Randomized trial of a home recovery intervention following coronary artery bypass surgery

For this study a randomized clinical trial was designed to test the effects of an early home recovery information intervention on physical functioning, psychological distress, and symptom frequency 1 month following coronary artery bypass graft surgery (CABG). Recovery outcomes were compared between two groups: those receiving an audiotape of information on expected physical sensations and their management (Cardiac Home Information Program [CHIP]) in addition to the usual care, and those receiving the usual cardiac discharge information protocol. A nonprobability sample of 180 patients (84 women and 96 men; mean age = 62 years) was equally distributed between the two study groups. When controlling for age, comorbidity, and cardiac functional status, the results showed positive effects on physical functioning in women and psychological distress, vigor and fatigue in men. Consistent with other studies, women had worse physical functioning and more symptom frequency than men. These findings indicate that the CHIP intervention is an effective method to prepare CABG patients for home recovery.     

Health education. Heart surgery

By means of a literature review of nursing articles, the authors aim to evaluate the importance of educational programmes before and after cardiac surgery, to assess the advantages and drawbacks of these programmes and to evaluate the need for following-up patients and their carers after being discharged from hospital. Health Education and cardiac surgery: Delivering information following cardiac surgery is an essential task, not only to achieve a behavioural change and the development of patients' self-care attitudes but also to reduce their anxiety. It is also essential to educate family members as they are the most importance source of physical and emotional support following surgery. Issues about in-hospital teaching programmes: Despite the numerous benefits of in-hospital teaching programmes, the actual tendency to shorten hospitalisation length in association with the high levels of anxiety, impede patients and carers' learning. Some studies suggest that these educational programmes have not completely achieved the task of preparing patients and their families to face the early recovery. Education during the early recovery: The authors highlight those studies that have focused on patients and their carers' needs for information following discharge from hospital. Results from these studies show the need for following-up patients and their carers at this period. Educational programmes can extent and reinforce the information provided at hospital.     

Assessment of recovery: with special reference to a study with post-operative cardiac patients

The recovery process is dependent on many psychological and physical factors. In this paper recovery refers to major, short-term illness often treated by surgery, which is not expected to result in permanent disability or handicap. Research reviewed which attempts to identify influences on recovery also shows how many patients are left with a degree of disability, usually for psychological reasons. It is suggested that the stress and impact of severe illness and surgery may have a long lasting, previously unrecognized effect.
Nursing which studies the interaction of physical and psychological aspects of illness and care is seen as the most suitable discipline from which to assess recovery and identify risk factors. A study reported here with patients after coronary artery grafting, provides information on recovery and illustrates how many aspects of a patients' experience may help or hinder this process. Data is obtained from patients' interviews to give a wider, more humanistic evaluation of outcome than is usually employed for this type of surgery.     

Rejuvenation improves roller pump-induced physical stress resistance of fresh and stored red blood cells

BACKGROUND: Retrospective studies on transfusion recipients suggested that transfusion of older red blood cells (RBCs) was associated with higher morbidity. Similar studies were also done on cardiac surgery patients who were placed on cardiac bypass pumps. It is possible that stored RBCs are more fragile and could be more easily damaged by these pumps, thus leading to additional morbidity. STUDY DESIGN AND METHODS: Fresh and stored (42 days) RBCs, rejuvenated and nonrejuvenated, were compared in resistance to physical stress, induced by a roller pump, and osmotic fragility changes during physical stress to model RBCs going through cardiac bypass instruments. In addition, posttransfusion in vivo recovery was evaluated in an immunodeficient mouse model to minimize species differences between transfusion product and recipient. RESULTS: Fresh RBCs were more resistant to both osmotic and physical stress than stored cells. After 2 hours of physical stress, the osmotic stress resistance of fresh cells declined and was the same as for stored cells. Rejuvenated fresh cells did not demonstrate a decline in osmotic resistance during the stress test and both fresh and stored cells had the same improved resistance to osmotic stress before and after the physical stress. Rejuvenation slightly improved recovery of fresh RBCs but almost doubled the recovery of stored cells in the mouse model. CONCLUSIONS: Our studies suggest that rejuvenation improves roller pump–induced physical and osmotic stress resistance of stored RBCs.     

Peer support. An under-recognized resource in cardiac recovery.

BACKGROUND: Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery. AIMS: To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions. METHODS: A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions. RESULTS: Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery. CONCLUSIONS: Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.     

