Nurses' Experiences of their Ethical Responsibilities during Coronavirus Outbreaks: A Scoping Review.

Globally, nurses have experienced changes to the moral conditions of their work during coronavirus outbreaks. To identify the challenges and sources of support in nurses' efforts to meet their ethical responsibilities during SARS, MERS, and COVID-19 outbreaks a scoping review design was chosen. A search was conducted for eligible studies in Ovid MEDLINE, Ovid Embase and Embase Classic, EBSCO CINAHL Plus, OVID APA PsycInfo, ProQuest ASSIA, and ProQuest Sociological Abstracts on August 19, 2020 and November 9, 2020.

Nurses' experiences of ethical responsibilities of care during the COVID-19 pandemic.

Background: The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses' capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care.

Research Objectives: 1) To explore nurses' experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to explore what has fostered nurses' capacity to fulfill these responsibilities.

Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates.

Unlabelled: Despite comprehensive multidisciplinary candidacy assessments to determine appropriateness for solid organ transplantation, limitations persist in identifying candidates at risk of adverse outcomes. Frailty measures may help inform candidacy evaluation. Our main objective was to create a solid organ transplant frailty index (FI), using the cumulative deficits model, from data routinely collected during candidacy assessments.

Referral Practices of Cardiologists to Specialist Palliative Care in Canada.

Background: Patients with heart failure have palliative care needs that can be effectively addressed by specialist palliative care (SPC). Despite this, SPC utilization by this patient population is low, suggesting barriers to SPC referral. We sought to determine the referral practices of cardiologists to SPC.

The relational dynamics of caregivers of patients with a left ventricular assist device for destination-therapy: A qualitative investigation.

Background: Caregivers are critical to the recovery and management of patients with destination-therapy left ventricular assist devices (DT-LVADs).

Objective: To explore the needs and impacts of caregiving for patients with DT-LVAD relative to the various relationships caregivers navigate from the shared perspectives of patients, caregivers, and healthcare providers.

Methods: Qualitative descriptive secondary analysis.

The "nurse as hero" discourse in the COVID-19 pandemic: A poststructural discourse analysis.

Background: Nurses have been labelled "heroes" by politicians, the mass media, and the general public to describe their commitment to providing front-line care to people with COVID-19, despite the risks of exposure and lack of clinical resources. Few studies have examined the implications of the hero discourse to nurses' professional, social, and political identities.

Objective: To critically examine the effects of the hero discourse on nurses who are contending with the ongoing COVID-19 crisis and to consider the political, social, cultural, and professional impact of this discourse on nursing work.

Engaging Patients in Care (EPIC): A Framework for Heart Function and Heart Transplant-Specific Patient Engagement.

ngaging atients n are (EPIC) is a local patient engagement initiative at the University Health Network for patients and families who have received care for heart failure, heart transplant, or mechanical circulatory support (left ventricular assist device). Patients and caregivers can engage at 4 different levels, including sharing, consulting, deliberating, and collaborating, depending on their knowledge, experience, and available time. The Engaging Patients In Care framework has 4 priority areas: Care Delivery and Policy, Patient Advocacy, Peer Support, and Research.

Heart Failure: A Palliative Medicine Review of Disease, Therapies, and Medications With a Focus on Symptoms, Function, and Quality of Life.

Despite significant advances in heart failure (HF) treatment, HF remains a progressive, extremely symptomatic, and terminal disease with a median survival of 2.1 years after diagnosis. HF often leads to a constellation of symptoms, including dyspnea, fatigue, depression, anxiety, insomnia, pain, and worsened cognitive function.

Advance care planning with chronically ill patients: A relational autonomy approach.

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).

Comparative effectiveness of the different components of care provided in heart failure clinics-protocol for a systematic review and network meta-analysis.

Background: Heart failure (HF) is a complex chronic condition, leading to frequent hospitalization, decreased quality of life, and increased mortality. Current guidelines recommend that multidisciplinary care be provided in specialized HF clinics. A number of studies have demonstrated the effectiveness of these clinics; however, there is a wide range in the services provided across different clinics.

Utility of the Seattle Heart Failure Model for palliative care referral in advanced ambulatory heart failure.

Background: Physicians face uncertainty when predicting death in heart failure (HF) leading to underutilisation of palliative care. To facilitate decision-making, we assessed the Seattle Heart Failure Model (SHFM) as a referral tool by evaluating its performance in predicting 1-year event-free survival from death, heart transplant (HTx), and ventricular assist device (VAD) implantation.

