Nursing Patients with Ventricular Assist Devices: An Interpretive Description

[Healthcare quality and safety in left ventricular assist device therapy from the patient perspective: A qualitative study on relevant aspects of care]

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.

Investigation of burnout and quality of work life of cardiac surgery nurses: A cross-sectional study

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.

Perceptions of Bedside Nurses Caring for Patients with Left Ventricular Assist Devices (LVAD): A Qualitative Study

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.

The relational dynamics of caregivers of patients with a left ventricular assist device for destination-therapy: A qualitative investigation

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.

Competence, challenges and attitudes of bedside nurses caring for patients with left ventricular assist devices

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.

Nursing Challenges in Interactions With Patients Receiving Mechanical Circulatory and Respiratory Support

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.

Nurses' Competence Caring for Hospitalized Patients With Ventricular Assist Devices

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.

DISPOSITIVOS DE ASSISTÊNCIA VENTRICULAR E CUIDADOS DE ENFERMAGEM

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.