Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 6 uppsatser.

O objetivo principal deste estudo foi compreender os significados culturais de apoio social e descrever a experiência da enfermidade na perspectiva de um grupo de pessoas submetidas à revascularização do miocárdio (CRVM). O método etnográfico foi utilizado na condução deste estudo bem como os modelos explanatórios, propostos por Arthur Kleinman, foram utilizados para compreender o processo de saúde e doença. Participaram do estudo 11 pacientes moradores de Ribeirão Preto que foram submetidos à CRVM em um hospital terciário e universitário da mesma cidade. Para a coleta de dados, foram utilizados questionário com registro de dados sociodemográficos, entrevista semiestruturada e observações diretas, realizadas na residência dos sujeitos e durante o retorno às consultas médicas. A maioria dos participantes era do sexo feminino (seis), casada, com idade variando entre 49 e 73 anos e ensino fundamental incompleto. A partir da análise e interpretação dos dados, dois temas principais foram identificados: 1) A experiência da revascularização do miocárdio e 2) Significado de apoio social: instrumental e emocional. A notícia da necessidade da CRVM aconteceu de forma inesperada para os pacientes que não relacionavam os sinais e sintomas que apresentavam a qualquer problema de saúde cardiovascular. A necessidade da cirurgia fez com que os pacientes elaborassem diferentes explicações para o problema, como: causas comportamentais (maus hábitos alimentares e tabagismo), físicas (casos na família e consequência de outras doenças crônicas - diabetes e hipertensão arterial), religiosas (desígnio de Deus - provação), sociais (separações, frustrações) e emocionais (muito estresse, nervoso, muitas preocupações, muita ansiedade). Para os pacientes, esse período foi muito difícil, pois não queriam operar, tinham medo de morrer. O apoio dos familiares e de DEUS foi fundamental para tomarem a decisão pela CRVM. Após a CRVM, a principal fonte de apoio para esses pacientes foram os familiares que ofereceram apoio emocional e apoio instrumental. Observamos que o apoio dos profissionais da saúde foi restrito ao ambiente hospitalar e de maneira pontual antes da cirurgia. Para os pacientes, o apoio significou ajuda nas atividades domésticas e de autocuidado, principalmente prestada pelos familiares (cônjuge e filhos). Para os pacientes é muito difícil estar dependente dos familiares, uma vez que antes da doença a situação era inversa. / The main goal of this study was to understand the cultural meanings of social support and to describe the disease experience from the perspective of a group of people submitted to coronary artery bypass graft (CABG). Ethnographic method was used to conduct this study, and the explanatory models proposed by Arthur Kleinman were used to understand the health and disease process. Study participants were 11 patients who lived in Ribeirão Preto and were submitted to CABG at a tertiary teaching hospital in the same city. For data collection, a questionnaire was used to register socio-demographic data, as well as a semi-structured interview and direct observations at the subjects\' homes and during medical return appointments. Most participants were female (six), married, with ages ranging from 49 to 73 years and unfinished primary education. Based on data analysis and interpretation, two main themes were identified: 1) The coronary artery by-pass graft experience and2) Meaning of social support: instrumental and emotional. Most patients unexpectedly received the News about the need for the CABG, who did not relate the signs and symptoms they displayed with any cardiovascular health problem. The need for the surgery made patients elaborate different explanations for the problem, such as: behavioral (bad eating habits and smoking), physical (cases in the family and consequences of other chronic illnesses - diabetes and arterial hypertension), religious (designed by God - probation), social (separations, frustrations) and emotional causes (great stress, nervous, many concerns, great anxiety). For patients, this period was very difficult, as they did not want to operate on, they were afraid of dying. The relatives and God\'s support was fundamental to decide on undergoing the CABG. After the CABG, the main support source for these patients were relatives, who offered emotional and instrumental support. We observed that health professionals\' support was restricted to the hospital environment and happenedpromptly before the surgery. For the patients, support meant help with housework and self-care activities and mainly come from relatives (partner and children). It is very difficult for the patients do depend on their family members, as the situation used to be the opposite before the disease.

