From hope and expectation to unexpected death after cardiac surgery

Department of Cardiothoracic Surgery, Lund University Hospital, Sweden.
Intensive and Critical Care Nursing 09/2008; 24(4):242-50. DOI: 10.1016/j.iccn.2008.02.002
Source: PubMed


Relatives of patients undergoing cardiac surgery expect successful outcome but sometimes complications cause death. The aim was to interview relatives of patients who have died in connection with cardiac surgery and describe their experiences of information, reception and care.
Data were obtained from semi-structured interviews with 18 relatives of deceased patients and then analysed using qualitative content analysis.
Two main groups emerged: "Analysing the situation" with the sub-groups: knowledge of cardiac disease, the road to operation, hope and despair, information and choice and "The thin thread of life" with the sub-groups, reception, life is over, care, death as a relief, cause of death and support.
Most relatives were satisfied with the information and care in connection with the operation and at the end of life. However, some aspects such as inadequate pain control and transportation of critically ill patients to other wards and hospitals could be improved. One way is to introduce a co-ordinator in order to better support patients, next of kin and colleagues without experience of cardio-thoracic surgery who need help during the patients' way from diagnosis and acceptance of cardiac surgery and through the treatment and postoperative care.

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    • "Sudden or unexpected death has mostly been studied from the perspective of acute and emergency care [18], intensive care [19] and cardiology settings [20] all of which have shown the importance of providing information to the next of kin. Research with stroke team members has shown that findings from other areas cannot simply be transferred to this context since stroke as illness influences the situation in specific ways which affects the situation, for example how ethical problems take a central role when death is a sudden and unexpected death [21]. "
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    ABSTRACT: Background Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke. Methods Data was collected over a 12-month period in 2009–2010. Twelve next of kin of patients cared for in stroke units who died suddenly and unexpectedly from stroke were interviewed using a narrative method. The narratives were analyzed using narrative thematic analysis. Results Three themes emerged showing facets of next of kin’s experiences of a relative’s sudden and unexpected death from stroke: Divided feelings about the sudden and unexpected death; Perception of time and directed attention when keeping vigil; Contradictions and arbitrary memories when searching for understanding. Conclusions To have to live in the aftermath of severe stroke is absolute horror in people’s imagination and death is seen as the lesser of two evils. The sudden and unexpected death totally pervades the next of kin’s life, directs their attention to the dying person and even causes them to forget themselves and their own needs, and leads to difficulties in information intake. It is a challenge for the healthcare professionals to be able to identify the individual needs of the next of kin in this situation.
    BMC Nursing 04/2013; 12(1):13. DOI:10.1186/1472-6955-12-13
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    ABSTRACT: Next of kin (NoK) to patients undergoing cardiac surgery expect successful outcomes but sometimes serious complications occur and this affects their NoK. To describe NoK's experiences of information and support when serious complications occur during the first 30 days after cardiac surgery. A qualitative, critical incident technique was used. Forty-two NoK were asked to describe their experiences of information and support. Three main areas emerged from the analysis. The first main area, Confidence during the waiting period, described how NoK could not participate in the forthcoming operation and how the NoK were informed. The second main area, Involvement during the hospital stay, described how the NoK feel trust in the healthcare professionals and dissatisfaction with the care in relation to the operation. The third main area, Sense of abandonment, described problems with the rehabilitation. These findings show the importance of pre- and post operative contacts between healthcare professionals, patients and NoK. When the NoK and the patients are well informed it constitutes a basis for fruitful conversations between them and the healthcare professionals, and everyone can be better prepared if complications occur.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 11/2011; 27(6):331-7. DOI:10.1016/j.iccn.2011.10.002
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