Effects of auricular acupressure on the quality of sleep and anxiety in patients undergoing cardiac surgery: A single-blind, randomized controlled trial.

AIM: This study aimed to evaluate the effects of auricular acupressure (AA), a non-invasive type of reflexotherapy, on sleep quality and anxiety in patients after cardiac surgery. BACKGROUND: Sleep disturbances and anxiety hinder the recovery of patients after cardiac surgery; thus, appropriate and adequate nursing interventions must be pursued. AA is a complementary therapy suitable for patients with limited pharmacological therapy options. METHOD: A single-blind, randomized controlled trial with a pretest-posttest control group design was applied. The study consisted of 42 patients, comprising an experimental group (n = 21) and a control group (n = 21). AA was applied for six days per trial for a total of 2 trials, while sleep (sleep score, sleep satisfaction) and anxiety (state, trait) were measured at three time points (pre-op, 7 days post-op, and 14 days post-op). RESULTS: The sleep and sleep satisfaction scores of the experimental group were significantly higher than those of the control group. No significant difference was found in anxiety state/trait between the two groups. CONCLUSIONS: We conclude that AA is a safe, effective, noninvasive, and low-risk nursing intervention that can improve sleep quality in patients after cardiac surgery.

Contribution of transpersonal care to cardiac patients in the postoperative period of heart surgery. / Contribuição do cuidado transpessoal ao ser-cardiopata no pós-operatório de cirurgia cardíaca.

OBJECTIVE: To know the contribution of Watson's theory to nursing care for cardiac patients in the postoperative period of cardiac surgery. METHODS: This is a qualitative study based on the research-care method conducted with ten patients who underwent cardiac surgery in a specialised hospital from June to August 2013, in the city of Fortaleza, Ceará, Brazil. Data were submitted to content analysis based on the Clinical Caritas Process. RESULTS: The results led to four thematic categories: Awareness of being cared for by another being, System of beliefs and subjectivity, Relation of support and trust, and Expression of feelings. Surgery transformed the lives of the patients related to the process of being cared for by other people. FINAL CONSIDERATIONS: The application of Watson's theory to care for cardiac patients after heart surgery shed valuable light on the importance of transpersonal care for the expansion of nursing care.

Contribuição do cuidado transpessoal ao ser-cardiopata no pós-operatório de cirurgia cardíaca / Contribución del cuidado transpersonal al ser-cardiopata en el post operatorio de cirugía cardíaca / Contribution of transpersonal care to cardiac patients in the postoperative period of heart surgery

Resumo OBJETIVO Conhecer a contribuição da teoria de Watson para o cuidado de enfermagem dirigido ao ser com cardiopatia no pós-operatório de cirurgia cardíaca. Métodos: Pesquisa qualitativa, por meio do método de pesquisa-cuidado, realizado com dez pessoas que realizaram cirurgia cardíaca em um hospital especializado, de junho a agosto de 2013, no município de Fortaleza-CE. Os dados foram submetidos à análise de conteúdo, com base no processo Clinical Caritas. RESULTADOS Foram construídas quatro categorias temáticas: Consciência de ser cuidado por outro ser, Sistema de crenças e subjetividade, Relação de ajuda-confiança e Expressão dos sentimentos. Compreendeu-se que a realização da cirurgia acarretou transformações na vida dos pesquisados-cuidados, as quais foram relacionadas ao processo de serem cuidados por outras pessoas. CONSIDERAÇÕES FINAIS Concluiu-se que, ao utilizar a teoria de Watson no cuidado ao ser com cardiopatia no pós-operatório, foi possível compreender a importância do cuidado transpessoal para expansão dos cuidados da enfermeira.

Resumen OBJETIVO Conocer la contribución de la teoría de Watson para el cuidado de enfermería dirigido al ser con cardiopatía en el postoperatorio de cirugía cardíaca. MÉTODOS Investigación cualitativa, por medio del método de investigación-cuidado, realizado con diez personas que realizaron cirugía cardiaca en un hospital especializado, de junio a agosto de 2013, en el municipio de Fortaleza-CE. Los datos fueron sometidos al análisis de contenido, con base en el proceso Clinical Caritas. RESULTADOS Se construyeron cuatro categorías temáticas: Consciencia de ser cuidado por otro ser, Sistema de creencias y subjetividad, Relación de ayuda-confianza y Expresión de los sentimientos. Se comprendió que la realización de la cirugía acarreó transformaciones en la vida de los encuestados-cuidados, las cuales fueron relacionadas al proceso de ser cuidados por otras personas. CONSIDERACIONES FINALES Se concluyó que, al utilizar la teoría de Watson en el cuidado al ser con cardiopatía en el postoperatorio, fue posible comprender la importancia del cuidado transpersonal para la expansión del cuidado de la enfermera.

