published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

No description available.

Background: Coronary heart disease (CHD) remains a major cause of death and ill- health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest.

The steady increase of technology has become particularly ubiquitous in environments of heart surgery. Patients in these environments come into close contact with technology in its many guises. Often, practitioners may be deterred from engaging with patients because technology and the associated routines of care become the focus. As a result, it is important to understand how patients make sense of the technological situations encountered during treatment and recovery with attention to the constitution of identity and emerging moral issues. A narrative methodology was employed to examine patients’ experiential accounts of the technological in open-heart surgery and recovery. Sixteen patients were interviewed 3-4 days after surgery and 4-6 weeks after discharge, in addition participant journals were employed. Study results pointed to the technological as the dominant discourse in heart surgery and recovery, strongly organizing health care practices and patients’ recovery. These discursive influences shaped participants’ stories resulting in two temporal shifts of authorial voice. Authorial voice reflects the dominant discourse and structured how stories unfolded. The first temporal shift exhibited how technology acted as the authorial voice, structuring stories of the preoperative and early postoperative period. Although participants were the narrators of their own stories, they were strongly influenced by the dominant discourse of the technological and its associated dimensions of care. Participants’ stories revealed how patients were at the centre of activity, but passive, universal and undifferentiated. Although technology continued to influence stories of the later postoperative period and recovery at home, there was a shift of authorial voice to participants. Narratives reflected how the technological was incorporated into participants’ daily lives, but their stories included more personal elements rooted in their own particularities. Study implications involve a critical uptake of technology that emphasizes the balance between technologically- and humanistically-focused practices in heart surgery and recovery. A key implication is the critical need to encompass affective and social dimensions of patients within the technologically-driven practices of heart surgery. Of great significance is how practitioners, particularly nurses, can act as supporting characters in helping with transitions of authorial voice from the technological back to the participant.

The steady increase of technology has become particularly ubiquitous in environments of heart surgery. Patients in these environments come into close contact with technology in its many guises. Often, practitioners may be deterred from engaging with patients because technology and the associated routines of care become the focus. As a result, it is important to understand how patients make sense of the technological situations encountered during treatment and recovery with attention to the constitution of identity and emerging moral issues. A narrative methodology was employed to examine patients’ experiential accounts of the technological in open-heart surgery and recovery. Sixteen patients were interviewed 3-4 days after surgery and 4-6 weeks after discharge, in addition participant journals were employed. Study results pointed to the technological as the dominant discourse in heart surgery and recovery, strongly organizing health care practices and patients’ recovery. These discursive influences shaped participants’ stories resulting in two temporal shifts of authorial voice. Authorial voice reflects the dominant discourse and structured how stories unfolded. The first temporal shift exhibited how technology acted as the authorial voice, structuring stories of the preoperative and early postoperative period. Although participants were the narrators of their own stories, they were strongly influenced by the dominant discourse of the technological and its associated dimensions of care. Participants’ stories revealed how patients were at the centre of activity, but passive, universal and undifferentiated. Although technology continued to influence stories of the later postoperative period and recovery at home, there was a shift of authorial voice to participants. Narratives reflected how the technological was incorporated into participants’ daily lives, but their stories included more personal elements rooted in their own particularities. Study implications involve a critical uptake of technology that emphasizes the balance between technologically- and humanistically-focused practices in heart surgery and recovery. A key implication is the critical need to encompass affective and social dimensions of patients within the technologically-driven practices of heart surgery. Of great significance is how practitioners, particularly nurses, can act as supporting characters in helping with transitions of authorial voice from the technological back to the participant.

Thesis (M.S.)--University of Michigan, 1982.

No description available.

