Biomedical subjects

S Barnason

Publications and source records attributed to S Barnason.

15 recordsLinked to original sources

PubMed2001

Patient outcomes after peripheral revascularization surgery.

Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction) and to determine the influence of selected patient demographic characteristics (gender, age) on selected patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction). A prospective, repeated measures design was used for the study. A total of 39 patients, 18 women and 21 men, participated in the study, with a mean age of 68.86 years (SD = 13.61). The average length of hospitalization after surgery was 4.05 days. At 1 month after discharge, the majority of patients had relief from claudication and paresthesia. In regard to outcomes related to atherosclerotic risk factor modification, patients reported that they exercised on a routine basis, an average of 5.31 +/- 1.97 times per week. Before surgery, 21 patients reported that they smoked; 6 patients reported that they continued to smoke at follow-up. There were no significant differences in mean total scores of atherosclerotic risk modification by either gender or age groups (<65 or > or =65 years) with the use of one-way analyses of variance (ANOVAs). By using a Likert scale (ie, 0 to 10), the mean level of functioning was 8.18 +/- 2.76, with women having significantly higher mean levels of functioning (F = 4.26, P <.05). Comparing baseline scores of functioning on the Medical Outcomes Study Short-Form 36 (MOS SF-36), there was a significant improvement (F = 2.11, P <.05) in general health subscale scores at 1 month after surgery. Subjects' mean overall satisfaction with the results of surgery, with a 0 to 10 scale, was 7.33 +/- 2.84. Again, by using one-way ANOVAs, females had significantly higher mean satisfaction rating than males (F = 4.52, P <.05). Although findings from this pilot study are limited in their generalizability, clinicians need to continue to evaluate opportunities to further reduce variability in clinical practice patterns for optimal patient outcomes. Study findings also indicated that additional interventions are warranted to educate and provide rehabilitation for patients regarding an exercise program and overall behavior modification strategies to reduce risk for atherosclerotic disease.

Aged↗

PubMed2000

Collaborative research: a community approach.

Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a positive outcome. The purpose of the demonstration project was to describe a collaborative process in one community, culminating in a research utilization study and development of nursing standards pertaining to an aggregate population of patients.

Clinical Nursing Research↗

PubMed2000

Chest pain management: linking tertiary and rural settings.

The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.

Electrocardiography↗

PubMed2000

Managing pain: the fifth vital sign.

Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality improvement, two processes that are complementary in assuring best practice.

Evidence-Based Medicine↗

PubMed2000

Comparison of clinical practice changes in a rapid recovery program for coronary artery bypass graft patients.

The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.

Adult↗

PubMed1999

Distance education programs for advanced practice nurses: questions to ask.

This article reviews the use of distance learning in nursing education and to summarize key questions that must be addressed by programs or students considering advanced practice nursing education using distance technology. An acute care nurse practitioner program using distance learning strategies is provided as an example to illustrate delivery of a clinically based curriculum. Examples of questions to be addressed in evaluating a distance education program include: How much of the course or graduate nursing program is available on-line? What are the specific informational technologies used? How does communication occur between graduate students and faculty? How are clinical requirements of a course managed? Are there any requirements for time to be spent directly on campus? Is it necessary for the student to have a computer and Internet provider? Knowledge of the available technology and components of distance education can enhance the ability of the advanced practice nurse to evaluate better and choose educational program offerings.

Curriculum↗

PubMed1998

Utilizing an outcomes approach to improve pain management by nurses: a pilot study.

Effective pain management is a major challenge for nurses. The literature indicates that patients' pain continues to be inconsistently and ineffectively managed. The purpose of the pilot study was to measure the effectiveness of a structured intervention to improve pain management for patients. The "Serial V" model for clinical outcomes improvement was used to frame key clinical processes and was the basis for determining the outcome measures for the pilot project. The structured intervention used to integrate and standardize "best practice" for pain management by nurses consisted of a self-study module and the use of critical thinking exercises for patient pain management. Evaluation of outcomes demonstrated: (1) significant improvement over time in cognitive knowledge (p < 0.001) of staff nurses related to pain management; (2) overall patient satisfaction with pain management while hospitalized; (3) consistency in patients' ability to rate pain intensity; (4) consistency in patients' ability to identify their perceived "acceptable" level of pain; and (5) utilization of more consistent practice patterns of pain management by nursing staff. The pilot findings provide the foundation for ongoing development of additional strategies to improve patient pain management.

