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Rosen CB, Roberts SE, Wirtalla CJ, Keele LJ, Kaufman EJ, Halpern S, Kelz RR. Emergency Surgery, Multimorbidity and Hospital-Free Days: A Retrospective Observational Study. J Surg Res 2023; 291:660-669. [PMID: 37556878 PMCID: PMC10530175 DOI: 10.1016/j.jss.2023.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Analyzing hospital-free days (HFDs) offers a patient-centered approach to health services research. We hypothesized that, within emergency general surgery (EGS), multimorbidity would be associated with fewer HFDs, whether patients were managed operatively or nonoperatively. METHODS EGS patients were identified using national Medicare claims data (2015-2018). Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set and stratified by treatment: operative (received surgery within 48 h of index admission) and nonoperative. HFDs were calculated through 180 d, beginning on the day of index admission, as days alive and spent outside of a hospital, an Emergency Department, or a long-term acute care facility. Univariate comparisons were performed using Kruskal-Wallis tests and risk-adjusted HFDs were compared between multimorbid and nonmultimorbid patients using multivariable zero-inflated negative binomial regression models. RESULTS Among 174,891 operative patients, 45.5% were multimorbid. Among 398,756 nonoperative patients, 59.2% were multimorbid. Multimorbid patients had fewer median HFDs than nonmultimorbid patients among operative and nonoperative cohorts (P < 0.001). At 6 mo, among operative patients, multimorbid patients had 6.5 fewer HFDs (P < 0.001), and among nonoperative patients, multimorbid patients had 7.9 fewer HFDs (P < 0.001). When length of stay was included as a covariate, nonoperative multimorbid patients still had 7.9 fewer HFDs than nonoperative, nonmultimorbid patients (P < 0.001). CONCLUSIONS HFDs offer a patient-centered, composite outcome for claims-based analyses. For EGS patients, multimorbidity was associated with less time alive and out of the hospital, especially when patients were managed nonoperatively.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chris J Wirtalla
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Luke J Keele
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Elinore J Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Scott Halpern
- Leonard Davis Institute, Philadelphia, Pennsylvania; Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
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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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Romo-Avilés N, Zapata JF, Keuneke A, Petroff D, Etz CD, Epstein D. "There is nothing better than participating in this study": Living the PAPAartis cardiovascular randomised controlled trial. Contemp Clin Trials Commun 2022; 29:100987. [PMID: 36111175 PMCID: PMC9468490 DOI: 10.1016/j.conctc.2022.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Qualitative research can bring new dimensions of understanding decision-making process in clinical trials. Participating in a randomized clinical trial requires patients to accept complex information and make decisions in a context of uncertainty. It becomes especially complicated in the case of serious diseases in which the treatment itself implies unknown risks. This study examines these issues in the context of the PAPAartis randomized clinical trial, which aims to prevent spinal cord injuries that can occur as an adverse event following complex surgical repair of thoracoabdominal aneurysm. In this study, we accessed a group of 16 patients participating in the trial and, through in-depth interviews, sought to understand the decision-making process when taking part in the trial and their experience of it. Our results showed that patients participated for different reasons: due to trust in doctors, the hope of having a better treatment or for altruistic and collaborative reasons with science. Many patients felt they did not fully understand the extraneous information provided about the study and the complex nature of the procedure. Avoidance of paraplegia played a fundamental role in the decision to participate in this trial. Family support and the socioeconomic conditions of the patients influenced the recovery process after surgery.
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Affiliation(s)
| | | | - Alena Keuneke
- Department of Social Anthropology, University of Granada, Spain
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Epstein
- Department of Applied Economics, University of Granada, Spain
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Oravec N, Arora RC, Bjorklund B, Gregora A, Monnin C, Dave MG, Duhamel TA, Kent DE, Schultz ASH, Chudyk AM. Patient and caregiver preferences and prioritized outcomes for cardiac surgery: A scoping review and consultation workshop. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01675-5. [PMID: 34924192 DOI: 10.1016/j.jtcvs.2021.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) In light of the absence of patient and caregiver input in Enhanced Recovery After Surgery Cardiac Surgery guideline development, we conducted a scoping review to identify patient and caregiver preferences and prioritized outcomes related to perioperative care in cardiac surgery and its lifelong impact. METHODS Five electronic databases were searched to retrieve studies investigating patient or caregiver preferences and prioritized outcomes. Information was charted in duplicate and analyzed using descriptive statistics or thematic analysis. A patient and caregiver consultation workshop validated scoping review findings and solicited novel preferences and outcomes. RESULTS Of the 5292 articles retrieved, 43 met inclusion criteria. Most were from Europe (n = 19, 44%) or North America (n = 15, 35%) and qualitative and quantitative designs were represented in equal proportions. Fifty-two methods were used to obtain stakeholder preferences and prioritized outcomes, the majority being qualitative in nature (n = 32, 61%). Based on the collective preferences of 3772 patients and caregivers from the review and 17 from the consultation workshop, a total of 108 patient preferences, 32 caregiver preferences, and 19 prioritized outcomes were identified. The most commonly identified theme was "information and education." Improved quality of life was the most common patient-prioritized outcome, and all caregiver-prioritized outcomes were derived from the consultation workshop. CONCLUSIONS Patient and caregiver preferences overlap with Enhanced Recovery After Surgery Cardiac Surgery recommendations targeting preoperative risk reduction strategies, prehabilitation, patient engagement technology, and intra- and postoperative strategies to reduce discomfort. To support clinical practice, future research should investigate associations with key surgical outcomes.
