Telephone support in the early post-discharge period following elective cardiac surgery: does it reduce anxiety and depression levels?

Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System

ABSTRACT

In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have significantly higher rates of care complications and hospital readmissions. This study is an observational quality improvement project completed from April 17, 2020 to January 31, 2022 at 22 hospitals in a large, integrated academic health system. A nurse-led scripted discharge follow-up phone call program was implemented to contact all patients discharged from inpatient care within 72 hours of discharge. Readmission rates were tracked before and after project implementation. Over a 21-month span, 137,515 phone calls were placed, and 57.92% of patients were successfully contacted within 7 days of discharge. The 7-day readmission rate for contacted patients was 2.91% compared with 4.73% for noncontacted patients. The 30-day readmission rate for contacted patients was 11.00% compared with 12.17% for noncontacted patients. We have found that discharge follow-up phone calls targeting patients decreases risk of readmission, which improves overall patient outcomes.

Barriers to Post-Discharge Monitoring and Patient-Clinician Communication: A Qualitative Study

INTRODUCTION

As postoperative length of stay has decreased for many operations, the proportion of complications occurring post-discharge is increasing. Early identification and management of these complications requires overcoming barriers to effective post-discharge monitoring and communication. The aim of this study was to identify barriers to post-discharge monitoring and patient-clinician communication through a qualitative study of surgical patients and clinicians.

MATERIALS AND METHODS

Semi-structured interviews and focus groups were held with gastrointestinal surgery patients and clinicians. Participants were asked about barriers to post-discharge monitoring and communication. Each transcript was coded by 2 of 4 researchers, and recurring themes related to communication and care barriers were identified.

RESULTS

A total of 15 patients and 17 clinicians participated in interviews and focus groups. Four themes which encompassed barriers to post-discharge monitoring and communication were identified from patient interviews, and 4 barriers were identified from clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences, while clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.

CONCLUSIONS

Multiple barriers exist to effective post-discharge monitoring and patient-clinician communication among surgical patients. These barriers must be addressed to develop an effective system for post-discharge care after surgery.

Lifestyle Changes Following Acute Myocardial Infarction: Patients Perspectives

BACKGROUND

Cardiovascular disease accounts for 39% of all deaths in Ireland each year. Many of these deaths are due to acute myocardial infarction (AMI). The diagnosis of AMI has major implications for individuals in terms of health and social gain, health related quality of life and living and adapting to a chronic illness. The diagnosis requires lifestyle changes such as changes to diet, smoking habit, physical activity, and stress management.

AIMS

The aim of this descriptive qualitative study was to explore patients' perspectives of making lifestyle changes following AMI.

METHODS

Using a descriptive qualitative approach, ten participants were interviewed 6 weeks following discharge about their experiences. Data were collected using in depth interviews and analysed using thematic analysis.

RESEARCH FINDINGS

Four themes emerged: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future. The findings offer insight into the everyday realities, which patients experience regarding lifestyle changes particularly in relation to smoking cessation and stress management. The difficulties encountered by participants 6 weeks following discharge reflect the implementation of too many life style changes at once as well as the lack of professional help in the community to support participants in their endeavours to make lifestyle changes. In addition, overprotection by family members was a source of frustration and aggravation for participants.

CONCLUSION

The study highlights the need for the development of primary care services and cardiac rehabilitation programmes to support patients as well as providing information to families to reduce anxiety and fear.

Patient Experiences Following Cardiothoracic Surgery: An Interview Study

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.

Preparing for a randomized controlled trial: strategies to optimize the design of an individualized cardiovascular surgical patient education intervention

Randomized controlled trial (RCT) designs are standardized to control for bias and allow for replication. Conducting RCTs is generally straightforward when dealing with interventions that contain a single component, such as a drug. However, interventions that do not contain single components, such as a patient education programs, are more difficult to standardize, as they contain multiple elements, which may act independently or interdependently of each other. The purpose of this discursive clinical methods paper is to describe and explain a methodology that can be used to optimize the design of a complex intervention prior to its evaluation in a randomized control trial.

Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

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.

Integrated literature review of postdischarge telephone calls

This systematic review of the literature assessed the impact of a postdischarge telephone call on patient outcomes. Nineteen articles met inclusion criteria. Data were extracted and an evidence table was developed. The content, timing, and professional placing the call varied across studies. Study strength was low and findings were inconsistent. Measures varied across studies, many sample sizes were small, and studies differed by patient population. Evidence is inconclusive for use of phone calls to decrease readmission, emergency department use, patient satisfaction, scheduled and unscheduled follow-up, and physical and emotional well-being. Among these studies, there was limited support for medication-focused calls by pharmacists but no support for decreasing readmission. Health care providers benefited from feedback but did not need to place the call to realize this benefit. Inpatient nurses were unable to manage the volume of calls. There was no standardized approach to the call, training, or documentation requirements.

[Effect of a telephone care program after hospital discharge from a trauma surgery unit]

OBJECTIVE

To determine the impact of a 1-month telephone care program after hospital discharge from a trauma surgery unit on health services utilization and patient anxiety and to perform a budgetary analysis.

METHODS

We carried out an experimental study in 604 patients who formed an experimental and a control group. The experimental group was offered telephone care to resolve doubts during the first month after discharge. After this period, data were collected from both groups on the following outcome variables: visits to the emergency department or family physician, hospital readmissions, and the results of an anxiety test. Data analyses included logistic and linear multivariate analyses and calculation of the budgetary impact of the program on the hospital, the Andalusian Health Service, and the National Health System.

RESULTS

A total of 73 telephone consultations were conducted with 60 patients, almost half for doubts about the therapeutic regimen. For the outcome variable "visit to emergency department", the group without telephone care had an odds ratio of 1.8 in the multivariate analysis adjusted for the other independent variables: days of hospital stay, patient anxiety and comprehension of discharge indications. No differences between groups were found in the remaining outcome variables. The budgetary analysis demonstrated the possibility of implementing the program at a cost of 1.65 € per patient.

CONCLUSIONS

This program proved effective in reducing visits to the emergency department at a low cost.

Nurse-led telephone interventions for people with cardiac disease: a review of the research literature

BACKGROUND

Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined.

AIM

To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD).

METHODS

A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria.

RESULTS

A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies.

DISCUSSION

Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions.

CONCLUSION

The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Breast cancer follow-up: Literature review and discussion

This paper presents a review of the evidence for long-term breast cancer follow up to determine if routine clinical review post treatment for breast cancer has benefits for patients. There is little evidence that clinical review of patients beyond 3 years post-diagnosis leads to improved patient survival. Separate to survival there is a dearth of inquiry relating to the value of long-term clinical review of patient in terms of psychological outcomes, quality of life, patient satisfaction, access to specialist advice regarding management of symptoms, and reassurance. Regardless of supporting evidence, most breast units in the UK continue to undertake routine six monthly clinical reviews of patients up to a minimum of 5 years. A literature search for the period 1989 to January 2006 was undertaken using the CINAHL, MEDLINE, and PsychINFO databases. Keywords such as 'cancer follow-up', 'cancer survivorship', and 'psychological outcomes of cancer' were utilised. Hand searching was also undertaken. Overall a paucity of evidence was found in relation to the long-term needs of breast cancer survivors. Alternatives to hospital-based follow-up are reported such as GP or nurse-led follow-up, but the fundamental question of the importance of follow-up in relation to psychological morbidity and quality of life still remains unanswered. Further research is needed to investigate the importance of follow-up to patient survivorship. Research to explore the concept of point of need access, as well as the qualitative experiences of patients post-discharge, informational needs at discharge and on-going psychosocial support is suggested. Ultimately this paper argues for a greater choice and involvement of patients in determining their future follow up needs, providing the patient with a personalised package of care based on risk assessment and subsequent education programmes to empower patients towards self-management following discharge.

Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home

BACKGROUND

It is known that many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. In recent years many projects have addressed discharge planning, with the aim of reducing problems after discharge. Telephone follow-up (TFU) is seen as a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early, giving reassurance and providing quality aftercare service. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, at present it is not clear whether TFU is also effective in reducing postdischarge problems.

OBJECTIVES

To assess the effects of follow-up telephone calls in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home.

SEARCH STRATEGY

We searched the following databases from their start date to July 2003, without limits as to date of publication or language: the Cochrane Consumers and Communication Review Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), PubMed, EMBASE (OVID), BiomedCentral, CINAHL, ERIC (OVID), INVERT (Dutch nursing literature index), LILACS, Picarta (Dutch library system), PsycINFO/PsycLIT (OVID), the Combined Social and Science Citation Index Expanded (SCI-E), SOCIOFILE. We searched for ongoing research in the following databases: National Research Register (http://www.update-software.com/nrr/); Controlled Clinical Trials (http://www.controlled-trials.com/); and Clinical Trials (http://clinicaltrials.gov/). We searched the reference lists of included studies and contacted researchers active in this area.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials of TFU initiated by a hospital-based health professional, for patients discharged home from an acute hospital setting. The intervention was delivered within the first month after discharge; outcomes were measured within 3 months after discharge, and either the TFU was the only intervention, or its effect could be analysed separately.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion and for methodological quality. The methodological quality of included studies was assessed using the criteria from the Cochrane Effective Practice and Organisation of Care Review Group. The data-extraction form was based on the template developed by the Cochrane Consumers and Communication Review Group. Data was extracted by one review author and checked by a second author. For as far it was considered that there was enough clinical homogeneity with regard to patient groups and measured outcomes, statistical pooling was planned using a random effects model and standardised mean differences for continuous scales and relative risks for dichotomous data, and tests for statistical heterogeneity were performed.

MAIN RESULTS

We included 33 studies involving 5110 patients. Predominantly, the studies were of low methodological quality. TFU has been applied in many patient groups. There is a large variety in the ways the TFU was performed (the health professionals who undertook the TFU, frequency, structure, duration, etc.). Many different outcomes have been measured, but only a few were measured across more than one study. Effects are not constant across studies, nor within patient groups. Due to methodological and clinical diversity, quantitative pooling could only be performed for a few outcomes. Of the eight meta-analyses in this review, five showed considerable statistical heterogeneity. Overall, there was inconclusive evidence about the effects of TFU.

AUTHORS' CONCLUSIONS

The low methodological quality of the included studies means that results must be considered with caution. No adverse effects were reported. Nevertheless, although some studies find that the intervention had favourable effects for some outcomes, overall the studies show clinically-equivalent results between TFU and control groups. In summary, we cannot conclude that TFU is an effective intervention.

Head and neck cancer patient and family member interest in and use of E-mail to communicate with clinicians

BACKGROUND

E-mail is actively discussed as a promising method for clinical communication, but little study of patient and family preferences regarding its use has been done. This study aimed to describe patients' and family members' interest in and use of E-mail with their surgeons and nurses after head and neck cancer surgery.

METHODS

Surveys were distributed to patients and family members attending postoperative clinic visits. Seventy-four patients and 35 caregivers completed the surveys.

RESULTS

Although one in three patients expressed interest in E-mailing their clinicians, only 9.5% reported actually doing so. Symptom management and prescription refills were the most common issues addressed by E-mail. Few family members expressed any interest in using E-mail.

CONCLUSIONS

The findings suggest that E-mail communication between patients with head and neck cancer or their family members with surgeons and nurses is not common. Interest in using E-mail tends to be stronger among patients than family members.

Surgeons' and nurses' use of e-mail communication with head and neck cancer patients

BACKGROUND

"Telephone tag" for questions about postoperative symptoms and other concerns often engenders dissatisfaction. E-mail use may improve communication between patients and clinicians. This study aimed to describe surgeons' and nurses' use of E-mail with patients and their caregivers after head and neck cancer surgery.

METHODS

We conducted a cross-sectional national survey of head and neck nurses and surgeons.

