Effect of the Nursing Process on the Quality of Life of the Patient With Definitive Pacemaker Implantation
Condition: Quality of Life
Study type: Interventional

Summary: 
      The nursing process consists of establishing interventions applying the scientific method for
      the resolution of real or potential health problems of the person, based on five stages:
      assessment, diagnosis, planning, execution and evaluation, which allows detecting the
      circumstances and elements that affect the adult's independence and the influence he has on
      his environment, his quality of life, his family, social and psychological role.

      MATERIAL AND METHODS: Clinical trial, randomized, controlled with standard management; to
      evaluate the effect of the nursing process on the quality of life in elderly patients who
      come or are referred to the Cardiology Hospital, National Medical Century XXI, with
      alterations in the ventricular atrial conduction and require the installation of a permanent
      pacemaker. The first evaluation (Time 0) will be carried out through an interview with the
      SF36 instrument, translated into several languages and applied to multiple studies in Mexico
      for validation. Two groups will be formed for comparison: Group I will be assigned to
      standard management; Group II: group of patients who are also treated through the nursing
      process with the model of Marjory Gordon with the intervention Handling the definitive
      pacemaker with education and information activities. It will be verified for quality control
      of the maneuver; through a checklist. As a final point, the quality of life will be evaluated
      through the use of the SF36 instrument that consists of 36 items that explore 8 dimensions of
      the state of physical health, physical function, physical role, body pain, general health,
      vitality, social function, emotional role and mental health: considering depression, anxiety,
      self-control, and general well-being; applying the assessment system of the functional
      patterns of the Marjory Gordon model, through surveys. Statistical analysis: Chi square or
      Fisher's exact test will be used according to expected values, for qualitative variables. For
      quantitative variables, the Mann Whitney U or Student's T according to their distribution.
      There will be a calculation of the number needed to be treated, and a multivariate analysis
      will be carried out using a binary logistic regression.
    

Detailed description: 
      Patients admitted to the Cardiology Hospital, National Medical Center Century XXI, will be
      included and a permanent pacemaker will be installed due to alterations in atrio-ventricular
      conduction that meet the selection criteria. They will be explained what the research
      consists of and they will be given an informed consent form to participate in the study, with
      all the ethical considerations that we will discuss later.

      they require to control their comorbidities according to the assessment of their treating
      physician. Having accepted their participation in the present research project, the first
      evaluation (Time 0) will be conducted through an interview with the instrument SF36 Spanish
      version containing a total of 36 questions, translated into several languages and applied to
      multiple studies in Mexico for its validation. The interview will be conducted in two parts
      and will last approximately 15 to 20 minutes.

      Once the first evaluation has been carried out, they will randomly assign, through the use of
      random number tables, to receive specific care from the nursing staff in the following
      manner:

      I. Group of conventional nursing intervention (Group I) that refers to the form performed up
      to now, hemodynamic assessment, local pacemaker verification, electrocardiographic tracing,
      surveillance and care of the incision, assessment of symptoms after the insertion of the
      pacemaker, risks and interferences, mobilization and posture, complications, care information
      and identification of other needs of the elderly in terms of mobility, degree of dependency,
      pain assessment, elimination, nutritional, rest and relationship difficulties family, work,
      emotional conflicts, values and religiosity in some cases.

      II. Nursing intervention group through the nursing process with the Marjory Gordon system
      (Group II).

        1. Starting with the assessment stage by functional patterns: health perception-management,
           nutrition, elimination, activity and rest, sleep and rest, perceptual cognitive,
           self-concept-self-perception, role-relationships, sexuality-reproduction,
           coping-tolerance of stress, values and beliefs and the quality of life.

        2. Following the diagnostic stage of nursing, the problem is identified through labels that
           define it as: Decrease in cardiac output, risk of bleeding, ineffective protection,
           acute pain, risk of imbalance of body temperature, deterioration of ambulation,
           deterioration of physical mobility, deterioration of gas exchange, disposition to
           improve one's health, sleep deprivation, deterioration of urinary elimination,
           constipation, self-care deficit, sensory perception disorder, deterioration of social
           interaction or conflict of decisions , hopelessness, low self-esteem, body image
           disorder, ineffective coping, anxiety, fear and hopelessness complementing the structure
           of the diagnosis with risk factors (for example: poor knowledge) and etiological (for
           example: altered frequency and heart rate) , as well as, with defining characteristics
           (signs and symptoms) that pre Say the problem.

