Theory
The present paper discusses the nursing care procedures for the patients after the coronary artery bypass graft (CABG). This surgery is conducted for the improvement of the blood flow to the heart that is complicated due to the blockage in the artery. Addressing this problem, an artery graft is taken from another part of the body and stitched to the coronary artery to bypass the blocked section. The current rate of mortality during CABG is 2% and is addressed by the nursing professionals by means of thorough pre-operational care (Chaisson et al., 2014). As for the post-operational care, Aslan, Badir, Arli, and Cakmakci (2009-10) note that pain is the most common cause of complaints among the patients. STAAR (state action on avoidable rehospitalizations) intervention is proposed as an effective method of the improvement of post-CABG surgical patient care (Bates, O’Connor, Dunn, & Hasenau, 2014).
Article 1 (Summary): Improving Patients’ Readiness for Coronary Artery Bypass Graft Surgery
The article by Chaisson et al. (2014) focuses on the methods of preparations of the patients to an urgent CABG surgery that would minimize the risk of adverse outcomes. The research is based on a quasi-experimental design with data collected in several interrupted time series before, during and after the intervention. The measured group of interventions involved seven aspects: “use of aspirin (within 7 days), use of a β-blocker (within 24 hours), use of a statin-type lipid-lowering agent (within 24 hours), preoperative hematocrit greater than 30%, 6 AM glucose level less than150 mg/dL (to convert to millimoles per liter, multiply by 0.0555) on the day of surgery, delaying surgery a minimum of 3 days after an acute myocardial infarction, and induction heart rate less than 80/min” (Chaisson et al., 2014, p. 30). All of the interventions were evidence-based. In total, the number of participants of the study was 1198. The calculation of the bundle score was compared to the patient outcomes and showed that the subjects with the higher bundle score (more interventions assigned) had better outcomes. The authors also calculated the number of hours to extubation and the days to discharge. Finally, the bundle scores were related to the mortality and composite outcomes (renal dysfunction, stroke, and mediastinitis or dehiscence). The least effective were the interventions estimating blood sugar, heart rate, and hematocrit. The authors concluded that their quality improvement intervention showed a high level of effectiveness.
The study has demonstrated the factors that impact the success of the urgent CABG and help the patients recover better. In the future, I intend to offer the evidence from this study as a basis for change in terms of the quality improvement effort.
Article 2 (Summary): Patient’s Experience of Pain after Cardiac Surgery
The article by Aslan et al. (2009-10) explores the issue of painful sensations as an outcome of the cardiac surgery for the ICU patients. The study included the participants who had undergone various cardiac procedures for coronary artery disease. Seventy-four percent of the participants (300 people in total) had CABG surgeries; the others underwent aortic valve replacements and mitral valve replacements. The researchers evaluated the perceptions of painful sensations by the patients (stabbing, throbbing, burning, limiting the range of movement, to name a few), the activities that caused main (change of dressings, movement, positioning), and the interventions minimizing pain (remaining still, taking analgesic medications, chest tube removal). In the research, the chest tubes were identified as the factor the causes the most discomfort in a form of painful sensations when the patients turn in their beds and move around. Another significant cause of pain among the ICU patients was endotracheal tube suctioning. Besides, Aslan et al. (2009-10) noted that some patients named air mattresses used for the minimization of pain as its primary drivers.
The findings of this article are valuable as they reveal several causes of pain in the ICU patients recovering after the cardiac surgeries such as CABG. None of the causes, however rare, should be left without attention. Having read this article, in the future, I will pay attention to such factors as air mattresses as contributors to discomfort and aspects that can be addressed in order to improve the patients’ experience. That way, this knowledge will allow me to deliver more nursing excellence based on evidence.