Adolescent↗

PubMed1998

The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient.

The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on the level of postoperative pain. Pain intensity, sensory pain, and affective pain were measured along with anxiety on postoperative day 2 and day 3 by the McGill Pain Questionnaire Subscales (PPI, PRIS, and PRIA) and State Anxiety Inventory Scale, respectively. A direct relationship of anxiety with pain was found over time with the highest relationship on postoperative day 2 (r = 0.235-0.492, P < 0.001). A significant interaction between time and level of anxiety on affective pain was specific to postoperative day 2 (P < 0.01). Significant differences by level of anxiety and time were reported. Factors of age, gender, marital status, number of previous surgeries, and operation time had no effect on the level of postoperative pain.

Adult↗

PubMed1996

The effects of music interventions on postoperative pain and sleep in coronary artery bypass graft (CABG) patients.

The purpose of this experimental study was to determine the effects of second and third day postoperative music interventions (music, music video) on pain and sleep in 96 postoperative patients having CABG surgery. The Verbal Rating Scale scores obtained before and after each 30-minute session showed that pain decreased over time for all three groups with no difference across groups. The McGill Pain Questionnaire (MPQ) was administered before session 1 and after session 2, and results indicated that Sensory, Affective, and Present Pain Intensity subscales showed no group difference for pain; however, pain decreased from Day 2 to Day 3 for all three groups. For the evaluative component of pain, those in the music group had significantly (F[2,93] = 4.74, p < .05) lower scores on postoperative Day 2 than the rest period control group. Effects of the intervention on sleep as measured by the Richard Sleep Questionnaire indicated that the video group had significantly (F[2, 92] = 3.18, p < .05) better sleep scores than the control group on the third morning. These findings lend some support for selected music interventions.

Adult↗

PubMed1995

Pain in the postoperative coronary artery bypass graft patient.

The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain significantly decreased from postoperative day 2 to postoperative day 3 for all components of the McGill Pain Questionnaire. Sensory words chosen from the McGill Pain Questionnaire on postoperative day 2 included sharp, sore, aching, and tender. Affective words chosen included exhausting on postoperative day 2 and tiring on postoperative days 2 and 3. The evaluative word annoying was chosen for both postoperative days 2 and 3. The present pain intensity (PPI) rating completed on a scale from no pain = 0 to excruciating pain = 5, showed a mean intensity rating of 1.08 for postoperative day 2 and 0.67 for postoperative day 3. These findings describing the typical pattern of postoperative pain are clinically significant in the differentiation of "normal" postoperative pain from pain experienced with postoperative complications from CABG surgery.

Adult↗

PubMed1995

A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients.

Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient cardiac patient teaching program. This study investigated the effect of three different teaching approaches (i.e., an inpatient teaching program, a postdischarge telephone follow-up program, and a postdischarge group teaching program) among 90 patients who had undergone coronary artery bypass graft surgery. Teaching outcomes were evaluated in this study by use of the Heart Disease Management Questionnaire and Cardiac Surgical Patient Teaching Satisfaction Inventory. Analyses of the data revealed similar patient teaching outcomes regardless of the type of teaching intervention the participant received. Findings supported the effectiveness of the inpatient teaching protocol which focused on "survival skills" for self-care management postdischarge. The findings are important in the redesign of teaching programs which are efficient yet meaningful to the patient within today's health care environment. Additional findings indicated that patients who had longer lengths of stay and those with more vessels bypassed were the least satisfied with their teaching. Further implications for nurses involved in patient teaching are discussed.

Adult↗

PubMedDate not supplied

Functional status outcomes of patients with a coronary artery bypass graft over time.

OBJECTIVE: To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes. DESIGN: A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time. SETTING: A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG. OUTCOME MEASURES: Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments. METHODS: Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments. RESULTS: Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation. CONCLUSION: Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.