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Affiliation(s)
- Nebojša Oravec
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Brian Bjorklund
- Enhanced Recovery Protocols for Cardiac Surgery Patient Researcher Group, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - April Gregora
- Enhanced Recovery Protocols for Cardiac Surgery Patient Researcher Group, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mudra G Dave
- Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada; Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - David E Kent
- Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Annette S H Schultz
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; Health Services & Structural Determinants of Health Research Group, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Anna M Chudyk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; Health Services & Structural Determinants of Health Research Group, St Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
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Robinson JA, Do-Nguyen CC. Increasing diversity in cardiothoracic surgery: First-generation medical students. JTCVS OPEN 2021; 7:289-293. [PMID: 36003754 PMCID: PMC9390249 DOI: 10.1016/j.xjon.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
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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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Soangra R, Lockhart T. Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures. SENSORS 2021; 21:s21051704. [PMID: 33801240 PMCID: PMC7958120 DOI: 10.3390/s21051704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Gait speed assessment increases the predictive value of mortality and morbidity following older adults' cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤0.833 m/s) and the remaining eight patients as non-frail (gait speed >0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app "Lockhart Monitor" available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.
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Affiliation(s)
- Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA;
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
| | - Thurmon Lockhart
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
- Correspondence: ; Tel.: +1-540-257-3058
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Højskov IE, Thygesen LC, Moons P, Egerod I, Olsen PS, Berg SK. The challenge of non-adherence to early rehabilitation after coronary artery bypass surgery: Secondary results from the SheppHeartCABG trial. Eur J Cardiovasc Nurs 2019; 19:238-247. [PMID: 31630532 DOI: 10.1177/1474515119883454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attending and maintaining a cardiac rehabilitation programme is a challenge. AIMS The purpose of this study was to explore associations between non-adherence to early coronary artery bypass graft rehabilitation and sociodemographic and clinical baseline data. METHODS Coronary artery bypass graft patients were randomised 1:1 to either four weeks of comprehensive early rehabilitation or usual care. Outcomes were assessed at three time-points points: baseline, discharge and four weeks post-coronary artery bypass graft. Differences in sociodemographic and clinical baseline data in adherent versus non-adherent patients were tested using the Pearson χ2 test for categorical variables. To test associations between non-adherence to exercise training and sociodemographic and clinical baseline data, multivariate logistic regression was used to estimate the odds ratio for in-hospital training and post-discharge training adjusted for age, sex and left ventricular ejection fraction. RESULTS Non-adherence to in-hospital versus post-discharge exercise training was 31% (n=48) versus 53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to in-hospital versus post-discharge mindfulness was 87% versus 70%. Male non-adherence to mindfulness was 85% versus 70%. Non-adherence to psycho-educational consultations was 3%, most of whom were men. Patients with university level education were more adherent to in-hospital exercise training than patients with lower educational level (odds ratio=3.14 (95% confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more non-adherent to exercise training after discharge (3.74 (1.54-9.08), p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01). CONCLUSIONS This study demonstrated wide acceptance of psycho-educational consultations in post-coronary artery bypass graft patients. Adherence to physical rehabilitation was low especially after discharge from hospital and the opportunity to attend a mindfulness programme was not used.
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Affiliation(s)
- Ida E Højskov
- The Heart Centre, University of Copenhagen, Denmark.,Department of Nursing and Nutrition Education. The Faculty of Health Sciences, University College, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, University of Leuven, Belgium.,Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Ingrid Egerod
- Department of Intensive Care Unit, Rigshospitalet, University of Copenhagen, Denmark
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Subih M, Al-Kalaldeh M, Salami I, Al-Hadid L, Abu-Sharour L. Predictors of uncertainty among postdischarge coronary artery bypass graft patients in Jordan. JOURNAL OF VASCULAR NURSING 2018; 36:85-90. [PMID: 29747788 DOI: 10.1016/j.jvn.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/19/2017] [Accepted: 11/23/2017] [Indexed: 11/16/2022]
Abstract
Uncertainty impacts negatively on adaptation and disease outcomes. During recovery, coronary artery bypass graft (CABG) patients experience uncertainty, symptom distress, and learning needs. This study aimed to examine predictors associated with uncertainty among CABG patients. This cross-sectional correlational study recruited CABG patients conveniently from out-patient clinics 1 month after discharge. Participants completed a self-administered questionnaire which included: demographic questionnaire, Mishel's Uncertainty of Illness Scale, Cardiac Symptoms Survey, and Cardiac Patients Learning Needs. A total of 161 participants completed the study questionnaires. Participants showed a moderate level of uncertainty, less cardiac symptom distress, and high learning needs. Uncertainty was significantly correlated with learning needs while less correlated with symptom distress. Hierarchal multiple regression revealed that gender, employment status, education level, and learning needs are factors associated with uncertainty among CABG patients. It was concluded that symptom distress does not necessarily induce uncertainty. Intensive care professionals should undertake individual's characteristics to anticipate uncertainty.
