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Background: Hypoplastic left heart syndrome (HLHS) was one of the highest mortality congenital heart defects; however, children with HLHS are living longer with medical and technological advancements. This reality resulted in an increased need for primary palliative care. Nurses assume a direct role in providing care to this specific population. Methods: The literature review from PubMed and CINHAL included key terms primary palliative care, pediatric palliative care, pediatric cardiology, HLHS AND nursing care, the role of the pediatric nurse, and pediatric palliative care education. Articles focusing on children with HLHS, pediatric palliative care, the nursing role, pediatric palliative care education, and parental perspectives were included. Articles with a focus on adults with congenital heart disease were excluded. Results: Thirty-three sources were selected for the final review. Palliative care has grown, specializing in children's care. Cardiology providers could improve upon integrating primary palliative care into practice compared to other pediatric specialties. This integration would enhance the quality of life for children with HLHS. Nurses who work with this population are essential in providing this type of care, and require proper education and training. Discussion: After reviewing the articles, it was evident that the nurse's role is crucial in providing primary palliative care to children with HLHS to maintain their quality of life. However, a gap in the literature exists, warranting further research on this topic. Findings in this article suggest that conducting and implementing research and relevant education might provide a better understanding of primary palliative care and its impact on children with HLHS. [ABSTRACT FROM AUTHOR]

Background: The wounded healer concept refers to healthcare providers who, in the past, have had similar experiences to those of their clients and now draw on these challenging experiences to assist their clients. This study explored the positive traits of nurses with chronic cardiovascular diseases who transitioned to wounded healers. Methods: A qualitative content analysis study was conducted within hospitals in Tehran, Iran, between November 2023 and March 2024. Sampling was conducted using a purposive sampling method in accordance with the study objectives and inclusion criteria. The data were collected through semi-structured face-to-face interviews. Twenty-three participants, comprising 16 females and 7 males, participated in the interviews. Data analysis was conducted by employing a qualitative content analysis approach, including creating codes, subcategories, generic categories, and main categories. MAXQDA v20 software was utilized to facilitate the analysis process. Results: The data analysis revealed one main category that aligned with the research question: the positive traits of a wounded healer nurse, consisting of three generic categories: (1) traits related to interpersonal and professional relationships; (2) traits related to the professional dimension; and (3) traits related to the personal dimension. wounded healer nurses demonstrate positive traits that enhance patient care. Conclusions: The findings of this study have important implications for nursing practice and education. By identifying the positive traits exhibited by nurses as wounded healers affected by chronic cardiovascular diseases, nursing programs can emphasize and strengthen these qualities to convert challenges into opportunities and bridge the theory-practice gap. [ABSTRACT FROM AUTHOR]

A virtual-reality-simulation-based nursing education program incorporating an information processing model helps nursing students develop their learned knowledge as nursing behavior and develop their ability to cope with complex clinical challenges. The purpose of this study is to develop a nursing education program using an immersive virtual reality simulation app for clinical situations based on an information processing model and identify the effects. A non-quantitative control group pretest–post-test design was employed. The programs were developed using the ADDIE model and an information processing model. In order to verify the effectiveness of the program, six adult nursing learning issues were taught to the experimental group over 6 weeks. The nursing education program in this study provides comprehensive experiential learning through advanced virtual simulation, significantly enhancing nursing students' performance confidence, critical-thinking abilities, and problem-solving skills across a wide range of clinical scenarios. By repeatedly engaging with diverse learning topics related to adult nursing, this program not only equips students with essential practical skills but also contributes to the overall improvement of patient safety and the quality of medical care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Standardized nursing measures are series of nursing interventions and practices that help in decreasing pulmonary atelectasis after open heart surgeries. Aim: the current study aimed to evaluate the effect of implementing standardized nursing measures on prevention of pulmonary atelectasis among patients undergoing open heart surgeries. Subjects and Method: Design: Quasi-experimental study design. Setting: this study was performed at Surgical Intensive Care Unit at Tanta International Teaching Hospital affiliated to Ministry of High Education and Scientific Research. Subjects: A purposive sample of 80 adult conscious patients admitted to the previously mentioned setting and was selected and divided to two equal groups 40 patients in each. Tools: Tool I: Open Heart Surgery Patients’ Assessment Tool, tool II: Pulmonary Atelectasis Assessment Tool. Results: In relation to signs of atelectasis, it was observed that most of the study sample (75%) and less than half (40%) of the control group didn’t have cough during the first and the fifth postoperative day, respectively. Regarding to sings of dyspnea it was observed that 5% of patients and more than half 52.5% of the control group had mild dyspnea during the fifth post-operative day. Conclusion: It can be concluded that implementation of standardized nursing measures techniques decreased signs of postoperative pulmonary atelectasis. Recommendations: It can be recommended that standardized nursing measures should be implemented for patients post heart surgeries to prevent pulmonary atelectasis. [ABSTRACT FROM AUTHOR]

