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Clinical Voices January 2022

Updated: 1 day ago

This month we feature reducing nonactionable alarms, solutions for socioeconomic disparities in women’s heart health, and cardiac radiotherapy for arrhythmia. Plus, read the new President’s Column and watch an informative video Q&A interview.

Solutions for Socioeconomic Disparities in Women’s Cardiovascular Health

Socioeconomic disparities need to be addressed individually and collectively.

Women, particularly those with minority or disadvantaged backgrounds, face increased cardiovascular risks associated with many socioeconomic disparities.

Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women,” in JACC: Journal of the American College of Cardiology, reviews the conditions associated with cardiovascular disease in women, finding potential barriers such as poverty, racism, geography, education, and access to care and insurance. “These contributing factors are often overlapping and, importantly, are modifiable, with actionable solutions,” notes Kathryn Lindley, chair of the ACC Cardiovascular Disease in Women Committee.

Socioeconomic disparities, which can adversely affect women’s health, need to be addressed individually and collectively, the review adds. The barriers can potentially be overcome and, with lifestyle modifications, help decrease the estimated 80% of women’s cardiovascular cases.

“Suggested solutions include addressing bias, resolving issues based on racial discrimination, expanding Medicaid coverage, emphasizing value-based care, using technology to expand access to cardiology care, improving patient education and health literacy, providing access to interpreters, and involving more women and diverse populations in clinical trials.

“Lack of diversity among health care professionals may be even more responsible for disparities in health care access and outcomes than lack of health insurance,” add Lindley and colleagues in a related article in Healio.

Other issues for women in socioeconomically disadvantaged communities include lack of patient-centered care, community support and transportation, and insufficient access to healthy foods and exercise centers. “Resolving health care outcome disparities in women will require both investment in sex-specific science and health policy advocacy and incorporating awareness of the impact of these barriers into our health care delivery (on both personal and systemic levels),” Lindley notes. Telemetry Strategies to Reduce Nonactionable Alarms

A nurse-led discontinuation protocol could remove certain patients from telemetry.

Using evidence-based guidelines and strategies to reduce telemetry for cardiac patients in non-critical care areas can decrease nonactionable alarms.

According to “Reducing Overuse of Telemetry,” in American Nurse, continuous cardiac monitoring (telemetry) frequently leads to false alarms in medical, surgical and intermediate care units. However, the American Heart Association (AHA) “has developed evidence-based guidelines for appropriate telemetry use,” adds a related article in Circulation.

The guidelines offer a rating system with three categories for cardiac monitoring:

  • “Class I: high indication for monitoring

  • Class II: may benefit, but not essential

  • Class III: no therapeutic benefit”

AHA recommends building the guidelines into ordering practices and calls for set times in the ordering process to stop and reevaluate a patient’s need to remain on telemetry, rather than using options such as “until discharged.”

“Revising the process for ordering telemetry and assessing clinical necessity, creating buy-in from key stakeholders, forming a task force to decrease telemetry use, and framing the AHA standards as evidence-based guidelines rather than protocol can ease tensions and resistance from providers,” adds the article in American Nurse.

A set of discontinuation criteria in 13 measurable categories can help develop “a nurse-led discontinuation protocol” to remove certain patients from telemetry. Using collaborative techniques, nurses can communicate possible reductions in telemetry to attending physicians when advocacy is needed.

AACN clinical resources on alarm reduction include a practice alert, “Managing Alarms in Acute Care Across the Life Span,” a nurse-led Clinical Scene Investigator project that offers a presentation and toolkit to help units achieve data-driven outcomes, and “Updated Practice Standards for ECG Monitoring: Impact at the Bedside,” an on-demand webinar.

Reducing alarm fatigue can also be accomplished through evidence-based interventions, such as a burn ICU’s quality improvement initiative and an ICU’s process-oriented intervention with a change of shift protocol. Nurses May Be at Risk of Suicidal Ideation

Burnout among nurses may be a risk factor for suicidal ideation.

Nurses face a greater risk of suicidal ideation than workers in other professions, according to a 2017 survey, and the risk is higher among those reporting depression or burnout.

Original Research: Suicidal Ideation and Attitudes Toward Help Seeking in U.S. Nurses Relative to the General Working Population,” in AJN: American Journal of Nursing, notes the cross-sectional survey had an 8.5% response rate with more than 7,000 nurses participating, of whom 5.5% reported suicidal ideation within the past year, compared with 4.3% in the general population.

“Most nurses (84.2%) indicated willingness to seek professional help for a serious emotional problem. Yet nurses with suicidal ideation were less likely to report that they’d seek such help (72.6%) than nurses without suicidal ideation (85%),” the review adds.

“Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalence of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help.”

The review adds that 38.2% of nurse respondents reported symptoms of burnout and, based on their answers, 43.3% were considered positive for depression. Respondents were overwhelmingly white and female, with a median age of 51 and 20 years of nursing experience.

“Burnout has always been a big topic in healthcare, becoming more prevalent since the pandemic,” lead author Elizabeth Kelsey, Mayo Cl