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You are now leaving the American Nurses FoundationThe American Nurses Foundation is a separate charitable organization under Section 501(c)(3) of the Internal Revenue Code. The Foundation does not engage in political campaign activities or communications. The Foundation expressly disclaims any political views or communications published on or accessible from this website. For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. ResultsFrom the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. ConclusionsVascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery. IntroductionVascular disease includes a wide range of arterial, venous, and lymphatic acute or chronic clinical events. A wide array of medical, endovascular, and surgical interventions is now available for the treatment of patients with vascular disease, including, for example, critical limb ischemia, arterial aortic and peripheral aneurysms, carotid stenosis, chronic venous disease, and lymphedema. Vascular disease affects millions of individuals worldwide and results in significant morbidity and mortality for affected patients. The complex nature of vascular problems, due to the presence of frailty, together with multiple comorbidities, considered in the context of vascular surgery, as one of the main therapeutic option in vascular system, determines clear implications in preoperative and postoperative care, suggesting also the need of a strict cooperation between physicians and nurses to improve the global care of these patients.1, 2, 3, 4 With the emergence of new technologies in the field of vascular surgery, the health care costs have been increased and the economic evaluations must be considered when managing vascular patients.5 A correct interaction between skilled nursing staff and vascular surgeons may play a critical role in optimizing patients’ clinical outcomes and related costs for the hospital, the national health system, and also for the patient.6 The aim of this review is to analyze the interplay between nursing personnel and attending medical staff in the area of vascular surgery in the view of improving the delivery of care in vascular patients. Section snippetsMaterial and MethodsWe decided to search for relevant articles in the following databases: Medline, Scopus, and ScienceDirect. We used the following main key words for the search strategy: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. ResultsThe relevant findings of this study are structured in the following sections as follows. DiscussionAs the western world population ages, the burden of vascular disease requires more attention and clinical skills,12 and the development of new technologies has been accompanied by changes in the medical and nursing aspects of care of vascular patients. In accordance with these developments, a more specialized role in nursing is demanded in the vascular area. In this context, vascular nurses, together with physicians and other health care professionals, act as a strong link with the patient's References (33)
Scoping review of frailty in vascular surgeryJ Vasc Surg(2019) Frailty assessment in vascular surgery and its utility in preoperative decision makingSemin Vasc Surg(2015) Research priorities in vascular nursingJ Vasc Nurs(1995) The impact of vascular surgery wound complications on quality of lifeJ Vasc Surg(2016) Specialisation within vascular surgeryEur J Vasc Endovasc Surg(2010) Role of nursing personnel in implementing clinical pathways and decreasing hospital costs for major vascular surgeryJ Vasc Nurs(1996) 2022, Journal of Vascular Nursing Show abstractNavigate Down Delirium is a frequent and serious acute neuropsychiatric syndrome leading to worse prognosis including mortality. Patients with ischaemic and/or haemorrhagic stroke are vulnerable to delirium. However, predisposing and precipitating factors have not been fully discovered to date, leaving this area of practice under-represented in available guidelines. To describe the prevalence, associated factors and main in-hospital outcomes of post-stroke delirium. A multi-centre observational study was conducted from 2019 to 2020 and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were collected in stroke units located in two large hospitals in the North-East region of Italy. Consecutive adult patients with ischaemic and/or haemorrhagic stroke with a Glasgow Coma Scale > 5, who were willing to participate, were included. Data at admission, during the in-hospital stay and at discharge were collected by trained nurses, not involved in the care of patients, with (a) validated tools, (b) direct observation, and (c) access of patients’ records. A total of 78 patients were enrolled (mean 73.1 years; 59% male), and 70.5% of them had suffered an ischaemic stroke. The mean National Institutes of Health Stroke Scale (NIHSS) at admission was 8.2 ± 7.0. A total of 34.6% of patients developed post-stroke delirium; the onset was mainly on the first day of admission (70.4%) and the condition lasted for an average of 3.7 days (SD 2.6). In the multivariate logistic regression, 64.1% of the delirium variance was explained by the NIHSS scores (RR 1.259, 95%CI 1.035–1.533; p = 0.022). Patients with post-stroke delirium reported higher functional dependence at discharge and the need for more delaying of hospital care to be admitted in rehabilitation units. At admission, higher scores in the NIHSS evaluation might suggest which patients are at an increased risk of delirium. Avoiding interventions that could potentially increase this risk, together with continuous surveillance, become imperative for nurses who are constantly and closely present by their patients’ side, in order to prevent this serious complication. 