Fitzsimons D, Parahoo K, Stringer M
Belfast City Hospital, Belfast.
J Adv Nurs. 2000 Nov;32(5):1243-52. doi: 10.1046/j.1365-2648.2000.01595.x.
Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients' health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list - referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience - uncertainty, chest pain and anxiety; with six secondary themes - powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self-esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients' skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients' anxiety levels. This is the first known qualitative study which specifically examines patients' perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.
在许多发达国家，冠状动脉搭桥手术（CABS）的候诊名单很常见。然而，目前关于患者医疗保健需求的信息有限。本文报告了一项前瞻性研究，旨在从定性角度调查等待CABS的经历。采用归纳研究方法，在等待名单的第一年分三个时间段对70名随机选择的患者进行访谈——手术转诊时、等待6个月后（n = 49）以及最后等待1年后（n = 28）。失访主要是由于已进行手术（n = 36），不过死亡（n = 4）和拒绝参与（n = 2）也有影响。进行了上门访谈并逐字记录。主题内容分析确定了这种经历中的三个核心主题——不确定性、胸痛和焦虑；还有六个次要主题——无力感、对治疗的不满、愤怒/沮丧、身体 incapacity、自尊降低以及家庭和社会关系改变。使用访谈引述描述了每个主题中固有的性质和意义，并提出了一个模型来总结这些数据以及主题之间的关系。通过该分析，不确定性、胸痛和焦虑成为这些患者负面结果的重要指标。本报告强烈表明，等待搭桥手术的患者需要更多关于此类手术等待时间的信息。护士还应提供疼痛管理方面的建议，以帮助提高患者的技能并减少与心绞痛相关的恐惧。护理干预和支持也应旨在降低患者的焦虑水平。这是第一项专门研究患者对搭桥手术前等待期看法的已知定性研究。因此，它可能为医院和社区护士的实践提供新的依据，也可能激发该领域的进一步研究。