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Affiliation(s)
- Maha Subih
- School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | - Ibrahim Salami
- Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Lourance Al-Hadid
- Nursing Department, Al Hussein Bin Talal University, Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Ma'an, Jordan
| | - Loai Abu-Sharour
- Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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Dunckley M, Ellard D, Quinn T, Barlow J. Recovery after coronary artery bypass grafting: Patients’ and health professionals’ views of the hospital experience. Eur J Cardiovasc Nurs 2016; 6:200-7. [PMID: 17092777 DOI: 10.1016/j.ejcnurse.2006.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 07/10/2006] [Accepted: 09/18/2006] [Indexed: 12/01/2022]
Abstract
Background Increasing access to revascularisation procedures is a key aspect of a National Service Framework. Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients do not report an improved quality of life or experience a good recovery. Aims To describe the recovery trajectory after CABG and identify facilitators and barriers to recovery. Methods Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients. Results Thematic analysis identified the following themes: definition and timeline of recovery, preparation for surgery including information provision, attitude to surgery and confidence in staff, clinical factors and the in-patient experience. The key finding is the different recovery trajectory between patients with severe versus mild pre-operative symptoms; patients with few pre-CABG symptoms reported a much longer recovery time. Conclusions This study has provided insights into the barriers and facilitators to recovery after CABG and the processes involved. Findings have indicated areas where health professionals can intervene to aid patients’ long-term recovery and thereby maximise the benefits of CABG.
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Affiliation(s)
- Maria Dunckley
- Interdisciplinary Research Centre in Health, Faculty of Health and Life sciences, Coventry University, Priory Street, Coventry, UK.
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Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Eur J Cardiovasc Nurs 2016; 15:447-58. [DOI: 10.1177/1474515115602678] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/25/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antonia Kalogianni
- Faculty of Nursing, Technological Educational Institute of Athens, Greece
| | - Panagiota Almpani
- Faculty of Nursing, Technological Educational Institute of Athens, Greece
| | - Leonidas Vastardis
- Intensive Care Unit of Department of Cardiac Surgery, ‘Evangelismos’ General Hospital, Athens, Greece
| | - George Baltopoulos
- Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Christos Charitos
- Cardiothoracic Surgery Department, ‘Evangelismos’, General Hospital of Athens, Greece
| | - Hero Brokalaki
- Faculty of Nursing, National and Kapodistrian University of Athens, Greece
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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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Abstract
The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients’ during the first 5 weeks following hospital discharge. Patients ( N = 200) were randomly allocated to two groups: (a) an intervention group who received telephone calls from an advanced practice nurse (APN) familiar with their clinical condition and care needs, twice during the first week following discharge then weekly thereafter for 4 weeks, and (b) a usual care group. Measures of health-related quality of life (HRQL), symptom distress, satisfaction with recovery care, and unexpected health care contacts were obtained at 5 weeks following discharge. There were no significant group differences in HRQL, unexpected contacts with the health care system, or symptom distress. The provision of APN support via telephone followup after cardiac surgery is feasible. However, further randomized trials of single and multicomponent APN interventions are needed to prove effectiveness.
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Karlsson AK, Johansson M, Lidell E. Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery. Eur J Cardiovasc Nurs 2016; 4:290-7. [PMID: 15886056 DOI: 10.1016/j.ejcnurse.2005.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 03/08/2005] [Accepted: 03/27/2005] [Indexed: 11/25/2022]
Abstract
Background: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions. Aim: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective. Method: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future. Findings: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude. Conclusions: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.
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Gardner G, Elliott D, Gill J, Griffin M, Crawford M. Patient Experiences Following Cardiothoracic Surgery: An Interview Study. Eur J Cardiovasc Nurs 2016; 4:242-50. [PMID: 15923146 DOI: 10.1016/j.ejcnurse.2005.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 04/09/2005] [Accepted: 04/20/2005] [Indexed: 11/24/2022]
Abstract
Background: Numerous studies have investigated patient outcomes of cardiac surgery, including some examining health-related quality of life. While these studies have provided some insight into patients' physical function, social abilities and perceived quality of life, studies examining the experiences of individuals recovering from cardiac surgery have received only limited investigation. Aims: This paper presents a thematic analysis of interviews conducted with patients recovering from cardiothoracic surgery, about their memories and experiences of hospital and recovery post-hospital discharge. Methods: Using an exploratory qualitative approach, eight participants were interviewed 6 months following their surgery. Transcripts of interviews were examined using a content analysis approach, with open coding of text and categorising of similar concepts into themes. Findings: Participants reported varying degrees of pain and physical dysfunction during their recovery from surgery and some had still not returned to optimal function. Seven themes emerged from the data: impressions of ICU; comfort/discomfort; being sick/getting better; companionship/isolation; hope/hopelessness; acceptance/apprehension; and life changes. A number of the themes were constructed as a continuum, with participants often demonstrating a range of views or experiences. Many had little or no memory of their stay in the intensive care unit, although others had vivid recollections. Their impressions of hospital were mostly positive, although many experienced fear, apprehension, and mood disturbances at some time during their recovery. Most participants recalled being sick, reaching a turning point, and then getting better. Many participants reported a change in life view since their recovery from surgery. Conclusions: Attention to specific areas of patient orientation, education and support was identified to facilitate realistic expectations of recovery. In addition, some form of systematic follow-up that focuses on patient recovery in terms of both physical and psychological function is important.