Methods: We retrospectively reviewed the charts of consecutive patients with advanced ambulatory HF with New York Heart Association Class III/IV HF and a left ventricular ejection fraction of ≤40% from 2000 to 2016.

The prognostic significance of frailty compared to peak oxygen consumption and B-type natriuretic peptide in patients with advanced heart failure.

Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO ) or B-type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies.

A palliative approach for heart failure end-of-life care.

Purpose Of Review: The current review discusses the integration of guideline and evidence-based palliative care into heart failure end-of-life (EOL) care.

Recent Findings: North American and European heart failure societies recommend the integration of palliative care into heart failure programs. Advance care planning, shared decision-making, routine measurement of symptoms and quality of life and specialist palliative care at heart failure EOL are identified as key components to an effective heart failure palliative care program.

Long-term use of left ventricular assist devices: a report on clinical outcomes.

Background: The literature examining clinical outcomes and readmissions during extended (> 1 yr) left ventricular assist device (LVAD) support is scarce, particularly in the era of continuous-flow LVADs.

Methods: We completed a retrospective cohort study on consecutive LVAD patients from June 2006 to March 2015, focusing on those who received more than 1 year of total LVAD support time. Demographic characteristics, clinical outcomes and readmissions were analyzed using standard statistical methods.

Barriers to Goals of Care Discussions With Patients Who Have Advanced Heart Failure: Results of a Multicenter Survey of Hospital-Based Cardiology Clinicians.

Background: Conversations about goals of care in hospital are important to patients who have advanced heart failure (HF).

Methods: We conducted a multicenter survey of cardiology nurses, fellows, and cardiologists at 8 Canadian teaching hospitals. The primary outcome was the importance of barriers to goals-of-care discussions in hospital (1 = extremely unimportant; 7 = extremely important).

Measuring quality of life in advanced heart failure.

Purpose Of Review: Patients with Stage D heart failure can benefit from palliative care consultation to help them manage unpleasant symptoms and improve quality of life. Although guidelines describe how to manage symptoms, very little direction is provided on how to evaluate the effectiveness of those interventions.

Recent Findings: Numerous studies have used the measurement of symptoms, emotional distress, functional capacity and quality of life to evaluate the effectiveness of interventions in heart failure.

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire.

Aims: Good end-of-life communication and decision-making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision-making about goals of care for hospitalized patients with advanced HF.

Methods: We distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital.

Patient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study.

Background: There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions.

Aim: To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions.

Readmissions Following Implantation of a Continuous-Flow Left Ventricular Assist Device.

Objective: The objective of this study is to review and analyze readmission data for patients who received a continuous flow left ventricular assist device (LVAD).

Methods: A retrospective review of 88 patients implanted with a continuous-flow LVAD between June 2006 and June 2014 was performed. Reason for readmission, frequency, length of stay, and procedures performed during each readmission were recorded.

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease.

Background: Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings.

Objectives: The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD.

Using heart failure instruments to determine when to refer heart failure patients to palliative care.

Aim: The purpose of this study was to determine whether the Edmonton Symptom Assessment Scale (ESAS) or the Palliative Performance Scale (PPS) are associated with traditionally used scores for heart failure patients -- specifically, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), an overall health visual analog scale (VAS), and the Seattle Heart Failure Model (SHFM). Furthermore, we sought to determine whether the PPS or the ESAS provided additional information on quality of life, symptom severity, or prognosis above that provided by the traditional scores for patients with heart failure.

Methods: We administered the ESAS, MLHFQ, VAS, PPS, and SHFM in a shuffled manner to 78 New York Heart Association Functional Classification (NYHA-FC) Ill-IV ambulatory heart failure patients.

Mechanical circulatory support as a bridge to transplant candidacy.

Introduction: The use of mechanical circulatory support (MCS) in nontransplant eligible candidates remains controversial. Our decision to offer MCS for nontransplant candidates has led to their reevaluation after a period of left ventricular assist device (LVAD) support.

Methods: From 2001 to September 2009, we had 37 patients who received an implantable LVAD, 22 (59%) were not deemed to be transplant eligible at the time of LVAD insertion (bridge to candidacy, BTC group).

Quality of life for patients supported on a left ventricular assist device.

Left ventricular assist devices (LVADs) are mechanical pumps implanted into patients at risk of dying from Stage D heart failure. These devices not only increase survival time, they also significantly improve quality of life. Implantation of a LVAD improves hemodynamics and reduces congestion in both the pulmonary and peripheral vasculature.