M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011 / In this present study, the instrument cardiac patients learning needs inventory (CPLNI) was assessed for validity and reliability by four cardiology doctors, two critical care nurses, and one patient with a history of myocardial infarction (stage one of the study). The instrument was not modified as a result of non modified CPLNI used in the pilot study which consisted of thirty seven items of information grouped into eight clusters (constructs). The aim of the study was to describe and compare intensive care nurses and patients perceptions of information needs of acute myocardial infarction patients at a public sector tertiary hospital in Johannesburg. The study has made recommendations for clinical practice and education of intensive care nurses. A quantitative, non experimental, descriptive, prospective two-part design using questionnaires was utilized in this study to find out what information out of that commonly given following myocardial infarction, patients and critical care nurses rated as being most and least important (stage two). These results were then compared with the results obtained from patients and nurses who were given the same instrument to complete. Seventy six subjects were recruited. Results indicated that some similarities existed between the patients and the nurses in terms of what they perceived as the most and least important clusters/constructs of information. The item one (what to do if I get chest pain)was ranked first with a frequency of seventy five(98,68%). The scores for some informational clusters included on the instrument were significantly different between the patient and the nurses groups (p<0.05). The constructs miscellaneous (p=0.0054), physical activity (p=0.0022) and symptom management (p=0.0284) were statistically significant. These findings and others are discussed, and recommendations are made for improving the information given on post myocardial infarction,

No description available.

Introduction. MRSA is a major healthcare problem with particular relevance to morbidity and mortality in ICU (Byers & Decker 2008). Due to the increased infection risks associated with cardiac surgery, MRSA screening and surveillance is widely used as a standard preoperative Investigation In many settings (Teoh, Tsim & Yap, 2008). The results, in conjunction with appropriate hygiene precautions, are used to control and prevent infection with MRSA. Following an outbreak of MRSA in cardiac patients an MRSA protocol (MRSAP) was implemented In the cardiac intensive care unit in this study. Purpose. To evaluate how nurses implement the MRSAP in the surgical cardiac intensive care unit in this study, and to evaluate the change in MRSA infection rates following implementation of the MRSAP. From the results obtained, to identify any areas for improvement in nursing practice with respect to the MRSAP. Methods. Nursing staff knowledge with respect to the MRSAP was assessed using a survey questionnaire. Their compliance with required Infection control practice for control of MRSA was assessed through periods of observation on the unit. Screening compliance and reduction in infection rates were investigated using a retrospective records review. Results. The survey revealed good awareness of the MRSAP (88%, n=23), but knowledge of the detailed content was variable. Most staff were apparently satisfied with the existing standards of infection control in CICU (84.6%, n=22). Observation revealed that, compliance with routine hygiene measures was good (66% correct contacts, n=144) by the standard of other studies, but, given the high risk of postoperative infection for these patients improvements are required. Inadequate data in sampled records prevented meaningful analysis of screening compliance, and hence the systems for handling screening swabs and results need to be reviewed. The change in infection rates between the pre and post MRSAP periods, which incorporated use of infection risk stratification data to demonstrate comparability of the two groups of patients, revealed that despite the high MRSA infection rate in 2005 (1.18%), and subsequent drop post MRSAP (0.35%), the actual number of cases found was too small to test statistically for significant difference. An incidental finding was that female cardiac surgery patients were getting significantly younger (p<0.01). There was a significant decrease in hospital MRSA infection rates for matched periods (p<0.0001 ). Conclusions. Evidence was found to support the efficacy of the MRSAP in the reduction of MRSA infections. Deficits in staff knowledge and infection control practice were identified and feedback has been implemented in order to improve compliance with the MRSAP and maintain the improved infection rates. Further research with respect to implementation of, and compliance with, infection control measures could both improve quality of patient care and decrease the burden of preventable infectious disease such as health care associated infections (HAls) in South Africa. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists. The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions. 19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy). From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group. The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted. In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2008. / Vita. Bibliography: p.36-42

Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions.The findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Acute myocardial infarction is a serious diagnosis. Both the patient and the loved ones experience an immediate uncertainty. To be able to emotionally support the patient´s spouse, the nurse in the coronary care unit must be prepared to also encounter the world of the spouse. The aim of this study was from a nursing perspective to illuminate how life was experienced during the first two months by the spouse of someone, who was stricken by a first time acute myocardial infarction. Interviews with six spouses were conducted. The methodological approach was phenomenological-hermeneutic, based on the French philosopher Paul Riceour. The result of the qualitative text analysis showed four themes: To lose one´s foothold, To be exposed to the medical and nursing staff, To get a changed relationship to one´s partner, To wish to make the most of one´s life. The first theme highlighted the spouse’s strong feelings of uncertainty concerning the outcome of the patient. The second theme showed the spouse’s confidence in the medical care. It also showed the spouse’s sense of being insulted by the nurses, who did not acknowledge the spouses´ need of obtaining information and emotional support. The third theme demonstrated how the partner cared for and felt responsible for observing the former patient´s health condition. The fourth theme showed that the spouse realized that life has to come to an end and therefore wanted to realize his/her plans for the future before it was too late. The findings from this study emphasize the importance of the medical and nursing staff to show interest in the spouses´ experiences. Thereby the spouses can experience a support in congruence with their needs, and their life situation might thereby be improved. It would be of great interest to study how nurses regard the spouses´ life situation during the patients´ stay in hospital. Further research could also highlight which factors could minimize the sufferings of partners to seriously sick patients, regardless of the patients´ diagnosis.

<p>Acute myocardial infarction is a serious diagnosis. Both the patient and the loved ones experience an immediate uncertainty. To be able to emotionally support the patient´s spouse, the nurse in the coronary care unit must be prepared to also encounter the world of the spouse. The aim of this study was from a nursing perspective to illuminate how life was experienced during the first two months by the spouse of someone, who was stricken by a first time acute myocardial infarction. Interviews with six spouses were conducted. The methodological approach was phenomenological-hermeneutic, based on the French philosopher Paul Riceour. The result of the qualitative text analysis showed four themes: To lose one´s foothold, To be exposed to the medical and nursing staff, To get a changed relationship to one´s partner, To wish to make the most of one´s life. The first theme highlighted the spouse’s strong feelings of uncertainty concerning the outcome of the patient. The second theme showed the spouse’s confidence in the medical care. It also showed the spouse’s sense of being insulted by the nurses, who did not acknowledge the spouses´ need of obtaining information and emotional support. The third theme demonstrated how the partner cared for and felt responsible for observing the former patient´s health condition. The fourth theme showed that the spouse realized that life has to come to an end and therefore wanted to realize his/her plans for the future before it was too late. The findings from this study emphasize the importance of the medical and nursing staff to show interest in the spouses´ experiences. Thereby the spouses can experience a support in congruence with their needs, and their life situation might thereby be improved. It would be of great interest to study how nurses regard the spouses´ life situation during the patients´ stay in hospital. Further research could also highlight which factors could minimize the sufferings of partners to seriously sick patients, regardless of the patients´ diagnosis.</p>

Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions.The findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Thesis (Ph. D.)--Northwestern University, 1977. / Also issued in print.