This article explores the use of Abdellah's Nursing Process in patient care with extracorporeal membrane oxygenation (ECMO). ECMO is a treatment used for patients with cardiopulmonary failure and acute respiratory distress syndrome. The article highlights the importance of a multidisciplinary approach and the use of nursing theories to enhance care practices. Abdellah's 21 Nursing Problem Theory is presented as a suitable model for addressing the needs of patients undergoing ECMO. The article includes a case report that demonstrates the implementation of Abdellah's approach in patient care, focusing on nursing diagnoses and interventions related to basic care needs, sustenance care needs, and restorative care needs. The article concludes that Abdellah's theory can effectively meet the nursing care needs of patients undergoing ECMO. [Extracted from the article]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The construction of knowledge from the exchange of knowledge between patients, families, and healthcare teams is a felt need that can impact health education and adherence to treatment. Objective: To develop a social appropriation strategy that enables innovation in the health care of people with ischemic heart disease and their families through the use of an MHealth tool. Materials and methods: Exploratory study that allowed the design of a strategy for the social appropriation of knowledge to improve the cardiovascular health of people suffering from myocardial ischemia. Thirty-one people participated, including patients, family members, and health professionals. Two virtual workshops were held in June, and follow-up phone calls were made between August and September. The participant's experiences and knowledge enabled the construction of the MHealth tool. Results: The critical reflection of the stakeholders facilitated the construction and development of the MHealth tool (webpage/app) named "Cuidando tu corazón" (Taking care of your heart). Discussion: Social appropriation strategies are a relevant tool for knowledge creation in health. Conclusions: The strategy implemented made it possible to recognize the importance of developing cardiovascular healthcare tools from stakeholders' needs, perspectives, and beliefs to improve education and care. [ABSTRACT FROM AUTHOR]

Aims: To examine patients' perceptions of care quality following a same‐day procedure in the cardiac catheterization laboratory and understand the extent to which they were prepared for discharge. Design: Single‐centre, mixed‐methods study. Methods: Postdischarge, online survey of patients who underwent a same‐day procedure in the cardiac catheterization laboratory (n = 150) and one‐on‐one interviews with 13 of these patients. Results: Survey responses were positive with mean scores between 4.39–4.83 out of five and 63.3% of respondents (n = 95) extremely likely to recommend the service to others. Interview data analysis identified three themes: the care experience, information and education for safe discharge, and follow‐up needs. Participants spoke highly of their interactions with clinicians and were satisfied with their care experience. Mode and content of information delivered varied, with some participants lacking guidance about postdischarge health management and clarity about follow‐up plans. Patient or public contribution: Participants were patients. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. Materials and methods. In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). Results. We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. Conclusions. Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19. [ABSTRACT FROM AUTHOR]

Despite the long history of integrating non-medical practitioners into the extended cardiac surgical team, concerns about job design that reduce job satisfaction persist in the literature. In the Kingdom of Saudi Arabia (KSA), previous research has found that these non-medical practitioners known as cardiac surgical assistants (SAs) express significant dissatisfaction with multiple aspects of their role. Improving job satisfaction can positively impact on the recruitment and retention of this valuable workforce who increase surgical capacity within cardiac units. This qualitative study was therefore conducted to gain an in-depth understanding of cardiac SAs' perspectives of their role and to explore how it could be redesigned to improve their job satisfaction. Through thematic analysis of 14 individual interviews, six themes were identified: the importance of the role, low level of autonomy, lack of recognition, inconsistency of training, poor appraisal and feedback, and feeling unappreciated and undervalued. The data allowed a number of specific recommendations to be formulated that could be implemented at service, organisational and professional levels to enhance SA job satisfaction. It is important that the working conditions of surgical assistants should be further improved to address the issues which cause lower levels of motivation and a greater intention to leave their role. [ABSTRACT FROM AUTHOR]

