Jill Riley, MSc, BA (Hons), RN, RM.
Senior Lecturer, Thames Valley University, Royal Brompton Hospital, LondonThe success of cardiac surgery depends not only on the pre- and perioperative periods but also on the preparation for discharge and provision of ongoing support. The trend is towards shorter hospital stays - despite increasingly complex surgery. Going home earlier is likely to reduce the risk of hospital-acquired infection and assist with early rehabilitation, but it increases the challenge to nurses to prepare both patient and family.
The success of cardiac surgery depends not only on the pre- and perioperative periods but also on the preparation for discharge and provision of ongoing support. The trend is towards shorter hospital stays - despite increasingly complex surgery. Going home earlier is likely to reduce the risk of hospital-acquired infection and assist with early rehabilitation, but it increases the challenge to nurses to prepare both patient and family.
Once home, patients need to care for themselves, manage their medication, solve problems and have the confidence to know when to seek help. For children, parents have to fulfil these roles. Education, starting in the pre-operative period, should involve what to expect about recovery rates, skills required, symptoms and contact details (Margereson and Riley, 2003).
Care-givers experience many emotions (Jickling and Graydon, 1997). If they are unsupported it can increase anxiety for them and the patient, delaying recovery and leading to re-admission.
Various support options exist. The 'hospital-at-home' scheme uses a care pathway or protocol that facilitates coordinated care by the practice nurse, district nurse, heath visitor, paediatric liaison nurse or the hospital outreach service.
Using telephone calls to support patients in the early post-discharge period has not shown a significant reduction in anxiety and depression (Johnson, 2000). However, a more structured model of care using booklets, tapes, videos and a website to provide information and reinforce skills such as breathing technique has shown patient benefit (Brennan et al, 2001).
Care-givers can face increasing burdens, spending time ferrying patients to work or on shopping trips, reminding them about medication and the need to take physical exercise, and looking after them in other ways. The effect on families can be anger or even depression.
Support groups have a key part to play (Box). Information, emotional support and provision of resources are all likely to improve self-esteem and make it easier to adopt healthier lifestyles (Ajzen and Fishbein, 1980).
The move to shorter hospital stays will continue. Despite the challenges, it also provides nurses with an opportunity for creative thinking and autonomous roles. Caring for patients throughout their illness brings satisfaction at seeing a job well done.
Ajzen, I., Fishbein, M. (1980) Understanding Attitudes and Predicting Behaviour. Englewood Cliffs, NJ: Prentice Hall.
Brennan, P.F., Moore, S.M., Bjornsdottir, G. et al. (2001)HeartCare: an internet-based information and support system for patient home recovery after coronary artery bypass grafting surgery. Journal of Advanced Nursing 35: 5, 699-708.
Jickling, J., Graydon, J. (1997)The information needs at time of hospital discharge of male and female patients who have undergone coronary artery bypass grafting: a pilot study. Heart Lung 26: 350-357.
Johnson, K. (2000)Use of telephone follow-up for post cardiac surgery patients. Intensive and Critical Care Nursing 16: 144-150.
Margereson, C., Riley, J. (2003)Cardiothoracic Surgical Nursing: Current trends in adult care. Blackwell Science: Oxford.