BACKGROUND: Understanding the psychological experience of living with a life-sustaining device is necessary for developing individualized, supportive interventions for patients with a left ventricular assist device. OBJECTIVES: To describe patients' experiences with left ventricular assist devices, strategies for coping with prolonged hospitalization, and suggestions for individualized nursing interventions. METHODS: The phenomenology method of qualitative research was used. Data collection involved unstructured, open-ended interviews of 6 hospitalized subjects who had a pneumatic left ventricular assist device. RESULTS: Patients described coping strategies for prolonged hospitalization, including family support, religious convictions, and diversional activities. Data analysis suggests that critical care nurses can best support these patients by establishing trusting relationships, fostering independence, and incorporating humor into their care. CONCLUSIONS: Patients awaiting cardiac transplantation coped effectively with prolonged hospitalization with a life-sustaining device in place. Spirituality, humor, and strong family relationships contributed to their positive outlook.
BACKGROUND: Monitoring the postoperative course of cardiac surgery patients remains essential but requires creative strategies now that length of hospitalization has been shortened to 5 days or less. OBJECTIVES: To determine patients' concerns in the early recovery period after open-heart surgery and to describe the impact of advanced practice nurses on this phase of recovery. METHOD: A cardiovascular clinical nurse specialist conducted follow-up by telephone for 342 cardiac surgery patients 7 to 14 days after discharge. Patients were asked both open-ended and direct questions. RESULTS: The major problems were leg edema (48%), appetite disturbance (35%), dyspnea (29%), sleep disturbance (12%), and wound drainage (9%). The nurse's interventions over the telephone included reassuring the patient about postoperative progress (86% of sample), giving diet information (31%), instructing about activity (29%), providing emotional support (25%), referring for medical treatment (16%), and explaining medications (13%). In response to these findings, the nursing practice council revised postoperative teaching to emphasize wound healing, sleep, and appetite issues. CONCLUSIONS: Telephone monitoring of cardiac surgery patients after early discharge can alleviate the often stressful transition to postoperative recovery at home. A cardiovascular clinical nurse specialist can provide patients and patients' family members with reassurance and ongoing reinforcement of the discharge information.