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Levelink M, Brütt AL. [Healthcare quality and safety in left ventricular assist device therapy from the patient perspective: A qualitative study on relevant aspects of care]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024:S1865-9217(24)00118-1. [PMID: 39138073 DOI: 10.1016/j.zefq.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/29/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Implantation of a left ventricular assist device (LVAD) requires extensive aftercare. It is largely unclear how aftercare should be designed from the patients' perspective. Implications can be developed based on an examination of the healthcare context. Its main components are mapped on five tiers in the Human Factors of Home Health Care Model by Henriksen, Joseph, and Zayas-Caban (2009). Using this model, the present study explores the patient perspective on the context of healthcare after an LVAD implantation. METHODS We employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers. RESULTS We interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.g., self-management skills), 3 on caregiver characteristics (e.g., professionalism), 11 healthcare-related tasks and requirements (e.g., wound management), 8 on factors of the physical environment (e.g., controllability), medical devices and technologies (e.g., carrying systems for external components), and cultural, social and community environment (e.g., interaction with peers), as well as 3 on external environmental factors (e.g., healthcare infrastructure). DISCUSSION The present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients' own initiative and the personal care provided by the VAD outpatient clinics. CONCLUSION Three key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.
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Affiliation(s)
- Michael Levelink
- Carl von Ossietzky Universität Oldenburg, Fakultät VI, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Oldenburg, Deutschland.
| | - Anna Levke Brütt
- Carl von Ossietzky Universität Oldenburg, Fakultät VI, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Oldenburg, Deutschland; Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, Hamburg, Deutschland.
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Celikturk Doruker N, Demir Korkmaz F. Investigation of burnout and quality of work life of cardiac surgery nurses: A cross-sectional study. Nurs Crit Care 2024. [PMID: 39004602 DOI: 10.1111/nicc.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/07/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The care processes of cardiac surgery patients are difficult, complex and stressful. Nurses, who have an important role in the care of these patients, may experience burnout or poor quality of work life may be affected because of difficult care processes, and professional difficulties. AIM This study analysed burnout and quality of work life in cardiac surgery nurses. STUDY DESIGN This cross-sectional study was conducted with 68 nurses in the clinic and intensive care unit of a university hospital's cardiovascular surgery department. Clinical nurses care for inpatients in this department, while intensive care nurses care for patients in the intensive care unit. The 'Sociodemographic and Descriptive Characteristics of Nurses Form', 'Maslach Burnout Inventory' and 'Nursing Work Quality of Life Scale' were used to collect the data. RESULTS The mean score of emotional exhaustion sub-dimension of Maslach Burnout Inventory was 15.25 ± 5.08 (min: 7, max: 27), the mean score of the personal accomplishment sub-dimension was 17.48 ± 4.90 (min: 8, max: 27), and the mean score of depersonalization sub-dimension was 5.60 ± 2.70 (min: 0, max: 13). The mean scores of the emotional exhaustion sub-dimension (t: -2.380, p: .020, risk ratio [RR]: 1.67, confidence interval [CI]: [14.21, 18.82]) and the personal accomplishment sub-dimension (t: -2.604, p: .011, RR: 1.00, CI: [16.08, 19.92]) were higher in intensive care nurses. The mean total score of the nursing quality of work life scale was 107.20 ± 14.60 (min: 72, max: 149). A negative statistically significant relationship was found between the mean scores of emotional exhaustion (r: -0.243, p: .045) and depersonalization sub-dimension (r: -0.325, p: .007) of the Maslach Burnout Scale and the mean total score of the nursing quality of work life scale. CONCLUSION In this study, it can be said that cardiac surgery nurses had moderate levels of emotional burnout, personal accomplishment and quality of work life, and low levels of depersonalization. At the same time, it can be seen that intensive care nurses have higher levels of emotional burnout. The increased emotional burnout and depersonalization in nurses decreased the quality of work life. RELEVANCE TO CLINICAL PRACTICE This study provided an understanding of burnout and quality of work life of cardiac surgery nurses. Strategies can be developed to reduce burnout and improve the quality of the work life of cardiac surgery nurses. Particular attention should be paid to intensive care nurses who experience more burnout on several sub-dimensions. This may be a good approach to improving the quality of patient care.
