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Ünver S, Yildirim M, Eyı S, Hüseyın S. Pain-related fear among adult patients undergoing open-heart surgery: an interpretative phenomenological analysis. Contemp Nurse 2023; 59:462-477. [PMID: 37608646 DOI: 10.1080/10376178.2023.2249127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND One of the sources of anxiety and fear among patients undergoing open-heart surgery is the possibility of experiencing pain, such as sternotomy-related chest pain. Giving them the chance to express their feelings about the potential pain may be effective in reducing their anxiety and may support their coping strategies. OBJECTIVES To examine pain-related fear among patients undergoing open-heart surgery and to understand the underlying reasons of their fears. METHODS A qualitative interview based on Heidegger's interpretative phenomenological approach was conducted adhering to the COREQ guidelines. Sixteen patients who were undergoing open-heart surgery in the following day were interviewed at the cardiovascular surgery ward of a university hospital. The organization and mapping of the qualitative data was done by using ATLAS.ti 8.0. RESULTS The patients who were afraid of experiencing pain after surgery seemed to be more concerned about open-heart surgery itself (such as pain from sternotomy and chest tubes) and the possibility of prolongation of postoperative pain. To cope with these fears, the patients employed a variety of social and self-coping strategies. Trusting the healthcare team, having a high pain tolerance, and having personal thoughts that take precedence over pain-related fear were the key factors explaining not being afraid of experiencing pain. CONCLUSIONS This study provides a deeper understanding of the underlying reasons and the needs of patients in controlling their pain-related fears before open-heart surgery. Trusting the healthcare professionals is one of the main factors for patients to control their pain-related fears. To develop a supportive sense of trust and to help patients in controlling their pain-related fears, surgical nurses must dedicate enough time for understanding patients' concerns while planning their nursing care plans. Future studies may focus on exploring the role of nursing interventions and multidisciplinary team approaches on the management of preoperative pain-related fear.
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Affiliation(s)
- Seher Ünver
- Faculty of Health Sciences, Department of Surgical Nursing, Trakya University, Edirne, Turkey
| | - Meltem Yildirim
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Semra Eyı
- Faculty of Health Sciences, Department of Surgical Nursing, Osmangazi University, Eskişehir, Turkey
| | - Serhat Hüseyın
- Medicine Faculty, Department of Cardiovascular Surgery, Trakya University, Edirne, Turkey
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Yildirim M, Akbal S, Turkoglu M. The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial. Appl Nurs Res 2023; 72:151687. [PMID: 37423676 DOI: 10.1016/j.apnr.2023.151687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/15/2023] [Accepted: 05/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery. AIM To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. METHODS This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS). RESULTS The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group. CONCLUSIONS Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery. CLINICALTRIALS gov Identifier: NCT05487430.
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Affiliation(s)
- Meltem Yildirim
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain.
| | - Sevim Akbal
- Trakya University, Kesan Hakki Yoruk School of Health, Department of Nursing, Hersekzade Yerleskesi Yeni Mah., Yusuf Capraz Cad., No:13, 22880 Izzetiye Koyu/Kesan/Edirne, Turkey.
| | - Meryem Turkoglu
- Istanbul Mehmet Akif Ersoy, Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi, Istasyon, Turgut Ozal Bulvari No:11, 34303 Kucukcekmece/Istanbul, Turkey
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3
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Gledhill K, Bucknall TK, Lannin NA, Hanna L. Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives. BMC Health Serv Res 2023; 23:425. [PMID: 37131178 PMCID: PMC10153031 DOI: 10.1186/s12913-023-09285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. METHODS A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. RESULTS Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). CONCLUSIONS These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Geelong, Australia.
- School of Primary and Allied Healthcare, Monash University, Frankston, Australia.
- Department of Occupational Therapy, School of Primary Health and Allied Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia.
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute of Health Transformation, Deakin University, Geelong, Australia
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Lannon H, Code J, Poole J, Simpson C, Badh V. Patients and caregivers perspectives of the connection between home and the transplant journey. Heart Lung 2023; 57:265-270. [PMID: 36332350 DOI: 10.1016/j.hrtlng.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND For many heart failure patients, a heart transplant is required. Few hospitals in Canada perform heart transplants; thus, patients and caregivers must relocate to access transplant care. OBJECTIVE This study explores Canadian patients' and caregivers' experiences of to access transplant care and how patients and caregivers define home. The study's goal is to gain insights from the patient and caregiver experience and identify opportunities to improve the experience for those who relocate to access heart transplants. The research question was: How is the concept of home connected to the heart transplant journey? METHODS We conducted 18 interviews with advanced heart failure patients and caregivers, to explore patient and caregiver experiences of relocating to access transplant care. Patients and caregivers ranged in ages from 20's to 60's and had left their home of origin to move to a new location where medical care was available. 7 patients were male, 3 were female. All caregivers were female. RESULTS Patients and caregivers identified three supports during relocation: other patients and caregivers, medical team and family. Patients and caregivers defined home as friends, family, community, warmth, safety, belonging and comfort. CONCLUSION During relocation, patients and caregivers were supported by: other patients and caregivers, their medical team and family, and how these people made them feel: safe, warm, comfortable and that they belonged is how they defined home. The supports and definitions of home are connected; thus, a sense of home is inextricably linked to the transplant journey for patients and caregivers.
