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Drakenberg A, Arvidsson-Lindvall M, Ericsson E, Ågren S, Sundqvist AS. The symphony of open-heart surgical care: A mixed-methods study about interprofessional attitudes towards family involvement. Int J Qual Stud Health Well-being 2023; 18:2176974. [PMID: 36812009 PMCID: PMC9970227 DOI: 10.1080/17482631.2023.2176974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
PURPOSE The overall aim of this study was to describe the attitudes towards family involvement in care held by nurses and medical doctors working in open-heart surgical care and the factors influencing these attitudes. METHODS Mixed-methods convergent parallel design. A web-based survey was completed by nurses (n = 267) using the Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) instrument and two open-ended questions, generating one quantitative and one qualitative dataset. Qualitative interviews with medical doctors (n = 20) were conducted in parallel, generating another qualitative dataset. Data were analysed separately according to each paradigm and then merged into mixed-methods concepts. Meta-inferences of these concepts were discussed. RESULTS The nurses reported positive attitudes in general. The two qualitative datasets from nurses and medical doctors resulted in the identification of seven generic categories. The main mixed-methods finding was the attitude that the importance of family involvement in care depends on the situation. CONCLUSIONS The dependence of family involvement on the situation may be due to the patient's and family's unique needs. If professionals' attitudes rather than the family's needs and preferences determine how the family is involved, care runs the risk of being unequal.
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Affiliation(s)
- Anna Drakenberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden,Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden,CONTACT Anna Drakenberg Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - MiaLinn Arvidsson-Lindvall
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Elisabeth Ericsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Susanna Ågren
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden,Department of Cardiothoracic Surgery and Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann-Sofie Sundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
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Arpag N, Öztekin SD. The Effect of Visits by Operating Room Nurses Before Cardiac Surgery on Anxiety and Pain Management. J Perianesth Nurs 2023; 38:892-900. [PMID: 37330723 DOI: 10.1016/j.jopan.2023.01.022] [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: 07/23/2022] [Revised: 01/05/2023] [Accepted: 01/21/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Further studies are needed in line with the Enhanced Recovery for Cardiac Surgery (ERCS) protocols with a view to reducing anxiety and opioid use in cardiac surgery patients. The present study investigates the effects of preoperative visits by operating room nurses to patients scheduled for cardiac surgery on postoperative anxiety, pain severity and frequency, and the type and dose of analgesic medication. DESIGN This is a quasi-experimental study with a pretest-posttest control group design involving nonrandomized groups. METHODS The study was conducted in the Department of Cardiovascular Surgery of a Foundation University Hospital in Turkey between August 20, 2020 and April 15, 2021. Included in the study were patients selected based on a nonprobability sampling approach who met the study inclusion criteria (aged 18-75 years, no psychiatric diagnosis or drug use, first cardiovascular surgery experience, scheduled for elective surgery, up to five coronary anastomoses, literate and able to speak and understand Turkish, undergoing cardiovascular surgery with Cardiopulmonary Bypass (CPB)) determined by the researcher. The treatment group was visited preoperatively by operating room nurses, and followed-up for the first 72 hours after surgery. FINDINGS The intervention was effective in reducing postoperative state anxiety levels (P < .05). In the control group, each one-point increase in the preoperative state-anxiety level caused a 9% increase in the length of stay in the intensive care unit (P < .05). Pain severity increased as the preoperative state-anxiety and trait-anxiety levels, and the postoperative state-anxiety levels, increased (P < .05). While there was no significant difference in pain severity, the intervention proved to be effective in reducing pain frequency (P < .05). It was further noted that the intervention reduced the use of opioid and nonopioid analgesics for the first 12 hours (P < .05). The probability of using opioid analgesics increased 1.56 times (P < .05) with each one-point increase in pain severity reported by the patients. CONCLUSIONS The participation of operating room nurses in preoperative patient care can contribute to the management of anxiety and pain and the reduction of opioids. It is recommended that such an approach be implemented as an independent nursing intervention given the potential contribution to ERCS protocols.
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Affiliation(s)
- Nurgül Arpag
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey.
| | - Seher Deniz Öztekin
- Department of Nursing, School of Health Sciences Director, Doğuş University, Istanbul, Turkey
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Baagil H, Baagil H, Gerbershagen MU. Preoperative Anxiety Impact on Anesthetic and Analgesic Use. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2069. [PMID: 38138172 PMCID: PMC10744982 DOI: 10.3390/medicina59122069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.
