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Youmans QR, Moutier CY, Neely K, Vela AM, Watkins EY, Tibrewala A. The Power in Our Patients' Hands: Exploring LVAD and Suicide. J Card Fail 2024:S1071-9164(24)00263-X. [PMID: 39147309 DOI: 10.1016/j.cardfail.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Quentin R Youmans
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | | | - Kathy Neely
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alyssa M Vela
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Anjan Tibrewala
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Yoo HJ, Shin S. Moving forwards to patient-centred care for patients with ventricular assist devices: A mixed methods study of nurses' perspectives. Intensive Crit Care Nurs 2024; 82:103635. [PMID: 38340544 DOI: 10.1016/j.iccn.2024.103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To identify nurses' caring behaviours toward patients with left ventricular assist devices and deepen their understanding of experiences in nursing care. Patients with left ventricular assist devices require care in many aspects, but there is limited in-depth research about caring behaviours and experiences from the perspective of nurses providing care. RESEARCH METHODOLOGY/DESIGN Mixed methods study with a sequential explanatory design. Data were collected from clinical nurses with experience caring for patients using left ventricular assist devices in South Korea between May-August 2022. MAIN OUTCOME MEASURES Quantitative data (n = 79) were collected through an online survey of the Caring Behaviours Inventory - 24 and analysed using descriptive statistics. For qualitative data (n = 15), nurses' caring experiences were collected through individual interviews and analysed using Colaizzi's phenomenological method. RESULTS The overall average of caring behaviours was 4.80 ± 0.85, specifically, 'knowledge and skill' (5.04 ± 0.78), 'assurance' (5.01 ± 0.79), 'respect' (4.85 ± 0.90), and 'connectedness' (4.04 ± 0.99), respectively. The experience of caring was trapped in the uncomfortable reality of left ventricular assist device nursing, causing device-focused care, and approaching the essence of nursing through care focused on the patient's wholeness. CONCLUSIONS Caring for patients with a left ventricular assist devices was challenging for nurses. However, through the care process, they realised the meaning of patient-centred care, reflected in the essence of nursing, and sublimated it into an opportunity to grow. IMPLICATIONS FOR CLINICAL PRACTICE Nurses must focus on patient-centred care for left ventricular assist devices. To achieve this, it is essential to create a clinical environment and educational system for nurses to provide effective nursing care and enhance patient participation.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
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Rao A, Violanti D, Elliott TI, Singh M, Kim B, VandenAssem K, Sheikh FH, Groninger H. Clinical Protocol for Left Ventricular Assist Device Deactivation at End of Life. J Palliat Med 2023; 26:1428-1434. [PMID: 37219893 DOI: 10.1089/jpm.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
As patients live longer with left ventricular assist device (LVAD) support, many will either suffer an acute event or develop a gradual, progressive disease that results in a terminal prognosis. At the end-of-life, patients, and more often, their families, will be faced with the decision to deactivate the LVAD to allow natural death. The process of LVAD deactivation carries some distinct features that distinguish it from withdrawal of other forms of life-sustaining medical technology: multidisciplinary collaboration is paramount; prognosis after deactivation is short, typically minutes-hours; and premedication doses of symptom-focused medications are typically higher than other situations involving withdrawal of life-sustaining medical technologies given the precipitous decline in cardiac output following LVAD deactivation. In this Case Discussion, we introduce the complexity of planned in-hospital LVAD deactivation through a clinical case, share our detailed institutional checklist and order set for LVAD deactivation, and broach multidisciplinary clinical protocol development processes.