A fibrilação atrial (FA) é a arritmia mais comum no pós-operatório de cirurgia cardíaca. Apesar de estar relacionada a alterações estruturais, alguns pacientes, mesmo que sem tais condições, ainda assim, cursam com fibrilação atrial no pós-operatório (FAPO) causando aumento no tempo de internação e custos. Estudos recentes vem ampliando o conhecimento sobre pequenos fragmentos de RNA, chamados de microRNAs (miRNAs) que podem interferir diretamente no aparecimento de algumas doenças na área cardiovascular. O objetivo do presente estudo é: 1) comparar a expressão dos miRNAs 1, 23 e 26 entre pacientes com e sem FAPO; 2) comparar nos grupos a expressão destes miRNAs entre os período pré e pós-cirúrgico; 3)comparar a expressão dos genes GJA1, KCNJ2, CACNB1, CACNA1C e KCNN3 entre os tempos pré e pós-cirúrgico no grupo FAPO; 4) comparar estes últimos genes no tecido atrial; 5) comparar os genes relacionados à produção de interleucinas (IL)-1, 6 e fator de necrose tumoral alfa (TNF?) entre os grupos e entre os tempos pré e pós-cirúrgico; 6)avaliar as características clínicas e evolutivas da população estudada. Pacientes submetidos à cirurgia de revascularização miocárdica foram submetidos à coleta de 20ml de sangue pré e pós-cirurgia bem como fragmento de tecido atrial. Um total de 143 pacientes compuseram os grupos: FAPO (24 pacientes), controle genético (24 pacientes) e controle total (97 pacientes + 24 grupo controle genético). Do ponto de vista clínico observou-se maior idade, tempo de anóxia, tempo de internação em terapia intensiva e hospitalar no grupo FAPO. A análise genética revelou menor expressão do miRNA-23 no grupo FAPO (p=0,02). A comparação entre os períodos pré e pós-cirúrgico revelou redução dos três miRNAs no tempo pós-cirúrgico (p<0,05) e dos genes relacionados às proteínas de canal (p<0,05). A comparação no tecido não evidenciou alterações entre os grupos. Os genes relacionados ás citocinas revelaram redução no período pós-cirúrgico (p<0,05) em ambos os grupos. Concluiu-se que o miRNA-23 pode ter implicação no surgimento da FAPO e outros miRNAs não estudados devem estar envolvidos neste processo uma vez que houve redução de outros genes de canais relacionados ao aparecimento de FAPO. / Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. AF is related to cardiac structural changes although a group of patients still remains developing post-operative atrial fibrillation (FAPO) even without those changes, leading to more days in the hospital and costs. Recent studies showed that short fragments of RNA, called microRNA (miRNA) can contribute to the development of several diseases in the cardiovascular area. The aim of this study is to 1) compare the expression of miRNA-1, 23 and 26 between the group with and without FAPO; 2) compare, in the FAPO group, the expression of these miRNAs in the pre and post-surgery periods; 3) compare the expression of GJA1, KCNJ2, CACNB1, CACNA1C e KCNN3 genes between the pre and post-surgery periods; 4) compare this genes in atrial tissue; 5) compare the genes related to inflammation cytokines as interleukin(IL)-1, 6 and alpha tumoral necrosis factor between the groups in the pre and post-surgery periods; 6) evaluate clinical and evaluative patterns of the study population. Twenty milliliters of blood samples in the pre and post-operative periods and an atrial fragment were extracted from patients submitted to coronary artery bypass graft surgery. A total of 143 patients were divided in the FAPO group (24 patients), genetic control group (24 patients) and a total control (97 + 24 genetic control patients). The clinical analysis showed bigger age and clamp-time, more days in the intensive care unit and hospital in the FAPO group. The genetic analysis revealed less expression of miRNA-23 in the FAPO group (p=0.02). The comparison between the pre and post-surgery periods showed reduction in the three studied miRNAs (p<0.05) and reduction in the genes related to the production of the membrane protein channel sites. The comparisons in the atrial tissue didn´t show any difference in the study groups. The cytokines showed post-surgery reduction (p<0.05) in both groups. The conclusion is that miRNA-23 can be implicated in FAPO as others miRNAs not studied can also be, once there was a significative reduction in the genes related to FAPO development.

