Patients Experience of Being in the Cardiac Care Unit

Cardiac care unit (CCU) is a particular unit in significant hospitals where patients with severe cardiac issues that need special care and thus need further technological, intense medical, close following-up and attention for them to be able to continue their normal functioning. Survival rates and physical care necessities have increased thanks to modernized technology and an increased number of qualified research and guidebooks that are frequently renewed. A positive cardiac care process enables the physical and psychological well being of the patient to elevate even after discharge thus preventing an adverse change in the quality of their lives. Patient care, therefore, necessitates a health team with specialized training who have full knowledge related to intensive care practices, those who follow and adopt research findings based on evidence and exercise precaution regarding complications that may occur after discharge. For the teams working at the CCU, keeping patients alive is their precedence, but this may be a setback since they sometimes ignore a patient's psychological needs and focus mainly on fulfilling their physical requirements. Precision towards psychological needs would upsurge with the guidance of studies that point towards psychological support being a positive contributor to recovery. 

Numerous studies show that patients find their experiences in the CCU as negative due to physical complications such as sleeplessness, pain, and discomfort. Additionally, patients dependent on many types of equipment and healthcare professionals that they are unfamiliar with are merely asked to be patient. This is seen to affect both their psychological and physical well-being. The increasing number of studies show that there is a relation between posttraumatic stress disorder and the patient’s negative experiences in the CCU. Patient's skills in the CCU are also used as quality indicators and assist health professionals in creating better intensive care experiences and outcomes for the patients. 

Problem statement 

A recent trend has been observed from patients post-intensive care experience. Systematic research done on various patients through a period of five years shows that patients recall their experience while in the CCU as negative and remember little to no positive thing about that period. As far as the information gathered goes, these patients attribute their deleterious experiences to physical discomfort and psychological trauma that arises from being unfamiliar with the equipment they are hooked on and isolation from the rest of the world. Various mitigations have been cited for elevating the experiences for these patients that include looking more into the patient's psychological status, doctors having a more personal interaction with the patients and enlightening patients about the various equipment that the patients are relying on for life among others. 

Significance 

To shed some light on the various difficulties that patients experience while in the Cardiac Care unit, educate people on the multiple causes of these conditions and possibly find ways to mitigate the same. 

This study will be vital to patients who have initially faced the Cardiac Care unit since it will help in improving the conditions in there and limiting the problems that might have been encountered previously. 

This research will as well give some preferences that are preferred by patients who have undergone the Cardiac care unit conditions. 

Lastly, the study is also significant to doctors and nurses since it is going to bring to the limelight some situations that were not thought of before, for example, patients feeling of discomfort and insomnia which need to be looked upon. 

Objectives 

Present history of relevant and accurate information on the phenomenon under study. 

Interpret the finding of present and documented research results and demonstrate an understanding of them, their effectiveness, limitations, and complications. 

Formulate a comprehensive patient problem list, synthesize a useful diagnostic and therapeutic plan and follow-ups. 

Hypotheses 

If the history of the subject matter, as well as relevant and accurate information, is attained, then the results that are likely to be obtained after the research might prove useful. The history regarding the subject matter will be vital during analyzing the obtained results since it highly contributes to the achievement of the objective. This history aids planning for the future and how cardiac care unit is ought to be manipulated to favor the prerequisites of patients. 

Confirming with the existing patient records concerning cardiac care unit should be a vital step during the formulation of objectives. The ability to interpret the information accurately and precisely should be top-notch. It can be put into consideration that the pre-existing data has the assured and required information which must be accurate to avoid giving contradicting information. 

If patients' problems are keenly and concisely formulated, then it is expected that the typical problems that are faced by the cardiac care unit will be brought into the limelight. The previous issues that might have been recorded by either the respective doctors or nurses should be preferred first and foremost. This is an assurance that the preliminary results will be on point and ideal. 

Methodology 

This research was carried out to systematically review the studies that examine patient experiences during their period in the Cardiac Care Unit. The research study was done Quantitatively. Steps of the systematic review are as follows; 

Determining the proper questions for the analysis 

The healthcare team primarily monitors the patient’s physiological changes. Communicating with the patient is of secondary importance and thus rarely undertaken. Physicians usually assume that patients are not aware of the happenings around them; therefore, they will not remember the process or experience. This research thus planned to define the lessons of the patients and generate contextual questions like 

Do the patients remember their CCU experiences? 