2022, Heliyon Show abstractNavigate Down Peripheral artery disease (PAD) of the lower limbs is a common condition that can affect quality of life. Androgen receptor (AR) can exert sex-specific effects on metabolic system, endothelial function and vascular tone. IGF-I receptor (IGF-IR) and insulin receptor (IR) may also be involved in the aforementioned functions. The aim of this study was to evaluate AR, IGF-IR and IR expression in the arterial vessel walls of PAD patients. This is a cross-sectional study examining 30 males with PAD undergoing open surgery procedures. Mean age was 75.9 ± 8.8y. All patients belonged to Rutherford stage 4–6. Median expression levels of IR, IGF-IR and AR significantly decreased from stage 4–6 (p < 0.05). The study evidenced a progressive decrease of IR, IGF-IR and AR expression as the severity of disease increased. Altered levels of IR, IGF-IR and AR following PAD may be useful for the clinical evaluation of these patients. 2022, Nursing Open 2021, Biology 2021, Israel Journal of Psychiatry 2021, Risk Management and Healthcare Policy Research article Maturitas, Volume 90, 2016, pp. 9-16 Show abstractNavigate Down Given the global increase in the number of people over the age of 85, there is a growing body of work concerning this group, termed the oldest old. Much of this work is confined to the literature specialising in geriatrics and the more generic health care papers refer to ‘older people’ with little definition of what is meant by ‘older’. Iatrogenesis (ill health caused by doctors) is a major issue and general practitioners (GPs) need practical help in prescribing for the oldest old. This paper presents a narrative review of the literature on prescribing and the oldest old. The results showed that all papers sourced referred to prescribing for the ‘old’ as those aged over 65, with only scant mention of oldest old. Yet prescribing for the oldest old involves clinical judgement and knowledge of the patient. It includes weighing up what will do good, cause no harm and is acceptable to the individual. GPs have to make treatment choices mostly in isolation from colleagues, during time-limited consultations and with few relevant guidelines on managing multi-morbidities in the oldest old. A major issue in prescribing for people over the age of 85 is that guidelines for diseases are based on trials with younger adults, outline the best practice for one disease in isolation (i.e. not in the presence of other diseases) and take little account of the interactions between the drugs used in managing several diseases in frail older people. There is a growing body of work, however, calling for specialist services for the oldest old. Research article Journal of Vascular Surgery, Volume 74, Issue 2, 2021, pp. 434-441.e2 Show abstractNavigate Down Although appreciated for its long-term benefits, open repair of abdominal aortic aneurysms (AAA) is associated with a significant perioperative burden. Enhanced recovery and fast track protocols have improved surgical outcomes in many specialties, but remain scarcely applied in the vascular field. Based on the applied perioperative protocol in a single-center experience, three consecutive study groups were identified among 394 consecutive patients undergoing elective AAA open repair in the last 12 years. Group A included 66 patients who underwent traditional surgery, group B comprised 225 patients treated according to a partially adopted perioperative protocol, and group C consisted of 103 patients, operated in line with a complete perioperative protocol. The aim of this study was to evaluate the impact of the perioperative protocol on recovery time by measuring complication rates, analgesic and antiemetic control, and return of bowel function and ambulation, as well as the length of hospitalization. The study groups had similar baseline characteristics. A significant improvement was noted in the complication rates (P = .019) and hospitalization time (P < .001) following a complete implementation of the perioperative protocol, where the median hospitalization time was 3 days. No mortality and no readmissions within 30 postoperative days were recorded in this group. There was an improvement in pain levels, as well as postoperative nausea and vomiting control (P < .001). Perioperative protocol implementation in AAA open repair is feasible; the clinical outcomes may be improved when strictly adhering to the protocol. All the applied perioperative management interventions seem to have a synergic effect on shortening the recovery time. Research article Annals of Vascular Surgery, Volume 68, 2020, pp. 510-521 Show abstractNavigate Down The clinical effectiveness of surgical versus endovascular therapy for chronic limb–threatening ischemia (CLTI) continues to be debated, and the resources required for each therapy are unclear. Systematic review of randomized controlled trials (RCTs) and observational studies comparing surgery with endovascular therapy for CLTI, which reported clinical effectiveness and resource utilization. Short-term and long-term clinical outcomes were examined. The search yielded 4,231 titles, of which 17 publications met our inclusion criteria. Five publications were all from 1 RCT, and 12 publications were observational studies. In the RCT, the surgical approach had greater resource use in the first year (total hospital days across all admissions for surgery versus angioplasty: 46.14 ± 53.87 vs. 36.35 ± 51.39; P < 0.001; also true for days in high-dependency and intensive therapy units), but differences were not statistically significant in subsequent years. All-cause mortality presented a nonsignificant difference favoring angioplasty in the first 2 years (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [95% CI], 0.75–2.15), but after 2 years, it favored surgical treatment (aHR, 0.34; 95% CI, 0.17–0.71). The observational studies reported short-term effectiveness and resource utilization favoring endovascular therapy, but most differences were not statistically significant. Long-term outcomes were more mixed; in particular, mortality outcomes generally favored surgery, although concluding that cause and effect is not possible as endovascularly treated patients tended to be older and may have had a shorter life expectancy