Professional Capstone Project - Review Of Literature

Using pre-operative education and psychological support to reduce mood disorders and post-operative morbidity in adult patients awaiting heart surgery
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Using pre-operative education and psychological support to reduce mood disorders and post-operative morbidity in adult patients awaiting heart surgery
Berg, A., Fleischer, S., Koller, M., & Neubert, T. R. (2009). Preoperative information for ICU patients to reduce anxiety during and after the ICU-stay: Protocol of a randomized controlled trial. BMC Nursing, 5(6)
Summary of Article:
Intensive care unit (ICU) admission is highly linked to anxiety, unpredictability, and uncertainty for the patients. In their study, Berg et al. (2009) investigated the possible advantages of a specially designed ICU-related information program for patients undergoing elective heart surgery and they are scheduled to stay at ICU.
Research Elements
Berg et al. (2009) carried out a prospective randomized controlled trial which included a control and an intervention group. In the control group, the investigators provide the patients with the standard preparation done by anesthetists and surgeons. In the intervention group, the patients also get a standardized information programme with particular sensory, procedural and coping information regarding the surgery and the intensive care unit. The sample size is 120 patients undergoing cardiac surgery.
Outcome(s): Research Results:
The pre-operative ICU-related information was effective in reducing anxiety among the patients.
Significance to Nursing and Patient Care:
It is important for patients waiting to undergo heart surgery and ICU-stay after the operation to be provided with adequate information pertaining to the surgical operation and the ICU stay.
Boni, A. L. M., Martinez, J. E., & Saccomann, I. Z. R. (2013). Quality of Life of Patients Undergoing Coronary Artery Bypass Grafting (CABG). Acta Paul Enferm, 26(6): 575-580
Summary of Article:
Boni, Martinez, and Saccomann (2013) conducted a study to establish the impact that CABG has on the Life Quality of CABG patients. They also analyzed and compared dimensions of Quality of Life prior to surgery and after it, and compared clinical and socio-demographic variables with the facets of anxiety and depression, in the preoperative and post-operative periods.
Research Elements:
This was a descriptive exploratory study that involved a total of 78 patients as participants who were included in the preoperative and postoperative periods. The researchers used and validated international research instruments to evaluate Quality of Life as well as the facets of anxiety and depression.
Outcome(s): Research Results:
There was considerable improvement in every domain of Quality of Life, anxiety, and depression.
Significance to Nursing and Patient Care:
CABG has a constructive impact on the patients’ Quality of Life. Preoperative education is an effective method of reducing stress, anxiety levels, and depression of patients awaiting CABG.
Destroyer, E., & Meyfroidt, G. (2010). Is Preoperative Anxiety and Depression Associated with Onset of Delirium after Cardiac Surgery in Older Patients? A Prospective Cohort arenas. The American Geriatrics Society, 56(12)
Summary of Article:
In their study, Destroyer and Meyfroidt (2010) sought to examine the occurrence of pre-operative anxiety as well as depressive signs, and how they relate to post-cardiac surgery delirium.
Research Elements:
The researchers utilized a prospective design, beginning pre-operatively and going on until patients’ discharge. Participants were aged at least 60 years. The strength of this study include (1) the use of prospective design; (2) usage of globally standardized and validated instruments in diagnosing depression, anxiety, and delirium; and (3) repetitive evaluations during hospitalization.
Outcome(s): Research Results:
Preoperative state-anxiety occurred in 55.8% while signs of depression happened in 15.5 percent. After discharge from hospital, 35.7 percent of the patients reported to have state anxiety, while 15.3 percent of them reported depressive symptoms.
Significance to Nursing and Patient Care:
The high occurrence of preoperative depressive and anxiety symptoms in older patients who had heart surgery could be effectively controlled through the use of psychological support and education programs.
Goodman, H. (2009). Patient Education around Cardiac Surgery. British Journal of Cardiac Nursing, 4(10), 483-488
Summary of Article:
Sufficient education and preparation provided to patients awaiting heart surgery may help them understand the need for the surgery and prepare for their admission as well as recovery. Goodman (2009) examines the information that cardiac surgery patients need as they prepare for the operation and explains the programs which have addressed patient education at this time.
Research Elements:
The article by Goodman (2009) considers the format and content of patient education prior to cardiac surgery, with a literature review on the needs of patients during this time, as well as previous methods employed.
Outcome(s): Research Results:
Patients who have heart surgery are each unique and they each differ in their need for education. Nonetheless, all of them have some anxieties that preparation for surgical operation has to recognize and address. Moreover, they might have particular misconceptions and/or concerns of their heart disease and operation. Hospitals could address these matters with combinations of pre-operative days and support programs as either telephone calls, home visits, or classes in order to offer support and provide appropriate information as the patients are preparing for their surgeries (Goodman, 2009).
