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Taylan S, Çelik GK. Experiences of Patients Undergoing Bypass Surgery With Health Professionals During the Perioperative Care Process: A Hermeneutic Phenomenological Study. J Perianesth Nurs 2022; 37:802-806. [PMID: 35753933 DOI: 10.1016/j.jopan.2021.11.016] [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: 07/11/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the experiences and perceptions of patients who underwent Coronary Artery Bypass Graft (CABG) surgery with perioperative health care professionals. DESIGN The study used a qualitative research design and was conducted by interviewing eight patients who underwent CABG surgery. METHODS Study data were collected between April 24, 2020 and February 25, 2021 via a demographic information form and a semi-structured interview form and analyzed by using Heidegger's phenomenological approach. FINDINGS The participants were between the ages of 51 and 70. They were patients who had undergone CABG surgery 2 months before data collection. Two themes were elicited from the interviews: "If you are bad, I am bad, too", which indicated negative experiences of CABG, and "If you are good, I am safe", which indicated positive patient experiences. In addition, eight sub-themes were determined under these two themes. CONCLUSIONS In the perioperative process, patients may experience feelings of restlessness, fear, vulnerability, insecurity, and threat when ignored by health care professionals. The provision of interaction between the health professional and the patient, along with family support, changes the perceived care positively and makes patients feel cared for, well, and safe. Awareness of health care professionals about patient experiences during the CABG surgery process points to an important aspect of quality health care.
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Affiliation(s)
- Seçil Taylan
- Surgical Nursing Department, Kumluca Faculty of Health Sciences, Akdeniz University, Kumluca-Antalya, Turkey.
| | - Gülden Küçükakça Çelik
- Nursing Department, Semra ve Vefa Faculty of Health Sciences, Hacı Bektaşi Veli University, Nevşehir, Turkey
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KÜÇÜKAKÇA ÇELİK G, TAYLAN S. The Unknown Side of the Iceberg in patients who underwent coronary artery bypass graft surgery: A Journey from Tracer Experiences to Today. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.844362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Cardiovascular disease and meaning in life: A systematic literature review and conceptual model. Palliat Support Care 2021; 19:367-376. [PMID: 33960285 DOI: 10.1017/s1478951520001261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks. METHODS A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model. RESULTS The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers. SIGNIFICANCE OF RESULTS An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.
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Katijjahbe MA, Royse C, Granger C, Denehy L, Md Ali NA, Abdul Rahman MR, King-Shier K, Royse A, El-Ansary D. Location and Patterns of Persistent Pain Following Cardiac Surgery. Heart Lung Circ 2021; 30:1232-1243. [PMID: 33608196 DOI: 10.1016/j.hlc.2020.12.009] [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: 09/21/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population. METHODS A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively. RESULTS Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time. CONCLUSION Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population.
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Affiliation(s)
- Mohd Ali Katijjahbe
- Department of Physiotherapy, Hospital Canselor Tunku Mukhriz, University, Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.