Este trabalho teve como objetivo comparar as freqüências e concordâncias em percentual os registros de diagnósticos e intervenções de enfermagem entre dois métodos: Sistematização de Assistência de Enfermagem (SAEP) e o Conjunto de Dados de Enfermagem Perioperatória (PNDS) no transoperatório de RM, Os métodos foram empregados por 2 grupos distintos de enfermeiros em 50 pacientes. Os registros encontrados no SAEP foram transcritos, mapeados para o PNDS e então comparados. No PNDS registrou-se 648 diagnósticos e no SAEP 38. A freqüência de intervenções registradas para o PNDS foi 1863 e para SAEP 1587. Não houve concordância em percentual para a presença de diagnósticos entre os métodos estudados. Nas intervenções do domínio segurança, houve concordância acima de 70% em 12 categorias / This study aimed to compare frequency and percentage agreement of nursing diagnosis and interventions documented by two different methods: Perioperative Nursing Care Process (SAEP) and Perioperative Nursing Data Set (PNDS) during intra-operative CABG surgery. The methods were employed by two distinct groups of nurses with 50 patients. SAEP nursing documentation was transcribed, mapped and compared to PNDS. With the PNDS documentation, 648 nursing diagnosis were recorded and 38 with SAEP. Nursing interventions frequency for PNDS were 1863 and SAEP, 1587. There was no percentage agreement of nursing diagnosis between the studied methods. There was over 70% agreement for safety domain interventions, in 12 categories

Ischemic heart disease is currently the leading cause of death globally. Coronary artery bypass grafting (CABG) is considered the best treatment for many patients and its success depends on the long-term patency of the conduits. Greater use of arterial grafts has been advocated because of their higher long-term patency compared to saphenous vein grafts (SVGs). Despite this, SVGs account for up to 80% of all grafts used in CABG. Consequently, the long-term patency of the saphenous vein (SV) is one of the most crucial challenges in cardiovascular surgery. The no-touch (NT) SV in CABG has shown a superior patency rate, slower progression of atherosclerosis, and better clinical outcome compared to conventional veins up to 8.5 years postoperatively. The aim of this thesis was to study the long-term angiographic, echocardiographic, and clinical aspects of CABG patients receiving either NT or conventional vein grafts and to investigate the health-related quality of life (HRQoL) in this patient group. Studies I-II report a randomized trial between NT and conventional veins where 74 patients were followed-up at a mean of 16 years postoperatively. Study III is a prospective cohort trial in which 97 patients with NT vein grafts anastomosed to the left anterior descending artery (LAD) were included and followed-up at a mean of 6 years postoperatively. Study IV included 257 patients in whom HRQoL and graft patency were studied during the same follow-up visit. Overall, NT vein grafts showed a higher patency compared to conventional veins at a mean of 16 years, 83% vs. 64% (p=0.03), which was similar to the patency of the left internal thoracic artery, 88%. The NT group had a better left ventricular ejection fraction compared to the conventional group, 57.9% vs. 49.4% (p=0.011). After a mean of 6 years, the patency rate of NT SVs to the LAD was 95.6% and to non-LAD targets, 93.9%. Graft patency was an independent predictor of HRQoL in CABG patients. These patients reported a function and wellbeing similar to that of the Swedish population and clearly higher health status than those in the same disease group in the general population.

D.Litt. et Phil. (Psychology) / It is an accepted fact that the incidence of coronary heart disease has reached endemic proportions in South Africa. One of the fastest growing clinical populations in this domain is that of the coronary artery bypass patient. As a result the facilities catering to the biomedical needs of this population are amongst the most sophisticated in the world. However, facilities for the effective psychosocial rehabilitation of these patients are relatively scarce. When they are addressed they tend to focus essentially on secondary emotional factors impeding reintegration back into society. A sadly neglected psychosocial factor and independent risk factor is that of the Type A behaviour pattern. Extensive research in this area has not only found this behaviour pattern to be detrimental to effective rehabilitation but has also found it to be instrumental in the reocclusion of grafted blood vessels resulting in an elevated re-operation rate as well as putting these patients at risk for a potentially fatal coronary event. In an attempt to address this problem a rehabilitation group intervention program adapted for South African conditions was launched. This program was based on the Recurrent Coronary Prone Prevention Project intended for the treatment of post-myocardial infarct patients in San Francisco. Essentially the aim of the project was to ascertain whether this intervention could be applied effectively to the coronary artery bypass population and whether its duration could significantly shortened so as to be more economically viable given the limited economic resources characteristic of the health care services in this country. The modified programme was administered to a group of 13 post-coronary artery bypass graft patients at two local cardiac rehabilitation centres. A second group of 10 patients at these same centres served as a no-treatment waiting list control group, while simultaneously undergoing an aerobic exercise and cardiovascular counselling programme. Results of the study indicate the modified programme to be highly successful in modifying Type A behaviour and its components within the South African context in the post coronary artery bypass patient samples exposed to it. Comparisons of the experimental and control groups after the intervention showed statistically significant differences on the majority of measures. Thus it was- concluded that the modified programme has the potential to be an invaluable aid in the treatment of .this population in South Africa. Presently, however, this sample is being monitored longitudinally in order to ensure that the treatment benefits remain.

