title: Cardiac rehabilitation patients' perspectives on the recovery following heart valve surgery: a narrative analysis.
abstract: OBJECTIVE
  To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation.
  
  
  BACKGROUND
  Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants.
  
  
  METHODS
  A qualitative study with serial interviews analysed using narrative methods.
  
  
  METHODS
  We collected data over 18 months (April 2013-October 2014). We recruited nine patients undergoing heart valve surgery from a randomized trial, CopenHeartVR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after surgery.
  
  
  RESULTS
  Following heart valve surgery, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality - being in a limbo and becoming a heart patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after surgery.
  
  
  CONCLUSIONS
  The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing heart valve surgery may benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory.
authors.affiliation: Department of Cardiology, Roskilde Hospital, Denmark.
authors.forename: Tina Birgitte
authors.initials: TB
authors.lastname: Hansen
authors.affiliation: National Centre of Rehabilitation and Palliation, University of Southern Denmark.
authors.forename: Ann Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Denmark.
authors.forename: Selina Kikkenborg
authors.initials: SK
authors.lastname: Berg
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Denmark.
authors.forename: Kirstine Laerum
authors.initials: KL
authors.lastname: Sibilitz
authors.affiliation: Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Niels
authors.identifier: http://orcid.org/0000-0003-4980-4096
authors.initials: N
authors.lastname: Buus
authors.affiliation: Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000523:psychology*; D006348:Cardiac Surgical Procedures / Q000523:psychology / Q000534:rehabilitation; D003718:Denmark; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D036301:Qualitative Research
keywords: cardiac rehabilitation; heart valve surgery; narrative analysis; nursing; patient experience; recovery