How do patients define their CCU experiences? 

Literature review 

To obtain substantial results, the quantitative method mentioned above were used. It is presumably asking the question that, what percentage of patients in the cardiac care unit is ever comfortable if any? According to the results obtained in the research study, most of the patients find it hard to remember the entire event. This can be primarily attributed to the fact that these patients are, at most times, never comfortable hence the need to make some definite improvement in our Cardiac Care unit operational systems and personnel. It is evident in the results that more than 60% of cardiac care patients could not recollect their entire incident in the care unit. Consequently, most of the patients recorded terrible experiences while in Cardiac Care units. The literature review data was carried out as explained below by the use of three systematic steps; 

Electronic database 

Manual research in relevant journals. 

Reference of the papers used. 

The databases where the papers were screened and numbers studied is given in Table one. Keywords used in the electronic database include; “Cardiac Care”, “memory”, “Emergency”, “case studies”, “Cardiac care patients”. 

“ patient experiences.” 

Determine the inclusion criteria for the systematic review 

Studies with the following features were included in the systematic review 

Those published between 1998 and 2013. 

Those published in English and Turkish. 

Those whose sample group consisted of patients that were 18 years and above. 

Those whose sample group consisted of patients who were conscious and could communicate after their time in the Cardiac Care Unit. 

Those composed of patients that were transferred or discharged from the Cardiac Care. 

Those whose sample group patients who have been in the Cardiac Care unit for at least a day 

Those whose sample group consisted of patients who were admitted six months before the study. 

Compounding the studies reached 

To multipart together, all the information that had been gathered, all the papers that had been administered were brought together for sampling purposes. A total of 1390 articles were reached with the keywords stated in the literature review and 15 documents found to match the specific criteria were included in the research. Processes used to choose and eliminate the papers the requirements are shown in the excel figure attached (See Excel file, Title: Table-2 sheet 1). 

After analyzing and locating the findings 

The findings of the 15 studies that were selected for the systematic review were analyzed and discussed in the paper. 

Ethical considerations 

All the papers published in the journals were reached through open databases. 

Results. 

The 15 study samples that were used for the study research included patients ranging between 4-464 total in number and the minimum age for participation was 18 years. The preferred duration inside the cardiac care unit was fluctuating between 36 hours from the time of entry up to 133 days of stay. The overall data was collected just after the patient is through with his cardiac care period and is declared free by the medical practitioner to leave. Other methods that were as well used for data collection include; use of phones and emails to obtain answers to some specific questions & face-to-face interviews. According to the whole procedure, the data was declared as prospective, descriptive, qualitative and finally quantitative. The overall combined results are as follows. 

Due to the results obtained, it is evident that a comparison between duration and feature of respective sedation were not clearly stated in some of the sampled papers. Additionally, in some paper's sedation is not mentioned. According to the daily mail in May 2013, a higher number of patients who recall most of their intensive care unit period are the ones who experienced a lot of pain. Between all the fifteen studies that were used for the review, very few participants cited that they could remember the whole incident. Most of them could only describe some of the moments they can barely remember. Some of the expressions that were expressed by some of the patients are quoted below; 

"Intensive care was like a factory. Everybody was busy taking care of the patients. They were running here and there. So intense, I am used to beats and crashing noises in 

the factory. It disturbed me so much to watch patients.” 

“ It was not nice to be in intensive care, but I cannot 

remember much.” 

“ I remember thinking that I would never go home again.” 

“ It was a quite distressing atmosphere. It looked like a 

battlefield. I remember a patient making animal noises." 

Discussion 

In general, this study review seeks to analyses an evaluation of cardiac care experiences of different patients as well their remembrance of these experiences. To achieve these results, fifteen studies were used to acquire findings for analyzation. Moreover, the study will bring into limelight the different patient experiences that in turn might offer some help to the health care personnel on the sectors to emphasize on while considering improvement in their services. The study also guides on the proper approach that can offer the health care personnel with the right directions. Despite the different sample types and sizes that were used for the study, common opinions were gathered regarding the patient experiences. The general argument was designed under the guidance of two titles as supposed by the other literature findings. The two guide titles were; 

Remembering/recollecting the entire Cardiac Care Period. 

