PATI ENT FEELI NGS DURI NG THE PREOPERATI VE PERI OD FOR CARDI AC SURGERY
1Tat iana Vict or elli Pir es Var gas2 Em anuelle Mendonça Maia3 Rosana Apar ecida Spadot i Dant as4
Var gas TVP, Maia EM, Dan t as RAS. Pat ien t f eelin gs du r in g t h e pr eoperat iv e per iod f or car diac su r ger y. Rev Lat ino- am Enfer m agem 2006 m aio- j unho; 14( 3) : 383- 8
This qualit at ive st udy aim ed t o ident ify t he feelings pat ient s present ed when confront ed wit h t he news about t he need t o under go car diac sur ger y and, lat er , dur ing t he pr eoper at iv e per iod. Tw ent y m ale pat ient s w er e int er v iew ed. The case st udy m et hodology w as adopt ed and t he analy sis pr ocess r esult ed in t w o t hem e cat egor ies: Feelin gs of appr eh en sion ( f ear , w or r y , an x iet y , su spicion an d j it t er y ) an d Posit iv e an d h opef u l feelings. We observed t hat , alt hough bot h cat egories w ere present at t he t w o m om ent s, over t im e, during t he pr eoper at iv e per iod, t he need for sur gical int er v ent ion w as accept ed bet t er and t he Feelings of appr ehension st ar t ed t o be m ent ioned less, w hile t he Posit iv e and hopeful feelings w er e m ost fr equent ly m ent ioned by t he pat ien t s.
DESCRI PTORS: t hor acic sur ger y ; per ioper at iv e car e; em ot ions; nur sing
SENTI MI ENTOS DE LOS PACI ENTES EN EL PREOPERATORI O DE CI RUGÍ A CARDÍ ACA
Fuer on ent r ev ist ados a 20 pacient es del géner o m asculino con obj et o de ident ificar los sent im ient os dem ost r ados t r as la not icia a cer ca de la necesidad de r ealizar una cir ugía car díaca y , post er ior m ent e, en el p er íod o d e in t er n ación p r eop er at or ia. La m et od olog ía u t ilizad a f u e la d el est u d io d e caso y el p r oceso d e análisis result ó en dos cat egorías t em át icas: Sent im ient os de aprensión ( m iedo, preocupación, ansiedad, recelo, descon f ian za y n er v iosism o) y Sen t im ien t os posit iv os y de esper an za. Con st at am os qu e, au n qu e esas dos cat egor ías est u v ier on pr esen t es en los dos m om en t os, a lo lar go del t iem po, en el per íodo de in t er n ación pr eoper at or ia, los pacient es acept ar on m ej or la necesidad de la int er v ención quir úr gica y los Sent im ient os de apr en sión pasar on a ser m en os cit ados, m ien t r as los Sen t im ien t os posit iv os y de esper an za er an los m ás r elat ados por los pacient es.
DESCRI PTORES: cir u gía t or ácica; at en ción per ioper at iv a; em ocion es; en fer m er ía
SENTI MENTOS DE PACI ENTES NO PRÉ-OPERATÓRI O DE CI RURGI A CARDÍ ACA
Com o obj et ivo de ident ificar os sent im ent os apresent ados frent e à not ícia da necessidade de realização de um a cir ur gia car díaca e, post er ior m ent e, no per íodo de int er nação que a ant ecede ( pr é- oper at ór io) , for am ent revist ados 20 pacient es do sexo m asculino. A m et odologia foi a de est udo de caso, e o processo de análise r esu lt ou em du as cat egor ias t em át icas: Sen t im en t os de apr een são ( m edo, pr eocu pação, an siedade, r eceio, cism a, e nervosism o) e Sent im ent os posit ivos e de esperança. Const at am os que, em bora essas duas cat egorias est iv essem pr esent es nos dois m om ent os, com o passar do t em po, no per íodo de int er nação pr é- oper at ór ia, os pacient es aceit aram m elhor a necessidade da int ervenção cirúrgica e os Sent im ent os de apreensão passaram a ser m enos cit ados enquant o os Sent im ent os posit ivos e de esperança eram os m ais relat ados pelos pacient es.
