Changes in reported dietary habit and exercise levels after an uncomplicated first myocardial infarction in middle-aged men

Education of patients and their partners about appropriate lifestyle changes following myocardial infarction (MI) is a key element in rehabilitation; developing relevant educational strategies requires a knowledge of patient beliefs and attitudes. This paper reports findings from a survey of diet and exercise in a group of 153 middle-aged men who had suffered a first uncomplicated MI. Just over half of those questioned expressed a desire to change their diet post-MI; those who perceived their pre-morbid diet to be 'less healthy' were more likely to want to change. Significant changes in food consumption (towards a more healthy diet) were observed at 3 months post-MI. Patients were less likely to change their behaviour with respect to exercise, and few attained recommended levels of physical activity either pre- or post-MI. Patients held a number of misconceptions regarding the role of diet and exercise in predisposing to coronary heart disease, and the need for change in behaviour. Beliefs and behaviour change were only weakly associated with receipt of information and advice. The findings have important messages for the more appropriate targeting of information-provision during the period of rehabilitation.

A study to determine patient satisfaction with nursing care

In this paper, the authors describe a newly constructed measure of patient satisfaction entitled the Newcastle Satisfaction with Nursing Scales (NSNS). A study using the NSNS found that patients 'most liked' the humour that nurses tried to inject into their interactions with patients, but that they were dissatisfied in general with the amount of information given to them by nurses. The sensitivity of the tool in relation to detecting differences between wards, hospitals or groups of patients is emphasised. The authors then discuss how the NSNS package can be used by others to carry out similar comparisons.

A novel mechanism for cyclosporine: inhibition of myocardial ischemia and reperfusion injury in a heterotopic rabbit heart transplant model

BACKGROUND

Advances in myocardial preservation techniques and immunosuppressive drug therapy have resulted in heart transplantation as an acceptable treatment for end-stage heart failure. However, excessive periods of global myocardial ischemia followed by reperfusion can progress to irreversible graft injury. It has been reported that cyclosporine A (in addition to its well-characterized immunosuppressive actions) can blunt certain features of ischemia and reperfusion injury. This study was performed to examine the ability of cyclosporine A to attenuate such injury in a model of heart transplantation.

METHODS

Twenty rabbit heterotopic transplants were divided into four study groups: (1) 30-minute ischemic control hearts; (2) 30-minute ischemic cyclosporine A-treated hearts; (3) 4-hour ischemic control hearts; and (4) 4-hour ischemic cyclosporine A-treated hearts. A single dose of cyclosporine A (10 mg/kg intravenously) or vehicle was administered to both the donor and recipient rabbits 45 minutes before heart explantation and heart transplantation, respectively.

RESULTS

After transplantation and 30 minutes of reperfusion, the 4-hour ischemic control hearts showed a significant (p < 0.01) leftward shift in the left ventricular end-diastolic pressure versus left ventricular volume curve compared with the 30-minute ischemic control hearts. This finding represents higher end-diastolic pressures and incomplete diastolic relaxation caused by ischemia and reperfusion. Cyclosporine A administration to the donor and recipient rabbits resulted in a significant improvement (p < 0.01) in diastolic relaxation (shift in the left ventricular end-diastolic pressure versus left ventricular volume curve back to the right) compared with 4-hour ischemic control hearts. Cyclosporine A-treated hearts also showed significant improvements in the rate of diastolic pressure fall (p < 0.05) and tau (the isovolumetric pressure decay constant) (p < 0.01) compared with ischemic control hearts.

CONCLUSIONS

These results indicate that single doses of cyclosporine A to both the donor and recipient inhibit the dysfunction in extent and rate of left ventricular relaxation caused by prolonged global ischemia and reperfusion. Possible mechanisms for cyclosporine A's myocardial protective actions are presented in the discussion.

Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care

OBJECTIVES

To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response.

DESIGN

Sample survey.

SETTING

20 wards in five hospitals in the north east of England.

PATIENTS

2078 patients in general medical and surgical wards.

MAIN MEASURES

Experiences of and satisfaction with nursing care.

