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

3Cs: the experiences of informal caregivers of patients undergoing thoracic surgery

The informal caregiver is pivotal to the postoperative experience of patients. The purpose of this study was to explore the informal caregivers' experience while accompanying patients through thoracotomy surgery. Specifically, and exclusively, the informal carers' personal reactions, needs and views regarding their experience in the patients' surgery trajectory were explored. A convenience sample of eight informal caregivers of patients who had undergone thoracotomy were interviewed approximately 2 weeks following discharge from a general hospital in Malta. The findings revealed knowledge regarding participants' experiences of demands and fears associated with the 3Cs: cancer, challenges and coping. The impact of timely information-sharing and support on the informal caregiver's experience was highlighted. These findings suggest that careful consideration of both a patient's and informal caregiver's needs promotes an enhanced hospitalisation experience, and creates opportunity for a better transition back home. Implications for research and practice are discussed.

Effect of Informational Support on Anxiety in Family Caregivers of Patients with Hemiplegic Stroke

BACKGROUND

Brain stroke causes physical and mental disabilities, as well as dependence on one's family. In such cases, the families suffer from severe crisis and anxiety due to the unexpected incidence of the disease and unawareness of the associated consequences.

OBJECTIVES

The aim of the present study was to evaluate the effectiveness of informational support on the level of anxiety in family caregivers of hemiplegic stroke patients.

METHODS

This quasi-experimental study was performed on 78 family caregivers of hemiplegic stroke patients admitted to the Neurology Department of Farshchian Hospital in Hamadan, Iran, over 8 months. The subjects were selected through convenience sampling method and divided into two groups of intervention (n = 40) and control (n = 38). Intervention started from the third day of hospitalization and continued until the eleventh day. During this period, information about the ward, equipment, patient status, and care procedure at home, was provided for the intervention group individually and in groups. On the other hand, the control group only received the routine care. Anxiety level of caregivers was measured through the Spielberger scale both before and after the intervention. Data analysis was performed in SPSS software (version 16).

RESULTS

Based on the results, both groups were similar in terms of demographic variables (P > 0.05). Moreover, there was no significant difference between the two groups regarding the mean level of state and trait anxiety before the intervention (P > 0.05). However, after intervention, the mean level of state and trait anxiety of the intervention group showed a significant reduction in comparison to that of the control group (P < 0.05).

CONCLUSIONS

According to the findings, it can be concluded that informational support is effective in reducing the state and trait anxiety in family caregivers of stroke patients. Therefore, it is suggested that nurses consider informational support as an important nursing intervention during hospitalization.

Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies

OBJECTIVES

To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery.

DESIGN

Systematic integrated review without meta-analysis.

DATA SOURCES

A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies).

RESULTS

Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress.

CONCLUSION

Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

PROSPERO REGISTRATION NUMBER

CRD42018096590.

Involving relatives in consultations for patients with long-term illnesses: Nurses and physicians' experiences

BACKGROUND

Due to the major changes occurring in the demographic composition of the world's population, the number of older individuals is increasing, which puts pressure on the healthcare systems in many different countries. The involvement of volunteers and family members may become necessary to fulfil a patient's needs for follow-up treatments and long-term care in their homes.

AIM

This study aimed to explore how nurses and physicians experienced and addressed ethical challenges when they dealt with relatives in what have traditionally been one-on-one consultations at two Norwegian hospital outpatient clinics.

RESEARCH DESIGN AND METHODS

A total of eight nurses and two physicians from two different hospitals participated in individual in-depth interviews. The transcribed interviews were analysed using an eclectic approach called 'bricolage' inspired by Kvale and Brinkmann. We combined cross-case thematic and theoretical normative analyses.

ETHICAL CONSIDERATIONS

The principles of voluntariness, confidentiality, withdrawal and anonymity were respected throughout the research process. In addition, the Norwegian Social Science Data Services approved this study.

FINDINGS

The findings showed that respect for a patient's autonomy was used as an argument for delimiting the relatives' access to the patient's consultations. We found that there were insufficient routines in place for inviting and involving relatives in the patient consultations in the outpatient clinics.

DISCUSSION

The traditional Western attitudes towards the principles of patient autonomy will likely be challenged due to the growing need for family involvement in the care of a patient in the future.

CONCLUSION

This study's description of the nurses and physicians' interpretations of 'patient autonomy' as a phenomenon uncover the need for systematic ethical deliberation in the clinical setting. On an organisational level, there is a strong indication of the need to discuss the routines that are in place to invite the next of kin to participate in such patient's healthcare consultations.

Next of kin's protracted challenges with access to relevant information and involvement opportunities

Background

Next of kin are considered a resource for both the patient and the health service. Need for information varies with severity and duration of health changes. A clear requirement is about what to expect upon homecoming, and what supportive services are available. The picture of relatives’ access to involvement and information is still somewhat unclear.

Objective

To investigate what information, knowledge, and involvement next of kin considered important for managing their caring role and collaboration with their close relatives who experienced events that led to chronic illness.

Design, setting, and methods

A qualitative exploratory design. Seventeen informants were recruited through various courses offered to relatives. Data were collected in 2017 from individual interviews, analyzed in an interpretative tradition, and involved qualitative content analysis.

Results

The results reflect a long intervening period in between the activating incident and a clarification of the situation. This period was characterized by unpreparedness for duration of anxiety and amount of energy involved in balancing the relationship. Further, the interviewees saw retrospectively that information about disease and treatment was available, but they had to find such resources themselves. Information about how to handle the situation was almost absent. Ultimately, they were disappointed over not being involved.

Conclusion

Previously provided prospective information about the embedded anxiety in the situation and consequences for relationships, involvement in patients’ services, and better communication about existing services seem to be significant. Health care professionals, especially in outpatient care, may improve their services by debating how they can implement family-oriented care in personalized treatment as usual. Focus on prospective information, early involvement, and relevant information about existing resources may empower relatives and relieve the experience of care burden.

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.

Barriers to health information seeking in Iranian patients with cardiovascular disease: a qualitative study

OBJECTIVE

Providing patients with health care information is a critical component of the process of cardiovascular disease (CVD) management. The purpose of this study was to explore obstacles to seeking health care information among cardiovascular patients from the perspectives of patients, their family caregivers, and health care providers.

METHODS

This study was conducted with a qualitative approach using conventional qualitative content analysis. The study included 31 Iranian participants including 16 cardiovascular patients, 5 family members, and 10 health care providers (multidisciplinary). Data were collected with semi-structured interviews and continued to the point of data saturation. Analysis of the data was performed continually and concurrently with data collection of using a comparative method.

RESULTS

Five themes emerged including 'poor quality of information provision,' 'mutual ambiguity,' 'beliefs, faith, and expectations,' 'from routine life to obtaining information,' and 'conditions governing information seekers.' Seven sub-themes indicated participants' experiences and understandings of obstacles in health care information seeking.

CONCLUSION

Health care information seeking in cardiovascular patients and their family members occurs as a result of the influence of beliefs, interaction with numerous information sources, and in the context and structure that the care and information are provided. Understanding the nature of obstacles to health information seeking will help health care policy makers to provide evidence-based, reliable, and patient-centered information to encourage cardiovascular patients' involvement in treatment decisions.