Introduction: acute coronary syndrome (ACS) is characterized by different symptoms, so the experience varies from person to person. Dodd's Conceptual Model of Symptom Management addresses this aspect that requires testing within nursing practice. Objective: to test the postulates of the symptom experience dimension of Dodd's Conceptual Model of Symptom Management in persons with acute coronary syndrome. Methods: theoretical testing by means of structural equations. A total of 256 individuals with a diagnosis of acute coronary syndrome, selected by stratified probability sampling, participated. Clinical and sociodemographic data were collected, and symptom assessment and response were measured with five valid instruments. Statistical analysis was performed with absolute adjustment, incremental adjustment and parsimony adjustment from which a structural equation model was derived. Results: the bidirectional relationship between symptom severity (assessment) and decision making (symptom response) was tested. A model was formed that explains 44% of the variance on decision making. This variable is also influenced by other variables such as cognitive evaluation and personal control. Conclusion: this conceptual model allowed us to understand the dimension of symptom experience in patients with acute coronary syndrome, proving its postulates in practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to determine in adults the risk perception for cardiovascular disease (CVD) and the associated factors. Background: CVDs are the leading cause of death globally. In adults, perceptions related to the risk for CVDs have a considerable effect on decision-making processes related to one's own health. Methods: A cross-sectional study was conducted with 453 adult people from April to June 2019 in İzmir, Turkey. Data were collected with a sociodemographic characteristics questionnaire, perception of risk of heart disease scale (PRHDS), and health perception. Findings: The mean PRHDS score of adults was 48.88 ± 8.12. The risk perception for CVD was influenced by variables that were age, gender, education, marital status, employment status, health perception, familial cardiovascular disease history, chronic disease status, smoking status, and body mass index. Although CVDs are the most prominent cause of disease-related death in the world, risk perception for CVD was found to be low among the individuals included in this study. This finding indicates the importance of informing individuals about CVD risk factors, raising awareness, and training. [ABSTRACT FROM AUTHOR]

Background: Nursing students are required to acquire the necessary clinical knowledge and skills to provide safe and quality care. The method of providing training, particularly for final-year nursing students, is of utmost importance. An internship is a program during which students work in shifts similar to nurses employed in a hospital; however, the number of their shifts and patients is less than nurses; a nurse and the faculty supervise the care they provide, and they are paid a monthly salary. This study was conducted to explore nursing faculty, managers, new graduates, and students' experiences of nursing internship program implementation. Methods: This descriptive qualitative study was conducted from November 2021 to March 2022. The participants were selected from among nursing managers, newly graduated nurses, nursing internship students (final-year undergraduate), and faculty of Iran. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used for data analysis. Results: Participants in this study included 17 nursing internship students, 12 nursing managers, three faculty members, ten nursing preceptors, and five newly graduated nurses from the internship program, 47 participants in total. After analyzing the data, five themes, including 'facilitation of socialization process,' 'filling the gap between theory and practice,' 'improving self-confidence and independence,' 'an opportunity for clinical skill training,' and 'Achilles' heel of the clinical setting,' and nineteen subthemes were extracted from the participants' experiences. Conclusion: Implementation of an internship program for final-year nursing students plays a role in preparing them for better professional performance, enhancing clinical skills, increasing self-confidence and independence, inspiring the nursing profession, strengthening professional commitment, and improving the chances of employment after graduation. In order to alleviate the identified challenges of the internship program, holding a briefing meeting with managers, supervisors, and faculty to determine working hours, performance standards, and amenities such as lunch, dinner, and resting place is efficient. [ABSTRACT FROM AUTHOR]

Background: Postoperative hypoxia (POH) is a complication that often occurs in patients after Coronary Artery Bypass Grafting (CABG). Breathing exercises are considered effective in overcoming POH after CABG. However, this intervention has not been implemented using the dynamic nurse-patient relationship model from Ida Jean Orlando. The dynamic nurse-patient relationship model is expected to improve the quality of nursing care after cardiac surgery. Purpose: This study aimed to describe the application of breathing exercises in postoperative hypoxia after CABG using the dynamic nurse-patient relationship model. Methods: This study was the summary of the case presentation along with the interventions on three patients after CABG through the dynamic nurse-patient relationship model approach with the main intervention focusing on breathing exercises. Results: After three days of implementing the intervention, most patients showed improvement in POH. Background: Postoperative hypoxia (POH) is a complication that often occurs in patients after Coronary Artery Bypass Grafting (CABG). Breathing exercises are considered effective in overcoming POH after CABG. However, this intervention has not been implemented using the dynamic nurse-patient relationship model from Ida Jean Orlando. The dynamic nurse-patient relationship model is expected to improve the quality of nursing care after cardiac surgery. Purpose: This study aimed to describe the application of breathing exercises in postoperative hypoxia after CABG using the dynamic nurse-patient relationship model. Methods: This study was the summary of the case presentation along with the interventions on three patients after CABG through the dynamic nurse-patient relationship model approach with the main intervention focusing on breathing exercises. Results: After three days of implementing the intervention, most patients showed improvement in POH. This condition was evidenced by an increase in the PaO2/FiO2 ratio from less than 200 to above 200, with an average increase of 89.3. The blood gas analysis results supported the results from a respiratory alkalosis condition to a normal PH and a PaCO2 value from <35 mmHg to the normal range (35-45 mmHg). Also, X-rays of the patients showed pulmonary atelectasis improvement. Conclusion: Applying breathing exercises in postoperative hypoxia after CABG using the dynamic nurse-patient relationship model can improve POH in post-cardiac surgery patients. We recommend using the model theory approach because this theory can see patients' psychological and physical changes dynamically in post- CABG patients. [ABSTRACT FROM AUTHOR]

