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Jeong Y, Yu H, Hwang B. Self-Care Behaviors Mediate the Impacts of Social Support and Disease Knowledge on Health-Related Quality of Life in Patients With Heart Failure. Clin Nurs Res 2022; 31:1308-1315. [DOI: 10.1177/10547738221092864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was aimed to test the mediation effect of self-care on the associations of social support and heart failure (HF) knowledge with health-related quality of life (HRQOL). We analyzed baseline data from patients with HF ( n = 122) enrolled in a randomized controlled trial. Mediation analysis was conducted using Hayes’ PROCESS macro for SPSS with Model 4, based on the bias-corrected bootstrap method. Higher levels of social support and HF knowledge were associated with better self-care. Better self-care was associated with better HRQOL. While social support and HF knowledge had no significant direct effects on HRQOL, they indirectly affected HRQOL through self-care. Our findings suggest that social support and HF knowledge affect HRQOL indirectly through self-care. To improve the HRQOL in patients with HF, it is necessary to motivate them to perform regular self-care by enhancing their HF knowledge and providing social support. Clinical trial identifier: KCT0002400 ( https://cris.nih.go.kr )
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Affiliation(s)
| | - Heajin Yu
- Seoul National University, Seoul, Korea
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2
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Temper the Specialist Nurses Heterogeneity in the Interest of Quality Practice and Mobility—18 EU Countries Study. Healthcare (Basel) 2022; 10:healthcare10030435. [PMID: 35326913 PMCID: PMC8953535 DOI: 10.3390/healthcare10030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The position of the specialist nurse profession varies across the European Union. Action is required to address the challenges to promote mobility and the contribution of specialist nurses to quality of care. The purpose of the study is to identify the interfaces of the specialist nurse profession across the European Union. Methods: A mixed method study was conducted in October 2019 and total of 40 answers from 18 different European Union countries were selected using a purposive sampling method. Results: The participants had completed various Bologna degree cycles and 57.2% had followed a specific educational programme to become a specialist nurse. More professional autonomy was acquired by 81.9% participants. Conclusion: A striving for homogeneity in the interpretation of the specialist nurses role and competencies is needed to achieve better quality of care provision and facilitate their mobility around the European Union. The lack of recognition identified in this study should encourage nurse managers to consider specialist nurse roles with the aim of capitalizing on the advanced care and expertise that specialist nurses provide. These results are an opportunity to improve the specialist nurses profession with an ultimate impact on management practices of streamlined, cost-effective clinical services.
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Chi SY, Soh KL, Raman RA, Ong SL, Soh KG. Nurses' knowledge of heart failure self-care education: A systematic review. Nurs Crit Care 2022; 27:172-186. [PMID: 35108749 DOI: 10.1111/nicc.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/03/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of heart failure is increasing, associated with high mortality and rehospitalization rate. The complexity and progressive clinical syndromes of heart failure have massively affected patients' quality of life. Heart failure self-care education provided by nurses seems to improve patients' knowledge and the clinical outcomes despite being in critical care or community settings. Nurses often gained heart failure self-care knowledge from formal and informal educational resources. However, the extent of knowledge acquired by nurses needs to be investigated before patient education could be successfully carried out. AIMS This systematic review identified the nurses' knowledge of heart failure self-care education according to the topics and factors that would be substantial to increase their knowledge. METHODS Literature resources from Medline, CINAHL, Ovid, Science Direct, Scopus and Google Scholar from 2002 to 2020 were studied and reviewed. This systematic review included nurses that take care of heart failure patients and studies that measured their knowledge score. The quality of all studies was determined using the JBI SUMARI Critical Appraisal tool, and a narrative approach was used to analyse the results. RESULTS 15 studies were selected, involving 1644 nurses that had experience in taking care of heart failure patients. The overall mean ± SD score of nurses' knowledges was unsatisfactory with 12.1 ± 2.7 to 17.3 ± 1.4, respectively, and it showed a significant increase in the level of knowledge after attending a heart failure speciality course or educational intervention. The majority of the nurses were uncertain about the deteriorating symptoms and fluid management for heart failure patients. CONCLUSIONS The nurses' level of knowledge was unsatisfactory, and therefore they need more in-depth learning and understanding of the heart failure topic through educational interventional. RELEVANCE TO CLINICAL PRACTICE Critical care nurses needed to have in-depth knowledge to recognize symptoms of deterioration in heart failure patients, especially during the decompensated stage.