regardless of therapy. The clinical effectiveness and resource utilization of surgery compared with endovascular therapy for CLTI is not known with certainty and will not be known until ongoing trials report results. It is likely that findings will vary by the time horizon, where initial outcomes and utilization tend to favor endovascular interventions, but long-term outcomes favor surgical revascularization. Research article Journal of Vascular Nursing, Volume 35, Issue 4, 2017, pp. 211-220 Show abstractNavigate Down Screening for abdominal aortic aneurysm (AAA) has proven to reduce AAA-related mortality, but how the knowledge of having an untreated AAA affects health and daily life requires further clarification. The aim was to investigate the psychosocial consequences and sense of coherence (SOC) in 65-year-old men diagnosed with AAA and participating in a national screening program during a 6-month follow-up compared with men with no AAA. The single-center cohort study included 52 men with AAA and 118 men without AAA. A questionnaire including the Short Form 36 Health Survey, Hospital Anxiety and Depression Scale, SOC, questions concerning stress, and questions related to AAA were answered at baseline and after 6 months. Men with AAA reported more problems with physical functioning, pain, and general health than men with a normal aorta at baseline. After 6 months, men with AAA still reported more problems with physical functioning and stress in relation to disease than men with normal aortic diameter. No differences were observed between groups in SOC, anxiety, and depression. A significantly higher satisfaction with information from the physician and desire to learn about the AAA diagnosis was reported at baseline compared with that at follow-up. Having knowledge about the AAA diagnosis may moderately impact physical health and perceived stress, and in combination with the increased prevalence of other cardiovascular diseases, may lead to impaired perceived health for men diagnosed with AAA. Research article Journal of Vascular Nursing, Volume 37, Issue 1, 2019, pp. 3-10 Show abstractNavigate Down Functional recovery, described by walking ability, is one of the significant outcomes for patients with peripheral arterial disease (PAD) after lower extremity bypass. Little is known about associated factors that help to improve this outcome. The purpose of this study was to examine factors associated with functional recovery among patients with PAD after lower extremity bypass, such as postoperative period, social support, and depression. Data were collected in a University Hospital in Bangkok, Thailand. A sample of 77 patients with PAD receiving lower extremity bypass treatment was recruited into the study. The interview questionnaires consisted of demographic characteristics, Medical Outcome Study social survey, Thai Geriatric Depression Scale, and Walking Impairment Questionnaire. Reliability of each instrument was 0.97, 0.87, and 0.92, respectively. Pearson's correlation was performed to identify the factors associated with functional recovery. The mean values of age, postoperative period, and walking ability score were 63.92 years (standard deviation [SD] = 11.21), 4.19 years (SD = 3.52), and 62.52 (SD = 13.83). Functional recovery and social support were significantly associated with depression (r = –0.272, P < .05; r = –0.463, P < .01, respectively). The postoperative period was also significantly associated with social support (r = 0.247, P < .03).In conclusion, psychological factors were significantly related to functional recovery among patients with PAD after lower extremity bypass. Therefore, health-care providers should consider these factors during discharge planning, and screening depression score as baseline should be performed. Research article Journal of Vascular Surgery, Volume 66, Issue 6, 2017, pp. 1719-1726 Show abstractNavigate Down Timing of carotid endarterectomy (CEA) after onset of neurologic symptoms remains controversial. We assessed the association of CEA timing with postoperative outcomes. The Vascular Study Group of New England (VSGNE) database (2003-2014) was queried to identify CEA performed for symptomatic carotid stenosis during the same hospitalization. Cases were divided into four groups based on the time from onset of neurologic symptoms to CEA: group I, <2 days; group II, 2 to 5 days; group III, ≥6 days; and group IV, same-day CEA. The χ2 test and t-test were used to compare demographics, medical history, modified Rankin scores, and outcomes (30-day postoperative death, stroke, myocardial infarction, and aggregate events [stroke/myocardial infarction]). Multivariable logistic regression was used to compare the association of time to surgery with outcomes while adjusting for confounding variables. Kaplan-Meier and Cox proportional hazards regression analyses were performed at 1 year to evaluate survival and stroke rates between the groups. There were 989 of 14,864 VSGNE CEA cases that fit the inclusion criteria. The frequency of cases was highest in group II (36.6%), followed by groups I (31.9%), III (18.9%), and IV (12.4%). Age, gender, and comorbidity compositions were similar between groups, although group III had the highest rates of diabetes mellitus, coronary artery disease, coronary artery bypass graft procedures, congestive heart failure, and American Society of Anesthesiologists class 4 and the highest modified Rankin score (P < .05). Stroke rates were highest in group I (7.3%; P = .016), whereas group III had the highest rate of discharges to nursing facilities (37.2%; P < .001); other adverse outcomes were comparable among groups. CEAs in group I had significantly increased adjusted odds of stroke; adverse outcomes of CEAs in groups II and III were comparable to those in group IV. Our results suggest that CEAs performed 2 to 5 days after a neurologic event have similar outcomes to CEAs performed ≥6 days later. Early CEA should be considered an area for quality improvement among these patients. |
