Page 344 - ACCCN's Critical Care Nursing

Cardiac Surgery and Transplantation 321

Research vignette
Bauer, BA, Cutshall SM, Wentworth LJ et al. Effect of massage interventions were set out in a very distinct way that minimised
therapy on pain, anxiety, and tension after cardiac surgery: A the chance of bias in collecting data. Nonetheless, two sets of data
randomized study. Complementary Therapies in Clinical Practice were collected; subjective data that could produce bias results;
2010 16(4): 70–75. and, objective data such as heart rate, blood pressure and respira-
Abstract tory rate that were not significantly different between the groups.
Integrative therapies such as massage have gained support as The subjective data such as pain, anxiety and tension, were signifi-
interventions that improve the overall patient experience during cantly different between the groups, with massage group patients
hospitalisation. Cardiac surgery patients undergo long procedures reporting less tension on day 2 compared with the control group
and commonly have postoperative back and shoulder pain, patients. At day 4 massage group patients reported lower levels of
anxiety, and tension. Given the promising effects of massage tension, pain and anxiety than the control group patients. Of note,
therapy for alleviation of pain, tension, and anxiety, we studied the when day-3 data were compared with day-2 posttreatment values,
efficacy and feasibility of massage therapy delivered in the post- patients who had received a massage had significant worsening of
operative cardiovascular surgery setting. Patients were randomised pain, anxiety, and tension, although when the change from day 2
to receive a massage or to have quiet relaxation time (control). In to day 3 was compared for the 2 groups the difference was not
total, 113 patients completed the study (massage, n = 62; control, significant.
n = 51). Patients receiving massage therapy had significantly Based on these results, massage as one specific complementary
decreased pain, anxiety and tension. Patients were highly satisfied and alternative therapy, is recommended in postoperative cardiac
with the intervention, and no major barriers to implementing patients, but mainly to start after day three postoperation for
massage therapy were identified. Massage therapy may be an maximum effects as patients have fewer invasive lines and are
important component of the healing experience for patients after more mobile. The study was conducted in a single centre and for
cardiovascular surgery. very specific surgical group (cardiac patient); hence results may not
be generalised to all surgical populations. The question of rele-
Critique vance and effect of complementary and alternative medicine
Pain, anxiety and tension management post cardiac surgery is vital earlier in the postoperative course has not been answered by this
for complete and on time recovery, and to prevent undesirable study but should be explored as a potential area for improvement
complications. Complementary and alternative medicine therapies in care.
such as massage have been used to alleviate pain and anxiety in
various clinical settings, including post operatively without proper This article gives an insight into a bigger picture in critical care
study design. The efficacy of these therapies needs to be proven in area; that is, critical care nursing is not just about haemodynamic
a randomised control research with appropriate scientific rigour. monitoring, ventilation and other advanced mechanical and tech-
The sample of patients in this study was stable, fairly uncompli- nical modalities. The provision of critical care nursing must com-
cated cardiac surgical patients without history of chronic pain syn- prise holistic, complete and all-rounded nursing practices. Critical
dromes. The study was designed to be credible with large enough care nurses should always think outside the square to find ways
sample size powered to detect a significant difference between the to improve outcomes of critically ill patients and should pass
two randomised groups. Randomisation was well controlled using these skills to novice nurses; skills such as complementary and
randomised block design to keep the difference in patient numbers alternative medicine therapies are one such skill to develop and
in each group less than or equal to two at all times. The share.

Learning activities

1. Discuss initial assessment of IABP timing and alarms with a 5. Describe the assessment needed throughout a ventilation
senior colleague. weaning process, in preparation for extubation and post-
2. Outline nursing assessment and management of patient with extubation. Identify any factors that would identify a patient
IABP in situ, including measures to prevent complications. that is not ready for extubation.
3. Identify the model of IABP that your critical care unit uses, and 6. Identify the possible causes of hypotension and low cardiac
review the alarms that are present, the causes of those alarms output in the postoperative cardiac surgical patient. Outline
and the response of the pump when it senses an alarm situa- the management options for each of these causes.
tion. With one of the senior staff, discuss the mechanisms that 7. Consider the possible causes of bleeding in the postoperative
you should undertake to correct each of the alarm situations. cardiac surgical patient and outline the appropriate assess-
4. Identify any abnormalities on the ABGs in the case study and ment and management for each of these causes.
discuss corrective treatment.