Social support and its relation to fear and anxiety in patients awaiting coronary artery bypass grafting

A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery

BACKGROUND

Fear of surgery has been associated with more postoperative pain, disability, and a lower quality of life among patients undergoing various surgical procedures. While qualitative studies indicate breast cancer patients to be afraid of surgery, detailed quantitative analyses are lacking. The present research aimed at investigating the prevalence, severity, and sources of fear of surgery in this patient group and to compare patients reporting different degrees of such fear.

METHODS

This cross-sectional study included 204 breast cancer patients, 18-70 years old, and scheduled for surgery at Oslo University Hospital, Norway. Following their preoperative visit participants completed validated psychological questionnaires online. Among these, the primary outcome measure, the Surgical Fear Questionnaire (SFQ; scores: 0-10 per item, 0-80 overall). Patients were grouped based on SFQ-percentiles (<25th = little, 25th-75th = moderate and >75th percentile = high fear) and compared on psychological (anxiety, depression, experienced injustice, optimism and expected postsurgical pain), sociodemographic, and medical outcomes.

RESULTS

195 patients completed the SFQ. On average fear of surgery was low (M = 26.41, SD = 16.0, median = 26, min-max = 0-80), but omnipresent. Only 1.5% (n = 3) indicated no fear at all. Overall, patients feared surgery itself the most (M = 3.64, SD = 2.8). Groups differed significantly (p < .001) in their experience of anxiety, depression, and injustice, as well as their disposition to be optimistic, and expectance of postsurgical pain. Differences between groups concerning demographic and medical information were largely insignificant.

DISCUSSION

This study was the first to demonstrate fear of surgery to be prevalent and relevant among female breast cancer patients. The higher a patients' fear group, the poorer their preoperative psychological constitution. This, largely irrespective of their current diagnoses or treatments, medical history, and demographics. Fear of surgery might thus cater as a prognostic marker and treatment target in this patient group. However, given the cross-sectional character of the present data, prognostic studies are needed to evaluate such claims.

Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial

INTRODUCTION

This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups.

METHODS

A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination.

RESULTS

Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time.

CONCLUSION

Access to 360°VCE can reduce patients' pre-CCTA anxiety levels.

IMPLICATIONS FOR PRACTICE

The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.

Social support and pre-operative anxiety in patients undergoing elective surgical procedures: A systematic review and meta-analysis

Pre-operative anxiety may adversely affect post-operative recovery and treatment satisfaction. This systematic review assessed the impact of social support on pre-operative anxiety in elective surgery patients. MEDLINE via Ovid, Embase, PsycINFO, Web of Science, CINAHL Plus, Emcare and LILACS were searched for publications (1950-2021). Fourteen studies were included for descriptive analysis and five for meta-analysis. The pooled estimate in the meta-analysis was r = -0.372 (95% CI: -0.578 to -0.122). Stronger social support was weakly associated with reduced pre-operative anxiety, but the quality of available evidence was low. The findings suggest potential benefit in enhancing utilisation of support networks before elective surgery.

Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise

OBJECTIVES

The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level.

BACKGROUND

Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes.

METHODS

Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units.

RESULTS

Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units).

CONCLUSIONS

The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.

A psychometric evaluation of the Italian short version of the Fear of Pain Questionnaire-III: Psychometric properties, measurement invariance across gender, convergent, and discriminant validity

Introduction

The Fear of Pain Questionnaire-III (FPQ-III) is a self-assessment instrument developed specifically to measure fear based on various pain stimuli converging on three factors: severe pain, medical pain, and minor pain. It actually remains the most studied and internationally used tool even in its short versions. The aim of this work was to propose a new validation study oriented to confirm the good psychometric properties of a short model of the FPQ-III for the Italian context.

Methods

A large sample of participants was recruited (n  = 1,064) and Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were performed. Measurement invariance of the FPQ-III across gender was also evaluated. In order to examine convergent validity, a further convenient sample (n  = 292) was used and variables related to the individual's pain experience, locus of control and coping orientations were assessed. A final discriminant assessment using experimental manipulation through fear eliciting videos was performed.