Activities of Daily Living↗

PubMedDate not supplied

The effects of music interventions on anxiety in the patient after coronary artery bypass grafting.

OBJECTIVE: To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. DESIGN: Prospective, repeated measures, quasiexperimental, random assignment. SETTING: The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study. PATIENTS: Ninety-six patients who underwent elective, heart bypass surgery; the mean age of the subjects was 67 years, with an age range of 37 to 84 years. Most subjects were men (n = 65, 68%). OUTCOME MEASURES: Physiologic measures of anxiety and mood include blood pressure and heart rate. Additional measures included the use of Spielberger's state-trait anxiety inventory (STAI) and patient verbal ratings of both mood and anxiety with use of a numeric rating scale (NRS). INTERVENTION: Patients were randomly assigned to one of three groups: (1) music therapy, (2) music-video therapy, or (3) scheduled rest group. Subjects in the groups received their assigned 30-minute intervention at two episodes on postoperative days 2 and 3. Subjects had physiologic measures of blood pressure and heart rate measured immediately before the intervention and at 10-minute intervals throughout the intervention. Mood and anxiety were evaluated by having subjects use a NRS (i.e., 0 to 10) to give rating of mood and anxiety immediately before and after each session. Anxiety was further measured with the STAI. A baseline measure of STAI was taken before surgery; patients also completed the "state" anxiety tool before the intervention session on postoperative day 2 and on completion of the session on postoperative day 3. RESULTS: With use of an analysis of covariance (ANCOVA), subjects' mood ratings showed significant improvement in mood among subjects in the "music intervention" group after the second intervention when controlling for the preintervention rating of mood, F(2, 87) = 4.33, p = 0.016. However, no significant differences were reported for anxiety ratings as measured by the NRS and state anxiety instruments. With use of repeated measures analysis of variance (ANOVA), there were no significant interactions between the intervention groups and time for any of the physiologic variables. However, there were significant main effects over time for heart rate and systolic and diastolic blood pressure, which indicated a generalized physiologic relaxation response. CONCLUSIONS: Although none of the three interventions was overwhelmingly superior, the overall response by all intervention groups demonstrated a generalized relaxation response. It is also important to note that there was reduced anxiety and improved mood within all three groups.

Adult↗

PubMedDate not supplied

Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity.

OBJECTIVE: To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient. DESIGN: A prospective, quasi-experimental design was used for the pilot study. SETTING: The setting for the pilot study included critical care units of 3 community hospitals and 1 veterans' hospital in a midwestern city. SUBJECTS: A total of 52 orally intubated adult subjects were enrolled in the study from the 4 clinical sites over a 6-month period of time. The participants in the study consisted of 30 men and 22 women. The subjects ranged in age from 22 to 85 years, with a mean age of 62.3 years. The mean length of intubation was 89.6 hours. OUTCOME MEASURES: The outcome measures of the study were (1) unplanned extubation, (2) oral mucosa status, and (3) facial skin integrity. INTERVENTIONS: Endotracheal tube securement with either the twill tape or the adhesive tape securement method. RESULTS: With use of multiple analysis of variances (MANOVA) and repeated analyses of variances (ANOVAs), there were no significant differences by time or type of endotracheal tube securement method on oral mucosa or facial skin integrity. A chi-square analysis demonstrated no significant association between the 2 types of endotracheal tube securement when comparing their efficacy in preventing unplanned extubation. CONCLUSION: The findings of this pilot study demonstrated both methods of endotracheal tube securement to be comparable in preventing unplanned extubation and in maintaining oral mucosa status and facial skin integrity.

Adhesives↗

PubMedDate not supplied

Preoperative and postoperative pain in total knee replacement patients.

This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20 subclasses of descriptors scaled on intensity dimensions, was administered to each subject prior to and on two occasions after surgery. The findings support results from previous studies indicating that clusters of words are more often selected to express chronic pain, and other patterns are used to describe acute pain during the early postoperative period. Also, subjects experienced considerable pain intensity related to arthritis prior to surgery, and they reported less overall pain intensity following their TKR.

Adult↗