Davina Banner

Becoming a coronary artery bypass graft surgery patient: a grounded theory study of women’s experiences

AIM To explore womens experiences of becoming a coronary artery bypass graft surgery patient. BACKGROUND Coronary heart disease is a leading cause of morbidity and mortality for both sexes worldwide and is associated with significant human, fiscal and personal burden. There are growing numbers of women undergoing coronary artery bypass graft surgery; however, little is known about their experiences of being diagnosed, referred and waiting for surgery. DESIGN Grounded theory. METHODS A grounded theory study of 30 UK women with coronary heart disease waiting to undergo coronary artery bypass graft surgery. Data were collected using semi-structured interviews and were contextualised through informal observation of the main clinical areas. RESULTS Coronary heart disease and associated symptoms had extensive physical, social and emotional ramifications for the women. A substantive theory of the public-private dialogue around maintaining and renegotiating normality emerged and demonstrated that women faced significant disruption to their lives as they attempted to normalise and make sense of their illness experiences. Six categories emerged from the data: help seeking, diagnosis and referral, conceptualising surgery, living with coronary heart disease and waiting for surgery. CONCLUSION This study has uncovered womens experiences of becoming a coronary artery bypass graft patient. It has highlighted the extensive ramifications of heart disease and the need for more gender-sensitive information and support. RELEVANCE TO CLINICAL PRACTICE The findings of this study provide health care professionals with a greater understanding of the experiences and needs of women through their journey to becoming a coronary artery bypass graft surgery. The study demonstrates that women need meaningful information particularly in relation to domestic and physical functioning. Nurses are in an important position to contribute to the care and support of women undergoing this process by providing appropriate and gender-sensitive information that can improve health outcomes and quality of life.

Women’s experiences of undergoing coronary artery bypass graft surgery

AIM This paper is a report of a study of womens experiences of coronary artery bypass graft surgery. BACKGROUND Worldwide, coronary heart disease is the leading cause of morbidity and mortality. It has traditionally been viewed as primarily affecting men. However, a growing body of literature exploring gender differences in this area is challenging accepted beliefs, particularly in relation to outcomes. Despite this, awareness of how women interpret and respond to the experiences of cardiac surgery remains limited. METHODS At regional cardiothoracic centres in England and Wales, during 2003 to 2006, data were collected from 30 women preoperatively and at 6 weeks and 6 months postoperatively using semi-structured interviews. A constructivist grounded theory approach was adopted and data were analysed using extensive coding and constant comparison techniques. RESULTS A substantive theory of the public-private dialogue of normality emerged demonstrating that participants faced lifestyle disruptions as they attempted to privately normalize and integrates limitations, while minimizing a public display of illness. During the preoperative period, participants experienced difficulties recognizing and acting on symptoms and endured physical and emotional distress while waiting for surgery. Following surgery, women experienced functional limitations which forced them to relinquish normal activities and roles. As recovery progressed, women came to accept their changed health status and renegotiated state of normality. CONCLUSION The findings increase understanding about the adjustments which women undergoing cardiac surgery make as part of living with a long-term condition and support the need to develop innovative gender-sensitive health education and services.

Nurses who work in rural and remote communities in Canada: a national survey

BackgroundIn Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions.MethodsA cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada.ResultsRural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses’ levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region.ConclusionsThe proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Understanding experiences of undergoing transcatheter aortic valve implantation: one-year follow-up

Background: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for frail, older adults with severe symptomatic aortic stenosis. Although research about long-term clinical outcomes is emerging, there is limited evidence from the perspectives of patients and family caregivers on their perceived benefits and challenges after TAVI. Aims: The aim of this study was to describe older adults and family caregivers’ perspectives on undergoing TAVI at one year post-procedure. Methods: Qualitative description was the method of inquiry. A purposive sample of 31 patients and 15 family caregivers was recruited from a TAVI programme in western Canada. Semi-structured interviews were conducted with participants one year after TAVI. Data were analysed thematically. Results: All participants were satisfied with the decision to undergo TAVI. There were three central themes. First, recovery was experienced in the context of aging and comorbidities, which was shaped by patients’ limited options for care and post-procedure symptom burden. Second, reconciling expectations with reality meant that, for some patients, symptom burden remained prevalent and was also influenced by others’ expectations. Third, recommendations for recovery related to having information needs met, keeping informed of evolving care processes, and addressing individualised needs for support. Conclusions: The perspectives of participants provide a valuable contribution to the literature about undergoing TAVI. Clinicians need to be attentive to patients’ expectations of benefit and temper these with consideration of the individual’s broader health situation to provide treatment decision support. Patients and family caregivers also need adequate teaching and support to facilitate safe transition home given the shift towards early discharge after TAVI.