DESCRI TORES: cir u r gia t or ácica; assist ên cia per ioper at ór ia; em oções; en fer m agem
1
Scient ific I nit iat ion Proj ect PI BI C/ USP/ CNPq 2003- 2004; 2 Undergraduat e st udent , Universit y of São Paulo at Ribeirão Pret o College of Nursing - WHO
Collaborat ing Cent re for Nursing Research Developm ent , CNPq grant holder; 3 Physiot herapist , Mast er’s st udent , Universit y of São Paulo at Ribeirão Pret o
Medical School; 4 RN, Junior Professor, Universit y of São Paulo at Ribeirão Pret o College of Nursing - WHO Collaborat ing Cent re for Nursing Research
Dev elopm ent , e- m ail: r sdant as@eer p.usp.br
I NTRODUCTI ON
T
he perspect ive of being subm it t ed t o heart sur ger y fr ight ens any hum an being. The hear t has acult ur al m eaning as an or gan t hat is r esponsible for
em ot ions and cont r ols life, and sur ger y of t his or gan
em ot ionally wears out pat ient s and t heir fam ilies, due
t o t h e t h r e a t i t p o se s t o t h e f u t u r e a n d t o t h e
r est r uct ur ing of daily life( 1).
Hear t disease and it s sur gical t r eat m ent can
r e p r e se n t a n a b r u p t l y i m p o se d , n e w r e a l i t y t h a t
d est r u ct u r es p at ien t s, w h o f eel t h r eat en ed in t h eir
self- im age, ar e afr aid of t heir healt h st at e and is at
t he m ercy of professionals who do not always t ransm it
securit y and em pat hy. This healt h t hreat also prov okes
anx iet y in t hese per sons, w ho ar e alr eady w eak ened
by t heir clinical condit ion( 2- 3).
When heart surgery is indicat ed, it is usually
ex p er ien ced w it h am b iv alen t f eelin g s. On t h e on e
h a n d , p a t i e n t s p e r c e i v e a m a g i c a l , m i r a c u l o u s
in t er v en t ion t h at w ill fr ee t h em fr om t h e r isk of an
in far ct ion . On t h e ot h er, t h er e is t h e fear of deat h ,
du r in g an d af t er t h e an est h et ic- su r gical pr ocedu r e,
and of suffer ing ir r ev er sible dam age. I n t his k ind of
sit u at ion s, it is com m on f or p at ien t s’ m in d s t o b e
occupied by a r ange of fant asies and feelings( 4- 6).
Pa t i e n t s ’ e x p e c t a t i o n s a b o u t m y o c a r d i a l
r evascular izat ion sur ger y w er e sur veyed in a st udy( 6)
t hat show ed t hat m any pat ient s ex pr essed fear and
ap p r eh en sion t ow ar d s t h e n eed f or su r g er y. Th ese
feelings w er e ev en m or e fr equent am ong indiv iduals
who were going t o be subm it t ed t o a surgical procedure
for t he first t im e( 6).
Of a l l d i a g n o s e s m a d e d u r i n g t h e
p r e o p e r a t i v e p e r i o d o f h e a r t su r g e r y, a n x i e t y i s
p r o b a b l y o n e o f t h e m o st co m m o n o n e s. I t i s a
u n i v e r sa l p h e n o m e n o n a n d a n e m o t i o n a l r e a l i t y
ex per ien ced by alm ost all su r gical pat ien t s. An x iet y
can influence pat ient s’ response t o surgical t reat m ent
a n d c a u s e n e g a t i v e e f f e c t s o n p o s t o p e r a t i v e
r ecov er y( 7 ). Hig h an x iet y lev els b ef or e m y ocar d ial
r ev ascu lar izat ion ar e associat ed w it h p ost op er at iv e
d e p r e s s i o n , p r e c a r i o u s r e c o v e r y a n d p a i n
a g g r a v a t i o n( 8 ). Mo d e r a t e l e v e l s o f p r e o p e r a t i v e
anx iet y can help pat ient s t o pr epar e for sur ger y and
reduce t he st ress of t he sit uat ion( 8).
A n x i e t y a n d f e a r d i a g n o s e s h a v e b e e n
def in ed( 9 ), r espect iv ely, as “ a v agu e an d dist u r bin g
f eel i n g o f d i sco m f o r t o r f ea r, a cco m p a n i ed b y a n
aut om at ic reply ( t he source is frequent ly non- specific
o r u n k n o w n t o t h e i n d i v i d u a l ) ; a f e e l i n g o f
apprehension caused by t he ant icipat ion of danger. I t
is a sign of alert t hat at t ract s at t ent ion t o an im m inent
danger and allows t he individual t o t ake m easures t o
deal w it h t h e t h r eat ” an d “ r espon se t o a per ceiv ed
t hr eat t hat is k now ingly r ecognized as danger.”( 9).