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Abstract
BACKGROUND Infective endocarditis (IE) is a traumatic health event, and recovery is often associated with massive physical deconditioning and reduced quality of life. Patients also report reduced cognitive functioning and are at risk of developing anxiety and depression as well as posttraumatic stress disorder. Although studies have found that survivors of IE have impaired physical functioning and mental health, little is known about patient experiences contributing to these findings. OBJECTIVE The aim of this study was to describe patient experiences of recovery after IE. SUBJECTS AND METHODS Within a phenomenological-hermeneutical framework, a qualitative interview study was conducted that included 6 men and 5 women (aged 29-86 years). Patients were interviewed 3 to 6 months after discharge. Analysis consisted of 3 levels: naive reading, structured analysis, and critical interpretation and discussion. FINDINGS The overall concept that emerged was "Insufficient Living." Patients all experienced a life after illness, which was perceived as insufficient. The overall concept can be interpreted in terms of the following 3 themes. The first was "an altered life," where participants described a phase of adaptation to a new life situation, which some perceived as manageable and temporary, whereas others found extremely distressing and prolonged. "Shocking weakness" was experienced physically, cognitively, and emotionally, and although it subsided quickly for a few, most experienced a persisting weakness and felt frustrated about the prolonged recovery phase. In "the road to recovery," support from relatives and healthcare professionals, as well as one's own actions, was emphasized as important in facilitating recovery. CONCLUSIONS Recovery after IE is perceived as "Insufficient Living." Patients experience an altered life and shocking weakness, and on the road to recovery, support is needed. Research in follow-up care, supporting patients' ability to cope with potential physical and psycho-emotional consequences of IE, is encouraged as a result of these findings.
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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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McTier L, Botti M, Duke M. Patient participation in medication safety during an acute care admission. Health Expect 2015; 18:1744-56. [PMID: 24341439 PMCID: PMC5060834 DOI: 10.1111/hex.12167] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient participation in medication management during hospitalization is thought to reduce medication errors and, following discharge, improve adherence and therapeutic use of medications. There is, however, limited understanding of how patients participate in their medication management while hospitalized. OBJECTIVE To explore patient participation in the context of medication management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. DESIGN Single institution, case study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including pre-admission and pre-discharge patient interviews (n = 98), naturalistic observations (n = 48) and focus group interviews (n = 2). RESULTS All patients had changes made to their pre-operative cardiovascular medications as a consequence of surgery. More patients were able to list and state the purpose and side-effects of their cardiovascular medications at pre-admission than prior to discharge from hospital. There was very little evidence that nurses used opportunities such as medication administration times to engage patients in medication management during hospital admission. DISCUSSION AND CONCLUSIONS Failure to engage patients in medication management and provide opportunities for patients to learn about changes to their medications has implications for the quality and safety of care patients receive in hospital and when managing their medications once discharged. To increase the opportunity for patients to participate in medication management, a fundamental shift in the way nurses currently provide care is required.
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Affiliation(s)
- Lauren McTier
- School of Nursing and MidwiferyDeakin UniversityMelbourneVic.Australia
| | - Mari Botti
- Epworth/Deakin Centre for Nursing ResearchEpworth HealthCare and School of Nursing and MidwiferyDeakin UniversityMelbourneVic.Australia
| | - Maxine Duke
- School of Nursing and MidwiferyDeakin UniversityMelbourneVic.Australia
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Thomsen T, Vester-Andersen M, Nielsen MV, Waldau T, Møller AM, Rosenberg J, Møller MH, Nystrup KB, Esbensen BA. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery: a qualitative sub-study of the Incare trial. J Clin Nurs 2014; 24:1280-8. [PMID: 25430728 DOI: 10.1111/jocn.12727] [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] [Accepted: 09/26/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND Emergency abdominal surgery is common, but little is known about how patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN A qualitative study with individual semi-structured interviews. METHODS We analysed interviews using Systematic Text Condensation. RESULTS Eighteen patients (nine intervention/nine controls) were strategically sampled from the InCare trial. Data analysis resulted in three distinct descriptions of intermediate care; two of standard surgical ward care. Intermediate care was described as 'luxury service' or 'a life saver.' The latter description was prevalent among patients with a perceived complicated disease course. Intermediate care patients felt constrained by continuous monitoring of vital signs as they recovered from surgery. Standard surgical ward care was described as either 'ok - no more, no less' or 'suboptimal'. Experiencing suboptimal care was related to patient perceptions of heavy staff workloads, lack of staff availability and subsequent concerns about the quality of care. CONCLUSION Postoperative intermediate care enhanced perceptions of quality of care, specifically in patients with a perceived complicated disease course. Patients were eager to contribute actively to their recovery; however, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE Intermediate care may increase patient perceptions of quality and safety of care.