RESULTS

Ninety-six percent of surgeon and 87% of nurse respondents used E-mail, but only 40% and 25%, respectively, used it with patients. More than 50% of both clinician groups that used E-mail with patients have done so for 2 to 5 years and began this practice at the request of patients. Surgeons not using E-mail with patients were twice as likely as nurses to cite privacy and liability issues, as well as time management and miscommunication concerns.

CONCLUSIONS

Some clinicians use E-mail with patients, most often by patient request. Medicolegal and clinical ramifications require further study.

Postponed or cancelled heart operations from the patient's perspective

OBJECTIVES

The aim was to describe postponements or complete cancellations of planned cardiac operations at a Swedish hospital during 1999 and the reception the patients received from the staff in connection with this, from the inpatient's perspective.

DESIGN

A qualitative descriptive design inspired by content analysis was used. Data were collected through questionnaires distributed to all 74 patients who had their heart operation cancelled.

RESULTS

During analysis of the questionnaires, five categories of answers emerged describing the patients' perception of: organization, medical aspects, information, waiting time and staff reception. Overall, the patients reacted negatively to the postponement/cancellation in the form of anxiety and disappointment and fear of being affected by cardiovascular problems, but were generally satisfied with reception received from hospital staff. A number of concerns were revealed, however, with possible practical implications for the health-care system.

CONCLUSION

An understanding of the disappointment and anxiety felt by patients because of the postponement/cancellation of heart surgery can help medical staff to improve the situation. An intervention program is suggested that includes a pre-admission clinic, a change in the planning and waiting list system and support via follow-up telephone calls or internet-based support system.

Follow-up for people with cancer: nurse-led services and telephone interventions

BACKGROUND

Questions about the suitability of traditional outpatient follow-up clinics as a way of providing on-going monitoring for patients following serious illness have led to the development of a range of nurse-led services. However, there has been little attempt to draw some of this knowledge together formally and consider the weight of evidence on the necessity and value of nurse-led follow-up.

AIM

To provide a review of literature evaluating the impact of nurse led follow-up in cancer care, with particular focus on the use and value of telephone interventions.

METHOD

A literature search was conducted of nursing, medical and social science databases and the following keywords: cancer follow-up, nurse-led follow-up, telephone follow-up, telephone-based interventions and telephone survey. The search yielded over 150 papers, of which 37 were relevant to this review.

FINDINGS

The literature suggests that nurse-led follow-up for people with cancer meets their needs for psychological support and information. The telephone is identified as a suitable means of providing this kind of service.

CONCLUSION

This review demonstrates that nurse-led follow-up services are acceptable, appropriate and effective. Combined with use of the telephone, such services can be an efficient means of maintaining contact with a large client group, providing vital support to vulnerable patients during their move into aftercare and beyond.

Advice nursing practice: on the quality of the evidence

OBJECTIVE

The primary objective was to review the research regarding advice nursing practice to determine the content areas investigated and the quality of the evidence.

METHODS

A systematic review of advice nursing research was done in electronic databases, reference lists, and the literature identified by experts (N = 527). After deletion of duplicates and clinical and theoretical articles, full text reviews were done on 62 studies.

RESULTS

Eight thematic content areas were identified: delivery and continuity of care to populations, appropriateness of advice given, patient/provider satisfaction, disposition/utilization after calls, reason for calling, cost analysis, process of decision-making, and documentation. The most frequently investigated subject was delivery/continuity of care (n = 16).

IMPLICATIONS

For certain chronic disease populations, interventions using telephone advice for social support, education, and symptom management improve clinical outcomes. Availability and use of protocols and guidelines do not guarantee standardized care or ensure that appropriate advice will be given. Consumer satisfaction with advice nursing is high, and appears to be related to the intervention component of the nursing process. The priority for future research should be given to those studies that describe the character and suitable dose of the nursing intervention that is advice nursing.