Significance to Nursing and Patient Care:
It is vital to make sure that a broad approach is taken to education including details of operation and details of admission process, as well as the nature of heart disease and reason for the operation. This has to include addressing fallacies and misunderstandings, and offering the chance for individual concerns and questions to be addressed.
Guo, P. (2014). Preoperative Education Interventions to Reduce Anxiety and Improve Recovery among Cardiac Surgery Patients: A Review of Randomized Controlled Trials. Research Gate.
Summary of Article:
In this article, Guo (2014) seeks to update evidence of the efficacy of pre-operative education amongst patients undergoing cardiac surgery. Patients who are scheduled for heart surgery might experience high depression and anxiety levels, which could negatively affect their current illness and surgical operation, and lead to prolonged recovery.
Research Elements:
The researcher conducted an exhaustive review of existing literature to find sufficient proof that pre-operative education interventions may result in improved patient experiences as well as positive post-operative outcomes amongst surgical patients. Guo (2014) analyzed studies obtained from MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL. The author used original articles that reported randomized controlled trials of cardiac preoperative education interventions.
Outcome(s): Research Results:
The author identified 6 trials which produced conflicting results. Some randomized controlled trials demonstrated evidence that the anxiety of patients is reduced as a result of cardiac preoperative education interventions.
Significance to Nursing and Patient Care:
A multidisciplinary pre-operative education approach that is nurse-coordinated can offer an efficient and effective service. Nurse training in developing and providing the pre-operative education interventions is a priority (Guo, 2014).
Guo, P., East, L., & Arthur, A. (2012). A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial. Int J Nurs Stud, 49(2): 129-37.
Summary of Article:
Patients scheduled to undergo heart surgery in most cases experience considerable psychological and physical stress. Evidence is available demonstrating that pre-operative education interventions could result in positive post-operative outcomes for surgical patients. However, not much is known about the efficacy amongst patients who undergoing heart surgery. The objective of the study was to establish if a pre-operative education intervention developed for Chinese heart surgery patients could lower anxiety levels and improve recovery (Guo, East and Arthur, 2012).
Research Elements:
The research design used by Guo, East and Arthur (2012) was randomized controlled trial. The settings were cardiac surgical wards of 2 public hospitals the city of Luoyang, China. The researchers randomized into trial a total of 153 adult patients who were undergoing heart surgery; 76 to operative education group that comprised the usual care in addition to verbal advise and an information leaflet and 77 to control group where they received usual care.
Outcome(s): Research Results:
The study subjects who were provided with pre-operative education had a greater reduction in the levels of anxiety relative to the participants who did not.
Significance to Nursing and Patient Care:
Pre-operative education needs to be included into routine practice in order to prepare patients scheduled for cardiac surgery.
Harkness, K., Morrow, L., Smith, K., Kiczula, M., & Arthur, H. M. (2010). The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs, 2(2): 113-21
Summary of Article:
A mismatch between demand and supply regarding cardiac catheterization usually leads to patients experiencing waiting times which differ from a few weeks to quite a few months. It is notable that long delays could impose psychological and physical distress for patients. In their study, Harkness et al. (2010) examined the effect of a psychoeducational nursing intervention at the start of the awaiting time on anxiety of patients as they awaited elective cardiac catheterization.
Research Elements
The research was essentially a two-group randomized controlled trial. Patients in the control group were given normal, typical care. The patients who were in the intervention group were offered a detailed, nurse-delivered education/information session within 14 days of being placed on the waiting list for elective cardiac catheterization.

Outcome(s): Research Results:
In both groups, anxiety increased over the waiting time and health-related life quality got worse over the waiting time. There was a considerable difference between the control and the intervention groups in self-reported anxiety 14 days before cardiac catheterization.
Significance to Nursing and Patient Care:
Simple intervention that involves early education provided to patients at the start of the waiting period can positively the experience of waiting positively.
King, J., Chamberland, P., Rawji, A., Ager, A., Leger, R., Michaels, R., Poitras, R., Skelton, D., & Warren, M. (2014). Patient Educational Needs of Patients Undergoing Surgery for Lung Cancer. J Cancer Educ, 29(4), 802-807
Summary of Article:
There is usually an inconsistency between the information that healthcare professionals give to their patients in pre-operative teaching sessions and the information which the patients consider as significant. King et al. (2014) conducted a study to establish the information that patients scheduled to undergo a lung cancer surgical resection wished to learn prior to and following their surgical operation.
Research Elements:
King et al. (2014) interviewed a total of 10 – five women and five men – patients preoperatively and postoperatively, and 11 healthcare professionals who are involved in preoperative and postoperative care of the patients. The researchers noted the emerging themes.
Outcome(s): Research Results:
Patients who took part stated that the most useful facet of the pre-operative education consisted of surgical details and the significance of physiotherapy, such as exercises. Such education helped to gain reassurance and reduce their fear and...