The application and value of continuous nursing in patients after coronary artery bypass grafting.

OBJECTIVE: To investigate the application and value of continuous nursing after coronary artery bypass grafting. METHODS: The clinical data of 62 patients after coronary artery bypass grafting from January 2016 to January 2018 were analyzed retrospectively. According to the nursing mode, the patients were divided into two groups: the continuous nursing group (n = 30) and the conventional nursing group (n = 32). All patients completed Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) at admission and 1 year after operation. All patients completed Seattle Angina Pectoris Questionnaire (SAQ) at discharge and 1 year after operation. RESULTS: All patients were followed up for more than one year. One year after operation, SAQ score in five items in continuous nursing group was significantly better than that in conventional nursing group.(P < 0.05) The continuous nursing group exhibited significantly decreased SAS and SDS scores 1 year after surgery compared to the preoperative SAS and SDS scores.(P < 0.05) The SAS and SDS scores of the continuous nursing group were significantly better than those of the conventional nursing group 1 year after surgery.(P < 0.05) Then incidence rate of chest tightness or chest pain and coronary restenosis in continuous nursing group were significantly less than that in conventional nursing group.(P < 0.05). CONCLUSION: Continuous nursing improved patient compliance with treatment and reduces the occurrence of complications. The patient also receives proper psychological evaluations, which relieve patient anxiety and depression and improve the quality of life.

Food and heart-the nutritional jungle: Patients' experiences of dietary habits and nutritional counselling after coronary artery bypass grafting.

AIMS AND OBJECTIVES: The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). BACKGROUND: Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. DESIGN: Qualitative study. METHODS: Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. RESULTS: In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits". CONCLUSION: The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. RELEVANCE TO CLINICAL PRACTICE: This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.

Readmission Rates and Skilled Nursing Facility Utilization After Major Inpatient Surgery.

BACKGROUND: There is widespread interest in reducing use of postacute care (ie, care after hospital discharge) following major surgery, provided that such reductions do not worsen quality outcomes such as readmission rates. OBJECTIVES: To describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. RESEARCH DESIGN: This was a observational study. SUBJECTS: Fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. MEASURES: Primary exposure was risk-adjusted SNF use initiated 0-2 days after hospital discharge, and the primary outcome was risk-adjusted readmission rates from 3 to 30 days after discharge. RESULTS: Among 176,994 patients who underwent CABG at 804 hospitals and 233,955 patients who underwent THR at 1220 hospitals, hospital-level SNF utilization increased after CABG (16.4%-19.0%, P=0.001) and THR (40.8%-45.5%, P<0.001), from 2008 to 2013. Hospital readmission rates decreased for CABG (14.7%-12.7%, P<0.001) but did not change for THR (4.9%-4.8%, P=0.55), from 2008 to 2013. However, there was wide variation in hospital-level change in readmission rates. After adjusting for hospital characteristics and baseline readmission rates, there was no statistically significant association between change in SNF use and change in readmission rates (0.017 and 0.011 percentage point increase in SNF use for every one percentage point increase in readmission rates for CABG and THR respectively, P=0.58 and 0.32). CONCLUSIONS: Changes in use of postacute care after THR and CABG have not been associated with changes in readmission rates.

Predictors of uncertainty among postdischarge coronary artery bypass graft patients in Jordan.

Uncertainty impacts negatively on adaptation and disease outcomes. During recovery, coronary artery bypass graft (CABG) patients experience uncertainty, symptom distress, and learning needs. This study aimed to examine predictors associated with uncertainty among CABG patients. This cross-sectional correlational study recruited CABG patients conveniently from out-patient clinics 1 month after discharge. Participants completed a self-administered questionnaire which included: demographic questionnaire, Mishel's Uncertainty of Illness Scale, Cardiac Symptoms Survey, and Cardiac Patients Learning Needs. A total of 161 participants completed the study questionnaires. Participants showed a moderate level of uncertainty, less cardiac symptom distress, and high learning needs. Uncertainty was significantly correlated with learning needs while less correlated with symptom distress. Hierarchal multiple regression revealed that gender, employment status, education level, and learning needs are factors associated with uncertainty among CABG patients. It was concluded that symptom distress does not necessarily induce uncertainty. Intensive care professionals should undertake individual's characteristics to anticipate uncertainty.

Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep Before Coronary Artery Bypass Grafting.

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.

Changes over time in caregiving demand and difficulty in spousal caregivers of coronary artery bypass graft surgery patients.

