Abstract
Background: Nurses have a key role in teaching cardiovascular (CV) surgical patients to manage their post-surgical care after discharge. There is evidence that effective patient teaching contributes to improved quality of life, decreased anxiety and depression and fewer post-CV surgery emergency department visits and hospital readmissions. Despite this, there are no guidelines or standards for how best to educate CV surgical patients for discharge. Aim: To conduct a literature review of published research on discharge education for CV surgical patients to inform guidelines for educating CV surgical patients. Method: An exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of Systematic Reviews, and ERIC was executed using the following search terms: cardiovascular, cardiac, cardio, heart, surg, transplant, discharge, self-manage, teach, educat, preop, patient, care. In addition, an ancestry search of all reference lists was completed. Studies were included if they were published between 2007 and 2012 and focused on preoperative CV surgery adult patient education. Results: The search yielded 20 studies, 12 were excluded because they did not meet the inclusion/exclusion criteria. Eight studies were included in the final review. Three studies reported statistically significant decreases in reported anxiety and depression and increased subjective health. Four studies had mixed results with both positive and neutral findings. No studies reported negative findings in relation to preoperative education. Conclusion: Patients and staff identified that patient education is essential. Standardized educational tools are appropriate as they can spare resources, but are only effective if used in conjunction with individualized education.
| Original language | English |
|---|---|
| Pages (from-to) | 22-31 |
| Number of pages | 10 |
| Journal | European Journal of Cardiovascular Nursing |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb. 2014 |
Keywords
- CV surgery
- discharge education
- discharge planning
Fingerprint
Dive into the research topics of 'Discharge education to promote self-management following cardiovascular surgery: An integrative review'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: European Journal of Cardiovascular Nursing, Vol. 13, No. 1, 02.2014, p. 22-31.
Research output: Contribution to journal › Review article › peer-review
TY - JOUR
T1 - Discharge education to promote self-management following cardiovascular surgery
T2 - An integrative review
AU - Veronovici, Nicole R.
AU - Lasiuk, Geraldine C.
AU - Rempel, Gwendolyn R.
AU - Norris, Colleen M.
N1 - Funding Information: CV surgery education has been demonstrated to improve patient outcomes post-discharge. Self-management skills are rarely innate and patients and families require education to acquire the knowledge and skill to manage their care at home post-CV surgery. This literature review was completed to determine what content, timing, and teaching methods will enhance the success of CV surgical patients. The review revealed that using mass produced pamphlets and videos in conjunction with individualized, face-to-face patient education enables patients to identify their own priorities and achieve improved outcomes such as decreased anxiety and depression, lower readmission rates, and have fewer physical complications post-surgery. The scarcity of recent literature regarding CV surgical patient education coupled with the positive results determined by this review indicate that further research is required to discover what material should be taught to patients at certain time points prior to surgery and in the post-surgical time period. More research is needed to determine how best to provide individualized care and how to educate nurses and other health professionals to provide this care. We are confident that these efforts will lead to improved patient knowledge, satisfaction and quality of life. Appendix 1. Studies in the review. Reference Country Study aim(s) Intervention Method, population/sample; outcome variables Major findings Babaee et al. 23 Iran Evaluate the ability of a health education program to improve the QOL for patients undergoing CABG surgery. Intervention based on Ross and Mico’s Health Education Planning Model and employed a booklet with information about lifestyle, anatomy and physiology of the heart, and the CABG procedure Control group received standard care RCT N = 80 Males 40–65 years old with atherosclerosis diagnosed by angiography requiring CABG. QOL; subjective report of physical function Significant improvement in QOL and in subjective reports of physical function Cebeci and Celik 24 Turkey Study the effect of pre-op discharge training and counseling on post-op CABG patients’ self-care ability and amount/types of problems experienced after discharged Intervention group received individualized education and counseling plus an information booklet Control group received standard care Prospective and quasi-experimental N = 109 Males and females First time CABG recipients Intervention group scored higher on self-care, had fewer problems post-discharge and fewer readmissions Guo et al. 25 China Determine whether a pre-op education intervention reduces anxiety and depression and improves recovery Education to patients and family provided through a pamphlet and verbal advice. The pamphlet ( Your Heart Surgery ) covered pre-op tests and preparation; what to expect post-op in the ICU and the cardiac surgical ward; recovery at home; and a contact number to call with post-discharge problems RCT N = 153 Gender? Age? First time cardiac surgery patients CABG? Intervention group had greater decrease in anxiety and depression scores and better sleep. This group spent an average of four hours less in the ICU, but there were no differences in total post-op hospital stay. No group differences in average pain, current pain, and activity Goodman et al. 29 United Kingdom Evaluation of nurse-led education and counseling program Intervention – individualized education that allows patients to ask questions and voice concerns. Cardiac risk assessment to help patients learn what lifestyle changes are needed Individualized counseling re: lifestyle modifications using motivational interviewing techniques Nurse reviewed a manual that was then given to patients; the manual covered risk factors, prep for surgery and what to do if they have chest pain Patients were able to telephone the team with any questions between visits Control group received standard care RCT N = 188 Patients listed for CABG with at least one poorly controlled risk factor There was no change in overall risk factors prior to CABG but the intervention did reduce overall healthcare utilization. Statistically significant improvement in BP and cholesterol but not BMI No change in length of hospital stay, QOL or post-op complications Slight improvement in physical QOL Cost minimized in the intervention group due to fewer readmissions Goodman et al. 30 United Kingdom Investigate patients and staff experiences and perspectives using an educational program pre-CABG Discovery interviews done three months post-CABG and focused on participants’ experiences and perspectives Discovery interviews N = 19 Participants were part of a previous RCT Participants reported being given standard information