Ventricular assist devices: what intensive care unit nurses need to know about postoperative management

Patients with advanced heart failure have limited treatment options despite advances in medical management. Ventricular assist devices represent a surgical option that offers improved end-organ function, survival, and quality of life. Postoperative nursing management involves the most complicated aspects of care following cardiac surgery as well as issues unique to advanced heart failure and mechanical circulatory support. Despite growing numbers of ventricular assist device implants, literature about the challenging care of patients following ventricular assist device implantation is limited. This article focuses on the physiological basis for postoperative nursing management strategies and the most important complications of which critical care nurses need to be aware.     

Managing as carers of stroke survivors: strategies from the field

Family members are required to provide increasingly complex care to relatives in the home. Stroke is a major cause of disability and there is increasing pressure being placed on carers to provide on-going support to stroke survivors living in the community. This study involved interviewing carers to determine their perspectives on the support and educational needs they require and the coping strategies they used. Data analysis revealed that carers experienced considerable uncertainty about their role as carers and their future and that they used a number of coping strategies to manage in their caring role. The coping strategies adopted by the carers included remaining positive, adapting to change, comparing their situation with others who were worse off, changing their employment status, humour, switching off and using family support. It is important for health care professionals to understand the complex role of the carers and to advise them on strategies they can use to assist managing this role.     

The lived experience of spouses of patients with a left ventricular assist device before heart transplantation.

BACKGROUND: No publications describe the life experience of spouses who are designated caregivers of patients with a left ventricular assist device before transplantation. OBJECTIVE: To explore what life is like for spouses serving as caregivers of patients with a left ventricular assist device before transplantation and to assess the meaning of such experience to them. METHODS: This phenomenological study included 3 women 38 to 52 years old who were designated caregivers of patients with a left ventricular assist device while the patients were waiting at home for a heart transplant. RESULTS: Three major themes emerged-emotional distress, determination, and optimism: a new lease on life. The identified themes were elucidated by 8 subthemes: guilt and realization of severity of illness, fear and anxiety, recognition that being a caregiver is an overwhelming experience and a burden, coping, living with hope, realization of loving relationship, adaptation to a new life, and joyful feeling. CONCLUSION: The spouses who served as caregivers had strong emotions as they entered each stage of this life experience. The stages were characterized by the identified themes and subthemes, which otherwise might not have been revealed or might have remained private to the study participants. Critical care nurses should recognize and anticipate challenges for these stages of life experienced by the spouses as caregivers. Heightened awareness of this phenomenon will guide nurses in individualizing plans of care, educating patients and patients' families, and evaluating outcomes of care.     

Parental coping and activities during pediatric critical care.

OBJECTIVE: To investigate the relationship of locus of control, parental age, and state anxiety to parental coping and activities performed during hospitalization of a child in a pediatric critical care center. DESIGN: Cross-sectional. SETTING: Pediatric critical care center at a university medical center. PARTICIPANTS: A convenience sample of 47 parents of 47 children hospitalized in a critical care center. MAIN OUTCOME MEASURES: Parental coping strategies and activities performed during hospitalization in a critical care center. RESULTS: Older, more self-directed and less anxious parents were found to use coping strategies focusing on problem solving rather than on their emotional response to a child's hospitalization. Further, those who used the problem-focused coping modes were more likely to be involved in caring for the child, while parents who used emotion-focused coping modes participated less in care activities. CONCLUSIONS: Appropriate strategies to bolster coping and reduce stress of parents need to be constantly reassessed because coping mechanisms vary according to parental age, locus of control, anxiety level, and parental involvement in child-care activities. More research is needed in the changes of parental coping mechanisms with time and child-care activity, to assess the benefits of interventions planned to encourage a problem-focused approach.     

Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia

This cross‐sectional study examined relationships among factors influencing caregiver burden, depressive symptoms, and physical health in family caregivers of individuals with schizophrenia. Two hundred family caregivers of individuals with schizophrenia completed standardized questionnaires related to depressive symptoms, physical health, perceptions of burden, coping, and social support. The results revealed that 19.5% of family caregivers of individuals with schizophrenia experienced significant depressive symptoms and 65.5% perceived themselves in poor physical health. Burden, self‐controlling coping strategies, and physical health status were all independently predictive of depressive symptoms. Two emotion‐focused coping strategies (self‐controlling and escape‐avoidance) were independently predictive of caregiver burden. Only burden predicted physical health status. The findings suggest that health professionals who provide community care for those with schizophrenia need to consider the “unit of care” as the family rather than the individual. The health status of family caregivers should be routinely assessed. Individualized interventions to reduce family burden could include community‐based health professionals as well as trained community volunteers, opportunities for social interaction, and improving self‐care for all family members.     

Interaction between caregivers and families expecting a malformed child

BACKGROUND: Earlier research has shown that the care of families expecting a malformed child should be intensified and that the topic is understudied. AIM: This study aimed at generating a practical nursing theory of interaction between caregivers and families expecting a malformed child, as experienced by families. METHODS: A grounded theory study was undertaken at a university hospital, Finland. Data consisted of semi-structured interviews with 29 mothers and fathers, analysed using the constant comparative method. FINDINGS: The interaction process starts with the confirmation of the diagnosis. It usually comes as a shock to the parents, and gives rise to questions about the nature of the malformation, family members' relationship with themselves, family relationships and relationships with people outside the family. These questions are crucial to the family's coping and form the core of interaction. Families' own coping strategies are either reinforced or undermined by caregivers' actions and are reflected in parents' expectations about caregivers, which in part account for their actions and experiences of interaction. The care system as an interactive environment is part of a process which results in the experiences of being helped or being left without help. The core of the interaction process comprises two dimensions: gaining strength and losing strength in relation to malformation issues. CONCLUSIONS: The findings of the study are consistent with earlier research and complement it by providing a detailed delineation of the interaction from the perspective of the family. They can be used to formulate recommendations for improving caregivers' interactive skills and awareness of the topic through training. The care system should be developed to ensure that families receive psychological support and that the family as a whole receives proper care. Consideration of the viewpoint of siblings is a challenge for further research.     

Management of adult patients with a left ventricular assist device.

The number of left ventricular assist device (LVAD) implantations is growing as a result of increased waiting periods for cardiac transplantation and the decreased availability of organ donors. Furthermore, the Food and Drug Administration (FDA) has approved permanent LVAD support. After an acute hospitalization, patients with LVADs may need prolonged convalescence in a healthcare facility because they have complex medical needs and are physically disabled. Admission criteria need to be developed as essential patient and nursing competencies need to be defined as a part of a successful LVAD program in an acute rehabilitation center. Acute rehabilitation centers can help patients with LVADs transition to a home setting.     

Preterm Birth: Implications for Family Stress and Coping

The event of preterm birth represents a significant risk to the equilibrium of the family, often placing the family under significant stress. This paper is intended to assist neonatal nurses in understanding factors related to a family's appraisal of stress and strategies used for coping. Such factors are an important consideration in planning the most effective interventions to support optimal family adaptation to their preterm infant's birth. In identifying the best clinical approaches to supporting a family coping with the event of a preterm birth, nurses need to consider levels of the evidence that supports adoption of clinical intervention strategies. Working to reduce family stress and improve family coping ensures the most optimal home environment for the preterm infant to grow and thrive in after discharge.     

Social support and coping in Turkish patients with cancer

This study was conducted with the aim of determining the relationship between social support and coping strategies in cancer patients and that between the sociodemographic and medical properties of patients. One hundred forty-eight cancer patients admitted to an oncology and hematology clinic in Erzurum were studied. The data were collected using a questionnaire that determines sociodemographic features: the Ways of Coping Inventory and the Perceived Social Support From Family Scale. Among the coping strategies, patients were found to use unconfident approach (emotion focused) (16.8 +/- 5.5) the most and seeking social support (problem focused) (8.3 +/- 2.6) the least. Mean +/- SD score for perceived social support from the family was 15.9 +/- 2.7. Significant correlations were found among social support and coping strategies. We found a negative correlation between social support and emotion-focused coping strategies (unconfident approach and submissive approach). As the social support scores increased, scores regarding emotion-focused coping strategies decreased. On the other hand, there was a positive correlation between social support and problem-focused coping strategies (confident approach, optimistic approach, and seeking social support); that is, mean social support scores increased as the mean problem-focused coping strategy scores increased. This result implies that families have important roles for patients and should be educated and supported by healthcare professionals in approaching patients in a knowing way. In addition to the results, this study could be used to help develop nursing interventions and efficient coping strategies. Patients may then be able to use the latter to solve symptom-associated distress, consequently enhancing their quality of life.     