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Affiliation(s)
- Suh Yenn Chi
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Training Institute of Ministry of Health, Sungai Buloh, Selangor, Malaysia
| | - Kim Lam Soh
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Rosna Abdul Raman
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Swee Leong Ong
- School of Nursing Science, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Kim Geok Soh
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
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4
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Faragli A, Abawi D, Quinn C, Cvetkovic M, Schlabs T, Tahirovic E, Düngen HD, Pieske B, Kelle S, Edelmann F, Alogna A. The role of non-invasive devices for the telemonitoring of heart failure patients. Heart Fail Rev 2021; 26:1063-1080. [PMID: 32338334 PMCID: PMC8310471 DOI: 10.1007/s10741-020-09963-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) patients represent one of the most prevalent as well as one of the most fragile population encountered in the cardiology and internal medicine departments nowadays. Estimated to account for around 26 million people worldwide, diagnosed patients present a poor prognosis and quality of life with a clinical history accompanied by repeated hospital admissions caused by an exacerbation of their chronic condition. The frequent hospitalizations and the extended hospital stays mean an extremely high economic burden for healthcare institutions. Meanwhile, the number of chronically diseased and elderly patients is continuously rising, and a lack of specialized physicians is evident. To cope with this health emergency, more efficient strategies for patient management, more accurate diagnostic tools, and more efficient preventive plans are needed. In recent years, telemonitoring has been introduced as the potential answer to solve such needs. Different methodologies and devices have been progressively investigated for effective home monitoring of cardiologic patients. Invasive hemodynamic devices, such as CardioMEMS™, have been demonstrated to be reducing hospitalizations and mortality, but their use is however restricted to limited cases. The role of external non-invasive devices for remote patient monitoring, instead, is yet to be clarified. In this review, we summarized the most relevant studies and devices that, by utilizing non-invasive telemonitoring, demonstrated whether beneficial effects in the management of HF patients were effective.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Abawi
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - C Quinn
- Department of Biological Sciences, Rensselaer Polytechnic Institute, 110 Eighth Street, Troy, NY, USA
| | - M Cvetkovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Schlabs
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - E Tahirovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - H-D Düngen
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - B Pieske
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Edelmann
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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5
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Tracy MF, Oerther S, Arslanian-Engoren C, Girouard S, Minarik P, Patrician P, Vollman K, Sanders N, McCausland M, Antai-Otong D, Talsma A. Improving the care and health of populations through optimal use of clinical nurse specialists. Nurs Outlook 2020; 68:523-527. [PMID: 32896305 PMCID: PMC7473707 DOI: 10.1016/j.outlook.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CNSs) are uniquely qualified to care for patients with complex illnesses as well as having the skills to optimize care for entire populations with complex needs. The absence of consistent legislative advanced practice registered nurse recognition of CNSs prevents health care systems from optimal use of this advanced practice registered nurse role to improve and provide safe and quality care for these patients. Additional barriers in optimal utilization of CNSs include lack of consistency: in title protection and licensing from state to state; ensuring patient access through identification and tracking of CNS numbers across the United States in order to determine workforce and educational program requirements; and ensuring appropriate reimbursement for care provided by CNSs. Therefore, it is the position of the American Academy of Nursing that addressing public and private sector regulatory, legislative, and policy concerns related to CNSs is essential to achieving optimal population health outcomes across the nation.
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Affiliation(s)
| | - Sarah Oerther
- Jonas Policy Scholar, Psychiatric, Mental Health and Substance Use Expert Panel
| | | | | | - Pamela Minarik
- Psychiatric, Mental Health and Substance Use Expert Panel
| | | | | | - Nena Sanders
- Building Health Care System Excellence Expert Panel
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6
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Fukuda T, Sakurai H, Kashiwagi M. Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists. PLoS One 2020; 15:e0234879. [PMID: 32542030 PMCID: PMC7295221 DOI: 10.1371/journal.pone.0234879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/03/2020] [Indexed: 11/18/2022] Open
Abstract
Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients’ length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients’ diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution’s electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05–0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients’ length of ICU stay.
