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Biomedical subjects

B Riegel

Publications and source records attributed to B Riegel.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effectiveness of a program of early hospital discharge of cardiac surgery patients.

Managed care was the impetus for a program designed to move adult patients from acute care to the lowest level of appropriate services after cardiac surgery. Clinical pathways and a home care cardiac specialty team were the major components of the Early Discharge Program. The program was evaluated based on both financial and clinical outcomes. A convenience sample of 119 pretest patients was compared with 101 posttest patients 3 months after program implementation. Hospital length of stay decreased only 0.34 days on average, but inpatient direct variable costs decreased by an average of $1,790 per patient. Based on the 101 patients in the posttest group, $180,790 in direct variable hospital costs were saved. The largest decrease in resource use was in those patients who were discharged to home care. Complications and home caregiver burden after discharge were no higher in patients discharged early. Early discharge of cardiac surgery patients appears to be safe and cost-effective.

Aged↗
PubMed1996

Tutorial: causal modeling and patient satisfaction.

Causal modeling is used in a variety of sciences because it allows exploration of complex relationships among several variables simultaneously. Although not used extensively in health care as yet, causal modeling could be helpful, given the complexity of the current health care system. The purpose of this article is to provide a general introduction to causal modeling and the syntax used in developing and testing a model. To illustrate the method, a sample model is tested using a combination of hypothetical and actual patient satisfaction data.

Data Interpretation, Statistical↗
PubMed1996

Are nurses still practicing coronary precautions? A national survey of nursing care of acute myocardial infarction patients.

BACKGROUND: Coronary precautions were common when coronary care units were instituted in the 1960s. However, research has failed to provide evidence of the validity of most of these restrictions. Only the avoidance of the Valsalva maneuver is clearly indicated as a universal precaution in patients who have experienced acute myocardial infarction. OBJECTIVES: To determine if nurses continue to restrict iced and hot fluids, caffeine, rectal temperature measurement, and vigorous back rubs, and to feed and mandate bedrest for acute myocardial infarction patients. METHODS: Survey techniques were used to describe practice patterns of nurses working in hospitals across the United States. Two sampling methods were used to access a random sample. The survey was mailed to members of the American Association of Critical-Care Nurses and nonmembers working in a hospital accredited by the American Hospital Association and with an intensive care unit. RESULTS: Of the 2549 mailed surveys, 882 were returned with usable data (34.8% response rate). Iced (28.1%) and hot (8.7%) fluids continued to be restricted by nurses. Most (85.6%) restricted stimulant beverages such as coffee. Rectal temperature measurement was avoided by 55.7%, and only 73.3% taught avoidance of the Valsalva maneuver. In terms of rest, 15.6% reported avoiding vigorous back rubs, 8.4% still fed patients, and 33.8% offered bedpans to pain-free patients on the first day after admission. A complete bedbath was offered by 19.8% of nurses to stable, pain-free patients even a day after admission. CONCLUSIONS: The data supporting liberalization of coronary precautions have not been adequately disseminated.

Adult↗
PubMed1995

Satisfaction with a new model of professional practice in critical care.

Although only a moderately severe general nursing shortage exists at this time, the shortage of critical care nurses remains severe. Innovative administrators across the country are trying new professional practice models aimed at maximizing autonomy and freeing nurses from mundane tasks with the hopes of retaining experienced clinicians. We implemented a professional practice model in which unlicensed assistive personnel were trained to assist registered nurses in patient care. Monies saved by increasing nurse-patient ratios were distributed to staff nurses. Acuity-based staffing was maintained and professional practice encouraged through self-scheduling and elimination of hierarchical relationships. Satisfaction among nurses working in the program increased in terms of coworkers and supervision. Patient satisfaction with the quality of care provided did not change during the course of the program. Data from interviews demonstrated that staff were satisfied with the quality of care provided by the assistants, but the changes in the staffing ratios coupled with the increased responsibility for overseeing the assistants caused stress in the nurses. We conclude that a professional practice model in which critical care assistants are added to the work force is a viable option, but creative methods of addressing the stress of increased workload are needed.