Patients who undergo coronary artery bypass graft (CABG) surgery are often dependent on spouses or family members for care during their recovery. The purpose of this study was to examine changes over time in spousal caregivers of coronary artery bypass graft (CABG) patients in caregiving demand and caregiving difficulty and to identify the key demands and difficulties at each time point. Spouses (n=34) of CABG patients comprised the sample. Caregiving demand and caregiving difficulty were measured using the Caregiving Burden Scale at three time points (baseline [early hospital discharge] and 3 and 6months later) and analyzed using repeated measures analysis of variance. Mean scores of each item were used to identify the top four caregiving demands and difficulties at each time point. There was a significant decrease over time in caregiving demands (F [1.696]=13.62, p<0.001) and caregiving difficulties (F [1.613]=4.52, p=0.02). The most demanding and/or difficult caregiving activities at all time points were providing social support, managing behavior problems, taking on additional household tasks, and monitoring symptoms. Early in recovery, providing transportation was a top ranked demand and difficulty. Later in recovery (3 and 6months), managing finances became a top ranked demand and difficulty. In conclusion, caregiving demands and difficulties declined significantly over six months for the caregivers in this study. These results indicate that caregiving demands and difficulties change over time and ongoing assessments of spouses and family members are needed to help them manage the caregiving situation.

Effects of nurse-led clinical pathway in coronary artery bypass graft surgery: A quasi-experimental study.

AIMS AND OBJECTIVES: To develop and evaluate the effects of a nurse-led clinical pathway for patients undergoing coronary artery bypass graft surgery. BACKGROUND: A clinical pathway is a multidisciplinary care plan, based on evidence and guidelines to provide consistent, quality care to patients and improve outcomes. DESIGN: Prospective, quasi-experimental design. METHODS: Patients hospitalised for coronary artery bypass graft between April 2014-November 2015 in a hospital in Turkey were studied. First 42 usual care patients were enrolled to determine outcomes and plan for the development of the clinical pathway followed by 40 patients in the newly developed clinical pathway. The primary outcome was length of stay and secondary outcomes related to recovery from surgery (e.g., time to extubation, first feeding). RESULTS: The mean age for the clinical pathway group was 60 and for usual care was 63 years. Most were male (CP = 78%, UC = 69%). There were significant differences between groups for the primary outcome. Length of stay in the intensive care unit was 38.9 hr for CP and 50.7 hr for usual care patients p < .01. Total hospital time was 144.4 hr for clinical pathway and 162.2 hr for usual care, p < .05. For secondary measures, the following times were less for the clinical pathway group than for the usual care: time to extubation and nasogastric tube removal (5.7 vs. 8.6 hr, p < .01), first oral feeding (4.7 vs. 10.9 hr, p < .001), first mobilisation (8.4 vs. 22.9 hr, p < .001) and first bowel movement (69.8 vs. 85.9 hr, p < .01). There were no statistically significant differences in the 3-month readmission rates and complication rates between the groups, except the renal complication rates were higher in the usual care (n = 16, 38%) than in the clinical pathway (n = 7, 17.5%) (p < .05). CONCLUSION: The nurse-led clinical pathway was effective in improving length of stay in both the ICU and hospital as well as the secondary outcomes. RELEVANCE TO CLINICAL PRACTICE: This study contributes to previous studies supporting clinical pathway use can improve the length of stay and quality of care in patients undergoing coronary artery bypass graft surgery.

Person-centred discharge education following coronary artery bypass graft: A critical review.

AIMS AND OBJECTIVES: To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery. BACKGROUND: Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation. DESIGN: A critical review of published peer-reviewed literature was conducted. METHODS: Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015. RESULTS: Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews. CONCLUSION: A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft. RELEVANCE TO CLINICAL PRACTICE: Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being.

Perceived learning needs according to patients who have undergone major coronary interventions and their nurses.

AIMS AND OBJECTIVES: The aim of this study was to identify the differences in perceived learning needs between cardiac patients who have undergone major coronary interventions and their nurses. BACKGROUND: The decrease in length of stay after cardiac interventions has signalled an urgent need to provide effective in-hospital health education. Therefore, the content of health education should bridge the gap between nurses' and patients' views of what information is important for ensuring patients' optimum recovery. DESIGN: A descriptive comparative design was employed. METHODS: Patients were invited to participate if they had undergone angioplasty or bypass surgery and were ready for discharge within 24-48 hours. A convenience sample of 365 cardiac patients and 166 cardiac nurses participated in this study. Baseline data on patients' and nurses' sociodemographics, clinical history and experience were collected through personal interviews. Then, participants completed the Patient Learning Needs Scale to identify their perceptions of the learning needs after cardiac interventions. RESULTS: The top-priority learning needs according to both patients and cardiac nurses was information on wound care and medication. In contrast, the lowest-priority learning need was physical activity. Nurses perceived information about physical activity as most needed to patients, whereas patients perceived information about medications, postintervention complications and postintervention concerns as mostly needed. CONCLUSION: The disparity between perceptions of patient and nurses on the essential content to be learned highlights the importance of considering both of these parties when establishing health education programmes. In addition, nurses should focus more on information related to the recovery period and immediate needs after discharge. RELEVANCE TO CLINICAL PRACTICE: Information about wound care, medication and potential complications should be the core of predischarge education programmes. In addition, nurses should focus on improve patients' awareness of secondary prevention and lifestyle modification, as patients pay less attention to these vital topics.

Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery.

BACKGROUND: In 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. OBJECTIVES: To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. METHODS: A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record. Outcomes of mechanical ventilation in CABG patients before and after the interventions are compared. RESULTS: All target outcomes changed significantly after the interventions, including a reduction in the median hours of initial mechanical ventilation (from 11.4 hours to 6.9 hours, P < .001). The percentage of patients reintubated did not increase (a decrease from 11.8% to 3.5% was not significant, P = .08). The rate of prolonged ventilation decreased from 29.4% to 8.6% (P = .004), and this reduction was sustained for 4 years after the interventions. CONCLUSIONS: Success factors included the multidisciplinary task force and continual protocol reeducation among front-line staff.

Short-term intervention to reduce anxiety before coronary artery bypass surgery--a randomised controlled trial.

AIMS AND OBJECTIVES: The aim of this study was to evaluate an intervention with individualised information and emotional support before coronary artery bypass grafting in a controlled randomised trial. BACKGROUND: Anxiety is a typical phenomenon in patients who are to undergo cardiac surgery. Preoperative anxiety has been shown to correlate to adverse postoperative outcomes. Emotional support could be an effective measure to reduce preoperative anxiety. DESIGN AND METHODS: Patients with planned first coronary artery bypass grafting were randomised into an intervention group (n = 139) and a control group (n = 114). The patients of the control group were routinely informed as usual. The patients of the intervention group received a dialogue with individualised information and emotional support one day before surgery in addition to standard care. This intervention of ~30 minutes was based on a supportive psychotherapy model and was delivered by trained nurses. The primary outcome was the change in anxiety before operation. The secondary outcomes consisted of changes in postoperative anxiety, time on intensive care unit and in-hospital mortality. RESULTS: Significantly reduced anxiety was found in the intervention group patients compared to control patients before coronary artery bypass grafting (p < 0·001) and five days after surgery (p < 0·001). Both groups did not differ in in-hospital mortality and duration of stay in the intensive care unit. CONCLUSIONS: Our short-term psychosocial intervention in patients undergoing coronary artery bypass grafting had a beneficial effect on reducing pre- and postoperative anxiety that was better than routine information alone. RELEVANCE TO CLINICAL PRACTICE: These results advocate training for nurses and physicians to provide emotional support to patients before coronary artery bypass grafting.

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran.

BACKGROUND AND AIMS: Coronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft. MATERIALS AND METHODS: A quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n=36), and control group (n=35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared. RESULTS: Adherence of treatment plan in both groups did not have significant difference before intervention (P=0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P< 0.01) and with control group after intervention (P<0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P<0.01). CONCLUSION: Tele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients' adherence to treatment plan in developing countries such as Iran.

[Efficacy of Multi-vessel Coronary Artery Bypass Grafting for Patient with Low Left Ventricular Ejection Fraction].

The efficacy of multi-vessel coronary artery bypass grafting (CABG) for low left ventricular ejection fraction (LVEF) is controversial. We assessed 31 consecutive low LVEF patients who underwent CABG in our hospital from April 2007 to September 2014. Seventeen patients underwent CABG with distal anastomosis 5 or less (group A), and 14 patients underwent CABG with distal anastomosis 6 or more (group B). Twenty-eight (90%)patients underwent off-pump CABG, and 3 (10%) patients underwent on-pump beating CABG. There was no operative mortality. Postoperative LVEF was improved in group B more than that in group A [9.3±7.0% vs 4.6±9.0% (p=0.023)]. The percentage of patients with improvement of LVEF more than 5% was higher in group B [group A vs group B=29.4% vs 78.6%(p=0.006)]. Early patency rate was 100% (137/137 anastomoses), and cumulative patency rate was not different between 2 groups [group A (1 year:100%, 3 year:100%, 5 year:100%), group B (1 year:100%, 3 year:94.8%, 5 year:94.8%).p=0.177]. The multi-vessel CABG (6 or more distal anastomoses) could be performed safely and would improve LVEF more than less number vessel CABG( 5 or less distal anastomoses) in low LVEF patients.

A typical day in cardiac theatres... or was it? Expect the unexpected.

The operating theatre department is a high risk area and the expectations from the surgical teams are very high in terms of delivering safe and good quality patient care. As healthcare practitioners working in this complex environment we are the guardians of our patients and are their eyes and ears. Scrub practitioners need to be focused, alert and vigilant during all surgical procedures and avoid complacency. As this incident account shows, never take anything for granted.

