The first month of recovery at home after undergoing cardiovascular surgery is critical to a patient’s health, says Dr. Suzanne Fredericks, a professor at Ryerson’s Daphne Cockwell School of Nursing and lead investigator of the study. Patients are expected to engage in self-management behaviours to prevent further infection and complications, such as taking proper dosages of medication, changing bandages and maintaining a low-sodium diet. This medical and nutritional regime is made all the more difficult to follow because some patients experience some neuro-cognitive impairments such as short-term memory loss, delirium as well as anxiety and depression during the immediate recovery period. Moreover, patients are being discharged and sent home earlier, often with complications.
“Hospitals are providing information for these patients on self-care before their discharge; however, this can be a futile exercise as these individuals may not be able to retain that information given their cognitive impairments and heightened levels of anxiety,” says Fredericks. “The hospital discharge experience may be perceived as very stressful because patients are required to engage in self-management activities at home without the immediate support of nurses or other health-care providers.”
Dr. Fredericks, along with her co-authors Dr. Jennifer Lapum and graduate student Joyce Lo, of the Daphne Cockwell School of Nursing, reviewed 16 studies involving 3,783 participants from Canada, U.S. and Europe to determine whether or not anxiety and depression impacts how patients care for themselves after they recover from heart surgery within the first few weeks at home.
The researchers found that of the 16 studies, at least half of the patients reported moderate to severe levels of anxiety and depression during their recovery at home. These patients were only able to do one self-management behaviour at a specific point in time while patients with milder anxiety and depression were able complete a variety of tasks, such as refilling their prescription on time, taking the medication and engaging in coughing or deep-breathing exercises. These are all common self-care behaviours patients are taught before leaving the hospital.
“From our review of these studies, there is some evidence to suggest that patients with milder anxiety and depression can engage in more self-care management tasks,” says Fredericks. “Their ability to perform these tasks can also be linked to their ability to retain and recall knowledge, which would affect how well they can remember the self-care tasks they were taught prior to their hospital discharge.”
Looking to the future, the researchers will use their findings from this initial review to launch a larger study to monitor heart-surgery patients during their recovery over a six-month period. From there, the researchers will design an intervention program to help those patients with higher levels of anxiety and depression learn how to care for themselves during their home recovery.
In the meantime, Dr. Fredericks recommends ongoing assessments of patients’ level of anxiety and depression prior to delivery of any self-management education interventions. In the presence of heightened levels of anxiety and depression, management of these conditions should first be addressed before providing education.
“This will greatly reduce the likelihood for the development of complications and re-admittance to the emergency rooms, which ultimately decreases the burden on the health-care system,” says Dr. Fredericks.
The study, published in the November issue of Clinical Nursing Research, was funded by the Ontario government’s Primary Health Care System Program and Ryerson University’s Faculty of Community Services Publication Support Grant Program.
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