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Affiliation(s)
- Anirudh Rao
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Diana Violanti
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | | | - Brian Kim
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Farooq H Sheikh
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Hunter Groninger
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
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Rashid M, Warriach HJ, Lawson C, Alkhouli M, Van Spall HGC, Khan SU, Khan MS, Mohamed MO, Khan MZ, Shoaib A, Diwan M, Gosh R, Bhatt DL, Mamas MA. Palliative Care Utilization Among Hospitalized Patients With Common Chronic Conditions in the United States. J Palliat Care 2022:8258597221136733. [PMID: 36373247 DOI: 10.1177/08258597221136733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Objective: Limited data exist around the receipt of palliative care (PC) in patients hospitalized with common chronic conditions. We studied the independent predictors, temporal trends in rates of PC utilization in patients hospitalized with acute exacerbation of common chronic diseases. Methods: Population-based cohort study of all hospitalizations with an acute exacerbation of heart disease (HD), cerebrovascular accident (CVA), cancer (CA), and chronic lower respiratory disease (CLRD). Patients aged ≥18 years or older between January 1, 2004, and December 31, 2017, referred for inpatient PC were extracted from the National Inpatient Sample. Poisson regression analyses were used to estimate temporal trends. Results: Between 2004 and 2017, of 91,877,531 hospitalizations, 55.2%, 13.9%, 17.2%, and 13.8% hospitalizations were related to HD, CVA, CA, and CLRD, respectively. There was a temporal increase in the uptake of PC across all disease groups. Age-adjusted estimated rates of PC per 100,000 hospitalizations/year were highest for CA (2308 (95% CI 2249-2366) to 10,794 (95% CI 10,652-10,936)), whereas the CLRD cohort had the lowest rates of PC referrals (255 (95% CI 231-278) to 1882 (95% CI 1821-1943)) between 2004 and 2017, respectively. In the subgroup analysis of patients who died during hospitalization, the CVA group had the highest uptake of PC per 100,000 hospitalizations/year (4979 (95% CI 4918-5040)) followed by CA (4241 (95% CI 4189-4292)), HD (3250 (95% CI 3211-3289)) and CLRD (3248 (95% CI 3162-3405)). Conclusion: PC service utilization is increasing but remains disparate, particularly in patients that die during hospital admission from common chronic conditions. These findings highlight the need to develop a multidisciplinary, patient-centered approach to improve access to PC services in these patients.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Haider J Warriach
- Cardiovascular Division, Department of Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA, USA
| | - Claire Lawson
- Cardiovascular Research Center, 4488University of Leicester, Leicester, UK
| | - Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
- Department of Cardiology, 158150Mayo Clinic School of Medicine, Rochester, NY, USA
| | | | - Safi U Khan
- Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
| | - M Shahzab Khan
- Department of Medicine, John H. Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Muhammad Zia Khan
- Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Masroor Diwan
- Department of Medicine, Southport District General Hospital, Southport, UK
| | - Raktim Gosh
- Department of Cardiology, 2546Case Western Reserve University, Metrohealth, Cleveland, OH, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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DeGroot LG, Bidwell JT, Peeler AC, Larsen LT, Davidson PM, Abshire MA. "Talking Around It": A Qualitative Study Exploring Dyadic Congruence in Managing the Uncertainty of Living With a Ventricular Assist Device. J Cardiovasc Nurs 2021; 36:229-237. [PMID: 33605640 PMCID: PMC8035157 DOI: 10.1097/jcn.0000000000000784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Vital components of communicating goals of care and preferences include eliciting the patient and caregiver's definition of quality of life, understanding meaningful activities and relationships, and exploring wishes for care at the end of life. Although current literature suggests framing conversations regarding end of life through the lens of meaning and quality of life, there is limited literature exploring dyadic congruence surrounding these important constructs among patients with ventricular assist devices (VADs) and their caregivers. OBJECTIVES The purpose of this study was to explore congruence of VAD patient and caregiver perspectives regarding end of life, definitions of quality of life, and meaning in life while managing the uncertainty of living with a VAD. METHODS We used thematic analysis to analyze semistructured qualitative interviews of 10 patient-caregiver dyads 3 to 12 months after VAD implantation. RESULTS Three major themes were identified: (1) differing trajectories of uncertainty and worry, (2) a spectrum of end-of-life perspectives, and (3) enjoying everyday moments and independence. Overall, patients and caregivers had differing perspectives regarding uncertainty and end of life. Within-dyad congruence was most evident as dyads discussed definitions of meaning or quality of life. CONCLUSIONS Dyadic perspectives on end of life, meaning in life, and quality of life can inform how palliative care and VAD teams approach conversations about planning for the end of life. Findings from this study can inform future shared decision-making interventions for patients living with VADs and their caregivers.
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