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Affiliation(s)
- Tomohide Fukuda
- Faculty of Nursing, Kyoritsu Women’s University, Tokyo, Japan
- * E-mail:
| | - Hironori Sakurai
- Department of Anesthesiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masanori Kashiwagi
- Department of Anesthesiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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7
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You J, Wang S, Li J, Luo Y. Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure. Med Sci Monit 2020; 26:e920469. [PMID: 32068197 PMCID: PMC7047924 DOI: 10.12659/msm.920469] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aims of the present study were to determine whether a nurse-led program of care can improve medication adherence, quality of life (QoL), rates of rehospitalization, and all-cause mortality for chronic heart failure (CHF) patients. MATERIAL AND METHODS CHF patients were randomly assigned into either a control group or an intervention group. At 12 weeks, patients were followed up to evaluate the rate of medication adherence, QoL (as assessed by SF-12 physical and mental component score [PCS and MCS]), rehospitalization, and all-cause mortality. RESULTS We recruited 152 patients. No significant differences in demographics, comorbidities, CHF severity, or etiology at baseline were observed. At discharge, no significant differences in medications prescription, PCS (46 vs. 45), or MCS (55 vs. 56) were observed. However, at 12-week follow-up, compared to the control group, patients in the intervention group were more likely to keep on medications therapy, with a significantly higher use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker [73.8% vs. 59.7%], beta-blocker (62.5% vs. 51.4%), and aldosterone receptor antagonist (60% vs. 54.2%). Both PCS (35 vs. 40) and MCS (42 vs. 49) were also significantly lower in the control group versus the intervention groups (P<0.05). Patients in the control group had higher incident rate of rehospitalization (8.0% vs. 5.2% per person-week) than in the intervention group, with an incident rate ratio of 1.54 (95% confidence interval [CI]: 1.06-2.23). CONCLUSIONS A nurse-led discharge program of care can be a cost-effective and feasible approach for management of CHF patients in China.
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Affiliation(s)
- Jinyan You
- Department of Nursing, Hainan Western Central Hospital, Danzhou, Hainan, China (mainland)
| | - Suping Wang
- Department of Nursing, Cadre Sanatorium of Hainan and Geriatric Hospital of Hainan, Danzhou, Hainan, China (mainland)
| | - Jing Li
- Department of Nursing, Hainan Western Central Hospital, Danzhou, Hainan, China (mainland)
| | - Yuanping Luo
- Department of Cardiology, Chinese People's Liberation Army Logistic Support Hospital No. 928, Danzhou, Hainan, China (mainland)
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8
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Fukuda T, Sakurai H, Kashiwagi M. Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes. PLoS One 2020; 15:e0228458. [PMID: 32023315 PMCID: PMC7001939 DOI: 10.1371/journal.pone.0228458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives This study evaluated the impact of the presence of a certified nurse specialist in critical care (CNS) as ICU head nurse in an open ICU on clinical outcomes. Methods The presence of a CNS as ICU head nurse was implemented in practice in April 2017. To evaluate the impact on patient outcomes before and after the implementation, patients were divided into two groups: before (April 2014 to March 2017; 1988 patients) and after (April 2017 to March 2019; 1664 patients). Patients’ demographic data were collected from the ICU database. Results Multivariable logistic regression analysis revealed that the presence of a CNS as ICU head nurse was associated with lower ICU mortality (odds ratio (OR): 0.52, 95% CI: 0.36–0.73, p < .001) and fewer patients receiving mechanical ventilation in the ICU (OR: 0.20, 95% CI: 0.15–0.26, p < .001). Conclusion CNSs are defined as one type of advanced practice nurses. Having a CNS as a head nurse in the ICU may have helped improve patient outcomes by leveraging these practical skills in nursing management.