Hjärt- och kärlsjukdomar är den största dödsorsaken i världen. En av behandlingarna som kan ges vid detta är koronar bypass operation. Väntan inför denna operation kan upplevas oviss och skapa oro hos patienten. Syftet med litteraturstudien var att undersöka patientens upplevelse i väntan på koronar bypass operation. Metod: Studien genomfördes som en allmän strukturerad litteraturstudie med induktiv ansats där sex kvalitativa, en kvantitativ samt en artikel med mixad metod erhölls. Data bearbetades genom en innehållsanalys. Resultat: Resultatet visade att patienter upplever såväl emotionell som somatisk påfrestning i väntan på koronar bypass operation. De mest framträdande upplevelserna var att patienterna upplevde ängslan och oro, ovisshet, rädsla och fysiska restriktioner. Dessa upplevelser mynnade ut till två teman den emotionella väntan och den somatiska väntan. Konklusion: I väntan på koronar bypass operation var de mest framträdande upplevelserna ovisshet samt ängslan och oro. För att reducera ovissheten, ängslan och oron var det av största vikt att sjuksköterskan arbetade personcentrerat. En sjuksköterskeledd intervention samt möjlighet att prata med tidigare koronar bypass operation patienter visade en signifikant reducering av den emotionella påfrestningen. En ökad förståelse för patienters upplevelse i väntan på koronar bypass operation är av stor vikt för att möjliggöra personcentrerad omvårdnad. / Cardiovascular disease is the leading cause of death in the world. One of the treatments for this is to undergo a coronary artery bypass graft. The waiting time before surgery causes uncertainty and worry in some patients. The aim was to examine patients’ experience while waiting for coronary artery bypass. The Method used was a general structured literature study with an inductive approach, where sixarticles with a qualitative approach, one quantitative and one with mixed method were found. The data was processed through a content analysis. The Result showed that patients experience both emotional and somatic stress while waiting for coronary artery bypass surgery. The most dominant experiences and emotions that patients felt were anxiety, uncertainty, fear, and physical restrictions. These experiences and emotions resulted in two themes Emotional waiting and Somatic waiting. TheConclusion showed to reduce uncertainty and anxiety it was of the utmost importance that the nurse applied person-centered care. A nurse-led intervention as well as the opportunity to talk with former coronary artery bypass patients showed a significant reduction in emotional strain. An increased understanding of patient´s experience while waiting for coronary artery bypass is of great importance to enable person-centered care.

Cognitive ratings that use bipolar constructs based upon similarity and contrast have been shown to be biased towards the similarity pole in approximately a 62/38 ratio. This bias has also been known to shift in the contrastive direction for individuals who have psychiatric problems. This quantitative measure of cognitive change has a potential for characterizing cognitive changes that occur during the disease process, including recovery from disease. The present study investigated changes in self-aspect ratings and bipolar construct use in adult male veterans who had undergone coronary artery bypass graft surgery. Results indicated that treatment subjects' self-aspect and construct ratings were more negative than controls'. Results also indicated that all subjects rated core interpersonal self-aspects closest to the expected bias, while self-aspects related to cardiac recovery problems were rated in the most contrastive direction. The results finally suggested that the greatest degree of change for the treatment subjects were in emotionally generated constructs. The results suggested a preliminary validation for characterizing cognitive changes in the disease process by measuring shifts in bipolar construct ratings.