| | - Colin Royse
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, USA
| | - Catherine Granger
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
| | - Nur Ayub Md Ali
- Cardiothoracic Surgery, Heart and Lung Centre, UKM Medical Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- Cardiothoracic Surgery, Heart and Lung Centre, UKM Medical Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alistair Royse
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Doa El-Ansary
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Clinical Research Institute, Westmead Private Hospital, Westmead, Australia
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Kemp KA, Quan H, Knudtson ML, Oddone Paolucci E, Santana MJ. Patient-Reported Experiences With Coronary Artery Bypass Grafting and Valve Replacement. Can J Cardiol 2019; 35:1344-1352. [PMID: 31445860 DOI: 10.1016/j.cjca.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/20/2019] [Accepted: 05/07/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Canadian Patient Experience Survey-Inpatient Care is a validated measure for adult inpatient experience. Linking surveys with administrative data can examine the experience of patients in specific demographic or clinical groups. METHODS We examined survey responses obtained over a 4-year period from patients who underwent coronary artery bypass graft and/or valve replacement in Alberta. The 56-question telephone survey was administered within 6 weeks of discharge. Surveys were linked with administrative records to identify the Canadian Classification of Intervention procedure codes, which were in scope. Responses to each question were reported as percentage in "top box," where "top box" represents the most positive answer choice (eg, "always" and "yes"). RESULTS From April 2014 to March 2018, 1082 surveys were completed by patients who underwent coronary artery bypass graft and/or valve replacement. Respondents were predominantly male (73.8%), with a mean age of 64.7 ± 11.9 years. Overall, 73.3% of respondents rated their hospital care as 9 or 10 out of 10 (best), and 86.2% would "definitely recommend" the hospital to friends/family members. Top performing questions pertained to having a discussion about help needed after discharge (96.6% responding "yes") and receiving written discharge information (93.2% responding "yes"). Lack of quietness of the hospital environment at night (34.8% responding "always") and lack of staff sufficiently describing side effects of new medications (44.9% responding "always") were identified as potential areas for improvement. CONCLUSIONS Our results provide patient-reported experiences about inpatient cardiac care in Alberta hospitals. The findings could inform quality improvement initiatives that are patient-centred.
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Affiliation(s)
- Kyle A Kemp
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Merril L Knudtson
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Oddone Paolucci
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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Jannati M, Attar A. Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature. Ther Clin Risk Manag 2019; 15:773-781. [PMID: 31417264 PMCID: PMC6592068 DOI: 10.2147/tcrm.s195267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/28/2019] [Indexed: 12/25/2022] Open
Abstract
This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: “analgesia”, “sedation”, “coronary artery bypass grafting”, CABG”, and “opioids”. Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.
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Affiliation(s)
- Mansour Jannati
- Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Impact of marital status and comorbid disorders on health-related quality of life after cardiac surgery. Qual Life Res 2017; 26:2421-2434. [PMID: 28484915 DOI: 10.1007/s11136-017-1589-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery. METHOD A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations between HRQL, social support, and comorbid disorders. RESULTS The overall 15D scores for the total sample improved significantly from 2 weeks to 3 months post surgery, with only a gradual change observed from 3 to 12 months. Thirty percent (n = 92) of the total sample reported a lower 15D total score at 12 months compared to preoperative status, of whom 78% (n = 71) had a negative minimum important differences (MID), indicating a worse HRQL status. When adjusted for age and marital status, women had statistically significant lower 15D total scores compared to men at 3, 6, and 12 months post surgery. Compared to pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of HRQL for women, and in 6 out of 15 dimensions for men at 12 months post surgery. Both men and women associated back/neck problems, depression, and persistent pain intensity with lower HRQL; for women, not living with a partner/spouse was associated with lower HRQL up to 12 months. CONCLUSION Women experienced decreased HRQL and a slower first-year recovery following cardiac surgery compared to men. This study demonstrates a need for follow-up and support to help women manage their symptoms and improve their function within the first year after cardiac surgery. This was particularly pronounced for those women living alone.
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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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Ball K, Swallow V. Patient experiences of cardiac surgery and nursing care: a narrative review. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjca.2016.11.7.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katie Ball
- Clinical Research Nurse, Central Manchester University Hospital Foundation Trust, Manchester (Formerly Staff Nurse, Cardiothoracic Critical Care at time of writing)
| | - Veronica Swallow
- Professor in Child and Family Health, School of Healthcare, University of Leeds, Leeds
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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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Waight CA, Strodl E, Sheridan J, Tesar P. Posttraumatic growth in post-surgical coronary artery bypass graft patients. Health Psychol Open 2015; 2:2055102915571370. [PMID: 28070351 PMCID: PMC5193300 DOI: 10.1177/2055102915571370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female) at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.
