Impacts of Treatment Modalities on Physical Activity After First Acute Myocardial Infarction in Jordan Background Promoting physical activity is a priority after coronary revascularisation for effective long-term cardiovascular care and to avoid further disease progression and complications. But little is known about the effect of different types of acute myocardial infarction (AMI) treatment modalities in changes in physical activity level post-AMI. Objective This study aimed to examine changes in physical activity among patients treated with different treatment modalities post–first AMI during early recovery phase at week 2 (time 1) and week 6 (Time 2) after hospitalization. Methods A descriptive study was done using a repeated-measures design. Physical activity was measured by a body-worn activity monitor (activPAL3 monitor) for 24 hours a day for full 7 consecutive days at time 1 and time 2 after hospitalization. Demographic and clinical data were collected from patients' records. The study was conducted in 1 setting in Jordan. Participants were met at time 1 and time 2. The study recruited a convenience sample of 94 patients with AMI. Participants did not have access to cardiac rehabilitation. The participants were categorized according to type of AMI treatment modalities into 3 groups: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non–ST-elevation myocardial infarction treated by medication. Results Patients treated by primary percutaneous coronary intervention had a statistically significant effect on changes in mean steps count and mean stepping time per day better than patients treated by other treatment modalities between weeks 2 and 6 after hospitalization. Conclusion The study showed that patients treated with primary percutaneous coronary intervention had better mean steps count and mean stepping time per day between weeks 2 and 6 after hospitalization in comparison with other treatment modalities. These findings could be used for development of effective intervention in the future. Further research using different research methods such as longitudinal studies among different cultures to confirm the finding of this study is recommended.

Fluid Overload and Risk of Mortality in Critically Ill Patients Background Fluid overload (FO) is a condition present in critical care units, and it is associated with clinical complications and worse outcomes for severe patients. Objective The aim of this study was to verify if FO is a risk factor for mortality in critically ill patients. Methods Retrospective study performed in a Brazilian intensive care unit, from January to March 2016, with patients older than 18 years and hospitalized for more than 24 hours. Demographic and clinical data, as well as fluid balance and overload, were analyzed to verify the risk factors for mortality. A logistic regression model was elaborated, and significance was set at P < .05. Results There were 158 patients included, of which only 13 (8.2%) presented FO. Mortality was verified in individuals 30 (18.9%), of whom only 7 (23.3%) developed FO, which was lower in survivors 6 (4.9%), P = .001. In the simple regression model, the FO was significant (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.04–19.53), P = .001. However, in the multiple regression model, there were significant findings only for mechanical ventilation (OR, 5.86; 95% CI, 2.10–18.12, P = .001), acute kidney injury (OR, 4.05; 95% CI, 1.53–11; P = .001), and noradrenaline (OR, 3.85; 95% CI, 1.01–9.51; P = .041); FO was not significant (OR, 3.68; 95% CI, 0.91–15.55; P = .069). Conclusion Fluid overload is higher in patients who died. Therefore, it was not considered a risk factor for mortality.

Utilizing an Integrated Learning Experience in a Senior Undergraduate Nursing Program Integration of nursing classroom didactics with clinical and simulation experiences is crucial to obtaining improved student learning outcomes and successful academic achievement. According to the Institute of Medicine (2010), to ensure the delivery of safe, patient-centered care across settings, the nursing education system must be improved. Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care. An important aim is to increase active learning behaviors and maintain student engagement, which will foster an effort to learn and meet the complex needs of patients today. The integration of clinical and simulation with theory concepts can contribute to successful student development, confidence, self-efficacy, and reenforced desire to learn which is the key to success and competence development. Teamwork and collaboration are valued in nursing educational objectives as well as in the workplace. Blending a shared vision and mutual expectations helps to meet goals.