Critical Care↗
PubMed1995

Monitoring electrocardiographic changes: results of a national survey.

This article describes the electrocardiographic (ECG) monitoring practices of a national sample of nurses caring for patients who have suffered an acute myocardial infarction (AMI). Of specific interest were lead section practices, diagnosis of infarct evolution, and use of right precordial leads. Two populations were randomly sampled in an attempt to minimize sampling bias. Of the 2,549 mailed surveys, 882 were returned (34.8% response rate) from 48 states. Lead II was used most commonly (66.3%) with a single-channel system. Lead II plus V1 (or MCL1) was selected most often (62.4%) with dual-channel systems. Few (20%) respondents reported "always" modifying lead selection based on location of AMI; selected most often (62.4%) with only 43.3% correctly identified classic ischemia, injury, and infarction. Right precordial leads are used infrequently in practice.

Chi-Square Distribution↗
PubMed1995

[Retrograde percutaneous catheterization of the internal jugular vein in head injured patients].

The monitoring of jugular venous oxygen saturation and lactate concentration in order to detect cerebral ischaemia or hyperaemia requires the insertion of a fibreoptic catheter into the upper bulb of the internal jugular vein. With dissection studies we have defined superficial anatomical landmarks which are constant and easily palpable, namely the mastoid process and the sternocleidomastoid muscle. This technique does not require a rotation of the head. The puncture site is located at the top of a triangular area between its sternal and clavicular insertions. At this site the jugular vein is rather superficial. This study reports our experience of the retrograde catheterisation of the jugular vein in twelve severely head injured patients.

Adult↗
PubMed1994

The relationship of marital quality and psychosocial adjustment to heart disease.

Psychosocial adjustment to heart disease is variable. Some patients recover from a myocardial infarction or cardiac surgery quickly, return to work and leisure activities, and experience little emotional distress. Others suffer significant problems in psychosocial adaptation. We proposed and tested a theoretical model of adjustment that included the quality of the marital relationship, dysphoria, chronologic age, and time from the cardiac event (myocardial infarction or surgery) to identify the role that these variables play in adjustment. The study was conducted in 198 men diagnosed with coronary heart disease using the following instruments: the Spanier Dyadic Adjustment Scale, the Multiple Affect Adjective Checklist, and the Psychosocial Adjustment to Illness Scale. Data were collected on entry into the study and 3 months later to identify the stability of the relationships over time. The theoretical model was supported. Findings demonstrated that positive psychosocial adjustment to illness is influenced both by the quality of the patient's marriage and dysphoria. The spouse appears to influence psychosocial adjustment in an indirect manner by influencing the patient's experience of emotional distress or dysphoria. Nurses can enhance psychosocial adjustment to coronary heart disease by helping patients and spouses focus on ways to improve the quality of their marriage and by suggesting strategies to improve marital communication and decrease fear and misconceptions related to the illness.

Adult↗
PubMed1994

National survey of pediatric fever management practices among emergency department nurses.

INTRODUCTION: Management of pediatric fever is controversial. Although many nursing texts advocate aggressive fever management, research provides evidence that fever is a normal physiologic process with beneficial effects. We sought to describe emergency nurses' pediatric fever management practices, their rationales for practice, and their practice consistency. METHODS: A researcher-developed tool was mailed to a systematic random sample of approximately 5% of ENA members. Surveys were mailed to 1136 nurses nationally; 731 surveys were returned (64% response rate). RESULTS: Temperature at which nurses initiate fever interventions varied from 37.8 degrees C (100 degrees F) to 40.6 degrees C (105 degrees F). Most frequently identified rationales for intervention were prevention of fever increase (83.3%), fever reduction (76.9%), comfort (74.7%), and seizure prevention (65.3%). Most nurses (79.8%) employ tepid sponging to reduce fever; 31% sponge routinely. Nurses reported sponging for temperatures higher than 38.9 degrees C (102 degrees F) to 40.6 degrees C (105 degrees F). Rationales for sponging included seizure prevention (58%), rapid cooling (56.8%), and treatment of fevers unresponsive to antipyretics (45.6%). Factors influencing rationales for practice included departmental standards of care (67.2%), physician practices (65.8%), and common sense (64.2%). DISCUSSION: The results of this nationwide survey demonstrate that fever management practices vary. ED nurses are practicing in a manner consistent with that advocated in many nursing texts but not necessarily the research literature. We believe that clinical trials of commonly used fever treatments are indicated. Standards of care could then be revised to reflect the research literature.