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Varaei S, Shamsizadeh M, Cheraghi MA, Talebi M, Dehghani A, Abbasi A. Effects of a peer education on cardiac self-efficacy and readmissions in patients undergoing coronary artery bypass graft surgery: a randomized-controlled trial. Nurs Crit Care 2014; 22:19-28. [DOI: 10.1111/nicc.12118] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/07/2014] [Accepted: 06/18/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Shokoh Varaei
- School of Nursing and Midwifery; Tehran University of Medical Sciences; Tehran Iran
| | - Morteza Shamsizadeh
- School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
| | - Mohammad A Cheraghi
- School of Nursing and Midwifery; Tehran University of Medical Sciences; Tehran Iran
| | - Mitra Talebi
- School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
| | - Ali Dehghani
- School of Nursing and Midwifery; Tehran University of Medical Sciences; Tehran Iran
| | - Ali Abbasi
- School of Nursing and Midwifery; Shahroud University of Medical Sciences; Shahroud Iran
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Bjørnnes AK, Rustøen T, Lie I, Watt-Watson J, Leegaard M. Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs 2014; 15:47-54. [PMID: 25192967 DOI: 10.1177/1474515114550441] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac surgery is a common intervention that involves several pain-sensitive structures, and intense postoperative pain is a predictor of persistent pain. AIMS To describe pain characteristics (i.e. intensity, location, interference, relief) and analgesic intake preoperatively and across postoperative days 1 to 4 after cardiac surgery, and to explore associations between postoperative pain and demographic and clinical characteristics. METHODS Four hundred and sixteen patients (24% women) undergoing elective coronary artery bypass grafting and/or valve surgery were enrolled in a randomized controlled trial. Data were collected using standardized measures including the Brief Pain Inventory-short form. A linear mixed model analysis estimated the impact of sex, age, body mass index, analgesic intake and preoperative pain on postoperative worst pain ratings in the previous 24 hours from postoperative days 1 to 4 prior to discharge RESULTS Thirty-eight per cent of the cardiac surgery patients reported preoperative pain. Postoperative worst pain remained in the moderate to severe range for the majority of patients across day 1 (85%) to day 4 (57%), mainly around the chest incision area for the majority (70%). Mean oral morphine intake was 17 mg/24 h (day 1: 27mg; day 4: 10mg). Lower age, female sex, preoperative pain and analgesic intake had a statistically significant association with higher postoperative worst pain ratings. CONCLUSION Study findings demonstrated a high prevalence of moderate to severe pain after cardiac surgery and insufficient analgesic administration. Results indicated that patients were discharged from hospital with unrelieved pain and a potential risk for further postoperative complications.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway Institute of Health and Society, University of Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, Senior Fellow, Massey College University of Toronto, Canada
| | - Marit Leegaard
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Norway
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Abbasi M, Mohammadi N, Nasrabadi AN, Fuh SB, Sadeghi T. Re-birth after coronary bypass graft surgery: a hermeneutic-phenomenological study. Glob J Health Sci 2014; 6:235-40. [PMID: 24762368 PMCID: PMC4825217 DOI: 10.5539/gjhs.v6n3p235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/20/2014] [Accepted: 01/10/2014] [Indexed: 11/12/2022] Open
Abstract
Although coronary artery bypass graft surgery has significant effects on reducing the symptoms of coronary artery disease, there is not enough knowledge and understanding of lived experience of patients after surgery. Understanding lived experience of this group of patients would be helpful for healthcare staff to provide better services to the patients. The aim of this study was to describe with a deeper understanding, the lived experiences of patients after Coronary Artery Bypass Graft Surgery. Using a hermeneutic phenomenological approach and a Van-Manen analysis method, in-depth semi-structured interviews were conducted with eleven participants who had lived experienced of at least six months post - coronary artery bypass graft surgery. Re-birth was the main theme that emerged in the process of data analysis. This theme was derived from four sub-themes including "feels younger", ''vigorous heart'', ''intrepid life'' and ''oriented to be healthy''. Life after a coronary artery bypass graft surgery is often appreciated as a re-birth by persons with these experiences as surgery did not only provide a feeling of wellness, but also added a sensation of youthfulness and improvement in the quality of life for these participants. In addition, they would actively participate in health promotional activities such as; adherence to medication and diet regimes, changes in lifestyle to maintain their health.