Applying STAAR interventions in incremental bundles: improving post-CABG surgical patient care.

BACKGROUND: Rehospitalization within 30 days of discharge after coronary artery bypass surgery (CABG) is a contributing factor to higher-than-acceptable overall hospital readmission rates throughout the United States. CABG rehospitalizations are of such concern that they are specifically targeted for action in 2015 under the Patient Protection and Affordable Care Act (2010). The phenomenon of increasing readmission rates has prompted the Institute for Healthcare Improvement to devise the Triple Aim initiative and the STate Action on Avoidable Rehospitalizations (STAAR) initiative to reduce 30-day readmission rates nationally. AIMS: This study explored the impact of implementing STAAR interventions delivered as part of a quality improvement project in incremental bundles on 30-day readmission rates and the experience of care in CABG patients. Specifically, the use of the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff were examined. METHODS: A quantitative comparative study was conducted with 189 post-CABG patients at a tertiary care facility in the United States over a 2-year period, comparing outcomes between the group of patients prior to implementation of the STAAR interventions and those who later received them. Outcome variables included 30-day readmission rate and patient perception of experience of care. RESULTS: The overall 30-day readmission rate for CABG patients in the postintervention group was decreased to 12.0%, compared to 25.8% in the preintervention group. Of the demographic and health characteristics explored, only chronic lung disease was significantly related to 30-day readmission rates, and only in the postintervention group. LINKING EVIDENCE TO ACTION: Thirty-day readmission rates among CABG patients can be reduced and the experience of care can be enhanced through the use of targeted interventions utilizing existing staff and resources. The deliberate incremental implementation of bundled initiatives is an effective strategy in reducing 30-day readmissions in post-CABG patients.

Cardiac surgery nurse practitioner home visits prevent coronary artery bypass graft readmissions.

BACKGROUND: We designed and tested an innovative transitional care program, involving cardiac surgery nurse practitioners, to improve care continuity after patient discharge home from coronary artery bypass graft (CABG) operations and decrease the composite end point of 30-day readmission and death. METHODS: A total of 401 consecutive CABG patients were eligible between May 1, 2010, and August 31, 2011, for analysis. Patient data were entered prospectively into The Society of Thoracic Surgeons database and the New York State Cardiac Surgery Reporting System and retrospectively analyzed with Institutional Review Board approval. The "Follow Your Heart" program enrolled 169 patients, and 232 controls received usual care. Univariate and multivariate analyses were used to identify readmission predictors, and propensity score matching was performed with 13 covariates. RESULTS: Binary logistic regression analysis identified "Follow Your Heart" as the only independently significant variable in preventing the composite outcome (p=0.015). Odds ratios for readmission were 3.11 for dialysis patients, 2.17 for Medicaid recipients, 1.87 for women, 1.86 for non-Caucasians, 1.78 for chronic obstructive pulmonary disease, 1.26 for diabetes, and 1.09 for congestive heart failure. Propensity score matching yielded matches for 156 intervention patients (92%). The intervention showed a significantly lower 30-day readmission/death rate of 3.85% (6 of 156) compared with 11.54% (18 of 156) for the usual care matched group (p=0.023). CONCLUSIONS: A home transition program providing continuity of care, communication hub, and medication management by treating hospital nurse practitioners significantly reduced the 30-day composite end point of readmission/death after CABG. More targeted resource allocation based on odds ratios of readmission may further improve results and be applicable to other patient groups.

Perceived learning needs of Syrian patients postcoronary artery bypass graft surgery.

AIMS AND OBJECTIVES: To describe the perceived learning needs of Syrian patients who underwent coronary artery bypass graft surgery before hospital discharge and to examine the differences in the mean scores of the categories (subscales) of the modified Cardiac Patients Learning Needs Inventory according to the demographic characteristics of the participants. BACKGROUND: Knowledge about the learning needs of patients who underwent coronary artery bypass graft surgery can help nurses in coronary care units to provide them with the information that they need. This might improve their quality of life through decreasing complications, length of stay in the hospital and hospital readmissions. DESIGN: A descriptive design was used for this study. METHODS: A convenience sample of 135 patients participated in this study and completed the demographic form and the modified Cardiac Patients Learning Needs Inventory. RESULTS: Information about chest and leg wound care, complications, medication and physical activity was the most important learning needs. There were significant differences between patients' perceptions of learning needs and their age, chronic illnesses and their working status. CONCLUSION: Syrian patients who underwent coronary artery bypass graft surgery were able to identify their learning needs that should be the focus of nursing practice. RELEVANCE TO CLINICAL PRACTICE: Meeting the needs of patients who underwent coronary artery bypass graft surgery should be emphasised in nursing practice. Meeting these needs might enhance their self-care behaviours.