RESULTS

75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home.

CONCLUSION

Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.

The impact of primary nursing on patient satisfaction

Primary nursing is considered by some to be an appropriate vehicle for meeting the named-nurse standard of the Patient's Charter. The study reported here set out to determine whether patients identifying one nurse as being in charge of their care would express more positive experiences of and greater satisfaction with nursing care. Patients who could identify a nurse in charge of their care reported more positive experiences of that care. However, in the wards studied, primary nursing did not appear to be any more successful than team nursing in encouraging this process. Given the limited resources to implement primary nursing, the authors advise increased efforts to ensure each patient has one nurse responsible for their care, and that they know who this nurse is.

Patients' and nurses' knowledge of cardiac-related symptoms and cardiac misconceptions

OBJECTIVE

To compare knowledge and reported incidence of cardiac-related symptoms among patients with nurses' knowledge and estimated incidence of symptoms in this patient group.

DESIGN

Retrospective collection of patient data by means of postal questionnaire and postal survey of hospital nurses.

SETTING

Five non-randomly selected hospitals in northeast England.

SUBJECTS

One hundred seventy-five male patients with a first uncomplicated myocardial infarction (MI), cared for by 168 registered nurses working in coronary care or medical wards.

OUTCOME MEASURES

Reported and estimated occurrence of 11 common cardiac symptoms in the 3 weeks after MI and 15-item knowledge and 10-item misconception scales about cause of and recovery from MI.

RESULTS

The percentage of nurses who correctly estimated the incidence of symptoms was low, 25% of nurses did not make any correct estimates, and the mean number of correct estimates was not associated with nurses' experience or qualifications. The overall mean score for the knowledge scale was 9.6 (SD 1.9) for nurses, which was significantly higher (t=7.5, p<0.001) than that for patients (mean 7.9, SD 2.3); the nurses' score was not significantly associated with experience or place of work. For the misconception scale the mean score for nurses was 6.8 (SD 1.5), which was significantly higher (t=6.85, p<0.001) than the mean score for patients (5.5; SD 2.6); nurses working in specialized cardiac wards and more experienced nurses had significantly higher scores.

CONCLUSIONS

Nurses should be provided with sound knowledge on cardiac symptoms and risks so that they can educate patients accordingly and, in particular, can correct misconceptions about the condition, prognosis, and appropriate lifestyle changes. Advanced-training personnel should recognize the need to enhance nurses' skills in patient education and rehabilitation; the importance of these skills also should be recognized in first-level training.

Measuring patients' satisfaction with nursing: 1990-1994

Assessing patients' satisfaction with the care they receive is assuming greater importance in the new-style National Health Service. This paper reviews recent developments in the measurement of patients' satisfaction with nursing, including new approaches and taking into account increased interest in users' opinions. Studies published since 1990 generally demonstrate lack of clarity with regard to the purpose and intent of the study, as well as a lack of conceptual rigour and methodological investment. However, several new approaches were found upon which future nursing research could build.

The effect of epigastric vessel ligation on the vascular territories of the pig rectus muscle

In a pig model, unilateral ligation of the inferior epigastric vessels caused an initial decrease in normal vascularity, followed by an increase toward normal vascularity, in the inferior portion of the rectus muscle over 42 days. Ligation appeared to dilate the choke vessels between the superior and inferior arterial territories. The results indicate that by ligation of the inferior epigastric vessels, the vascular territory, which is normally tenuous, can undergo a transposition without vascular compromise.

Involving clients in clinical audits of mental health services

Involving clients in service audits is never straightforward. In developing a new audit system for use in mental health settings a review of the literature demonstrated that the concept of satisfaction, like quality, is problematic because it is multidimensional, it is affected by expectations, and may be defined differently by professionals and clients. Furthermore, it fails to address the notion of empowerment. However, the literature provided some clear methodological guidance about involving clients in clinical audit. Clients must be involved in defining audit topics, and the most appropriate techniques of data-collection are open-ended and qualitative. Clients can also be involved in the process of audit, particularly through conducting audits in collaboration with professionals. Evidence from the literature persuaded the authors to abandon the idea of developing an audit module on patient satisfaction, and instead to develop one with a clear focus on clients' perspectives, entitled "Clients' Appraisal of Care" as part of the Newcastle Audit System, with clients involved throughout.

