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

The Impact of Caregiving Burden on Mental Well-Being in Coronary Artery Bypass Graft Surgery Caregivers: The Mediatory Role of Perceived Social Support

An increase in caregiver burden and a decrease in social support have both been identified as predictors of poor caregiver psychological distress. However, little is known about the role of these factors in coronary artery bypass graft (CABG) caregivers. The purpose of this study was to investigate whether change in perceived social support from pre to post surgery mediated the relationship between change in caregiver burden and caregiver depressive symptoms and subjective well-being post surgery. A sample of 101 caregivers of elective CABG patients were assessed 28 days before and 62 days after patients' surgery. Caregivers completed the Oberst Burden Scale, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, the Beck Depression Inventory, and the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Simple mediation analyses showed that change in social support significantly mediated both the relationship between change in caregiver burden and post-surgery depressive symptoms (unstandardised β = 0.041, 95% CI (0.005, 0.112)) and the relationship between change in caregiver burden and post-surgery subjective well-being (unstandardised β = 0.071, 95% CI (0.001, 0.200)). Psychological interventions aimed at the CABG caregiver population should promote social support to deal with the increase of caregivers' tasks and demands after the patients' surgery.

Pre-surgical Caregiver Burden and Anxiety Are Associated with Post-Surgery Cortisol over the Day in Caregivers of Coronary Artery Bypass Graft Surgery Patients

Background

The relationship between pre-surgical distress and diurnal cortisol following surgery has not been investigated prospectively in caregivers of coronary artery bypass graft (CABG) patients before. We aimed to examine the relationship between pre-surgical anxiety and caregiver burden and diurnal cortisol measured 2 months after the surgery in the caregivers of CABG patients.

Method

We used a sample of 103 caregivers of elective CABG patients that were assessed 28.86 days before and 60.94 days after patients’ surgery. Anxiety and caregiver burden were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale and the Oberst Burden Scale respectively. Saliva samples were collected to measure cortisol area under the curve with respect to ground (AUCg) and diurnal cortisol slope. Anxiety and caregiver burden were entered into linear regression models simultaneously.

Results

While high levels of pre-surgical anxiety were positively associated with increased follow-up levels of AUCg (β = 0.30, p = 0.001), greater pre-surgery perceived burden score was associated with steeper cortisol slope (β = 0.27, p = 0.017) after controlling for a wide range of covariates.

Conclusion

These outcomes support the utility of psychological interventions aimed to increase the awareness of caregiving tasks and demands in informal caregivers.

Enhancing Postoperative Recovery of Cardiac Surgery Patients

The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients’ during the first 5 weeks following hospital discharge. Patients ( N = 200) were randomly allocated to two groups: (a) an intervention group who received telephone calls from an advanced practice nurse (APN) familiar with their clinical condition and care needs, twice during the first week following discharge then weekly thereafter for 4 weeks, and (b) a usual care group. Measures of health-related quality of life (HRQL), symptom distress, satisfaction with recovery care, and unexpected health care contacts were obtained at 5 weeks following discharge. There were no significant group differences in HRQL, unexpected contacts with the health care system, or symptom distress. The provision of APN support via telephone followup after cardiac surgery is feasible. However, further randomized trials of single and multicomponent APN interventions are needed to prove effectiveness.

Impact of Satisfaction, Nurse–Patient Interactions and Perceived Benefits on Health Behaviors Following a Cardiac Event

Aims: To describe patient perceptions of quality and satisfaction with nursing care, nurse–patient interactions and barriers to and benefits of implementing a healthy lifestyle. Methods: A pretest–posttest cross-sectional correlational research design was used. Subjects were randomly selected between November 2001 and January 2002 from patients admitted to the National Institute of Cardiology in Budapest, Hungary. Participants completed 3 self-reported measures and a demographic survey, which assessed individual lifestyle behaviors (e.g. frequency of smoking, physical activity, stress and unhealthy dieting). Results: Satisfaction with nursing care and nurse–patient interactions influenced both perceived benefits and barriers. Patient satisfaction and perceived benefits at discharge were associated with more frequent exercising and less smoking. Among other factors, perceived benefits at discharge were predicted by attentive nurse behaviors toward patients and by patients’ ability to initiate discussion with nurses. Conclusions: Findings support effects of patient satisfaction and nurse–patient relationships on perceived benefits/barriers. Compared to barriers, perceived benefits more importantly determined health behaviors. Attentive nursing care and the patient's ability to discuss health concerns with nurses appear more influential in modifying patient perceptions. Exploring nursing interventions to maximize perceived benefits during hospitalization is suggested.

