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Journal Club Presentation
1
Presented By
Sonia Pal
M.Sc. Nursing 2nd year
Article 1:
Quantitative
Research
2
3
TITLE
Application of checklist- based
Nursing care process in patients
undergoing intervention for
coronary chronic total occlusion
:A Quasi-randomized
Keywords
4
Coronary
chronic total
occlusions
Checklist
Percutaneous
coronary
intervention
Nursing
Quasi-
Randomized
Study
Article details
• Author : Xia Ge , Haiyang Wu, Zhe Zang and Jiayi Xie
• Journal: BMC Nursing
• Publishing year: 2023
• DOI: https://doi.org/10.1186/s12872-023-03627-8
• Trial registration: ChiCTR 2200056804
• Impact factor: 3.18
5
Background
6
Compensated
Stage
Decompensated
Stage
Cont..
7
However, only a few nursing methods are specifically
applied to patients undergoing CTO interventions.
the conventional nursing effect is not ideal, urgent
need to explore more effective nursing methods.
Coronary chronic total occlusion (CTO) interventions
are more complex than general percutaneous
coronary intervention (PCI) procedures.
8
The checklist is a simple and effective tool for
error management and performance
improvement that has been widely used in many
fields. But there have been no reports of the
checklist being used to improve care for CTO
patients.
Cont..
Objective
9
This study aimed to investigate the effectiveness
of a checklist-based nursing care process in
patients undergoing Coronary chronic total
occlusion (CTO) interventions.
Aims
This study aimed to investigate the
effectiveness of a checklist-based nursing
care process in patients undergoing Coronary
chronic total occlusion (CTO) interventions,
including duration of care, patient anxiety,
improved patient satisfaction, and occurrence
of adverse events.
10
Methodology
• Approach: Quantitative Research
• Design: Quasi Randomized ( Chinese Clinical Trial Registry
(registration number ChiCTR2200056804, reg date17/02/2022).
• Study setting: Department of Cardiology, Shengjing Hospital,
China Medical University, in Shenyang, China, from December
2020 to July 2021
• Population: Patients who underwent CTO intervention
• Sample Size: 120 patients 11
13
Two Groups are intervention group (n = 60,
adopted the checklist-based nursing care
process for patient care) and a control group (n
= 60, adopted nursing care according to the
existing workflow) according to different nursing
interventions.
Cont..
Inclusion criteria
The clinical symptoms and
coronary angiographic results
were in accordance with the
international diagnostic criteria
for CTO
Age ≥ 18 years and the disease
was within the scope of
indications for intervention
Exclusion Criteria
Patients with serious chronic
diseases or major organ
dysfunctions such as diseases of
the liver and kidney
Patients with unopened vessels
requiring secondary surgery or
bypass
Criteria
Inclusion criteria
physically able to receive cardiac
treatment interventions
No relevant contraindications
Normal cognition, hearing and
intelligence, and basic
communication and
understanding ability
Exclusion Criteria
Patients who are not undergoing
PCI for the first time
Patients who cannot
communicate effectively
Patients with psychiatric
disorders, psychiatric history,
visual and hearing impairment, or
cognitive impairment
Criteria
Inclusion criteria
Complete data collection,
voluntary participation, and good
compliance in this study
Exclusion Criteria
Patients who develop serious
mental or physical illnesses during
hospitalization
Patients who are breastfeeding or
pregnant.
Criteria
ETHICAL CONSIDERATIONS
17
This study followed the Declaration of Helsinki,
and patients signed informed consent.The study
was approved by the ethics committee of
Shengjing Hospital of China Medical University
(approval no. 2020PS795K).
Declaration of Helsinki
Set of ethical principles
regarding human
experimentation
developed by the World
Medical Association
(WMA).
Goal-New knowledge
Helsinki is a city name
Started -1964
Amendment-
1975,1983,1983,1989,
1996,2000,2002,2008,
2013
18
GENERAL PRINCIPLES
1. Risks, Burdens and Benefits
2. Vulnerable Groups and Individuals
3. Scientific Requirements and Research Protocols
4. Research Ethics Committees
5. Privacy and Confidentiality
6. Informed Consent
7. Use of Placebo
8. Post-Trial Provisions
9. Research Registration and Publication and Dissemination of
Results
10.Unproven Interventions in Clinical Practice
Sample size
20
Group sample sizes of 43 and 43
achieve 90% power to reject the
null hypothesis of equal means
when the population mean
difference of preoperative
nursing care time is 5 min and -
with a standard deviation for
both groups of 7 min and with a
significance level (alpha) of
0.050
Assuming a 20% potential
dropout rate, the final
sample size was increased
to 120 subjects, with 60
subjects in each
intervention group.