Development and validation of scales to measure organisational features of acute hospital wards

In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

The experience of women during their partners' hospital stay after MI

Structured interviews were undertaken with 159 women following their partner's myocardial infarction (MI) and 129 of these women completed a further postal questionnaire approximately three weeks later. While in hospital, only a quarter of women were spoken to by nurses about possible dietary change for their partners, 24 percent were advised about exercise and 11 percent about work. Thirty one percent were spoken to about general lifestyle of their partners. When asked to rate the usefulness of information from all sources about various topics, those women who had been spoken to by nurses had significantly higher scores three weeks post-MI than women who had not. Nurses were frequently not proactive in offering information to women who showed high levels of anxiety and depression at both time points. These findings are discussed in relation to the role of hospital nurses in secondary prevention strategies.

Nurse involvement in cardiac rehabilitation prior to hospital discharge

Interviews were undertaken with 202 men admitted to five hospitals in northeast England following an uncomplicated first myocardial infarction. The likelihood of patients speaking to a nurse about recovery or seeing a physiotherapist, dietician or specialist rehabilitation nurse, varied considerably between hospitals. Whilst virtually all patients received written information concerning some aspect of life-style change or cardiac rehabilitation, the quality and range of information, particularly with regard to information about stress or anxiety, was frequently limited. Instructions about seeing a general practitioner following discharge were often vague; formal rehabilitation programmes, where they existed, excluded some patients. The study suggests that much patient education is dependent on the provision of written information alone, and that further evaluation of the effectiveness of self-help material supported by nursing input is desirable.

Ketanserin accelerates wound epithelialization and neovascularization

We investigated the acute effects of topical ketanserin, a 5-HT(2) (serotonin) receptor blocker, on wound epithelialization and vascularization with the use of the hairless mouse ear model. Varying concentrations of Ketanserin (0%, 0.2%, 2.0%, 20% weight/volume) were administered to standardized full-thickness skin wounds on the dorsum of the hairless mouse ear immediately after surgery and daily thereafter. With the use of video microscopy and computer-assisted planimetry, vascularization and epithelialization were traced every third day until the wounds were fully healed. Arteriole diameters at selected sites near the skin wound were measured before wound creation and after wounding. It was concluded that topically administered ketanserin significantly accelerates both the vascular (p < 0.001 at 2% and 20% concentrations) and epithelial (p < 0.001 at 20% concentration) rates of wound healing in full-thickness nonpathologic skin wounds. Vasodilation of terminal arterioles was not a major response to Ketanserin. Faster epithelialization was possibly due to direct effect of ketanserin on epithelial cells.

Obtaining patients' views of nursing care to inform the development of a patient satisfaction scale

Patient satisfaction is increasingly being measured as an indication of the effectiveness of nursing care. At present, however, there are no validated UK scales available specifically addressed to nursing. The aim of the present study was to develop a sensitive, valid and reliable measure of patient satisfaction. This paper describes the first phase of the study, the development of a multidimensional concept of satisfaction from the patients' perspective. Using qualitative methods, patients were interviewed both in hospital and following discharge. Eleven main concepts were identified: nurses' manner, attentiveness, availability, reassurance, individual treatment, openness/informality, information, professionalism, ward organization, nurses' knowledge and ward environment. Beginning with customer-defined values has provided the starting point for the development of a scale to measure patients' satisfaction with nursing using concepts important to patients, rather than hospital personnel or research teams.

The effectiveness of nursing: a review

This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sizes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions. Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research.

Extending the range of primary nursing

One of the key achievements of the primary nursing system was to put the patient at the forefront of care and raise the status of clinical nursing. The values associated with primary nursing, however, need to be adopted by the whole organisation. The author highlights what actions need to be taken to maintain the momentum of primary nursing and urges the introduction of case management.