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Trunk stabilising exercises promote sternal stability in patients after median sternotomy for heart valve surgery: a randomised trial. J Physiother 2022; 68:197-202. [PMID: 35753968 DOI: 10.1016/j.jphys.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/27/2021] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
QUESTION What is the effect of trunk stabilising exercises on sternal stability in women who have undergone heart valve surgery via median sternotomy? DESIGN Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Thirty-six women aged 40 to 50 years who had undergone heart valve surgery via median sternotomy 7 days before enrolment. INTERVENTION All participants in both groups received cardiac rehabilitation during hospitalisation and three times per week for 4 weeks after discharge. In addition, participants in the experimental group were prescribed a regimen of trunk stabilising exercises to be performed three times per week for 4 weeks. At each exercise session, each of 11 exercises were to be performed with five to ten repetitions. OUTCOME MEASURES The primary outcome was sternal separation (the distance between the two halves of the bisected sternum). The secondary outcome was the Sternal Instability Scale from 0 (no instability) to 3 (an unstable sternum with substantial movement or separation). Measures were taken before and after the 4-week intervention period. RESULTS After the 4-week intervention period, the experimental group had a greater decrease in sternal separation by 0.09 cm (95% CI 0.07 to 0.11). The experimental group was twice as likely to improve by at least one grade on the Sternal Instability Scale by 4 weeks (RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three times as likely to have a clinically stable sternum (grade 0 on the Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04). CONCLUSION Trunk stabilising exercises were an effective and feasible method of promoting sternal stability in women who underwent heart valve surgery via median sternotomy. TRIAL REGISTRATION NCT04632914.
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Abraham J, Kandasamy M, Huggins A. Articulation of postsurgical patient discharges: coordinating care transitions from hospital to home. J Am Med Inform Assoc 2022; 29:1546-1558. [PMID: 35713640 DOI: 10.1093/jamia/ocac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cardiac surgery patients are at high risk for readmissions after hospital discharge- few of these readmissions are preventable by mitigating barriers underlying discharge care transitions. An in-depth evaluation of the nuances underpinning the discharge process and the use of tools to support the process, along with insights on patient and clinician experiences, can inform the design of evidence-based strategies to reduce preventable readmissions. OBJECTIVE The study objectives are 3-fold: elucidate perceived factors affecting the postsurgical discharge care transitions of cardiac surgery patients going home; highlight differences among clinician and patient perceptions of the postsurgical discharge experiences, and ascertain the impact of these transitions on patient recovery at home. METHODS We conducted a prospective multi-stakeholder study using mixed methods, including general observations, patient shadowing, chart reviews, clinician interviews, and follow-up telephone patient and caregiver surveys/interviews. We followed thematic and content analyses. FINDINGS Participants included 49 patients, 6 caregivers, and 27 clinicians. We identified interdependencies between the predischarge preparation, discharge education, and postdischarge follow-up care phases that must be coordinated for effective discharge care transitions. We identified several factors that could lead to fragmented discharges, including limited preoperative preparation, ill-defined discharge education, and postoperative plans. To address these, clinicians often performed behind-the-scenes work, including offering informal preoperative preparation, tailoring discharge education, and personalizing postdischarge follow-up plans. As a result, majority of patients reported high satisfaction with care transitions and their positive impact on their home recovery. DISCUSSION AND CONCLUSIONS Articulation work by clinicians (ie, behind the scenes work) is critical for ensuring safety, care continuity, and overall patient experience during care transitions. We discuss key evidence-based considerations for re-engineering postsurgical discharge workflows and re-designing discharge interventions.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Madhumitha Kandasamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashley Huggins
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Gray E, Smith C, Bunton R, Skinner M. Perceptions and experiences of engaging in physical activity following coronary artery bypass graft surgery. Physiother Theory Pract 2021; 38:2841-2855. [PMID: 34666600 DOI: 10.1080/09593985.2021.1989733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Engagement in physical activity (PA) during the recovery period following coronary artery bypass graft (CABG) surgery improves physical and health-related quality-of-life outcomes. OBJECTIVE To explore people's perceptions and experiences of engaging in PA during the first three months following CABG surgery. METHODS A mixed methods study design was utilized. Quantitative data were collected via accelerometer activity capture and standardized questionnaires. Qualitative data were collected via semi-structured interviews at weeks 1, 3, 6 and 12 post-hospital discharge. Interviews were analyzed using inductive thematic analysis. RESULTS Two overarching themes described the overall experience of engaging in PA: 1) "Navigating a difficult and unfamiliar road to recovery" and 2) "Still cautious but becoming more confident and able." These themes described the impact over time that various physical (i.e., fatigue, pain, medical complications, and physical deconditioning), psychological (i.e., fear, confidence, uncertainty, and motivation), and environmental (support) factors had on PA engagement, as well as the relationships between these factors. CONCLUSION The findings provided insight into the physical, psychological, and environmental factors that impacted participants' PA engagement following CABG surgery. This knowledge may benefit health professionals to optimize preparation and support for adults to engage in PA post-hospital discharge following CABG surgery.
