Cardiac Nursing Protocols/Research

[Adenium]

I'm a student in a nursing research class, and one of the things we're doing over the term is selecting a research topic and reading up on it in journals, etc with the eventual goal of making a mock proposal for testing out a protocol, new practice, etc...prepping us to eventually put forward such ideas at our own hospitals once we have an actual idea of what we're doing :)

I'm interested in cardiac nursing, and I've been happily perusing the board. I've seen some nice applicable discussions come up, like the question of ice and weight over a cath site and the like. I wish I had clinicals on cardiac floors so I could be seeing these issues come up in practice, but alas that's not the case. Reading journals is great, but it's hard to assess the practicality of some of the new research. Can you tell I'm itching to be out and working?

My question is, if you had infinite time and energy, what would be some things you'd like to see put up against evidence-based practice? What interesting new protocols would you like to see tested or put into place on your units? I know my elders and wisers must have some thoughts on this from working away in the trenches. Any care to share?

Thanks much!

[ghillbert, MSN, NP]

Most of my interests lie with mechanical circulatory support device, and issues with patient/family education. There's always lots of research needed into ways to improve patient compliance with heart failure diets/medications, as well as education about post-cardiac surgery issues prior to discharge. Early postoperative mobilization and the effect on respiratory function/failure. Timing of tracheostomy post cardiac surgery with concomitant respiratory failure. Optimal timing to pull lines such as swan ganz catheters. Whether we need to stick patients every day for routine blood tests which never seem to change (!).

That's a few off the top of my head.

[nerdtonurse?, BSN, RN]

Most of my pts have PICC or TLCs. I'd like a definitive yea/nay on whether flushing those ports with heparin vs. 10cc NS has any bearing on whether an unused port clogs up. Sometimes you can see reasoning why you'd want a person to not have any heparin, sometimes one doc will say NS and the next will say heparin for the flush, with no apparent rhyme or reason. You'd think the heparin flushes would stay open better, but it seems to me they actually clot up worse than the NS flushes. Is it because we don't flush 10cc's of heparin down the line? Should we flush with the 10cc NS and then top it off with heparin or vica versa?

Just a question from down in the trenches....

[BBFRN, BSN, PhD]

There's always lots of research needed into ways to improve patient compliance with heart failure diets/medications, as well as education about post-cardiac surgery issues prior to discharge.

I wholeheartedly agree with this. Post-cardiac surgery patients do learn some stuff in cardiac rehab, but not enough in the way of long-term lifestyle changes. They definitely don't learn enough about these things from their cardiologists. However, as a disease management nurse, that's where I come in. I teach these things to my patients after they are home, and have finished cardiac rehab. I think they would benefit from receiving education in-hospital from a nurse specialist (like a diabetes educator, only focused on cardiac disease/surgery). What a great idea.

[Adenium]

Wow, thanks guys. Those are some nice starting points to contemplate...more is always welcome, but it's wonderful to see gears turning.

Have I mentioned I think allnurses.com is great?