Competence,challenges and attitudes of bedside nurses caring for patients with left ventricular assist devices

ObjectivesWe aimed to describe the bedside registered nurses perceived competence, attitudes, and challenges surrounding the management of patients with left ventricular assist devices (LVAD) in the intensive care unit (ICU) and stepdown unit (SDU).Research methodology/designAn exploratory research was employed using a survey.SettingBedside participants were recruited via an electronic recruitment flyer circulated in online professional and social networking sites.Main outcome measuresItems consisted of a numeric rating scale, measuring competence and attitudes related to the management of patients with left ventricular assist devices. The one open-ended question asked the participants to write responses regarding challenges in left ventricular assist device care. Data were analysed using quantitative and qualitative analytics software.ResultsA total of 36 intensive care unit and 35 stepdown unit bedside nurse (n = 71) from six regions of the United States responded. Overall mean scores for competency and attitude domains were ≥ 7.0. Intensive care nurses scored higher in competence and attitude when compared to stepdown unit nurses care of short-term left ventricular assist devices. Competence and attitude were positively associated with years of experience. Five themes related to challenges in care were identified.ConclusionOverall, bedside nurses had satisfactory competence and attitudes surrounding the care of hospitalised left ventricular assist device patients.     

Promoting lifestyle change in the prevention and management of type 2 diabetes

PURPOSE: To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices. DATA SOURCES: Selected scientific literature and the Internet. CONCLUSIONS: There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals. IMPLICATIONS FOR PRACTICE: APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow-up.     

Withdrawal of cardiac medications and devices

Withdrawal of life-sustaining therapies such as cardiac medications, pacemakers, internal cardioverter defibrillators, and ventricular assist devices occurs in patients with advanced cardiac disease as goals of treatment transition from active to less aggressive. This article defines life-sustaining therapies and describes ethical and legal considerations related to withdrawal of cardiac medications and cardiac devices. Healthcare providers need to anticipate clinical situations in which implantable cardiac devices and medications are no longer desired by patients and/or are no longer medically appropriate. Discussions are important between patients, families, and healthcare providers that focus on each patient's condition, prognosis, advance directives, goals of care, and treatment options. Critical care nurses support each patient and his or her family and work with other members of the healthcare team to achieve a peaceful death.     

Coping Responses of Emergency Physicians and Nurses to the 2003 Severe Acute Respiratory Syndrome Outbreak

Objectives: During the 2003 severe acute respiratory syndrome (SARS) outbreak, health care workers (HCWs) experienced unusual stressors. The study hospital introduced psychosocial interventions to help HCWs. This study aimed to examine the coping strategies adopted by the emergency department (ED) HCWs who cared for the SARS patients. Methods: In November 2003, a self-administered questionnaire of physicians and nurses was conducted in the hospital ED that is the national SARS screening center in Singapore. Data collected included demographics and responses to these instruments: 1) the Coping Orientation to Problems Experienced (COPE) to assess coping strategies, 2) the Impact of Event Scale (IES) to measure psychological reactions, and 3) the General Health Questionnaire 28 (GHQ 28) to measure psychiatric morbidity. Results: Thirty-eight of 41 (92.7%) physicians and 58 of 83 (69.9%) nurses responded. The respondents reported a preference for problem-focused and emotion-focused coping measures. The physicians chose humor as a coping response significantly more frequently (p < 0.001) than nurses, scoring 9.61/16 (95% CI = 8.52 to 10.69), compared with the nurses' score of 7.05/16 (95% CI = 6.28 to 7.83). The Filipino HCWs turned to religion as a coping response significantly more frequently (p < 0.001) than the non-Filipino HCWs, scoring 14.38/16 (95% CI = 13.33 to 15.42), compared with 9.93/16 (95% CI = 9.00 to 10.87) for the non-Filipinos. Psychiatric morbidity was 17.7% on the IES and 18.8% on the GHQ 28, with the trend for physicians to report lower psychiatric morbidity. Conclusions: With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.     