Effect of support programme to reduce stress in spouses whose partners 'fall off' clinical pathways post cardiac surgery.

Cardiac surgery is flourishing in today's health care industry and looks to prosper well into the future. More than ever, improved technology, surgical skill and the worldwide trend of increasing longevity means that surgical intervention is offered to patients rarely seen in cardiac units in previous years. Patients are now much older, with multiple co-morbidity including repeat cardiac surgery. In line with advances in cardiac surgery, critical pathways to map the expected recovery route for the patient have been introduced. These maps are used extensively as guides for treatment and care. It is not only health professionals who use the pathways; patients and their relatives also refer to them as indicators of a 'normal' post-operative route. As a result, the critical pathway provides an avenue for expectations of predicted progress through to discharge. These predictors appear to give spouses hope, access to earliest possible visitation and confidence in a positive outcome. Nevertheless, it has recently become increasingly clear that for partners of patients who fail to proceed as expected, who apparently 'fall off' the predicted road to recovery, the critical pathway is problematic. Partners of such patients tend to demonstrate greatly heightened anxiety and nurses often have to deal with them at the point of crisis. In the cardio-thoracic unit at which this study was undertaken, the significant number of spouses who ended up in crisis drew attention to the need for additional support to be built into the post open-heart surgery critical recovery pathway. This study sought therefore to examine how nurses might assist spouses to adapt in the event of a complicated recovery following bypass surgery. A convenience sample of 39 spouses of cardiac surgical patients admitted to the cardio-thoracic recovery unit was obtained to assess stress responses at a critical post-operative data point, 5 days post-surgery. A symptoms of stress inventory was used to measure 94 items of physiological stress in 10 specific subscale categories. As a result of this study, it was found that incorporating a spousal support programme into the critical pathway of open-heart surgical patients significantly reduced stress suffered by spouses of patients who deviated from pre-determined recovery goals. The findings suggest that nurses need to understand the implications of the critical pathway and provide families with information concerning issues associated with complicated recovery. An unexpected finding of the study pointed to an apparent difference in the stress experienced by male spouses to that of female spouses. Recommendations from this study are to further explore the qualitative component of the stress felt by spouses and the negative association of stress with morbidity and mortality for women and patients without spouses. Nurses need to consider developing and implementing a stress management programme for spouses, establishing spousal support groups and exploring the possibility of incorporating spousal support strategies into the critical pathways of patients across hospital settings.     

Sleep and rest in patients undergoing cardiac surgery

Sleep deficit is not uncommon in cardiac surgery patients, but research in this area is limited. This article examines the processes involved in sleep and how promoting these processes can optimise recovery in cardiac surgery patients. The two main parts of sleep, non-rapid eye movement and rapid eye movement, are believed to be responsible for the physical and psychological repair of the body. The combination of surgical injury, underlying disease and increased stress levels during hospitalisation for cardiac surgery increases the need for this repair. Nurses with a good understanding of sleep theories and the nursing process can use sleep and rest as an intervention to promote healing and prevent further injury after surgery.     

Telephone monitoring after early discharge for cardiac surgery patients.

BACKGROUND: Monitoring the postoperative course of cardiac surgery patients remains essential but requires creative strategies now that length of hospitalization has been shortened to 5 days or less. OBJECTIVES: To determine patients' concerns in the early recovery period after open-heart surgery and to describe the impact of advanced practice nurses on this phase of recovery. METHOD: A cardiovascular clinical nurse specialist conducted follow-up by telephone for 342 cardiac surgery patients 7 to 14 days after discharge. Patients were asked both open-ended and direct questions. RESULTS: The major problems were leg edema (48%), appetite disturbance (35%), dyspnea (29%), sleep disturbance (12%), and wound drainage (9%). The nurse's interventions over the telephone included reassuring the patient about postoperative progress (86% of sample), giving diet information (31%), instructing about activity (29%), providing emotional support (25%), referring for medical treatment (16%), and explaining medications (13%). In response to these findings, the nursing practice council revised postoperative teaching to emphasize wound healing, sleep, and appetite issues. CONCLUSIONS: Telephone monitoring of cardiac surgery patients after early discharge can alleviate the often stressful transition to postoperative recovery at home. A cardiovascular clinical nurse specialist can provide patients and patients' family members with reassurance and ongoing reinforcement of the discharge information.     

