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Lakew BA, Bekele DM, Alemu Kassa W, Dugassa Tolera B. Suboptimal Knowledge and Care of Patients with Acute Coronary Syndrome Among Nurses Working in Selected Hospitals in Addis Ababa, Ethiopia 2021. Vasc Health Risk Manag 2023; 19:637-649. [PMID: 37753511 PMCID: PMC10519216 DOI: 10.2147/vhrm.s422339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
Background Acute Coronary Syndrome is the leading cause of morbidity and mortality in developing nations including Ethiopia. As frontline healthcare providers, nurses need to be prudent in handling cases of acute coronary syndrome. However, nurses' knowledge and practice of acute coronary syndrome are not well-known across Ethiopia. Thus, this study aimed to assess knowledge, practice, and associated factors regarding the care of acute coronary syndrome among acute care nurses working at selected hospitals in Addis Ababa, Ethiopia. Methods Institution-based descriptive cross-sectional study design was conducted from February to March among 252 purposively selected nurses working in tertiary hospitals of Addis Ababa, Ethiopia. A pretested and structured questionnaire was used for data collection. Data were entered into Epi-Data 4.6 and exported to SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. P-values < 0.05 were declared as significant factors for the outcome variable. Results Out of 252 nurses, (52%) had good knowledge, and (44.4%) had good practice towards care of Acute Coronary Syndrome. Being a master's degree [AOR=3.801, (95% CI:1.314-10.996), P =0.014] and having guidelines [AOR= 10.998, (95% CI:2.478-48.805), P =0.002] were significantly associated with nurse's good knowledge of ACS. While having a master's degree [AOR=4.258, (95% CI:1.676-10.820), P=0.002] and getting in-service training [AOR= 1.902, (95% CI:1.022-3.539), P = 0.042] were significantly associated with nurse's good level of practice. Conclusion In this study, nurses had inadequate knowledge and practice regarding the care of Acute Coronary Syndrome. Nurses' educational level, presence of clinical practice guidelines, and getting training were determinant factors associated with good knowledge and practice. Therefore, organizational and nursing educational support are needed to improve this gap by providing short- and long-term training, and updated evidence-based clinical practice guidelines should be available for all acute care nurses.
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Affiliation(s)
- Bizuayehu Ashine Lakew
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel M Bekele
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wudma Alemu Kassa
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Boka Dugassa Tolera
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Weaver MJ, Mok D, Hughes I, Hattingh HL. Effect of a Senior Cardiology Nursing Role on Streamlining Assessment of Emergency Cardiology Presentations During COVID-19: An Observational Study. Heart Lung Circ 2023; 32:604-611. [PMID: 37003937 PMCID: PMC10063155 DOI: 10.1016/j.hlc.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The Emergency Cardiology Coordinator (ECC) was a senior nursing role implemented from 14 April 2020 to 15 September 2020 at the Gold Coast Hospital and Health Service in South-East Queensland, Australia to streamline and expedite assessment of patients presenting to the Emergency Department (ED) with suspected cardiac problems. ECC implementation occurred in the context of the emergence of COVID-19. Evaluation of the impact of the ECC role focussed primarily on the time interval from triage to cardiology consult (TTCC). METHODS ED and Cardiology Department data were extracted from electronic medical records for the period 2 September 2019 to 1 March 2021. The TTCC for each presenting problem (chest pain, palpitations, shortness of breath, altered level of consciousness) was compared between patients seen by the ECC and those not seen on the days the ECC worked. The effect of COVID-19 on TTCC was assessed by an interrupted time series analysis. Data recorded by the ECC included patients seen and interventions provided. RESULTS The ECC saw 378 patients. Most presented with chest pain (269/378, 71.2%). The ECC determined that 68.8% (260/378) required a cardiac assessment. Following COVID-19 the median weekly TTCC increased by 0.029 hours (1.74 min) each week on average relative to that beforehand (p=0.008). For patients seen by the ECC the median TTCC was 2.07 hours (interquartile range [IQR]: 1.44, 3.16) compared to 2.58 hours (IQR: 1.73, 3.80; p=0.007) for patients not seen by the ECC. Chest pain (ECC: 1.94 hours; no ECC: 2.41 hours; p=0.06) and non-obvious cardiac presenting problems (ECC: 1.77 hours; no ECC 3.05 hours; p=0.004) displayed the largest reductions in TTCC when the ECC was involved. Presentations with palpitations, respiratory distress and altered level of consciousness had similar TTCCs. CONCLUSION The ECC role resulted in an overall decrease in TTCC despite the role coinciding with the emergence of COVID-19. In order to clarify the optimal strategy for the ECC role, further analyses involving patient risk factors and presenting problems along with a health economic evaluation of this model of care and the effect on patient outcomes will be required.
