1Annapoorana College of Nursing, Vinayaka Mission Research Foundation, Salem, Tamilnadu, 636308 India
2Department of Mental Health Nursing, Amrita College of Nursing, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041 India
*Corresponding Author’s Email: saranapr26@gmail.com
Keywords: Cardiovascular Disease; Coronary Artery Bypass Grafting (CABG); Lived Experience; Patient Undergone CABG
According to Kalra et al. (2023) Coronary Artery Disease (CAD) is one of the most common reasons for death and illness in both developed and underdeveloped countries. Angina, dyspnoea, fatigue, and health problems can be triggered by CAD. The patient's capacity to carry out daily tasks is affected by these issues. CAD develops when the coronary arteries, the blood vessels responsible for supplying oxygen and nutrients to the heart muscle, become narrowed or blocked due to atherosclerosis, characterised by the accumulation of fatty deposits and plaque on the arterial walls (Dhakal & Pokharel, 2024).
Coronary artery bypass graft surgery (CABG) becomes unavoidable as CAD progresses. In fact, one of the best techniques for managing and treating CAD is thought to be CABG. Both survival and quality of life can be enhanced by CABG (Serruys et al., 2024, Saranya & Parimala, 2020). Furthermore, Kim et al. (2022) indicated that this surgical approach significantly impacts the patient's mental and emotional well-being also identified that
numerous studies have been conducted on the effects of CABG on quality of life. The majority of research has used a cultural lens to understand how patients actually lived their lives following CABG. In essence, according to Sawalha et al. (2024) patients' interpretations of health and sickness are influenced by their culture, which helps them make sense of their own suffering. Culture has the ability to significantly alter people's behaviour. Culture has an effect on patients' ability to follow their treatment plans as well as their general health.
McCann et al. (2023) conducted a qualitative inquiry into patient experiences. The study explored the enduring psychological and social impacts of CABG surgery on patients. It discussed issues related to mental health, lifestyle changes, and adaptation to new health behaviours.Sawalha et al. (2024) considers patients' involvements during the recovery phase following CABG. Key findings include the challenges of managing post-surgery pain, coping strategies, and the role of family support in recovery.
Therefore, Zaidova et al. (2022) specified that in all communities with diverse cultural backgrounds, cultural beliefs impact behaviour connected to health. For instance, some individuals choose not to receive blood transfusions due to their personal or religious beliefs (Crowe & DeSimone, 2022). Thus, it is reasonable to anticipate that, in the case of CABG, family has a significant impact on the experience that patients have after undergoing this surgical procedure. Altınbas & Yavuz Van Gıersbergen (2021) identified the research on patients' actual experiences following CABG as, however, absent from the body of literature now in publication. Comprehending the lived experience after obtaining a CABG could aid healthcare providers in formulating more suitable strategies for self-care practices and treatment plan compliance. This work, as a component of hermeneutics—the theory and practice of interpretation—involves a method of textual analysis within a broader hermeneutic phenomenological investigation. This approach is applied to deepen the understanding of patients' lived experiences following coronary artery bypass grafting (Dangal & Joshi, 2020). Consequently, the results of the current study will be investigated along with the role that family plays in the lived experiences of post-CABG patients.
The objective of the article is to explore the lived experiences of patients who have undergone coronary artery bypass graft.
In this study, a qualitative descriptive phenomenological approach was adopted. According to the Moustakas (1994), phenomenology is "an approach that concentrates on the study of consciousness and the objects of direct experience."
As per the study of Moustakas (1994), the eligible participants in the study were selected by the purposive sampling method. The participants were then given a description of the study's purpose. Patients who had undergone CABG surgery and were willing to speak about their experiences in the outpatient department were invited to take part in this study.
A comprehensive, semi-structured, in-person interview method was utilised to investigate the patients' post-operative experiences. The interviews were performed in a calm environment within the hospital area. The interviews took from forty-five to sixty minutes. Each conversation was audio recorded.
After receiving approval, the researcher began conducting the interview. Initially, they received a participant information form that provided a detailed description of the study. After the participant agreed to take part in the investigation, the investigator provided them with a consent form. Data was gathered continuously until saturation was reached. Saturation is defined as the time after data collection that produced no useful information. The interviews were then completely verbatim transcribed. Every interview has a typed transcript.
