Improving family functioning after cardiac surgery: a randomized trial

Article Abstract:

Advances in cardiac care can extend the lives and improve the functioning of many heart patients, but the effects of surgical intervention on the psychology of patients and their families have not been assessed. There is little research on whether nursing intervention can help prevent adjustment problems. After a heart attack, the patient's spouse is often anxious and depressed for up to six months, and the different concerns of patient and spouse sometimes result in conflicts. The patient usually concentrates of pain management and short-range problems, while the family has begun to look ahead to long-range recovery. Spouses had higher stress levels than patients during the hospitalization phase, and their perception of their role as the monitors of the recovery phase sometimes led to nagging and overprotective behavior. Counseling after a heart attack has received mixed reviews. Whether the same pattern of stress is true of recovery after coronary bypass, transplantation, percutaneous transluminal coronary angioplasty, or other heart surgery is not known. It is generally acknowledged that there is a stressful period of transition, but few patients suffer long-lasting effects. The framework for this study was based on the supposition that a crisis, plus a family's resources, plus the family's perception of the crisis interact over a long period and influence adaptation. The ''resources'' of the family were increased by adding nursing care and counseling, which would in turn influence the family's ability to adapt. Out of 79 patient-spouse pairs, five patients died and seven others suffered complications or withdrew for other reasons. The remaining 67 couples provided too small a sample to detect small changes due to intervention, but the results were interesting nonetheless. There was no significant difference between those who received counseling and those who did not, indicating that perhaps the low-key approach to counseling used in this study is inadequate. It is becoming increasingly clear that family counseling is a complex task, requiring special knowledge and skills. All patients reported family problems at the three-month and six-month points, but at the latter time, spouses who had received counseling no longer reported a decrease in family functioning. Immediately after surgery, the ''threat'' is external, but three months later the problem becomes one of individual coping. Although previous family patterns of relationships and coping influence this period, there are predictable stresses after heart surgery that put the family at added risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

Services, Surgery, Heart, Nurse and patient, Nurse-patient relations, Family services, Heart surgery

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Patient anxiety before cardiac catheterization: an intervention study

Article Abstract:

The waiting period prior to an invasive diagnostic test can be a stressful period for the patient. Feelings of uncertainty and anxiety are common. Cardiac catheterization is an invasive diagnostic test that can cause significant stress during the waiting period. Several studies have reported that providing educational classes on the diagnostic procedure during the waiting period can reduce patient anxiety. Since all patients who undergo cardiac catheterization are informed about the details and risks of the procedure well in advance, it is not clear whether the educational intervention programs reduce anxiety by repeating information about the procedure or because they distract the patient so that the patient does not have time to become anxious. To investigate this issue, 72 patients scheduled for cardiac catheterization were studied. During the waiting period, 24 of the patients participated in a 30-minute educational program that reviewed the details of the diagnostic procedure, 24 participated in social discussions about their hobbies and interests, and 24 patients were left alone in the waiting room. After 30 minutes, each patient completed a questionnaire (the Spielberger State-Trait Anxiety Inventory) to determine the patient's level of anxiety. The patients in the educational and social intervention groups experienced a significant decrease in anxiety compared with the control group. Both of these interventions were equally effective in reducing anxiety. It is concluded that patient anxiety can be reduced if support is provided by a concerned individual. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Stress management, Anxiety, Cardiac catheterization, Heart catheterization

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