Community perspectives of end-of-life preparedness

ABSTRACT While death is a universal human experience, the process of planning for death can be difficult and may be avoided altogether. To understand community perspectives of end-of-life preparedness, we undertook a multimethod study exploring the experiences of 25 community members and 10 stakeholders engaged in end-of-life planning. In addition, card sorting activities and focused discussions with 97 older adults were undertaken to highlight perspectives and needs. Data were analyzed using descriptive statistics and qualitative description. Overall, the participants perceived many benefits to being end-of-life prepared, however, few community members had engaged in formal planning. Key barriers include concerns about the accessibility and accuracy of information, discomfort when engaging in end-of-life conversations, and perceptions about the cost associated with engaging in formal legal or financial preparations. Areas for further research include the need for studies that capture the cultural dimensions of end-of-life planning and explores the implementation and evaluation of community-based interventions to improve preparedness.

The Participant Recruitment Outcomes (PRO) study: Exploring contemporary perspectives of telehealth trial non-participation through insights from patients, clinicians, study investigators, and study staff

Background Telehealth has been proposed as an alternative means to providing traditional modes of care while alleviating the need for participant travel and reducing overall healthcare costs. The purpose of this study was to explore contemporary perspectives of patients and stakeholders regarding non-participation in telehealth trials. Methods We undertook a two-phase exploratory qualitative study to understand the reasons behind patient non-participation in telehealth. Data were collected through semi-structured interviews with non-participating patient participants (n = 8) and stakeholders (n = 27) including clinicians, study investigators, and study staff. An analysis of interview data were undertaken and guided by a qualitative descriptive approach. Findings Patients and stakeholders reported many barriers to telehealth participation including technological barriers, limited understanding of disease, and an understated need for services. Both groups had some overlap in their concerns but also provided unique insights. Conclusion The analysis of study findings revealed perspectives of patients and stakeholders including barriers to participation as well as suggestions for future telehealth initiatives. Further research is needed to explore non-participation including patient readiness to assist in the development of future telehealth programs.

The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED)

Study objective: Lack of oral anticoagulation prescription in the emergency department (ED) has been identified as a care gap in atrial fibrillation patients. This study seeks to determine whether the use of a tool kit for emergency physicians with a follow‐up community‐based atrial fibrillation clinic resulted in greater oral anticoagulation prescription at ED discharge than usual care. Methods: This was a before‐after study in 5 Canadian EDs in 3 cities. Patients who presented to the ED with atrial fibrillation were eligible for inclusion. The before phase (1) was retrospective; 2 after phases (2 and 3) were prospective: phase 2 used an oral anticoagulation prescription tool for emergency physicians and patient education materials, whereas phase 3 used the same prescription tool, patient materials, atrial fibrillation educational session, and follow‐up in an atrial fibrillation clinic. Each phase was 1 year long. The primary outcome was the rate of new oral anticoagulation prescription at ED discharge for patients who were oral anticoagulation eligible and not receiving oral anticoagulation at presentation. Results: A total of 631 patients were included. Mean age was 69 years (SD 14 years), 47.4% were women, and 69.6% of patients had a CHADS2 score greater than or equal to 1. The rate of new oral anticoagulation prescription in phase 1 was 15.8% compared with 54.1% and 47.2%, in phases 2 and 3, respectively. After multivariable adjustment, the odds ratio for new oral anticoagulation prescription was 8.03 (95% confidence interval 3.52 to 18.29) for phase 3 versus 1. The 6‐month rate of oral anticoagulation use was numerically but not significantly higher in phase 3 compared with phase 2 (71.6% versus 79.4%; adjusted odds ratio 2.30; 95% confidence interval 0.89 to 5.96). The rate of major bleeding at 6 months was 0%, 0.8%, and 1% in phases 1, 2, and 3, respectively. Conclusion: An oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow‐up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6‐month follow‐up.

Drugs and Pharmacology for Nurses. Drugs and Pharmacology for Nurses by S. J. Hopkins. 1999. Churchill Livingstone, London. ISBN 0-443-06008-8. Pp. 350. Price f15.95.

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