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Dağcan N, Özden D, Gürol Arslan G. Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model. Nurs Crit Care 2024; 29:512-520. [PMID: 37527978 DOI: 10.1111/nicc.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes. AIM This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM). STUDY DESIGN A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM. RESULTS The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain). CONCLUSIONS The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated. RELEVANCE TO CLINICAL PRACTICE Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.
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Affiliation(s)
- Necibe Dağcan
- Nursing Department, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylul University, Izmir, Turkey
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Dağcan Şahin N, Gürol Arslan G. Perspectives of patients, families and nurses on pain after cardiac surgery: A qualitative study. Nurs Crit Care 2024; 29:501-511. [PMID: 37970732 DOI: 10.1111/nicc.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Post-cardiac surgery pain affects patients, family caregivers and nurses. The pain experiences of patients, caregivers and nurses remain largely unknown. Therefore, it is important to examine the experiences of patients, caregivers and nurses in depth to ensure effective pain management. AIM The aim of this study is to examine post-cardiac surgery pain from the perspectives of patients, caregivers and nurses. STUDY DESIGN A descriptive qualitative research design was used. The study was carried out in the cardiovascular surgery ward of a tertiary hospital in Türkiye between June and December 2022. The data-driven triangulation method was used in the research. The study sample consisted of eight patients who had undergone cardiac surgery in the tertiary hospital, eight family caregivers and nine nurses who provided care for these individuals. A 'semi-structured interview form' was used to collect data through face-to-face and in-depth interviews. The data were analysed using the thematic analysis method. The COREQ checklist was used for reporting the study. RESULTS As a result of the interviews, six themes were elicited from the data. These themes were 'explaining pain', 'assessment of pain', 'responses to pain', 'effect of pain on activities of daily living', 'expectations in painful situations' and 'pain management'. CONCLUSIONS This study revealed the differences between pain perceptions and coping processes of patients who experienced pain after cardiac surgery, their caregivers and nurses. RELEVANCE TO CLINICAL PRACTICE Considering the experiences of patients, caregivers and nurses in pain management after cardiac surgery, applications that will ensure joint participation in care practices should be planned.
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Affiliation(s)
- Necibe Dağcan Şahin
- Fundamentals of Nursing Department, The Institute of Health Sciences, Dokuz Eylül University, Izmir, Türkiye
| | - Gülşah Gürol Arslan
- Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylül University, Izmir, Türkiye
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Rodrigues SFNM, Henriques HMDSR, Henriques MAP. Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery. Nurs Open 2022; 9:1774-1784. [PMID: 35318826 PMCID: PMC8994954 DOI: 10.1002/nop2.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/12/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Aims The purpose of this research was to identify the needs of older persons waiting for elective open‐heart surgery. Design A qualitative exploratory design methodology, using Focus Groups. Methods A purposive sampling technique was used. Three interviews were conducted with experienced nurses, individuals waiting for open‐heart surgery (≥65years) and individuals having had open‐heart surgery (≥65years); enrolling up to 17 participants from October 2019 to January 2020. Qualitative data analysis was conducted using the iteractive model and MaxQDA® software, and EQUATOR COREQ guidelines were followed. Results Three themes were identified from the analysis of all three Focus Groups: (i) Needing health information; (ii) Needing emotional support; and (iii) Needing access to care.
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Affiliation(s)
- Soraia Filipa Nicola Martins Rodrigues
- Lisbon Nursing School, Lisbon University, Lisbon, Portugal.,Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal.,Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Maria Adriana Pereira Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal.,Lisbon Nursing School, Lisbon, Portugal.,ISAMB_Lisbon Medical School, Lisbon, Portugal
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Cruz-Ramos NA, Alor-Hernández G, Colombo-Mendoza LO, Sánchez-Cervantes JL, Rodríguez-Mazahua L, Guarneros-Nolasco LR. mHealth Apps for Self-Management of Cardiovascular Diseases: A Scoping Review. Healthcare (Basel) 2022; 10:322. [PMID: 35206936 PMCID: PMC8872534 DOI: 10.3390/healthcare10020322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
The use of mHealth apps for the self-management of cardiovascular diseases (CVDs) is an increasing trend in patient-centered care. In this research, we conduct a scoping review of mHealth apps for CVD self-management within the period 2014 to 2021. Our review revolves around six main aspects of the current status of mHealth apps for CVD self-management: main CVDs managed, main app functionalities, disease stages managed, common approaches used for data extraction, analysis, management, common wearables used for CVD detection, monitoring and/or identification, and major challenges to overcome and future work remarks. Our review is based on Arksey and O'Malley's methodological framework for conducting studies. Similarly, we adopted the PRISMA model for reporting systematic reviews and meta-analyses. Of the 442 works initially retrieved, the review comprised 38 primary studies. According to our results, the most common CVDs include arrhythmia (34%), heart failure (32%), and coronary heart disease (18%). Additionally, we found that the majority mHealth apps for CVD self-management can provide medical recommendations, medical appointments, reminders, and notifications for CVD monitoring. Main challenges in the use of mHealth apps for CVD self-management include overcoming patient reluctance to use the technology and achieving the interoperability of mHealth applications with other systems.