For bot h diagnoses, anx iet y and fear, som e
fact or s can be r elat ed, such as: deat h t hr eat , t hr eat
of change in healt h condit ion, t hreat of change in t he
e n v i r o n m e n t . W i t h r e sp e ct t o f e a r, w e ca n a l so
highlight t he separat ion from t he support syst em in a
p o t e n t i a l l y s t r e s s i n g s i t u a t i o n , l i k e d u r i n g
hospit alizat ion for ex am ple( 8 ).
I d en t i f y i n g p at i en t s’ p r eo p er at i v e f eel i n g s
bef or e h ear t su r ger y is v er y im por t an t becau se, in
t he hospit al environm ent , nurses play a broad role in
c a r e f o r p e o p l e s u b m i t t e d t o c o m p l e x s u r g i c a l
procedures like cardiac surgeries. Nursing care ranges
f r o m d e l i v e r i n g p r e o p e r a t i v e c a r e a n d c a r e f u l l y
m o n i t o r i n g f o r e a r l y d e t e c t i o n o f p o s t o p e r a t i v e
com plicat ions t o offer ing em ot ional and psychological
suppor t t o pat ient s and t heir fam ilies t hr oughout t he
post - sur gical r ecov er y per iod( 1 0 ).
We believe t hat reducing pat ient s’ anxiet y and
pr epar ing t hem for sur ger y ar e pr eoper at iv e nur sing
t arget s. The cont ent s and t eaching approach in pat ient
edu cat ion sh ou ld alw ay s be in div idu alized, an d on e
of it s obj ect iv es sh ou ld be t o r edu ce t h e fear s t h at
cont ribut e t o preoperat ive pat ient anxiet y. These fears
are: fear of t he unknown, of deat h, anest hesia and of
changes in one’s body im age.
I dent ify ing how pat ient s face and cope w it h
t he sit uat ion of await ing heart surgery is an im port ant
aspect for t he pr ofessionals w ho ar e deliv er ing car e.
Th ey sh o u l d k n o w ab o u t t h e p r esen ce o f d ef en se
m echanism s and how pat ient s respond t o t he sit uat ion
in t h e pr e- an d post oper at iv e per iods( 1 1 ). Th er e is a
r ange of anx iet y t hat should be consider ed desir able
and will st im ulat e pat ient s t o act , for exam ple: asking
q u est ion s t o t h e t eam , m eet in g w it h r elat iv es an d
accep t in g t h e r est r ict ion s im p osed b y p r eop er at iv e
pr eparat ion. How ever, w hen anx iet y lev els ar e high,
pat ien t s can dem on st r at e apat hy. Th is w ou ld cau se
dif f icu lt ies t o lear n t h e v er bal or ien t at ion s r eceiv ed
from t he t eam . Low anxiet y levels, on t he ot her hand,
c a n i n d i c a t e a l a c k o f i n t r o v e r s i o n , l e a d i n g t o
r esi st a n ce a g a i n st u n d er st a n d i n g a n d r ea f f i r m i n g
Thus, considering t he assessm ent of pat ient s’
p r eop er at iv e f eelin g s b ef or e car d iac su r g er y as an
im port ant aspect for nursing care, we decided t o carry
out t his assessm ent as one of t he goals of a lar ger
research proj ect called “ Proposal of a t eaching prot ocol for pat ient s dur ing t he pr eoper at iv e per iod for hear t sur ger y: a pilot st udy”.
OBJECTI VE
This st udy aim s t o ident ify t he feelings m ale
p at ien t s p r esen t ed w h en con f r on t ed w it h t h e n ew s
about t he need t o undergo cardiac surgery and, lat er,
d u r in g t h e h osp it alizat ion p er iod t h at p r eced es t h e
h ear t su r ger y ( pr eoper at iv e) .
METHODOLOGY
Populat ion and place of st udy
Th e pot en t ial st u dy popu lat ion con sist ed of
pat ient s hospit alized for hear t sur ger y. The follow ing
inclusion crit eria were est ablished: m en, over 21 years
old, who were hospit alized in t he preoperat ive period
for heart surgery; did not have a hist ory of psychiat ric
diseases lik e dem ent ia, depr ession or schizophr enia;
w e r e o r i e n t e d i n t i m e a n d sp a ce ; h a d n o t b e e n
subm it t ed t o pr ev ious hear t sur ger ies and agr eed t o
par t icipat e in t he st udy.
