Patient education for discharge after coronary bypass surgery in the 1990s: are patients adequately prepared?

Perceived learning needs of Yemeni patients after coronary artery bypass graft surgery

AIMS AND OBJECTIVES

  To explore the information needs of Yemeni patients who have undergone coronary artery bypass graft surgery before hospital discharges and to examine the differences in the patients' learning needs according to age, gender, level of education and working condition.

BACKGROUND

Postcoronary artery bypass graft (CABG) patients need more information before their discharge from the hospital. This need of information must be assessed and provided for them before their discharge from hospital to help them with adequate care and recovery at home. Design.  A descriptive, correlational design.

METHODS

Data were collected from 120 CABG patients before their discharge from Al- Thawra Hospital, Sana'a, Yemen, by using modified Cardiac Patients Learning Needs Inventory (CPLNI) instrument. The Statistical Package for the Social Sciences was used to analyse the collected data.

RESULTS

The information about chest and leg wound care, medication information, other pertinent information and complications were indicated to be the most valued by CABG patients prior to discharge. There was a statistically significant difference between patients' total learning needs according to their socio-demographic characteristics. Male patients needed more information than female patients (p=0.004). Younger (p=0.021) and middle-aged (p=0.032) patients needed more information than older ones. Highly educated (p=0.000) and school-level (p=0.002) patients needed more information than those in the uneducated group. Working patients needed more information than non-working ones (p=0.000).

CONCLUSION

This study suggests that CABG patients have high information needs within 24-48 hours before hospital discharge. In addition, the results of this study showed that there are statistically significant differences in patients' learning needs according to their demographic characteristics.

RELEVANCE TO CLINICAL PRACTICE

Assessment of CABG patients' information needs before their discharge from hospital helps in developing effective educational programme that will help these patients in their recovery at home.

Postoperative patient education: a systematic review

INTRODUCTION

Knowledge of the effects of the specific approach, mode of delivery, and dose of educational interventions is essential to develop and implement effective postoperative educational interventions. Understanding the relationships of patient characteristics to outcomes is important for educational interventions.

PURPOSE AND METHOD

The purpose of this systematic review was to examine who would most benefit from postoperative education, given in what type of approach and mode, and at what dose? The sample included 58 studies involving 5,271 participants.

MAJOR RESULTS

Findings indicate that delivery of postoperative patient education through the individualization of content, use of combined media for delivery, provision of education on a one-on-one basis, and in multiple sessions is associated with improvement in educational/health outcomes. Samples that contained individuals younger than 50 years and higher percentages of males showed benefits in outcomes of moderate magnitude.

APPLICATION

The results highlight the importance of attending to the characteristics of both the elements of postoperative educational interventions and the individual patients in the design and delivery of patient education.

How do nurses record pedagogical activities? Nurses? documentation in patient records in a cardiac rehabilitation unit for patients who have undergone coronary artery bypass surgery

AIMS

To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit.

BACKGROUND

Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients.

METHODS

The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes.

RESULTS

Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple.

CONCLUSIONS

The documentation of pedagogical activities in nursing records was infrequent and inadequate.

RELEVANCE TO CLINICAL PRACTICE

The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.

Patient information at discharge--a study of a combined approach

OBJECTIVE

To describe patients' perceptions of a new information procedure related to going home after urological surgery. This procedure, developed in an action research project, included a discharge talk with the nurse and an information booklet for the patients to keep.

METHODS

A convenience sample of 99 patients responded to a survey sent home 1 week after discharge (return 78.6%). The Patient Information and Nurse Interaction Scale (PINI) was used for data collection.

RESULTS

The sample were mostly male (81%), older (mean 71.9 years), and hospitalised on average less than 4 days. Patients who got the booklet had significantly more favourable perceptions on information received (p<0.05) on 11 of 21 items, and 91% said they would not have managed very well at home without it.

CONCLUSION

The patients who received the booklet knew more about what might happen to them, were less uncertain and had fewer concerns when going home.

PRACTICE IMPLICATIONS

The combination of standardised written information and a talk with the nurse where patients participated in individualising the information appears to have had a significant impact on self-management at home.

Peer support. An under-recognized resource in cardiac recovery

BACKGROUND

Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery.

AIMS

To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions.

METHODS

A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions.

RESULTS

Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery.

CONCLUSIONS

Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.

Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery

Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225 ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients (N=406) were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1-5 after surgery. Outcomes were pain-related interference (BPI-I), pain (MPQ-SF), analgesics (chart), concerns about taking analgesics (BQ-SF), and satisfaction (American Pain Society-POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain-related interference in activities ( t(355)=2.54, P<0.01) and fewer concerns about taking analgesics ( F(1,313)=2.7, P<0.05) on day 5. Despite moderate 24-h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain-related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.

Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan

OBJECTIVE

To assess the effects of phase I cardiac rehabilitation intervention on anxiety of patients hospitalized for coronary artery bypass graft (CABG) surgery.

DESIGN

Prospective, quasi-experimental, random assignment, repeated measurements.

SETTING

The Veterans General Hospital Taipei, Taiwan, Republic of China.

PATIENTS

Seventy patients were randomly assigned to (1) the phase I cardiac rehabilitation intervention (experimental) group and (2) the nonintervention (comparison) group. Ultimately, 60 subjects were included in the data analyses.

OUTCOME MEASURES

Psychological status was evaluated by the state of anxiety scores on the State-Trait Anxiety Inventory. Anxiety scores were measured 3 times: (1) after admission, before the patient underwent CABG surgery; (2) the day before the patient underwent CABG surgery; and (3) the day of discharge from the hospital.

INTERVENTION

Individual instruction in progressive exercises and daily activities according to the phase I cardiac rehabilitation program (Chinese manual) were used during hospitalization.

RESULTS

Data analysis was performed with use of generalized estimating equations (GEE) to assess the between- and within-group variations. The mean anxiety for all subjects before undergoing CABG surgery was 42.6. The mean anxiety on the day before undergoing CABG surgery was 33.7 in the experimental group and 49.8 in the comparison group; there were statistical differences, with a P <.05 level of significance between these 2 groups. The mean anxiety on the day of discharge in the experimental group was 28.6 and in the comparison group was 38.4; there were statistical differences, with a P <.05 level of significance between these 2 groups.

CONCLUSIONS

These results have been supported by similar studies. This finding suggests that application of phase I cardiac rehabilitation intervention can reduce the anxiety level during hospitalization of patients undergoing CABG surgery.

[Problems during the recovery of patients following coronary artery bypass surgery: the follow up by nurses in the first month after hospital discharge]

Patients may present problems after coronary artery bypass surgery and nurses play an important role in the detection of such problems. With the purpose to determine the problems of 25 patients during the first month after hospital discharge, they were followed up via telephone as well as when they returned to hospital. Content analyses of detailed nurses' recording revealed eight categories of problems. The most frequently related problems were related to the surgical incision site (76%), pharmacological therapy (28%), other pathologies (24%), mood alterations (20%) and sleep pattern disturbances (16%). The strategy chosen showed to be efficient to analyze the recovery of these patients during the first month after hospital discharge.

Effective teaching for the elderly: back to basics

Providing effective patient education is an essential part of every nurse's role. The elderly have special learning needs related to health promotion and management of chronic disease processes. Elderly orthopaedic patients require additional education related to their specific functional and rehabilitation needs. Planning and implementing effective patient education for the elderly orthopaedic patient requires knowledge of adult learning principles and knowledge of the special learning needs and teaching methods that can be adapted for this growing population. Adult learning principles and aspects of normal aging that affect learning are described in this article. Suggestions for planning, implementing, and evaluating education for patients and their families are based on the nursing process. Basic teaching tips and criteria for evaluating educational materials are included.

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

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

Implementation strategy: one-stop recovery for cardiac surgical patients

"Fast-track" or "rapid recovery" for cardiac surgical patients is enjoying widespread use due to its benefits of increased patient comfort, enhanced quality of care, and cost-savings. Successful implementation of a fast-track program, however, may be challenged by physicians, the institution, or patients and their families. One-Stop Recovery is a fast-track program that emphasizes the benefits of traditional rapid recovery programs while addressing potential challenges.

Patient problems and evaluation of patient discharge education after coronary artery bypass graft surgery

Coronary artery bypass graft surgery (CABGS) patients who have a routine postoperative course are now being discharged as early as the fourth postoperative day. This descriptive and comparative study explored the postoperative problems experienced by CABGS patients after discharge from hospital and evaluated the patient discharge education program. No correlations were found between the length of hospital stay and the following factors: number and type of problems/concerns; whether patients felt ready to leave hospital on the discharge day; whether patients felt they were coping after discharge, and the number of and reasons for readmission to hospital after discharge. Continual review of the patient education program is recommended and further research into the discharge needs of rural patients is required.