QUALITY CARE ASSESSMENT AND ASSURANCE

From its beginnings in 1955, the American College of Nurse-Midwives has supported the concept of Quality Care Assessment and Assurance (QCAA) and charged its members with responsibility to involve themselves in such activities within their practice. Six tools are reviewed that represent a sound basis for the development of QCAA programs within nurse-midwifery practice, the ultimate goal being the provision of optimal health care to women and the childbearing family.     

Cardiac MRI in Congenital Heart Disease – Our Experience

A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.Key Words: Cardiac MRI, Congenital heart disease, Cyanotic and Acyanotic heart disease     

Part V. Self-care for Continued Breastfeeding

The resources of motivation and knowledge that make the nurse a valuable support to the new mother initiating breastfeeding are needed again, equally as much, as the nurse prepares the mother for self-care at home and remains available for counseling afterwards. There are general guidelines for promoting continued breastfeeding success and for avoiding potential problems. The nurse should be familiar with these and with how to proceed in special situations and with specific breastfeeding problems. "Self-Care for Continued Breastfeeding" and "Some Breastfeeding Problems and Solutions", presented below, end the series on breastfeeding begun in the July/August issue.
The advantages of continuing breastfeeding beyond the neonatal period are reviewed and general guidelines for selfcare at home are discussed. Developmental changes in the instant and psychological and physical changes in the mother are outlined and related to breastfeeding success. Advice for working mothers and for weaning is also presented.     

Non-invasive mechanical ventilation in patients with acute cardiogenic pulmonary edema

AIM: To evaluate the use of noninvasive mechanical ventilation (NIMV) in patients with acute cardiogenic pulmonary edema. METHODS: Design: prospective study. Setting: Emergency Department at a University hospital. Patients: 84 patients with acute respiratory distress due to pulmonary edema. Interven-tions: NIMV, using a pressure support mode and positive end-expiratory pressure (PEEP). A "weaning test" to evaluate clinical stability. Measurements: heart rate, arterial blood pressure, respiratory rate, arterial blood gases, electrocardiogram and incidence of myocardial infarction before and after NIMV. Mortality and duration of hospital stay were also considered. RESULTS: A total of 84 patients received NIMV with 14+/-3.6 cm H2O pressure support over PEEP of 8.3+/-2.1 cm H2O and FiO2 1. At the end of the study period, 16 patients (19%) were considered "non responders" and required invasive ventilation; 62 patients (74%) were considered "responders" and subsequently transferred to the medical ward. The hospital mortality was 14% and 25% in the "responder" and "non responder" groups, respectively; the length of stay was 15.7+/-10.1 days in the "responder" group vs 16+/-10.6 days in the "non responder" group. We never found new episodes of myocardial infarction related to NIMV. The only significant difference between "responder" and "non responder" patients was arterial blood pressure. CONCLUSIONS: We hypothesize that "non responder" patients, characterized by blood pressure values lower than "responders", are less "cardiocompetent" and thus unable to cope with the increased work of breathing. NIMV avoided Intensive Care Unit admission for 74% of the observed patients.     

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting

Aims and objectives

To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards.

Background

Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital‐acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people.

Design

Observational, point prevalence study.

Methods

Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail.

Results

Approximately one‐quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one‐third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one‐third of these were receiving intravenous fluids.

Conclusions

There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids.

Relevance to clinical practice

Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.     

An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions of Janis and Mann's conflict-theory model (CTM) of decision making within Lazarus and Folkman's transactional framework. Through combining decisional and stress and coping theories, a model is developed that addresses the theoretical limitations of the CTM and provides greater specificity within decision-making research. The paper examines the complexity of treatment decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.