Hear t d iseases m or e f r eq u en t ly af f ect m en
t han w om en. Considering t his aspect and in order t o
l i m i t s e l e c t i o n e r r o r s r e s u l t i n g f r o m e x i s t i n g
differ ences bet w een m en and w om en’s r eact ions and
percept ions t owards a st ress sit uat ion, we decided t o
include only m ale pat ient s.
I n v iew of t h ese cr it er ia, t h e st u dy sam ple
con sist ed of 2 0 adu lt pat ien t s w it h cor on ar y ar t er y
d isease or v alv ar d iseases ( v alv ar in su f f icien cy or
st enosis) w ho w ould be subm it t ed t o hear t sur ger y.
Par t icipant s w er e hospit alized in t he car diac sur ger y
an d car diology w ar ds, locat ed, r espect iv ely, on t h e
9 t h an d 5 t h f loor of t h e Un iv er sit y of São Pau lo at
Rib eir ão Pr et o Med ical Sch ool Hosp it al d as Clín icas
( HCFMRP- USP) bet w een May and Nov em ber 2003.
Th is st u d y w as ap p r ov ed b y t h e Resear ch
Et h ics Com m it ee of t h e Un iv er sit y of São Pau lo at
Ribeir ão Pr et o Medical Sch ool Hospit al das Clín icas.
Pot ent ial part icipant s were invit ed t o part icipat e in t he
st u d y an d r eceiv ed an in f or m at ion d ocu m en t t h at
pr esent ed t he r esear ch obj ect iv es and pr ocess. Aft er
t h ey ag r eed , each p ar t icip an t sig n ed t h e f r ee an d
infor m ed consent t er m t oget her w it h t he r esear cher.
Al l p ar t i ci p an t s r ecei v ed t h e g u ar an t ee t h at t h ei r
anonym it y would be respect ed in t he research result s.
St udy design
We car r ied out a qualit at ive st udy, follow ing
t h e p r in cip les of case st u d ies. Dat a w er e collect ed
t h r ou gh in div idu al sem ist r u ct u r ed in t er v iew s, based
on a scr ipt t hat cont ained dat a for t he par t icipant s’
sociodem ogr aph ic an d clin ical ch ar act er izat ion , an d
also on t he following guiding quest ions: “ What did you feel when you found out t hat you had t o do t his surgery on y ou r h ear t ?”, “ How ar e y ou f eelin g n ow ?” an d
“ What are you t hinking about your experience of being hospit alized for a hear t sur ger y ?”.
Dat a an aly sis
D at a an al y si s i n v o l v ed d i f f er en t st ep s: a)
r eadin g all collect ed in f or m at ion ; b) or gan izin g t h e
m at er ial in codes ( u n it s of m ean in g) , con sider in g a
n u m b e r o f a sp e ct s: e x h a u st i v e co n t a ct w i t h t h e
m a t e r i a l t o b e co m e d e e p l y a ccu st o m e d w i t h i t s
cont ent s; organizat ion of t he m at erial t o com ply wit h
t h e f o l l o w i n g v a l i d i t y st a n d a r d s: e x h a u st i v e n e ss,
r e p r e se n t a t i v e n e ss, h o m o g e n e i t y, p e r t i n e n ce ; c)
det erm ining t he recording unit , cont ext unit and cut s;
and, finally, d) grouping t he codes int o cat egories( 12).
To allow us t o check t he creat ed codes and cat egories
m or e t h an on ce, w e ask ed an ot h er r esear ch er w it h
ex p er ien ce in t h is k in d of st u d ies t o d o t h e sam e
procedure wit h all of our dat a. No m odificat ions were
m ade as a result of t his process.