Article 3: Applying STAAR Interventions in Incremental Bundles: Improving Post-CABG Surgical Patient Care
The article by Bates et al. (2014) addresses the issue of the 30-day readmission rates in the patients who have undergone CABG. The authors specify that the high rehospitalization rates were the focus of the ACA and some other quality improvement programs. In the study, the researchers test the STAAR interventions such as “the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff” (Bates et al., 2014). The study is quantitative-comparative. The number of participants is 189. The patient outcomes were observed within two years. The results of the patients who have not undergone the STAAR interventions and those who did later were compared. The measured outcomes were the patients’ perceptions of care and the rates of readmission. The study documented the positive influence of the intervention as the rate of rehospitalization dropped from 25.8% (pre intervention group) to 12% (post intervention group). The researchers found that the patients with chronic lung disease were more likely to be readmitted. The study has confirmed the positive impact of the follow-up appointments with a cardiologist scheduled before the patients were discharged combined with a teach-back method reduced the rates of rehospitalization significantly.
This study is important for my future practice as a patient educator because it specifically targets the delivery of education to the patients and their family members and caregivers. The teaching aspects involved were a meeting with the patient and a caregiver three days after the discharge, repeating the new information and providing a detailed demonstration (as many times as necessary), and assessing its comprehension by both the patient and the caregiver. I plan to use this structure in my patient-education practice in the future.
Case Study
Patient Description
The patient is a 61-year old female who has undergone CABG surgery. She requires education concerning self-care and lifestyle changes she needs to accomplish after discharge. She has complained that her memory is not good and is worried that she would not memorize all the information. She uses an organizer in her table to manage day-to-day activities.
Existing Tool
MyHealth.Alberta.ca is a website that provides accessible and easy to comprehend information for the patients. The article useful for my patient is “Coronary Artery Bypass Graft Surgery: Self-Care for Recovery”.
The patient may find it using the link above or going to www.myhealth.alberta.ca and typing in “CABG self-care” in the search bar. The article provides bullet points Do’s and Don’t’s as well as clear instructions for lifestyle changes and self-care activities.
Original Tool
Since the patient cannot rely on her memory, I have created a self-care schedule of all the activities and changes she needs to make to avoid health problems.
Self-Care.
- Instructions: This is a one day schedule that can be repeated every day with the inclusion of additional activities (more walks, shopping for healthy food, writing down meals, attending cardiac rehabilitation, adding more notifications about medication). You should print out a full version of it and hang it where you can see it. Also, add all of the activities to your organizer set with the sound notifications. This schedule will allow you to arrange all the necessary activities without forgetting them.
- Teaching plan: I will meet with the patient and her daughter who helps her with the daily activities and explain the necessary tasks for the patient and the importance of their regularity. The patient is 61, and her daughter is 38. For them to memorize the list of primary activities I will present them as 3 W’s – Weight (keeping track of body mass, eating more fruits and vegetables and less fat and sugar), Walks (one of two walks daily), Wound (caring about the incision). To assess the results of the teaching session, at the end of it, I will ask the patient and her daughter to repeat the 2 W’s and explain what activities they stand for. The teaching method and tool are designed for the patient who has memory problems to simplify the information and help her memorize the required tasks.
- Objectives:
- Achieve easy understanding and memorization;
- Integrate the use of schedule in the daily life of a patient;
- Organize the patient’s day with the help of reminders and ensure proper self-care for recovery.
References
Aslan, F., Badir, A., Karadag A. S., & Cakmakci, H. (2009-10). Patients’ experience of pain after cardiac surgery. Contemporary Nurse, 34(1), 48-54. Web.
Bates, O., O’Connor, N., Dunn, D., & Hasenau, S. (2014). Applying STAAR Interventions in Incremental Bundles: Improving Post-CABG Surgical Patient Care. Worldviews On Evidence-Based Nursing, 11(2), 89-97.
Chaisson, K., Sanford, M., Boss, R., Leavitt, B., Hearne, M., & Ross, C.,… Malenka, D. J. (2014). Improving Patients’ Readiness for Coronary Artery Bypass Graft Surgery. Critical Care Nurse, 34(6), 29-36. Web.