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.

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

Perceptions of recovery, physical health, personal meaning, role function, and social support after first-time coronary artery bypass graft surgery

Coronary artery bypass graft surgery is one of the most frequently performed major surgeries in the United States. Because of fast-track protocols and decreased lengths of stay, critical care nurses have even more demanding challenges in the care of these patients. Critical care nurses are well aware that these patients still have health needs that extend beyond discharge from the hospital, but these needs are now addressed by the patient's caregiver. This descriptive, comparative study was conducted to examine perceptions of recovery by these patients and the relationships among physical health, personal meaning, role function, and social support. The results of the study are presented, as well as the implications for critical care nurses.

Global women's health: a spotlight on caregiving

Caregiving is a women's health issue globally, as many more women than men are informal caregivers. Caregiving related to gender role socialization, burden, and economic and health consequences has been discussed in the literature. Together this body of work demonstrates some positive but mainly negative consequences to the health and economic circumstances of women. Overall achievement of the United Nations' Millennium Development Goals has important implications for informal caregivers globally, because achievement of these goals is essential to reducing the undue burden, the lost opportunities, and the injustice of health care systems that take advantage of women's volunteer caregiving.

Addressing spouses' unique needs after cardiac surgery when recovery is complicated by heart failure

BACKGROUND

Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

OBJECTIVES

To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

METHODS

Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

RESULTS

During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

CONCLUSIONS

By identifying spouses' needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses' needs are important because they are vital to the patients' recovery.

Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery

BACKGROUND

Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses' ability to provide care to the patient.

OBJECTIVES

The purpose of this study was to compare burden and caregiving outcomes across three groups of spouses. Spouse groups varied by the interval of time between surgery and follow-up, which may have been 3, 6, or 12 months.

METHODS

This cross-sectional comparative study recruited a convenience sample of 166 spouses on the basis of a power analysis. A total of 166 spouses completed caregiver surveys on burden and other caregiving outcomes.

RESULTS

Total, objective, and subjective burden levels were low to moderate. Although no burden differences were found between groups, men had higher total burden but more positive caregiving outcomes. Future outlook and social activities were less positive in the 6-month group. Burden levels were not lower, nor were caregiving outcomes higher, in the 12-month group, suggesting a steady caregiving demand across the first year after coronary artery bypass graft surgery.

CONCLUSION

Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.

Rapid recovery following cardiac surgery: a nursing perspective

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

Depressive mood after a cardiac event: gender inequality and participation in rehabilitation programme

BACKGROUND

Depressive mood after a cardiac event is common with serious consequences for the patient.

AIMS

To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood.

METHODS

166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation.

RESULTS

At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs.

CONCLUSION

Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men.

Caregivers of ICU patients discharged home: what burden do they face?

Reforms in healthcare aimed at cost-cutting have led to early hospital discharge for many patients, including those who have sustained critical illness or injury requiring admission to an intensive care unit (ICU). Many former ICU patients experience ongoing health-related problems following discharge from hospital, and need ongoing support and care from their family once discharged. However, family members who take on a caregiving role often experience an enormous burden. The literature has demonstrated the impact of economic, social, physical and psychological factors on those who care for the critically ill following discharge. It is therefore essential that all nurses involved in the ongoing management of ICU patients have an understanding of the caregiving role, and consider both the patient and his/her carer in the discharge planning process. This paper reviews the literature on caregiving, and examines research studies which describe and measure the factors involved in the caregiving role. Although only a small number of studies specifically focus on caregivers of former ICU patients, findings suggest that these caregivers experience a substantial burden which is associated with the complexity of the patient's physical and psychological impairment, and complex technology. To enable nurses to incorporate planning strategies and interventions aimed at minimizing the impact on the caregiver, further research is needed to more fully explore, examine and measure the factors involved in caring for ICU patients post-discharge. Furthermore, ongoing research and evaluation of interventions will build an evidence-base to inform future practice.