Factors influencing patient entrance into a cardiac rehabilitation program

The purpose of this descriptive pilot study was to identify factors that influence patient participation in a cardiac rehabilitation program. Thirty-nine patients who were admitted to a midwestern hospital with a coronary problem and who were candidates for cardiac rehabilitation completed the Patient Entrance Into a Cardiac Rehabilitation Program (PECRP) questionnaire. The PECRP evaluates a subject's responses to Health Belief Model-based statements. Analysis by t test revealed significant differences for perceived benefits and barriers, indicating that patients who participated in a cardiac rehabilitation program perceived more benefits and fewer barriers to entering such a program than those who did not. No significant differences were found between groups for perceived susceptibility and perceived severity constructs. Analysis of demographic variables revealed significant differences for income and marital status on the perceived benefits and barriers construct, indicating that those who had an income greater than $20,000 and those who were married perceived more benefits and fewer barriers than those whose income was less than $20,000 and who were not married. Nursing implications for these patients are discussed, particularly those related to patient teaching before discharge.

Marital functioning after cardiac surgery

Using Barnhill's components of family health functioning, we examined the relationships of spouse anxiety, coping methods, couple responsibility for compliance, and reported compliance with marital couple functioning. Five psychosocial scales were returned by mail by 136 Mended Heart members and spouses from five geographic regions. By multiple regression analysis, confrontive coping strategies and spouse trait anxiety were the two factors predictive of couple marital functioning. When marital functioning scores were examined separately, spouses' confrontive behaviors and patient reported compliance for diet, stress, and smoking prescriptions were predictive of both spouse and patient marital functioning. In addition, spouse marital functioning was predicted by state anxiety and patient compliance, and patient marital functioning by compliance and shared responsibility for compliance. Further studies should evaluate spouse inclusion in rehabilitation programs during hospitalization and convalescence and examine interactional strategies that facilitate confrontive behaviors and patient compliance to promote couple marital functioning after the cardiac event.

Open-heart surgery in Jehovah's Witnesses

During a 7-year period, 11 adult members of the religious sect Jehovah's Witnesses underwent cardiac surgery with extracorporeal circulation. No homologous blood transfusions were given. Blood-conserving procedures were employed, viz. initial collection of autologous blood, haemofiltration or processing (Cell Saver) of blood collected during extracorporeal circulation and reinfusion of shed mediastinal blood. The total perioperative blood loss averaged 1080 ml (15 ml/kg body weight), equalling 19% of total body blood volume. The mean haemoglobin on discharge from hospital was 11.0 g/100 ml. There was no perioperative mortality. Postoperative pulmonary function was good and there was no serious morbidity. Jehovah's witnesses with serious, surgery-necessitating heart disease can be offered operation comprising recognized blood-conserving procedures.

[Rehabilitation of patients after heart surgery: experience and problems]

The problem of rehabilitation of cardiac surgical patients is of great humane and socioeconomic significance. Over years, a great scientific and practical experience has gained in rehabilitating patients with acquired and congenital heart diseases after surgical correction. Stages of rehabilitation, a complex of medical, somatic, psychological, and socio-occupational measures are specified. Substantial shortcomings in medical labour examination of operated patients lead to an increase in the number of disabled persons. There is a lag in the study into the problem of patients with coronary heart disease after aortocoronary bypass.

[Education of heart surgery patients--did it reach the goal?]

To find out how well informed they were about their disease and operation, 104 patients who had undergone aortocoronary bypass surgery (group A) or heart valve replacement (group B) were asked to complete a questionnaire on discharge from the operating hospital and, after patient briefing during in-hospital rehabilitation, again 3 months after the operation. The level of anxiety and presence of depression were also assessed. We found the following percentages of wrongly or inadequately answered questions (the figures in brackets are from the second questionnaire 3 months after the operation): all questions 40 (27), anticoagulation 26 (15), prophylaxis of endocarditis 54 (29), risk factors 21 (21), nutrition 56 (38), exercise 47 (32), anatomy/physiology 35 (21), postoperative course 40 (24). The learning effect was significant (p less than 0.005) for all but the risk factor questions. There were no significant differences between men and women or between group A and group B. With a proportion of 14% (13%) anxiety was a common problem which had subsided by the end of rehabilitation. With percentiles of 3% (5%), depression was rare.