Introduction: Family-focused nursing has gained ground worldwide, and a range of healthcare systems are now practicing family-focused nursing, which has been shown to increase the quality of care. Even so, a lack of research remains into family-focused nursing for various groups of patients in clinical practice. Objectives: The purpose of this study was to explore how family members (FMs) of patients with atrial fibrillation (AF) experienced a family-focused nursing intervention in a clinical outpatient setting. Methods: This was a qualitative phenomenological interview study employing Reflective Lifeworld Research (RLR) to explore humans' lived experiences. The data reported herein were derived from semi-structured interviews with seven FMs of patients with AF who participated in a clinical trial which tested a family-focused intervention in a Cardiology outpatient clinic treating patients with AF. The transcribed interviews were analyzed in four phases which is an iterative process as proposed by Dahlberg and Dahlberg. Findings: The essence of the phenomenon was experiencing less panic and finding peace, which emerged from the following four patterns. (1) The FMs' post-AF experience, (2) Enhanced understanding and knowledge of AF, (3) Personal interaction with a nurse specialist and (4) AF becomes manageable. A space facilitating reflection upon the disease and daily life with the disease was established through group sessions and family conversations. Conclusion: A family-focused nursing intervention facilitated by specialized nurses with extensive communication skills filled a knowledge gap related to AF thereby reducing panic and increasing peace among FMs. Furthermore, the intervention facilitated family awareness of their resources to bring about change, regain balance, and enhance well-being in their everyday lives and initiated a healing process in the families. Future interventions for patients with AF should consider FMs as well as patients as an entity of care. [ABSTRACT FROM AUTHOR]

Background: It is proposed that the biggest gap in control of rheumatic heart disease is in implementing of ineffective primary and secondary preventive measures. These measures are supposed to be well addressed by nurses. For prevention and proper management, nurses are expected to have full knowledge about rheumatic heart disease. Therefor the main objective of the study was to assess the level of nurse's knowledge and factors behind regarding RHD in the current study. Method: Institution based cross sectional study was conducted on nurses working in cardiac centers of public and private hospitals at Addis Ababa from April 1 to 30, 2021. Total sample size is 163 selected by purposive sampling method. Data was entered in to Epi-data version 4.5 and exported to SPSS version 25.0 and was checked for missing values. Data was cleaned. Descriptive statistics such as frequency, mean and percentages were calculated, described and displayed in tables, graphs and charts. Binary logistic regression was done to see the crude significant relation of each independent variable with nurse's good knowledge score. Significant factors were identified based on multivariate logistics regression in 95% confidence level at P-value less than 0.05. Result: In the present study about 154 participants were participated. The mean correct answer response of the nurses for knowledge of RHD questions is 12.2 ± 5.2. Only 48.7% of the nurses have good knowledge towards RHD. Being male in gender, having history of sore throat, taking formal education in university or collage, taking in-service training on RHD, having higher wok experience, have found significantly associated with higher odds of nurses' good knowledge towards RHD. Conclusion and recommendation: Regular training regarding RHD management should be given to nurses who are working in cardiac centers. Rheumatic heart disease early treatment and prevention should be incorporated and reinforced in to nursing and other health related professions curriculums. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19. Objective: To investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic. Methods: A cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted. Results: In total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health. Conclusion: Meaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health. [ABSTRACT FROM AUTHOR]

BackgroundThe sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19.ObjectiveTo investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic.MethodsA cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted.ResultsIn total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health.ConclusionMeaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health.

Aim: To evaluate missed nursing care and patient safety during the first wave of the COVID‐19 pandemic at in‐patient cardiology wards. Design: A cross‐sectional design with a comparative approach. Method: Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey‐Swedish version, and questions on patient safety and quality of care during the COVID‐19 pandemic. The data were compared with a reference sample. Results: A total of 43 registered nurses and nurse assistants in the COVID‐19 sample and 59 in the reference sample participated. The COVID‐19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID‐19 sample reported more missed nursing care in wound care and in basic nursing. [ABSTRACT FROM AUTHOR]