RESULTS AND DI SCUSSI ON
Pat ien t s’ ages r an ged f r om 3 9 t o 8 9 y ear s
( m ean age 60.6 y ear s) . Four t een par t icipant s ( 70% )
had not finished prim ary educat ion and 13 ( 65% ) were
m ar r ied. As t o t heir clinical sit uat ion, a m aj or it y ( 16
pat ient s) would undergo coronary art ery bypass graft
surgery and 10 persons ( 50% ) had bet ween 3 and 4
co m o r b i d i t i e s. Ta b l e 1 p r e se n t s t h e p a r t i ci p a n t s’
Table 1 - Sociodem ographic and clinical charact erist ics
of t he st udy sam ple. Ribeir ão Pr et o- SP, 2004
e l b a i r a
V N (%)
e g A s r a e y 9 4 li t n
U 2 (10)
s r a e y 0 6 d n a 0 5 n e e w t e
B 8 (40)
s r a e y 1 6 r e v
O 10 (50)
s u t a t s li v i C e l g n i
S 2 (10)
r e n t r a p a h t i w g n i v il / d e i r r a
M 13 (65)
d e w o d i
W 3 (15)
d e c r o v i d / d e t a r a p e
S 2 (10)
n o i t a c u d E e t a r e t il
lI 3 (15)
n o it a c u d e y r a m i r p d e h s i n if n
U 14 (70)
n o it a c u d e y r a m i r p d e h s i n i
F 2 (10)
n o it a c u d e y r a d n o c e s d e h s i n if n
U 0 (0)
n o it a c u d e y r a d n o c e s d e h s i n i
F 0 (0)
n o it a c u d e r e h g i
H 1 (5)
s e i t i d i b r o m o c f o o N 2
-1 3 (15)
4
-3 10 (50)
4
> 7 (35)
y r e g r u s f o e p y T * G B A
C 16 (80)
t n e m e c a l p e r e v l a v t r a e
H 2 (10)
t n e m e c a l p e r e v l a v t r a e H + G B A
C 1 (5)
e v l a v t r a e h f o t n e m t a e r t l a c i g r u S + G B A
C 1 (5)
* CABG – coronary art ery bypass graft
When inquiring about what pat ient s felt when
t hey were inform ed about t he need t o undergo a heart
surgery, answers led t o t he ident ificat ion of t wo large
cat egories: Feelings of apprehension and Posit ive and hopeful feelings. These cat egor ies w er e found w hen pat ient s r eceiv ed t he new s about sur ger y as w ell as
aft er hospit alizat ion, dur ing t he pr eoper at iv e per iod.
Th e Fe e l i n g s o f a p p r e h e n s i o n c a t e g o r y included feelings of fear, worry, anxiet y, suspicion and
j i t t e r y t o w a r d s t h e n e w s. We o b se r v e d t h a t t h i s
cat egory st ood out in relat ion t o t he m om ent pat ient s
w er e in f or m ed abou t t h e n eed of h ear t su r ger y. I n
t his case, t he m ost m ent ioned feeling was fear. The
following st at em ent s are exam ples: I felt a sudden
break-down, a pain in m y heart and fear of opening m y chest ( pat ient 2) . I felt fear and I am st ill scar ed. Just fear of doing t he su r ger y becau se m eddlin g w it h t h e h ear t an d t h e h ead. . . ? ( pat ient 6) .
Ot her pat ient s also m ent ioned t he feeling of
fear but denied it s presence: I didn’t get scared, I t hought
I should do t he surgery as soon as possible t o be able t o lead a norm al life soon ( pat ient 4) .
I didn’t get scared, j ust a lit t le worried... ( pat ient 1) .
Besid es f ear, w e f ou n d ot h er f eelin g s t h at
m ade pat ient s afraid of t he fut ure surgical experience.
Th e s e w e r e e x p r e s s e d , f o r e x a m p l e , a s w o r r y,
an x iet y, su spicion an d j it t er y t ow ar ds t h e n ew s, as
shown next : I felt t wo t hings, I felt relief because I have t o do it , not t hat I don’t w ant t o, but I hav e t o do it , and I felt apprehensive, anxious about undergoing a surgery. But now I ’m convinced t hat it is going t o work out ... ( pat ient 5) .
The first im pact of t he m om ent ... I felt t hat dist rust , t hat fear. Som et im es we even t hink about t hings t hat don’t exist ... ( pat ient 17) .
These result s are in line wit h ot her st udies(
6-7)
about preoperat ive feelings. Basically, t here are t hree
s o u r c e s o f p r e o p e r a t i v e a n x i e t y b e f o r e h e a r t
su r g er ies: sep ar at ion f r om h om e, f am ily an d on e’s
en v ir on m en t ; b ein g f or ced t o p lay a m or e p assiv e
r ole, t hat of being “ pat ient ” and, finally, fear r elat ed
t o life it self( 11). This w as obser ved in t he int er view ed
pat ien t s’ discou r se.
An ot h er aspect is t h at , in t h e pr eoper at iv e
p er iod , p at ien t s’ d ep r ession an d an x iet y lev els ar e
alt er ed , as w ell as t h ose of t h eir r elat iv es, m ain ly
t h e i r p a r t n e r s( 1 1 ). I t s h o u l d b e h i g h l i g h t e d t h a t
d e p r e s s i o n l e v e l s a r e s i g n i f i c a n t l y h i g h e r t h a n
average rat es in t he general populat ion and t hat , aft er
t he sur ger y, t hese levels should r et ur n t o t he rat es
com m on in t heir com m unit y( 11).