Results

The three factors structure of the 13-item version of the questionnaire was confirmed (χ² = 148.092, CFI = 0.971, TLI = 0.962, RMSEA = 0.046, RMSEA 90% CI = 0.037-0.056) as well as the measurement invariance across gender. Item internal reliability was satisfactory. The results provided evidence of the good predictive validity of the FPQ-III and the discriminant assessment demonstrated that the instrument is suitable in detecting changes in fear of pain induced by specific situational conditions.

Discussion

The scale in this short version is suitable for quickly and efficiently gathering information about the perceived intensity of such anticipatory fears that might affect even the healthy person dysfunctionally.

Fear of coronavirus (COVID-19) and mental health outcomes in Palestine: The mediating role of social support

The current investigation was conducted to test the correlation between fear due to coronavirus (COVID-19) and mental health outcomes (stress, depression, and anxiety) and the mediating role of social support during the Covid-19 Pandemic in Palestine. Structural equation modeling (SEM) was performed to test the conceptual model, where fear of Covid-19 was considered as a predictor, social support as a mediating variable, and mental health (stress, depression, and anxiety) as outcomes. The participants involved were 370 Palestinians, 266 females, and the remaining were males. Participants were recruited through online methods; Facebook advertising, Network email, and Twitter during the COVID-19 in Palestine. Results of the study showed that fear related to COVID-19 was positively and significantly correlated with mental health outcomes (anxiety; r = .29, p < .01, depression; r = .25, p < .01, and stress; r = .36, p < .01), while negatively correlated to perceived emotional support (r = -.30, p < .01), support seeking (r = -.29, p < .01), and received support (r = -.31, p < .01). Results of SEM indicated a standardized total effect of social support on mental health outcomes (β_{X, M} = -.57; p < .001), and an indirect but statistically significant effect (via social support, β_{X, M, Y} = -. 286; p < .01). These results indicate that social support fully mediated the relationship between fear associated with COVID-19 and mental health distress (stress, depression, and anxiety). The current study supported previous findings demonstrating that fear related to COVID-19 positively correlated with mental health distress (depression, anxiety, and stress). In addition, social support mediated the relationship between fear of COVID19 and mental health outcomes. However, further investigations are needed to test the correlation between current study variables and other associated factors and develop intervention programs targeting affected populations during crises to enhance mental health outcomes.

Effect of family presence on stress response after bypass surgery

BACKGROUND

Coronary artery bypass grafting (CABG) is a major surgery that may cause severe surgical stress response (SR). Although the presence of family members in intensive care unit (ICU) is known to benefit intensive care patients socially and emotionally, its effects on surgical SR are unknown.

OBJECTIVES

To investigate the effect of an informed family member (IFM)'s presence in the awakening process in ICU on patients' SR after CABG.

METHODS

A nonrandomized controlled clinical study was completed with a total of 73 patients: 37 patients in the control (CG) and 36 in the intervention group (IG) underwent CABG surgery. In the CG patients, no family members were taken into the ICU during the awakening process and routine care and treatment practices were continued. In the IG patients, besides routine care and treatment practices, an IFM was taken into the ICU during the awakening process in accordance with the research method. Groups were statistically compared in terms of serum cortisol level which is the one of the main indicators of surgical SR, state anxiety, sedative drug requirements, and duration of intubation, sedation, and ICU stay. A p value <0.05 was accepted as statistically significant.

RESULTS

Presence of an IFM in the ICU was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirements, and the duration of intubation, sedation, and ICU stay (p<0.05).

CONCLUSIONS

In CABG, the presence of IFM in ICU is effective in reducing SR.

Roles of Religious Commitment, Emotion Regulation and Social Support in Preoperative Anxiety

Surgery is a relatively commonplace medical procedure in healthcare settings. The mental health status of the person undergoing surgery is vital, but there is dearth of empirical studies on the mental health status of surgery patients, particularly with regard to the factors associated with anxiety in surgical conditions. This study investigated the roles of religious commitment, emotion regulation (cognitive reappraisal and expressive suppression) and social support in preoperative anxiety in a sample of 210 surgical inpatients from a Nigerian tertiary healthcare institution. A cross-sectional design was adopted. Before the surgery, respondents completed the state anxiety subscale of State-Trait Anxiety Inventory, Religious Commitment Inventory, Emotion Regulation Questionnaire and Multidimensional Scale of Perceived Social Support. After controlling for relevant demographic factors, regression results showed that cognitive reappraisal, social support and interpersonal religious commitment were negatively associated with preoperative anxiety, while expressive suppression was positively associated with preoperative anxiety. The emotion regulation strategies made robust and significant explanation of variance in preoperative anxiety. Appropriate interventions to promote interpersonal religious commitment, encourage cognitive reappraisal and enhance social support quality may improve mental health outcomes in surgery.