Everybody agree that the pre-operative nutritional condition of large surgeries patients, mainly those envolving intestinal tract, influence their clinical evolution. However, studies that evaluate the impact of pre-operative nutritional status in the morbimortality of heart surgery patients are rare. Objective: Know the influence of pre-operative nutritional status in the morbimortality of heart surgery patients. Methods: This is an observational, descriptive and prospective study, based on a peri-operative monitoring heart surgery patients in a hospital of Aracaju-SE city. The data collect was divided in three steps: 1 step pre-operative variables collect (age, genre, co-morbidity presence, euro-score determination, body mass index, tricipital skin fold fitness percentage, arm circumference and arm muscle circumference, and waist circumference); 2 step post-operative data collect (death and infectious complications presence, or not); 3 step The post-operative monitoring extended before hospital check out by a weekly phone call until 30 days after. Results: The sample was formed by 173 individuals of both sexes, with average age (57,4±10,5 years), most of male sex (59,5%). The most frequent surgical procedure was the coronary artery bypass graft surgery, that was performed in 116 patients (67%). The mortality tax was 16,2% and the average time of hospital stand was 8 days. 58,8% of the individuals presented overweight/obesity diagnosis determined by body mass index and more than 30% of patients presented muscular mass reservations, expressed by arm circumference and arm muscle circumference fitness percentage, below normality rate (34,7% and 32,4%, respectively). The multivariable analysis didn t show a significant association (p=0,13) of death variable with antropometric variables set, however the effect dimension (eta2parcial = 0,050) and the power (Power = 0,592) were low. A significant association was shown between body mass index (p=0,02), the waist circumference (p=0,001), the arm circumference fitness percentage fitness (p=0,02) and post-operative complications occurrence (p=0,01), with dimension effect between small and large intensity. Conclusion: The malnutrition status influence the increase of post-operative complications occurrence, strongly associated with noninfectious complications incidence in this patients group. / É consenso que a condição nutricional pré-operatória de pacientes candidatos a cirurgias de grande porte, pricipalmente cirurgias envolvendo o trato gastrointestinal, influenciam na evolução clínica destes indivíduos. Entretanto, são excassos os trabalhos que avaliem o impacto que o estado nutricional pré-operatório tem sobre a morbimortalidade de paciente submetidos à cirurgia cardiaca. Objetivo: Conhecer a influência do estado nutricional pré-operatório na morbimortalidade de pacientes submetidos à cirurgia cardíaca. Metodologia: Trata-se de um estudo observacional, descritivo, de caráter prospectivo, baseado no acompanhamento peri-operatório de pacientes submetidos à cirurgia cardíaca em um hospital da cidade de Aracaju-SE. A coleta de dados foi dividida em três etapas: 1ª etapa Coleta das variáveis pré-operatórias (idade, gênero, presença de co-morbidades, determinação do euroSCORE, índice de massa corpórea, percentual de adequação da prega cutânea tricipital, circunferência do braço e circunferência muscular do braço, e circunferência da cintura); 2ª etapa Coleta das variáveis pós-operatórias (óbito e complicações); 3ª etapa O acompanhamento pós-operatório se estendeu após a alta hospitalar por meio de um contato telefônico semanal até o 30º DPO, afim de identificar os casos de óbito ocorridos neste período. Resultados: A amostra foi constituída por 173 indivíduos de ambos os sexos, com idade média de 57,4±10,5 anos, sendo a maioria do sexo masculino (59,5%). O procedimento mais frequente foi a cirurgia de revascularização do miocárdio, a qual foi realizada em 116 indivíduos (67%). A mortalidade foi de 16,2% e o tempo médio de permanência hospitalar de 8 dias. Sobrepeso/obesidade, determinado pelo IMC, foi encontrado em 58,8% dos indivíduos e mais de 30% dos pacientes apresentaram reservas de massa muscular, expressas pelo percentual da adequação da circunferência do braço e da circunferência muscular do braço, abaixo da faixa de normalidade (34,7% e 32,4%, respectivamente). A análise multivariada não mostrou associação significativa (p=0,13) da variável óbito com o conjunto das variáveis antropométricas, porém a dimensão do efeito (Eta2parcial = 0,050) e o poder (Poder=0,592) foram pequenos. Uma associação significativa foi mostrada entre o índice de massa corpórea (p=0,02), a circunferência da cintura (p=0,001), o percentual de adequação da circunferência do braço (p=0,02) e a ocorrência de complicações pós-operatórias (p=0,01), com dimensão de efeito de pequena a moderada intensidade. Conclusão: O estado de desnutrição influencia o a ocorrência de complicações pós-operatórias, estando este associado mais fortemente a incidência de complicações não infecciosas neste grupo de pacientes

M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

This is a study of some of the families in the Loma Linda University Medical Center infant heart transplant program.