Die hier vorliegende Studie stellt die Früh- und Langzeitergebnisse der chirurgischen Vorhofablation zur Behandlung des ischämischen Vorhofflimmerns (VHF) in Kombination mit einer aortokoronaren Bypass-Anlage vor. Dabei wurden die epikardiale Pulmonalvenenisolation mittels Radiofrequenzenergie (RF) und die endokardiale Kryoablation inklusive einer Box-Läsion und Mitralisthmuslinie miteinander verglichen. Im Zeitraum von 2002 bis 2009 wurden die prä- und postoperativen Daten von 262 Patienten mit paroxysmalem oder lang-persistierendem VHF prospektiv erhoben und anschließend eine Nachbeobachtung von durchschnittlich 2,30 Jahren durchgeführt. Die Kryoablation war im Vergleich zur RF-Ablation mit einer signifikant höheren perioperativen Invasivität und Morbidität verbunden. Die Operations- und Ischämiezeit sowie die postoperative intensivmedizinische Betreuung waren nach der Kryoablation signifikant länger. Die Rate an Schrittmacherimplantationen (4,8 % vs. 0,0 %), kardialen bzw. zerebralen Komplikationen (22,9 % vs. 12,3 %) und die Krankenhausmortalität (8,4 % vs. 2,2 %) lagen ebenfalls signifikant höher. Hingegen waren die Langzeitergebnisse ohne signifikante Unterschiede zwischen den Ablationsmethoden. Sowohl das Überleben (81,9 % vs. 86,0 %) als auch die Konversionsrate in den Sinusrhythmus (55,6 % vs. 61,5 %), die Lebensqualität der Patienten und die Komplikations- und Reinterventionsraten zeigten im Langzeitverlauf vergleichbare Ergebnisse. Auf der Basis der oben erhobenen Befunde kann die endokardiale Kryoablation nicht als Standardverfahren zur Therapie des paroxysmalen und lang-persistierenden ischämischen VHFs begleitend zu einer aortokoronaren Bypass-Anlage empfohlen werden. Die epikardiale RF-Ablation ist hier aufgrund der geringeren operativen Invasivität bei vergleichbaren Früh- und Langzeitergebnissen der endokardialen Ablation vorzuziehen. :BIBLIOGRAFISCHE ZUSAMMENFASSUNG ABKÜRZUNGSVERZEICHNIS TABELLENVERZEICHNIS ABBILDUNGSVERZEICHNIS 1 EINLEITUNG 1.1 Grundlagen zum Vorhofflimmern 1.1.1 Definition 1.1.2 Epidemiologie 1.1.3 Ätiologie 1.1.4 Klassifikation 1.1.5 Pathophysiologie 1.1.6 Klinik und Komplikationen 1.1.7 Therapieansätze 1.2 Chirurgische Vorhofablation 1.2.1 Entwicklung der VHF-Chirurgie 1.2.2 Indikation 1.2.3 Chirurgische Ablationskonzepte 1.2.4 RF-Ablation 1.2.5 Kryoablation 1.2.6 Alternative Energiequellen 1.3 KHK und operative Revaskularisation bei VHF-Patienten 1.4 Ziele der Arbeit und Fragestellung´ 2 MATERIAL UND METHODEN 2.1 Patientenkollektiv 2.2 Erfassung der Patientenvariablen 2.3 Definition der Endpunkte 2.4 Operations- und Ablationstechnik 2.5 Postoperatives Management 2.6 Follow-Up 2.7 Statistische Auswertung 3 ERGEBNISSE 3.1 Patienten mit paroxysmalem VHF 3.1.1 Patientencharakteristik 3.1.2 Operative Ergebnisse 3.1.3 Postoperative Ergebnisse und Komplikationen 3.1.4 Zustand bei Krankenhausentlassung 3.1.5 Ergebnisse der Langzeitbeobachtung 3.2 Patienten mit lang-persistierendem VHF 3.2.1 Patientencharakteristik 3.2.2 Operative Ergebnisse 3.2.3 Postoperative Ergebnisse und Komplikationen 3.2.4 Zustand bei Krankenhausentlassung 3.2.5 Ergebnisse der Langzeitbeobachtung 3.3 Ausgewählte Vergleiche von Patienten mit paroxysmalem und mit lang-persistierendem VHF 3.3.1 Patientencharakteristik 3.3.2 Operative Ergebnisse 3.3.3 Zustand bei Krankenhausentlassung 3.3.4 Ergebnisse der Langzeitbeobachtung 3.4 Ausgewählte Vergleiche von Patienten mit RF- und Kryoablation 3.4.1 Patientencharakteristik 3.4.2 Operative Ergebnisse 3.4.3 Postoperative Ergebnisse und Komplikationen 3.4.4 Zustand bei Krankenhausentlassung 3.4.5 Ergebnisse der Langzeitbeobachtung 4 DISKUSSION 4.1 Bezug zur Fragestellung 4.2 Einfluss des ischämischen VHFs 4.3 Einfluss des Ablationskonzepts 4.4 Einfluss der Ablationsenergie 4.4.1 Herzspezifische Laborparameter 4.4.2 Postoperative Verlaufsparameter 4.4.3 Ergebnisse der Langzeitbeobachtung 4.5 Schlussfolgerung und Ausblick 4.6 Limitationen 6 ZUSAMMENFASSUNG DER ARBEIT 7 LITERATURVERZEICHNIS 8 ANLAGEN SELBSTÄNDIGKEITSERKLÄRUNG PUBLIKATIONEN DANKSAGUNG