Validation of the Turkish Version of the Surgical Fear Questionnaire

PURPOSE

Preoperative surgical fear is an emotional reaction that can be observed in many patients who are waiting to undergo a surgical procedure. The Surgical Fear Questionnaire (SFQ) was originally developed to determine the level of fear in patients who are to undergo surgery; this study aims to translate the questionnaire into the Turkish language and to test the validity and reliability of this Turkish version.

DESIGN

Methodological research model.

METHODS

The population of this methodological study included the patients who presented to surgical clinics at a university hospital in Turkey between January and August 2016 and were scheduled to undergo elective surgery; the sample involved 405 patients who met the inclusion criteria.

FINDINGS

Results of the analyses showed that the SFQ can be used with two subscales-the S subscale, which shows the short-term consequences, and the L subscale, which shows the long-term consequences of surgery. The mean score of the patients was 18.03 ± 11.44 on the former, 19.52 ± 11.87 on the latter, and 37.55 ± 21.11 for the entire questionnaire. The Cronbach's α coefficient was 0.96 for the SFQ-S subscale, 0.90 for the SFQ-L subscale, and 0.93 for the entire questionnaire.

CONCLUSIONS

In this study, the translated SFQ was found to have a similar structure to the original questionnaire and a high level of validity and reliability and therefore can be used in Turkey.

Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery

OBJECTIVES

The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment.

METHODS

In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline.

RESULTS

Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear.

DISCUSSION

Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

Family involvement in rehabilitation: Coronary artery disease-patients' perspectives

AIMS AND OBJECTIVES

To describe coronary artery disease patients' perceptions of family involvement in rehabilitation and the connection between background factors and family involvement.

BACKGROUND

Coronary artery disease patients' hospital stays can be very concise. Family members can support rehabilitation, but many challenges can emerge. There is a need to nurture patients and family members in an individual way and to recognise their concerns. More accurate patient education should be available for patients and their family members.

DESIGN

This study is a descriptive cross-sectional study.

METHODS

Data were collected from patients with coronary artery disease at least 6 weeks after discharge from hospital (n = 169) with a postal questionnaire. The Family Involvement in Rehabilitation (FIRE) scale measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. The data have been analysed with statistical methods. Both parametric and nonparametric tests were used to evaluate group differences.

RESULTS

Patients with coronary artery disease perceived that family promotes their rehabilitation significantly. Respondents also perceived challenges at home. Family relations before hospitalisation were related to all subareas of family promoting rehabilitation and one subarea of issues encumbering rehabilitation in family. Patients with symptoms at rest also had more encumbrance on their rehabilitation. Patients who had undergone coronary artery bypass surgery perceived more challenges than percutaneous coronary intervention (PCI) patients in many subareas of issues encumbering rehabilitation in family.

CONCLUSIONS

Family relations prior to illness and the rigour of heart symptoms are significantly relevant to challenges that can occur between patient and their family members.

RELEVANCE TO CLINICAL PRACTICE

Healthcare staff need to pay attention to coronary artery disease patients' individual situation, and patient education should be more family-centred. In the future, it would be noteworthy to collect more data from family members of patients with coronary artery disease and to find out their perceptions of family involvement.

The association between supportive relatives and lower occurrence of anxiety and depression in heart patients: Results from a nationwide survey

BACKGROUND

Approximately 30-40% of heart patients develop anxiety and/or depression, which might influence recovery and long-term survival. Research has suggested that support from relatives may decrease anxiety and depression among heart patients; however, the results are inconsistent and often based on small study populations.

AIM

The paper aimed to investigate the association between having supportive relatives and the occurrence of anxiety and depression in heart patients.