A survey of postoperative pain management in fourteen hospitals in the UK

The effectiveness of acute pain services in 14 hospitals in one English region was audited. We collected data on analgesia used, its efficacy and patient satisfaction for 522 patients after four commonly performed procedures: abdominal hysterectomy, total knee replacement, mastectomy and major abdominal surgery.Pain scores were measured on a verbal numeric rating scale in the recovery room and both pain scores and patient satisfaction were assessed at 24 h and 7 days postoperatively.Pain was managed well in recovery rooms but less well on the wards. Epidural analgesia gave significantly better pain scores than other therapies. Better pain relief was obtained if opioids were combined with NSAIDs than when given alone. There were marked differences between hospitals in the delivery of postoperative analgesia. Pain scores in most hospitals left room for improvement, particularly following abdominal hysterectomy, but patient satisfaction was good. The better efficacy of multimodal analgesia was confirmed. Evidence from this data for the effectiveness of multidisciplinary acute pain services was equivocal.     

Sex differences in sick role behavior during hospitalization after open heart surgery.

The proposition examined here is that there are sex differences in the enactment of the sick role. Specifically, in comparing the recovery of 50 male and 50 female patients following open heart surgery, it was hypothesized that male patients would (a) be transferred from the cardiac recovery room earlier, (b) be discharged from the hospital earlier, (c) achieve independence in self-care and in ambulation earlier, and (d) receive fewer pain medications and tranquilizers. Support was found only for the hypotheses of earlier hospital discharge and earlier self-care. The patient's physical condition—indicated by type of surgery, time in operating room, time on bypass, and units of blood—was related to time in recovery room and length of postoperative hospitalization. Of the variables examined, age emerged as the most powerful predictor of medication dosage, with older patients receiving significantly fewer analgesics and tranquilizers. The following conclusions were reached: (a) the salience of sex role expectations for sick role behavior varies with the particular measure considered and (b) the overall significance of sex role expectations in determining sick role behavior was slight for this sample of seriously ill patients.     

Rapid recovery following cardiac surgery: a nursing perspective

Fast track or rapid-recovery pathways following cardiac surgery are becoming common practice in many cardiac units in order to maximize use of scarce critical care resources. Within the UK, rapid recovery generally describes same-day discharge from the initial intensive care facility to a lower-dependency unit. There are no nationally agreed protocols to help guide this practice. In a London teaching hospital a nurse-led audit was undertaken to identify which patients were selected for rapid recovery and to evaluate safety (length of hospital stay and incidences of postoperative complications) compared to a conventional recovery pathway. The study also sought to gain insight into the patients' views on rapid recovery. Data were collected on 104 patients, all patients (n = 56) who followed a rapid-recovery pathway were included. A comparison group (n = 48) was selected from patients who followed a conventional recovery but who were eligible for rapid recovery. The primary outcome, median length of hospital stay was 6 days for both groups, but the rapid-recovery group experienced significantly fewer postoperative complications. Rapid recovery as currently practised on this unit is safe for carefully selected cardiac surgical patients but barriers to rapid recovery need to be explored.     

Patterns of recovery among Norwegian heart surgery patients

Utilizing a prospective longitudinal design, the recovery pattern of 91 heart patients was followed for the first 8 weeks following coronary artery by-pass graft surgery The patients' perceived and actual performance of walking, their resumption of roles, and social support and family functioning were measured pre-operatively and at 4 and 8 weeks postoperatively Findings indicate that recovery is swift in terms of health and physical functioning, somewhat more time-consuming in terms of role functioning, and delayed with regard to work-related role activities Contrary to American findings, the heart surgery recovery process did not significantly affect family functioning in this Norwegian sample Social support was experienced as high throughout the recovery period, with spouses and children being the main providers     

Cardiac surgery in the elderly: the critical care phase.

A growing number of elderly patients (aged 70 years and older) are seen in critical care units after valve surgery or coronary artery bypass grafting. While studies show that the elderly demonstrate overall successful results after cardiac surgery, the mortality and morbidity risks are higher than in younger adults. The elderly patient is more likely to experience postoperative complications, prolonging the recovery phase. Commonly reported postoperative complications include dysrhythmias, pneumonia, cerebral vascular accidents, and infection. Elderly surgical candidates must be evaluated preoperatively to determine risk factors that may affect the critical care recovery phase. The length of stay tends to be longer in the intensive care unit, requiring nursing care that takes the aging process into consideration. The following article focuses on trends in cardiac surgery in the elderly, physiologic factors that affect outcome and recovery, and nursing interventions aimed at preventing or limiting postoperative complications.     