Impact of discharge from day surgery on patients and carers

This article outlines the increase in the amount and complexity of day-case surgery currently being undertaken in the UK. The continuing increase in day surgery has led to a corresponding rise in patient and lay carer involvement throughout the pre- and postoperative period. The impact day surgery expansion is having on patients and their carers' contribution to care are therefore highlighted as challenging issues for modern day-case surgery. Utilizing the evidence available from the literature, the article focuses specifically on the contemporary issues concerning patient and lay carer experiences of discharge from a day surgery facility. The main challenges identified are pain management, recovery behaviour and community care provision. The clinical application of the issues raised within these themes is considered and recommendations for future practice are highlighted.

Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event

OBJECTIVE

The purpose of this study was to test the effect of a post-discharge telephone counseling intervention on women's psychosocial adjustment following a cardiac event.

DESIGN

The study was a prospective, randomized, controlled trial.

PATIENTS

Women (n = 196) were recruited from 4 hospitals in Sydney, Australia, who were hospitalized for coronary artery disease: myocardial infarction, coronary artery bypass grafts, coronary angioplasty, or stable angina. Women were randomized to usual care (n = 103) or telephone counseling (n = 93) and were 67 years of age (range 34-92). The majority had not completed high school (92%) and were not employed (84%).

OUTCOMES

Psychosocial adjustment was measured by the Psychosocial Adjustment to Illness Scale and the Hospital Anxiety and Depression Scale the day before hospital discharge and 12 weeks postdischarge.

INTERVENTION

Individualized information and support, was designed to promote self-managed recovery and psychosocial adjustment, and began with an evaluation during admission and was followed up by telephone counseling at 1, 2, 3, and 6 weeks after discharge.

RESULTS

The intervention had no effect on psychosocial adjustment (F[1,182] = 0.06, P =.8), anxiety (F[1,182] = 0.15, P =.69) or depression (F[1,182] = 0.11, P =.74) at 12 weeks after discharge. Women made significant improvements during the 12 weeks on mean scores for psychosocial adjustment (F[1,182] = 58.37, P =.00), anxiety (F [1,182] = 74.58, P =.00) and depression (F[1,182] = 14.11, P =.00). The predictors of poor psychosocial outcomes for women included being less than 55 years of age, being unemployed or retired, having poor psychosocial adjustment to illness at baseline, having readmission, or experiencing a stressful, personal event during follow-up.

CONCLUSIONS

Women at risk for poor outcomes following hospitalization for a cardiac event can be identified (ie, women less than 55 years of age, unemployed or retired, poorly adjusted to their cardiac illness, or readmitted to hospital within 12 weeks of a previous cardiac admission), but an effective intervention to enhance psychosocial outcomes remains to be established.

Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety

OBJECTIVE

The purpose of this study was to determine the effectiveness of an information and support telephone intervention for reducing anxiety in patients who have undergone coronary artery bypass graft surgery and their partners.

DESIGN

The study is a randomized controlled trial. Intervention began at discharge; 6 telephone calls were made to patients and partners over 7 weeks. Primary outcome was Beck Anxiety Inventory measured at baseline in hospital, at home on day 3, week 4, and week 8.

SAMPLE

The subjects were 131 patients who have undergone elective coronary artery bypass graft surgery and their partners.

RESULTS

Patients' anxiety was moderate to severe the day before discharge. It was significantly lower in the treatment group than in the control group at day 2 at home. Partners always had lower anxiety than patients. A more sustained decrease in anxiety in the partner treatment group was found at both day 2 and week 4.

CONCLUSION

Intervention effect is in the early period after discharge-- the time most affected by reduced lengths of stay.

Health-related quality of life after myocardial infarction: an interview study

AIM

The aim of this qualitative study was to explore and gain insights into the effects of myocardial infarction on health-related quality of life.

BACKGROUND

The study was undertaken as part of a larger on-going project to develop and validate a disease-specific health-related quality of life instrument suitable for use with patients after myocardial infarction.

