Coronary artery bypass surgery--impact upon the patient's spouse

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

Family stress, family adaptation, and psychological well-being of elderly coronary artery bypass grafting patients

As our population ages, more elderly patients will undergo coronary artery bypass grafting. The psychological well-being of a patient is influenced by many factors, including family support. This descriptive, correlational pilot study was conducted to examine the relationship between family characteristics and psychological well-being in elderly coronary artery bypass grafting patients. The results of this study, which consists of 42 participants, are presented, as well as implications for critical care nursing.

Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery

BACKGROUND

Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses' ability to provide care to the patient.

OBJECTIVES

The purpose of this study was to compare burden and caregiving outcomes across three groups of spouses. Spouse groups varied by the interval of time between surgery and follow-up, which may have been 3, 6, or 12 months.

METHODS

This cross-sectional comparative study recruited a convenience sample of 166 spouses on the basis of a power analysis. A total of 166 spouses completed caregiver surveys on burden and other caregiving outcomes.

RESULTS

Total, objective, and subjective burden levels were low to moderate. Although no burden differences were found between groups, men had higher total burden but more positive caregiving outcomes. Future outlook and social activities were less positive in the 6-month group. Burden levels were not lower, nor were caregiving outcomes higher, in the 12-month group, suggesting a steady caregiving demand across the first year after coronary artery bypass graft surgery.

CONCLUSION

Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.

The effect of hypnotherapeutic ego strengthening with female spouses of South African coronary artery bypass surgery patients

In addition to exacerbating morbidity in male coronary artery bypass surgery (CABS) patients, their plight can also impose considerable strain on their female spouses' mood states, resulting in compromised quality of life. The current study was aimed at determining the impact of pre postoperative hypnotherapeutic ego strengthening (HES) on anxiety and depression in female spouses. It was conducted simultaneously with a recently published study of their CABS husbands' response to HES. Spouses whose husbands had been randomly assigned to an experimental group, were designated the experimental spouse group (n = 25) and spouses whose husbands constituted the control group, likewise comprised the control spouse group (n = 25). Assessment occurred preoperatively, on the day of discharge and at six week follow-up. Spouses in the experimental group (n = 25) were introduced to hypnotherapeutic ego strengthening (HES), pre and postoperatively. In the postoperative assessment experimental female spouses showed significantly reduced morbidity levels, which were maintained at follow-up. In contrast, females in the control group (n = 25) showed no change. The results supported the value of brief hypnotherapy as a means of psychologically empowering spouses whose husbands' were undergoing CABS.

Emotional well-being in spouses of patients with advanced heart failure

BACKGROUND

The physical demands and psychological stressors of caregiving negatively impact the emotional well-being of spouses in many chronically ill populations such as patients with Alzheimer's disease and end-stage renal failure. Heart failure (HF) is a chronic illness with a poor prognosis that is increasing in prevalence and incidence, yet little is know about its effect on the family, particularly the spouse.

OBJECTIVE

We conducted this study to describe the emotional well-being of spouses of patients with HF, to identify factors associated with spouses' decreased emotional well-being, and to compare emotional well-being between spouses with higher and lower levels of perceived control. We proposed a model that included age, sex, employment status, perceived control, and caregiver burden to explain the emotional well-being of spouses.

METHODS

Data were collected from 69 spouses of patients with advanced HF (mean age 54 years and predominantly female) using 2 subscales of the SF-36, control attitudes scale-family version and caregiver appraisal tool. Descriptive statistics, Pearson correlations, and stepwise multiple regression were used to analyze data.

RESULTS

The model explained 40% of the variance in the emotional well-being of spouses (P = 0.001). Perceived control (P = 0.001) and age (P = 0.046) were associated with emotional well-being. In spouses with higher levels of control, emotional well-being was significantly higher than in spouses with lower levels of control (P = 0.003). Older spouses had higher levels of emotional well-being compared with younger spouses (P = 0.01).

CONCLUSIONS

Health care professionals must assess the level of control perceived by spouses of patients with advanced HF and provide information and counseling directed toward increasing their sense of control. Younger spouses are particularly at risk for decreased emotional well-being and may require special intervention.

Coronary artery bypass graft surgery: discharge planning for successful recovery

BACKGROUND

Coronary artery bypass graft (CABG) surgery is a lifesaving intervention, but the early recovery period presents a number of challenges for patients, carers and nurses. Early and adequate discharge planning based on in-depth knowledge of the postdischarge experience can help to ensure optimal recovery.

AIM

This paper reports a study to examine the range of postdischarge issues, concerns and needs of patients and their family carers after discharge after CABG surgery, and explore their perceptions of unmet needs 1 year later.

METHODS

A two-phase naturalistic inquiry was undertaken. Interviews were conducted with 30 patients and their carers 4-5 weeks after coronary artery bypass grafting (phase 1) and 1 year after the initial interview (phase 2). Thematic analysis was used to identify the major concerns of participants.

FINDINGS

Almost half the patients experienced heart surgery as a huge personal shock. Adjusting to life afterwards was difficult, and they experienced a variety of changes, including pain. An unexpected finding was a heightened sense of body awareness and the need for postoperative physical adjustments. The financial implications of surgery were a major burden. Lifestyle adjustments were important and led to suggestions for support services, using telephone support and/or community patient networks. All participants recommended strengthening discharge planning with more accurate information about what to expect during recovery, to help them anticipate fluctuations in health and wellbeing. Carers experienced a wide range of unanticipated feelings during early recovery and had to deal with a number of personal changes.

CONCLUSIONS

The findings suggest a need to improve discharge preparation and provide enhanced home support services. Further research should evaluate models of periodic follow-up and mechanisms for mutual support, and compare the experiences of cardiac patients and their carers with those of other surgical cohorts.

Social networks, social support and coping with serious illness: the family connection

Selected social support and family research is reviewed to highlight potential problems in social support exchange as patients and families collectively cope with illness and disability. Results indicate that family support is a primary source of patient support and that the impact of illness on families is substantial, underscoring their need for support. Results also indicate that there are numerous opportunities for problematic supportive exchange within families. The case is made that future studies of social support are needed to answer a series of questions about social support process within families coping with serious illness.

Spouses' perceptions of readiness for discharge after cardiac surgery

The purpose of this study was to describe spouses' perceptions of readiness for discharge after a partner's coronary artery bypass graft (CABG) surgery. An exploratory design was used to address the research questions. Six weeks after discharge, a nonrandom sample of 67 female spouses responded to open-ended questions about discharge readiness. The data were examined using content analysis. One hundred eighty-six statements were coded from the 67 questionnaires. Forty-two women (62%) reported they felt prepared for discharge. Four key people were identified as very helpful to spouses at discharge: nurse, physician, immediate family member, and friends who have had the same experience. Availability of social support, use of coping strategies, personal resources, and knowing what to expect were the major factors that influenced spouses perceptions of readiness for discharge.