that was not individualized Participants appreciated having a nurse come to their home to answer their individual medical questions and refer back to the medical team if needed. While they appreciated the support from the nurses, they wanted better communication and physical assessment and did not find the waiting period for a CABG to be a suitable time to address risk factors for CAD Participants reported getting information from other sources (e.g. family physician, diabetic clinic or previous cardiac rehab courses) Participants’ understanding of the health care system was much different from that of the providers A key nursing perspective was that the success of the program was influenced by the patients’ attitudes toward their health and research Liou et al. 26 China Evaluate the effect different types (video versus booklet) of pre-op CV education have on autonomic responses and anxiety levels Group 1: video Group 2: booklet RCT N = 91 First time CABG patients Perceived stress scores and recovery outcomes were similar between groups; no differences in heart rate between groups Total instruction time was significantly shorter using the video Sørlie et al. 27 Norway Evaluate the efficacy of an information intervention on emotional recovery following CABG Intervention group received video plus individualized instruction at admission and at discharge Control group received standard education and no video Pre-op education included procedural and sensory information related to diagnostic and pre- and post-op events plus some behavioral instructions Post-op education included lifestyle changes and self-management techniques for at home and work RCT N = 109 Patients younger than 68 years, with stable angina, first CABG, no severe co-morbidities The intervention group reported: less anxiety and better subjective health at discharge; better subjective health throughout entire two-year follow-up; less anxiety up to one year; less depression six months to two years after discharge Zhang et al. 28 China Evaluate the effect of nurse-initiated pre-op education and counseling program on post-op complications and anxiety symptoms following CABG Intervention group received standard pre- and post-op care plus a structured education and counseling course three days prior to surgery Course material included hospitalization and CABG processes, post-op pain control, pulmonary care (abdominal breathing and effective coughing), rehabilitation (nutrition, medication administration, early mobility) and psychological counseling Control group received standard care Prospective RCT N = 40 High-risk surgical with a EuroSCORE of 6 or more going for CABG Intervention group reported statistically significant physical problems and mean anxiety scores CABG: coronary artery bypass graft; pre-op: preoperative; post-op: postoperative; ICU: intensive care unit; BP: blood pressure; BMI: body mass index; QOL: quality of life; CV: cardiovascular; RCT: randomized control trial The authors would like to thank Cathy Osborne and Shelley Vallaire from the Cardiac Sciences Program at the Mazankowski Alberta Heart Institute for their encouragement and support with this project. Their encouragement and commitment to improving the patient journey through cardiovascular surgery are exemplary. Conflict of interest The authors declare that there is no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
PY - 2014/2
Y1 - 2014/2
N2 - Background: Nurses have a key role in teaching cardiovascular (CV) surgical patients to manage their post-surgical care after discharge. There is evidence that effective patient teaching contributes to improved quality of life, decreased anxiety and depression and fewer post-CV surgery emergency department visits and hospital readmissions. Despite this, there are no guidelines or standards for how best to educate CV surgical patients for discharge. Aim: To conduct a literature review of published research on discharge education for CV surgical patients to inform guidelines for educating CV surgical patients. Method: An exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of Systematic Reviews, and ERIC was executed using the following search terms: cardiovascular, cardiac, cardio, heart, surg, transplant, discharge, self-manage, teach, educat, preop, patient, care. In addition, an ancestry search of all reference lists was completed. Studies were included if they were published between 2007 and 2012 and focused on preoperative CV surgery adult patient education. Results: The search yielded 20 studies, 12 were excluded because they did not meet the inclusion/exclusion criteria. Eight studies were included in the final review. Three studies reported statistically significant decreases in reported anxiety and depression and increased subjective health. Four studies had mixed results with both positive and neutral findings. No studies reported negative findings in relation to preoperative education. Conclusion: Patients and staff identified that patient education is essential. Standardized educational tools are appropriate as they can spare resources, but are only effective if used in conjunction with individualized education.
AB - Background: Nurses have a key role in teaching cardiovascular (CV) surgical patients to manage their post-surgical care after discharge. There is evidence that effective patient teaching contributes to improved quality of life, decreased anxiety and depression and fewer post-CV surgery emergency department visits and hospital readmissions. Despite this, there are no guidelines or standards for how best to educate CV surgical patients for discharge. Aim: To conduct a literature review of published research on discharge education for CV surgical patients to inform guidelines for educating CV surgical patients. Method: An exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of Systematic Reviews, and ERIC was executed using the following search terms: cardiovascular, cardiac, cardio, heart, surg, transplant, discharge, self-manage, teach, educat, preop, patient, care. In addition, an ancestry search of all reference lists was completed. Studies were included if they were published between 2007 and 2012 and focused on preoperative CV surgery adult patient education. Results: The search yielded 20 studies, 12 were excluded because they did not meet the inclusion/exclusion criteria. Eight studies were included in the final review. Three studies reported statistically significant decreases in reported anxiety and depression and increased subjective health. Four studies had mixed results with both positive and neutral findings. No studies reported negative findings in relation to preoperative education. Conclusion: Patients and staff identified that patient education is essential. Standardized educational tools are appropriate as they can spare resources, but are only effective if used in conjunction with individualized education.
KW - CV surgery
KW - discharge education
KW - discharge planning
UR - http://www.scopus.com/inward/record.url?scp=84893106997&partnerID=8YFLogxK
U2 - 10.1177/1474515113504863
DO - 10.1177/1474515113504863
M3 - Review article
C2 - 24042728
AN - SCOPUS:84893106997
SN - 1474-5151
VL - 13
SP - 22
EP - 31
JO - European Journal of Cardiovascular Nursing
JF - European Journal of Cardiovascular Nursing
IS - 1
ER -