Coronary artery bypass graft surgery: discharge planning for successful recovery

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.     

Patients' narrative accounts of open-heart surgery and recovery: Authorial voice of technology

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.     

Electroconvulsive therapy in the Nordic countries, 1977-1987.

In 1977 a questionnaire was sent to all psychiatric departments in the Nordic countries: Sweden, Norway, Denmark, Finland and Iceland, concerning indications for electroconvulsive therapy (ECT) and the use of unilateral and bilateral treatment, respectively. The inquiry was repeated in 1987 and the answers compared with those obtained in 1977. In addition, the answers from Denmark were compared with previously performed inquiries. The use of exclusively unilateral treatment (U) and of both unilateral and bilateral treatment (UB) has increased in most of the countries and exclusively bilateral treatment (B) has decreased drastically. In Denmark the situation has not changed for ECT in endogenous depression and acute delirium, and the use in reactive psychosis, mania and schizophrenia decreased somewhat during the 1970s and then again stabilized or increased during the 1980s. Nearly all departments in the Nordic countries used ECT in endogenous depression in 1977 and were still doing it in 1987. In mania, about 50% of all departments have found ECT indicated occasionally or exceptionally both in 1977 and 1987. Manic-depressive mixed states have been regarded as an indication in somewhat more than two thirds of departments, increasing during the period. The use of ECT in schizophrenia has been rare and somewhat decreasing, but still about half of the departments apply it once in a while. In reactive psychosis the use of ECT decreased slightly, but in 1987 it was still in use for this indication in about 50% of all departments. In acute delirium there has been an overall increase in the use of ECT.(ABSTRACT TRUNCATED AT 250 WORDS)     

PB的数据窗口实现增量查询功能的方法及在HIS中的应用

本文系统介绍了如何实现增量查询功能的两种方法。该增量查询功能在医院的药品检索系统中使用后,受到计算机操作员的欢迎。     

An exploration of best practice in multi‐agency working and the experiences of families of children with complex health needs. What works well and what needs to be done to improve practice for the future?

Aims and objectives. This Appreciative Inquiry study aimed to explore appreciatively examples of best multi‐agency working practice with families (mothers, n = 20; fathers, n = 7; children, n = 1) and people working with children with complex needs (n = 41), to determine what works well, why it has worked well and what best practice in the future could be. Background. The term ‘children with complex health needs’ encompasses a diverse group of children and this population is increasing. This diverse group of children often requires high levels of physiological, psychological and social care which brings them and their families into therapeutic contact with a wide range of health, social and education professionals and people from other agencies. Design. The study used appreciative interviews, nominal group workshops and consensus workshops to develop a set of 10 ‘best practice’ guidelines that reflected the views of all participants. Two of these are discussed in detail in this article. All participants were seen as co‐researchers whose expert contributions were vital to understanding of what works well and what needs to be done in multi‐agency working practice. Results. The study resulted in ‘best practice’ statements that illuminated ‘what works well’ in multi‐agency working practice that spanned issues including information, decision making, communication, accessibility, collaboration, respect and sharing a common vision. Conclusions. The guidance that results from this study suggests that parents need the opportunity to share and receive support from other parents who understand the lived reality of caring for a child with complex needs. Parents and people from across various agencies need to work together to ensure that the most appropriate person acts in the role of a long‐term coordinator, where the family wants this aspect of support. This study adds a multi‐disciplinary and appreciatively oriented focus on what works well in complex care. It contributes to an understanding of the value of an Appreciative Inquiry approach within health‐care research. Relevance to clinical practice. The guidelines arose from and are grounded in practice and as such they provide clear, workable directions for enhancing practice and for considering what already does work well.     

Women’s recovery,negotiation of appearance,and social reintegration following a burn

The gendered nature of postburn coping has received scant research attention in South Africa, a country that has a high rate of burns with significant concentrations among women. In this study, narratives that emerged from in-depth interviews with seven women were examined. The narratives emphasized essential needs of these burn survivors for personal support, the complexities of negotiating intimate relationships, struggles with the humiliation from family and friends, in some instances strained relationships with children, the support found through religious beliefs and institutions, and often frustratingly slow psychological acceptance of scars. These difficulties faced by women survivors of burns have highlighted the need to include religion/spirituality, intimate male partners, and women’s children into the psychological recovery process, in an attempt to assist women’s journey to psychological and emotional healing after burn.     

Narrative inquiry: Locating Aboriginal epistemology in a relational methodology

BACKGROUND: This methodology utilizes narrative analysis and the elicitation of life stories as understood through dimensions of interaction, continuity, and situation. It is congruent with Aboriginal epistemology formulated by oral narratives through representation, connection, storytelling and art. Needed for culturally competent scholarship is an experience of research whereby inquiry into epiphanies, ritual, routines, metaphors and everyday experience creates a process of reflexive thinking for multiple ways of knowing. Based on the sharing of perspectives, narrative inquiry allows for experimentation into creating new forms of knowledge by contextualizing diabetes from the experience of a researcher overlapped with experiences of participants--a reflective practice in itself. AIM: The aim of this paper is to present narrative inquiry as a relational methodology and to analyse critically its appropriateness as an innovative research approach for exploring Aboriginal people's experience living with diabetes. NURSING APPLICATION: Narrative inquiry represents an alternative culture of research for nursing science to generate understanding and explanation of Aboriginal people's 'diabetic self' stories, and to coax open a window for co-constructing a narrative about diabetes as a chronic illness. The ability to adapt a methodology for use in a cultural context, preserve the perspectives of Aboriginal peoples, maintain the holistic nature of social problems, and value co-participation in respectful ways are strengths of an inquiry partial to a responsive and embodied scholarship.