Food and heart-the nutritional jungle: Patients' experiences of dietary habits and nutritional counselling after coronary artery bypass grafting

AIMS AND OBJECTIVES

The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG).

BACKGROUND

Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients.

DESIGN

Qualitative study.

METHODS

Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines.

RESULTS

In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits".

CONCLUSION

The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling.

RELEVANCE TO CLINICAL PRACTICE

This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.

Experience of cardiac tele-rehabilitation: analysis of patient narratives

INTRODUCTION

Research suggests the need for further studies of patients' experiences of cardiac tele-rehabilitation to understand how they adapt to life with heart disease in a program with long-distance contact, remote supervision and monitoring of health behavior. Therefore, the aim of this study was to explore patients' experiences of tele-rehabilitation and the perceived gains of taking part in the program.

MATERIALS AND METHODS

Seven patients were interviewed using a phenomenological-hermeneutic approach. Interview transcripts were analyzed as narratives using the interpretation theory of the French philosopher Paul Ricoeur. This involves three levels of textual analysis: a naïve reading as the first interpretation followed by a structural analysis, where the text is explored in detail, before identifying the most significant interpretation through critical interpretation.

RESULTS

Patients valued cardiac tele-rehabilitation because it was not restricted to the hospital setting. They felt that the program's flexibility was an advantage because the program could be adjusted to their daily lives. The patients showed greater acknowledgement of and commitment towards the rehabilitation interventions if they were consistent with the patients' self-image, and if the activities were already part of their daily lives. If they were not, they were experienced as an extra challenge.

CONCLUSIONS

Understanding patients' self-image and prior lifestyle may better inform clinicians about why it can be difficult for patients to follow rehabilitation recommendations. Therefore, clinicians may need to focus more on these two factors to help patients adapt to life with heart disease. IMPLICATIONS FOR REHABILITATION Patients' self-image and prior lifestyle may be important factors for how patients adapt to their new life situation with heart disease within a cardiac tele-rehabilitation program. Patients' commitment to selected rehabilitation interventions may be either too high or too low if it fails to take into consideration their self-image and prior lifestyle. Understanding patients' self-image and prior lifestyle may better inform clinicians and their understanding of why it can be difficult for patients to follow the rehabilitation recommendations.

Movement perceived as chores or a source of joy: a phenomenological-hermeneutic study of physical activity and health

Physical activity has become the most documented and acknowledged health advice in relation to both staying healthy and regaining health both physically and mentally. Thus, physical activity in relation to spinal cord injury, low back pain and heart disease is respectively means to regain bodily function, avoid or reduce pain and early death. A second analysis of three studies with a phenomenological-hermeneutic approach building on Ricoeur's philosophy on how people understand themselves and their world through narrative configurations revealed that physical activity had different meanings to people. This revealed that the meanings of physical activity could range from movements being unpleasant, maybe even painful to movements being a source of joy. This caused participants (1) to engage in movement as a source of joy, (2) to overcome the bodily struggle to do their chores, and maybe feel better as a result or (3) to minimize bodily functions equivalent to a functional daily life. Illustrated by 10 different approaches this provides knowledge about driving forces for health professional support. As joy and passion are the strongest driving forces to physical activity, this highlights the importance of supporting people to find a kind of physical activity that they like.

From threat to gradual lifestyle changes: Iranians' experiences with chronic illnesses

AIM

This study aimed to explore and describe the experience of making a healthy lifestyle change among the patients with chronic illness.

BACKGROUND

Despite the existence of different evidence on the critical role of lifestyle in the prevention and management of chronic diseases, many people face challenges in terms of starting and maintaining a healthy lifestyle.

METHODS

A descriptive qualitative study with in-depth semi-structured interviews was carried out in 2015 in Iran. Thirty-four patients with common chronic illnesses were invited to the study using purposive sampling. The collected data were analysed by content analysis.

FINDINGS

The main themes were: trying to remove the perceived threat, considering and trying to do physical activities, considering and planning for a healthy diet, striving to manage stress and having gradual acceptance of new habits and coping with them.

LIMITATIONS

The participants were selected from among those with chronic illness. However, there is also a need to assess the family and healthcare providers' perspectives.

CONCLUSION AND IMPLICATIONS FOR NURSING

The perceived threat of the disease plays an important role in the process of changing to a healthy lifestyle in Iranian with chronic illnesses. It is necessary for healthcare providers, especially nurses, to use this threat as a golden opportunity to accelerate changes in patients' behaviours.

IMPLICATIONS FOR NURSING POLICY

Findings may help policy makers become aware of the need for nurses to create community-based nursing in Iran. Community nurses can remind patients of perceived threats to their health to motivate them for continued healthy behaviours. Therefore, nursing curricula should be revised and educational programs utilise a community-based health approach.