Background Nosocomial infection is a crucial problem and cause of morbidity and mortality especially in cardiac surgery settings. The risk of acquiring such infection is even higher because cardiac surgery patients require intensive care postoperatively. The phenomenon is evidenced by longer length of hospital stay and increased cost of care. Pneumonia and surgical site infections were ranked among the top three most common hospital acquired infections. The usual practice for mouth care is diluted thymol gargle solution for intubated patients after cardiac surgery in Hong Kong. No local studies examine the effect of oronasopharyngeal care on minimizing such infections. An evidence based guideline in oral and nasopharyngeal nursing care is necessary to implement in hospitals for improving patient surgical outcome. Objective To develop an evidence based practice guideline for pre- and postoperative oronasopharyngeal care of in-patients undergoing cardiac surgery with implementation planning and discussion on evaluation. Methods The most recent publications were searched till August 2011. Randomized controlled trials with oropharyngeal and/ or nasopharyngeal care with outcome measures on surgical site infection and/ or nosocomial pneumonia were reviewed. Essential data were extracted with quality assessed methodologically. Results Six randomized controlled trials comparing oropharyngeal and/ or nasopharyngeal care intervention with usual care were reviewed. The studies mostly included middle-aged male patients undergoing cardiac surgery. The results showed positively of interventions on nosocomial pneumonia and surgical site infection when compared with usual care. In view of quality assessments and statistically significant findings, the proposed change that could improve surgical outcome of patients is to use chlorhexidine gluconate on oronasopharyngeal care in the guideline. It mainly carries out in in-hospital settings both by patients with education from nurses preoperatively, and by nurses postoperatively. Conclusion Reviewed evidence shown that the oronasopharyngeal care interventions help effectively on minimizing the occurrence of nosocomial pneumonia and surgical site infections for patients undergoing heart surgery. It could be potentially adopted for nurses working in cardiac surgical ward and cardiac intensive care unit. / published_or_final_version / Nursing Studies / Master / Master of Nursing

It is generally recognized that a serious illness with concurrent hospitalization in an ICU will have an impact on family members. Few researchers, however, have described the ways in which spouses are affected when their mates are hospitalized in an ICU. Therefore, this study aimed to describe and explain the spouses' experiences of having a mate in an ICU following coronary artery bypass graft surgery. Kleinman's conceptual framework guided the development of the research question and provided the focus for data collection and analysis. Kleinman proposes that an understanding of the client's perspective is necessary for the provision of effective health care. A qualitative research method based on the theoretical perspective of phenomenology was used to answer the research question. The spouses' viewpoints were elicited through unstructured interviews. The sample consisted of seven spouses, four women and three men. The spouses were interviewed on two occasions, once while their mate was still in the ICU and once shortly following their mate's discharge from the ICU. A total of 13 in-depth interviews were conducted over a 3 month period. Data were analyzed simultaneously with and following data collection. Responses that were similar were grouped together into categories. After the data were examined and sorted into categories, the researcher defined the theme that dominated each category. The themes that emerged from the data were clarified, validated, and/or rejected by the participants during subsequent interviews. As relationships between the categories were identified, the important aspects of the spouses' experiences became apparent. The findings revealed that the spouses located the ICU experience within the context of their experience with their mate's coronary artery bypass graft surgery. The spouses understood and made sense of the ICU experience by attaching meaning to specific events that related to the entire surgical experience. They perceived the surgical experience as consisting of three distinct but interrelated phases: pre-surgery; waiting during surgery; and post-surgery. During each phase, the spouses described and explained how they reacted to and coped with each new situation. These two themes, "reaction to the situation" and "coping with the situation," appeared as threads throughout the entire surgical experience. By organizing the data in relation to phases and themes, the researcher was able to meaningfully understand and communicate the spouses' entire surgical experience. In view of the study findings, implications for nursing practice, education and research are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

Coronary bypass surgery is an increasingly common occurrence. Current literature does not validate the coping mechanisms involved for patients facing this life-threatening event. Lazarus’ theory of stress and coping was utilized as the framework for the study. The purpose of the study was to identify the degree of threat coronary bypass surgery presents and coping mechanisms utilized with this specific insult. The significance of the study was to assist nurses in identification of perceived risks/benefits of having open heart surgery from the patient’s perspective. The population included patients from a private cardiovascular practice in Indianapolis, Indiana. The convenience sample included 38 subjects recovering from coronary bypass graft surgery. Subjects were identified as uncomplicated post-operative surgical patients and were mailed questionnaires one month after discharge from the hospital. The Jalowiec Coping Scale and a questionnaire for demographic data were utilized to collect data. Procedures for protection of human subjects were followed. The research design was non-experimental and descriptive, correlational procedures were utilized to analyze data.The data supported the notions that clients utilized both problem-focused coping and emotion-focused coping, and emotion-focused coping strategies were more effective in reducing the threat. Education was significantly related to emotive coping styles and clients that perceived a higher threat intensity utilized more emotion-focused coping strategies. Recognition of the need to minimize stressors can be an important role the nurse facilitates. Through participatory care, the nurse may assist in finding the meaning for the stressor and encourage open communication patterns and emotional responses. Allowing for reduction of threat perception and intensity may enhance the outcome of the experience. / School of Nursing

The experience of living through an unexpected, life-threatening cardiovascular surgery can be a profound. This study examined the experience of 4 men who had survived ruptured aortic aneurysm using a phenomenological research design.Audio-taped interviews were analyzed for common themes and patterns. Two strong, opposing constitutive patterns were found. The patterns the data conveyed were: 1) fear as a response to overwhelming pain and clouded perceptions, and 2) gratitude for recovery in an atmosphere of caring support.This study was significant in beginning to bring to understanding the phenomenon of surviving major, unexpected cardiovascular surgical trauma. It is recommended that health care providers be more attentive to similar patients' experiences and listen to how their lives have changed as a result of their experiences. / School of Nursing

Zhu, Fang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 171-185). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Valvular disorders can be corrected by means of surgery, after which very comprehensive discharge planning should be implemented to prevent the occurrence of post-operative complications. Advances in medical technology and intellect instigate earlier discharge for patients after they have undergone valvular surgery. The aim of this research study is to establish the extent of discharge planning by nurses for patients who have undergone valvular surgery, so that practice guidelines in the form of an in-service educational framework can be compiled for nurses in the management of these patients post-operatively. Patients, many of whom are from rural areas, are discharged without an adequate referral system. There are, currently, no set guidelines or referral persons to direct these patients during their rehabilitation period. Based on the researcher’s personal observations, it is evident that many patients suffer from bacterial endocarditis or clotted valves due to poor post-surgery management. However, both of these conditions could be avoided if proper health education was given to these patients. The study will take the form of a quantitative, exploratory, descriptive and contextual survey. Data will be collected by means of a structured questionnaire that will be completed by the nurses working in the cardiac general ward and the cardiac clinic. Findings of the research study will be used to assist the researcher in developing an in-service educational framework for staff that are both nursing and preparing post valvular surgery patients for discharge. The goal is to prevent complications such as clot formation and endocarditis and to enable patients to deal effectively with their rehabilitation period.

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)