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Routine withholding of digitalis for heart rate below 60 beats per minute: widespread nursing misconceptions
S A Walthall1, B Odtohan, M A McCoy
1Patient Care Services, Harper Hospital, Wayne State University School of Medicine.
Objective:
To describe the nursing practice of withholding digitalis solely on the basis of a heart rate less than 60 beats/min and to determine the rationale for this practice.
Design:
Non-randomized survey.
Setting:
Five hospitals in a midwestern metropolitan area, ranging from affiliates of a university medical center to a private community-based hospital.
Subjects:
Two hundred twelve nurses, 53% from critical care units, 19% from step-down units, and 28% from nonmonitored units).
Results:
Eighty-one percent of respondents either withheld digitalis unnecessarily or administered the drug without correctly indicating why they did so. Nurses with CCRN certification were more likely to answer correctly than those who were not certified (p = 0.0001). Categories for incorrect rationale were (1) incorrect understanding of the drug's mechanism of action (46%), (2) deference to physician's decision-making (28%), (3) adherence to hospital policy (18%), and (4) adherence to guidelines taught in nursing school (6%).
Conclusions:
The results document the need to correct widespread misconceptions regarding the mechanism of action for digitalis and subsequent nursing practice.