Coronary artery bypass grafting: patients' and health professionals' views of recovery after hospital discharge.

BACKGROUND: Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients report no improvement or a decline in quality of life and hence do not experience a good recovery after surgery. Little published research has explored patients' and particularly health professionals' views on barriers and facilitators to recovery or the processes by which these factors affect recovery. AIMS: To identify post-discharge facilitators and barriers to recovery after CABG. METHODS: Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients. RESULTS: Thematic analysis identified the following themes: person characteristics, including the impact on recovery of anxiety, depression, optimism and determination; rehabilitation classes; social support; and the effect of surgery. Findings indicate a complex relationship between the various barriers and facilitators to recovery and explore possible processes by which these influences on recovery operate. CONCLUSIONS: Findings have indicated areas where health professionals can intervene to aid patients' long-term recovery, and thereby maximise the benefits of CABG, by providing information, support and reassurance particularly to patients who appear anxious and/or depressed.

Recovery after coronary artery bypass grafting: patients' and health professionals' views of the hospital experience.

BACKGROUND: Increasing access to revascularisation procedures is a key aspect of a National Service Framework. Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients do not report an improved quality of life or experience a good recovery. AIMS: To describe the recovery trajectory after CABG and identify facilitators and barriers to recovery. METHODS: Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients. RESULTS: Thematic analysis identified the following themes: definition and timeline of recovery, preparation for surgery including information provision, attitude to surgery and confidence in staff, clinical factors and the in-patient experience. The key finding is the different recovery trajectory between patients with severe versus mild pre-operative symptoms; patients with few pre-CABG symptoms reported a much longer recovery time. CONCLUSIONS: This study has provided insights into the barriers and facilitators to recovery after CABG and the processes involved. Findings have indicated areas where health professionals can intervene to aid patients' long-term recovery and thereby maximise the benefits of CABG.

Acute coronary syndrome nurses: perceptions of other members of the health care team.

Acute coronary syndromes (ACS) are a major health care problem and result in a large number of hospital admissions each year. Nurses across the NHS are being empowered to undertake a growing range of responsibilities but little research evidence exists related to the impact on patient care nor working practice with other health professionals. This paper reports part of the evaluation of a British Heart Foundation pilot project to place an 'ACS nurse' in participating hospitals. In each of 5 hospitals, 100 staff across accident and emergency, general medicine and cardiac specialities were sent a questionnaire. The response rate was 33%. Respondents felt that the ACS nurse role was beneficial to patient care and had little overlap with existing roles within the hospital. Support for nurse initiated thrombolysis was high, but comments reflected the on-going debate around accountability and training. Communication and problem solving were identified as key elements of the ACS nurse role. Findings in this study show support for the integration of an ACS nurse role as a way to provide improved care to ACS patients.

What is important to measure in the last months and weeks of life?: A modified nominal group study.

BACKGROUND: Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals. AIMS: To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals. METHODS: Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison. FINDINGS: Seven themes were identified as most important to participants: symptom management; choice and control; dignity; quality of life; preparation; relationships; and co-ordination and continuity. Bereaved relatives and professionals emphasised symptom management, relationships and quality of life, whilst patients prioritised issues around preparation. CONCLUSIONS: The study was successful in identifying aspects of end of life care that are important to patients, families and health professionals in the United Kingdom. Although participants were not representative of the wider population in the United Kingdom, the degree of concordance with published studies from outside the United Kingdom increases the credibility of the findings. Quality assurance initiatives need to ensure that they act on information such as this on users' priorities. Further research is needed to test out the findings in other settings in the United Kingdom, to build on the findings about different participants' views and to identify similarities and variations between countries.

A research study to identify facilitators and barriers to outcome measure implementation.

AIM: To identify facilitators and barriers to implementing outcome measures. METHODS: An action-research approach within a hospice and nursing home was used. Staff took part in semistructured interviews pre- and post-implementation of the Palliative Care Outcome Scale (POS), completed diaries and participated in monthly meetings. FINDINGS: Qualitative content analysis identified barriers to implementation including: a top-down decision-making approach; outcome measures perceived as time-consuming to use; limited resources for data analysis; and a lack of knowledge of the importance of outcome measures. Facilitators to successful implementation include: involving all staff in decisions about implementation; and using a measure that can be adapted to organization needs and clinical practice. The benefits of using the measure are rapidly noticeable. CONCLUSIONS: Given the need to evaluate services and the role outcome measures can have within clinical governance, this article indicates methods by which measures may be more successfully implemented.