METHODS

A population-based cross-sectional study among Danish patients diagnosed with ischemic heart disease, atrial fibrillation, heart failure, or heart valve disease. Presence of supportive relatives was measured as the degree to which the patients felt that they had relatives they could count on, while symptoms of anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Multiple logistic regression analyses accounting for confounders were used to examine the association between supportive relatives and anxiety/depression.

RESULTS

The questionnaire was answered by 2496 heart patients, corresponding to 50% of the invited population. Patients with low or some degree of supportive relatives had a higher odds ratio (OR) of anxiety than patients with a high degree (OR = 2.20, 95% confidence interval (CI): 1.28-2.37; OR = 1.75, 95% CI: 1.57-3.08, respectively). Likewise, patients with low or some degree of supportive relatives had a higher OR of depression than patients with a high degree (OR = 1.96, 95% CI: 1.40-2.66; OR = 1.93, 95% CI: 1.37-2.60, respectively).

CONCLUSIONS

The presence of supportive relatives was found to be associated with lower occurrence of anxiety and depression. Health professionals should focus on including relatives in the treatment and rehabilitation of heart patients.

Traumatic exposure and posttraumatic stress disorder among flood victims: Testing a multiple mediating model

A total of 187 flood victims from Wuhu, a Chinese city affected most severely by a flood during July 2016, were selected to complete self-report measures of traumatic exposure, feelings of safety, fear, posttraumatic negative cognition, and posttraumatic stress disorder. The results found that traumatic exposure could directly predict posttraumatic stress disorder. Besides, traumatic exposure had indirect prediction on posttraumatic stress disorder through three ways, including a one-step path of negative self-cognition, a two-step path from feelings of safety to fear, and a three-step path from feelings of safety to negative self-cognition via fear. Implications and future directions are correspondingly discussed.

Patients' Experiences of Support while Waiting for Cardiac Surgery. A Critical Incident Technique Analysis

BACKGROUND

Patients waiting for cardiac surgery experience the period from decision about surgery to the operation as long, heavy and dreary.

AIMS

The aim was to describe patients' experiences of support in the form of important events during the waiting period.

METHODS

The design was qualitative and the 'critical incident' technique was used. Incidents were collected via interviews with 26 patients waiting for heart surgery. The selection of patients was strategic.

RESULTS

In all, 223 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Internal factors describe how an experience of support was influenced by changes in life style and by finding strength from within. External factors describe how experiences of support was influenced by being allowed to participate in care management, by receiving attention, as well as by the health care organisation and the social network.

CONCLUSION

By identifying factors that influence patients' experiences of support while they wait for heart surgery, institutional and non-institutional health-care services can improve the organisation of the entire health care process, and develop patient-focused support programmes.

“No More Couch-Potato!” Patients' Experiences of a Pre-Operative Programme of Cardiac Rehabilitation for Those Awaiting Coronary Artery Bypass Surgery

BACKGROUND

The waiting period for coronary artery bypass surgery is a difficult time for patients and families. Pre-operative cardiac rehabilitation may be safe and effective, but there is limited evidence regarding patients' experience and perceptions of such intervention.

AIM

To describe patients' experiences of a pre-operative programme of cardiac rehabilitation developed specifically for those awaiting coronary artery bypass surgery.

METHOD

A convenience sample of eight patients awaiting non-urgent surgery who had completed a 12 week pilot programme of cardiac rehabilitation were invited to be interviewed using a descriptive phenomenological approach. Domicillary interviews using an open technique were taped, transcribed and analysed using Colaizzi's framework.

RESULTS

Participants described this programme as a useful means of improving exercise capacity and decreasing anxiety. Through the combination of exercise, advice and support participants stated that their initial fear that exercise would cause a heart attack was replaced with confidence, enabling them to become fitter and modify other risk factors.

CONCLUSIONS

Findings of this study suggest that the programme was acceptable and perceived as beneficial by participants. Further research is required to evaluate the efficacy of pre-operative rehabilitation on risk factor modification.

Healing Environments

Objective:

The main aim of this research was to identify the impact of design characteristics (DCs) of a patient room on self-reported patient well-being.

Background:

This knowledge enables the construction of healing environments focusing on DCs that maximize well-being. Six themes were identified in literature that create healing environments: spatial comfort, safety and security, autonomy, sensory comfort, privacy, and social comfort. We wondered what themes and associated DCs should be prioritized if needed to maximize well-being.

