Page 126 - Encyclopedia of Nursing Research

CoRonARY ARTERY BYPASS GRAFT SURGERY n 93

Lindquist, Treat-Jacobson, & Savik, 2008). A education intervention after CABG surgery
study examining perceived cognitive func- (Fredericks, 2009). Although no differences
tion and emotional distress following CABG were found between the two time points, C
surgery found that emotional symptoms and the recommendation was made that nurses
perceived cognitive difficulties were sig- assess anxiety levels before the delivery of
nificantly related at the same point in time education, implement strategies to reduce
as well as across time periods. Although high anxiety (highest level is 24 hours before
perceived cognitive difficulties at baseline discharge), and provide individualized
predicted a more negative course of emo- teaching. Several randomized controlled
tional symptoms, baseline emotional symp- trials of nursing interventions (two by tele-
toms did not predict the course of cognitive phone and one in home) examined anxiety,
difficulties (Gallo, Malek, Gilbertson, & depression, and QoL in patients following
Moore, 2005). CABG surgery (Hartford, Wong, & Zakaria,
The benefits of preoperative interven- 2002; Lie, Arnesen, Sandvik, Hamilton, &
tions have been examined in three random- Bunch, 2007; Rollman et al., 2009). one of the
ized controlled studies of patients awaiting telephone interventions, which consisted of
CABG surgery (Arthur, Daniels, McKelvie, information and support to assist patients
Hirsh, & Rush, 2000; Garbossa, Maldaner, and their partners in meeting their needs,
Mortari, Biasi, & Leguisamo, 2009; McHugh found decreased anxiety in the intervention
et al., 2001). Arthur et al. (2000) found that the group 2 days after discharge but no signifi-
treatment group receiving exercise training cant differences at Weeks 4 and 8 (Hartford
twice weekly, education, reinforcement, and et al., 2002). The second study (Rollman et al.,
monthly nurse-initiated phone calls spent 2009) examined the impact of an 8-month
less time in the hospital overall and less telephone multidisciplinary intervention for
time in intensive care units. Intervention treating depression post CABG surgery. The
group patients reported improved QoL nurse care manager called patients to review
both pre- and postoperatively. In the study their psychiatric history, to provide basic psy-
by McHugh et al. (2001), care provided in choeducation about depression and its effect
patient’s homes by nurses led to decreases in on cardiac disease, and to describe treatment
cardiovascular disease risk factors as well as options. Compared with usual care, patients
levels of anxiety and depression. A study of in the intervention group reported greater
the effects of physiotherapeutic instruction improvements in HRQL, physical function-
on anxiety of CABG patients (Garbossa et al., ing, and mood symptoms at 8 months of fol-
2009) found that preoperatively patients in low-up. In addition, men benefited more than
the intervention group reported lower lev- women from the intervention. In a study on
els of anxiety, whereas postoperatively both the effects of a home-based intervention pro-
groups reported decreased levels of anxiety gram on anxiety and depression 6 months
without a significant difference between the after CABG surgery (Lie et al., 2007), inves-
groups. Anxiety was higher preoperatively tigators found significant improvements in
for female patients, and higher postopera- both the intervention and the control groups
tive anxiety led to longer lengths of hospital at 6 weeks and 6 months but no differences
stay. between groups. In a randomized controlled
There is a general agreement that early pilot of cognitive behavioral therapy with 15
postoperative intervention should be offered depressed women after surgery, investiga-
to patients experiencing depression and/ tors found that cognitive behavioral therapy
or anxiety. A randomized controlled trial yielded moderate to large effects for improv-
examined the timing (before or after dis- ing depression and immunity and reducing
charge) for delivering individualized patient infection and inflammation after surgery