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Affiliation(s)
- Emily Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Cath Smith
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Richard Bunton
- Department of Surgical Sciences, Otago Medical School, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Gray E, Dasanayake S, Sangelaji B, Hale L, Skinner M. Factors influencing physical activity engagement following coronary artery bypass graft surgery: A mixed methods systematic review. Heart Lung 2021; 50:589-598. [PMID: 34087676 DOI: 10.1016/j.hrtlng.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Engagement in physical activity during the initial months following coronary artery bypass graft (CABG) surgery is important in order to improve health, quality of life and functional outcomes. There are, however, many potential barriers to physical activity engagement during the recovery period. No review studies have focused on barriers and facilitators to engagement in physical activity during the early stages of recovery following CABG surgery. OBJECTIVE To explore the factors that influence engagement in physical activity during the first three months following CABG surgery. METHODS Four electronic databases were searched. Extracted data from selected studies were synthesised using the Joanna Briggs Institute convergent integrated approach. RESULTS Nineteen studies met the inclusion criteria. Four main themes that influenced engagement were identified: sociodemographic variables; physical symptoms; psychosocial factors; and environmental factors. More barriers were identified than facilitating factors. Psychosocial factors were the most commonly reported barriers in the literature. CONCLUSIONS The findings of this review provide insights into factors that inhibit and facilitate engagement in physical activity following CABG surgery. Further research specifically exploring factors that influence engagement, especially facilitators, is required.
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Affiliation(s)
- Emily Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Suranga Dasanayake
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Bahram Sangelaji
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Margot Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
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Martorella G, Hanley AW, Pickett SM, Gelinas C. Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30951. [PMID: 34459749 PMCID: PMC8438614 DOI: 10.2196/30951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac surgery is a frequently performed procedure. However, pain after cardiac surgery may become chronic (lasting >3 months) in adults. Once discharged from the hospital, patients are at greater risk of developing chronic postsurgical pain (CPSP) and of prolonged opioid use, as they need to self-manage their pain. Psychological risk and protective factors such as pain-related catastrophic thoughts and pain acceptance determine their ability to cope and their use of opioids, which is crucial for self-management of pain. Studies on mindfulness-based cognitive therapy (MBCT) have multiplied their potential effects on pain acceptance and catastrophic thoughts. However, web-based MBCT for the prevention of CPSP has not yet been examined. OBJECTIVE The aim of this study is to pilot test a 4-week-long web-based MBCT intervention for adults following discharge from the hospital by assessing the acceptability or feasibility of the intervention and examining preliminary effects on pain intensity, pain interference with activities and opioid use, and pain acceptance and catastrophic thoughts in the 6 months following surgery. METHODS A double-blinded pilot randomized controlled trial will be used to assess a web-based MBCT intervention. Patients will be selected according to the following criteria: age ≥18 years; first-time elective cardiac surgery via a median sternotomy; worst pain in the past week score ≥4/10; ability to understand and complete questionnaires in English; and ability to use an electronic device such as a smartphone, computer, or tablet. After baseline measures, 32 participants will be randomized into two groups: one receiving both the brief, 4-week-long web-based MBCT intervention and usual care (experimental group) and the other receiving only one standardized, web-based educational session with weekly reminders and usual care (attention control group). Peer-reviewed competitive funding was received from Florida State University's Council on Research & Creativity in January 2021, as well as research ethics approval from Florida State University's institutional review board. RESULTS Recruitment began in June 2021. Unfortunately, because of the current COVID-19 pandemic, recruitment is not progressing as expected. Recruitment strategies are constantly monitored and updated according to latest data and restrictions surrounding the pandemic. CONCLUSIONS This research is significant because it targets the trajectory of CPSP, a leading cause of disability and opioid misuse. This is the first study to assess MBCT for the prevention of CPSP after cardiac surgery in the recovery phase. This approach is innovative because it promotes self-management of pain through the modulation of individual factors. If successful, the intervention could be expanded to numerous populations at risk of chronic pain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30951.
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Affiliation(s)
- Geraldine Martorella
- Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, United States
| | - Scott M Pickett
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Céline Gelinas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Centre for Nursing Research, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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Gledhill K, Hanna L, Nicks R, Lannin NA. Defining discharge-readiness from subacute care from all stakeholders' perspectives: a systematic review. Disabil Rehabil 2020; 43:3127-3134. [PMID: 32126189 DOI: 10.1080/09638288.2020.1733107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders' perspectives.Methods: Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted.Results: From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge.Conclusion: Despite limited literature defining sub-acute patients' discharge-readiness from all stakeholders' perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.IMPLICATIONS FOR REHABILITATIONDischarging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.Multiple factors need to be considered when considering the discharge readiness of an inpatient.Ensuring adequate social support is key to maximising transition from hospital to home.Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | | | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Sun V, Raz DJ, Erhunmwunsee L, Ruel N, Carranza J, Prieto R, Ferrell B, Krouse RS, McCorkle R, Kim JY. Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention. Contemp Clin Trials 2019; 83:88-96. [PMID: 31279090 PMCID: PMC6661176 DOI: 10.1016/j.cct.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery. DESIGN The study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms. SETTING One National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California. PARTICIPANTS Patients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only. INTERVENTION Based on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support. MAIN OUTCOME MEASURES FCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions). ANALYSIS Repeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes. ClinicalTrials.gov Identifier: NCT03686007.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, United States of America.