Various st udies( 8,14- 15) have inv est igat ed heart
pat ient s’ m anifest at ions of fear and anxiet y when t hey
ar e subm it t ed t o diagnost ic pr ocedur es( 13) and in t he
p r e o p e r a t i v e p e r i o d , w i t h d i f f e r e n t a p p r o a c h e s .
Aut hor s w ho select ed a m or e quant it at iv e appr oach
hav e used inst r um ent s lik e t he By pass Gr aft ing Fear Scale, St at e- Trait Anxiet y I nvent ory e Anxiet y Specific t o Surgery Quest ionnaire, for exam ple, which m easure fear an d an x iet y, r espect iv ely( 8 , 1 4 ). Ot h er au t h or s( 1 5 )
u sed n ot on ly a qu an t it at iv e, bu t also a qu alit at iv e
ap p r oach , in t h e at t em p t t o id en t if y w h at act u ally
cau ses p at ien t s’ an x iet y d u r in g t h is p er iod . I n ou r
st u d y, w e ch ose a q u alit at iv e ap p r oach t o id en t if y
w hich w er e t he act ual feelings pat ient s pr esent ed.
Al t h o u g h w e al so f o u n d o t h er Feel i n g s o f appr eh en sion, besides an x iet y an d fear, t h ese h av e r eceiv ed lit t le at t en t ion f r om ot h er au t h or s, w h ich
t ur ned our discussion about t hem m or e difficult .
A s o b s e r v e d b y p a t i e n t 5 , f e e l i n g s a n d
e m o t i o n s a r e d u a l w h e n t h e a ct u a l n e e d f o r t h e
s u r g e r y i s c e r t i f i e d . Th u s , b e s i d e s Fe e l i n g s o f ap p r eh en sion, w e also f ou n d Posit iv e an d h op ef u l f eelin g s.
The cat egory of Posit ive and hopeful feelings
r ehabilit at ion) , t r anquilit y ( ar ising fr om fait h in God,
f r om seein g ot h er p at ien t s w h o alr ead y u n d er w en t
su r ger y an d fr om k n ow in g t h at t h e r isk of deat h is
higher w it hout t he sur ger y ) and r elief ( because t he
surgery is necessary t o live) , as shown by t he following
st at em ent s: I calm ed down because, if I don’t get t he surgery, t he risk is higher. This can im prove m y condit ion. I have fait h in God t hat it ’s going t o work out fine ( pat ient 3) .
I felt very sat isfied because I was suffering so m uch, because I couldn’t sleep anym ore. When I at e I used t o feel a swelling in t he m out h of m y st om ach and t hat m ade m e feel a lack of air ( pat ient 11) .
Look, I felt relieved, very happy, because it ’s a serious problem , so I ’m very happy because when you have a fam ily you are worried, t he surgery is going t o be good. ( pat ient 12) .
...I hope I will be happy, I hope t hat , aft er I get out of here, I believe in God, t hat I ’m going t o work a lit t le m ore, at least t o have fun ( pat ient 18) .
Th e abov e ex am ples also r ev eal t h at m an y
p a t i e n t s l o o k f o r st r e n g t h / h o p e i n r e l i g i o u sn e ss,
a f f i r m i n g t h a t t h e y h a v e f a i t h i n Go d a n d t h a t
ev er y t h in g w ill w or k ou t fin e. Th ese feelin gs at t h e
sam e t im e ex pr ess hope and disclose pr eoccupat ion
w it h t h e su r g er y, as p at ien t s look f or su p p or t in a
supr em e being t o ov er com e t he pr oblem .
Besid es r elig iou sn ess, d u r in g p r eop er at iv e
h o s p i t a l i z a t i o n , p a t i e n t s s o u g h t s t r e n g t h i n t h e
su ccessf u l su r g er ies in ot h er p at ien t s at t h e sam e
w ar d. As pat ient s w er e hospit alized in nur sing w ar ds
w i t h ot h er h ear t p at i en t s, t h ey u sed t o ex ch an g e
ex per ien ces an d obt ain h elp fr om t h ese colleagu es,
as dem onst r at ed by t he follow ing ex am ples: I didn’t get scared, j ust a lit t le worried, but m y room m at es who already did t he surgery t ranquilized m e ( pat ient 1) .
I t hink I ’m gonna be fine during t he surgery, seeing m y room m at es who were already operat ed on. I ’m confident ( pat ient 4) .
