[PDF] Complex Factors That Influence Patient And Partner And Dyad Outcome 4 Months After Coronary Artery Bypass Surgery eBook

Author : Patricia Thomson
Publisher :
Page : pages
File Size : 12,67 MB
Release : 2008
Category :
ISBN :

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Background: Coronary heart disease (CHD) remains a major cause of death and ill-health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest. Aim: To explore the complex factors that influence patient and partner and dyad outcome 4 months after CABG surgery. Design and methods: A multifactorial exploratory, prospective study was carried out. A consecutive sample of 80 patient-partner/family pairs were recruited and data were collected on a number of physical and psychosocial variables 2-3 months prior to elective CABG and 4 months after surgery. The outcome measures were perceived health status, quality of life and CHD risk factors. Findings: The patients' CHD risk factors and physical and mental health (SF-12) improved significantly from pre- to post-operatively, but there was no corresponding improvement in the partners. Most patients were free from angina following CABG. Though the partners' quality of life improved it remained sub-optimum post-operatively. The patients' self efficacy beliefs and partners' efficacy judgements about the patient's cardiac capabilities improved significantly at 4 months; treatment beliefs were unchanged. The patients' perceived social support improved post-operatively, but not the partners. Patients' and partners' total number of important need met increased significantly post-operatively, and the number of important needs unmet decreased. There were significant differences between the patient and partner groups over the two time periods (pre- and post-operatively) for CHD risk factors, physical health (SF-12), self-efficacy for maintaining function, affectionate support, positive social interaction and important needs met and unmet. Overall, the recovery patterns indicated a move towards concordance. The patients' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical health, and lower pre-operative importance need met predicted poorer mental health. Greater pre-operative CHD risk factors and being female predicted higher post-operative risk factors. Partners' poorer pre-operative physical and mental health (SF-12) significantly predicted their poorer post-operative physical and mental health; low pre-operative affectionate support predicted poorer physical and social health (QL-SP); and a greater number of pre-operative CHD risk factors predicted higher post-operative risk factors. The patients' pre-operative beliefs about CABG - mortality risk reduction predicted the partners' poorer post-operative physical health (SF-12) and emotional health (QL-SP); and patients' poorer pre-operative mental health (SF-12) and greater physical limitation (SAQ) predicted the partners' poorer physical and social health (QL-SP). Only the partners' poorer pre-operative physical health predicted patients' poorer post-operative physical health (SF-12). This unidirectional relationship in which the patients' pre-operative factors predominantly influenced partner outcome(s) was also evident when the physical and mental health and CHD risk factors of the dyad (outcomes) were examined. Results highlight the potential that pre-operative rehabilitation and use of interventions, which target the dyad have for the primary and secondary prevention of CHD. Nurses are heavily involved in the pre-operative preparation for CABG and in the post-operative care of patients and could contribute further to improving the outcomes of surgery for patients and partners.

Author : Friederike Kendel
Publisher : Springer Science & Business Media
Page : 106 pages
File Size : 12,31 MB
Release : 2009-01-24
Category : Medical
ISBN : 3798518564

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Progress in coronary artery bypass graft surgery has irrefutably improved the quality of life of many patients. However, we are confronted with the finding that women - hibit a higher mortality rate than men. In part, this difference can be explained by clinical parameters such as age, disease severity, or comorbidity – factors that have been well studied, but which do not fully explain the observed differences. This is one reason why, in recent years, psychosocial variables have attracted special atten- on in this context. In fact, women and men having undergone a bypass operation - ry a great deal with respect to, e. g. , depression, partner status, and socio-economic status. Moreover, psychological well-being, on the one hand, and social isolation, on the other hand, definitely influence the recovery process, particularly when consi- red under the gender aspect. The Deutsches Herzzentrum Berlin has been actively supporting gender-specific research for many years. In this context, a large prospective study on gender dif- rences in recovery after bypass surgery, carried out by the Competence Network of Heart Failure, was started at our Department for Cardiothoracic and Vascular Sur- ry. From the beginning of the study, psychosocial variables were included as being substantial contributors. The starting point of the study presented here* by psychologist Dr. Friederike Kendel are recent empirical investigations about gender differences in coronary heart disease and the course of recovery after bypass surgery.