Supporting families of patients who die in adult intensive care: A scoping review of interventions

BackgroundFamilies who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement.AimTo identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used.DesignScoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines.Data sourcesA systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently.ResultsSeven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported.ConclusionThis review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care.Implications for clinical practiceIntensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure.     

Coping processes of Taiwanese families during the postdischarge period for an elderly family member with hip fracture

The purposes of this study were to develop a conceptual framework explaining the coping processes of Taiwanese families after hospital discharge of an elderly family member with hip fracture and to use the Roy adaptation model to examine their interdependence relationships. In-depth, face-to-face interviews were tape-recorded and transcribed verbatim. Data were analyzed by grounded theory method. Findings revealed that a harmony between receiving and giving relationships was maintained by care receivers and caregivers during the postdischarge period to achieve an outcome of adaptation in their relationships. By understanding these coping processes, nurses can assist families to enhance adaptation.     

Percutaneous left ventricular assist devices for treatment of patients with cardiogenic shock

PURPOSE OF REVIEW: This review will discuss the rationale and clinical utility of percutaneous left ventricular assist devices in the management of patients with cardiogenic shock. RECENT FINDINGS: Left ventricular assist devices maintain partial or total circulatory support in case of severe left ventricular failure. Currently, two percutaneous left ventricular assist devices are available for clinical use: the TandemHeart and the Impella Recover LP system. Compared with the intraaortic balloon pump, the TandemHeart has been shown to significantly reduce preload and to augment cardiac output. In a randomized comparison between the TandemHeart and intraaortic balloon pump support in patients with cardiogenic shock, the improved cardiac index afforded by the left ventricular assist device resulted in a more rapid decrease in serum lactate and improved renal function. There were, however, no significant differences with respect to 30-day mortality, and complications including limb ischemia and severe bleeding were more frequent with left ventricular assist devices than intraaortic balloon pump support. SUMMARY: The advent of percutaneous left ventricular assist devices constitutes an important advance in the management of patients with severe cardiogenic shock and may serve as bridge to recovery or heart transplantation in carefully selected patients. While improvement of hemodynamic parameters appears promising, it remains to be determined whether this benefit translates into improved clinical outcome.     

Life-sustaining treatment. A legal-ethical dilemma

The U.S. Supreme Court decision in Cruzan by Cruzan v. Harmon will have a major impact on how we will care for patients in a persistent vegetative state. Each healthcare institution will need to review its life-sustaining treatment policies to match the guidelines established by the Supreme Court. Nurse executives also need to develop strategies to manage staff morale in coping with the conflicts surrounding the issues of preservation of life, quality of life, and patient/family choice regarding treatment.     

Interventions to improve care during withdrawal of life-sustaining treatments

Withdrawal of life-sustaining therapies is a common occurrence in the intensive care unit (ICU) setting and also occurs in other hospital settings, long-term care facilities, and even at home. Many studies have documented dramatic geographic variations in the prevalence of withdrawal of life-sustaining therapies, and some evidence suggests this variation may be driven more by physician attitudes and biases than by factors such as patient preferences or cultural differences. A number of studies of interventions in the ICU setting have provided some evidence that withdrawal of life-sustaining therapies is a process of care that can be improved. The interventions have included routine ethics or palliative care consultations, routine family conferences, and standardized order protocol for withdrawal of life support. For some of the interventions, for example, ethics consultations or palliative care consultations, the precise mechanisms by which the process of care is improved are not clear. Furthermore, many of these studies have used surrogate outcomes for quality, such as ICU length of stay. Emerging research suggests more direct outcome measures may be useful, including family satisfaction with care and assessments of the quality of dying. Despite these relative limitations, these studies provide convincing evidence that withdrawal of life-sustaining therapy is a process of care that presents opportunities for quality improvement and that interventions are successful at improving this care. Further research is needed to identify and test the most appropriate and responsive outcome measures and to identify the most effective and cost-effective interventions.