Waiting for Cardiac Surgery—Support Experienced by Next of Kin

Factors Influencing Intraoperative Waiting Time According to the Experience of Iranian Families

PURPOSE

The purpose of this study was to explore factors influencing family members' experience of waiting for patients' surgery.

DESIGN

A qualitative design using content analysis approach was used.

METHODS

The study took place at a university medical center hospital in an urban area of Iran. After using a purposive sampling method for the selection of participants, semistructured interviews and field notes were held for data collection.

FINDINGS

The experience of 16 Iranian family members who were waiting for their patient's surgery to be finished was analyzed. Data analysis led to the development of three main themes: "family member-related factors," "patient-related factors," and "organization-related factors."

CONCLUSIONS

The results revealed some factors in real context that can help health care professionals, especially nurses, to get a better understanding of the situation and improve quality of care. In addition, understanding these factors will contribute to the body of knowledge in nursing.

The waiting process: a grounded theory study of families' experiences of waiting for patients during surgery

In this qualitative study, conducted with a grounded theory approach, 17 family members awaiting their relatives’ surgery, were interviewed. The interviews were semi-structured and the data from them was analysed using the constant comparative method suggested by Corbin and Strauss. The findings showed ‘attempt to reassure’ as the core category. The main theme of ‘assurance’, comprising patterns of ‘recourse to spirituality’, ‘communication’, ‘physical proximity’, and ‘coping’ indicated the processes used by participants to achieve their goals. These findings may help health care professionals, especially nurses, to better understand the subject and better facilitate the process of waiting whilst relatives have surgery.

Iranian families' experience of receiving support during their patients' surgical process: qualitative study

BACKGROUND

The time spent waiting through the surgery of a loved one is stressful for family members because of their worries regarding the procedure and potential outcomes. In Iran, the attention and support of healthcare professionals focus almost exclusively on the patient. No studies have explored the related support experiences of family members. Understanding these experiences may facilitate the development by healthcare professionals of support strategies to alleviate the surgery-related stresses of patients' family members.

PURPOSE

This study elucidates the support experiences of the Iranian families of patients undergoing surgery.

METHODS

A qualitative design using a content analysis approach was used to gather and analyze the support experiences of 16 Iranian families awaiting the conclusion of their relative's surgical operation. The study was conducted at a university medical center hospital in an urban area in Iran. After employing a purposive sampling method to select participants, semistructured interviews were used to collect data.

RESULTS

Data analysis led to the development of two main themes: "interaction:" and "physical proximity." One significant finding was the role of productive interactions among family members to facilitate the passing of time and to provide a buffer. These interactions may take place among family members as well as among other companions.

CONCLUSIONS

The findings of this study may be used to guide nursing practices and may help change nursing attitudes toward the family members of surgical patients. By better understanding the experience of families, nurses may improve their professional actions and reduce the stress experienced by family members while waiting for the conclusion of surgery.

Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients

OBJECTIVE

In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients' experience of seeking and receiving information before cardiac surgery.

METHODS

Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach.

RESULTS

A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support.

CONCLUSION

In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health.

PRACTICE IMPLICATIONS

Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.

Waiting for a heart or lung transplant: Relatives' experience of information and support

OBJECTIVES

To describe the relatives' experiences of information and support while heart or lung transplant candidates were waiting for a transplantation.

METHODOLOGY/DESIGN

The critical incident technique was used. Incidents were collected via interviews with 18 relatives (28-73 years old) of heart or lung transplant patients within four weeks of the patients being accepted onto the transplant waiting list.

FINDINGS

A total of 286 important events, both positive and negative, were identified and divided into two main areas: "Experiencing information and support" and "Reflecting upon information and support." "Experiencing information and support" was associated with "dissatisfaction with the health-care system", "being relatively satisfied", "supporting patients" and "the role of social networks." "Reflecting upon information and support" was associated with "finding strength" and "uncomfortable with emotions". Relatives experiences suggest that needs can be met through specific targeted information and support for them as well as mediating contact to previously transplanted persons.

CONCLUSION

The findings indicate a gap between the information and support that relatives need and receive, and that more attention should be paid to information and support for this group. By increasing awareness among healthcare professionals and the community, interventions can be developed that benefit relatives.

Serious complications in connection with cardiac surgery--next of kin's views on information and support

OBJECTIVE

Next of kin (NoK) to patients undergoing cardiac surgery expect successful outcomes but sometimes serious complications occur and this affects their NoK. To describe NoK's experiences of information and support when serious complications occur during the first 30 days after cardiac surgery.

METHODS

A qualitative, critical incident technique was used. Forty-two NoK were asked to describe their experiences of information and support.

RESULTS

Three main areas emerged from the analysis. The first main area, Confidence during the waiting period, described how NoK could not participate in the forthcoming operation and how the NoK were informed. The second main area, Involvement during the hospital stay, described how the NoK feel trust in the healthcare professionals and dissatisfaction with the care in relation to the operation. The third main area, Sense of abandonment, described problems with the rehabilitation.

CONCLUSIONS

These findings show the importance of pre- and post operative contacts between healthcare professionals, patients and NoK. When the NoK and the patients are well informed it constitutes a basis for fruitful conversations between them and the healthcare professionals, and everyone can be better prepared if complications occur.

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (ß = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (ß = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.

A meta-synthesis of qualitative research into needs and experiences of significant others to critically ill or injured patients

AIMS AND OBJECTIVES

This study aimed to describe the significant others' experiences and needs when a person is critically ill or injured in an acute care setting.

