Coronary artery bypass graft surgery: discharge planning for successful recovery.
BACKGROUND
Coronary artery bypass graft (CABG) surgery is a lifesaving intervention, but the early recovery period presents a number of challenges for patients, carers and nurses. Early and adequate discharge planning based on in-depth knowledge of the postdischarge experience can help to ensure optimal recovery.


OBJECTIVE
This paper reports a study to examine the range of postdischarge issues, concerns and needs of patients and their family carers after discharge after CABG surgery, and explore their perceptions of unmet needs 1 year later.


METHODS
A two-phase naturalistic inquiry was undertaken. Interviews were conducted with 30 patients and their carers 4-5 weeks after coronary artery bypass grafting (phase 1) and 1 year after the initial interview (phase 2). Thematic analysis was used to identify the major concerns of participants.


RESULTS
Almost half the patients experienced heart surgery as a huge personal shock. Adjusting to life afterwards was difficult, and they experienced a variety of changes, including pain. An unexpected finding was a heightened sense of body awareness and the need for postoperative physical adjustments. The financial implications of surgery were a major burden. Lifestyle adjustments were important and led to suggestions for support services, using telephone support and/or community patient networks. All participants recommended strengthening discharge planning with more accurate information about what to expect during recovery, to help them anticipate fluctuations in health and wellbeing. Carers experienced a wide range of unanticipated feelings during early recovery and had to deal with a number of personal changes.


CONCLUSIONS
The findings suggest a need to improve discharge preparation and provide enhanced home support services. Further research should evaluate models of periodic follow-up and mechanisms for mutual support, and compare the experiences of cardiac patients and their carers with those of other surgical cohorts.
School of Nursing, Queensland University of Technology, Brisbane, Australia. k.theobald@qut.edu.au
Karen
K
Theobald
Anne
A
McMurray
D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D001026:Coronary Artery Bypass / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000592:standards; D010351:Patient Discharge / Q000592:standards; D017060:Patient Satisfaction; D010465:Perception; D011182:Postoperative Care; D012944:Social Support; D016896:Treatment Outcome