Assessing palliative care outcomes for people with motor neurone disease living at home.

A number of palliative care outcome measures are used to facilitate the provision of palliative care. This short article reports the use of one palliative care outcome measure, the Palliative care Outcome Scale, with people with motor neurone disease (MND) living at home. The outcome measure was generally viewed positively by those involved. However, problems with this scale itself point to the need for a specialized instrument to assess palliative care outcomes for people living with MND.

It just didn't work: the realities of quality assessment in the English health care context.

AIMS: Assessment of care quality is integral to health and palliative care provision and there is a need to develop and implement outcome measures to assess quality. This study aimed to: (1) describe the implementation of a palliative care outcome measure in non-specialist palliative care settings and (2) to understand the implementation of the measure. METHOD: Twenty-five non-specialist palliative care settings were purposely sampled and invited to implement a palliative care outcome measure. Fifteen settings agreed to take part. The research team provided training and support in the use of the measure. Data were collected on actual use of the measure and, via interviews with patients and nurses, on their experiences. RESULTS: The number of assessments was low (21 patients assessed against an anticipated minimum of 240). The analysis of nurses' accounts identified important considerations in understanding the low response. Although nurses saw the implementation of the outcome measure as bringing opportunities for themselves, including their own professional development, and for the organisations they represent, including raising organisational profiles, there were a number of factors that acted as impediments. These include: perceived time to administer the paperwork; competence and confidence in recruiting patients and proceeding with informed consent; concerns about the effects of completing the measure with very ill patients; and the effects of nurses raising palliative care issues on their relationships with patients. CONCLUSIONS: It is difficult to integrate outcome measures into routine clinical practice. Future interventions should consider how to tailor the implementation of outcome measures within existing working structures and provide education and training to enable nurses to deal with potentially sensitive palliative care issues.

What is the potential for the use of clinical outcome measures to be computerised? Findings from a qualitative research study.

Clinical outcome measures are used in clinical audit to monitor the quality of care provided to patients. As information technology (IT) is increasingly being integrated into the delivery of health care, computerising the use of clinical outcome measures has been proposed. However, little is known about the attitudes of health professionals towards this. Aims to understand professionals' views on adapting one clinical outcome measure--the palliative care outcome scale (POS)--for use on hand-held computers. Concludes that these results reinforce existing research on clinical outcome measures and IT in health care; identify special palliative care issues when considering the use of computerised clinical outcome measures with patients; and highlight the need for further research.

Translating clinical tools in nursing practice.

BACKGROUND: The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools. AIM: The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice. DISCUSSION: Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations. CONCLUSION: Clinical tools provide benefits in identifying patients' problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools.

Professionals' views and experiences of using outcome measures in palliative care.

In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audit and research. The objective of this study was to elicit professionals' views and experiences of using outcome measures, paying special attention to the Palliative care Outcome Scale (POS). This article presents the results of a qualitative study of 26 professionals, experienced in using the POS, who were invited to participate in semi-structured telephone interviews. Of those invited, 22 people took part. Participants' comments were noted verbatim through the interviews and data subjected to content analysis. Analysis of data identified a number of key themes surrounding outcome measures, notably their reasons for use, application in clinical settings and a range of professionals' attitudes. The article concludes that understanding the process of outcome measures is important for improving their implementation. When undertaking further research, attention should be paid to the wider social, cultural and structural contexts, as factors that can influence the implementation of outcome measures. As the drive towards outcome measures continues, it is essential that measures are not developed in a vacuum. Instead they should always be informed by the needs and experiences of individuals and services.

Language translation of outcome measurement tools: views of health professionals.

Assessing the outcome and effectiveness of treatment is extremely important in nursing practice and it is vital that outcome measures are available to non-English speakers. We investigated health professionals' views on translating outcome measures for use in nursing practice. Semi-structured interviews were conducted with a purposive sample of 10 health professionals. Content analysis of data identified the following two broad themes: meeting need and cultural consideration. Specific palliative care issues were also identified. Low literacy levels among ethnically diverse communities and the need to ensure cultural equivalence were perceived as major challenges for palliative nursing practitioners when translating outcome measures. Given increasing cultural diversity within the UK, health professionals considered clinical tool translation worthwhile because it helps to address inequalities in health-care provision for ethnically diverse communities. A consideration of the cultural context is needed when interpreting responses on translated outcome measure. However, translations into appropriate languages can help overcome communicant barriers and minimize the need for family members to act as interpreters for patients with palliative care needs.