Abstract OBJECTIVE To know the contribution of Watson's theory to nursing care for cardiac patients in the postoperative period of cardiac surgery. METHODS This is a qualitative study based on the research-care method conducted with ten patients who underwent cardiac surgery in a specialised hospital from June to August 2013, in the city of Fortaleza, Ceará, Brazil. Data were submitted to content analysis based on the Clinical Caritas Process. RESULTS The results led to four thematic categories: Awareness of being cared for by another being, System of beliefs and subjectivity, Relation of support and trust, and Expression of feelings. Surgery transformed the lives of the patients related to the process of being cared for by other people. FINAL CONSIDERATIONS The application of Watson's theory to care for cardiac patients after heart surgery shed valuable light on the importance of transpersonal care for the expansion of nursing care.

Pretreatment with an intravenous lipid emulsion increases plasma eicosapentanoic acid and downregulates leukotriene b4, procalcitonin, and lymphocyte concentrations after open heart surgery in infants.

BACKGROUND: The effect of providing a lipid emulsion containing medium-chain triglyceride (MCT), soybean oil, and fish oil in critically ill infants is not widely studied. This study investigated lipid emulsion effects on plasma phospholipids and immune biomarkers. MATERIALS AND METHODS: Thirty-two infants undergoing cardiopulmonary bypass (CPB) and dependent on parenteral nutrition (PN) were randomized to receive either soybean oil (control, n = 16) or a 50:40:10 mixture of MCT, soybean oil, and fish oil (treatment, n = 16). PN was administered for 3 days preoperatively and 10 days postoperatively. Fatty acids, procalcitonin (PCT), leukotriene B4 (LTB4), and lymphocytes were quantified at baseline, before surgery, and days 1, 7 and 10 after surgery. RESULTS: PCT was significantly lower in the treatment vs control group 1 day postoperatively (P = .01). The treatment group exhibited a lower ω-6 to ω-3 ratio (P = .0001) and a higher ω-3 concentration at all postoperative study periods (P = .001). Treatment resulted in higher (P < .05) plasma phospholipid eicosapentaenoic acid (EPA) on days 7 and 10, while α-linolenic acid, arachidonic acid, and docosahexaenoic acid remained constant. An increase in plasma phospholipid EPA concentration was associated with a decrease in plasma phospholipid LTB4 concentration (P < .05). On postoperative day 10, treatment infants with high Pediatric Risk of Mortality III scores exhibited a 45% lower lymphocyte concentration (P < .05). CONCLUSION: These findings suggest that treating infants undergoing CPB with a lipid emulsion containing ω-3 improves fatty acid status and results in a lower inflammatory response after surgery. Overall, this alternative ω-3-enriched lipid emulsion may benefit clinical outcomes of critically ill infants after cardiac surgery.

Effect of music on postoperative pain and physiologic parameters of patients after open heart surgery.

The aim of this study was to investigate the effect of listening to personal choice of music on self-report of pain intensity and the physiologic parameters in patients who have undergone open heart surgery. The study design was quasiexperimental. Patients were selected through convenience sampling in the Cardiovascular Surgery Intensive Care Unit at a university hospital. The study was conducted with a total of 87 patients who underwent open heart surgery: 44 in the music group, 43 in the control group, ages between 18 and 78 years. Through pretest-posttest design, postoperative first-day data were collected. First, physiologic parameters (blood pressure, heart rate, oxygen saturation, and respiratory rate) were recorded and a unidimensional verbal pain intensity scale applied to all participants. Later, the control group had a rest in their beds while the music group listened to their choice of music for 30 minutes. Physiologic data were then collected and the pain intensity scale applied once more. In the music group, there was a statistically significant increase in oxygen saturation (p = .001) and a lower pain score (p = .001) than in the control group. There was no difference between the groups in the other physiologic parameters. Results of this research provide evidence to support the use of music. Music might be a simple, safe, and effective method of reducing potentially harmful physiologic responses arising from pain in patients after open heart surgery.

A randomized trial of massage therapy after heart surgery.

OBJECTIVES: To determine whether massage therapy improves postoperative mood, pain, anxiety, and physiologic measurements; shortens hospital stay; and decreases occurrence of atrial fibrillation. METHODS: Two hundred fifty-two adults undergoing cardiac surgery were randomized to usual postoperative care (n=126) or usual care plus two massages (n=126). Assessments of mood, depression, anxiety, pain, physiologic status, cardiac rhythm, and hospital length of stay were completed. Logistic and linear regressions were performed. RESULTS: Preoperative pain, mood, and affective state scores were positively associated with postoperative scores; however, there were no postoperative differences between groups for any measures (P=.11 to .93). There were no differences in physiologic variables except lower postoperative blood pressure after massage (P = .01). Postoperative atrial fibrillation occurrence (P = .6) and median postoperative hospital length of stay (P = .4) were similar between groups. CONCLUSION: Massage therapy is feasible in cardiac surgical patients; however, it does not yield therapeutic benefit. Nevertheless, it should be a patient-selected and -paid option.

Anxiety and open heart surgery.