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Affiliation(s)
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences; Center for Nursing Care Research, Tehran, Iran.
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Sethares KA, Chin E, Costa I. Pain intensity, interference and patient pain management strategies the first 12weeks after coronary artery bypass graft surgery. Appl Nurs Res 2013; 26:174-9. [DOI: 10.1016/j.apnr.2013.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
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Sattari M, Baghdadchi ME, Kheyri M, Khakzadi H, Ozar Mashayekhi S. Study of patient pain management after heart surgery. Adv Pharm Bull 2013; 3:373-7. [PMID: 24312863 DOI: 10.5681/apb.2013.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate postoperative pain control and analgesic use after heart surgery. METHODS 20 patients undergone heart surgery, randomly entered the study. Each patient was asked to score his pain intensity on visual analog scale (VAS) at four different occasions. RESULTS 120 patients aged 59 year-old; including 81 male were enrolled in the study. 69.2% had coronary artery disease and 16.7% had heart-valve problem. Main types of surgeries were coronary artery bypass surgery (70.5%) and valve repairement (23%). Duration of ICU stay was 4.78±2.7 days and duration of intubations was 17.38 ± 36.46 hours. Pre-surgery pain relief was administrated to 42% of the subjects and morphine and promethazine was the main pre-surgery analgesia medication. Post surgery analgesic included morphine (injection), petidine (injection) and NSAIDS (oral or rectal). According to VAS, mean pain level, 1 and 4 hours after extubation, and before and one hour after transferring to wards was 5.05±2.5, 4.09±2.0, 3.52±1.8, 2.36±1.89, respectively. Although the level of pain reported was mostly moderate, 80% were reported satisfaction with their post-surgery pain management. CONCLUSION A closer pain management control is needed for patients after heart surgery. Introduction of newer pain management techniques, medications and dosages could reduce the pain and suffering.
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Affiliation(s)
- Mohammadreza Sattari
- Infectious and Tropical Research Center, Pharmacology and Toxicology Department, Faculty of Pharmacy, Tabriz University of Medical Sciences, Iran
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Korhonen A, Hakulinen-Viitanen T, Jylhä V, Holopainen A. Meta-synthesis and evidence-based health care - a method for systematic review. Scand J Caring Sci 2012; 27:1027-34. [DOI: 10.1111/scs.12003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/24/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Anne Korhonen
- Nursing Research Foundation; Helsinki Finland
- Finnish Centre for Evidence-Based Health Care: an Affiliated Centre of the Joanna Briggs Institute; Helsinki Finland
| | - Tuovi Hakulinen-Viitanen
- Finnish Centre for Evidence-Based Health Care: an Affiliated Centre of the Joanna Briggs Institute; Helsinki Finland
- National Institute for Health and Welfare; Helsinki Finland
| | - Virpi Jylhä
- Nursing Research Foundation; Helsinki Finland
- Finnish Centre for Evidence-Based Health Care: an Affiliated Centre of the Joanna Briggs Institute; Helsinki Finland
| | - Arja Holopainen
- Nursing Research Foundation; Helsinki Finland
- Finnish Centre for Evidence-Based Health Care: an Affiliated Centre of the Joanna Briggs Institute; Helsinki Finland
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Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review. J Cardiovasc Nurs 2012; 27:175-91. [PMID: 22210146 DOI: 10.1097/jcn.0b013e318239f5f5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.
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Schaufel MA, Nordrehaug JE, Malterud K. Hope in action-facing cardiac death: A qualitative study of patients with life-threatening disease. Int J Qual Stud Health Well-being 2011; 6. [PMID: 21423599 PMCID: PMC3061819 DOI: 10.3402/qhw.v6i1.5917] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2011] [Indexed: 11/29/2022] Open
Abstract
Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26–88 years) who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons' future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient.
