Aims To describe the incidence and impact of adverse clinical events (ACEs) during first 24 h of bedrest of patients after cardiac implantable electronic device (CIED) implantation. Methods and results We conducted a prospective observational study of patients aged over 18 years undergoing elective placement of permanent bicameral pacemaker (PM), cardiac resynchronization therapy (CRT) PM, CRT defibrillator, or implantable cardioverter-defibrillator. Patients were maintained on bedrest post-operatively for 24 h and delirium, post-operative urinary retention, severe post-operative pain, pressure ulcer, and sleep disturbance were recorded using standardized assessments. Of 90 patients, 66 (73.3%) were male and average age was 76 ± 10 years. The median time to first mobilization was 23 (21–24) h. The adverse clinical events occurred in 48/90, with severe pain (38/90), sleep disturbance (12/90), delirium (9/90), and urinary retention requiring urinary catheterization (8/90) most frequent. Patients receiving implantable cardioverter-defibrillator or CRT defibrillator experienced ACEs significantly more frequently than those receiving PM. Adverse clinical event was associated with prolonged hospital stay [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.16–6.17]. Patients with delirium were more dependent for daily living activities on admission (OR 8.0; 95% CI 1.55–41.3). Conclusion Adverse clinical events frequently occur post-insertion of a CIED and impact patient clinical course and experience. The progressive increase in ageing and frailty of CIED implant candidates requires special nursing attention to improve patients’ satisfaction and to prevent increased healthcare resource use.
BackgroundThe COVID-19 pandemic entailed cutting off the usual access to hospitals, denying patients daily visits from their relatives and friends. The standard communication between medical staff and relatives also suffered, with a perceived negative impact on overall care. We developed an electronic communication solution to re-establish a proactive daily communication with patients’ families.MethodsThe communication software allowed families to receive daily interprofessional (medical, nursing, and physiotherapy) updates by text message, on patients’ postoperative clinical state. Appreciation and performance of this communication was evaluated through a prospective randomised study. Two groups were compared (group D, 32 patients “Digital” receiving daily SMS, and group S, 16 patients “Standard” without SMS), assessing satisfaction through dedicated surveys under COVID-19 restrictions. Moreover, private outgoing vs. incoming communication flow between patients and their relatives (phone calls and text messages, for both groups) were analysed at different timeframes of the postoperative hospital stay.ResultsMean age of the population was 66 ± 7 years for both groups. The digital communication service was successfully adopted in group D in all cases, sending overall 155 communications (4.84 per patient). Calls received from relatives were 13 in group D vs. 22 in group S (0.4 vs. 1.4 calls per patient, p = 0.002). Patients’ outgoing vs. incoming traffic flow was equal in the two groups for every timeframe (first two postoperative days vs. the rest), independently from digital communication. Comparing satisfaction of communication (from 1 to 7), level of information and understandability resulted in 6.7 in group D vs. 5.6 in group S (p = 0.004). Appreciation of digital communication was highest during the first three postoperative days.ConclusionThe restrictions caused by the COVID-19 pandemic generated simple and effective ideas on digital solutions for interprofessional communication. Offering this digital service, which complements rather than replace the classic communication, eased the need of the families to be informed and significantly enhanced the overall satisfaction regarding the healthcare service.SummaryThe COVID-19 pandemic has interrupted access to hospital patients and cut off physical contact, denying patients, their families, and medical staff the necessary constant communication about the progress of their stay. It has become necessary, therefore, to compensate for the lack of “physical” face-to-face interaction by introducing innovative digital communication solutions. Our interprofessional project aims to assess the overall satisfaction and acceptance of digital communication service between the hospital and the families, updating on postoperative clinical condition of patients. Specifically, the introduction of a digital communication module attached to the electronic patient record allows relatives to be informed on a daily basis. The development of this module/software enabled families to receive daily, interprofessional and proactive digital updates, on their relative ones’ postoperative stay.
Introduzione: Il progetto di ricerca nasce da un’esperienza formativa nell’ambito del Master of Science in Cure infermieristiche della Scuola Universitaria Professionale della Svizzera Italiana (SUPSI) che si prefigge di ampliare le competenze professionali nell’ambito della pratica infermieristica avanzata. L’obiettivo é quello di preparare professionisti che raggiungano un alto livello di competenza nella pratica clinica per fronteggiare le sfide del sistema sanitario, caratterizzato da complessità , cronicità e multimorbidità . La capacità dell’infermiere di migliorare la qualità dell’assistenza dipende in gran parte dallo sviluppo delle competenze di ragionamento clinico e pensiero critico essenziali al processo decisionale. Entrambi questi concetti descrivono il processo mentale che l’infermiere compie nel fare le scelte migliori per il proprio assistito. Emerge l’importanza di rinforzare l’apprendimento di queste competenze attraverso specifiche metodiche didattiche. È presentato il protocollo di ricerca per lo sviluppo di una scoping review, con l’obiettivo di rilevare gli studi in letteratura relativi alle migliori strategie di insegnamento relative al ragionamento clinico. Metodi e analisi: La scoping review sarà svolta sul modello di Arksey e O’Malley, con il supporto delle linee guida Preferred Reporting Items for Systematic Reviews and Meta-Analysis – Scoping Reviews del Joanna Briggs Institute. La revisione della letteratura sarà condotta nei database: PubMed, CINAHL, Cochrane Library, Scopus e OVID. Saranno considerate le pubblicazioni degli ultimi 5 anni, in lingua inglese, italiana, francese e tedesca. Secondo specifici criteri di inclusione tre autori valuteranno in modo indipendente gli articoli per titoli, abstract e full-text. I risultati saranno riportati in forma narrativa e attraverso il supporto di grafici e tabelle. Diffusione dei risultati: questa review fornirà una visione attuale e completa delle strategie didattiche più efficaci per lo sviluppo del ragionamento clinico nella pratica clinica avanzata. I dati raccolti verranno condivisi con la comunità scientifica professionale. Parole chiave: infermieristica clinica avanzata, formazione infermieristica, insegnamento, ragionamento clinico, pensiero critico.
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