We found t hat , over t im e, during preoperat ive
hospit alizat ion, pat ient s gr adually accept ed t he idea
of t h e su r ger y bet t er. Hen ce, t h e n egat iv e f eelin gs
in clu d ed in t h e Feelin g s of ap p r eh en sion cat eg or y
b eca m e l ess m en t i o n ed a n d Po si t i v e a n d h o p ef u l
feelings st ood out in t his period, as shown next : Now m y children are in favor, before t hey were afraid t hat I would do t he surgery. My spirit s are high t o get t he surgery ( pat ient 4) .
I ’m t hinking about get t ing well, about t he surgery being successful so t hat we get peace ( pat ient 12) .
I t hink it can be a good t hing because I can get bet t er... get well ( pat ient 19) .
The st at em ent s present ed by pat ient s 12 and
1 9 , bot h su bm it t ed t o cor on ar y ar t er y by pass gr aft
surgery, reveal not always realist ic percept ions about
t he r esult s of hear t sur ger y. Cor onar y ar t er y disease
is a chr onic illness. Hence, t her e is no cur e, but it s
pr ogr ession can be cont r olled. Pat ient s oft en believ e
t h a t m y o ca r d i a l r ev a scu l a r i za t i o n h a s cu r ed t h ei r
disease and do not adhere t o ot her t reat m ent form s,
su ch a s m ed i ca t i o n i n t a k e a n d t h e a cq u i si t i o n o r
m a i n t e n a n c e o f a h e a l t h y l i f e s t y l e . S i m i l a r
ex p ect at ion s, su ch as t h e cu r e of a h ear t d isease,
w e r e a l s o f o u n d i n a n o t h e r s t u d y( 6 ). I n v a l v a r
su r g er ies, t h e im p r ov em en t or ev en d isap p ear an ce
of lim it ing sym pt om s like dyspnea and t iredness also
fav or ed t his ex pect at ion of “ being cur ed for ever ”.
Ou r l i t e r a t u r e r e v i e w r e v e a l e d m a n y
st u d ies( 8 , 1 4 - 1 6 ) ab ou t p at ien t s’ p r eop er at iv e f eelin g s
w h ich , h ow ev er, alw ay s em p h asize t h e Feelin g s of a p p r e h e n si o n l i k e a n x i e t y a n d f e a r. Po si t i v e a n d h opef u l f eelin gs, on t h e ot h er h an d, h av e r eceiv ed lit t le at t ent ion unt il now, which t urned t he com parison
of our r esult s m or e difficult .
Alt hough at t he st ar t of t he int er v iew , w hen
w e a s k e d p a t i e n t s w h a t t h e y f e l t w h e n t h e y
discov er ed t he need t o under go a hear t sur ger y, w e
ob ser v ed t h e p r ed om in an ce of p at ien t s m en t ion in g
Feelings of appr ehension, w e found t hat , aft er som e t i m e , d u r i n g p r e o p e r a t i v e h o s p i t a l i z a t i o n , t h i s
p r e d o m i n a n ce ch a n g e d t o p a t i e n t s t a l k i n g a b o u t
Posit iv e and hopeful feelings.
CONCLUSI ON
Based on t h ese f in d in g s, w e con clu d e t h at
pat ient s, when t hey receive t he news about t he need
f o r h e a r t s u r g e r y, p r e s e n t m a n y Fe e l i n g s o f apprehension, such as: fear, worry, anxiet y, suspicion a n d j i t t e r y t o w a r d s t h e n e w s. Ov e r t i m e , i n t h e
pr eoper at iv e per iod, t hese feelings ar e inv er t ed and
Posit iv e an d h opef u l f eelin gs b ecom e p r ed om in an t , such as: feelings of hope t owards a possible cure and
rehabilit at ion, feelings of t ranquilit y ( com ing from fait h
i n Go d , f r o m s e e i n g r o o m m a t e s w h o a l r e a d y
underw ent surgery and from know ing t hat deat h risk
is higher wit hout t he surgery) and relief ( because t he
surgery is necessary t o live) . We verified t hat pat ient s
s t a r t e d t o a c c e p t t h e n e e d f o r t r e a t m e n t a n d
REFERENCES
1 . Ol i v e i r a MFP, S h a r o v s k y LL, I s m a e l S MC. A s p e c t o s
em ocionais no pacient e coronariano. I n: Oliveira MFP, I sm ael
SMC. Ru m os d a p sicolog ia h osp it alar em car d iolog ia. São
Pau lo ( SP) : Papir u s Edit or a; 1 9 9 5 . p. 1 8 5 - 9 8 .
