Date of Completion of Thesis/SIP

Spring 5-1-2020

Document Type

Scholarly Inquiry Paper (SIP)

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

First Advisor

Sandy Paddock

Second Advisor

Ann Loth

Abstract

As femoral access percutaneous cardiac interventions (PCIs) increase in the United States, so will vascular complications. Nurses play a vital role in increasing comfort and decreasing vascular complications in patients who have undergone a femoral access PCI, through monitoring and early ambulation. Early ambulation is supported by the literature, yet a sacred cow of nursing, prolonged bed rest, continues in clinical practice with varied nursing perception of optimal early ambulation time. The purpose of this integrative review was to assess if nursing perception of optimal ambulation time after a femoral access PCI, four hours, has any impact on vascular complications in adult patients. The 15 articles reviewed showed that low-risk patients are eligible for early ambulation at four hours or less post-femoral access PCI and nurses should consider a patient’s history and risk factors prior to ambulating the patient. Other themes include lack of evidence from clinical practice guidelines (CPGs), varying definitions of low-risk patients and variables, methodological study flaws, lack of evidence linking risk factors and early ambulation, and nursing need for early ambulation education. Wagner’s Chronic Care Model’s elements of decision support and clinical information systems were used to guide the nursing implications and recommendations. Decision support systems such as evidence-based CPGs, are needed for post-PCI nursing care in the United States. Clinical information systems such as the electronic health record, can help guide and support post-PCI nursing care in the form of flow sheets, clinical decision tools, and clinical pathways. Additional nursing implications and recommendations include nursing education based on the latest evidence-based literature, standardizing variable definitions, and a call for an additional randomized control trial to correlate risk factors and early ambulation after a femoral access PCI.

Comments

To my family, friends, editor, Dr. Sandy Paddock, Dr. Loth, and Scott Faust:

Thank you for all your support, feedback, and helping me celebrate not only this paper, but also this journey towards my Master’s Degree in nursing.

No one can accomplish great things without the support of their community.

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