Method:

The physical environment of patient rooms in four hospital locations was measured and patients who stayed in these rooms were asked to evaluate the room design on above mentioned themes and its contribution to their well-being. We used a machine-learning technique and regression analysis to find relations between the physical environment of a patient room and patient well-being.

Results and Conclusions:

We found that spatial comfort, safety and security, autonomy, and associated DCs have the strongest ability to influence patient’s self-reported well-being in a patient room. Privacy appears to have the smallest influence.

Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery

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.

Design Research and the Globalization of Healthcare Environments

OBJECTIVE:

Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, “how pervasive is healthcare design research outside of the United States?”

METHOD:

The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies.

RESULTS:

While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited.

CONCLUSION:

Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered.

Role of psychosocial care on ICU trauma

CONTEXT

Patients treated in intensive care units (ICU) though receive the best medical attention are found to suffer from trauma typically attributed to the ICU environment. Biopsychosocial approach in ICUs is found to minimize ICU trauma.

AIMS

This study investigates the role of psychosocial care on patients in ICU after coronary artery bypass graft (CABG).

SETTINGS AND DESIGN

The study included 250 post-operative CABG patients from five corporate hospitals. The combination of between subject and correlation design was used.

MATERIALS AND METHODS

The ICU psychosocial care scale (ICUPCS) and ICU trauma scale (ICUTS) were used to measure the psychosocial care and trauma.

STATISTICAL ANALYSIS

ANOVA and simple and multiple regression were applied.

RESULTS

Hospitals significantly differed in psychosocial care provided in ICUs. Higher the psychosocial care in ICU, lower was the ICU trauma experienced and vice versa. Psychosocial care was a significant major predictor of ICU trauma.

CONCLUSIONS

The study suggests emphasis on psychosocial aspects in ICU care for optimizing prognosis.

Coping with the effects of myocardial infarction from the viewpoint of patients' spouses

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

Serious complications in connection with cardiac surgery--next of kin's views on information and support

OBJECTIVE

Next of kin (NoK) to patients undergoing cardiac surgery expect successful outcomes but sometimes serious complications occur and this affects their NoK. To describe NoK's experiences of information and support when serious complications occur during the first 30 days after cardiac surgery.

METHODS

A qualitative, critical incident technique was used. Forty-two NoK were asked to describe their experiences of information and support.

RESULTS

Three main areas emerged from the analysis. The first main area, Confidence during the waiting period, described how NoK could not participate in the forthcoming operation and how the NoK were informed. The second main area, Involvement during the hospital stay, described how the NoK feel trust in the healthcare professionals and dissatisfaction with the care in relation to the operation. The third main area, Sense of abandonment, described problems with the rehabilitation.

CONCLUSIONS

These findings show the importance of pre- and post operative contacts between healthcare professionals, patients and NoK. When the NoK and the patients are well informed it constitutes a basis for fruitful conversations between them and the healthcare professionals, and everyone can be better prepared if complications occur.

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (ß = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (ß = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.

Predictors of preoperative anxiety in surgical inpatients

AIMS AND OBJECTIVES

The aims of the present study were to identify the levels of preoperative anxiety in patients undergoing elective surgery and the relationship between preoperative anxiety and social support. In addition, predictors of preoperative anxiety were studied in surgical inpatients.

BACKGROUND

Major life changes are significant factors that cause anxiety; hospitalisation and surgery are among such changes. Social support may decrease the anxiety associated with surgery.

DESIGN

This is a descriptive study that included 500 patients in a surgery clinic.

METHODS

The data collected included: A Patient Information Form, Multidimensional Scale of Perceived Social Support and the Surgical Anxiety Scale. The results were analysed using the Chi-square test and logistic regression analysis. RESULTS; Five hundred patients participated in this research: 59·6% were female, 54·6% were 65 years of age or older, 80·6% were married, 70·4% were literate and 62% of the patients had moderate level surgery. There was a significant relationship between the sociodemographic patient features, the level of preoperative anxiety (p < 0·05), the presence of social support and the severity of anxiety (p = 0·001). The age and level of anxiety were not significant factors. The mean anxiety score for all patients was 31·91 (SD 6·30) and the mean social support score was 66·38 (SD 13·69).

