Linda S. Baas

Spirituality in Persons with Heart Failure

Spiritual expression has been proposed as a dimension of quality of life. Persons with chronic diseases such as AIDS or cancer have described the value of spiritual expression in living with their illnesses. The authors examined the role spirituality plays in the lives of 58 people with heart failure being treated medically or by transplant. Instruments used included the Medical Outcome Survey Short Form 36 and Index of Well-Being measures of quality of life, the Spiritual Well-Being Scale, and the Relative Importance Scale. Combined spirituality scores predicted 24% of the variance in global quality of life. There were no significant gender differences in spiritual well-being or quality of life.

An exploratory study of body awareness in persons with heart failure treated medically or with transplantation.

Heart failure is a chronic disabling problem afflicting a growing number of adults. These individuals experience episodes of exacerbation demonstrated by increasing shortness of breath, fatigue, and fluid retention. The symptoms often develop in a slow and insidious manner making perception of worsening difficult to determine. Theoretically, an increase in body awareness may help individuals recognize symptoms of worsening heart failure earlier, but it is not known whether increased body awareness leads to somatization, an abnormal dwelling on body symptoms. This study was conducted to describe body awareness in 90 persons with heart failure or after transplant. We found that the Body Awareness Quesionnaire was a reliable measure of this concept in this sample. When body awareness was examined for age, gender, and treatment (HF or transplant) group were examined, no significant differences were found. Furthermore, there were no significant relationships between body awarenss and negative moods such as anxiety, depression, or anger. Interventions to enhance body awareness may be a fruitful new direction that will improve symptom recognition without increasing somatization in persons with heart failure.

Promoting self-care through symptom management: A theory-based approach for nurse practitioners

Purpose: To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. Data sources: Literature review of relevant theory and associated literature, case studies from clinical practice. Conclusions: An individual asks several questions when experiencing a physical sensation: “Am I sick, stressed, or is this a sign of aging? If I’m sick, is the symptom connected with a disease label?” After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual’s cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. Implications for practice: NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal’s CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual’s cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient’s distress in the management of symptoms.

Self-care resources and activity as predictors of quality of life in persons after myocardial infarction.

An ex post facto correlational study was conducted to examine predictors of quality of life in persons 3 to 6 months after a myocardial infarction. Self-care resources, self-care knowledge (needs), activity level, and selected demographic variables were examined as predictor variables. A convenience sample of 86 subjects with a mean age of 61 years, was recruited for participation in this study. The study that explained 35% of the variance in quality of life included self-care resources available, activity level, and self-care needs. Modeling and Role Modeling Paradigm provided a useful explanation of how self-care resources and self-care knowledge can be applied to persons recovering from myocardial infarction.

Medical devices and attachment: holistic healing in the age of invasive technology.

The environment is filled with wonderful examples of medical technology that provide emergency life support, improve well-being, and offer the possibility of a longer and more productive life. But these devices are no longer only a part of the external environment. As technology advances, more devices are becoming a part of the internal environment (i.e., our bodies) as well. For some people an implanted mechanical device, such as a cardiac pacemaker or a cardioverter defibrillator, is readily accepted; for others it may be seen as an encroachment. It may be a symbol of loss and debilitation or of independence and resilience. What makes the difference? How can nurses facilitate a healthy adjustment and healing in an era permeated with technology? A discussion of the symbolism, related theory, and nursing implications is provided.

An Exploratory Study of Developmental Growth in Adults with Heart Failure

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.