Anxiety has a negative effect on patients undergoing cardiac surgery. Preoperative and postoperative complications, pharmacologic and holistic treatment, and nursing interventions for patients undergoing open heart surgery will be discussed.

Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial.

AIM: To evaluate the effect of bed rest with music on relaxation for patients who have undergone heart surgery on postoperative day one. BACKGROUND: Music intervention has been evaluated as an appropriate nursing intervention to reduce patients 'pain, stress and anxiety levels in several clinical settings, but its effectiveness in increasing patients' subjective and objective relaxation levels has not been examined. DESIGN: A randomised controlled trial. METHOD: Forty patients undergoing open coronary artery bypass grafting and/or aortic valve replacement surgery were randomly allocated to either music listening during bed rest (n = 20) or bed rest only (n = 20). Relaxation was assessed during bed rest the day after surgery by determining the plasma oxytocin, heart rate, mean arterial blood pressure, PaO2 SaO2 and subjective relaxation levels. RESULTS: In the music group, levels of oxytocin increased significantly in contrast to the control group for which the trend over time was negative i.e., decreasing values. Subjective relaxation levels increased significantly more and there were also a significant higher levels of PaO2 in the music group compared to the control group. There was no difference in mean arterial blood pressure, heart rate and SaO2 between the groups. CONCLUSION: Listening to music during bed rest after open-heart surgery has some effects on the relaxation system as regards s-oxytocin and subjective relaxations levels. This effect seems to have a causal relation from the psychological (music makes patients relaxed) to the physical (oxytocin release). RELEVANCE TO CLINICAL PRACTICE: Music intervention should be offered as an integral part of the multimodal regime administered to the patients that have undergone cardiovascular surgery. It is a supportive source that increases relaxation.

Myectomy for hypertrophic obstructive cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiovascular death in young people. Myectomy is the gold standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). This article briefly reviews the pathophysiology and medical management of HOCM. The physiologic rationale for myectomy and associated cardiac surgical procedures such as unroofing of coronary artery muscle bridges and the MAZE procedure are presented. Outcomes after myectomy, as well as alternative therapies such as percutaneous septal ethanol ablation and pacing are compared. Nursing management of patients after myectomy is discussed.

Fragility--the price of renewed life. Patients experiences of open heart surgery.

BACKGROUND: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions. AIM: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective. METHOD: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future. FINDINGS: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude. CONCLUSIONS: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.

Effect of a music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients.

BACKGROUND: Exposure to noise in a critical care unit may trigger a response by the sympathetic nervous system, thereby increasing cardiovascular work in patients recovering from cardiac surgery. OBJECTIVE: To investigate the effects of a music intervention given twice on the first postoperative day on noise annoyance, heart rate, and arterial blood pressure in subjects with high (n = 22) and low (n = 18) sensitivity to noise. METHODS: A prospective, quasi-experimental, repeated-measures design was used. Based on results of power analysis, the sample size was 40. Subjects were recruited preoperatively, and their sensitivity to noise was assessed. On the first postoperative day, repeated-measures data were collected on levels of noise annoyance and physiological variables during 15 minutes of baseline and 15 minutes of music intervention on two occasions. Subjects completed a follow-up questionnaire regarding their perceptions of the noise in the critical care unit and the music intervention. RESULTS: Repeated-measures analysis of variance showed that subjects had lower levels of noise annoyance during music intervention than at baseline. Heart rate and systolic blood pressure decreased during the music intervention compared with baseline. Diastolic blood pressure decreased during the music intervention from baseline during time 2, but not time 1. Subjects with high baseline scores of noise sensitivity preoperatively had higher baseline levels of noise annoyance in the critical care unit the first postoperative day. Subjects rated the music intervention as highly enjoyable regardless of their baseline noise sensitivity or noise annoyance. CONCLUSION: Results of this study support the idea that noise annoyance is a highly individual phenomenon, influenced by a transaction of personal and environmental factors. Use of a music intervention with cardiac surgery patients during the first postoperative day decreased noise annoyance, heart rate, and systolic blood pressure, regardless of the subject's noise sensitivity.

Therapeutic use of play in the psychological preparation of preschool children undergoing cardiac surgery.

Hospitalization and surgery are generally accepted as stressful situations for children. A review of the literature indicates therapeutic play is effective in helping children cope with stressful situations. This article further illustrates the benefits of using therapeutic play in the psychological preparation of preschool children undergoing cardiac surgery. Play as a useful assessment and intervention tool for the nurse is examined.

Hemodynamic monitoring modalities in pediatric cardiac surgical patients.

Transthoracic monitoring lines yield vital information in the care of the pediatric postoperative cardiovascular surgical patient. It is the critical care nurse, in the holistic care of the patient, who integrates this data into the daily plan of care. Invasive monitoring carries risks; therefore, guidelines for care must be followed. The care of these critically ill infants requires a multifactoral approach. Hemodynamic monitoring is one of many avenues that we follow in the intensive care unit.