European Journal of Cardiovascular Nursing

Background: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively.

Aim: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented.

Methods: MEDLINE and CINAHL databases were searched from 1989 to July 2004.

Findings: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45–82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness.

Conclusion: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

Background: Heart failure is an escalating health problem around the world. Despite significant scientific advances, heart failure patients experience multiple physical and psychological symptoms that can impact the quality of life.

Aims: To determine the (1) symptom prevalence, severity, distress and symptom burden in patients with heart failure; (2) impact of age and gender on symptom prevalence, severity, distress and symptom burden; and (3) impact of symptom prevalence and symptom burden on health-related quality of life (HRQOL) in patients with heart failure.

Methods: A convenience sample of 53 heart failure patients participated in this descriptive, cross-sectional design. Symptoms and HRQOL were measured using the Memorial Symptom Assessment Scale—Heart Failure and the Minnesota Living with Heart Failure Questionnaire.

Results: Patients experienced a mean of 15.1 ± 8.0 symptoms. Shortness of breath and lack of energy were the most prevalent. Difficulty sleeping was the most burdensome symptom. Lower age, worse functional status, total symptom prevalence and total symptom burden predicted 67% of the variance in HRQOL.

Conclusion: Patients with heart failure experience a high level of symptoms and symptom burden. Nurses should target interventions to decrease frequency, severity, distress and overall symptom burden and improve HRQOL.

Background: Critical care nurses caring for cardiac patients in the immediate postoperative period continually make decisions about the implications and treatment of their patients' haemodynamic status.

Aim: The aim of this study was to describe the haemodynamic status of patients on admission to critical care and over the 2-h period following cardiac surgery.

Methods: A quantitative, descriptive design was used. Data were collected using non-participant observation and an observation tool. The sample consisted of 38 patients.

Results: Analysis of data revealed the dynamic nature of the haemodynamic status of postoperative cardiac patients. On admission, 60% of patients (n = 23) were haemodynamically unstable. The instability in these patients (n = 23) was due to hypotension (34%), bleeding (21%) and hypoxaemia (18%). During the 2-h recovery period, 55% of patients were hypotensive, 16% of patients had low cardiac output syndrome and 16% of patients had low systemic vascular resistance (SVR) syndrome. Twenty-one percent of patients experienced bleeding complications. Shivering was a clinically significant problem in terms of occurrence (23%) and duration (X = 45, S.D. = 30 min). Twenty-nine percent of patients (n = 11) had a profound deterioration in haemodynamic status, necessitating urgent interventions.

Conclusion: Haemodynamic parameters indicate that 95% of patients in this study were haemodynamically unstable at some time during the initial 2-h recovery period. These findings inform resourcing decisions by organisations and have implications for nurses' assessment and interventional haemodynamic decision making.

Background: Self-efficacy is a person's confidence in being able to successfully perform a specific activity or behavior. Self-efficacy has been shown to influence exercise capacity in patients post myocardial infarction, but has not been fully explored in patients with heart failure (HF). This study examined the impact of performance of a single treadmill exercise test and participation in a 3-month program of walking and resistance exercise on self-efficacy in HF patients.

Methods: 24 patients were randomized to either a home-based walking and resistance exercise program or usual care for 3 months. Prior to enrollment into the exercise program all participants performed a single treadmill exercise test with respiratory gas analysis. Self-efficacy questionnaires were completed at 3 time points, 1) prior to performance of an exercise treadmill test; 2) immediately after completing an exercise test; and 3) at the end of a 3-month exercise program.

Results: Self-efficacy for walking (p = 0.07), climbing (p = 0.17), lifting (p = 0.73) and general activity (p = 0.15) did not improve after performance of a single treadmill exercise test and usual care. However, self-efficacy for walking increased after 3 months of a walking and resistance exercise program. (p = 0.04).

Conclusions: The findings from this study suggest that in patients with stable mild to moderate heart failure, self-efficacy is improved with participation in a home-based walking and endurance exercise program. Self-efficacy is not enhanced by performance of a single treadmill exercise test and usual care.

Background: Cardiac nurses instruct women to wear a brassiere (bra) after a sternotomy for cardiac surgery to reduce lateral tension on the wound. However this practice is rarely implemented because regular bras impede nursing care in the immediate postoperative period. The Cardibra was developed to address the inadequacies of the regular bra and provide an alternate method of breast support.

Aim: To develop a purpose designed support bra (the Cardibra) and evaluate its effectiveness on sternal wound healing and the reduction of pain for women who had a sternotomy for cardiac surgery.

Methods: The study consisted of two stages. Stage 1 described the development of the Cardibra. Stage 2 was a pilot study of a clinical trial, prospective, randomised two-group design. The treatment group consisted of 10 women using the Cardibra immediately following surgery and the control group of 10 who wore a regular bra 3 days post surgery. Repeated measures at six time points assessed pain levels and wound healing.

Results: This study indicated that the Cardibra might have beneficial therapeutic effects on pain levels and wound healing up to day 14 after cardiac surgery.

Conclusion: This innovative device may offer therapeutic benefits to women following cardiac surgery.