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Affiliation(s)
- Nancy Aracely Cruz-Ramos
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9, No. 852, Col. Emiliano Zapata, Orizaba 94320, Mexico; (N.A.C.-R.); (L.R.-M.); (L.R.G.-N.)
| | - Giner Alor-Hernández
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9, No. 852, Col. Emiliano Zapata, Orizaba 94320, Mexico; (N.A.C.-R.); (L.R.-M.); (L.R.G.-N.)
| | - Luis Omar Colombo-Mendoza
- Tecnológico Nacional de México/Instituto Tecnológico Superior de Teziutlán, Fracción l y ll, Teziutlán 73960, Mexico;
| | - José Luis Sánchez-Cervantes
- CONACYT-Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9, No. 852, Col. Emiliano Zapata, Orizaba 94320, Mexico;
| | - Lisbeth Rodríguez-Mazahua
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9, No. 852, Col. Emiliano Zapata, Orizaba 94320, Mexico; (N.A.C.-R.); (L.R.-M.); (L.R.G.-N.)
| | - Luis Rolando Guarneros-Nolasco
- Tecnológico Nacional de México/I. T. Orizaba, Av. Oriente 9, No. 852, Col. Emiliano Zapata, Orizaba 94320, Mexico; (N.A.C.-R.); (L.R.-M.); (L.R.G.-N.)
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Martorella G, Hanley AW, Pickett SM, Gelinas C. Web- and Mindfulness-Based Intervention to Prevent Chronic Pain After Cardiac Surgery: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30951. [PMID: 34459749 PMCID: PMC8438614 DOI: 10.2196/30951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac surgery is a frequently performed procedure. However, pain after cardiac surgery may become chronic (lasting >3 months) in adults. Once discharged from the hospital, patients are at greater risk of developing chronic postsurgical pain (CPSP) and of prolonged opioid use, as they need to self-manage their pain. Psychological risk and protective factors such as pain-related catastrophic thoughts and pain acceptance determine their ability to cope and their use of opioids, which is crucial for self-management of pain. Studies on mindfulness-based cognitive therapy (MBCT) have multiplied their potential effects on pain acceptance and catastrophic thoughts. However, web-based MBCT for the prevention of CPSP has not yet been examined. OBJECTIVE The aim of this study is to pilot test a 4-week-long web-based MBCT intervention for adults following discharge from the hospital by assessing the acceptability or feasibility of the intervention and examining preliminary effects on pain intensity, pain interference with activities and opioid use, and pain acceptance and catastrophic thoughts in the 6 months following surgery. METHODS A double-blinded pilot randomized controlled trial will be used to assess a web-based MBCT intervention. Patients will be selected according to the following criteria: age ≥18 years; first-time elective cardiac surgery via a median sternotomy; worst pain in the past week score ≥4/10; ability to understand and complete questionnaires in English; and ability to use an electronic device such as a smartphone, computer, or tablet. After baseline measures, 32 participants will be randomized into two groups: one receiving both the brief, 4-week-long web-based MBCT intervention and usual care (experimental group) and the other receiving only one standardized, web-based educational session with weekly reminders and usual care (attention control group). Peer-reviewed competitive funding was received from Florida State University's Council on Research & Creativity in January 2021, as well as research ethics approval from Florida State University's institutional review board. RESULTS Recruitment began in June 2021. Unfortunately, because of the current COVID-19 pandemic, recruitment is not progressing as expected. Recruitment strategies are constantly monitored and updated according to latest data and restrictions surrounding the pandemic. CONCLUSIONS This research is significant because it targets the trajectory of CPSP, a leading cause of disability and opioid misuse. This is the first study to assess MBCT for the prevention of CPSP after cardiac surgery in the recovery phase. This approach is innovative because it promotes self-management of pain through the modulation of individual factors. If successful, the intervention could be expanded to numerous populations at risk of chronic pain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30951.