Patients different experiences in Cardiac Care Unit 

Recollecting the entire Cardiac Care Period. 

According to all the sample group of patients that were involved in the research study, there is no any single group of patients who were able to recollect the entire period of cardiac care ( Jaarsma, 2010 ). Only some individual patients recorded either partial recollection of complete recollection. It was difficult for patients to record full memory since it requires one to ensure that they are awake for the entire incident. There were many factors according to the research that blocked patients from recollecting the whole event, for example; medical treatments, sedation, the severity of illness and the time in which the data was being collected. According to a cohort study done by Granberg (n.d), there was a decrease in the skills and ability for a patient in delirium to interpret reality as compared to ones who were not in fever. According to this study, a majority of the patients who were interviewed gave realistic results (186). 

In general, amongst the fifteen studies that were conducted, seven of them indicated patients who were able to record high levels of recollection while three studies showed patients who did not record clear memory or were not able to recollect at all. According to Hekmat (2010) , Sedation of patients while in cardiac care is done to aid decrease the overall patient anxiety, to increase the ability to suppress stress response mostly in patients who are critically ill and finally enhance facilitation of doctor services or the nurse (106). Sedation can as well be used to increase the level of comfort for a patient while in the cardiac care unit. On the other side, sedation of patients in the cardiac care unit refutes the ability of patients to recollect later on when they get out of the care unit (Granberg et al., n.d). Most of the patients who underwent sedation in the cardiac care unit find it quite hard to recollect as compared to patients who did not go through sedation. According to a study done by Lemiale, sedation was seen to be negatively affecting one's ability to recollect efficiently (1976). Moreover, one-third of the patients that contributed towards this research study results reported that they were able to recall despite having undergone through sedation activities. 

Different patient experiences inside any Cardiac Care Unit 

According to both English and Turkish studies that were part of this research, it is evident that there are no significant differences in the patient experiences that were recorded. After all, studies were carried out; the common results were singled out into two titles which were "difficult in communication" and "discomfort." For discomfort, the reasons behind were concisely medical response, hallucination, endotracheal tube and pain as a result of noise hearings. According to some information obtained from CCU patients, Endotracheal tube is likely to cause discomfort while in the CCU. Some point outs on the troubles that were recorded by patients include; the inability to communicate or speak as a result of Endotracheal tube and the discomfort that is brought about by the aspiration process. Without focusing first on how to end the intubation, it is almost impossible to make a patient feel comfortable. 

Moreover, the upfront response of nurses can stimulate partial discomfort to the patient. It is advisable to use non-verbal communication performances to increase the level of pain to patients affected by the Endotracheal tube (Cutlera, 2013). Some other procedures that are vital and can enhance patient comfort include; close monitoring by nurses, evaluation of the average of respiratory as well as blood pressure, consistent and systematic monitoring of the location of intubation tubes and fixing them as required. Pain is also a primary causative agent of discomfort as recorded by patients in the CCU, and its intensity might vary from one person to another. Different studies from varying locations indicate that patients in cardiac care undergo pain as a result of many various reasons. Some reasons that might result into pain onto the patient include; inserting and also removing the catheter, inability to change their positions for a long time, trauma, surgical attempts on their bodies, endotracheal and drain tube, existing diseases within the body which are yet to be noticed by the medical practitioner and finally the dressing exercise (Lemiale, 2013). According to Walker, patients who have frequent pains can ascertain to the positive experience during their cardiac care period (Walker, 2012). Despite the different power of this statement, the standing fact that only patients who had frequent and intensified pain received higher attention from medical practitioners in an attempt to reduce their pains still stands. Through the process of nurses trying to minimize this pain, the positive experience of these patients is assumed. Nurses ensure that they evaluate the location with which the pain is emanating from not forgetting the measures that can be taken into consideration to ensure that the pain is reduced significantly. It is their responsibility to ensure that they explain to the patient the action they are taking into practice, help the patient assume the best position to allow them to carry out their operations keenly and lastly, try to eliminate the chief cause of the pain. Majority of the patients recollected that the strains caused to their bodies by nurses were even severe as compared to their stable condition without the nurse's intervention. 