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, United States of America
| | | | - Nora Ruel
- Biostatistics and Mathematical Modeling Core City of Hope, Duarte, CA, United States of America
| | - Jacqueline Carranza
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Rosemary Prieto
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, United States of America
| | - Robert S Krouse
- Surgical Services, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, United States of America
| | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, United States of America
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Grønset CN, Thygesen LC, Berg SK, Zangger G, Kristensen MS, Sibilitz KL, Pedersen SS, Oldridge NB, Zwisler AD. Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument. Qual Life Res 2019; 28:1245-1253. [PMID: 30610503 DOI: 10.1007/s11136-018-02098-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following heart valve surgery. DESIGN This project involved a cross-sectional validity study and a test-retest reliability study. METHODS Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following heart valve surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach's alpha. An independent sample of patients participated in the test-retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. RESULTS Internal consistency was high with Cronbach's alpha ≥ 0.87. ICC was 0.86-0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. CONCLUSIONS The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test-retest reproducibility in patients following heart valve surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following heart valve surgery.
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Affiliation(s)
- Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Internal Medicine, Section of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Neil B Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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13
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Hascoet S, Dalla Pozza R, Bentham J, Carere RG, Kanaan M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Lecerf F, Lehner A, Kantzis M, Kurucova J, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EUROINTERVENTION 2019; 14:1378-1385. [DOI: 10.4244/eij-d-18-01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Martorella G, Graven L, Schluck G, Bérubé M, Gélinas C. Nurses' Perception of a Tailored Web-Based Intervention for the Self-Management of Pain After Cardiac Surgery. SAGE Open Nurs 2018; 4:2377960818806270. [PMID: 33415209 PMCID: PMC7774353 DOI: 10.1177/2377960818806270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
Background Cardiac surgeries rank among the most frequent surgical procedures and present a risk of chronic postsurgical pain (CPSP). A continuum approach is required to prevent the development of CPSP. As a first step, a tailored web-based intervention was developed and successfully tested to tackle pain management during hospitalization. Before proceeding to further development, preliminary acceptability of the intervention including the postdischarge phase must be evaluated. Purpose The purpose of this study was to examine nurses’ perception of a tailored Web-based intervention for pain management in the early recovery phase. The objectives were to evaluate intervention’s acceptability and to identify ways to enhance its acceptability. Methods A parallel mixed methods approach was used to assess the acceptability of the intervention in the early recovery phase (first month after surgery). Results In total, 249 participants completed the online survey and 10 participants were individually interviewed. Overall, the intervention was rated as acceptable. No difference was found in acceptability ratings by demographics. The intervention was rated as appropriate to very much appropriate by 79% of participants. Although nurses seemingly would recommend it to their patients, they did not perceive that their patients would be as highly willing to use it. Interviews highlighted several strengths of the intervention, such as postoperative pain awareness, customization of content, and flexible dosage and schedule. However, the main weakness was related to patient adherence. Opting for a hybrid format and integrating individual preferences could enhance the coaching experience. Conclusion The innovative intervention was judged as acceptable for pain management in the early recovery phase. Considering that the intervention has demonstrated positive effects on the pain experience in the first week after cardiac surgery, it seems logical to explore its potential impact after discharge on the transition to CPSP.
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Affiliation(s)
- Geraldine Martorella
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, FL, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Mélanie Bérubé
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Canada.,Centre for Nursing Research, Jewish General Hospital, Montreal, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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15
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Integrated Care Approaches Used for Transitions from Hospital to Community Care: A Scoping Review. Can J Aging 2018; 37:145-170. [PMID: 29631639 DOI: 10.1017/s0714980818000065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTIntegrated care is a promising approach for improving care transitions for older adults, but this concept is inconsistently defined and applied. This scoping review describes the size and nature of literature on integrated care initiatives for transitions from hospital to community care for older adults (aged 65 and older) and how this literature conceptualizes integrated care. A systematic search of literature from the past 10 years yielded 899 documents that were screened for inclusion by two reviewers. Of the 48 included documents, there were 26 journal articles and 22 grey literature documents. Analysis included descriptive statistics and a content analysis approach to summarize features of the integrated care initiatives. Results suggest that clinical and service delivery integration is being targeted rather than integration of funding, administration, and/or organization. To promote international comparison of integrated care initiatives aiming to improve care transitions, detailed descriptions of organizational context are also needed.
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16
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Angus JE, Dale CM, Nielsen LS, Kramer-Kile M, Lapum J, Pritlove C, Abramson B, Price JA, Marzolini S, Oh P, Clark A. Gender matters in cardiac rehabilitation and diabetes: Using Bourdieu's concepts. Soc Sci Med 2018; 200:44-51. [PMID: 29421471 DOI: 10.1016/j.socscimed.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Habitual practices are challenged by chronic illness. Cardiac rehabilitation (CR) involves changes to habits of diet, activity and tobacco use, and although it is effective for people with diabetes and cardiovascular disease (CVD), some participants are reportedly less likely to complete programs and adopt new health related practices. Within the first three months of enrolling in CR, attrition rates are highest for women and for people with diabetes. Previous studies and reviews indicate that altering habits is very difficult, and the social significance of such change requires further study. PURPOSE The purpose of the study was to use Bourdieu's concepts of habitus, capital and field to analyse the complexities of adopting new health practices within the first three months after enrolling in a CR program. We were particularly interested in gender issues. METHODS Thirty-two men and women with diabetes and CVD were each interviewed twice within the first three months of their enrolment in one of three CR programs in Toronto, Canada. RESULTS Attention to CR goals was not always the primary consideration for study participants. Instead, a central concern was to restore social dignity within other fields of activity, including family, friendships, and employment. Thus, study participants evolved improvised tactical approaches that combined both physical and social rehabilitation. These improvised tactics were socially embedded and blended new cultural capital with existing (often gendered) cultural capital and included: concealment, mobilizing cooperation, re-positioning, and push-back. CONCLUSIONS Our findings suggest that success in CR requires certain baseline levels of capital - including embodied, often gendered, cultural capital - and that efforts to follow CR recommendations may alter social positioning.
