Nina Fålun

Evaluation of the appropriateness and outcome of in-hospital telemetry monitoring.

The American Heart Association classifies monitored patients into 3 categories. The aims of this study were to (1) investigate how patients are assigned according to the American Heart Association classification, (2) determine the number and type of arrhythmic events experienced by these patients, and (3) describe subsequent changes in management. A prospective observational study design was used. All patients assigned to telemetry during a 3-month period were consecutively enrolled in our study. Data were collected 24/7. Only arrhythmias that might require a change in management were recorded. Monitor watchers at the central monitoring station completed a standard data sheet assessing 64 variables. These data, as well as medical records, were reviewed by the investigator. Overall, 1,194 patients were included. Eighteen percent of the patients were assigned to American Heart Association class I (monitoring indicated), 71% to class II (monitoring may be of benefit), and 11% to class III (monitoring not indicated). The overall arrhythmia event rate was 33%. Forty-three percent of class I patients, 28% of class II patients, and 47% of class III patients experienced arrhythmia events. Change in management occurred in 25% of class I patients, 14% of class II patients, and 29% of class III patients. Although the number of class III indications should have been reduced, nearly 1/2 of class III patients experienced arrhythmia events and 1/3 of them received management changes. This outcome challenges existing guidelines. In conclusion, most patients in this study were monitored appropriately, according to class I and II indications.

Patients’ goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction

Background: Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients’ ability to effect lifestyle changes at the time of discharge is limited. Aim: The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients. Methods: We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis. Findings: Three themes suggested that, at the time of discharge, patients’ views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going. Conclusions and implications: There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.

Improvement of in-hospital telemetry monitoring in coronary care units: An intervention study for achieving optimal electrode placement and attachment, hygiene and delivery of critical information to patients

Background: In-hospital telemetry monitoring is important for diagnosis and treatment of patients at risk of developing life-threatening arrhythmias. It is widely used in critical and non-critical care wards. Nurses are responsible for correct electrode placement, thus ensuring optimal quality of the monitoring. The aims of this study were to determine whether a complex educational intervention improves (a) optimal electrode placement, (b) hygiene, and (c) delivery of critical information to patients (reason for monitoring, limitations in cellular phone use, and not to leave the ward without informing a member of staff). Methods: A prospective interventional study design was used, with data collection occurring over two six-week periods: before implementation of the intervention (n=201) and after the intervention (n=165). Standard abstraction forms were used to obtain data on patients’ clinical characteristics, and 10 variables related to electrode placement and attachment, hygiene and delivery of critical information. Results: At pre-intervention registration, 26% of the electrodes were misplaced. Twelve per cent of the patients received information about limiting their cellular phone use while monitored, 70% were informed of the purpose of monitoring, and 71% used a protective cover for their unit. Post-intervention, outcome measures for the three variables improved significantly: use of protective cover (p<0.001), information about the purpose of monitoring (p=0.005) and information about limitations in cellular phone use (p=0.003). Nonetheless, 23% of the electrodes were still misplaced. Conclusion: The study highlights the need for better, continued education for in-hospital telemetry monitoring in coronary care units, and other units that monitor patients with telemetry.

Music during after-death care: a focus group study.

BACKGROUND The intensive care unit (ICU) is not only a place to recover from injuries incurred during accidents and from serious illness. For many patients, it is also a place where they might die. Nursing care does not stop when a patient dies; rather, it continues with the care of the deceased and with family support. The aims of this study were (1) to explore the experiences and attitudes of nurses towards the use of ambient music in the ICU during after-death care and (2) to describe the feedback nurses received from relatives when music was used during the viewing. METHOD A qualitative design employing focus group interviews was used. Three focus group interviews with 15 nurses were conducted. All the interviews were audiotaped, transcribed verbatim and analysed using qualitative content analysis. FINDINGS Six main categories of attitudes emerged from the analysis: (1) different attitudes among nurses towards the use of music; (2) music affects the atmosphere; (3) music affects emotions; (4) use of music was situational; (5) special choice of music and (6) positive feedback from the bereaved. CONCLUSION This study demonstrates that music might be helpful for nurses during after-death care as well as for the care of the relatives. RELEVANCE TO CLINICAL PRACTICE Including ambient music in an after-death care programme can help nurses show respect for the deceased as the body is being prepared. Music played during the viewing may be a way of helping relatives in their time of grieving. It may ease the situation by making that event special and memorable. However, standardizing this intervention does not seem appropriate. Rather, the individual nurse and the family must decide whether music is to be used in a particular situation.

Practical challenges regarding in-hospital telemetry monitoring require the development of European practice standards.

Practical challenges regarding in-hospital telemetry monitoring require the development of European practice standards

Telemetriovervåkning av hjertepasienter: En studie av elektrodeplassering, hygiene og pasientinformasjon

Background: The telemetry technology is used for in-hospital detection of arrhythmias, both in critical and non-critical care wards, and is an important part of diagnostics and treatment. Nurses are responsible for electrode placement, and ensuring optimal quality of the monitoring. Aim: The aim of the study was to investigate i) whether electrode placement during telemetry monitoring was correct, ii) whether the quality of electrode attachment was satisfactory, iii) whether hygiene was ensured by using a telemetry cover, and iv) whether patients had received the information needed. Methods: The survey was conducted during two weeks in 55 patients on telemetry monitoring in two coronary care units. This was 64% of all patients monitored during this period. Patients participating in the study did not differ from those not participating on important variables. A registration form with ten variables regarding Electrode placement, Electrode attachment, Hygiene, and Patient information was developed. Results: The study revealed that 30% of the electrodes were misplaced. However, in the majority of the patients (78%) the electrodes were optimally attached. In 71% of the patients telemetry covers were used in order to ensure a hygienic practice. Most of the patients (76%) reported to have received information about the intent of monitoring, but only two patients had received information about caution of mobile telephone use. Patients reporting not to have received information were older (p=0.024). Conclusion: Current practice of telemetry monitoring highlights the need for better education of nursing staff, and clearer guidelines to be developed and implemented. An intervention study testing an educational model to improve practice is recommended.