Claesson Lingehall Helena, Smulter Nina, Olofsson Birgitta, Lindahl Elisabeth
Department of Nursing, Umeå University, Umeå, SE-901 87 Sweden ; Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Umeå, SE-901 85 Sweden.
Department of Nursing, Umeå University, Umeå, SE-901 87 Sweden.
BMC Nurs. 2015 Mar 30;14:17. doi: 10.1186/s12912-015-0069-7. eCollection 2015.
Cardiovascular disease is common among old people and many undergo cardiac surgery. Scientific knowledge is available on cardiac surgery from several perspectives. However, we found few studies focusing on older patients' experiences of cardiac surgery. The aim of this study was to illuminate experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium, a one year follow-up.
Qualitative interviews were conducted with 49 participants (aged ≥70 years) diagnosed with delirium after cardiac surgery. Data were collected in Sweden during 2010 through individual, semi-structured interviews in participants' homes one year after surgery. The interviews were analyzed using qualitative content analysis.
Four themes with sub-themes were formulated: Feeling drained of viability includes having a body under attack, losing strength and being close to death. Feeling trapped in a weird world describes participants having hallucinations, being in a nightmare and being remorseful for their behavior. Being met with disrespect includes feeling disappointed, being forced, and feeling like cargo. On the other hand, Feeling safe, including being in supportive hands and feeling grateful, points to participants' experiences of good care and the gift of getting a second chance in life.
Even one year after cardiac surgery, participants described in detail feelings of extreme vulnerability and frailty. They also had felt completely in the hands of the health care professionals. Participants described experiences of hallucinations and nightmares during hospitalization. Cardiac surgery was a unique, fearful, traumatic and unpleasant experience yet could also include pleasant or rewarding aspects. It seems that health care professionals need deeper knowledge on postoperative delirium in order to prevent, detect and treat delirium to avoid and relieve the suffering these experiences might cause.
心血管疾病在老年人中很常见，许多人接受心脏手术。从多个角度都有关于心脏手术的科学知识。然而，我们发现很少有研究关注老年患者心脏手术的经历。本研究的目的是阐明患有术后谵妄的老年人接受心脏手术的经历，并进行为期一年的随访。
对49名（年龄≥70岁）心脏手术后被诊断为谵妄的参与者进行了定性访谈。2010年在瑞典，通过在参与者家中进行的个人半结构化访谈收集了术后一年的数据。采用定性内容分析法对访谈进行分析。
形成了四个主题及子主题：活力耗尽感包括身体受到攻击、失去力量和濒临死亡；被困在怪异世界描述了参与者出现幻觉、身处噩梦以及对自己的行为感到懊悔；受到不尊重包括感到失望、被强迫以及感觉像货物；另一方面，感到安全包括得到支持和心怀感激，这指向了参与者得到良好护理的经历以及获得人生第二次机会的恩赐。
即使在心脏手术后一年，参与者仍详细描述了极度脆弱和虚弱的感觉。他们也完全感到自己掌控在医护人员手中。参与者描述了住院期间出现幻觉和噩梦的经历。心脏手术是一次独特、可怕、创伤性且不愉快的经历，但也可能包括愉快或有益的方面。医护人员似乎需要对术后谵妄有更深入的了解，以便预防、检测和治疗谵妄，避免和减轻这些经历可能带来的痛苦。