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Affiliation(s)
- Thordis Thomsen
- Abdominal Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Berg SK, Zwisler AD, Pedersen BD, Haase K, Sibilitz KL. Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality. BMC Nurs 2013; 12:23. [PMID: 24070399 PMCID: PMC3849933 DOI: 10.1186/1472-6955-12-23] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients’ perception of recovery after heart valve replacement is essential. The objective was to describe the experience of recovery at home after heart valve replacement. Methods Qualitative interviews were conducted with 10 patients representing the population and these were later transcribed. The analysis was inspired by Ricoeur’s theory of interpretation, which consists of three levels: naive reading, structured analysis, and critical interpretation and discussion. Results The overall concept that emerged was suffering weakness and struggling to resume normality. Patients all struggled to resume normal living, both in regaining physical strength and in reestablishing balance in overall living. The overall concept can be interpreted in terms of the following themes: Disturbed network: Invaluable relatives, Contact with healthcare staff, Rehabilitation. Disturbed body: Stressful complications, Bodily attention, Physically affected, Physical capability. Recovery: Interrupted living, Suffering weakness, Gradual recovery, Achieving normality. Reflections: Thoughts about the procedure and Feeling sad and fragile. Conclusion The study presents the main themes of network, body, recovery and reflection for ten patients after heart valve replacement. These main themes can overall be summarized as suffering weakness and struggling to resume normality. Patients felt weak with a changed body, but after a long recovery process regained vitality and returned to their daily life.
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Schafer LM, Hsu C, Eaves ER, Ritenbaugh C, Turner J, Cherkin DC, Sims C, Sherman KJ. Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012. [PMID: 23186539 PMCID: PMC3533863 DOI: 10.1186/1472-6882-12-234] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers’ views of their patients’ expectations regarding CAM therapy and the role of these expectations in patient outcomes. Methods To better understand how CAM providers view and respond to their patients’ expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1. Results CAM providers reported that they attempt to ensure that their patients’ expectations are realistic. Providers indicated they manage their patients’ expectations in a number of domains— roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients’ expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment. Conclusions Providers of four types of CAM therapies viewed patients’ expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.
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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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Alkubati SA, Al-Zaru IM, Khater W, Ammouri AA. Perceived learning needs of Yemeni patients after coronary artery bypass graft surgery. J Clin Nurs 2012; 22:930-8. [PMID: 22784274 DOI: 10.1111/j.1365-2702.2012.04177.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the information needs of Yemeni patients who have undergone coronary artery bypass graft surgery before hospital discharges and to examine the differences in the patients' learning needs according to age, gender, level of education and working condition. BACKGROUND Postcoronary artery bypass graft (CABG) patients need more information before their discharge from the hospital. This need of information must be assessed and provided for them before their discharge from hospital to help them with adequate care and recovery at home. Design. A descriptive, correlational design. METHODS Data were collected from 120 CABG patients before their discharge from Al- Thawra Hospital, Sana'a, Yemen, by using modified Cardiac Patients Learning Needs Inventory (CPLNI) instrument. The Statistical Package for the Social Sciences was used to analyse the collected data. RESULTS The information about chest and leg wound care, medication information, other pertinent information and complications were indicated to be the most valued by CABG patients prior to discharge. There was a statistically significant difference between patients' total learning needs according to their socio-demographic characteristics. Male patients needed more information than female patients (p=0.004). Younger (p=0.021) and middle-aged (p=0.032) patients needed more information than older ones. Highly educated (p=0.000) and school-level (p=0.002) patients needed more information than those in the uneducated group. Working patients needed more information than non-working ones (p=0.000). CONCLUSION This study suggests that CABG patients have high information needs within 24-48 hours before hospital discharge. In addition, the results of this study showed that there are statistically significant differences in patients' learning needs according to their demographic characteristics. RELEVANCE TO CLINICAL PRACTICE Assessment of CABG patients' information needs before their discharge from hospital helps in developing effective educational programme that will help these patients in their recovery at home.
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Patients' experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting. Eur J Cardiovasc Nurs 2012; 11:14-24. [PMID: 21030311 DOI: 10.1016/j.ejcnurse.2010.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients' detailed experiences, and give direction for future clinical practice. AIM To explore the CABG patients' symptoms and needs in the early rehabilitation phase. METHODS A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. RESULTS Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgery the patients' symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. CONCLUSION CABG patients' experiences indicate a need to extend the hospital's discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.
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Bergvik S, Sørlie T, Wynn R. Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work. Br J Health Psychol 2011; 17:596-608. [PMID: 22151690 DOI: 10.1111/j.2044-8287.2011.02058.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway. DESIGN Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records. METHODS Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis. RESULTS A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health. CONCLUSIONS Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.