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El Zein S, Fawaz M, Al-Shloul MN, Rayan A, ALBashtawy MS, Khader IA, Jallad M, Al-Kharabsheh M, ALBashtawy S, Alshloul DM. Perceptions of Bedside Nurses Caring for Patients with Left Ventricular Assist Devices (LVAD): A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241252249. [PMID: 38746075 PMCID: PMC11092549 DOI: 10.1177/23779608241252249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/17/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Bedside nurses in the intensive care units are exposed to multiple challenges in their regular practice and recently have taken in ventricular assist device care in Lebanon since its introduction as a fairly new practice. Objectives To explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD). Methods This study employed a qualitative phenomenological research design, where semi-structured interviews were carried out among fifteen LVAD nurses in an acute care hospital. Results The qualitative data analysis produced six main themes. The first theme prevalent was "LVAD incompetence and shortage" and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, "Patient and family knowledge", which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by "Burden of complications", "LVAD patient selection", "Perception of the LVAD team as invulnerable", and "High workload and patient frailty" which reflected the perspectives of LVAD nurses. Conclusion This study shows that the Lebanese LVAD nurses who participated in this study perceived inadequate competence, yet lacked proper training and induction. The nurses reported multiple challenges relating to care tasks, workload, and patient and family interactions which need to be addressed by coordinators.
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Affiliation(s)
- Sara El Zein
- MSN Student, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mirna Fawaz
- Assistant professor, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mohammad N. Al-Shloul
- Associated Professor, Applied Medical Sciences Department, Al-Balqa' Applied University, Prince Al Hussein Bin Abdduallah II Academy for Civil Protection, Amman, Jordan
| | - Ahmad Rayan
- Associate professor, Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Mohammed S ALBashtawy
- Professor, Department of Community and Mental Health, Princess Salma Faculty of Nursing, AL Al-Bayt University, Mafraq, Jordan
| | - Imad Abu Khader
- Assistance Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Mohammed Jallad
- Associate Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Muna Al-Kharabsheh
- Assistance Professor, Nursing College, Al-Balqa Applied University, Salt, Jordan
| | | | - Doha M. Alshloul
- Internship Medicine Student, Ministry of Health, Princess Basma Teaching Hospital/Irbid, Irbid, Jordan
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Lewis KB, Harkness K, Hummel A, Leung J, MacIver J. The relational dynamics of caregivers of patients with a left ventricular assist device for destination-therapy: A qualitative investigation. Heart Lung 2021; 50:375-381. [PMID: 33621834 DOI: 10.1016/j.hrtlng.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Caregivers are critical to the recovery and management of patients with destination-therapy left ventricular assist devices (DT-LVADs). OBJECTIVE To explore the needs and impacts of caregiving for patients with DT-LVAD relative to the various relationships caregivers navigate from the shared perspectives of patients, caregivers, and healthcare providers. METHODS Qualitative descriptive secondary analysis. Patients with a DT-LVAD (n = 3), caregivers (n = 2), and healthcare providers (n = 13) from all DT-LVAD programs in Ontario, Canada were invited to participate in semi-structured interviews. We used thematic analysis to identify, analyze, organize, describe, and report caregiver-related themes. RESULTS Eighteen participants were interviewed. The needs and impact of caregiving for patients with DT-LVADs were characterized by connection with others (relational), and drastic and ongoing changes from normalcy within established and new relationships (dynamics). CONCLUSIONS DT-LVAD caregivers' unique needs may be a result of multi-leveled and compounding relational dynamics within and across established and new relationships. These could be considered to inform the content of targeted support strategies.