The research made use of Van Manen recommends that nursing researchers develop a more effective way to acquire information through investigating thoughtful statements provided by individuals with similar experiences of their life experiences (Van Manen, 2016).
The present study received ethical clearance from the ethics Review Committee of Annapoorna College of Nursing, Research Foundation, Vinayaka Mission, Salem, India. The study was approved with the reference number VMACON/IEC/02/2020, on 12th October, 2020 prior to the collection of data and conducting interviews.
The study was extracted according to one main theme, entitled desire to live, which contains 3 sub-themes of getting attention through family, cherishing hope, and possessing spiritually oriented.
Table 1 exemplify the application of Max van Manen’s phenomenological research methodology to explore post-operative experiences of coronary artery bypass graft (CABG) patients. This table describes six activities: establishing the essence of lived experience, exploring reality as encountered, considering main themes, hermeneutic writing, maintaining a focused approach, and balancing context. Each activity relates to specific methodological tasks and researcher actions, concluding in a systematic and transparent overview of the study approach.
Table 1: Summarises Van Manen's Six Proposed Activities
Van Manen’s Methodological Tasks | Researchers’ Actions |
Moving on to discuss the essence of experienced life | Determining the post-operative experiences of patients with CABG and considering living with the condition in order to formulate a phenomenological investigation |
Exploring reality as we encounter it | Engaging with post-CABG patients for an extended period of time, conducting in-depth interviews, and reflecting on Indian culture and the viewpoint of Indians towards health and disease |
Considering the main themes | Reading transcripts, immersing oneself in the data, listening to audio recordings, and performing thematic data analysis |
Hermeneutic writing as phenomenological | Composing an extensive phenomenological work and discussing the topics and sub-themes that have emerged |
Keeping a focused and vigorous nursing approach to the problem | Comparing and contrasting the concepts with personal experience |
Balancing the context of the research by taking parts and total into account | Alternating between transcripts and themes in light of the lived experience after CABG |
Source: Van Manen, 2016
The investigator reviewed the passage several times to have a thorough comprehension of the experiences of the individuals. Phrases, sentences, and words were taken out based on the study's major issue, which is the real-life experiences of patients following CABG. In this study, 11 patients who had undergone CABG surgery were explored for their lived experience after the surgery. Three major themes emerged via in-depth interviews: having a receiving attention through family, cherishing hope, and possessing a spiritually oriented perspective. These themes provide significant understanding into the recovery process and emphasise the complexity that the healing process becomes after CABG surgery.
Among the 11 patients, receiving attention through family was frequently mentioned as a vital component in their recovery. Several individuals were dependent on family members for support and attention during both the immediate post-operative time and the subsequent process of recovery.
Out of the 11 participants, 6 men and 3 women clearly acknowledged that their family played a crucial part in their recovery. These patients described how their family members supported them with everyday tasks such as personal care, managing their medications, and transportation to medical visits. Patients expressed how their loved ones provided reassurance, encouragement, and a sense of normality across their struggles of recovery. For example, one patient described how their spouse's consistent attention and care gave them the determination to stay positive during difficult times. Another patient emphasised the value of their children's involvement in their care, stating that their presence reduced feelings of loneliness and dread. These reports are consistent with previous research that has proven that family support has a positive impact on recovery outcomes post-CABG.
McCann et al. (2023) highlighted that patients who receive strong family support tend to have better recovery outcomes, including lower rates of depression and anxiety. Zaidova et al. (2022) also found that family involvement in the care process, particularly in managing medications and attending medical appointments, significantly reduces the risk of post-operative complications.
Hope emerged as an important coping technique for a large proportion of the patients in this study. Among the 11 participants, four men and three women acknowledged hope as an important aspect that helped them overcome the physical and mental hurdles of recovery.
For many patients, hope was inextricably linked to their belief in the potential of complete recovery and their expectation of returning to their normal lives. Several patients disclosed how they stuck to their hope of regaining strength and returning to their normal routines. This hope was frequently strengthened by pleasant interactions with healthcare personnel who informed them of their progress and the efficacy of their treatment.
One patient, for example, clarified how setting tiny, attainable goals - such as moving a little farther each day - helped them keep a positive attitude. Another patient discussed the importance of visualising a healthy and active future, which inspired them to remain committed to their rehabilitation regimen. The importance of hope in the recovery process is well supported by research, suggesting that patients who have an overwhelming feeling of hope are more likely to engage in positive health activities and have better psychological outcomes.