Copyright of Revista Enfermagem Digital Cuidado e Promoção da Saúde is the property of Revista Enfermagem Digital Cuidado e Promocao da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Heart failure (HF) is a global pandemic affecting individuals globally and is rising in magnitude. Despite the advancement of treatment for HF, the problem continues to cause substantial hospitalization, economic costs, disability, morbidity, and mortality. However, knowledge, attitude, and associated factors towards HF management in Ethiopia were unknown. Objective: To assess knowledge, attitude, and associated factors towards HF management of nurses working in the cardiac unit. Methods: An institution-based cross-sectional survey was conducted on 180 nurses working in a cardiac unit at selected government hospitals in Addis Ababa, Ethiopia. The data were collected from March to April 2020 by self-administered questionnaire. The data were analyzed by using SPSS version 24.0 software. Results: A total of 180 nurses were enrolled into the study with a response rate of 95%. The mean age of the participants was 31 years. The majority (105; 58.3%) were females. About 108 (60%) of them were married and 34 (18.9%) of them were qualified with a MSc in nursing. More than two-thirds (134; 74.4%) of them had ≤ 6 years of work experience. The majority (131; 72.8%) of them have not taken training on the management of HF. The level of a good knowledge and positive attitude towards the management of HF were 30.56% (n = 55; 95% CI: 24.20– 37.50) and 94.4% (n = 170; 95% CI: 90.6– 97.8), respectively. Having a monthly income of > 6700 Ethiopian birr (AOR = 3.20, 95% CI: 2.87– 9.58), master's degree in nursing (AOR = 4.35, 95% CI: 3.42– 14.36), having > 6 years of working experience (AOR = 5.21, 95% CI: 4.41– 15.72), and having training about HF management (AOR = 6.18, 95% CI: 4.76, 15.95) were factors significantly associated with knowledge towards HF management. Conclusion: The level of good knowledge towards HF management was very low, while the level of positive attitude towards HF management was satisfactory. Educational programs and comprehensive training are recommended to take place to improve them. [ABSTRACT FROM AUTHOR]

Background Early mobilization (EM) is beneficial in critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods Consecutive admissions of adults ≥80 years old to a Cardiac Intensive Care Unit (CICU) prior to and following implementation of a nurse-driven EM program were reviewed. Mobility was measured using the Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 meters). The primary outcome was discharge home. Results There were 412 patients included (N  = 234, intervention; N  = 178, preintervention). There was no difference in age between groups (overall 86.3 ± 4.8 years old) or sex (overall female N  = 215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prehospitalization and in 209 patients (89.3%) on admission. Nearly half of patients (N  = 107; 45.7%) improved their LOF by ≥1 during admission. Mobilization occurred during nearly all opportunities (838/850; 98.6%), and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2% adverse event rate]) and transient. Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4 vs. 65.7%, P  = 0.047, respectively) and had a lower rate of in-hospital death (6.4 vs. 14.6%, P  = 0.006, respectively). There was no difference in mean length of hospital stay, 30-day emergency department visit or hospital re-admission. Conclusion EM is safe in older adults in the CICU and is associated with reduced discharge to healthcare facility and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Objective: to identify the prevalence of delirium in elderly inpatients from an Intensive Care Unit in the postoperative period of cardiovascular surgery and to verify an association between delirium and sociodemographic and clinical variables. Method: cross-sectional, analytical study, carried out in a cardiology center. Elderly inpatients between June and October 2018 were analyzed. Screening for delirium was performed using the Confusion Assessment Method for Intensive Care Unit. Results: males had an incidence of 65% and systemic arterial hypertension (75%) was the most reported chronic disease; 30% had acute myocardial infarction and longer time in cardiopulmonary bypass, in addition to having remained hospitalized longer; and 30% of the delusional ones died. Conclusion: the prevalence found was 40% and was associated with the elderly, with the male sex, with the significant level of education, use of tobacco, previous comorbidities; these remained hospitalized longer and died more when compared to the other group. [ABSTRACT FROM AUTHOR]

Background: Patient safety is essential for the promotion of quality of care, especially when associated with the global and regional epidemiological impact of cardiovascular health, highlighting the need for a clear introduction of the theme in the health curriculum. Objective: Analyze nursing teaching in the field of safe cardiovascular care. Methodology: Hermeneutic study carried out in the nursing course of a public university in the interior of Northeastern Brazil with teachers, students, and graduates. Sampling was by convenience. The interviews and focus groups were submitted to thematic categorical analysis with theoretical reference of the Curricular guide of patient safety of the World Health Organization. The final sample was 46 participants. Results: The categories resulted in the themes: Care is complex and its teaching is fragmented, The lack of specificity in teaching safe cardiovascular care, The recognition of safe cardiovascular care and The challenges of teaching and learning in safe cardiovascular care. Conclusion: The teaching of safe cardiovascular care proved to be indirect and fragmented by all groups of participants. [ABSTRACT FROM AUTHOR]