METHODS

A consecutive sample of 31 patients admitted to a district general hospital in the North of England was recruited and interviewed at home. Semi-structured interviews were conducted based on a guide developed from a review of the literature pertaining to quality of life and expert opinion. Interviews were audio-tape recorded and transcribed verbatim. Transcripts were subjected to latent and manifest content analysis and inter-rater reliability was confirmed by a researcher not involved with the interview process.

FINDINGS

Analysis of the data revealed seven major categories: physical activity/symptoms; insecurity; emotional reactions; dependency; lifestyle modification; concern over medication; and side-effects. Breathlessness, insecurity and feelings of over-protection were major problems, as was dissatisfaction with information and support.

CONCLUSION

Myocardial infarction resulted in a variety of health-related problems which affected quality of life. Systematic monitoring and evaluation of health status should be performed routinely. This is likely to be aided by the development and use of a health-related quality of life instrument for this patient group.

Patients' and carers' perceptions of factors influencing recovery after cardiac surgery

Stress and anxiety experienced by patients following myocardial infarction are well documented. Moreover, partners feel distress when they realize that they must assume responsibility for day-to-day care once the period of hospitalization is over. However, despite the trend towards early hospital discharge and the role which carers appear to be expected to undertake during the recovery of patients who have had cardiac surgery, few studies have been undertaken with this group outside the United States of America. This omission was filled by a descriptive survey with 60 patients and carers following cardiac surgery. Data were obtained during early recovery (1 week after hospital discharge) and 6 weeks later. The results indicated that carers assumed a heavy burden once the patient had left hospital and were less satisfied with the timing of discharge than the patients. Information provided by nurses was consistently rated more highly than information provided by doctors or physiotherapists but there was scope for increasing input with both groups. High levels of satisfaction with the information provided by health professionals were associated with lower scores on the Hospital Anxiety and Depression Scale. More qualitative, in-depth studies to explore the precise needs of patients and their carers are needed to ensure that in future both groups are better prepared.

Use of telephone follow-up for post-cardiac surgery patients

Telephone follow-up has been used in a variety of settings as a means of supporting patients post-discharge. This paper describes the implementation of a telephone follow-up service for cardiac surgical patients, both to monitor their progress and to bridge the gap between home and hospital. Surgical unit nurses called 1594 patients between May 1995 and October 1997. These calls were made a month after each patient had been discharged and a specially designed form was used as a guideline for the calls. This covered three main aspects of their recovery: discharge monitoring; medical problems; and convalescence problems. As well as providing a framework for the calls, the forms were then used for data collection. The forms were audited on a monthly basis with the results being communicated to the ward staff. Data gathered from the calls have highlighted areas where patient education needs to be improved, e.g. pain control, and this has been addressed. In October 1996, an evaluation of the service was performed. One hundred patients were sent a postal questionnaire asking for their views on the telephone service. Eighty-two of these were returned and the results of this survey are also contained in this report. Over time, the number of patients called each month has increased; information regarding support post-discharge has improved and the form used for calls has been revised to make the questions more appropriate.

Carers' opinions and emotional responses following cardiac surgery: cardiac rehabilitation implications for critical care nurses

The recent joint position statement made by the RCN Critical Care and Rehabilitation Nursing Forums highlights the need for rehabilitation to commence early. This paper reports the findings of a descriptive survey of 59 carers of cardiac surgery patients and presents implications for cardiac rehabilitation. Data were obtained by postal questionnaire during early recovery (one week following discharge) and six weeks later. The questionnaire explored carers' perceptions about the timing of discharge from hospital; opinions of the information provided by hospital staff; and anxiety and depression measured on the Hospital Anxiety and Depression Scale. The results indicated that carers assumed a heavy burden once the patient had left the specialist cardiac centre. Carers responding at one week were less satisfied with the timing of discharge than those questioned at six weeks. Information provided by nurses was rated more highly than that provided by doctors or physiotherapists. However, there was scope for increasing input. The findings suggest that cardiac rehabilitation needs to be aimed at carers as well as patients. Investment in targeted carer support could facilitate patient recovery and rehabilitation. Strategies aimed at the carer need to begin early and commence during the acute stage of the patients' recovery.