Pietkiewicz and Smith (2014) emphasised the importance of positive reinforcement by healthcare providers in fostering hope among patients, which aligns with your findings on the role of healthcare personnel in reinforcing hope. Similarly, Folkman (2013) highlighted that hope is a critical element in coping with chronic illnesses, serving as a protective factor that enables patients to adapt to health challenges more effectively. Also, Borah et al. (2023) discussed how hope serves as a dynamic force that evolves throughout the recovery process, often starting as hope for survival and gradually shifting to hope for quality-of-life improvements, much like the patients in your study who hoped for a return to normalcy.
A spiritually inclined perspective was an ongoing matter throughout five men and three women. These individuals utilise their spiritual beliefs and practices to navigate with the obstacles of recovery, find meaning in their lived experiences, and to maintain a sense of peace and resilience.
Patients with strong spiritual beliefs frequently perceived their surgery and recovery as part of a bigger, divinely guided journey. They engaged in spiritual practices such as prayer, meditation, and reading religious books to help them cope through their uncertainty and dread. For example, one patient explained how prayer provided reassurance and a sense of connection to a higher power, granting them the courage to face the obstacles of the day. Another patient expressed how their faith created a framework for understanding the circumstances, allowing them to find meaning in their pain and consider their recovery as part of an extended spiritual journey. These findings are consistent with research that emphasised the vital role of spirituality for promoting patients' emotional well-being and resilience.
These 11 patients' narratives reveal the vital roles that family support, hope, and spirituality play in their recovery process following CABG surgery. Each of these topics reinforces the necessity of an extensive approach to patient care that involves, in addition to the physical recovery but additionally the emotional, social, and spiritual desires of patients. Integrating these findings into clinical practice enables health care providers to improve the quality of treatment and recovery outcomes for patients with CABG surgery (Van Manen, 2023).
Borah et al. (2023) discussed how a spiritual perspective can enhance resilience by allowing patients to frame their recovery within a broader spiritual or religious context, thereby promoting emotional stability. Kalra et al. (2023) explored how spirituality acts as a crucial coping mechanism for patients recovering from major surgeries, including CABG, highlighting the importance of spiritual practices in reducing anxiety and promoting mental health.
The researcher found that there were few limitations in the study. The study involved small sample size which made it difficult to extrapolate the results to a larger population. The study showed more male than female participants, which might not accurately represent the experiences of women following CABG surgery. Furthermore, as the study took place in a single site, the outcomes could not be generalised to other settings with different practices or patient demographics. The study's qualitative integrity is based on self-reported experiences, which may trigger bias.
The researcher noted the present outcomes of the lived experiences of after CABG surgery patients, that their desire to live constituted the primary theme explored based on the interviews with the participants. This theme constitutes 3 sub-themes of obtaining attention through the family, cherishing hope, and possessing spiritual orientation. The individuals' determination to live was evident from the results following their surgery. After surgery, patients often gain a fresh perspective on their lives and health, according to the study's overall findings.
The future scope of studying the lived experiences of patients who have undergone Coronary Artery Bypass Graft (CABG) surgery through qualitative research is promising and multifaceted. By delving deeper into these experiences, researchers can uncover nuanced insights into patients' emotional, psychological, and social adjustments post-surgery. Understanding how patients perceive their quality of life, coping mechanisms, and the impact on their daily activities can inform tailored healthcare interventions and improve patient-centered care. Furthermore, exploring the cultural and societal influences on patients' experiences across diverse demographics can provide a comprehensive understanding of recovery trajectories and patient outcomes. This research avenue not only enriches clinical practice but also contributes to shaping healthcare policies that prioritize holistic patient care and well-being.
Based on the findings of the study, the following recommendations are put forth.
A similar study can be conducted with a large sample and diversity. The effect of teaching could be evaluated on a long-term basis. A study can be conducted as longitudinal research and incorporate technology in follow-up care. Future study can be conducted with strengthen post- discharge follow-up which can develop peer support programs for patients who have undergone CABG to share their experiences.
The authors certify that they have no conflicting personal or financial interests.
The authors would like to thank the study participants who showed their interest and perception towards sharing their experiences. The authors are thankful to the panellists who gave their best in making this paper valuable to the nursing profession.
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