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Affiliation(s)
- Hanaa Baagil
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
| | - Hamzah Baagil
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany;
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich, RWTH Aachen University, 52074 Aachen, Germany
| | - Mark Ulrich Gerbershagen
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
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McCann WD, Hou XY, Stolic S, Ireland MJ. Predictors of Psychological Distress among Post-Operative Cardiac Patients: A Narrative Review. Healthcare (Basel) 2023; 11:2721. [PMID: 37893795 PMCID: PMC10606887 DOI: 10.3390/healthcare11202721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Following surgery, over 50% of cardiac surgery patients report anxiety, stress and/or depression, with at least 10% meeting clinical diagnoses, which can persist for more than a year. Psychological distress predicts post-surgery health outcomes for cardiac patients. Therefore, post-operative distress represents a critical recovery challenge affecting both physical and psychological health. Despite some research identifying key personal, social, and health service correlates of patient distress, a review or synthesis of this evidence remains unavailable. Understanding these factors can facilitate the identification of high-risk patients, develop tailored support resources and interventions to support optimum recovery. This narrative review synthesises evidence from 39 studies that investigate personal, social, and health service predictors of post-surgery psychological distress among cardiac patients. The following factors predicted lower post-operative distress: participation in pre-operative education, cardiac rehabilitation, having a partner, happier marriages, increased physical activity, and greater social interaction. Conversely, increased pain and functional impairment predicted greater distress. The role of age, and sex in predicting distress is inconclusive. Understanding several factors is limited by the inability to carry out experimental manipulations for ethical reasons (e.g., pain). Future research would profit from addressing key methodological limitations and exploring the role of self-efficacy, pre-operative distress, and pre-operative physical activity. It is recommended that cardiac patients be educated pre-surgery and attend cardiac rehabilitation to decrease distress.
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Affiliation(s)
- William D. McCann
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD 4305, Australia;
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Snezana Stolic
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD 4305, Australia;
| | - Michael J. Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD 4305, Australia;
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Desai RH, L'Hotta A, Kennedy C, James AS, Stenson K, Curtin C, Ota D, Kenney D, Tam K, Novak C, Fox I. Caregiving for People With Spinal Cord Injury Undergoing Upper Extremity Reconstructive Surgery: A Prospective Exploration of Lived Experiences, Perioperative Care, and Change Across Time. Top Spinal Cord Inj Rehabil 2023; 29:58-70. [PMID: 38076291 PMCID: PMC10644855 DOI: 10.46292/sci22-00063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Nerve transfer (NT) and tendon transfer (TT) surgeries can enhance upper extremity (UE) function and independence in individuals with cervical spinal cord injury (SCI). Caregivers are needed to make this surgery possible, yet caregivers experience their own set of challenges. Objectives This comparative study explored the perioperative and nonoperative experiences of caregivers of individuals with cervical SCI, focusing on daily life activities, burden, and mental health. Methods Caregivers of individuals with cervical SCI were recruited and grouped by treatment plan for the person with SCI: (1) no surgery (NS), (2) TT surgery, and (3) NT surgery. Semistructured interviews were conducted at baseline/preoperative, early follow-up/postoperative, and late follow-up/postoperative. Caregivers were asked about their daily life, mental health, and challenges related to caregiving. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative, single-item standardized burden score (0-100) data were collected at each timepoint. Results Participants included 23 caregivers (18 family members, 4 friends, 1 hired professional). The surgeries often brought hope and motivation for caregivers. Caregivers reported increased burden immediately following surgery (less for the NT compared to TT subgroup) yet no long-term changes in the amount and type of care they provided. NS caregivers discussed social isolation, relationship dysfunction, and everyday challenges. Conclusion Health care providers should consider the changing needs of SCI caregivers during perioperative rehabilitation. As part of the shared surgical decision-making approach, providers should educate caregivers about the postoperative process and the extent and potential variability of short- and long-term care needs.