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Affiliation(s)
- Svein Bergvik
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway
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26
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Sveinsdóttir H, Ingadóttir B. Predictors of psychological distress in patients at home following cardiac surgery: an explorative panel study. Eur J Cardiovasc Nurs 2011; 11:339-48. [DOI: 10.1016/j.ejcnurse.2011.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Herdís Sveinsdóttir
- Faculty of Nursing, University of Iceland, Eirberg Eiríksgötu 34, 101 Reykjavík, Iceland
| | - Brynja Ingadóttir
- Faculty of Nursing, University of Iceland, Eirberg Eiríksgötu 34, 101 Reykjavík, Iceland
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27
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Lapum J, Angus JE, Peter E, Watt-Watson J. Patients' discharge experiences: Returning home after open-heart surgery. Heart Lung 2011; 40:226-35. [DOI: 10.1016/j.hrtlng.2010.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/11/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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Abstract
AIMS To explore the care needs of older patients in the intensive care units. Background. As the numbers of older patients admitted to the intensive care units are growing, care quality of critically ill older patients has become an important issue. However, there are few studies directly investigating perceived care needs of hospitalised older patients and the studies on care needs of older patients in the intensive care units are even fewer. The identification of care needs from older patients' perspective will help develop qualified nursing practice. DESIGN A qualitative exploratory design. METHODS Purposive sampling was performed to recruit 35 older patients from three hospitals in Taiwan. The interview transcripts were analysed by qualitative content analysis. RESULTS The results revealed that care needs of older patients in the intensive care units are multidimensional, including physical, informational and psychosocial dimensions. Older patients' needs of the physical dimension included relieving pain and discomfort, starting oral intake as soon as possible and having continuous sleep. Informational needs included adequate explanations about their disease progression and prognosis and information on recovery-promoting activity. Psychosocial needs included caring behaviour of intensive care units staff, flexible visiting hours, increase in control ability and maintenance of good communication with intensive care units staff. CONCLUSION The findings can assist nurses in understanding the interventions necessary to meet care needs of critically ill older patients. The critically ill older adults need more than medical-technical care. They need more holistic care. The psychosocial and informational needs must be considered commensurate with the presenting physical needs. RELEVANCE TO CLINICAL PRACTICE Nurses have an important role in meeting intensive care units older patients' care needs. Intensive care units nurses should conduct comprehensive assessment regarding older patients' needs at the beginning and at various points in their intensive care units stay and match these needs with appropriate nursing interventions.
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Affiliation(s)
- Ching-Wen Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
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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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Bergvik S, Sørlie T, Wynn R. Approach and avoidance coping and regulatory focus in patients having coronary artery bypass graft surgery. J Health Psychol 2010; 15:915-24. [PMID: 20453051 DOI: 10.1177/1359105309359542] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Coronary artery bypass graft (CABG) surgery is stressful, and the patient's coping affects recovery and outcome. The aim of the study was to identify patients' thoughts and concerns, and explore the relevance of approach/avoidant coping and Regulatory Focus Theory (RFT). Nine patients were interviewed, using an interpretative phenomenological approach. The patients made use of various avoidant (e.g. neglecting symptoms, delaying help-seeking, avoiding thoughts) and approach strategies (e.g. persistent search for the diagnosis, mental preparation for surgery). RFT versus approach/avoidant coping is discussed. RFT may contribute to our understanding of motivational cognitions in patients' coping with illness and treatment.
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Affiliation(s)
- Svein Bergvik
- University of Tromsø & University Hospital of Northern Norway, Tromsø, Norway
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Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2010; 24:454-64. [PMID: 19858954 DOI: 10.1097/jcn.0b013e3181ac8a3c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. PARTICIPANTS AND METHODS A convenience sample (N = 54) was recruited from 2 hospitals in rural regions from 2 different mid-Atlantic states. The sample included participants who underwent coronary artery bypass graft or valve replacement surgery for the first time. The study used a longitudinal design, and data were collected preoperatively in the hospital or surgeons' offices and 4 weeks postoperatively by telephone interviews. Participants were interviewed using the following questionnaires: the Future Expectations Regarding Life with Heart Disease scale, the Hospital Anxiety and Depression scale, and the Medical Outcomes Study 36-Item Short Form Health Survey. Repeated-measures analysis of variance, Pearson product-moment correlations, and multiple regression were used for data analyses. RESULTS AND CONCLUSIONS Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.
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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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Colbert CY, Mirkes C, Cable CT, Sibbitt SJB, VanZyl GO, Ogden PE. The patient panel conference experience: what patients can teach our residents about competency issues. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1833-1839. [PMID: 19940596 DOI: 10.1097/acm.0b013e3181bf27db] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE In 2007, the Scott & White/Texas A&M HSC College of Medicine began requiring all internal medicine residents to attend quarterly patient panel conferences, during which former Scott & White patients speak frankly about their inpatient and outpatient experiences. The main purpose of this mixed-methods pilot study was to determine whether residents' competency education could be enhanced via the conferences. METHOD Of the 54 internal medicine residents in the residency program, 31, 39, and 41 participated in three patient panel conferences, respectively, between December 2007 and August 2008. Each resident completed an assessment that included a reflection on his or her own practice and the identification of competency issues highlighted by patients' oral narratives. Content analyses of responses to open-ended questions were performed. Consensus on themes was reached. Descriptive statistics were run on quantitative data. RESULTS Six themes were identified: improve communication with patients/families, improve patient care, improve professional behaviors, empathize with patients/families, display sensitivity to patients'/families' needs/concerns, and recognize system issues. When asked if the conference highlighted competency problems, residents answered "agree" or "strongly agree" as follows: 82% for professionalism, 82.9% for systems-based practice, 85.2% for interpersonal and communication skills, and 84.4% for patient care. The majority were able to provide examples of competency issues. CONCLUSIONS The patient panel conference experience was a powerful mechanism for enhancing competency education. The conferences were an effective means of presenting real-life examples of systems issues in the context of a hospital system.
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Affiliation(s)
- Colleen Y Colbert
- Department of Internal Medicine, Scott & White Hospital, 2401 South 31st St., Temple, TX 76508, USA.
