Search

There is an escalating prevalence of heart failure (HF) with high mortality. Compared with other races, African Americans face a higher incidence of HF at earlier age of onset, with more rapid progression, and with increased family care burden and greater care costs and disparity in health care services at the end of life (EOL). Concomitant out-of-pocket HF costs and care demands indicate the need for early discussion of palliative and EOL care needs. We therefore developed and pilot tested a culturally sensitive intervention specific to the needs of African American HF patients and their families at the EOL. Our pilot study findings encompass patient and caregiver perspectives and align with the state of EOL science. The ultimate long-term goal of this intervention strategy is to translate into practice the preferred, culturally sensitive, and most cost-efficient EOL care recommendations for HF patients and families. [ABSTRACT FROM AUTHOR]

Patients presenting with pulmonary arterial hypertension (PAH), the rarest of the groups of pulmonary hypertension diagnoses, are infrequently seen in the critical care arena. However, when patients with PAH present in the intensive care unit, it is generally related to an exhaustion of treatments. This article focuses on the current state of the literature addressing the group designation, pathophysiology, symptom expression, and treatment modalities of the patient with PAH. [ABSTRACT FROM AUTHOR]

Background: The Self-management and Care of Heart Failure through Group Clinics Trial evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high-risk heart failure (HF) patients. Objective: The purpose of this article is to (1) describe key Self-management and Care of Heart Failure through Group Clinics Trial group clinic interactive learning strategies, (2) describe resources and materials used in the group clinic appointment, and (3) present results supporting this patient-centered group intervention. Methods: This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients' (1) group clinic session evaluations, (2) HF self-care behaviors skills, (3) HF-related discouragement and quality of life scores, and (4) HF-related reshopitalizations during the 12-month follow-up. Also, the costs of delivery of the group clinical appointments were tabulated. Results: Overall, patients rated group appointments as 4.8 of 5 on the "helpfulness" in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio, 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ²1 = 3.9, P = .04). The total cost for implementing 5 group appointments was $243.58 per patient. Conclusion: The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF-related hospitalizations. [ABSTRACT FROM AUTHOR]

This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death.HF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21-0.98; P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7-4.1).Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00439842. [ABSTRACT FROM AUTHOR]

The article discusses several types of technology and electronic health assistance that support family caregivers and caregiving in the U.S. It includes information on assistive medical devices, telecare devices, computer-based services, smart homes with sensors and robotic assistants and the assistance they offer to the elderly and their caregivers.

The purpose of this article is to provide a blueprint for nursing programs to create or modify baccalaureate critical care courses. The benefits of providing a critical care course include offering students an in-depth experience in a specialty area, reinforcing previously learned medical-surgical content, and improving students' critical thinking skills. In addition, hospitals are given the opportunity to interact with students while also recruiting them into a high-demand area. [ABSTRACT FROM AUTHOR]

A clinically relevant model, grounded in nursing theory, has evolved to become a midrange theory. This article describes the processes used to derive, validate, revise, and test the Caregiving Effectiveness Model. Testing of this midrange theory used prospective longitudinal research with family members caring for patients requiring lifelong, complex, technology-based home care. It presents the conceptual critiques and statistical procedures and discusses derivation of model-generated nursing interventions and implications for use of these validation processes in developing nursing knowledge. The article summarizes limitations of the model and presents recommendations for future research. [ABSTRACT FROM AUTHOR]

Discusses guidelines to be followed in cardiac assessment by nurses. Symptoms of the disease; Relationship between myocardial infarction and arrhythmias; Analysis of patient's general appearance; Indications of long-standing arrhythmias.

Presents the key factors to staff nursing, aimed towards professional growth and career development. Acceptance of patient's priorities; Seizing of the teachable moment; Sharing of oneself with the patient.

Offers advice to nurses in the United States concerning the practice of their profession. Charting effectively; Collaboration to solve problems; Communication with one's manager; Avoidance of burnout; Knowing when it is time to quit; Employer's payment of one's continuing education.

Responses to inquiries about nursing procedures. Causes of the slowing of intravenous drip rates; Assessment of a gastrointestinal condition called melena; Blood tests for patients receiving total parenteral nutrition.

Presents guidelines for conducting nursing assessment of chest pain. Symptom analysis; Steps in gathering objective data; Assessment of carotid arteries for pulsations and vibrations; Assessment of post-myocardial infarction patients. INSETS: HOW TO MINIMIZE YOUR PATIENT'S ANXIETY;ANALYZING SUBJECTIVE CHARACTERISTICS OF CHEST PAIN;A STEP-BY-STEP APPROACH TO CHEST PAIN ASSESSMENT.

Discusses nursing assessment guidelines in detecting acute abdominal distention. Pathophysiology of abdominal distention; Factors to consider; Steps to follow. INSETS: TWO CAUSES OF ABDOMINAL DISTENSION TO WATCH FOR;PERCUSSION NOTES WITH ABDOMINAL DISTENSION;A CLOSER LOOK AT PERITONITIS.

Presents a guideline for nurses in performing accurate patient assessments. Review of existing data about the patient; Providing a quiet and private environment; History-taking; Importance of hands-on skill and mental alertness in physical assessment; Techniques in inspection, palpation, percussion and auscultation.

Offers advice to nurses on how to care for patients with a history of myocardial infarction (MI). Cases of two patients, both with a history of MI, and complaining of chest pain; Guidelines for responding to a patient with chest pain; Determining the location of pain; Use of traditional techniques of inspections, palpation, percussion and auscultation.

Presents tips on how nurses can save time and effort when looking for new jobs. Self-evaluation of strengths and interests; Match with different types of positions; Application of job hunt/self-analysis grid to current job.

Focuses on investigating absent bowel sounds. Nursing implications; Life-threatening crisis; History taking of the patient; Possible causes of absent bowel sounds.

Highlights the importance of patient teaching in the practice of the nursing profession in the United States. Protection derived by a nurse from patient education; Charges commonly associated with nursing malpractice claims; Violations that constitute ethical malpractice.

Discusses principles of anatomy and physiology that directly affect techniques in assessing the liver. Anatomy and physiology of the liver; Description of applications of palpation, percussion and auscultation; Description of abnormal findings.

A letter to the editor is presented in response to the article "Blood Glucose Problems: Gatifloxacin Contraindicated for Patients with Diabetes" in the May 2006 issue.

Offers advice to nurses on upgrading shift reports. Components of a thorough shift report; Utilization of tape-recorded reports; Right place for a shift report.

Focuses on the different techniques in abdominal assessment. Variables of an abdominal symptom; Historical information related to specific abdominal organ functions; Inspection of abdomen for symmetry of contours, masses and movement; Auscultation of the abdomen; Use of percussion to evaluate the size and position of the liver; Light and deep palpation of the abdomen. INSETS: WHAT'S IN AN ABDOMEN?;FLOWCHART FOR ABDOMINAL ASSESSMENT.