Ineffective ICD therapy due to excessive alcohol and exercise

A 49-year-old man with dilated cardiomyopathy and an ICD received eight unsuccessful shocks for a single episode of ventricular tachycardia after excessive alcohol intake and exercise. The patient had low defibrillation thresholds just 8 days prior to his event during a routine 6-week postimplant electrophysiological study. Defibrillation threshold testing after his incident confirmed the low energy requirement for ventricular tachycardia termination. A previous animal study reported that intravenous ethanol elevates the defibrillation energy in a dose dependent manner. However, a recent study in humans showed that modest alcohol intake had no effect on defibrillator thresholds. This case report supports the animal data and suggests that excessive alcohol consumption can cause a life-threatening situation in ICD patients.     

Ineffective airway clearance and ineffective breathing patterns: theoretical and research base for nursing diagnosis

This article addresses the conceptual approach to nursing diagnosis in general and the theoretical and research base for these two nursing diagnoses. Pertinent issues concerning the use of nursing diagnoses in clinical practice are presented within the framework of the nursing process. This is followed by a review of mechanisms of airway clearance and normal breathing patterns which form the theoretical basis for the subsequent articles on alterations in airway clearance and breathing patterns.     

The art of nursing: communication and self-expression

Nursing is considered both an art and a science, yet the nature of art and science has been historically depicted as two distinct fields of inquiry in the health professions. To meet the health challenges of the future, blending science and art through nursing theory, research, and practice is critical. This article describes how nurses in a master's of nursing program at Dalhousie University broke with tradition for the practicum course to articulate and apply the theoretical elements of knowing using aesthetic inquiry. The challenge was in articulating and guiding students through the theory of aesthetic knowing, the linkages with the fine arts, and the conceptualization of nursing art.     

Effective nursing documentation and communication

OBJECTIVES: To identify the documentation and communication requirements an oncology nurse should follow to avoid negligence or malpractice suits. DATA SOURCES: Lexis, Medline, Westlaw, nursing and medical literature, and nursing legtal texts. CONCLUSIONS: Effective communication and documentation is an essential part of an oncology nurses' role and will reduce the risk of liability. IMPLICATIONS FOR NURSING PRACTICE: The old adage "not documented, not done" applies more today than ever before. Continuous, meticulous documentation and communication are essential for quality care as well as reduction of liability in every setting the oncology nurse practices.     

Perceptions and observations of off-shift nursing

Aim The purpose of this paper is to qualitatively explore registered nurse perceptions of off-shift (e.g. nights and weekends) nursing care and quality compared with regular hours. Background Patients admitted to hospitals on off-shifts have worse outcomes than patients admitted on more regular hours. The underlying mechanism for this association is not well understood. Methods In-depth semi-structured interviews of 23 registered nurses and four observer-as-participant observations were conducted on both medical–surgical and intensive care units in two large (>850 beds) tertiary hospitals. Content analysis was used to identify themes. Results Six themes emerged: (1) collaboration among self-reliant night nurses; (2) completing tasks; (3) taking a breather on weekend day shift; (4) new nurse requirement to work at night; (5) mixture of registered nurse personnel; and (6) night nurse perception of under-appreciation. Conclusions Although nurses collaborate, complete more tasks and work with other types of registered nurses, the decreased resources available on off-shifts may affect quality care delivered in hospitals. Implications for nursing management These findings support the importance of management to provide sufficient resources in terms of ancillary personnel and balance less experienced staff. Facilitating communication between night and day nurses may help allay night nurses’ feelings of under-appreciation.     

Intershift report: oral communication using the nursing process

To enhance the quality of orally communicated patient care data, use of the patient's problem list and subjective objective assessment plan (SOAP) format for organizing intershift report is described. This reporting structure requires use of the nursing process, with nursing diagnosis being the focus in reporting nursing care management.     

护理信息沟通本在护理管理中的应用

信息沟通广泛存在于组织的管理活动中。管理者的决策需要信息沟通,决策一旦做出,又需要通过沟通的手段来实现,否则决策就难以得到较好的贯彻执行。而组织成员中一些好的建议和好的想法也需要沟通,否则就无法得到认可和实施。对管理者来说,有效的沟通是至关重要的,是护理管理的重要内容。由于护理人员的班次为三班倒,难免有些信息不能及时传达到每一个人。护理信息沟通本作为文字性沟通方式,避免信息丢失,便于查阅,使信息传递及时准确,护理人员信息共享,各项护理工作顺利实施。我院自2004年4月起,在科室护理管理中增设护理信息沟通本,经过一…     

Teaching communication skills to nursing home certified nursing assistants

Increasing numbers of terminally ill patients are admitted to nursing homes. Quality palliative care requires good communication skills, but certified nursing assistants (CNAs), who spend the most time with residents, are inadequately trained. They receive little education in communication during training programs or as in-services in the nursing home. Education and role-playing during their training program could be used to learn these skills, as could a series of short videos. Further research is needed to develop and test new methods of teaching communication skills to nursing home CNAs.