Background: The clinical presentation of chest pain is a major problem for primary health care professionals. Rapid access chest pain clinics (RACPC) enable quick assessment, investigation and formation of a treatment plan for such patients without a waiting list. There has been a chest pain clinic in operation at Harefield Hospital since 1988. Until 2001, the cardiology registrars were responsible for the clinic. Beginning in January 2001, the management of the clinic was taken over by the Cardiology Nurse Consultant. This paper will describe the organisation and outcomes of the first 3 years of this nurse-run RACPC.

Process: Patients are seen within 2 weeks of referral in line with the National Service Framework for Coronary Heart Disease [Department of Health. National service framework for coronary heart disease. Dept of Health; 2000. London.]. An electrocardiogram (ECG) is recorded on arrival in the clinic and the Nurse Consultant then examines the patients and decides if further investigation is required.

Analysis of Results: Four hundred and fifty-four patients were seen in the clinic from January 2001–December 2003. Three hundred and twenty-four patients (71.4%) underwent exercise testing of which 54 (16.7%) had a positive result. One hundred and thirteen patients (24.9%) were referred for angiography. Of these, 75 (66.4%) had coronary heart disease. Thirty-three patients (29.2%) have undergone percutaneous coronary intervention (PCI) and 19 (16.8%) have required coronary artery bypass grafting (CABG). Twenty-three patients (20.4%) are being treated medically. Satisfaction with the service offered by the clinic was high, evidenced by the results of questionnaires sent to patients.

Conclusion: This paper demonstrates that nurses can successfully run RACPCs without an increased risk of incorrect diagnosis. These clinics offer patients timely access to assessment of their chest pain and facilitate early diagnosis of cardiac disease. They are also well accepted by the patients attending the clinic.

Background: Invasive coronary procedures are increasing in number and complexity over time. This trend translates in an increased need for economical and human resources, among which is nurse staffing the most affected.

Aims: To identify possible predictors of nurse workload, during and after diagnostic and interventional procedures.

Methods: Two hundred and sixty consecutive patients were included: 52 and 208 patients underwent femoral and radial access, respectively. Nurse workload was calculated with a self-developed model.

Results: Cathlab nurse workload was 103 [63–156] min. Independent predictors of increased Cathlab nurse workload were: femoral access, failed radial access and cross-over, interventional procedures, procedural time, urgent procedures. Cathlab nurse workload was 174 [134–218] and 86 [58–126] min, for femoral and radial access, respectively (p < 0.001).

Among the overall population, 174/260 patients (44 females, mean age 66 ± 11 years) were hospitalised at our Center after the procedure. Fifty-six and 118 patients had femoral and radial access, respectively.

Ward nurse workload was 457 [226–954] min. Independent predictors of increased Ward nurse workload were: access-site complication, length of in-hospital stay, admission to CCU, interventional procedures. Ward nurse workload was 386 [226–652] and 720 [314–1375] min, respectively for radial and femoral access (p < 0.001).

Conclusions: A systematic radial access is an effective strategy for reducing nurse workload, both during, by simplifying nurse tasks in the CathLab, and after coronary invasive procedures, by preventing access-site complications, shortening in-hospital stays, and reducing admissions to CCU.

Background: Numerous studies have investigated patient outcomes of cardiac surgery, including some examining health-related quality of life. While these studies have provided some insight into patients' physical function, social abilities and perceived quality of life, studies examining the experiences of individuals recovering from cardiac surgery have received only limited investigation.

Aims: This paper presents a thematic analysis of interviews conducted with patients recovering from cardiothoracic surgery, about their memories and experiences of hospital and recovery post-hospital discharge.

Methods: Using an exploratory qualitative approach, eight participants were interviewed 6 months following their surgery. Transcripts of interviews were examined using a content analysis approach, with open coding of text and categorising of similar concepts into themes.

Findings: Participants reported varying degrees of pain and physical dysfunction during their recovery from surgery and some had still not returned to optimal function. Seven themes emerged from the data: impressions of ICU; comfort/discomfort; being sick/getting better; companionship/isolation; hope/hopelessness; acceptance/apprehension; and life changes. A number of the themes were constructed as a continuum, with participants often demonstrating a range of views or experiences. Many had little or no memory of their stay in the intensive care unit, although others had vivid recollections. Their impressions of hospital were mostly positive, although many experienced fear, apprehension, and mood disturbances at some time during their recovery. Most participants recalled being sick, reaching a turning point, and then getting better. Many participants reported a change in life view since their recovery from surgery.

Conclusions: Attention to specific areas of patient orientation, education and support was identified to facilitate realistic expectations of recovery. In addition, some form of systematic follow-up that focuses on patient recovery in terms of both physical and psychological function is important.

The results of research using a narrative analysis provide new clinical knowledge, but the methods used are unknown to many readers. In this paper we present an example of how an analysis may be performed in practice. The purpose of the interpretation of this specific story was to develop clinical knowledge of how it is to live with chronic heart failure from a daily life perspective. The steps in the interpretation process, within the framework of Paul Ricoeur's Interpretation theory, were: (1) general or naïve reading, (2) distancing, (3) examination of discourse, (4) conjectures and questions, and (5) reflection over the whole. The demonstrated interpretation of the interview resulted in a theme called: “Struggling to comprehend medical information”. This systematic way of working with narratives makes implicit assumptions about the relationship between meaning and language explicit. These themes can be used in everyday practice as clinical tools. Because of the interpretative nature of human understanding the experienced health professional will be capable of integrating evidence-based research findings and individual illness experience.