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Affiliation(s)
- Jan E Angus
- University of Toronto, Toronto, Ontario, Canada.
| | - Craig M Dale
- University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | - Paul Oh
- University Health Network, Toronto, Canada.
| | - Alex Clark
- University of Alberta, Edmonton, Alberta, Canada.
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17
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Sun V, Raz DJ, Ruel N, Chang W, Erhunmwunsee L, Reckamp K, Tiep B, Ferrell B, McCorkle R, Kim JY. A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery. Clin Lung Cancer 2017; 18:e151-e159. [PMID: 28233696 PMCID: PMC5413411 DOI: 10.1016/j.cllc.2017.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility and acceptability of a multimedia self-management (MSM) intervention to prepare patients and family caregivers for lung surgery. PATIENTS AND METHODS This is a quasi-experimental, 2-group, sequential enrollment pilot study of a 4-session multimedia intervention (audio/visual + print) to enhance self-management and quality of life (QOL) for patients and family caregivers. The intervention, Preparing for Lung Surgery, begins before surgery, and continues through hospitalization and discharge, with 2 telephone support sessions after discharge. Outcomes were assessed before surgery (preintervention), at discharge, and 2 to 4 weeks postdischarge (postintervention). Patient outcomes were assessed using the Functional Assessment of Cancer Therapy-General (QOL), MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Pulmonary Symptom Index (symptoms), self-efficacy, surgery-related knowledge, and patient activation. Family caregiver outcomes included City of Hope-QOL-Family (QOL), Caregiver Burden Scale, and knowledge. Paired t tests were used for exploratory evaluations of score changes from pre- to postintervention. RESULTS Sixty participants (38 patients, 22 family caregivers) enrolled in the study (70% accrual). Postintervention scores were significantly improved for patients' emotional QOL (P = .001). Trends for improvements were observed for patient self-efficacy, surgery-related knowledge, and activation. Family caregivers' surgery-related knowledge was significantly improved (P = .02). Overall, participants were highly satisfied with the acceptability/usability of the intervention (3.6-3.7 of 4.0). CONCLUSION A standardized MSM intervention was feasible and acceptable in supporting readiness and preparedness for lung surgery and postoperative recovery. A larger randomized trial is needed to verify the impact of the MSM intervention on patient/family caregiver outcomes and health care resource use.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA.
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA
| | - Nora Ruel
- Biostatistics Core, Department of Information Sciences, City of Hope, Duarte, CA
| | - Walter Chang
- Department of Anesthesiology, City of Hope, Duarte, CA
| | | | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Brian Tiep
- Department of Respiratory Diseases and Pulmonary Rehabilitation, City of Hope, Duarte, CA
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | | | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA
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18
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Halm MA. Age and gender influences on the needs, concerns and strategies of CABG caregivers. Heart Lung 2017; 46:159-165. [PMID: 28411960 DOI: 10.1016/j.hrtlng.2017.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caring for coronary artery bypass (CABG) surgery patients can be challenging. No studies have explored caregiver burden by age and gender. OBJECTIVE To describe age and gender-specific concerns, needs and strategies during the first 3 months. METHODS Themes for burden concerns, needs and strategies were derived from interviews of 32 CABG caregivers using constant comparative analysis. RESULTS Age-specific themes related to motivating exercise (<70), applying support hose, and self-reliance (>70). Gender-specific themes related to incision worries and transportation (all females); regulating blood sugars, vital sign anxiety, hurrying back, reinforcing healthy behaviors, and being there (females <70); meal planning, coordinating appointments, and anger over self-care reminders (females >70); caregiver relief, inconsistent information, and doing it all (all males); upsetting scars (males <70), and lost sleep (male >70). CONCLUSIONS Future research should validate concerns in diverse samples so interventions can be targeted to support male and female caregivers by age groups.
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Affiliation(s)
- Margo A Halm
- Salem Health, An OHSU Partner, 890 Oak Street SE, Salem, OR 97301, USA.
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19
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Sanchez LM, Cooknell LE. The Power of 3: Using adult learning principles to facilitate patient education. Nursing 2017; 47:17-19. [PMID: 28121782 DOI: 10.1097/01.nurse.0000511819.18774.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lynda M Sanchez
- At Midland Memorial Hospital, in Midland, Tex., Lynda M. Sanchez is a simulation lab coordinator and Lynn E. Cooknell is a cardiovascular care coordinator
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20
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Discharge Planning After Myocardial Revascularization: Differences in Opinions From Patients and Health Experts. J Cardiovasc Nurs 2016; 31:441-4. [PMID: 27518373 DOI: 10.1097/jcn.0000000000000262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In-hospital education and discharge planning contribute to recovery after coronary artery bypass graft surgery (CABG). OBJECTIVE The objective of this study was to identify differences in perception of the importance of discharge instructions between a sample of adult patients after CABG and health experts responsible for their care. METHODS Thirty-five first-time CABG adult patients and 8 multidisciplinary experts rated a 46-item questionnaire of discharge education themes on a 3-point scale. Items were classified as most important if rated as "very important" by more than 85% of the participants in each group. RESULTS Of the 31 items considered most important (reaching the 85% approval criteria), agreement between groups was reached for 15 (48%), whereas 11 (35%) items were selected only by the patients and 5 (16%) were selected only by the experts. CONCLUSIONS The authors of this study demonstrate a difference in perception between patients and health experts regarding the importance of various discharge instructions. Better understanding areas of patient concern may improve discharge routines.