[Evaluation of patients after heart surgery in the 20-year period of the 2d rehabilitation phase (1967-1986) in Sliac]

In the 1967-1986 in the Czechoslovak State spa Sliac 961 (48.15%) men and 1035 (51.85%) women after surgical operations on the heart were followed up during the second rehabilitation stage. The operations were made because of the following indications: acquired rheumatic valvular defects 1208 (60.52%), congenital heart disease 461 (23.10%), ischaemic heart disease 260 (13.03%), myxomas and thrombi of the left atrium 31 (1.55%), pericardiectomy was performed in 36 (1.80%). As to surgical operations, commissurotomy and commissurolysis were performed in 724 (36.27%) an artificial prosthesis was implanted in 330 (16.53%), homotransplants in 151 (7.57%) autotransplants in 3 (0.15%), aortocoronary by-pass/revascularization in 260 (13.03), surgical operations on account of congenital heart disease, thrombi and myxomas of the left atrium were performed in 492 (24.65%) of the patients. Rehabilitation care comprised in addition to remedial exercise a therapeutic regime, clinical and laboratory examinations, dietotherapy, medicamentous and physical therapy and carbon dioxide baths. After rehabilitation care objective improvement was recorded in 850 (42.59%), subjective improvement in 953 (47.74%) no change in 143 (7.16%), deterioration in 47 (2.35%), and three patients (0.15%) died.

Educating the cardiac surgery patient and family

Preoperative, discharge, and follow-up instruction of cardiac surgical patients is considered essential to the recovery of these patients. However, increasing patient acuity and decreasing length of stay compromise patient learning ability and minimize the time available for teaching. This article reviews the research on preoperative, discharge, and postdischarge instruction. Suggestions for application in the clinical setting are based on experience from Brigham and Women's Hospital. Detailed strategies for improving learning are discussed.

Road to recovery

The role of the nurse in giving information to patients has grown considerably following the work of researchers such as Hayward (1975), Boore (1978) and Wilson-Barnett (1978). From admission to discharge the nurse has a valuable educational role to play in helping patients come to terms with their present position and preparing them for the future. The questions facing nursing now are not whether nurses should undertake this role, but how well do they provide information? Do patients act on advice? And how far should relatives be included in the process of patient education? These are the questions that prompted the present study, in which 43 people completed questionnaires 6 to 8 weeks following discharge from hospital after cardiac surgery. Eighty-two per cent were completely or 'on the whole' satisfied with the information given, though the perceived adequacy varied between topics; 70% reported some associated behaviour change and in each case their relatives had been involved in receiving pre-discharge advice.

Improving recovery following cardiac surgery: a randomized clinical trial

To enhance individual and family health during recovery from heart surgery, this study employed nursing interventions based on self-efficacy and family stress theory during the hospitalization period and for 3 months thereafter. The effectiveness of the interventions were assessed through a randomized trial in which 67 prospective bypass and valve surgery patients, aged 30-77 years, and their spouses, were allocated either the experimental interventions or usual care and followed for 6 months. At 3 months post-surgery, the only statistically significant differences between the experimentals and controls were on perceived self-efficacy for lifting and tolerating emotional distress. At 6 months no significant differences were found on individual or family measures. Analyses revealed that age, gender and preoperative cardiac status significantly affected individual recovery. The study is continuing with a larger sample in order to explicate the recovery process and to better determine whether a low intensity nursing intervention can effect changes in individual and family recovery.

[Role of ambulatory electrocardiography in the evaluation of interventions: rehabilitation of a patient who has undergone surgery]

The authors relate their own experience with 24 hr Holter monitoring in course of cardiac rehabilitation after coronary bypass surgery as well as after valvular replacement. As regards patients after coronary surgery they report the experience they got in the evaluation of heart rate trend and cardiac arrhythmias as well as in silent ischemia study. About this last problem 116 patients with signs of ischemia both in stress test and in Holter recording are considered out of 491 who had undergone coronary surgery. Ischemia during 24 hr Holter monitoring develops at an heart rate lower than effort ischemia. Holter monitoring proves to be very useful also in patients after valvular replacement to study arrhythmias and to check drugs' efficacy. After displaying the results concerning arrhythmias of 24 hr Holter electrocardiograms recorded in 207 randomized patients who had undergone valvular replacement 15 days before, the authors dwell upon the use of Holter electrocardiography in 82 valvular patients after pharmacological cardioversion and show that major arrhythmias get a clear reduction thanks to rehabilitation.

Psychosocial outcome one year after heart surgery. A prospective study

Ninety-nine of 118 patients receiving cardiac valve replacements (n = 55) or coronary artery bypass grafts (n = 44) were studied before surgery and again one year after surgery. Psychological, social, and physical variables were assessed. For the 19 subjects not returning for follow-up, medical data collected by their general practitioner were available. The physical results of surgery were good, with over 90% of the patients showing improvement. Mean scores for psychological distress and quality of life improved; however, a bad psychosocial adjustment was present in about 25% of patients at follow-up. Bad psychosocial adjustment was not correlated with surgical results. The preoperative variables most predictive of poor psychosocial outcome were high scores in the general hypochondriasis and irritability subscales of the illness Behaviour Questionnaire, bad psychological adjustment characterized by high anxiety, depression, and global scores on the Symptom Distress Checklist, and ischemic rather than valvular heart disease.