BACKGROUND

Being a significant other to a hospitalised critically ill or injured patient is a heavily distressing life event. Addressing significant others' needs adequately has been shown to be essential to mitigate the psychological consequences of such distressing events.

DESIGN

A systematic review of qualitative research.

METHODS

Meta-ethnographic synthesis was used for analysis.

RESULTS

The key findings are described in five major themes: uncertainty and emotional 'roller coaster'; information--balancing hope and reality; to guard and to protect the loved one; alliance with caregivers--crucial support; and social network--support and disequilibrium.

CONCLUSIONS

The study can provide a broader understanding of the significant others' situation. They are facing an overwhelming and emotionally challenging situation and need to be seen and heard.

RELEVANCE TO CLINICAL PRACTICE

The results point towards the nurses' key position in handling the needs of the significant others. This kind of description might be helpful in taking on this delicate task and might also serve as a body of knowledge to influence clinical practice guidelines and nursing interventions in this field.

The subject of pedagogy from theory to practice--the view of newly registered nurses

The aim was to describe, from the newly registered nurses' perspective, specific events when using their pedagogical knowledge in their everyday clinical practice. The design was qualitative and the critical incident technique was used. Data was collected via interviews with ten newly registered nurses who graduated from the same University program 10 months earlier and are now employed at a university hospital. Two categories emerged in the analyses. The first category was "Pedagogical methods in theory" with the sub-categories Theory and the application of the course in practice, Knowledge of pedagogy and Information as a professional competence. The second category was "Pedagogical methods in everyday clinical practice" with sub-categories Factual knowledge versus pedagogical knowledge, Information and relatives, Difficulties when giving information, Understanding information received, Pedagogical tools, Collaboration in teams in pedagogical situations, and Time and giving information. By identifying specific events regarding pedagogical methods the findings can be useful for everyone from teachers and health-care managers to nurse students and newly registered nurses, to improve teaching methods in nurse education.

Sharing life with a gluten-intolerant person--the perspective of close relatives

BACKGROUND

Several studies indicate the importance of social support in the case of chronic disease.

AIM

The aim was to explore dilemmas experienced by close relatives living with a person suffering from coeliac disease, and to describe the strategies they used to deal with these dilemmas.

METHODS

Twenty-three informants were interviewed. A systematic inductive qualitative method, the critical incident technique was used.

RESULTS

Disease-related worries included having bad conscience about not being affected by the disease, experiencing anxiety and witnessing the vulnerability of the affected relative in social situations. Dilemmas related to manage daily life were connected with increased domestic work, restricted freedom of action and the diseased person's preferential right of interpretation of health risks associated with the coeliac disease and deviations from the diet restrictions. Dilemmas related to disturbances in social life, concerned lack of information, knowledge and understanding. Different strategies were described to manage daily life.

CONCLUSIONS

Close relatives experienced a variety of dilemmas that affected the situation of the whole family. The role of relatives in handling the coeliac disease with the diseased person in the everyday life might be underestimated, and to provide relatives with better knowledge regarding the disease might improve the situation also for patients.

An exploration of the information needs of spouse/partner following acute myocardial infarction using focus group methodology

This study aimed to explore spouse/partners' experience of the information received and required in the acute myocardial infarction (AMI) in-hospital recovery period. A dearth of information exists that uncovers the information needs of spouse/partners following AMI. Although information needs, emotional reactions, support and information provision are prevalent themes within the literature, there are few studies that specifically address these issues in this population. While survey methods abound, with more recent qualitative interviews apparent, focus group methodology is underused. The study employed a qualitative descriptive design. Using focus group techniques, 15 partners were interviewed. Emerging themes included: reactions to the event, feeling like a burden on the health service, the need for information and pulling apart - pulling together. Spouse/partners play a critical role in helping patients recover from acute cardiac events thus information and support for the latter are crucial. While spouse/partners commonly seek information as a problem-solving coping strategy, in an effort to regain personal control, spouses often lack information. This study identifies spouse/partner isolation and suggests that additional supports need to be in place to adequately deal with the challenges that AMI brings to family life. Suggested support mechanisms to enhance current provision are inclusion of spouse/partner in cardiac rehabilitation programs and hospital-based care, self-help groups supported and attended by professionals and telephone support systems.

Patients perceptions of information about risks at cardiac surgery

OBJECTIVE

The aim was to describe the patients' own experiences of risk information in connection with cardiac surgery and it's outcome.

METHODS

Questionnaires were answered prior to and 8 weeks after cardiac surgery. Data were analysed using qualitative content analysis. Patients in the intervention group (n=55) received standard information and a newly written extended information brochure about risks in connection with cardiac surgery. Patients in the control group (n=44) only received standard information.

RESULTS

Three categories emerged: attitude towards information, deficiencies and advantages of the information and concerns related to cardiac surgery. Patients in both groups pointed out the importance of information when they were put on the waiting list. Patients in the control group missed information about complications and some patients thought that their complications were caused by maltreatment. Patients having complications in the intervention group were more understanding about their situation.

CONCLUSION

Much can be done for the patients on their path from diagnosis and being accepted for cardiac surgery and throughout the treatment period regarding the provision of information.

PRACTICE IMPLICATIONS

If patients become carefully and thoroughly informed by the health care professionals, they are more satisfied and better prepared if complications occur.