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21
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Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L, Hansen TB, Johansen PP, Gluud C, Lindschou J, Schmid JP, Hassager C, Køber L, Taylor RS, Zwisler AD. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart 2016; 102:1995-2003. [PMID: 27492941 DOI: 10.1136/heartjnl-2016-309414] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart valve surgery. METHODS The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36. RESULTS 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). CONCLUSIONS Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group. TRIAL REGISTRATION NUMBER NCT01558765, Results.
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Affiliation(s)
- Kirstine L Sibilitz
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina K Berg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - Signe Stelling Risom
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Bachelor's Degree Programme in Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Tang
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Technology, Bachelor's Degree Programme in Physiotherapy, Department of Rehabilitation and Nutrition, Metropolitan University College, Copenhagen, Denmark.,CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tina B Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Zealand University Hospital, Department of Cardiology, Køgevej 7-13, 4000 Roskilde, Denmark
| | - Pernille Palm Johansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean Paul Schmid
- Cardiology Clinic, Tiefenau Hospital and University of Bern, Bern, Switzerland
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Institute of Health Research, University of Exeter Medical School, Exeter, England
| | - Ann-Dorthe Zwisler
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark.,National Centre of Rehabilitation and Palliation, University of Southern Denmark, and University Hospital of Odense, Odense, Denmark
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22
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Jerofke T, Weiss M. Development and psychometric analysis of the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale (PPPNBS). J Adv Nurs 2016; 72:2923-2936. [DOI: 10.1111/jan.13060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Teresa Jerofke
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
| | - Marianne Weiss
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
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23
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Bjørnnes AK, Parry M, Lie I, Fagerland MW, Watt-Watson J, Rustøen T, Stubhaug A, Leegaard M. The impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Eur J Cardiovasc Nurs 2016; 16:18-27. [PMID: 26846145 DOI: 10.1177/1474515116631680] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Relevant discharge information about the use of analgesic medication and other strategies may help patients to manage their pain more effectively and prevent postoperative persistent pain. AIMS To examine patients' pain characteristics, analgesic intake and the impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Concerns about pain and pain medication prior to surgery will also be described. METHODS From March 2012 to September 2013, 416 participants (23% women) were consecutively enrolled in a randomized controlled trial. The intervention group received usual care plus an educational booklet at discharge with supportive telephone follow-up on postoperative day 10, and the control group received only usual care. The primary outcome was worst pain intensity (The Brief Pain Inventory - Short Form). Data about pain characteristics and analgesic use were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery. General linear mixed models were used to determine between-group differences over time. RESULTS Twenty-nine percent of participants reported surgically related pain at rest and 9% reported moderate to severe pain at 12 months post-surgery. Many participants had concerns about pain and pain medication, and analgesic intake was insufficient post-discharge. No statistically significant differences between the groups were observed in terms of the outcome measures following surgery. CONCLUSION Postoperative pain and inadequate analgesic use were problems for many participants regardless of group allocation, and the current intervention did not reduce worst pain intensity compared with control. Further examination of supportive follow-up monitoring and/or self-management strategies post-discharge is required.
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Affiliation(s)
- Ann Kristin Bjørnnes
- 1 Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Monica Parry
- 2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Irene Lie
- 3 Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål/Center for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
| | - Morten Wang Fagerland
- 4 Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway
| | - Judy Watt-Watson
- 2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Tone Rustøen
- 5 Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Health and society, Department of Nursing Science, University of Oslo, Norway
| | - Audun Stubhaug
- 6 Department of Pain Management and Research, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Marit Leegaard
- 7 Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Norway
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24
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Lapum JL, Fredericks S, Liu L, Yau TM, Retta B, Jones VM, Hume S. Facilitators and Barriers of Heart Surgery Discharge. J Cardiovasc Nurs 2016; 31:350-6. [DOI: 10.1097/jcn.0000000000000253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
BACKGROUND Infective endocarditis (IE) is a traumatic health event, and recovery is often associated with massive physical deconditioning and reduced quality of life. Patients also report reduced cognitive functioning and are at risk of developing anxiety and depression as well as posttraumatic stress disorder. Although studies have found that survivors of IE have impaired physical functioning and mental health, little is known about patient experiences contributing to these findings. OBJECTIVE The aim of this study was to describe patient experiences of recovery after IE. SUBJECTS AND METHODS Within a phenomenological-hermeneutical framework, a qualitative interview study was conducted that included 6 men and 5 women (aged 29-86 years). Patients were interviewed 3 to 6 months after discharge. Analysis consisted of 3 levels: naive reading, structured analysis, and critical interpretation and discussion. FINDINGS The overall concept that emerged was "Insufficient Living." Patients all experienced a life after illness, which was perceived as insufficient. The overall concept can be interpreted in terms of the following 3 themes. The first was "an altered life," where participants described a phase of adaptation to a new life situation, which some perceived as manageable and temporary, whereas others found extremely distressing and prolonged. "Shocking weakness" was experienced physically, cognitively, and emotionally, and although it subsided quickly for a few, most experienced a persisting weakness and felt frustrated about the prolonged recovery phase. In "the road to recovery," support from relatives and healthcare professionals, as well as one's own actions, was emphasized as important in facilitating recovery. CONCLUSIONS Recovery after IE is perceived as "Insufficient Living." Patients experience an altered life and shocking weakness, and on the road to recovery, support is needed. Research in follow-up care, supporting patients' ability to cope with potential physical and psycho-emotional consequences of IE, is encouraged as a result of these findings.