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Affiliation(s)
- Rachel Heeb Desai
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Allison L'Hotta
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Carie Kennedy
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Doug Ota
- Palo Alto Veterans’ Healthcare System, Palo Alto, California
| | - Deborah Kenney
- Department of Orthopedic Surgery, Stanford University, Palo Alto, California
| | - Katharine Tam
- Saint Louis Veterans’ Healthcare System, St. Louis, Missouri
| | - Christine Novak
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ida Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Drakenberg A, Prignitz Sluys K, Ericsson E, Sundqvist AS. The Family Involvement in Care Questionnaire-An instrument measuring family involvement in inpatient care. PLoS One 2023; 18:e0285562. [PMID: 37582093 PMCID: PMC10426968 DOI: 10.1371/journal.pone.0285562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay. OBJECTIVE To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care. METHODS The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery. RESULTS Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items. CONCLUSIONS The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.
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Affiliation(s)
- Anna Drakenberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Kerstin Prignitz Sluys
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Elisabeth Ericsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ann-Sofie Sundqvist
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Laflamme SZ, Bouchard K, Sztajerowska K, Lalande K, Greenman PS, Tulloch H. Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease. PLoS One 2022; 17:e0269366. [PMID: 36121800 PMCID: PMC9484654 DOI: 10.1371/journal.pone.0269366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.
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Affiliation(s)
- Simone Zofia Laflamme
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karolina Sztajerowska
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul S. Greenman
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Bagheri M, Maleki M, Mardani A, Momen MH, Daliri S, Rezaie S. The effect of video training and intraoperative progress report on the anxiety of family caregivers waiting for relatives undergoing surgery. Heliyon 2022; 8:e10065. [PMID: 35992003 PMCID: PMC9382265 DOI: 10.1016/j.heliyon.2022.e10065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/24/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose This study aimed to examine the effect of video training and intraoperative progress report on the anxiety of family caregivers awaiting relatives undergoing surgery. Methods A three-armed randomized controlled design was used. One hundred and two participants were enrolled and randomly assigned to three groups: the video training group (n = 34), the intraoperative progress report group (n = 34), and the control group (n = 34). Interventions were performed when the relatives of the participants were undergoing surgery. The participants in the video training group received video training containing images of the operating room environment and animations related to the patient’s surgical procedure, postoperative care, and possible complications from the surgery. In the intraoperative progress report group, information regarding the patient’s general condition, the percentage of surgical progress, and the approximate time of the patient’s transfer from the operating room were provided. The control group received routine care. A demographic data questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI) was used for data collection. Results It was found a statistically significant decrease in the state anxiety in the video training (p < 0.001) and intraoperative progress report (p < 0.001) group after the intervention when compared to before the intervention. It was found no significant difference among the study groups in terms of the level of state and trait anxiety after the intervention (p > 0.05). Conclusions This study found that both video training and intraoperative progress report are effective in reducing the state anxiety of family caregivers awaiting relatives undergoing surgery.
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Topan H, Mucuk S, Yontar Y. The Effect of Patient Education Prior to Rhinoplasty Surgery on Anxiety, Pain, and Satisfaction Levels. J Perianesth Nurs 2022; 37:374-379. [PMID: 35304018 DOI: 10.1016/j.jopan.2021.07.001] [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: 02/18/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to evaluate the effect of education before rhinoplasty surgery on patients' anxiety, pain, and satisfaction levels. DESIGN This was a randomized controlled experimental study. METHODS Of the 90 patients who underwent rhinoplasty surgery at Kayseri City Hospital, Turkey between October 2017 and December 2018, 79 were included in the study. The patients were assigned to an experimental or control group according to a computer-generated randomization list. The experimental group (n = 36) was educated using a rhinoplasty training guide prior to routine plastic surgery procedures. The control group (n = 35) received only routine plastic surgery procedures. A patient identification form, State-Trait Anxiety Inventory, Newcastle Satisfaction with Nursing Care Scale, and Visual Analog Scale were used to collect data. Data analysis included the Shapiro-Wilk normality test, Q-Q plot, two-way analysis of variance, Friedman and Mann-Whitney U tests, and Pearson's chi-square. FINDINGS In the postoperative period, the mean state anxiety inventory score of the experimental group (36.25 ± 9.78) was found to be significantly lower than that of the control group (42.28 ± 9.42) (P < .05). There was no statistically significant difference between the trait anxiety inventory scores of the experimental (39.63 ± 10.20) and control (38.77 ± 6.16) (P > .05) groups. The mean Newcastle Satisfaction with Nursing Care Scale score of the experimental group (71.01 ± 14.65) was significantly higher than the control group (62.93 ± 16.36) (P < .05). There was no significant difference between the pain scores of experimental and control groups postoperatively at 6, 12, and 24 hours (P > .05). CONCLUSIONS Based on the results of our study, we conclude that it would be beneficial to educate patients before rhinoplasty surgery in line with their needs and aesthetic concerns.