Varje år genomgår omkring 800 000 personer en kranskärlsoperation i världen. En kranskärlsoperation är omfattade och påverkar patienten fysiskt, psykiskt och psykosocialt, vilket i sin tur kan komma att påverka livskvaliteten efter operationen. Livskvalitet är subjektivt och kan upplevas olika beroende på personen i fråga. Eftersom livskvaliteten kan förändras efter en kranskärlsoperation är det viktigt att sjuksköterskan har kunskap och förståelse om vilka faktorer som kan vara betydande för den postoperativa livskvaliteten. Syftet med studien var att belysa faktorer som kan påverka patientens livskvalitet efter en genomgången kranskärlsoperation. Metoden för detta arbete var en litteraturöversikt med en systematisk sökstrategi i databaserna PubMed och CINAHL. Sökningarna som genomförts resulterade i 15 kvantitativa artiklar som analyserades med hjälp av en integrerad analys. Resultatet består av fyra kategorier som belyser faktorer som påverkar livskvaliteten. De kategorier som utgjorde resultatet var fysiska faktorer, psykiska faktorer, biologiska faktorer samt psykosociala faktorer. De mest framstående faktorerna som sågs påverka livskvaliteten var fysiska begränsningar, oro och ångest, social isolering samt komplikationer. Vidare framkom det att faktorer som ålder och kön påverkade hur deltagarna skattade sin livskvalitet. Slutsatsen från denna litteraturöversikt var att livskvaliteten kan komma att påverkas av flera olika faktorer efter en kranskärlsoperation. Resultatet kan vara användbart för sjuksköterskor som arbetar med patienter som ska eller har genomgått en kranskärlsoperation för att kunna ge information om hur livskvaliteten kan påverkas av olika faktorer. Genom att informera patienten om detta kan en trygghet och medvetenhet skapas vilket kan främja hälsan och därmed livskvaliteten. För att få en ytterligare förståelse för hur personer på ett subjektivt sätt ser på livskvalitet behövs mer kvalitativ forskning. / Every year about 800 000 people around the world undergo coronary artery bypass surgery. A coronary artery bypass is an extensive surgery and affects the patient both physically, mentally and psychosocially, which in turn may affect the quality of life after the surgery. Quality of life is subjective and can be experienced differently depending on the person. Since quality of life can change by a coronary artery bypass surgery, it is important that the nurse has knowledge and an understanding of the factors that may be significant for the postoperative quality of life. The aim of this study was to illustrate factors which can affect the quality of life of patients who undergo a coronary artery bypass surgery. The method of this study was a literature review with a systematic search strategy in the databases PubMed and CINAHL. The searches made resulted in 15 quantitative articles that were analyzed using an integrated analysis. The result consists of four categories that illustrate factors which can affect the quality of life. The categories in the result were physical factors, mental factors, biological factors and psychosocial factors. The main factors identified affecting the quality of life were physical limitations, worries and anxiety, social isolation and complications. Furthermore, it emerged that factors such as age and gender also affected how the participant rated their quality of life. The conclusion of this literature review shows that quality of life can be affected by several different factors after coronary artery bypass surgery. The results of this study can be useful for nurses who work with patients who are planning or have undergone coronary artery bypass surgery, by providing adequate information on how quality of life can be affected. By informing patients about these factors which can impact on quality of life, security and awareness can be created, which can help promote health. To gain further understanding of how patients in a subjective way experience quality of life, more qualitative research is needed.