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Affiliation(s)
- Krystina B Lewis
- Assistant Professor, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5 Canada; Affiliate Researcher, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 Canada,.
| | - Karen Harkness
- Clinical Strategist, CorHealth Ontario, 4100 Yonge Street, Toronto, M2P 2B5 Canada; Assistant Clinical Professor, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8 Canada
| | - Amanda Hummel
- Masters' Student, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5 Canada
| | - Jennifer Leung
- Clinical Specialist, CorHealth Ontario, 4100 Yonge Street, Toronto, M2P 2B5 Canada
| | - Jane MacIver
- Scientist Ted Rogers Center for Heart Research and Peter Munk Cardiac Center, University, Health Network, 585 University Avenue, Toronto, M5G 2N2 Canada; Adjunct Lecturer Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1 Canada
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Combs P, Schroeder S, Meehan K, Dubyk N, Stewart S, Casida J. Competence, challenges and attitudes of bedside nurses caring for patients with left ventricular assist devices. Intensive Crit Care Nurs 2020; 63:103002. [PMID: 33358599 DOI: 10.1016/j.iccn.2020.103002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We aimed to describe the bedside registered nurses perceived competence, attitudes, and challenges surrounding the management of patients with left ventricular assist devices (LVAD) in the intensive care unit (ICU) and stepdown unit (SDU). RESEARCH METHODOLOGY/DESIGN An exploratory research was employed using a survey. SETTING Bedside participants were recruited via an electronic recruitment flyer circulated in online professional and social networking sites. MAIN OUTCOME MEASURES Items consisted of a numeric rating scale, measuring competence and attitudes related to the management of patients with left ventricular assist devices. The one open-ended question asked the participants to write responses regarding challenges in left ventricular assist device care. Data were analysed using quantitative and qualitative analytics software. RESULTS A total of 36 intensive care unit and 35 stepdown unit bedside nurse (n = 71) from six regions of the United States responded. Overall mean scores for competency and attitude domains were ≥ 7.0. Intensive care nurses scored higher in competence and attitude when compared to stepdown unit nurses care of short-term left ventricular assist devices. Competence and attitude were positively associated with years of experience. Five themes related to challenges in care were identified. CONCLUSION Overall, bedside nurses had satisfactory competence and attitudes surrounding the care of hospitalised left ventricular assist device patients.
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Affiliation(s)
- P Combs
- Department of Cardiac Surgery, University of Chicago, 5841 S. Maryland Avenue, Suite E500, Chicago, IL 60637, USA.
| | - S Schroeder
- Department of Cardiology, Bryan Heart, 1600 S. 48th St., Lincoln, NE 68506, USA.
| | - K Meehan
- Department of Cardiac Surgery, University of Chicago, 5841 S. Maryland Avenue, Suite E500, Chicago, IL 60637, USA.
| | - N Dubyk
- Mazankowski Heart Institute, Edmonton, 112 St., Edmonton, Alberta T6G 2B7, Canada.
| | - S Stewart
- Hackensack, University Medical Center, 20 Prospect Avenue, Suite 201, Hackensack, NJ 07601, USA.
| | - J Casida
- Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, USA.
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What Really Matters? Understanding Quality of Life Determinants Impacting Ventricular Assist Device Stakeholders. ASAIO J 2020; 66:626-636. [DOI: 10.1097/mat.0000000000001175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Nursing Challenges in Interactions With Patients Receiving Mechanical Circulatory and Respiratory Support. J Cardiovasc Nurs 2019; 33:E10-E15. [PMID: 29727375 DOI: 10.1097/jcn.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mechanical circulatory and respiratory support (MCRS) systems provide short- to long-term life support for patients with severe cardiac or respiratory failure. Whereas the challenges of patients with these lifesaving systems are well understood, the challenges faced by nurses of patients receiving MCRS remain relatively unidentified. OBJECTIVES In this study, we investigated the challenges and experiences of MCRS nurses, with the aim of informing the design of future interventions. DESIGN A qualitative approach was taken to develop an in-depth understanding of the emotional issues nurses experience in their daily interactions with patients. PARTICIPANTS AND SETTING Nine MCRS nurses ranging in clinical experience were recruited from Australian hospitals. METHODS Participants were divided into 3 focus groups, with design prompts being used in the focus groups to facilitate discussion. Data from these focus groups were analyzed through a thematic analysis protocol. RESULTS The nurses' accounts were clustered around 2 themes, including (1) patient connection and (2) compassion vitality and fatigue. Each theme elicits a conflicting compromise that MCRS nurses face daily. CONCLUSION The challenges of nurses who support patients with MCRS are complex, multifaceted, emotionally stimulating, and exhausting. We therefore contributes a set of design criteria to support such nurses, setting a direction for future research.
