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Patients' experiences of mediastinitis after coronary artery bypass graft procedure
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (Caring Sciences)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Caring Sciences)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Caring Sciences)
2007 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 41, no 4, 255-264 p.Article in journal (Refereed) Published
Abstract [en]

Few studies have focussed on patients' experiences of and suffering due to mediastinitis following Coronary Artery by-pass Graft (CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients' experiences of the medical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes with regard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it would influence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. The staff's medical knowledge and the quality of nursing care as well as the patients' understanding of the situation influenced their experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such as problem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handle the situations. The third theme comprised the patients' belief that the mediastinitis would not affect the outcome of the CABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.

Place, publisher, year, edition, pages
2007. Vol. 41, no 4, 255-264 p.
Keyword [en]
Coronary artery by-pass, surgical wound infection, mediastinitis, vacuum assisted closure, psychology, quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-94924DOI: 10.1080/14017430701283856ISI: 000248577400008PubMedID: 17680514OAI: oai:DiVA.org:uu-94924DiVA: diva2:168946
Available from: 2006-10-06 Created: 2006-10-06 Last updated: 2011-01-21Bibliographically approved
In thesis
1. Wound Infection Following Coronary Artery Bypass Graft Surgery: Risk Factors and the Experiences of Patients
Open this publication in new window or tab >>Wound Infection Following Coronary Artery Bypass Graft Surgery: Risk Factors and the Experiences of Patients
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered.

Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life.

SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 177
Keyword
Caring sciences, coronary artery bypass graft, surgical wound infection, infection control, risk factor, blood glucose, postoperative, Saphenous vein harvesting, wound evaluation scale, mediastinitis, psychology, quality of life, Vårdvetenskap
Identifiers
urn:nbn:se:uu:diva-7168 (URN)91-554-6669-9 (ISBN)
Public defence
2006-10-27, Auditoriet, Museum Gustavianum, Akademigatan 3, 753 10 Uppsala, 13:15
Opponent
Supervisors
Available from: 2006-10-06 Created: 2006-10-06Bibliographically approved

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Swenne, Christine LeoSkytt, BerniceCarlsson, Marianne

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