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Rothberg MB, Benjamin EM, Lindenauer PK. Public reporting of hospital quality: recommendations to benefit patients and hospitals. J Hosp Med 2009; 4:541-5. [PMID: 19514092 DOI: 10.1002/jhm.481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Public reporting of hospital performance holds tremendous promise for improving the care provided by hospitals. To date, however, consumers have failed to embrace public reporting, despite considerable efforts to promote it. We review a number of reasons that public reporting has failed to live up to expectations, and we make 10 recommendations to improve the value of public reporting for both patients and hospitals. We also review 3 leading performance reporting programs to evaluate how well they adhere to these recommendations.
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Affiliation(s)
- Michael B Rothberg
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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Swenne CL, Skytt B, Lindholm C, Carlsson M. Patients' experiences of mediastinitis after coronary artery bypass graft procedure. SCAND CARDIOVASC J 2009; 41:255-64. [PMID: 17680514 DOI: 10.1080/14017430701283856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Few studies have focussed on patients' experiences of and suffering due to mediastinitis following Coronary Artery by-pass Graft (CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients' experiences of the medical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes with regard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it would influence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. The staff's medical knowledge and the quality of nursing care as well as the patients' understanding of the situation influenced their experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such as problem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handle the situations. The third theme comprised the patients' belief that the mediastinitis would not affect the outcome of the CABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.
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Affiliation(s)
- C L Swenne
- Department of Cardiothoracic Surgery, Uppsala University Hospital, OTM Division, Uppsala, Sweden.
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Falk-Brynhildsen K, Nilsson U. Cardiac Surgery Patients’ Evaluation of the Quality of Theatre Nurse Postoperative Follow-Up Visit. Eur J Cardiovasc Nurs 2009; 8:105-11. [DOI: 10.1016/j.ejcnurse.2008.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 07/10/2008] [Accepted: 07/14/2008] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ulrica Nilsson
- Department of Cardiothoracic Surgery and Centre for Health Care Sciences, Örebro University Hospital, Sweden
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Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation 2009; 119:1442-52. [PMID: 19289649 DOI: 10.1161/circulationaha.107.742775] [Citation(s) in RCA: 512] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leslie A Curry
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine at Yale University School of Medicine, New Haven, Conn., USA.
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Ong J, Miller PS, Appleby R, Allegretto R, Gawlinski A. Effect of a Preoperative Instructional Digital Video Disc on Patient Knowledge and Preparedness for Engaging in Postoperative Care Activities. Nurs Clin North Am 2009; 44:103-15, xii. [DOI: 10.1016/j.cnur.2008.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Leegaard M, Fagermoen MS. Patients’ key experiences after coronary artery bypass grafting: a synthesis of qualitative studies. Scand J Caring Sci 2008; 22:616-28. [DOI: 10.1111/j.1471-6712.2007.00556.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rothberg MB, Morsi E, Benjamin EM, Pekow PS, Lindenauer PK. Choosing The Best Hospital: The Limitations Of Public Quality Reporting. Health Aff (Millwood) 2008; 27:1680-7. [DOI: 10.1377/hlthaff.27.6.1680] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Peter K. Lindenauer
- Tufts University School of Medicine, Baystate Medical Center, in Springfield, Massachusetts
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Abstract
Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients.
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Affiliation(s)
- Catherine Cole
- University of Arkansas for Medical Sciences College of Nursing in Little Rock, USA.
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Suhonen R, Leino-Kilpi H. Adult surgical patients and the information provided to them by nurses: a literature review. PATIENT EDUCATION AND COUNSELING 2006; 61:5-15. [PMID: 16533673 DOI: 10.1016/j.pec.2005.02.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2004] [Revised: 02/09/2005] [Accepted: 02/18/2005] [Indexed: 05/07/2023]
Abstract
OBJECTIVE A literature review was conducted to explore what is already known of surgical patients' informational needs, their opinions about the provision of information and the effect of individualised information. METHODS Computerised searches from 1994 to March 2004 were conducted on MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials using the keywords information, surgical patient adult and nursing. RESULTS Findings about the provision of information and important areas for surgical patients vary from study to study. Surgical patients have specific informational needs during the peri-operative period. However, some studies showed that the patients were not given the information that they need. This is a concern because patients have to take care of themselves after discharge. Individually tailored learning and teaching strategies are needed for patients to ensure the quality and usefulness of information for patients post-discharge. CONCLUSIONS The results of this review confirm that information, which is tailored to individual patient needs, has an important role for surgical patients. At present there is a poor understanding of the processes that describe the detailed experiences of surgical patients in clinical care and the possibilities of empowerment through learning. PRACTICE IMPLICATIONS As surgical patients differ individually in their learning needs and benefit from different content and quantity of information, more emphasis should be put into evaluating and assessing these individual needs.
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Affiliation(s)
- Riitta Suhonen
- Health care district of Forssa, Forssa and University of Turku, Department of Nursing, Haagantie 184, 31410 Somero, Finland.