CONCLUSION

The results of this study showed that the preoperative anxiety of patients awaiting surgery was associated with demographic characteristics as well as social support resources.

RELEVANCE TO CLINICAL PRACTICE

Anxiety testing is feasible during the preoperative period. Such testing allows for the detection of patients with high anxiety, and for clinicians to take the appropriate steps to ameliorate this problem. Identification of patient anxiety allows for providing a focus on social support in an attempt to reduce the level of anxiety.

The views of compliant glaucoma patients on counselling and social support

The purpose of this study was to describe the views of compliant glaucoma patients with good compliance on patient education and social support they received during their illness. The aim was to gain knowledge for developing patient compliance by means of promoting education and support methods. Twelve glaucoma patients with good compliance were interviewed, and the transcripts based on those interviews were analysed using content analysis. In the data, the participants described education and social support they had received from healthcare personnel, relatives and partly from their peers. Patient education emerged as the content, timing and methods of education. Social support emerged as emotional, informational and instrumental support, lack of support as well as patients' activity. Consequently, patients need education and support from healthcare personnel as well as from their relatives to cope with glaucoma. The need for education and support is individual but the most important time for education and support is at the initial stages of the illness. The need for education and support is also evident when the patient's treatment is changed or an operative procedure is performed. To conclude, the individual, patient-centred and properly timed education and support is a huge challenge for healthcare personnel because of the decrease in individual time for each patient. Therefore, new and timesaving methods of education and support should be developed.

Predictors of fear and anxiety nine years after coronary artery bypass grafting

AIM

This paper is a report of a study to identify (i) associations between fear and anxiety with variables of demography, symptoms, treatment and perceived health, (ii) associations between fear, anxiety, depression and social support and (iii) predictors of fear and anxiety nine years after coronary artery bypass grafting.

BACKGROUND

Earlier research shows that anxiety and fear are common, but there is a lack of knowledge about the long-term (>five years) situation of people after coronary artery bypass grafting.

METHOD

A convenience sample (n = 170) was formed of patients who had undergone coronary artery bypass grafting (n = 723) in one university hospital in 2007, nine years after surgery, by postal questionnaire. The questionnaire was sent to 152 surviving patients, and 114 responded (75%).

RESULTS

Fear had a connection to female sex, age under 65 years, more chest pain, hospitalization and poor perceived health. Anxiety had a connection to age under 65 years, living alone, more chest pain and poor perceived health. Social support had a low negative correlation with anxiety. Age under 65 years and chest pain explained 28% of the variance in fear. Age under 65 years and depressive symptoms explained 51-57% of the variance in anxiety.

CONCLUSION

Anxiety in people with coronary heart disease can be alleviated by developing social support from peers and professionals. Those aged under 65 years should be recognized as at greater risk of a predictor of long-term fear and anxiety after coronary artery bypass grafting.

Factors associated with health-related quality of life in patients and significant others one month after coronary artery bypass grafting

AIM

To describe and compare the health-related quality of life of patients and their significant others and to identify factors associated with health-related quality of life one month after coronary artery bypass surgery.

BACKGROUND

Heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients might feel their quality of life is poor. Significant others are a major source of support for patients; therefore, it is important to know how their health-related quality of life is affected.

METHODS

This study is part of a major longitudinal research project. The questionnaire data for the study were collected one month after the surgical procedure from 270 patients and 240 significant others at one Finnish university hospital. Data analysis was by descriptive and inferential statistics. Stepwise linear regression analysis was used as a multivariate method.

RESULTS

Coronary artery bypass grafting patients had a poorer health-related quality of life than both the age and gender-standardised general population and their significant others. Significant others, on the other hand, had the same health-related quality of life as the general population. In patients, health-related quality of life was associated with the occurrence of cardiac symptoms and New York Heart Association class; in significant others, it was explained by chronic illnesses, employment, gender and emotional support received from members of the support network.

CONCLUSION

In the early stages of recovery, the health-related quality of life of coronary artery bypass grafting patients is inferior to that of the general population. There are also differences in the health-related quality of life of patients and their significant others.

RELEVANCE TO CLINICAL PRACTICE

Postcoronary artery bypass grafting rehabilitation programmes should provide support for both patients and significant others through networks that involve both professionals and peer supporters.