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Affiliation(s)
- Mark James Weaver
- Specialist Medical Services, Medicine, Gold Coast Health, Southport, Qld, Australia
| | - Desmond Mok
- Medicine, Gold Coast Health, Southport, Qld, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, Southport, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - H Laetitia Hattingh
- Office for Research Governance and Development, Gold Coast Health, Southport, Qld, Australia; School of Pharmacy and Medical Sciences, Griffith University, Southport, Qld, Australia.
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Li Z, Liu B, Li D, Jia Y, Ye L, Liao X, Zeng Z, Wan Z. Relationship between Braden Scale scores and acute kidney injury among patients with acute coronary syndrome: a multicentre retrospective cohort study. BMJ Open 2022; 12:e049102. [PMID: 34987039 PMCID: PMC8734026 DOI: 10.1136/bmjopen-2021-049102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the impact of pressure ulcer events assessed by the Braden Scale (BS) on acute kidney injury (AKI) in patients with acute coronary syndrome (ACS). DESIGN A multicentre retrospective cohort study. SETTING Chest pain centres from seven tertiary hospitals in China. PARTICIPANTS We analysed 3185 patients with ACS from the Retrospective Evaluation of Acute Chest Pain study. The patients were divided into three groups (B1, B2 and B3) according to their BS scores (≤12 vs 13-14 vs ≥15, respectively) at admission. OUTCOME MEASURES AKI was defined according to the criteria of the 2012 Kidney Disease: Improving Global Outcomes. Multivariate logistic analysis was used to evaluate the relationship between the BS score and AKI. RESULTS There were 461 patients (14.5%) with ACS who had the complication of AKI. Patients with a lower score on the BS had a higher incidence of AKI (p<0.001). Multivariate logistic regression analysis showed that adjusted ORs of the BS score for AKI were 2.242 (B1 vs B3: 95% CI: 1.643 to 3.060, p<0.001) and 1.566 (B2 vs B3: 95% CI: 1.186 to 2.069, p=0.002). The receiver operating characteristic curve analysis showed that the area under the curve of the BS score was 0.719 (95% CI: 0.702 to 0.736; p<0.001) for AKI. CONCLUSIONS The BS score was independently associated with AKI. It may be a useful tool to identify those who may benefit from further prediction and prevention of AKI in patients with ACS. TRAIL REGISTRATION NUMBER ChiCTR1900024657 (http://www.chictr.org.cn/). The satge rekates to results.
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Affiliation(s)
- Zhichao Li
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bofu Liu
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Ye
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Kes D, Ozduran B, Celik S, Cetin E. The effectiveness of short text messages on nurses' arrhythmia interpretation skills. Nurs Crit Care 2021; 28:362-369. [PMID: 34505332 DOI: 10.1111/nicc.12712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive care nurses play an important role in the management of critically ill patients including identification of cardiac arrhythmias. Interventions to improve arrhythmia identification can be expensive, time-consuming, and are not always successful. AIMS This study aimed to explore the effectiveness of using short message service (SMS) messaging to improve intensive care nurses' cardiac arrhythmia interpretation skills. DESIGN This study was a prospective, two-group, assessor-blinded, randomized controlled trial with a pretest-posttest experimental design. METHODS The study was conducted from February 2020 to February 2021 for the intervention as well as the control group, in a teaching hospital in northwest Turkey. The intervention group was sent the one-way SMS messages on cardiac arrhythmias via WhatsApp during an 8-week period, whereas the control group did not receive any intervention. The Cardiac arrhythmias assessment questionnaire (CAAQ) was used to measure outcomes. The data were analysed using ANCOVA and an independent t-test. RESULTS A total of 66 intensive care nurses were randomly assigned to either the intervention or the control group. The ANCOVA analysis indicated that ICU nurses who received SMS messages about cardiac arrhythmias two times a week had significantly increased CAAQ scores (P < 0.001) with a large effect size (partial eta-squared = 0.588). CONCLUSION This study concluded that using SMS messages as a training tool has a positive influence on cardiac arrhythmias interpretation skills among ICU nurses. RELEVANCE TO CLINICAL PRACTICE Using SMS messages could be an alternative, effective, and innovative approach to improve nurses' clinical practice skills.