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20
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Leegaard M, Rustøen T, Fagermoen MS. Interference of Postoperative Pain on Women's Daily Life after Early Discharge from Cardiac Surgery. Pain Manag Nurs 2010; 11:99-107. [DOI: 10.1016/j.pmn.2009.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 02/23/2009] [Accepted: 04/19/2009] [Indexed: 12/12/2022]
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21
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Factors associated with long hospital length of stay in patients receiving warfarin after cardiac surgery. J Cardiovasc Nurs 2010; 24:465-74. [PMID: 19858955 DOI: 10.1097/jcn.0b013e3181b152d7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients receiving warfarin therapy after coronary artery bypass graft (CABG) or valve surgery have longer length of stay (LOS) than those not receiving warfarin therapy. Longer LOS increases patient costs, postdischarge recovery time, and rehabilitation. It is important to identify variables of longer postoperative LOS in this patient population so that the healthcare team can develop and facilitate interventions to minimize length of hospitalization. METHODS Using a hospital registry and medical record review of cases completed in 2004, data from cardiac surgery patients having CABG and/or valve procedures and given warfarin postoperatively were analyzed based on short (<7 days, CABG; 9 days, valve procedure) and long (> or =7 days, CABG; > or =9 days, valve procedure) postoperative LOS. By groups, significant associations were assessed using chi or Fisher exact test for categorical variables and Wilcoxon 2-sample test or Student t test for continuous variables. RESULTS In 82 patients (33 CABG and 49 valve +/- CABG) who were given warfarin, most demographic, medical history, postoperative complications, and use of cardiac drugs did not predict longer LOS. Longer postoperative LOS was associated with being older (mean age, 73.5 vs 68.5 years), being not married, having postoperative respiratory insufficiency, and receiving more red blood cell transfusions, all P < .05; and having more healthcare consultations, longer critical care stay, and longer time between surgery date and start of warfarin; all P < .001. CONCLUSIONS Variables associated with longer LOS were nonmodifiable by nursing services and were difficult to assess preoperatively. They primarily involved intraoperative or postoperative bleeding that led to red blood cell infusion and longer critical care stays that delayed warfarin initiation. However, older age and marital status are nursing targets because they may be associated with social isolation and other psychosocial issues. Transition of care programs can be developed to promote earlier discharge.
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22
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Lapum J, Angus JE, Peter E, Watt-Watson J. Patients' narrative accounts of open-heart surgery and recovery: authorial voice of technology. Soc Sci Med 2009; 70:754-62. [PMID: 20042262 DOI: 10.1016/j.socscimed.2009.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/25/2009] [Accepted: 11/13/2009] [Indexed: 11/28/2022]
Abstract
In this narrative inquiry, we examined patients' experiential accounts of technology in open-heart surgery and recovery. A convenience sample of sixteen individuals was recruited from a preoperative clinic at a regional centre for cardiac services in Canada. Each participated in two interviews following transfer from cardiovascular intensive care and 4-6 weeks post discharge from the hospital. Participants also documented their experiences in journals during the first 3-4 weeks following discharge. The focal point of the study's theoretical foundations was narrative emplotment, which directs attention to the active processes of plot construction and shaping forces of stories. In our narrative analysis, we used narrative mapping to document the temporal flow of events. We found that technology acted as the authorial voice, or controlling influence, over how participants' narratives were shaped and unfolded. Key were the ways in which technology as the authorial voice was linked with participants becoming background characters and surrendering agency. Problematic and important to health care professionals is ensuring that authorial voice shifts back to patients so that they become active in shaping their own course of recovery. This study underscores the benefits of using literary techniques such as narrative analysis in health science research. Examining the narrative structures and forces that shape patients' stories sheds light on how health care professionals and their technologically-driven practices of care strongly affect the stories' content and how they unfold. By focusing on how stories unfolded, we revealed ways in which cardiac surgery practices and patients' course of recovery could be enhanced.
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Affiliation(s)
- Jennifer Lapum
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada.
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Leegaard M, Nåden D, Fagermoen MS. Postoperative pain and self-management: women’s experiences after cardiac surgery. J Adv Nurs 2008; 63:476-85. [DOI: 10.1111/j.1365-2648.2008.04727.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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