Author : June B. Pimm
Publisher : Springer Science & Business Media
Page : 239 pages
File Size : 32,61 MB
Release : 2013-11-11
Category : Medical
ISBN : 1461327350

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Heart surgery is still a relatively recent advance in medical technology. The first open-heart procedure was closure of an atrial septal defect in a child at the University of Minnesota Hospital in 1953. This issued in a life-saving advance, the use of which has expanded enormously to in clude treatment of many areas of cardiac disease. Not unexpectedly, surgical techniques allowed through the use of the heart-lung machine (open-heart surgery) came to be applied in 1967 to the major killer of Americans, namely, coronary artery disease. This operation, known as coronary artery bypass, has become one of the most common surgical operations. Coronary artery disease, with the possibility of total incapacitation or sudden death from a heart attack, can alter severely the personality of the patient. Corrective surgery can sometimes intensify rather than ame liorate a patient's fears. To the surgeon, occupied by increasing numbers of patients, there is not time enough to give the preoperative attention that might be helpful. Also, the surgeon and cardiologist are limited in their ability to recognize those patients near the breaking point. The research outlined in these chapters by Drs. Pimm, Feist, and their associates is welcomed by cardiologists and cardiac surgeons. It provides insight into what appears to be reliable recognition of those patients likely to have an adversely affected mental status by coronary bypass surgery and "crisis intervention" to avert this effect and allow the complete benefit of returning the patient to a normal life.

Author : Karen Theobald
Publisher :
Page : pages
File Size : 15,28 MB
Release : 2001
Category : Coronary heart disease
ISBN :

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Abstract: Many things change following Coronary Artery Bypass Graft (CABG) surgery for both the patient and his/her carer. The major aim of this research was to provide an indepth examination of these changes to investigate influences on recovery. The study was devised on the premise that this information would provide a significant basis for hospital discharge planning.-- A qualitative research approach, naturalistic inquiry, guided the study. Sixty people were interviewed, including thirty patients and their carers. Interviews were undertaken four to five weeks following discharge from hospital after CABG surgery. Subsequently, twelve months after the initial interview, patients and carers were again contacted to verify the findings generated from the first phase of the study, and to gain further data on his/her current health status.-- Data analysis revealed a number of maj or themes and sub themes for patients and carers. Almost half the patients stated that heart surgery was a huge personal shock. Adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. They spoke of mental and emotional changes as well as concerns over the financial burden of the surgery. Coming to terms with lifestyle adjustments and worrying about the future were other themes that emerged in patients' accounts. They offered suggestions to improve support services, like establishing a twenty-four hour telephone chat line and forming community clubs to link up with other patients. In assisting to better prepare for discharge home, they suggested providing more information about what to expect during recovery, like the up and down days that they might experience.-- Carers experienced a separate set of issues/needs and concerns as they came to terms with their loved one's cardiac surgical recovery. The major findings for carers fell under four major themes, Events Surrounding Another's Heart Surgery; Adjusting to the Surgery; Personal Changes Due to Surgery and Discovering Pathways to Recovery. Carers were shocked with the news that a family member required urgent cardiac surgery and theft reactions suggested a sequence of experiences that encountered in coming to terms with the event. Carers adjusted to the situation by taking on the role of watcher or minder and monitored the patient's recovery. Some of the personal changes that carers dealt with, were changes in their activities and responsibilities; tiredness; experiencing a range of emotions and wonying about the unknown. Carers also offered suggestions for improved support services, like identifying a range of community services in close locality to his/her home. In better preparing for discharge home, some carers wanted more assistance and advice on how to be an effective carer.-- This research study provides unique insights into the experiences of patients and carers after coronary bypass graft surgery in the first four to five weeks following discharge home from hospital. The study outlines the issues/concerns and needs of CABG patients and their carers after they leave hospital, highlighting those related to age, gender, and family support. For example, many patients commented that they were too young for this to occur. Gender differences included, that the majority of carers were females and male patients reported experiencing more pain following cardiac surgery. Family support was a critical factor in enhancing recovery. Study findings suggest the need for a re-examination of hospital discharge preparation and the further provision and monitoring of home support services.