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Affiliation(s)
- Handan Topan
- Erciyes University, Faculty of Health Sciences, Department of Nursing, Kayseri, Turkey.
| | - Salime Mucuk
- Erciyes University, Faculty of Health Sciences, Department of Nursing, Kayseri, Turkey
| | - Yalçın Yontar
- Acıbadem Kayseri Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Kayseri, Turkey
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Mignault A, Tchouaket Nguemeleu É, Robins S, Maillet É, Matetsa E, Dupuis S. Automated intra-operative SMS message updates: a quality improvement initiative to relieve caregivers’ worries (Preprint). JMIR Perioper Med 2022; 5:e36208. [PMID: 35436760 PMCID: PMC9084444 DOI: 10.2196/36208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alexandre Mignault
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Stephanie Robins
- Département des sciences infirmières, Université du Québec en Outaouais, St-Jérome, QC, Canada
| | - Éric Maillet
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Edwige Matetsa
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stéphane Dupuis
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Berg SK. Social and emotional factors as predictors of poor outcomes following cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 34:193-200. [PMID: 34606597 PMCID: PMC8766216 DOI: 10.1093/icvts/ivab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors. RESULTS Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes. CONCLUSIONS Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE. Subj collection 105, 123
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Affiliation(s)
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Kuruppu S, Ghani M, Pritchard M, Harris M, Weerakkody R, Stewart R, Perera G. A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London. Eur Psychiatry 2021; 64:e13. [PMID: 33455615 PMCID: PMC8057466 DOI: 10.1192/j.eurpsy.2021.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/07/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. METHODS A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. RESULTS Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33-1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35-2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. CONCLUSION Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.
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Affiliation(s)
- Sajini Kuruppu
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
| | - Marvey Ghani
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
| | - Megan Pritchard
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
| | - Matthew Harris
- Department of Vascular Surgery, The Royal Free Hospital, Pond Street, LondonNW3 2QG, United Kingdom
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Ruwan Weerakkody
- Department of Vascular Surgery, The Royal Free Hospital, Pond Street, LondonNW3 2QG, United Kingdom
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
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14
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Riordan P, Davis M. Anxiety and psychological management of heart disease and heart surgery. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:393-408. [PMID: 33632455 DOI: 10.1016/b978-0-12-819814-8.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety is associated with many forms and facets of heart disease, and, by extension, neurologic manifestations of heart disease. Despite its seeming self-evidence, anxiety is challenging to consistently define, measure, and operationalize in the context of medical research. Various diagnostic nosologies have been defined and refined over time, but anxiety is also a universal human experience that may be "normal" in many circumstances, particularly in the face of major medical issues. For these and other reasons, the research on anxiety and heart disease is mixed, incomplete, and often characterized by challenging questions of causality. Nonetheless, a broad body of literature has established clear connections between anxiety and vascular risk factors, cardiac disease, and cardiac surgery. These relationships are often intuitive, with research suggesting, for example, that chronic activation of the sympathetic nervous system is associated with increased risk of heart disease. However, they are sometimes complexly reciprocal or even surprising (e.g., with high-anxiety individuals found to have better outcomes in some cardiac conditions by virtue of seeking evaluation and treatment earlier). This chapter reviews the construct of anxiety and its complexities, its associations with heart disease, and the established treatments for anxiety, concluding with questions about anxiety, heart disease, and their optimal management that still need to be answered.