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Nurses' Competence Caring for Hospitalized Patients With Ventricular Assist Devices. Dimens Crit Care Nurs 2019; 38:38-49. [PMID: 30499791 DOI: 10.1097/dcc.0000000000000332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nursing care is an essential component of the delivery of high-quality patient care for advanced heart failure patients with ventricular assist devices (VADs). However, there is little information about how VAD patient care competence is formed, and there are no empirical data regarding the bed nurses' competence. OBJECTIVES The aim of this study was to explain how nurses perceived their competence related to VAD technology and how they utilized resources to equip themselves for the management of patients with implantable VADs. METHODS An exploratory correlational research design was used in this study. Online surveys including demographic and work characteristics questionnaires as well as VAD Innovation in Nursing Appraisal Scale (knowledge, adoption, and communication) were completed by 237 critical-care unit and progressive care unit (PCU) nurses. RESULTS Ventricular assist device knowledge, adoption, and communication of innovation mean scores were 3.9 ± 0.6, 3.9 ± 0.8, and 3.7 ± 0.9, respectively, indicating moderate/high levels. Critical-care unit nurses reported higher levels of knowledge (3.7 vs 3.6) and adoption (4.0 vs 3.8; P < .05) of innovation than did the PCU nurses, with no differences in communication. Compared with PCU nurses, critical-care unit nurses were more likely to seek VAD competence-related information using mass media. Innovation and adoption were associated with years of nursing experience and some hospital characteristics. CONCLUSION Critical-care unit nurses have higher self-reported VAD care competence than PCU nurses. Further research is needed to confirm the findings and link nurse competence with VAD patient outcomes.
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Cestari VRF, Pessoa VLMDP, Moreira TMM, Florêncio RS, Barbosa IV, Ribeiro SB. DISPOSITIVOS DE ASSISTÊNCIA VENTRICULAR E CUIDADOS DE ENFERMAGEM. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017000980016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: descrever o funcionamento, os benefícios e as complicações associadas ao uso de dispositivos de assistência ventricular e identificar as intervenções realizadas por enfermeiros no cuidado ao paciente com este dispositivo, de acordo com as evidências. Método: revisão integrativa, com artigos coletados em bases de dados da saúde, em fevereiro de 2015. Os descritores utilizados foram heart diseases, heart-assist devices e nursing. Identificaram-se 34 artigos, os quais foram submetidos à análise temática. Resultados: os dispositivos de assistência ventricular funcionam como bombas mecânicas promotoras de débito cardíaco adequado. Seu principal benefício é a estabilização hemodinâmica. A complicação mais comum é a infecção. Educação em saúde, suporte emocional, cuidados com sítio de saída e realização de curativo são os principais cuidados realizados por enfermeiros. Conclusão: as evidências comprovam a melhoria da sobrevida de pacientes com insuficiência cardíaca grave com o uso dos dispositivos de assistência ventricular, reiterando a importância da ampliação dessa tecnologia no Brasil como possibilidade de tratamento.
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Burns T, Fernandez R, Stephens M. The experience of waiting for a kidney transplant: A qualitative study. J Ren Care 2017. [DOI: 10.1111/jorc.12209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Ritin Fernandez
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
- Centre for Research in Nursing and Health; St George Hospital; Kogarah NSW Australia
| | - Moira Stephens
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
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Avery LJ, Szwajcer A, Zieroth S, Temple B, Sawatzky JAV. Caregiver experiences of providing care to adult individuals living with a left ventricular assist device: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2016; 14:44-54. [PMID: 26878919 DOI: 10.11124/jbisrir-2016-2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lorraine J Avery
- 1. WRHA Cardiac Sciences Program, College of Nursing, Faculty of Health Sciences, University of Manitoba, Canada2. University of Manitoba Libraries, Canada3. WRHA Cardiac Sciences Program, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada4. College of Nursing, Faculty of Health Sciences, University of Manitoba, Canada
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