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Affiliation(s)
- Tomohide Fukuda
- Faculty of Nursing, Kyoritsu Women’s University, Tokyo, Japan
- * E-mail:
| | - Hironori Sakurai
- Department of Anesthesiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masanori Kashiwagi
- Department of Anesthesiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Hambly N, Goodwin S, Aziz-Ur-Rehman A, Makhdami N, Ainslie-Garcia M, Grima D, Cox G, Kolb M, Fung D, Cabalteja C, DeMarco P, Moldaver D. A cross-sectional evaluation of the idiopathic pulmonary fibrosis patient satisfaction and quality of life with a care coordinator. J Thorac Dis 2019; 11:5547-5556. [PMID: 32030274 DOI: 10.21037/jtd.2019.11.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Canadian and international guidelines recommend specialized, multidisciplinary teams for the treatment of patients with idiopathic pulmonary fibrosis (IPF). The objective of this cross-sectional clinical study was to investigate the effect of a care coordinator on IPF patient satisfaction and quality of life. Methods Forty IPF patients were enrolled from the practices of two physicians (n=20/physician), with either low (LCU) or high-coordinator use (HCU). Patient satisfaction was measured with modified FAMCARE and IPF Care UK Patient Support Program (UK-CARE) surveys. Health related quality of life (HRQoL) was assessed with the living with IPF impacts (L-IPFi) survey. An economic model assessed the impact of the coordinator; staff surveys informed patient management requirements, and costs were derived from published literature. Results Patient satisfaction was similar between the clinics; a trend (P=0.1) towards increased satisfaction among HCU patients was observed. Patients in the HCU clinic reported increased satisfaction (P<0.05) with their current care compared with care prior to joining the tertiary-care clinic, while LCU patients did not. IPF patient HRQoL did not differ between clinics. The coordinator was estimated to alleviate approximately 30% of a physician's IPF-related work load, and to facilitate the care of more patients per physician. Modelled estimates suggest the coordinator lead to annual cost-savings of $137,212. Conclusions Reliance upon a coordinator during routine management of IPF patients may improve patient satisfaction, spare physician time and lead to annual cost-savings. Future studies should examine the impact of a coordinator on healthcare resource utilization.
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Affiliation(s)
- Nathan Hambly
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Goodwin
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Afia Aziz-Ur-Rehman
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Gerard Cox
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Martin Kolb
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Fung
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | - Czerysh Cabalteja
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | - Patricia DeMarco
- Department of Medical Affairs, Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
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Swamy V, Brainin P, Biering-Sørensen T, Platz E. Ability of non-physicians to perform and interpret lung ultrasound: A systematic review. Eur J Cardiovasc Nurs 2019; 18:474-483. [PMID: 31018658 DOI: 10.1177/1474515119845972] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. AIMS To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. METHODS AND RESULTS We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0-12 h of didactic training and 58-62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79-98% and a specificity of 70-99%. In image adequacy studies, medical students with 2-9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50-100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. CONCLUSIONS Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.
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Affiliation(s)
- Varsha Swamy
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Philip Brainin
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- 2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Elke Platz
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,3 Harvard Medical School, Boston, USA
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11
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Integrating Entrepreneurial Skills Into Clinical Nurse Specialist Education: The Need for Improved Marketing, Negotiation, and Conflict Resolution Skills. CLIN NURSE SPEC 2019; 33:146-148. [PMID: 30946112 DOI: 10.1097/nur.0000000000000440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Implementation of a Patient Navigator Program to Reduce 30-day Heart Failure Readmission Rate. Prog Cardiovasc Dis 2017; 60:259-266. [PMID: 28743529 DOI: 10.1016/j.pcad.2017.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
Abstract
With increasing awareness to provide personalized care our institution applied the American College of Cardiology (ACC) Patient Navigator Program to identify hospitalized heart failure (HF) patients and improve transitions and outcomes. Utilizing a Navigator Team (NT) composed of a nurse and clinical pharmacist, we delivered evidenced-based interventions and hypothesized this approach would improve identification of HF inpatients and reduce the 30-day all-cause readmission rate. Patients were followed from admission to discharge and received at least one intervention, tailored to the patient's health literacy and social needs. The 30-day all-cause readmission rate was 17.6% for the Patient Navigator Program and 25.6% for the medical center. Compared to the medical center there was a statistically significant increase in education and follow-up. For patients who received specific NT interventions of education and follow-up the readmission rate was 10.3% and 6.1% respectively. Hospital programs can easily embed a NT into existing initiatives to further reduce the readmission rate.
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