2. Gom es AM. Enferm agem na Unidade de Terapia I nt ensiva.
2 ª ed. São Pau lo ( SP) : Edit or a pedagógica e u n iv er sit ár ia;
1 9 9 8 .
3. Sant os FLMM, Ar aúj o TL. Viv endo infar t o: os significados
da doen ça segu n do a per spect iv a do pacien t e. Rev Lat in
o-am En f er m agem 2 0 0 3 n ov em br o- dezem br o; 1 1 ( 6 ) : 7 4 2 - 8 .
4. Ruschel PP. Quando o coração adoece. I n: Rom ano BW. A
prát ica da psicologia nos hospit ais. São Paulo ( SP) : Pioneira;
1 9 9 4 . p . 3 9 - 5 4 .
5. Luk k ar inen H. Life cour se of people w it h cor onar y ar t er y
d isease. J Clin Nu r s 1 9 9 9 ; 8 : 7 0 1 - 1 1 .
6. Lindsay GM, Sm it h LN, Hanlon P, Wheat ley DJ. Cor onar y
a r t e r y d i se a se p a t i e n t s’ p e r ce p t i o n o f t h e i r h e a l t h a n d
ex p ect at i o n s o f b en ef i t f o l l o w i n g co r o n ar y ar t er y b y p ass
gr af t in g. J Adv Nu r s 2 0 0 0 ; 3 2 ( 6 ) : 1 4 1 2 - 2 1 .
7. Phippen ML. Nur sing assessm ent of pr eoperat ive anx iet y.
AORN J 1 9 8 0 ; 3 1 ( 6 ) : 1 0 1 9 - 2 6 .
8. Koiv ula M, I lm onen MP, Tar k k a MT, Tar k k a M, Laippala P.
Fear and anxiet y in pat ient s aw ait ing coronary art ery bypass
gr af t in g. Hear t Lu n g 2 0 0 1 ; 3 0 ( 4 ) : 3 0 2 - 1 0 .
9 . N o r t h Am e r i ca n N u r si n g D i a g n o si s. D i a g n ó st i co s d e
En f er m ag em d a NANDA: Def in ições e classif icação 2 0 0 1
-2 0 0 -2 . Por t o Alegr e ( RS) : Ar t m ed; -2 0 0 -2 .
10. Dant as RAS. Reabilit ação de pacient es após cir ur gia de
r ev ascu lar ização do m iocár dio. [ t ese] . Ribeir ão Pr et o ( SP) :
Escola de Enfer m agem de Ribeir ão Pr et o/ USP; 1 9 9 9 .
11. Rom ano BW. Por que considerar os aspect os psicológicos
n a cir u r g ia d e r ev ascu lar ização d o m iocár d io. I n : Rom an o
BW. A pr át ica da psicologia n os h ospit ais. São Pau lo ( SP) :
Pion eir a; 1 9 9 4 . p. 5 5 - 6 6 .
1 2 . Mi n a y o MCS. O d e sa f i o d o co n h e ci m e n t o : p e sq u i sa
qualit at iva em saúde. 7ª ed. São Paulo ( SP) : Hucit ec- Abrasco;
2 0 0 0 .
13. Grazziano EL, Bianchi ERF. Nível de ansiedade de client es
s u b m e t i d o s a c i n e a n g i o c o r o n a r i o g r a f i a e d e s e u s
acom pan h an t es. Rev Lat in am En f er m agem 2 0 0 4 j an eir
o-f ev er eir o; 1 2 ( 2 ) : 1 6 8 - 7 4 .
14. Karanci AN, Dirik G. Predict ors of pre - and post operat ive
an x iet y in em er g en cy su r g er y p at ien t s. J Psy ch osom Res
2 0 0 3 ; 5 5 ( 4 ) : 3 6 3 - 9 .
1 5 . Fit zsim on s D, Par ah oo K, Rich ar d son SG, St r in g er M.
Pat ien t an x iet y w h ile on a w ait in g list f or cor on ar y ar t er y
bypass surgery: a qualit at ive and quant it at ive analysis. Heart
Lu n g 2 0 0 3 ; 3 2 ( 1 ) : 2 3 - 3 1 .
16. Sj öling M, Nordahl G, Olofsson N, Asplund K. The im pact
of pr eoperat iv e in for m at ion on st at e an x iet y, post operat iv e
pain an d sat isf act ion w it h pain m an agem en t . Pat ien t Edu c
Co u n s 2 0 0 3 ; 5 1 ( 2 ) : 1 6 9 - 7 6 .