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Affiliation(s)
- Patrick Riordan
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
| | - Matthew Davis
- Mental Health Service Line, Edward Hines Jr. VA Hospital, Hines, IL, United States
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15
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Milisen K, Van Grootven B, Hermans W, Mouton K, Al Tmimi L, Rex S, Detroyer E. Is preoperative anxiety associated with postoperative delirium in older persons undergoing cardiac surgery? Secondary data analysis of a randomized controlled trial. BMC Geriatr 2020; 20:478. [PMID: 33208091 PMCID: PMC7672929 DOI: 10.1186/s12877-020-01872-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery. Methods Secondary data analysis of a randomized, observer-blind, controlled trial. A total of 190 patients 65 years or older and admitted to the intensive care unit and cardiac surgery unit of a university hospital scheduled for elective on-pump cardiac surgery were included. State anxiety was measured preoperatively using the Amsterdam Preoperative Anxiety and Information Scale and the Visual Analogue Scale for anxiety. Incidence of delirium was measured during the first 5 postoperative days using the Confusion Assessment Method for Intensive Care Unit (when ventilated), or the 3 Minute Diagnostic Interview for Confusion Assessment Method (when extubated) and by daily chart review. Results Preoperative state anxiety was reported by 31% of the patients and 41% had postoperative delirium. A multiple step logistic regression analyses revealed no association between preoperative anxiety and postoperative delirium. Significant risk factors for postoperative delirium were age (OR = 1.10, 95% CI (1.03–1.18)), activities of daily living (0.69, 95% CI (0.50–0.96)), diabetes mellitus (OR = 3.15, 95% CI (1.42–7.00)) and time on cardiopulmonary bypass (OR = 1.01, 95% CI (1.00 to 1.02)). Conclusions No relationship could be found between preoperative anxiety and postoperative delirium.
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Affiliation(s)
- Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium. .,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Wim Hermans
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Karen Mouton
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Layth Al Tmimi
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Elke Detroyer
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
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16
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Abstract
PURPOSE OF REVIEW To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. RECENT FINDINGS Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients' preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients' knowledge or social support and to modify and optimize expectations and illness beliefs. Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients' psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.
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Affiliation(s)
- Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | | | - Marcel Wilhelm
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Frank Euteneuer
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
- Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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17
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Zi J, Fan Y, Dong C, Zhao Y, Li D, Tan Q. Anxiety Administrated by Dexmedetomidine to Prevent New-Onset of Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Graft. Int Heart J 2020; 61:263-272. [DOI: 10.1536/ihj.19-132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jie Zi
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yi'ou Fan
- Department of Toxicological and Functional Test, Shandong Centers for Disease Control and Prevention
| | - Chunhui Dong
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yuping Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University
| | - Decai Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University
| | - Qi Tan
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University
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18
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Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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Cromhout PF, Moons P, Thygesen LC, Nashef S, Damgaard S, Berg SK. Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters. Eur J Cardiovasc Nurs 2018; 17:760-766. [DOI: 10.1177/1474515118783835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.
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Affiliation(s)
- Pernille F Cromhout
- Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Selina Kikkenborg Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Public Health, University of Copenhagen, Denmark
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20
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Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart Vessels 2017; 32:1458-1468. [DOI: 10.1007/s00380-017-1022-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
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21
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Psychologie in der Herzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Ramesh C, Nayak BS, Pai VB, George A, George LS, Devi ES. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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23
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Karhe L, Kaunonen M, Koivisto AM. Loneliness in Professional Caring Relationships, Health, and Recovery. Clin Nurs Res 2016; 27:213-234. [PMID: 27836936 DOI: 10.1177/1054773816676580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated patients' experiences of loneliness in professional caring relationships and their associations with perceived recovery, health, psychological distress, and general loneliness in life. The sample consisted of 406 patients who had undergone breast cancer or heart surgery 6 months earlier. The data were collected in May 2014-March 2015 using a postal survey including the Caring Loneliness Scale (CARLOS), questions concerning perceived health and recovery, 12-item General Health Questionnaire (GHQ-12), and a question concerning perceived general loneliness in life. Data analysis was done using Mann-Whitney U test and Kruskal-Wallis test. The variables showing a statistically significant association with professional caring loneliness were perceived health, recovery, psychological distress, and general loneliness in life. It is necessary for health care professionals to identify the phenomenon of this dimension of loneliness because it is bound to affect patients' experiences. Further studies with different patient groups are required.
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Affiliation(s)
- Liisa Karhe
- 1 University of Tampere, Finland.,2 Tampere University Hospital, Finland
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