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Nasal High Flow Versus Conventional Oxygen Therapy for Postoperative Cardiothoracic Surgery Patients Background Reintubation and complications in postoperative cardiothoracic patients remain high despite medical advancements. A 2-year retrospective, observational study was conducted in postextubated cardiothoracic patients to assess the effectiveness of the current standard—conventional oxygen therapy (COT) compared with a nasal high flow (NHF) therapy. Objectives The objective of this study was to understand whether NHF therapy would reduce the need for reintubation and improve clinical outcomes after surgery. Method All consecutive postoperative patients who had same-day elective cardiothoracic surgery in a tertiary hospital were included. The 2013 data were from patients' charts who received COT, and the 2014 data were from patients' charts after the implementation of NHF therapy post extubation as a standard of care. Results A total of 400 patient charts were analyzed: 221 and 179 patients in the COT and NHF, respectively. No significant difference was seen in the frequency of reintubation (P = .48). Despite both cohorts having the same length of stay (P = .10), patients treated with NHF required less time on supplemental oxygen (P = .001). Day 1 postoperative chest x-ray results did not show any significant differences between groups, whereas day 2 x-rays showed worsening results in the COT cohort (P < .001). Furthermore, the incidence of ventilator-associated pneumonia (VAP) post extubation was significantly higher in the COT cohort, with zero VAP episodes reported in the NHF cohort (P = .02). Discussion Although this study was not able to demonstrate the reduction in reintubation between groups, the use of NHF compared with COT seems to reduce the time spent on oxygen therapy and decrease the rate of VAP. Further evidence including randomized controlled trials is required to determine the impact of NHF on reintubation and complications in postoperative cardiothoracic surgery.

Survivor But Not Fully Recovered: The Lived Experience After 1 Year of Surviving Sepsis Background Hospital mortality rates related to sepsis have decreased over the last decade, increasing the number of survivors of sepsis who may experience long-term consequences. Yet, little is known about how they perceive their illness experience and its aftermath. Objective This study explores the experiences of sepsis survivors after 1 year of their index intensive care unit (ICU) stay. Methods This phenomenological study was guided by Merleau-Ponty's philosophy. Participants were adult patients admitted directly to the medical ICU with sepsis who had an ICU stay of at least 48 hours and had been discharged from their index ICU stay for at least 1 year. Participants were invited by letter to participate in face-to-face or telephone interviews and a brief survey. Interviews were audio recorded, transcribed verbatim, and verified. An interpretive group read transcripts aloud to increase rigor of identifying meaning units, existential grounds, and thematic structure. Results Eight participants were recruited over 20 months. Participants were primarily white (87.5%) females (75%) with an age range of 37 to 74 years who were interviewed between 1 and 2 years following an index sepsis ICU stay. Five major themes emerged from the transcripts: (1) how they survived, (2) blurring of time versus counting time by events, (3) helpful help versus unhelpful help, (4) powerless versus striving for control, and (5) survivor but not fully recovered. Discussion Findings reflected a long trajectory of chronic illness in which the index episode of sepsis was not necessarily what stood out as figural to participants. The meaning of participant experiences must be considered in the context of a health care system that offers little to no systematic follow-up care after sepsis and little prevention. Participants expressed a need for advocacy and follow-up support.

The Impact of HeartMath Resiliency Training on Health Care Providers Background Health care providers must think clearly and make critical decisions under stressful circumstances. Providing effective strategies for managing stress in the moment helps mitigate the physical, emotional, and psychological impacts associated with caring for others and promotes resiliency. Staff may also utilize these techniques with patients and their families to help alleviate the symptoms of stress that may be experienced as the result of illness. Aim The purpose of this study was to measure whether HeartMath techniques reduce stress and improve resiliency in health care providers. Methods Study participants were asked to complete the Personal and Organizational Quality Assessment–Revised 4 Scale (2016) immediately before the start of training and then again 4 to 6 weeks after completion of the class. Participants were also asked to voluntarily share their experiences using HeartMath techniques personally or with family, friends, and patients. Results Significant improvements were found in 3 of 4 primary scales (organizational stress, emotional stress, and physical stress) and in 6 of 9 subscales on the Personal and Organizational Quality Assessment–Revised 4 Scale indicating a positive impact on employee health, well-being, and performance. Stories shared by participants posttraining indicated that HeartMath techniques were being used personally and with patients as an adjunct in the management of pain, anxiety, and insomnia. Conclusions This study supports existing evidence that HeartMath techniques are effective in managing stress and increasing resiliency. These techniques are also valuable tools for health care providers to use with patients and their families in the management of symptoms such as pain, anxiety, and sleeplessness related to hospitalization and illness.

DCCN on the Web No abstract available

Thank You 2018-2019 Peer Reviewers No abstract available