Background: Patient safety is essential for the promotion of quality of care, especially when associated with the global and regional epidemiological impact of cardiovascular health, highlighting the need for a clear introduction of the theme in the health curriculum. Objective: Analyze nursing teaching in the field of safe cardiovascular care. Methodology: Hermeneutic study carried out in the nursing course of a public university in the interior of Northeastern Brazil with teachers, students, and graduates. Sampling was by convenience. The interviews and focus groups were submitted to thematic categorical analysis with theoretical reference of the Curricular guide of patient safety of the World Health Organization. The final sample was 46 participants. Results: The categories resulted in the themes: Care is complex and its teaching is fragmented, The lack of specificity in teaching safe cardiovascular care, The recognition of safe cardiovascular care and The challenges of teaching and learning in safe cardiovascular care. Conclusion: The teaching of safe cardiovascular care proved to be indirect and fragmented by all groups of participants. [ABSTRACT FROM AUTHOR]

Objective: to develop and test an SMS monitoring software application for patients with acute decompensated heart failure. Method: the waterfall model was used for software development. All expected functionalities were defined, program modules were codified and tests were done so as to ensure good performance by the software application. Ten patients participated in the prototype test. Results: the system sends two types of messages: questions that should be answered by patients and unilateral educational reinforcements. In addition, the system generates alarms in case of no response or according to a flow chart to detect congestion in the patient previously created by the team. Of the 264 SMS texts sent, 247 were answered. The alarm was triggered seven times: three patients woke up with shortness of breath for two consecutive nights, and four patients felt more fatigued for two consecutive days. All patients took the prescribed medications during follow-up. The study nurse guided the patients who generated alarms in the system. Conclusion: the SMS software application was successfully developed and a high response rate and preliminary evidence of improvements in self-management of HF were observed. With this regard, telehealth is a promising alternative in the treatment of chronic diseases [ABSTRACT FROM AUTHOR]

Aims: An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme.Methods and Results: Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting.After a mean follow-up of 22 months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.85; P = 0.014]. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09-0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26-1.34; P = 0.206).Conclusion: An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management. [ABSTRACT FROM AUTHOR]

Objective: to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing. Method: conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud. Results: the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept. Conclusion: we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases. [ABSTRACT FROM AUTHOR]

The article presents the discussion on the year 2020 which being designated by the World Health Organisation as ‘Year of the Nurse' in honour of the 200th anniversary of Florence Nightingale's birth. Topics include considering many ways in which cardiovascular nurses supporting patients through a lifespan to live with a variety of cardiovascular conditions; and primary care nurses being an important contributor for preventive cardiovascular care.

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Background: This study examined the long-term effects of nurse-led, individualized education on self-efficacy, self- care compliance, and health-related quality of life (HRQoL) in middle-aged patients with new-onset acute coronary syndrome. Methods: A quasi-experimental pretest-posttest design was used in the study. A cardiovascular nurse provided individualized education to the intervention group (n = 32), and self-efficacy, self-care compliance, and HRQoL at baseline and 3 and 12 months after discharge were compared to those of a control group (n = 30). Patients were recruited from a cardiovascular care unit at a university hospital between 2012 and 2013. Repeated measures analysis of variance was used to compare time-related changes. Results: There was no significant difference in self-efficacy between the 2 groups over a fixed period (F = 3.47, p = 0.067) and showed no interaction between the 2 groups (F = 0.45, p = 0.636). However, significant differences were found in the main and interaction effects between the 2 groups and changes in self-care compliance over the follow-up period differed significantly between the 2 groups (F = 28.72, p < 0.001). Changes in mental HRQoL over the follow-up period differed significantly between the 2 groups (F = 33.34, p < 0.001) and significant interaction effect (F = 4.40, p = 0.040). Conclusions: Structured nurse-led education should be provided to middle-aged patients with new-onset acute coronary syndrome, as part of routine predischarge education, to increase self-care compliance and mental HRQoL and prevent secondary adverse events. [ABSTRACT FROM AUTHOR]

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Introduction: chronic degenerative diseases such as coronary heart disease are caused by various risk factors, habits and styles of unhealthy life, so that prevention and health promotion based on theories or models of nursing, play an essential role in solving public health problems. Objective: To develop a proposal for implementation of nursing care to patients with cardiovascular risk supported by the Health Promotion Model (HPM) of Nola J Pender. Proposal: The care of people is proposed based on the HPM where the nurse: 1)basally determines the self-efficacy perceived, health perception, risk factors, the profile of healthy lifestyles and personal factors; 2) gets involved in an education course with the participation of a "model patient" (3-12 sessions of 30-60 minutes during the (s) week (s) of hospitalization) and home monitoring with workshops and written tools; 3) evaluates the effect of the intervention; and 4) follows up with information technology and communication. Conclusion: Nursing care of patients with cardiovascular risk based on the HPM, using information technology and communication, can influence cognitive-perceptual factors, barriers to action, perceived benefits, affections, competition and especially the perceived self-efficacy, modifying active, vicarious, persuasive or emotional risk behavior. However, it is essential to consider the personal, interpersonal, situational factors and prior conduct in educational nursing interventions. [ABSTRACT FROM AUTHOR]