Author : Marlies Alvarenga
Publisher : Springer
Page : 0 pages
File Size : 12,46 MB
Release : 2017-11-11
Category : Medical
ISBN : 9789812872050

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This handbook brings together the full weight of contemporary evidence bearing on what is now commonly termed “psycho-cardiology”. It focuses on the role of psycho-social factors in the genesis and clinical management of cardiovascular disease (CVD). The book constitutes a critically reviewed compendium of current knowledge in the area, coupled with guides to evidence-based best practice in the field of psycho-cardiology. The following categories are covered: Social/demographic risk for CVD, Personality and CVD risk, Stress and CVD risk, Psychopathology (particularly affective disorders) and CVD risk, The psychological management of those with clinical CVD, Psychology in the prevention of CVD. The book integrates the evidence into a compelling argument that clinicians, researchers and those in public health will discount the role of psychological factors in regard to CVD at their own peril. And importantly for clinicians charged with the care of patients with CVD, the book poses the argument that failure to recognize the links between psychological factors and CVD may well be at the considerable peril of those patients under their care.

Author : Jeffry A. Simpson
Publisher : Guilford Publications
Page : 465 pages
File Size : 34,32 MB
Release : 2015-02-20
Category : Psychology
ISBN : 1462518737

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This volume showcases the latest theoretical and empirical work from some of the top scholars in attachment. Extending classic themes and describing important new applications, the book examines several ways in which attachment processes help explain how people think, feel, and behave in different situations and at different stages in the life cycle. Topics include the effects of early experiences on adult relationships; new developments in neuroscience and genetics; attachment orientations and parenting; connections between attachment and psychopathology, as well as health outcomes; and the relationship of attachment theory and processes to clinical interventions.

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
Page : 335 pages
File Size : 21,88 MB
Release : 2020-01-02
Category : Medical
ISBN : 0309495474

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Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.

Author : National Research Council
Publisher : National Academies Press
Page : 421 pages
File Size : 22,74 MB
Release : 2013-04-12
Category : Social Science
ISBN : 0309264146

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The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
Page : 399 pages
File Size : 21,83 MB
Release : 2019-01-27
Category : Medical
ISBN : 0309477891

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In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

Author : Nathan E Goldstein
Publisher : Elsevier Health Sciences
Page : 739 pages
File Size : 27,40 MB
Release : 2023-11-07
Category : Medical
ISBN : 032384703X

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Using a practical, question-and-answer approach, Evidence-Based Practice of Palliative Medicine, 2nd Edition, helps you provide optimal care for patients and families who are dealing with serious illness. This unique reference focuses on patient and family/caregiver-centered care, highlighting the benefits of palliative care and best practices for delivery. The highly practical, user-friendly format sets it apart from other texts in the field, with concise, readable chapters organized around clinical questions that you’re most likely to encounter in everyday care. Uniquely organized using a question-and-answer approach, making it easy to find answers to common questions asked by practitioners and patients. Up-to-date, reader-friendly chapters explore interventions, assessment techniques, treatment modalities, recommendations and guidelines, communication techniques, and available resources for palliative care. Expanded discussions on hospice in every chapter, and a new emphasis on pediatrics, with increased material on pediatric malignancies, developmental delays, cystic fibrosis, and perinatal palliative care. New chapters on wellness of the palliative care practitioner, patients with opioid use disorders, telehealth in palliative care, health disparities, rural palliative care, caring for people with hematologic malignancies, integrative and alternative therapies, LGBTQ+ populations, mobile health technologies, and national palliative care implementation strategies. High-quality evidence gathered and reviewed by leading experts in palliative medicine, including clinicians, educators, and researchers across a broad range of disciplines. Numerous algorithms throughout help you make informed decisions, and “take-home” points in every chapter provide a quick summary of key content. Any additional digital ancillary content may publish up to 6 weeks following the publication date.