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Affiliation(s)
- Geraldine Martorella
- Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, United States
| | - Scott M Pickett
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Céline Gelinas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Centre for Nursing Research, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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Martorella G, McDougall GJ. Barriers and Facilitators to the Prevention of Chronic Pain in the Subacute Phase After Cardiac Surgery. Pain Manag Nurs 2021; 22:28-35. [PMID: 33189543 PMCID: PMC10673644 DOI: 10.1016/j.pmn.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although a transitional approach promoting continuity of care is warranted to prevent chronic post-surgical pain (CPSP) and opioid misuse, there is limited research examining interventions targeting the subacute phase after cardiac surgery. Contextual multi-level factors may explain this scarcity. AIMS The purpose of this study was to explore the potential implementation of a nursing intervention to prevent CPSP in the subacute phase by describing nurses' viewpoints of current barriers and facilitators. DESIGN A descriptive qualitative study was conducted using secondary data analysis. SETTINGS A Web-based survey was used along with in-person interviews. PARTICIPANTS 75 perioperative nurses. METHODS Qualitative data from individual interviews (n=10) and open-ended responses to a survey (n=65) regarding the intervention's acceptability were used. Content analysis was conducted using a deductive approach. RESULTS The introduction of nurses from various clinical settings to a new intervention allowed reflection on current practice and represented a shift toward a preventive approach. The main barrier expressed was the lack of communication and continuity of care between clinical settings. Several policy implications were outlined such as increasing the involvement of rehabilitation programs and strengthening collaboration between pain specialists and primary care providers. CONCLUSIONS Based on perceptions of nurses involved at different stages of the continuum, the findings provide a preliminary picture of clinical challenges and potential avenues for the prevention of CPSP in the subacute phase after cardiac surgery. An expanded pain management nursing role in primary care would allow earlier interventions and contribute to the prevention of CPSP for a tremendous number of patients undergoing surgeries.
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Ouellette C, Henry S, Turner A, Clyne W, Furze G, Bird M, Sanchez K, Watt-Watson J, Carroll S, Devereaux PJ, McGillion M. The need for novel strategies to address postoperative pain associated with cardiac surgery: A commentary and introduction to "SMArTVIEW". Can J Pain 2019; 3:26-35. [PMID: 35005416 PMCID: PMC8730666 DOI: 10.1080/24740527.2019.1603076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/24/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022]
Abstract
Background: With coronary heart disease affecting over 2.4 million Canadians, annual cardiac and major vascular surgery rates are on the rise. Unrelieved postoperative pain is among the top five causes of hospital readmission following surgery; little is done to address this postoperative complication. Barriers to effective pain assessment and management following cardiac and major vascular surgery have been conceptualized on patient, health care provider, and system levels. Purpose: In this commentary, we review common patient, health care provider, and system-level barriers to effective postoperative pain assessment and management following cardiac and major vascular surgery. We then outline the SMArTVIEW intervention, with particular attention to components designed to optimize postoperative pain assessment and management. Methods: In conceptualizing the SMArTVIEW intervention design, we sought to address a number of these barriers by meeting the following design objectives: (1) orchestrating a structured process for regular postoperative pain assessment and management; (2) ensuring adequate clinician preparation for postoperative pain assessment and management in the context of virtual care; and (3) enfranchising patients to become active self-managers and to work with their health care providers to manage their pain postoperatively. Conclusions: Innovative approaches to address these barriers are a current challenge to health care providers and researchers alike. SMArTVIEW is spearheading this paradigm shift within clinical research to address barriers that impair effective postoperative pain management by actively engaging health care providers and patients in an accessible format (i.e., digital health solution) to give primacy to the need of postoperative pain assessment and management following cardiac and major vascular surgery.
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Affiliation(s)
- Carley Ouellette
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shaunattonie Henry
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Andy Turner
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Gill Furze
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Marissa Bird
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Karla Sanchez
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Carroll
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
| | - PJ Devereaux
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michael McGillion
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Perioperative & Digital Health Department, Population Health Research Institute, Hamilton, Ontario, Canada
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