatory volume and mean airway pressure upon the activity of pulmonary stretch receptors and rapidly adapting receptors during high frequency oscillatory ventilation. The experiments were conducted on dogs anaesthetized with either chloralose or nembutal. In Series I (16 slowly adapting stretch receptors) the effects of changing in turn, the oscillatory frequency, oscillatory volume and mean airway pressure were examined. The bias flow was held constant. Significant changes in the frequency of discharge of slowly adapting stretch receptors occurred only with alterations in oscillatory frequency (8,16,28 Hz) and mean airway pressure (3, 6 & 9 cm H2O). No significant changes in the activity of slowly adapting stretch receptors were observed when the oscillatory volume was altered (2.5, 5.0 & 7.5 ml/kg). With each manoeuvre there were significant small increments in intrathoracic gas volume. In Series II (16 slowly adapting stretch receptors) the interaction between oscillatory frequency and mean airway pressure was studied. The effect of each was greatest at the lowest value of the other variable. In Series III the effect of changing oscillatory frequency on the discharge from rapidly adapting receptors were examined. It was found that changes in frequency at a fixed airway pressure (3 cm H2O) and oscillatory volume failed to alter the activity significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial reflexes during high frequency oscillatory ventilation.

High frequency oscillatory ventilation (HFOV) is a new method of artificial ventilation which has been advocated for use in critically ill individuals. It alters the discharge in pulmonary stretch receptors (SAR) from a phasic to a continuous pattern. Since some cardiovascular neurones in the medulla are influenced by the discharge from SAR, experiments were undertaken to determine whether the reflexes from the left atrial (volume) receptors (LAR) were influenced by HFOV. The reflex increases in heart rate and urine flow which result from activation of the (LAR) were examined during both intermittent positive pressure ventilation (IPPV) and HFOV. In five dogs, the increase in heart rate was 23.9 +/- 4.3 and 24.5 +/- 5.4 beats/min during IPPV and HFOV, respectively. In six dogs the response of an increase in urine flow was examined and this response also was not altered by HFOV. It is concluded that the integrity of these reflexes was unaffected by HFOV in the anesthetized dog model.