The American Association of Critical-Care Nurses completed a three-phased process of priority identification for critical care nursing research. In phase 1, a 78-item survey was generated following a comprehensive review of potential research topics. In phase 2, approximately 1000 critical care nurses rated each item on the survey for importance to critical care nursing. Based on these results, the AACN Research Committee formulated a clinical and a nonclinical (contextual) list of research topics. Each list contained 25 topics. In phase 3, topics were given final rankings at a 1-day Consensus Conference on Research Priorities. Both Likert-type and magnitude estimation scaling were used to determine priority ranking of items on each list. As a result, both clinical and contextual research priorities were established for AACN.

BACKGROUND: Investigators have suggested that lateral position may have clinically significant effects on oxygenation in cardiac surgery patients. Presence of lung disease and type of cardiac surgery may be important considerations. OBJECTIVES: To determine the effect of position (left, right, supine) on blood gases in patients who have had coronary artery bypass or cardiac valvular surgery and to compare the effect of position on blood gases in cardiac surgery patients having preoperatively diagnosed lung disease with those having no lung disease. METHODS: A repeated measures design was used to study 120 mechanically ventilated, postoperative cardiac surgery patients. Subjects were randomly assigned a sequence of three positions (supine, and 45; right and left lateral) after cardiac surgery. Heart rate, respiratory rate, and arterial blood gas values were collected in each position. Venous blood gas values were collected from a subset of 40 subjects. RESULTS: A statistically significant effect of position on PaO2 was found in the group as a whole. The mean PaO2 in the left lateral position was lower than the value in the right or supine positions. No significant effects for position and pH, PaCO2, or bicarbonate were detected. No significant effects were found for type of surgery or the presence of absence of preoperative lung disease. A significant effect of position on venous pH was detected. No significant position effects were found for PvO2, PvCO2, bicarbonate, or venous saturation. No significant position effects were found for the calculated arterial-venous oxygen difference. CONCLUSIONS: The results of this study support those of previous research, which reported lower PaO2 in postoperative coronary artery bypass graft patients in the left lateral position. Mean differences in PaO2 were small, suggesting that the known benefits of lateral positioning in the early postoperative period outweigh the potential risks.

BACKGROUND: Indirect/noninvasive blood pressure, heart rate and central venous pressure are frequently monitored hemodynamic parameters in postoperative cardiac surgery patients. No previous studies have explored the effect of lateral position on these variables in this population. OBJECTIVES: To determine differences in (1) blood pressure, central venous pressure, or heart rate measurements among postoperative cardiac surgery patients due to position (supine, 45 degrees right lateral, and 45 degrees left lateral), (2) responses to position between patients having cardiac surgery in which the myocardium was opened (valvular replacement) and those in which it was not (coronary artery bypass graft), and (3) responses to position between cardiac surgery patients having preoperatively diagnosed lung disease and those without lung disease. METHODS: Phlebostatic axis in lateral positions was determined by echocardiography and geometric diagrams prior to the initiation of data collection. Postoperative cardiac surgery patients (N = 120) were studied in the three positions in random sequences. In each position, simultaneous blood pressure measurements were obtained from each arm, and central venous pressure and heart rate were recorded. RESULTS: Statistically significant differences were found in response to position in systolic and diastolic blood pressure, central venous pressure, and heart rate. Certain positions produced greater changes in selected variables, both in the total group and within specific subgroups. No differences were found between coronary artery bypass graft and valve (closed or opened myocardium) subgroups or between subgroups with and without lung disease. CONCLUSIONS: Lateral positioning of postoperative cardiac surgery patients appears to cause no detrimental effects on indirect/noninvasive blood pressure or heart rate measurements. However, significant differences in central venous pressure may occur and supine positioning for determination of central venous pressure is recommended.

This article reviews and summarizes the research conducted following publication of the 1980s American Association of Critical-Care Nurses' clinical research priorities. Original research conducted on the clinical priority topics between 1981 and 1991 was included. Review articles, doctoral dissertations, theses and abstracts were excluded unless judged to provide important information on the topic. Following the statement of each priority, progress in the area is summarized. Limitations and measurement issues are discussed as appropriate. Recommendations for future research are provided, and progress in the area is summarized.