Academic journal article Scholarly Inquiry for Nursing Practice

Women Recovering from Coronary Artery Bypass Surgery

Academic journal article Scholarly Inquiry for Nursing Practice

Women Recovering from Coronary Artery Bypass Surgery

Article excerpt

Coronary heart disease is the leading cause of death among American women over 50, and women are undergoing surgical revascularization procedures in ever increasing numbers. There are, however, little research-based data upon which to guide the nursing care of these patients. This study explored the nature of the recovery process for women following coronary bypass surgery in order to extend our understanding of the posthospitalization phase of the recovery trajectory. Ten patients participated in semi-structured interviews that were analyzed using thematic analysis. Data reveal significant problems with caregiver recognition and access to care. Barriers to care may also exist due to women's traditional subordinate role in American society and their use of gender specific interactive skills. Recovery for women was found to differ significantly from that: of men due to the later developmental stage when women are more likely to experience cardiac illness.

Coronary heart disease is the leading cause of death among American women over 50 and the second leading cause of death in women between 35 and 39. An estimated 250, 000 women die each year from this disease (American Heart Association, 1989; Thorn, 1987). Despite these impressive statistics, coronary heart disease is generally thought of as a disease primarily of men in their middle years (Hawthorne, 1991; Wingate, 1991). This view is reflected in both the clinical diagnosis and management of women with coronary heart disease and the research underpinning the decision tree for treatment. For example, several recent studies of gender bias in physicians' use of diagnosis and treatment options indicate that women in several major cardiac centers have not been undergoing procedures such as coronary angioplasty and artery bypass procedures as frequently as men (Ayanian & Epstein, 1991; Kahn et al., 1990; Tobin et al., 1987; Wenger, 1990).

The apparent gender bias operating in diagnosis and treatment and also in clinical trials involving patients with coronary heart disease has special significance for nursing. A consequence is that the assumptions and knowledge base that guide nursing management of these patients may be based upon incomplete or even inaccurate information. The lack of research-based data to guide nursing care for women with cardiac disease is particularly worrisome in the case of women recovering from infarction or cardiac surgery, where recovery outcomes have been linked to patients' perceptions of illness events (Evart et al., 1986; Mishel, 1980; Peel, Semple, Wang, Lancaster, & Dall, 1962). A major aspect of the nursing care of these patients is enhancement of the patient's understanding of illness events through providing appropriate information and correcting misconceptions.

Patients recovering from coronary artery surgery may be viewed as facing a novel phase within a chronic illness trajectory (Corbin & Strauss, 1988; Hawthorne, 1990). This illness phase is characterized by ambiguity and uncertainty as symptoms that have guided illness management are significantly altered or even eradicated. Nurses can help patients foresee the recovery phase of the illness trajectory and also help them to understand the new demands of illness. Patients are assisted to construct plans to meet regimen demands and renegotiate relationships (Corbin & Strauss, 1988). Patient and family expectations can then approach alignment with clinical realities, enabling the patient to manage the work of recovery.

A necessary antecedent to this kind of nursing care is an understanding of the patient's interpretation of clinical events (Paterson & Zderad, 1976). This understanding requires acknowledging the individual's own interpretive framework, which operates from within to assign meaning to lived events (Shutz, 1967). Unfortunately, for women recovering from cardiac surgery, patients' views of the surgical experience and recovery trajectory have not yet been described. …

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