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Affiliation(s)
- Duygu Kes
- Faculty of Health Sciences, Department of Nursing, Karabuk University, Demir-Celik Campus, Karabuk, Turkey
| | - Bahar Ozduran
- Cardiovascular Surgery Intensive Care Unit, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Sevim Celik
- Faculty of Health Sciences, Department of Nursing, Bartin University, Agdacı Campus, Bartın, Turkey
| | - Erdem Cetin
- Faculty of Medicine, Department of Cardiovascular Surgery, Karabuk University, Karabuk, Turkey
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Cramer H, Hughes J, Johnson R, Evans M, Deaton C, Timmis A, Hemingway H, Feder G, Featherstone K. 'Who does this patient belong to?' boundary work and the re/making of (NSTEMI) heart attack patients. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1404-1429. [PMID: 29956339 PMCID: PMC6282527 DOI: 10.1111/1467-9566.12778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This ethnography within ten English and Welsh hospitals explores the significance of boundary work and the impacts of this work on the quality of care experienced by heart attack patients who have suspected non-ST segment elevation myocardial infarction (NSTEMI) /non-ST elevation acute coronary syndrome. Beginning with the initial identification and prioritisation of patients, boundary work informed negotiations over responsibility for patients, their transfer and admission to different wards, and their access to specific domains in order to receive diagnostic tests and treatment. In order to navigate boundaries successfully and for their clinical needs to be more easily recognised by staff, a patient needed to become a stable boundary object. Ongoing uncertainty in fixing their clinical classification, was a key reason why many NSTEMI patients faltered as boundary objects. Viewing NSTEMI patients as boundary objects helps to articulate the critical and ongoing process of classification and categorisation in the creation and maintenance of boundary objects. We show the essential, but hidden, role of boundary actors in making and re-making patients into boundary objects. Physical location was critical and the parallel processes of exclusion and restriction of boundary object status can lead to marginalisation of some patients and inequalities of care (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
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Affiliation(s)
- Helen Cramer
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Jacki Hughes
- Centre for Trials ResearchCardiff UniversityCardiffUK
| | - Rachel Johnson
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Maggie Evans
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Christi Deaton
- Department of Public Health and Primary Care, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Adam Timmis
- Department of CardiologyBarts and The London NHS TrustLondonUK
| | - Harry Hemingway
- UCL PartnersFarr Institute of Health Informatics ResearchLondonUK
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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Abstract
The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study-based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient's clinical history and presenting characteristics.
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Affiliation(s)
- Rodel V Bobadilla
- Rodel Bobadilla has been practicing in an interventional cardiology practice for the past 14 years and is an adjunct assistant professor with the South Carolina College of Pharmacy, Columbia, South Carolina.
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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Deaton C, Johnson R, Evans M, Timmis A, Zaman J, Hemingway H, Hughes J, Feder G, Cramer H. Aligning the planets: The role of nurses in the care of patients with non-ST elevation myocardial infarction. Nurs Open 2016; 4:49-56. [PMID: 28078099 PMCID: PMC5221466 DOI: 10.1002/nop2.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/30/2016] [Indexed: 01/15/2023] Open
Abstract
Background Studies have shown variation in care for patients with non‐ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care. Aim The aim of this study was to describe the roles and responsibilities of specialist and advanced practice nurses in providing care for patients with NSTEMI. Methods Secondary analysis of observational field notes and interviews from an ethnographic study of variation in care for NSTEMI patients in 10 UK hospitals conducted 2011–2012. Data were thematically analysed to identify key concepts and themes related to the roles of specialist nurses. Results Seven of 10 hospitals had roles for specialist nurses in NSTEMI care. The major theme related to high demand and the complexity of patients and organizations (‘Aligning the planets’). In this theme, nurses contributed to improving services or compensating for deficiencies (‘Making the system work versus making up for the system’). Data collection for audit could take precedence over time with patients (‘Paying worship to the paper’). Nurses expressed a sense of ownership of cardiovascular patients that drove their desire to provide quality of care (‘They are our patients’).
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Affiliation(s)
- Christi Deaton
- Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine, and Cambridge Biomedical Research Centre Cambridge UK
| | - Rachel Johnson
- Centre for Academic Primary Care School of Social and Community Medicine University of Bristol Bristol UK
| | - Maggie Evans
- Centre for Academic Primary Care School of Social and Community Medicine University of Bristol Bristol UK
| | - Adam Timmis
- Barts NIHR Biomedical Research Unit Queen Mary University of London London Chest Hospital London UK
| | - Justin Zaman
- Department of Emergency Medicine James Paget University Hospital Gorleston-on-Sea Norfolk; Department of Medicine University of East Anglia Norwich UK
| | - Harry Hemingway
- Department of Epidemiology and Public Health Clinical Epidemiology Group University College London London UK
| | | | - Gene Feder
- Centre for Academic Primary Care School of Social and Community Medicine University of Bristol Bristol UK
| | - Helen Cramer
- Centre for Academic Primary Care School of Social and Community Medicine University of Bristol Bristol UK
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Loreto L, Andrea T, Lucia D, Carla L, Cristina P, Silvio R. Accuracy of EASI 12-lead ECGs in monitoring ST-segment and J-point by nurses in the Coronary Care Units. J Clin Nurs 2016; 25:1282-91. [DOI: 10.1111/jocn.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lancia Loreto
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | | | - Dignani Lucia
- Nursing Science; University of L'Aquila; L'Aquila Italy
| | | | - Petrucci Cristina
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | - Romano Silvio
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
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Carlton EW, Khattab A, Greaves K. Beyond triage: the diagnostic accuracy of emergency department nursing staff risk assessment in patients with suspected acute coronary syndromes. Emerg Med J 2015; 33:99-104. [DOI: 10.1136/emermed-2015-204780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/17/2015] [Indexed: 11/04/2022]
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Andersson EK, Sjöström-Strand A, Willman A, Borglin G. Registered nurses views of caring in coronary care--a deductive and inductive content analysis. J Clin Nurs 2015; 24:3481-93. [PMID: 26335244 DOI: 10.1111/jocn.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case. BACKGROUND Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic--particularly in the context of coronary care--is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses. DESIGN Qualitative descriptive study. METHODS Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis. RESULTS The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it. CONCLUSION Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences. RELEVANCE TO CLINICAL PRACTICE To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.