Heart transplantation: state of the art

Outcomes in cardiac transplantation have improved during the past 30 years because of advances made in medicine and surgery. Patients referred for cardiac transplantation are examined through a rigorous evaluation process that involves a multidisciplinary approach to determine candidacy. The list for candidates awaiting transplantation has grown more rapidly than the donor pool, resulting in a need to expand the criteria for donors. Some centers now extend criteria to include older donors, those with prolonged periods of ischemia, donor-recipient mismatches, and donors requiring bypass surgery. Long-term outcomes from the expanded donor pool are under evaluation. Studies are currently in progress to explore inducing tolerance through bone marrow infusion and rejection detection with the use of a pacemaker. Future alternatives to transplantation include the left ventricular assist device as a bridge to recovery, xenotransplantation, and the totally artificial heart.     

Predictors for Early Physical Recovery for General and Orthopedic Patients after Major Surgery: Structural Equational Model Analyses

BackgroundAttention to factors that may affect patients’ ability to experience enhanced recovery after surgery is essential in planning for postoperative care.AimsTo create models of predefined pre,- peri-, and postoperative variables in order to analyze their impact on patients’ physical recovery on postoperative days 1 and 2 after major orthopedic and general surgery.DesignAn exploratory design with repeated measures was used, including 479 patients who had undergone orthopedic (289) or general surgery (190) at three hospitals.MethodsPain, nausea, and level of physical ability were measured preoperatively and on postoperative days 1 and 2 by using the Numerical Rating Scale and items from the Postoperative Recovery Profile. Structural equation modeling was used to explore the impact of the predefined variables on patients’ physical recovery.ResultsThe orthopedic group contained significantly more women and significantly more patients with pain and opioid use. Although the models showed good fit, “traditional” preoperative (pain, nausea, physical abilities, chronic pain, opioid use) and perioperative variables (anesthesia, length of surgery) constituted few (orthopedic) or no (general surgery) predictive properties for physical recovery. Postoperative average pain intensity, average nausea intensity, and physical ability explained physical recovery on day 1, and physical recovery on day 1 predicted physical recovery on day 2.Conclusions“Traditional” predictors had little effect on patients’ postoperative physical recovery, while associations with common postoperative symptoms were shown. Further research is needed to explore additional variables affecting early physical recovery and to understand how soon patients are physically ready to return home.     

Effects of coping instruction in reducing young adolescents' pain after major spinal surgery

BACKGROUND: Enduring pain following major orthopaedic surgery is a major challenge for adolescents. PURPOSE: To evaluate the effects of coping instruction and concrete-objective information on adolescents' postoperative pain and focus on potential applications of these interventions for orthopaedic nursing practice. DESIGN/METHOD: A randomized controlled trial of 66 young adolescents (age 11-14) undergoing major spinal surgery for idiopathic scoliosis. RESULTS: The intervention that focused only on coping instruction was the most effective intervention on postoperative Day 2. On postoperative Day 4, adolescents receiving coping instruction (coping alone or coping plus information) reported less pain than those not receiving coping instruction. DISCUSSION: Interventions that direct adolescent patients' attention to learning coping strategies they can use during recovery to lessen pain may be more efficacious than others following major spinal surgery.     

全机器人心脏手术患者术前心理需求调查

目的探讨Da Vinic S心脏手术患者术前心理需求状况,为实施有效的针对性护理措施提供依据。方法随机选取106例择期行全机器人心脏手术患者,采用自行设计的问卷,分别在入院第1天和手术前2h进行问卷调查。结果全机器人心脏手术患者的心理需求是多方面的,主要体现在：希望了解机器人心脏手术的成功率（3．70±0．54）分,想知道病情进展及变化情况（3．68±0．51）分,了解机器人手术的治疗效果（3．64±0．59）分,想和已经接受机器人心脏手术患者交流（3．63±0．62）分。结论机器人心脏手术患者术前存在很多心理需求,应根据不同心理需求采取相应护理对策,重视对患者的健康指导,加强手术前后的访视,促进患者康复。