To Örebro University

In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.

In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.

Clinical trials register number and URL: NCT05045196, https://clinicaltrials.gov/study/NCT05045196?cond=NCT05045196 & rank=1;

BACKGROUND: As open-heart surgery can be stressful for the patient and their family, the objective of this study was to generate knowledge on how to support families in relation to open-heart surgery based on important situations.

AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement as expressed by family members of patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique used is a qualitative method appropriate for identifying issues relating to clinical problems.

ETHICAL ISSUES AND APPROVAL: Ethical approval was obtained from the Swedish Ethical Review Authority. Allowance was made for the unexpected presence of the patient.

RESEARCH METHODS: Individual interviews with 29 family members of patients who underwent open-heart surgery in Sweden in 2023 were analysed using the critical incidence technique, as applied in nursing and healthcare sciences.

RESULTS: The family members experienced being-or not being-seen as significant and were fearing the loss of normal life in relation to open-heart surgery. Actions taken during important situations were building confidence to relinquish control and relieving burdens to improve well-being.

CONCLUSIONS: Family involvement, in terms of being informed and welcomed, led to an improved ability to care for their loved ones. Emotionally supportive interventions targeting families should be considered in relation to a loved one's open-heart surgery.

Perioperative neurocognitive disorders, including postoperative delirium, delayed neurocognitive recovery and mild/major postoperative neurocognitive disorder, are common complications that affect older adults after surgery. Postoperative delirium, which occurs in 10-60% of major surgery patients, can increase the risk of delayed neurocognitive recovery and postoperative neurocognitive disorder, which affects 10-25% of patients. Preoperative and postoperative assessment of neurocognitive functioning typically involve the use of screening tools, such as Mini-Cog or 4AT. Despite the availability of evidence-based cognitive screening tools, many patients remain undiagnosed in clinical settings. Both postoperative delirium and postoperative neurocognitive disorder can lead to long-term cognitive and emotional complications, such as forgetfulness, trouble with initiating tasks, and mood disturbances. Next of kin experience considerable distress when witnessing delirium in a family member, a situation that is frequently exacerbated by a lack of information from health care professionals. Ethical challenges arise when cognitive impairment impacts patients' decision-making capacity, raising concerns about autonomy, use of restraints, and resource allocation. Informing patients about their risk of postoperative neurocognitive disorder before surgery is vital; however, it is not standardized in clinical practice. Further, there is a notable lack of interventions aimed at promoting neurocognitive recovery, with most guidelines relying on expert consensus. This narrative review therefore aims to explore recent advances in perioperative neurocognitive recovery, focusing on symptomatology, patient and next of kin experiences, assessments, care interventions and ethical aspects.

Background: Person-centred care promotes a holistic, collaborative care, aiming to improve patient outcomes, enhance interprofessional collaboration and increase patient and family satisfaction. Implementing person-centred team rounds is one method to achieve this, to enhance individualized care with a focus on nursing, ensuring that important aspects of the patient’s well-being are considered.

Methods: At the Cardio-Thoracic Intensive Care Unit in Örebro, Sweden, person-centred rounds have been implemented weekly on Thursdays for patients with extended ICU stays (> 2 days), with about 15 minutes allocated per patient. The rounding team includes the patient’s nurse, nursing assistant, anesthesiologist, physiotherapist and a project facilitator. Information is gathered from the patient and their family, to obtain a comprehensive understanding of the patient's needs, preferences, challenges, risks and resources. This multidisciplinary approach centers on the patient’s overall experience, prioritizing their physical, emotional, and social needs rather than just the medical aspects. The rounds focus on tailoring the care plan to the patient’s evolving situation, addressing potential barriers to recovery, and ensuring that care is coordinated and responsive.

Results: Since the start in March, a project fascilitator has attended all rounds to ensure adherence to the new routine, time management and team participation. Early feedback suggests that the rounds can increase team involvement and communication between healthcare providers, patients, and their families.

Discussion: The possibility of enhancing communication is advantageous, but time constraints in the ICU may limit discussion depth. The project facilitator’s role is identified as important to maintain adherence to the routine.

Open-heart surgery is known to affect not only the patient, but also his or her family members. Therefore, family involvement in relation to this surgical procedure ought to be supported. Attention should be paid to the whole family’s well-being. There is a lack of research on how this should be done in current open-heart surgical care settings. The overall aim was to describe, explore, evaluate, and interpret family involvement in relation to patients undergoing open-heart surgery using social support theory. Study I had a mixed-methods convergent parallel design and was conducted through integrating one cross-sectional and two qualitative datasets describing registered nurses’ (n = 267) and licensed physicians’ (n = 20) attitudes toward family involvement in open-heart surgical care. Descriptive qualitative data were analyzed using the critical incident technique to explore patients’ (n =35) (Study II) and family members’ (n = 29) (Study III) experiences and actions regarding family involvement. In Study IV, quantitative data were analyzed in a randomized clinical trial to evaluate the effects of the family health conversations when delivered to patients with their family members via videoconferencing. The primary analysis was based on questionnaire responses from 101 patients (control = 54, intervention = 47) and 99 of their family members (control = 52, intervention = 47). The results of Study I–IV were synthesized by applying a mixed-methods approach. The synthesized findings showed that family involvement in open-heart surgical care entails social and professional supportive aspects. Family involvement is a concept that also has unsupportive aspects. Patients and family members have needs connected to all these aspects that can be met by family-centered care policy and intervention. The family health conversations is one intervention that has potential to meet the needs of families in this context. In addition to the implementation of family-centered policies, the findings support a team approach to supportive conversations in open-heart surgical care and further exploration and evaluation of peer support programs in this context.

BACKGROUND: As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not.

ETHICAL ISSUES AND APPROVAL: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps.

RESEARCH METHODS: Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method.

RESULTS: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support.

CONCLUSIONS: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.