Adult↗
PubMed1994

[Lumbar disk herniation with surgical option: general versus local anesthesia. Round table].

Lumbar disc hernia is a frequent pathology whose treatment remains essentially surgical. The type of anesthesia can be general anesthesia with intubation and controlled ventilation, both mandatory due to the position, peridural or spinal anesthesia. The usual position is knee-chest position which impairs circulation and ventilation if some precaution are not taken. Spinal anesthesia has been chosen in more than 40% of the patients by Lille CHU Team. This choice is justified by the important level of satisfaction of the patients and the absence of complications due to the anesthesia in a series of 1871 consecutive spinal anesthesia for lumbar disc surgery.

Adolescent↗
PubMed1994

[Hemodynamic effects of genu-pectoral position during the surgery of lumbar disk herniation: spinal anesthesia versus general anesthesia].

Spinal anesthesia (SA) for lumbar disk surgery in the genu-pectoral position (GP) has been proposed as an alternative to general anesthesia (GA). This study compares the haemodynamic effects of GP in two groups of patients undergoing either SA (n = 43) or GA (n = 40). Mean arterial pressure (MAP) and heart rate (HR) were recorded before and after GP. MAP and HR were significantly lower in the GA group after GP. We conclude that SA during GP for lumbar disk surgery is haemodynamically well tolerated.

Adult↗
PubMed1994

Reviews and summaries of research related to AACN 1980 research priorities: contextual topics.

This article reviews and summarizes the research conducted following publication of the 1980s American Association of Critical-Care Nurses' contextual research priorities. Reports of original research conducted on the contextual priority topics between 1981 and 1991 were included. Review articles, doctoral dissertations, theses, and abstracts were excluded unless judged to provide important information on the topic. Following the statement of each priority, progress in the area is summarized. Limitations and measurement issues are discussed as appropriate. Recommendations for future research are provided, and progress in the area is summarized.

Academic Dissertations as Topic↗
PubMed1994

Effects of a bedbath on mixed venous oxygen saturation and heart rate in coronary artery bypass graft patients.

OBJECTIVE: To determine the physiologic effects of a bedbath on critically ill patients. METHODS: Thirty hemodynamically stable coronary artery bypass graft patients were studied less than 24 hours after surgery in a repeated measures, quasi-experimental design. Study sites were the medical/surgical and coronary intensive care units of a large community hospital in the south-central United States. Two bedbaths consisting of bathing and turning phases were given to subjects early (mean, 3.6 hours) and late (mean, 18.5 hours) in the immediate postoperative period. Mixed venous oxygen saturation (Svo2) and heart rate were recorded at 1-minute intervals before, during, and for 5 minutes after each bedbath. RESULTS: Mean Svo2 decreased from baseline during the bathing phase of early and late bedbaths 1.6% and 1.9%, respectively, whereas mean heart rate increased from baseline 3.2% and 1%, respectively. During the turning phase, mean Svo2 decreased from baseline 9.2% and 12.1%, respectively, whereas mean heart rate increased from baseline 5.2% and 1.8%, respectively. Svo2 declined to less than 53% in 10 (33%) subjects during both early and late bedbaths. The most severe decreases in Svo2 occurred during early bedbaths and were usually associated with coughing, shivering, and/or agitation. CONCLUSIONS: Early bedbaths caused more dramatic declines in Svo2 than late bedbaths. Coughing, shivering, and agitation accentuated Svo2 declines and could be prevented by waiting to bathe coronary artery bypass graft patients until 1 day postoperatively. Routine bathing, at least in the early postoperative period, should be reconsidered.

Baths↗