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Affiliation(s)
- Ewa K Andersson
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Ania Willman
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.,Department of Care Science, Malmö University, Malmö, Sweden
| | - Gunilla Borglin
- Department of Care Science, Malmö University, Malmö, Sweden.,Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden
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Hendriks JM, Crijns HJ, Vrijhoef HJ. Integrated Chronic Care Management For Patients With Atrial Fibrillation - A Rationale For Redesigning Atrial Fibrillation Care. J Atr Fibrillation 2015; 7:1177. [PMID: 27957148 DOI: 10.4022/jafib.1177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 01/18/2023]
Abstract
Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with underlying (cardio)vascular disease. Due to this the management of AF is often complex and current practice calls for a more comprehensive, multifactorial and patient-centred approach. Therefore an Integrated Chronic Care approach in AF was developed and implemented in terms of a nurse-led specialized outpatient clinic for patients with AF. A randomised controlled trial comparing the nurse-led approach with usual care demonstrated superiority in terms of cardiovascular hospitalization and death as well as cost-effectiveness in terms of Quality Adjusted Life Years (QALYs) and life years, in favour of the nurse-led approach. Implementing such approach can be difficult since daily practice can be persistent. To highlight the importance of integrated care wherein the nurse fulfils a significant role, and to provide a guide in developing and continuing such approach, this paper presents the theoretical framework of the AF-Clinic based on the principles of the Taxonomy for Integrated Chronic Atrial Fibrillation Management.
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Affiliation(s)
- Jeroen Ml Hendriks
- Maastricht University Medical Centre, Maastricht, The Netherlands; Linköping University, Linköping, Sweden
| | - Harry Jgm Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hubertus Jm Vrijhoef
- Maastricht University Medical Centre, Maastricht, The Netherlands; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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Pettersen TR, Fålun N, Norekvål TM. Improvement of in-hospital telemetry monitoring in coronary care units: an intervention study for achieving optimal electrode placement and attachment, hygiene and delivery of critical information to patients. Eur J Cardiovasc Nurs 2013; 13:515-23. [PMID: 24304659 DOI: 10.1177/1474515113515585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-hospital telemetry monitoring is important for diagnosis and treatment of patients at risk of developing life-threatening arrhythmias. It is widely used in critical and non-critical care wards. Nurses are responsible for correct electrode placement, thus ensuring optimal quality of the monitoring. The aims of this study were to determine whether a complex educational intervention improves (a) optimal electrode placement, (b) hygiene, and (c) delivery of critical information to patients (reason for monitoring, limitations in cellular phone use, and not to leave the ward without informing a member of staff). METHODS A prospective interventional study design was used, with data collection occurring over two six-week periods: before implementation of the intervention (n=201) and after the intervention (n=165). Standard abstraction forms were used to obtain data on patients' clinical characteristics, and 10 variables related to electrode placement and attachment, hygiene and delivery of critical information. RESULTS At pre-intervention registration, 26% of the electrodes were misplaced. Twelve per cent of the patients received information about limiting their cellular phone use while monitored, 70% were informed of the purpose of monitoring, and 71% used a protective cover for their unit. Post-intervention, outcome measures for the three variables improved significantly: use of protective cover (p<0.001), information about the purpose of monitoring (p=0.005) and information about limitations in cellular phone use (p=0.003). Nonetheless, 23% of the electrodes were still misplaced. CONCLUSION The study highlights the need for better, continued education for in-hospital telemetry monitoring in coronary care units, and other units that monitor patients with telemetry.
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Affiliation(s)
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Norway Institute of Nursing, Bergen University College, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Norway Department of Clinical Science, University of Bergen, Norway
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