        3. The planning stage will be carried out through expected results from the problems
           identified as nursing diagnoses and using the classification of expected nursing
           outcomes (NOC) each of them with a target score of maintaining results; will increase;
           and scales from severe to none, or from seriously compromised to uncommitted will depend
           on the proposed result. Decreased cardiac output The expected result will be
           effectiveness of the heart pump which will be measured with indicators such as: systolic
           blood pressure, diastolic blood pressure, heart rate , peripheral pulses. From the
           expected result, nursing interventions will be derived:

           Intervention "Cardiac care" with activities

             1. Observing vital signs frequently

             2. Monitor cardiovascular status

             3. Check and check the operation of the pacemaker,

             4. Instruct the patient on the importance of the immediate report of any chest
                discomfort.

             5. Take note of the significant signs and symptoms of decreased cardiac output. •
                Intervention "Management of the definitive pacemaker" with activities of

             1. Education on the potential risks of metabolic alterations (eg potential to increase
                the thresholds of rhythm or capture);

             2. The importance of attending their periodic checks;

             3. Sources of higher electromagnetic interference (eg arc welding equipment, radio
                transmitters, electronic muscle stimulators, concert loudspeakers, electric drills,
                hand-held metal detectors, magnetic resonance, radiotherapy).

             4. Keep about 15 cm away from cell phones;

             5. Signs and symptoms of a dysfunctional pacemaker (eg bradycardia, dizziness,
                weakness, fatigue, chest discomfort, angina, dyspnea, orthopnea, edema, paroxysmal
                nocturnal dyspnea, exertional dyspnea, hypotension, syncope, cardiac arrest)

             6. The importance of carrying the identification card of the manufacturer at all
                times.

             7. Information to the patient and the family related to the implantation of the
                pacemaker (eg, indications, functions, universal programming codes, potential
                complications); related to the effects of pacemaker treatment to reduce patient
                uncertainty, fear and anxiety about symptoms (eg dizziness, palpitations, chest
                pain, shortness of breath) related to treatment (arm edema or augmentation) of
                heat);

             8. Teach the patient to check the manufacturer's warnings when in doubt about
                electrical appliances.

        4. Fourth stage of the nursing process execution of nursing interventions (NIC) obtained
           through the expected results (NOC).

      To evaluate the response of patients to nursing interventions in their quality of life, the
      following will be done:

      1. Before discharge from hospital, verification of quality control of the maneuver will be
      carried out, using a checklist, on the indications given by the nursing staff to the patient.

      2. One month after the patient's hospital discharge, during which patients are regularly
      scheduled for follow-up consultation, after their routine medical assessment, an interview
      will be conducted where we will make a total of 36 questions with 3 to 5 answer options each,
      with the SF36 instrument. The 36 items explore 8 dimensions of the state of physical health,
      physical function, physical role, body pain, general health, vitality, social function,
      emotional role and mental health: considering depression, anxiety, self-control, and general
      well-being; applying the assessment system of the functional patterns of the Marjory Gordon
      model, through surveys. The interview will be conducted in two parts and will last
      approximately 15 to 20 minutes. (Outcome) The system by Functional Employers focuses its
      attention on 11 items with importance for the health of the individual, family or community.

        1. Ability of the person to identify their health status.

        2. Ability of the person to identify their nutritional needs.

        3. Identify the excretory function (intestinal, urinary and skin).

        4. Realization of the activities and exercise carried out by the person.

        5. Conciliar sleep activity

        6. Sensory alterations: Hearing, gustatory, tactile and olfactory views as well as the
           presence of pain.

        7. Form in which the patient feels, feelings, knowledge of himself.

        8. Way to live with others.

        9. It is experienced or expressed in the form of thoughts, fantasies, desires, beliefs,
           attitudes, values, activities, practices, roles and relationships.

       10. Way to handle stress.

       11. Values, beliefs that guide the decisions and choices of the individual.
    

Intervention name(s): Educational; Maneuver control
Intervention type(s): Other; Other
Intervention description(s): Traditional method of nursing care with what is done every day, with the method through the nursing process using nursing language as a nursing diagnosis, classification of nursing interventions, and nursing outcomes.; Verify that the control and intervention group developed the assigned activities in each case.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Control group and intervention group, were selected randomly from consecutive cases and standard management
Masking: Double (Participant, Care Provider)
Primary purpose: Health Services Research
Keywords: Effect, Nursing, Process, Functional, Patterns,health