Background: Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses' (ANs') prehospital care of patients experiencing suspected ACS, related to pain intensity. Methods: This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria. Results: The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine. Conclusions: An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials. [ABSTRACT FROM AUTHOR]

Background: Chest tube is a widely applied therapeutic postsurgical intervention in respiratory and cardiothoracic care. Chest tube can be a life saving intervention for patients presenting with pneumothoraces, effusions and hemothoraces. It is however associated with significant morbidity and mortality. Aim of this study: The study aimed to evaluate the impact of an educational program on nurses' practice related to care of patients with chest tube. Methodology: A quasi-experimental design was used in the current study. The study was carried out on a convenient sample of 30 nurses working in intensive cardiothoracic unit, cardiothoracic care unit, and general surgical unit at Ismailia University Hospital. Data were obtained through; Nurses, chest tube performance observation checklist. The educational program was designed based on an extensive revision of the related materials, recent medical textbooks, studies and literature. Results: of this study indicated that all studied nurses (100.0%) had statistically significant unsatisfactory level of practice pre-program implementation. The statistically significant level of improvement in nurses' practice was very high immediately after the program implementation and there was decline in the studied nurses' total practice scores throughout the first follow –up and second follow up after program implementation but it showed significant improvement than pre-test (P<0.0001***, P=1.0, P=0.031* respectively). Conclusions: The study concluded that there was statistically significant improvement immediately after program implementation and throughout the follow up phases regarding nurses' practice related to care of patients with chest tube. Recommendations: The study recommended that regular continuous educational program should be designed to give information about chest tube for enhancing and reinforcement of nurses' practice to achieve high quality care. [ABSTRACT FROM AUTHOR]

Background: There is emerging evidence that exercise training could positively impact several of the cardiovascular risk factors associated with sudden cardiac death amongst patients on haemodialysis. The primary aim of this study is to evaluate the effect of an intradialytic exercise programme on left ventricular mass.Method and Design: Prospective, randomised cluster open-label blinded endpoint clinical trial in 130 patients with end stage renal disease on haemodialysis. Patients will be randomised 1:1 to either 1) minimum of 30 min continuous cycling thrice weekly during dialysis or 2) standard care. The primary outcome is change in left ventricular mass at 6 months, assessed by cardiac MRI (CMR). In order to detect a difference in LV mass of 15 g between groups at 80 % power, a sample size of 65 patients per group is required. Secondary outcome measures include abnormalities of cardiac rhythm, left ventricular volumes and ejection fraction, physical function measures, anthropometric measures, quality of life and markers of inflammation, with interim assessment for some measures at 3 months.Discussion: This study will test the hypothesis that an intradialytic programme of exercise leads to a regression in left ventricular mass, an important non-traditional cardiovascular risk factor in end stage renal disease. For the first time this will be assessed using CMR. We will also evaluate the efficacy, feasibility and safety of an intradialytic exercise programme using a number of secondary end-points. We anticipate that a positive outcome will lead to both an increased patient uptake into established intradialytic programmes and the development of new programmes nationally and internationally.Trial Registration Number: ISRCTN11299707 (registration date 5(th) March 2015). [ABSTRACT FROM AUTHOR]

Objective: to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. Method: a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. Results: women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. Conclusion: this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life. [ABSTRACT FROM AUTHOR]

In the United States, approximately 1.7 million cardiac catheterizations are performed each year, making it the fifth most common procedure. In this article, the author reviews the literature on the alternative transradial approach versus the traditional transfemoral approach for cardiac catheterization. Through a meta-analysis, clinical trials were thoroughly analyzed. The clinical and procedural outcomes are compared to provide evidence that the transradial approach for coronary angiography and angioplasty is associated with lower risks of adverse outcomes compared with the traditional transfemoral approach. An educational focus highlights the role of the nurse practitioner to ensure proper assessment and management of patients after transradial access. [ABSTRACT FROM AUTHOR]

