title: Routine withholding of digitalis for heart rate below 60 beats per minute: widespread nursing misconceptions.
abstract: 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.
  
  
  METHODS
  Non-randomized survey.
  
  
  METHODS
  Five hospitals in a midwestern metropolitan area, ranging from affiliates of a university medical center to a private community-based hospital.
  
  
  METHODS
  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.
authors.affiliation: Patient Care Services, Harper Hospital, Wayne State University School of Medicine.
authors.forename: S A
authors.initials: SA
authors.lastname: Walthall
authors.forename: B
authors.initials: B
authors.lastname: Odtohan
authors.forename: M A
authors.initials: MA
authors.lastname: McCoy
authors.forename: B
authors.initials: B
authors.lastname: Fromm
authors.forename: D
authors.initials: D
authors.lastname: Frankovich
authors.forename: M H
authors.initials: MH
authors.lastname: Lehmann
mesh_terms: D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000451:nursing* / Q000503:physiopathology; D002568:Certification; D003422:Critical Care; D003625:Data Collection; D004071:Digitalis Glycosides / Q000627:therapeutic use*; D004522:Educational Status; D006339:Heart Rate; D006801:Humans; D013041:Specialties, Nursing
chemical_list: D004071:Digitalis Glycosides