Nursing Commons^™

Out Of The Comfort Zone, Patricia Harris

Patricia Harris

Imagine the following experience: Your are a student nurse working with other health care providers in the obstetric unit of your facility. A fifteen-year-old Haitian girl, along with her grandmother, arrives seeking help because her two-day-old, eight-pound baby boy is having difficulty breathing...

Feasibility And Compliance With Daily Home Ecg Monitoring Of The Qt Interval In Heart Transplant Recipients, Erik V. Carter, Kathleen T. Hickey, David M. Pickham, Lynn V. Doering, Belinda Chen, Patricia Harris, Barbara J. Drew

Patricia Harris

Background: Recent evidence suggests that acute allograft rejection after heart transplantation causes an increased QT interval on electrocardiogram (ECG). The aims of this pilot study were to (1) determine whether heart transplant recipients could achieve compliance in transmitting a 30-second ECG every day for 1 month using a simple ECG device and their home telephone, (2) evaluate the ease of device use and acceptability by transplant recipients, and (3) evaluate the quality of transmitted ECG tracings for QT-interval measurement. Methods: A convenience sample of adult heart transplant recipients were recruited and trained to use the device (HeartOne, Aerotel Medical Systems, …

Prognostic Value Of Heart Rate Turbulence For Risk Assessment In Patients With Unstable Angina And Non-St Elevation Myocardial Infarction, Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Patricia Harris

Background: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Methods: Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at …

Prevalence And Prognostic Significance Of Long Qt Interval Among Patients With Chest Pain: Selecting An Optimum Qt Rate Correction Formula, Amer A. Hasanien, Barbara J. Drew, Jill Howie-Esquivel, Gordon Fung, Patricia Harris

Patricia Harris

Background: Little is known about the prevalence and prognostic significance of long QT interval among patients with chest pain during the acute phase of suspected cardiovascular injury. Objectives: Our aim was to investigate the prevalence and prognostic significance of long QT interval among patients presenting to the emergency department (ED) with chest pain using an optimum QT rate correction formula. Methods: We performed secondary analysis on data obtained from the IMMEDIATE AIM trial (N, 145). Data included 24-hour 12-lead Holter electrocardiographic recordings that were stored for offline computer analysis. The QT interval was measured automatically and rate corrected using seven …

Heart Rate Variability Measured Early In Patients With Evolving Acute Coronary Syndrome And 1-Year Outcomes Of Rehospitalization And Mortality, Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Patricia Harris

Objective: This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with �18 hours of sinus rhythm were selected for HRV analysis (number [N] �193). Time domain, frequency …

Insights Into The Problem Of Alarm Fatigue With Physiologic Monitor Devices: A Comprehensive Observational Study Of Consecutive Intensive Care Unit Patients, Barbara J. Drew, Patricia Harris, Jessica K. Zègre-Hemsey, Tina Mammone, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, Xiao Hu

Patricia Harris

Purpose: Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing ‘‘alarm fatigue’’ which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms. Results: A total of 2,558,760 unique alarms occurred in the …

A Comparison Of Skills Competency Test Scores Among Philippine-Educated Nursing Students After An Intensive Medical-Surgical Course, Margaret Fink, Debbie Daunt, Patricia Harris, Barbara Mccamish

Patricia Harris

Objective: This study examined the effect of a 10-week intensive medical-surgical course on ability to perform 16 common, acute care skills among Philippine educated nursing students seeking licensure in California. The aims of the study were to (1) determine competency in performing skills at the start of the medical-surgical course and (2) evaluate the effectiveness of the medical-surgical course in improving skill competency.

Methods: Twenty-three Philippine educated nursing students participated in a 4-hour skills competency test procedure that involved 4 patient care stations and 16 common acute care skills. During the last week of the 10-week medical-surgical course that included …

A Comparison Of Skills Competency Test Scores Among Philippine-Educated Nursing Students After An Intensive Medical-Surgical Course, Margaret Fink, Debbie Daunt, Patricia Harris, Barbara Mccamish

Patricia Harris

Objective: This study examined the effect of a 10-week intensive medical-surgical course on ability to perform 16 common, acute care skills among Philippine educated nursing students seeking licensure in California. The aims of the study were to (1) determine competency in performing skills at the start of the medical-surgical course and (2) evaluate the effectiveness of the medical-surgical course in improving skill competency. Methods: Twenty-three Philippine educated nursing students participated in a 4-hour skills competency test procedure that involved 4 patient care stations and 16 common acute care skills. During the last week of the 10-week medical-surgical course that included …

Prognostic Value Of Heart Rate Turbulence For Risk Assessment In Patients With Unstable Angina And Non-St Elevation Myocardial Infarction, Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Patricia Harris

Background: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Methods: Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at …

Prevalence And Prognostic Significance Of Long Qt Interval Among Patients With Chest Pain: Selecting An Optimum Qt Rate Correction Formula, Amer A. Hasanien, Barbara J. Drew, Jill Howie-Esquivel, Gordon Fung, Patricia Harris

Patricia Harris

Background: Little is known about the prevalence and prognostic significance of long QT interval among patients with chest pain during the acute phase of suspected cardiovascular injury. Objectives: Our aim was to investigate the prevalence and prognostic significance of long QT interval among patients presenting to the emergency department (ED) with chest pain using an optimum QT rate correction formula. Methods: We performed secondary analysis on data obtained from the IMMEDIATE AIM trial (N, 145). Data included 24-hour 12-lead Holter electrocardiographic recordings that were stored for offline computer analysis. The QT interval was measured automatically and rate corrected using seven …

Insights Into The Problem Of Alarm Fatigue With Physiologic Monitor Devices: A Comprehensive Observational Study Of Consecutive Intensive Care Unit Patients, Barbara J. Drew, Patricia Harris, Jessica K. Zègre-Hemsey, Tina Mammone, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, Xiao Hu

Patricia Harris

Purpose: Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing ‘‘alarm fatigue’’ which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.

Results: A total of 2,558,760 unique alarms occurred in the …