Objectives: To determine the rate and variability of polypharmacy in nursing home (NH) residents and investigate its relationship to age, sex, functional status, length of stay, and comorbidities. Methods: We conducted a cross sectional, multicenter study that included six nursing homes. Demographic, clinical characteristics, Charlson comorbidity index (CCI), the number and classes of chronic medications, rate of polypharmacy>5 drugs (per day) and polypharmacy>7 drugs (per day) were recorded. Results: Nine hundred and ninety-three residents were included; 750 (75.5%) fully dependent residents and 243 (24.5%) mobile demented residents requiring institutional care. The mean age was 85.04±7.55 (65-108) years. The mean rates of polypharmacy>5 drugs and polypharmacy>7 drugs were 42.6% and 18.6%, respectively. Differences in polypharmacy>5 drugs and polypharmacy >7 drugs were observed in NHs 24.7%-56% and 4.9%-30.4%, respectively (P<0.001). Mean number of chronic drugs per resident was 5.14±2.60 from 3.81±2.24 to 5.95±2.73 (P<0.001). No differences in polypharmacy were found between sex and fully dependent versus mobile demented residents. The most common medications taken were for gastrointestinal, neurological, and cardiovascular disorders. Regression analysis revealed four independent variables for polypharmacy>5 drugs: groups aged 75-84 and>85 relative to 65-74, odds ratio (OR) 0.46 (95% confidence interval [CI] 0.27-0.78) P=0.004, OR 0.35 (95% confidence interval 0.19-0.53), respectively, P<0.001; length of stay>2 years, OR 0.51 (95% CI 0.36-0.73) P<0.001; CCI, OR 1.58 (95% CI 1.42-1.75) P<0.001; and feeding tube versus normal feeding, OR 0.27 (95% CI 0.12-0.60) P=0.001. Conclusion: Rates of polypharmacy in NHs are high with significant variability. Variability rates of polypharmacy, distinct residents' characteristics, and excessive use of certain drug groups may indicate that a decrease in medication is potentially feasible. [ABSTRACT FROM AUTHOR]

Aims: We aimed to document the drug management of patients at high cardiovascular risk in daily practice, with the special focus on lipid-lowering treatment. Methods and results: In this prospective noninterventional study in 2387 outpatient centers throughout Germany, a total of 13,942 high-risk patients (mean age 65.7 years, 61.6% males) were treated with simvastatin 40 mg/day at entry as monotherapy. All patients were followed up for 12 months in terms of drug utilization, laboratory values, target attainment, and clinical events (including death, hospitalization, vascular events, and dialysis). Patients had coronary heart disease in 35.0%, diabetes mellitus in 24.4%, and the combination of coronary heart disease plus diabetes mellitus in 25.7%. In 21% of patients, a cholesterol absorption inhibitor was added to statin therapy at the entry visit, and in 23%, this was added at the follow up visit 6 months later. The target values for low-density lipoprotein-cholesterol (<2.6 mmol/L) were reached by 31.8% of patients at entry and by 50.0% at the end of this registry after 12 months. Mean blood pressure decreased (from 135.9/80.5 mmHg at baseline) by 3.1/1.9 mmHg after 12 months. In patients with documented diabetes, the targeted glycated hemoglobin (HbAlc <6.5%) was reached by 33.5% at baseline and by 40.0% after 12 months. Clinical events occurred in 11.7% of patients between baseline and month 6, and in 12.0% between months 6 and 12. Conclusion: In patients at high risk for cardiovascular events, comprehensive management under daily practice conditions leads to improvement of lipid, glucose, and blood pressure parameters. There is a need to improve secondary prevention among high-risk patients. [ABSTRACT FROM AUTHOR]

This integrative review investigates how nurses plan the hospital discharge of patients with Congestive Heart Failure (CHF) since an inadequate discharge plan and patients' subsequent non-adherence to instruction provided upon discharge are indicated as potential factors for re-hospitalization. A total of 24 papers were found in a search carried out in the LILACS and MEDLINE databases between 2004 and 2008, which given the inclusion criteria, were reduced to 14 papers. The papers were analyzed and categorized into 'Health Education', and 'Nursing Care'. The synthesis of results indicates that the discharge plan devised by nurses is based on two categories. The actions of nurses to promote health education can enable patients with CHF to improve self-care. [ABSTRACT FROM AUTHOR]

Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one-group pre-to-post-intervention design. Educational interventions included faculty-led, simulation-based case presentations using the Harvey® cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer-based CD-ROM program. Outcome measures included a 31-item cognitive written exam, a 13-item skills checklist used in each of a three-station objective structured clinical exam, learner self-efficacy and satisfaction survey, instructor satisfaction and self-efficacy survey, and a participant logbook to record practice time using the self-learning materials. Thirty-six students who received the simulation-based training showed statistically significant pre-to-post-test improvement in cognitive knowledge and cardiovascular assessment skills. [ABSTRACT FROM AUTHOR]