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Abstract
AIM This paper reports the qualitative findings of qualitative interviews conducted as part of a study assessing the effectiveness of structured, postdischarge, telephone intervention for patients and their partners recovering from bypass surgery. The data reported here describe the postoperative recovery experiences of a small sample of patients (n = 10) and the intervention role of the specialist nurse delivering the intervention. BACKGROUND Reduced length of hospital stay for bypass patients means that there are fewer opportunities to provide necessary information and respond to patient concerns in hospital, and much of the process of wound healing and regaining functioning that would once have taken place in hospital now takes place at home and place additional burdens on patients and their caregivers. METHOD The study was a randomized controlled trial of a telephone intervention aimed at reducing anxiety for patients experiencing a first bypass, and for their caregivers. The intervention consisted of a series of protocols delivered by a nurse with cardiac experience. It was conducted via telephone at discharge and on days 1, 2, 4, 7 and weeks 2 and 7 postdischarge. In the qualitative component of the study, a purposive sample of telephone calls in the treatment group was analysed and data saturation was achieved with 10 transcripts. FINDINGS Three major patient concerns emerged: physical, affective and lifestyle changes. Anxiety about speed of discharge was a common concern at discharge and at day 1. Otherwise, physical concerns predominated during the first week. At day 7 and after, a shift began to occur to longer term, future-oriented concerns. By week 7, most patients were planning for return to normal activities, and several were making lifestyle changes. The specialist nurse was able to give personalized health promotion information at a time that was appropriate for individual patients. CONCLUSION Using a qualitative interview method made it possible to understand patients' concerns and study the working of telenursing interventions in terms of providing timely reassurance and health promotion. Further research is needed to test the generalizability of the findings.
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Affiliation(s)
- Kathleen Hartford
- Lawson Health Research Institute, University of Western Ontario, London, Ontario N6A 4G5, Canada. kathleen.hartford.@lhsc.on.ca
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Gallagher R, McKinley S, Dracup K. Post discharge problems in women recovering from coronary artery bypass graft surgery. Aust Crit Care 2004; 17:160-5. [DOI: 10.1016/s1036-7314(04)80021-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
BACKGROUND Coronary artery bypass graft (CABG) surgery is a lifesaving intervention, but the early recovery period presents a number of challenges for patients, carers and nurses. Early and adequate discharge planning based on in-depth knowledge of the postdischarge experience can help to ensure optimal recovery. AIM This paper reports a study to examine the range of postdischarge issues, concerns and needs of patients and their family carers after discharge after CABG surgery, and explore their perceptions of unmet needs 1 year later. METHODS A two-phase naturalistic inquiry was undertaken. Interviews were conducted with 30 patients and their carers 4-5 weeks after coronary artery bypass grafting (phase 1) and 1 year after the initial interview (phase 2). Thematic analysis was used to identify the major concerns of participants. FINDINGS Almost half the patients experienced heart surgery as a huge personal shock. Adjusting to life afterwards was difficult, and they experienced a variety of changes, including pain. An unexpected finding was a heightened sense of body awareness and the need for postoperative physical adjustments. The financial implications of surgery were a major burden. Lifestyle adjustments were important and led to suggestions for support services, using telephone support and/or community patient networks. All participants recommended strengthening discharge planning with more accurate information about what to expect during recovery, to help them anticipate fluctuations in health and wellbeing. Carers experienced a wide range of unanticipated feelings during early recovery and had to deal with a number of personal changes. CONCLUSIONS The findings suggest a need to improve discharge preparation and provide enhanced home support services. Further research should evaluate models of periodic follow-up and mechanisms for mutual support, and compare the experiences of cardiac patients and their carers with those of other surgical cohorts.
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Affiliation(s)
- Karen Theobald
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
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Abstract
OBJECTIVE The objective of this study was to determine the uses of the Quality Health Outcomes framework and indicator categories in the healthcare literature. DATA SOURCES We studied personal communications and conducted a literature search using computerized databases since 1997, when the recommendations of the Invitational Conference on Measures and Outcomes of Care Delivery were available. PRINCIPAL FINDINGS The Quality Health Outcomes Model has been used explicitly to frame a small number of research summaries and programs. The outcome indicator categories can be found in several "report card" initiatives in the United States and Canada. Use of these outcome categories, thought to be sensitive to nursing care inputs, has grown since 1977, with a rising number of uses linked to system or organizational factors or interventions. CONCLUSIONS This model and others like it are increasingly forming the conceptual framework for studies that evaluate quality and system interventions to improve care. However, the available data continue to require the linking of negative outcomes (adverse events, complications) to structural and process inputs that reflect nursing care. An urgent need remains to incorporate this broader range of outcomes into available databases.
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Affiliation(s)
- Pamela H Mitchell
- University of Washington School of Nursing, Seattle, Washington 98195-7265, USA.
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Abstract
Sleep deprivation is a significant problem for patients in critical care units. Sleep is a complex, active process that is divided into 4 stages of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. Noise, lights, discomfort, pain, medications, and stress all contribute to a patient's inability to sleep. Lack of knowledge about the sleep stages, nursing routines, and frequent nursing assessment and interventions also impact the critically ill patient's ability to sleep. Education about sleep deprivation needs to be integrated into critical care courses and orientation programs. Sleep deprivation should be addressed on the multidisciplinary care plan and in health team conference, and nursing care planned accordingly. Sleep medications and their effects should be evaluated for each patient, as well as identifying medications that might be preventing or disturbing sleep.
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Affiliation(s)
- Vicky L Honkus
- Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
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