European Journal of Cardiovascular Nursing

Editorial Board

2010-03-01

Driving in ICD recipients — New European recommendations

Tone M. Norekvål, Johan Vijgen — 2010-03-01

Laws and regulations governing the right of implantable cardioverter defibrillator (ICD) recipients to drive motor vehicles vary across Europe. Furthermore, there are no randomized, controlled intervention studies that can advise us on this issue. Therefore, making uniform recommendations are difficult. The first recommendations on driving in ICD recipients were published in 1997 , mainly aiming at ICD implantation as secondary prevention. Today, there is a considerable increase in ICD implants for primary prevention, and therefore new recommendations are needed. In 2007, the European Heart Rhythm Association (EHRA) in the European Society of Cardiology (ESC) appointed a task force on ICD and driving in order to update the 1997 recommendations. The paper outlining these recommendations is now co-publised in this issue of the European Journal of Cardiovascular Nursing .

Consensus statement of the European Heart Rhythm Association: Updated recommendations for driving by patients with implantable cardioverter defibrillators

2010-03-01

Abstract: Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document.Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.

European cardiovascular nurses' experiences of and attitudes towards having family members present in the resuscitation room

2009-11-05

Abstract: Purpose: To investigate cardiovascular nurses' experiences of and attitudes towards the presence of family members during resuscitation of adult patients.Methods: A 36-item questionnaire exploring the experiences of and attitudes towards family members being present in the resuscitation room was distributed to a convenience sample of nurses attending three national and one international cardiovascular nursing conferences held in Europe during 2007.Results: Of 820 questionnaires distributed, 411(50%) completed ones were returned. Of these 411 respondents, 178 (44%) had experienced at least one situation of families being present. Positive (23%) and negative (21%) experiences of family presence were equally distributed. Only 28 (7%) respondents stated that their unit had a protocol covering family presence. Nurses in Ireland (n=30; 59%) and the UK (n=18; 55%) were most likely to have experienced family presence and protocols relating to this were most commonly found in the UK (n=4; 14%).Conclusion: Less than half of the included European cardiovascular nurses had experienced a situation of families being present during resuscitation and protocols pertaining to this were rare. There was no clear attitude towards family presence, though experience in nursing made nurses more favourable towards it.

Sexual counselling of cardiac patients: Nurses' perception of practice, responsibility and confidence

2009-12-11

Abstract: Background: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients.Method: An adapted version of the nurses' survey of sexual counselling of MI patients was administered during a scientific meeting of the Council on Cardiovascular Nursing and Allied Professionals within the European Society of Cardiology.Results: Most of the 157 cardiovascular nurses (87%) who completed the survey felt responsible to discuss sexual concerns with their clients, especially when patients initiated a discussion. However in practice, most respondents rarely addressed sexual issues. The items that nurses reported to counsel patients were closely related to the cardiac disease, symptoms and medications and seldom more sensitive subjects (e.g. foreplay, positions). Nurses estimated that their patients could be upset (67%), embarrassed (72%) or anxious (68%) if they were asked about sexual concerns. One-fifth of the nurses felt they had insufficient knowledge and 40% sometimes hesitated to discuss sexual concerns with clients because they might not know how to answer questions. Additional education on sexuality was significantly related to being more comfortable and active in sexual counselling.Conclusion: Although cardiac nurses feel responsible and not anxious discussing patients' sexual concerns, these issues are not often discussed in daily practice. Nurses might need more knowledge and specific practical training in providing information on sexual concerns and sexual counselling to cardiac patients.

Effects of the characteristics of teaching on the outcomes of heart failure patient education interventions: A systematic review

Suzanne Fredericks, Heather Beanlands, Karen Spalding, Monica Da Silva — 2009-09-07

Abstract: Background: Limited research has examined the specific approach, mode of delivery, and dose of educational interventions. Yet such knowledge is essential to develop effective heart failure educational interventions.Aims and methods: The intent of this systematic review was to determine what approach, mode, and dose is most effective in producing changes in heart failure patient education. The sample included 69 studies involving 1865 study participants.Results: Findings indicate the most effective means for delivery heart failure patient education is through the individualization of content, the use of combined mediums for delivery, provision of education on a one-on-one basis, and in multiple sessions.Conclusion: These results highlight the need to redesign current heart failure patient education initiatives to enhance patient outcomes.

Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions

Robyn Gallagher, Renée Trotter, Judith Donoghue — 2009-10-21

Abstract: Background: Patients with anxiety prior to coronary angiography and percutaneous coronary intervention (PCI), may have negative physical and psychological consequences.Aim: To identify patients factors associated with anxiety and assess the validity of the Faces Anxiety Scale (FAS) in this sample.Methods: Patients (n=159) were surveyed preprocedure using the Spielberger State Anxiety Inventory (SAI) and the FAS and asked to identify their major concern.Results: The sample was aged an average 66.73years (sd 10.12) and predominantly male (72%). Anxiety was low to moderate (SAI mean 36.44, sd 11.23; FAS median 2, range 1–5). There was a moderate correlation between the SAI and the FAS (r=.521, p=<.001), with the FAS having low sensitivity (27%) and high specificity (95%). Patients' most common concern (37%) was uncertainty about the outcome from the procedure. Predictors of higher anxiety were taking medication for anxiety or depression (ß=5.84), experiencing angina (ß=4.96) or having a major concern about the procedural outcome (ß=4.00).Conclusions: Many patients have moderate anxiety before coronary angiography and PCI; therefore, routine assessment and management of anxiety are justified. The FAS is not as useful as the SAI for this purpose.

Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment

2009-10-15

Abstract: Background: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF.Aims: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation.Methods: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used.Results: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered.Conclusion: HRQOL is improved in AF patients with severe symptoms after PVI intervention.

Training nurses for CPR: Support for the problem-based approach

2009-11-05

Abstract: Aim: to assess whether problem-based learning (PBL) is more effective over conventional teaching methods by comparing final resuscitation exam results of nursing students who received cardiopulmonary resuscitation (CPR) training either by traditional or by a PBL approach.Methods: A retrospective and comparative research design was implemented. Data on final CPR exam grades, collected both from PBL and traditionally trained students, were obtained for a total of 1775 students between 2000 and 2007 in three major schools of health sciences in Hungary. Comparison between PBL and traditional teaching methods as well as across schools was made.Results: t-tests on means yielded significant differences (t=3.569; p<0.001) between PBL and conventional training favoring PBL instructed students. Students who received PBL training had better final CPR exam grades than traditionally trained peers. The only significant difference among schools was found for PBL training. There was no difference across schools in final CPR grades when traditional training was concerned.Conclusion: PBL was a superior instruction method for CPR training. Students who attended PBL classes achieved greater theoretical knowledge and demonstrated better resuscitation skills when tested. Whether or not PBL is superior in real-life application of CPR practice is yet to be confirmed.

Peer support intervention trials for individuals with heart disease: A systematic review

Monica Parry, Judy Watt-Watson — 2009-11-19

Abstract: Background: Heart disease is a major cause of illness, disability and death worldwide with high personal, community and healthcare costs. Social support affects psychological and physical morbidity, mortality, and adjustment to chronic disease. Peer support, a specific type of social support, has been shown to be an effective intervention for a variety of populations.Aim: The aim of this paper is to critically examine the effects of peer support interventions on health outcomes in individuals with heart disease.Methods: Searches were made of ACP Journal Club, EBM, CDSR, DARE, CCTR (1982–2005), MEDLINE (1966–2005), PsycINFO (1975-July 2005), HealthSTAR (1975-June 2005), and CINAHL (1982-July 2005) using text words and MeSH headings.Results: Electronic and hand searching yielded 27 studies and reviews. Six studies met the inclusion criteria and were assessed using guidelines from The Evidence-Based Medicine Working Group and The Cochrane Collaboration. Inferences about the results were limited to critical appraisal. The trials demonstrated some positive effects of peer support for individuals with heart disease, including higher levels of self-efficacy, improved activity, reduced pain, and fewer emergency room visits.Conclusion: Despite some evidence supporting peer support for individuals with heart disease, methodological problems preclude generalizations. Further research with greater methodological rigor is warranted.

Exploring uptake of cardiac rehabilitation in a minority ethnic population in England: A qualitative study

Umesh Chauhan, Deborah Baker, Helen Lester, Richard Edwards — 2009-11-23

Abstract: Background: In the United Kingdom ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of coronary heart disease related mortality and morbidity. Variation in prevalence and outcome is in part related to access to appropriate health care.Aims: This study explores the experiences of participants following an acute cardiac event; with a specific focus on reasons for the take up of cardiac rehabilitation services.Methods: Twenty participants (12 Pakistani, 6 Indian and 2 Bangladeshi) eligible for CR were interviewed using a semi-structured format.Results: Previous negative experience of the health care service related to communication difficulties was an important factor for not engaging with cardiac rehabilitation services. The importance of interventions by professional friends and family members appeared to increase appropriate access to care. Gender and religious beliefs were also important aspects that had an impact on uptake of services. Reasons for non-attendance were also related to service provision (setting and timing of classes), practical considerations (language barrier and transport problems), and poor understanding of cardiac rehabilitation.Conclusions: The findings highlight significant barriers to uptake at the participant level which require changes at the system and provider level if uptake is to improve.

Note to Authors

2010-03-01