American Association of Heart Failure Nurses Position Paper on Educating Patients with Heart Failure

Heart failure (HF) affects nearly 6 million Americans, a number projected to increase by 46% in the year 2030.1 The diagnosis of HF necessitates that patients and families develop self-care skills and adopt lifestyle changes that facilitate controlling symptoms and slowing the progression of the disorder.2,3 These lifestyle changes include: managing a prescribed medication regimen; recognizing signs and symptoms of worsening HF; making dietary changes and adopting an individually tailored exercise program.2,3 In order to engage in self-care, persons with HF and their support systems need to acquire knowledge and skills specific to the health problem and the various pharmacologic therapies, devices, and nonpharmacologic interventions that are part of overall HF disease management.4 The aim of these efforts is to improve quality of life5 and increase survival. Thus, patient and family education is essential to prepare patients with HF for self-care. The American Nurses Association (ANA) Scope and Standards of Cardiovascular Nursing identifies patient education as a fundamental responsibility of the nurse.6 Since its inception in 2004, The American Association of Heart Failure Nurses (AAHFN) has been a participating organization in the development of all editions of the Cardiovascular Scope and Standards that guide HF nursing practice. Furthermore, multidisciplinary guidelines for the treatment of patients with HF include patient education as a highly recommended non-pharmacologic treatment.7e9 In addition, adherence with national standards that address patient education are required for program accreditation10 and certification.11e13 Heart failure discharge instructions for patients has been defined by The Joint Commission to include six topics: diet, exercise, weight monitoring, worsening symptoms, medications and follow up appointments.10,12 Thus, comprehensive patient education has been solidified as essential to patient care and is a responsibility of nursing.14 Heart failure patient education has had increased awareness and efforts to complete documentation of “discharge instructions”,15 yet such education has been performed using varied methods with uncertain effectiveness.11,12,16,17 Meaningful

Development of the implanted devices adjustment scale.

Advances in microelectronics have resulted in exponential growth in the number of implanted medical devices. Most people do well adjusting to their devices, but others show signs of depression and/or anxiety. The Implanted Device Adjustment Scale (IDAS) was developed to measure how well a person is adjusting to an implanted device. First, a pool of items was generated and reviewed by 2 panels of clinicians and psychometricians for content validity. The revised version was then administered to a small sample that provided information about problematic items. Finally, a convenience sample of 45 persons (66% males) with implanted devices (18 pacemakers only, 37 cardioverter/defibrillators) completed the revised IDAS twice. After deleting weak items, the Cronbach alpha was 0.90. No age, gender, or device differences were found. Test-retest reliability was 0.92. The IDAS may be useful to evaluate how well a person is adjusting to her/his device. This may lead to more timely and appropriate interventions to improve outcomes.

HFSA and AAHFN Joint Position Statement: Advocating for a Full Scope of Nursing Practice and Leadership in Heart Failure

The Heart Failure Society of America (HFSA) and theAmerican Association of Heart Failure Nurses (AAHFN)share a common core mission to improve outcomes ofpatients with heart failure. A recent report underscoredthe importance of increasing advocacy efforts to enablenurses to practice to the full extent of their education andtraining and engage in full partnership with physiciansand other health professionals in redesigning health care.

Infection precautions with temporary pacing leads: A descriptive study*

OBJECTIVE To describe infection precautions used by nurses when caring for patients with temporary epicardial and transvenous pacemakers. DESIGN Descriptive, nation-wide survey. SETTING All U.S. hospitals performing cardiac surgery. RESPONDENTS Nurse managers and clinical specialists from cardiac and thoracic intensive care, coronary care, and telemetry units at all U.S. hospitals performing cardiac surgery. INTERVENTION The Pacemaker Electrode Care and Safety Survey. RESULTS Responses came from 43% (388) of the 895 hospitals. Most respondents indicated that they wore gloves when handling electrodes (approximately 96%); usually the gloves were nonsterile (73%). A sterile procedure was often used to perform site care (37% for epicardial and 65% for transvenous). The most common agent used for site cleansing was povidone-iodine. Concern has been expressed in the literature about use of this agent. Gauze was the most common type of dressing (used by 60% for epicardial dressings and 31% for transvenous). CONCLUSION There is diversity in clinical practice. Further study is recommended to establish the safety, efficacy, and cost-effectiveness of identified infection precautions.