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26
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Buus N, Lee A. Cardiac rehabilitation patients' perspectives on the recovery following heart valve surgery: a narrative analysis. J Adv Nurs 2016; 72:1097-108. [PMID: 26799453 DOI: 10.1111/jan.12904] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/08/2023]
Abstract
AIMS To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. BACKGROUND Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. DESIGN A qualitative study with serial interviews analysed using narrative methods. METHODS We collected data over 18 months (April 2013-October 2014). We recruited nine patients undergoing heart valve surgery from a randomized trial, CopenHeartVR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after surgery. FINDINGS Following heart valve surgery, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality - being in a limbo and becoming a heart patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after surgery. CONCLUSION The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing heart valve surgery may benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory.
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Affiliation(s)
| | - Ann Dorthe Zwisler
- National Centre of Rehabilitation and Palliation, University of Southern Denmark
| | | | | | - Niels Buus
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Lee
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Dale CM, Angus JE, Seto Nielsen L, Kramer-Kile M, Pritlove C, Lapum J, Price J, Marzolini S, Abramson B, Oh P, Clark A. "I'm No Superman": Understanding Diabetic Men, Masculinity, and Cardiac Rehabilitation. QUALITATIVE HEALTH RESEARCH 2015; 25:1648-1661. [PMID: 25583960 DOI: 10.1177/1049732314566323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Exercise-based cardiac rehabilitation (CR) programs help patients with coronary heart disease (CHD) reduce their risk of recurrent cardiac illness, disability, and death. However, men with CHD and Type 2 diabetes mellitus (T2DM) demonstrate lower attendance and completion of CR despite having a poor prognosis. Drawing on gender and masculinity theory, we report on a qualitative study of 16 Canadian diabetic men recently enrolled in CR. Major findings reflect two discursive positions men assumed to regain a sense of competency lost in illness: (a) working with the experts, or (b) rejection of biomedical knowledge. These positions underscore the varied and sometimes contradictory responses of seriously ill men to health guidance. Findings emphasize the priority given to the rehabilitation of a positive masculine identity. The analysis argues that gender, age, and employment status are powerful mechanisms of variable CR participation.
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Affiliation(s)
| | - Jan E Angus
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Cheryl Pritlove
- York University, Toronto, Ontario, Canada Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | | | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Alex Clark
- University of Alberta, Edmonton, Alberta, Canada
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Martorella G, Gélinas C, Purden M. Acceptability of a web-based and tailored intervention for the self-management of pain after cardiac surgery: the perception of women and men. JMIR Res Protoc 2014; 3:e63. [PMID: 25487135 PMCID: PMC4288043 DOI: 10.2196/resprot.3175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/23/2014] [Accepted: 08/26/2014] [Indexed: 11/13/2022] Open
Abstract
Background Approximately two thirds of adults undergoing cardiac surgery suffer from moderate to severe postoperative pain. Assisting patients with pain management is therefore critical to prevent its negative consequences. Information technologies have become part of our lifestyle and can facilitate the implementation of interventions to manage pain in a busy care setting. A computer-tailored and Web-based intervention—referred to as SOUtien à L’AutoGEstion-Traitement-Assistance Virtuelle Infirmière-Enseignement (SOULAGE-TAVIE)—for the self-management of pain was developed. Findings from a previous pilot randomized controlled trial (RCT) provided some evidence of the feasibility and preliminary effectiveness of this intervention in decreasing pain interference with a few postoperative activities and by modulating pain beliefs and analgesic intake. However, its acceptability from the patient’s perspective remains unclear. Moreover, the proportion of women is much lower in the cardiac surgical population, making it difficult to detect differences in experiences between men and women. Objective The objectives were (1) to describe SOULAGE-TAVIE’s acceptability from the perspective of adults experiencing pain after cardiac surgery and (2) to compare the perceptions of men and women. Methods A mixed-method approach was used to capture the various attributes of patients’ perceptions of the intervention’s acceptability and to compare the perceptions of men and women. Quota samples of men (n=10; mean age 62.5 years, SD 7.3) and women (n=10; mean age 64.3 years, SD 10.7) who had cardiac surgery in the past month were invited to view the intervention, complete a brief questionnaire rating its acceptability, and then to discuss each component in a 60-minute, semistructured interview. Mann-Whitney U tests were used to compare groups. The transcripts were content analyzed to generate themes based on patients’ experiences with the intervention and reports of acceptability. The content of each category and subcategory were compared between men and women. Frequency counts were also done to validate the emergence of a difference between the 2 subgroups. Results Participants perceived the intervention to be very acceptable in terms of content and format, and tended to describe awareness-raising and convenient support experiences. Women scored higher than men in terms of the intervention’s appropriateness (U=13.5, P=.008). They were willing to adhere to the intervention based on the importance and relevance of the advice provided, whereas men were more focused on the delivery mode and its flexibility. Conclusions This study underlined the acceptability of computer tailoring and persuasive communication to modulate pain beliefs and attitudes in an acute care context. Both men and women appreciated the Web-based interface and general self-guided approach of the intervention. The delivery of SOULAGE-TAVIE across the continuum of care seems to be an interesting avenue to influence the transition from acute to chronic postoperative pain.
