Head of bed elevation, early walking, and patient comfort after percutaneous transluminal coronary angioplasty:

A Survey of Coping Strategies With Stress in Patients With Acute Myocardial Infarction and Individuals Without a History of Fixed Myocardial Infarction

Background

This study aimed at investigating the coping strategies with stress in patients with acute myocardial infarction (MI) and individuals without a history of fixed MI and cardiovascular disorders.

Methods

This case-control crossover study was conducted from March 2015 to February 2016 on 220 patients with acute MI (MI patients) as case group and 220 patients without any history of MI and cardiovascular diseases as the control group using availability sampling method. To collect the required data, demographic information questionnaire, Holms-Raheh life stress inventory, perceived stress questionnaire, and coping inventory for stressful situations (CISS) were applied.

Results

On the basis of our findings, 118 patients (53.6%) with MI used emotion-focused coping strategy. Ninety-seven patients (82.2%) with MI who used emotion-focused coping strategy had negative perceived stress. Additionally, 71 patients (60.2%) with MI who had used emotion-focused coping strategy suffered from very high level of stress.

Conclusion

The most MI patients had very high level of stress while most people in control group had high level of stress. Most MI patients that had very high level of stress cope with it in emotion-focused coping strategy and it proves that people with higher levels of stress are more likely to use inefficient coping strategies.

The Effect of Head of Bed Elevation on Patient Comfort After Angiography

BACKGROUND

Maintaining patient comfort and avoiding complications after coronary angiography are important both to the patient and the nurse. Strict bed rest with the head of bed (HOB) completely flat is standard care for postprocedure positioning to decrease pressure on the femoral artery. This position is not thought to be the most comfortable position for patients.

OBJECTIVE

The purpose of this study was to determine if raising the HOB to 15° would impact patient comfort after cardiac angiography.

METHODS

This study used a randomized, controlled crossover design to compare 3 groups with different HOB positions during the first hour after procedure.

RESULTS

Data from 71 patients demonstrated that HOB position did not significantly impact difference in pain/discomfort rating.

CONCLUSIONS

Of all the nursing interventions designed to improve patient comfort after angiography, slightly raising the HOB was not a factor in reducing pain/discomfort.

Hours During and After Coronary Intervention and Angiography

The purpose of this study was to describe patients’ experience during and after coronary angiography and percutaneous coronary intervention. Data were collected by interviews with 14 patients. A qualitative content analysis approach was used. Four main categories were identified that describe patients’ experience of the hours during and following intervention: emotional thoughts, bodily sensations, nursing intervention of importance, and personal strategies. All patients made a comment on staff conduct and pointed out that even minor nursing actions may be of great importance. Patients were most positive toward the transradial approach. Even though the approach via arteria radialis will increase, many patients will still have their procedure done via arteria femoralis. In spite of all research and technical developments, the patients’ experience from intervention via arteria femoralis is pretty much the same as it was 1997.

Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses

BACKGROUND

Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care.

AIM

This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand.

METHOD

Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system.

RESULTS

Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area.

CONCLUSION

This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.

Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach

AIM

To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management.

DESIGN

Systematic review.

METHOD

The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage).

RESULTS

Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase.

CONCLUSIONS

Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design.

RELEVANCE TO CLINICAL PRACTICE

To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.

Nursing Outcomes

Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.