According to the research, it was evident that fears resulting from uncertainty, difficulties while communicating, nightmares and hallucinations, anxiety and cardiac care responses are assumed as causative agents of patient’s psychological discomfort. Wang et al. quantified that patient's evaluation on the nurses who gave them proper care and talked to them politely was "good" (189). On the contrary, patients also evaluated the nurses who only made procedures on them without making any explanation to them as "bad." On the other side noted that patients felt better with the presence of nurses as opposed to when they were left on their own. Similarly, Jaarsma et al. observed that patients recorded that they preferred staying with nurses all through and also requested for the positive attitude of the medical practitioner ( Jaarsma, 2010 ). Increasing the patients’ comfort while in cardiac care can be cheaply done through increasing the number of nurses and shifts hence increase the frequency of nurses visiting the care units. Increasing the number of check-ups done by the nurses also is critical to decreasing the level of anxiety on patients. Family relatives can also lower the level of concern by increasing the frequency of visits to the patients. Another method to improve comfort and reduce anxiety include; promulgation of non-verbal communication, teaching the patients alternative communication methods. 

The bigger number of patients reported anxiety while in the intensive care unit as a result of noise emanating from nearby patients and equipment. To decrease fear, patients should be avoided from visiting other patients who might be undergoing immediate and exclusive treatments, making clear and concise explanations on the source of noise around them, patients should as well be taken through an orientation of the environment they are in. Another major problem encountered by patients in the intensive care unit is the lack of sleep due to pain and sleep disturbances amidst the night. It was established in his research that 60% of the total cardiac care population endure problems during their sleep. This is to mean that a whopping 60% of the cardiac care unit population is never comfortable which is higher than half cardiac care fraternity, hence the need to improve the cardiac care systems. 

Additionally, a higher population as well encountered nightmares amidst their sleep. More patients who have been into the cardiac care unit previously had the worst experiences of horrifying nightmares ever. In conclusion of the discussion, most patients don’t have positive encounters with the cardiac care unit. 

Conclusion 

This study has tackled the various possible experiences of a patient who has gone through a cardiac care unit. On a positive note, the study tried to shed light on some possible causes of fear that should be refuted totally. The study also gave way forward on how nurses can enhance the experiences of patients in the intensive care unit. The problems that are encountered in any cardiac care unit patients should be worked on to reduce the overall anxiety perceived by individuals and previous patients as well. Nurses should also be encouraged to first ensure the self-comfort of the patient before even working on them. 

References  

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Chalfin, D. B., Trzeciak, S., Likourezos, A., Baumann, B. M., & Dellinger, R. P. (2017). Impact of delayed transfer of critically ill patients from the emergency department to the cardiac care unit.  Critical care medicine ,  35 (6), 1477-1483. 

Cutlera LR, Hayterb M, Ryan T. A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive and Cardiac Care Unit Patients. Forthcoming 2013 

Daily Mail [Internet] [cited 2013 May 17]. Available from: http://www.dailymail.co.uk/health/article446387/Why-intensive-care-living-nightmarepatients.html 

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Hekmat, K, Doerr, F., Kroener, A., Heldwein, M., Bossert, T., Badreldin, A. M., & Lichtenberg, A. (2010). Prediction of mortality in cardiac care unit cardiac surgical patients.  European Journal of Cardio-Thoracic Surgery ,  38 (1), 104-109. 

Jaarsma, T., Strömberg, A., Fridlund, B., De Geest, S., Mårtensson, J., Moons, P., ... & Thompson, D. R. (2010). Sexual counseling of cardiac patients: nurses' perception of practice, responsibility, and confidence.  European Journal of Cardiovascular Nursing ,  9 (1), 24-29. 

Lemiale, V., Dumas, F., Mongardon, N., Giovanetti, O., Charpentier, J., Chiche, J. D., ... & Cariou, A. (2013). Cardiac care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort.  Intensive care medicine ,  39 (11), 1972-1980. 

Walker, D. M., West, N. E., & Ray, S. G. (2012). From coronary care unit to acute cardiac care unit: the evolving role of specialist cardiac care. 

Wang K, Zhang B, Li C, Wang C. Qualitative analysis of patients’ intensive care experience during mechanical ventilation. J CLIN NURS . 2008; 18: 183– 190.