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Abdalrahim MS, Zeilani RS. Jordanian survivors' experiences of recovery from critical illness: a qualitative study. Int Nurs Rev 2014; 61:570-7. [PMID: 25382166 DOI: 10.1111/inr.12142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the fact that a lot of patients consider their discharge from hospitals as a positive sign of progress towards regained health, many of them start suffering from physical, psychological and social problems after discharge from intensive care units. AIM This study aims to describe the experiences of Jordanian survivors of critical illnesses 3 months after discharge from a hospital intensive care unit. METHODS A descriptive qualitative approach was used to involve 18 Jordanian patients from two hospitals in a major Jordanian city using open-ended interviews. Interview transcripts were analysed using content analysis method. RESULTS Three main themes have emerged from the data: (1) new meaning of life; (2) different perspectives on the meaning of life, and (3) struggle for role identity. LIMITATION The sample was chosen from one city in Jordan; longitudinal study might help identify the change in patients' experiences over time. CONCLUSION Patients described the discharge from the intensive care unit as a means of rescue from death; they began to value their spiritual and religious rituals. Negative traumatic experiences hindered the patients' recovery process. During recovery, patients struggled to resume their power and role in family. IMPLICATIONS FOR NURSES AND HEALTH POLICY This study emphasizes the importance of providing care according to the patient's individual needs, related to their cultural and spiritual milieu; there is a need to develop follow-up services for ICU survivors within a national health policy. Further educational and training programmes in the patient's issues after discharge from hospital are needed. This will definitely help nurses care after this patient group.
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Affiliation(s)
- M S Abdalrahim
- Clinical Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Jerofke T, Weiss M, Yakusheva O. Patient perceptions of patient-empowering nurse behaviours, patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses. J Adv Nurs 2013; 70:1310-22. [DOI: 10.1111/jan.12286] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Teresa Jerofke
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
| | - Marianne Weiss
- College of Nursing; Marquette University; Milwaukee Wisconsin USA
| | - Olga Yakusheva
- Department of Economics; Marquette University College of Business and Graduate School of Management; Marquette University; Milwaukee Wisconsin USA
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Berg SK, Zwisler AD, Pedersen BD, Haase K, Sibilitz KL. Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality. BMC Nurs 2013; 12:23. [PMID: 24070399 PMCID: PMC3849933 DOI: 10.1186/1472-6955-12-23] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients’ perception of recovery after heart valve replacement is essential. The objective was to describe the experience of recovery at home after heart valve replacement. Methods Qualitative interviews were conducted with 10 patients representing the population and these were later transcribed. The analysis was inspired by Ricoeur’s theory of interpretation, which consists of three levels: naive reading, structured analysis, and critical interpretation and discussion. Results The overall concept that emerged was suffering weakness and struggling to resume normality. Patients all struggled to resume normal living, both in regaining physical strength and in reestablishing balance in overall living. The overall concept can be interpreted in terms of the following themes: Disturbed network: Invaluable relatives, Contact with healthcare staff, Rehabilitation. Disturbed body: Stressful complications, Bodily attention, Physically affected, Physical capability. Recovery: Interrupted living, Suffering weakness, Gradual recovery, Achieving normality. Reflections: Thoughts about the procedure and Feeling sad and fragile. Conclusion The study presents the main themes of network, body, recovery and reflection for ten patients after heart valve replacement. These main themes can overall be summarized as suffering weakness and struggling to resume normality. Patients felt weak with a changed body, but after a long recovery process regained vitality and returned to their daily life.
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Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial. Trials 2013; 14:104. [PMID: 23782510 PMCID: PMC3748823 DOI: 10.1186/1745-6215-14-104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/25/2013] [Indexed: 11/29/2022] Open
Abstract
Background Heart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery. Methods A randomised clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study. Discussion The study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015). Trial registration ClinicalTrials.gov (http://NCT01558765).
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Sawatzky JAV, Christie S, Singal RK. Exploring outcomes of a nurse practitioner-managed cardiac surgery follow-up intervention: a randomized trial. J Adv Nurs 2013; 69:2076-87. [DOI: 10.1111/jan.12075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 01/18/2023]
Affiliation(s)
- Jo-Ann V. Sawatzky
- Associate Dean & Faculty Development Coordinator - Graduate Programs; Faculty of Nursing; University of Manitoba; Winnipeg Canada
| | - Sandra Christie
- Cardiac Sciences Program; St. Boniface Hospital; Winnipeg Manitoba Canada
| | - Rohit K. Singal
- Cardiac Sciences Program; St. Boniface Hospital; Winnipeg Manitoba Canada
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