A Review of the Research Literature on Evidence-Based Healthcare Design

Objective:

This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.

Background:

It builds on a literature review conducted by researchers in 2004.

Methods:

Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.

Results:

This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.

Conclusions:

The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.

Social support and family functioning on psychological symptoms in elderly Chinese

The purpose of this study was to extend our knowledge about how social support and family functioning affect mental health, and to examine the buffering effects of support in the presence of health stressors. A random cluster sample of 507 elderly community people were surveyed with a structured questionnaire, which included the depression and anxiety subscale of the Chinese version of Symptom Checklist 90-R (SCL-90-R), Social Support Rating Scale (SSRS), Family Emotional Involvement and Criticism Scale (FEICS), Short Portable Mental Status Questionnaire (SPMSQ), and the Katz Activities of Daily Living Scale (KADL). Results revealed that women had more anxiety symptoms than men (mean=3.49; 95% CI: 3.02-3.95 versus mean=2.56; 95% CI: 2.27-2.85). Emotional support was more important than instrumental support for psychological symptoms. Family emotional involvement was inversely correlated to depression (r=-0.19) and anxiety (r=-0.22), while criticism was positively correlated to depression (r=0.29) and anxiety (r=0.31). Multivariate analysis revealed that women, impaired cognitive function, urban residents with chronic diseases, less emotional support, and more criticism from the family were associated with more depressive and anxiety symptoms. Family involvement had buffering effects on psychological symptoms for people with cognitive impairment and medical diseases. Our results imply that elderly people with mental symptoms and chronic medical diseases benefit more from family involvement.

Modeling Pathways to Affective Barriers on Colorectal Cancer Screening Among Japanese Americans

The study aimed to identify the mechanisms through which colorectal cancer (CRC)-specific affective barriers, including fear of finding CRC, embarrassment, and concerns for screening discomfort, can be reduced to guide the development of interventions aimed at the secondary prevention of CRC. A model explaining these affective barriers was developed and tested among a random sample of 305 asymptomatic Japanese Americans using a path analysis. The model suggested that affective barriers could be reduced by increasing CRC-related knowledge, which could be enhanced by acculturation, social support, and physician recommendation. Interventions that focus on increasing CRC-related knowledge could reduce affective barriers to CRC screening for this population when taking the enhancement of communication skills and interpersonal interactions into account.

Nursing-Sensitive Outcomes in Cardiac Surgery Patients

Achieving optimum patient outcomes has always been the primary focus of healthcare providers. The degree to which any healthcare discipline can impact outcomes varies since patient outcomes are multiple and diverse. As the measurement and reporting of outcomes has moved into the arena of public reporting, it has become essential for disciplines to be able to identify which outcomes they can either partially or completely influence. The focus of this article is to (1) identify what specific nursing-sensitive outcomes have been measured or monitored on cardiac surgery patients in the past and then (2) suggest potential next generation outcomes.

Coronary artery bypass grafting: social support for patients and their significant others

BACKGROUND

Patients and significant others may experience physical and psychological stress symptoms during the recovery time from coronary artery bypass surgery. It has been shown that social support is associated with health and well-being in various situations. It is important to study how patients and significant others describe the social support received.

AIM AND OBJECTIVE

To describe social support for bypass surgery patients and their significant others from the social network and nurses during hospitalization and the association between demographic variables and support received from nurses.

DESIGN

A descriptive study using a questionnaire. This was a pilot study.

METHOD

Questionnaires were mailed to 146 subjects and 103 responded. The questionnaires included background variables, the Social Support from the Social Network Scale and the Support from Nurses during Hospitalization Scale.

RESULTS

In most cases, the spouse, children and friends were the major sources of support for patients and significant others. Patients reported equal amounts of both affect and aid or concrete support while significant others reported the highest level of affect and the lowest level of affirmation from the social network. Patients and significant others reported the highest level of affirmation and the lowest level of aid from nurses during hospitalization.

CONCLUSIONS

Relatives are important sources of support for bypass surgery patients and their significant others. Patients reported higher levels of all types of social support from both the social network and nurses than did significant others.

RELEVANCE TO CLINICAL PRACTICE

The provision of nursing support for significant others can be enhanced by focusing nursing care on the whole family. This would promote the health of the whole family.