RANDOMIZATION
Doctors use random sequence software to
generate 1 to 120 random serial numbers.
Random serial numbers and then in the order in which
the patients were treated, from front to back.
Odd-numbered patients were included in the
intervention group, while even-numbered
patients were included in the control group.
the intervention group and the control group
were arranged in wards A and B respectively.
21
Blinding
They are unaware whether the evaluated patients are in the
experimental group or the control group; The nurses in the
control group used a blind method, that is, they were unaware
that the ward had become the control group and still used
existing working
● Single blind trail use:
TOOL FOR DATA COLLECTION
1- Preoperative -PCI nursing care checklist for CTO Patients
2-Postoperative -PCI nursing care checklist for CTO Patients
3-Zung self -Rating Anxiety scale
4-Doctors and Patient Satisfaction Nursing Care Questionnaire
5-Doctors Satisfaction Nursing Care Questionnaire
6-Patient Satisfaction Nursing Care Questionnaire
Zung self -Rating Anxiety scale
There were 20 items in total, and the 4-level scoring
method was adopted, with 15 positive scores and 5
negative scores.
<50 => no anxiety
60–69 => moderate anxiety
>69 => severe anxiety.
Zung Self-Rating Anxiety Scale (SAS)
1 I feel more nervous and anxious than usual
2 I feel afraid for no reason at all.
3 I get upset easily or feel panicky.
4 I feel like I’m falling apart and going to pieces.
5 I feel that everything is alright and nothing bad will happen
6 My arms and legs shake and tremble.
7 I am bothered by headaches neck and back pain
8 I feel weak and get tired easily.
9 I feel calm and can sit still easily.
10 I can feel my heart beating fast.
11 I am bothered by dizzy spells.
12 I have fainting spells or feel like it.
13 I can breathe in and out easily.
14 I get numbness and tingling in my fingers and toes.
15 I am bothered by stomach aches or indigestion.
16 I have to empty my bladder often.
17 My hands are usually dry and warm.
18 My face gets hot and blushes.
19 I fall asleep easily and get a good night’s rest.
20 I have nightmares.
Measurements
Occurrence
of Adverse
effect
Patient’s
Anxiety
Doctor and
Patient
satisfaction
Preoperative
nursing care
time
Interventions
28
The primary nurse will create a checklist for patient admitted in the
hospital, fill in the complete patient information, and manage the
admitted patient according to the checklist.
Within 24 h of admission, the primary nurse will score the patient
based on the Self-Rating Anxiety Scale (SAS)
All contents of the preoperative nursing care checklist for patients
with CTO should be completed 1 day before surgery to 1 h before
surgery .
The checklist-based nursing care process was used to provide care
and education to patients with CTO before and after PCI
Cont…
29
The members of the quality control team should check quality of
all the activity and reports to the primary nurse in case any issue.
The primary nurse provided care to the patient following the“CTO
patient postoperative nursing care list,”
The primary nurse completed the postoperative nursing care
checklist for patients with CTO within 24 h after surgery
Members of the quality control team checked the completion of the
checklist before the patients were discharged and checked the
completion of various questionnaires
Preoperative-PCI nursing care checklist for CTO patients
Item Content
Implementation Status
Ye
s
No Not
Applicable
Dietary
guidance
Low-salt and low-fat diet before surgery. ⬵ ⬵ ⬵
Diabetic diet for Diabetic patients. ⬵ ⬵ ⬵
Patient
Preparati
on
Left arm preferred for indwelling needle left
foot for special cases.
⬵ ⬵ ⬵
Skin preparation: assess whether the patient
needs skin presentation
⬵ ⬵ ⬵
Dress code: wear wristbands on left hand
female patients take off underwear with steel
ring.
⬵ ⬵ ⬵
Item Content
Implementation Status
Yes No Not
Applicable
Patient
Preparation
Get enough sleep the night before
surgery.
⬵ ⬵ ⬵
History of allergy to contrast media. ⬵ ⬵ ⬵
Fasting or eating less before surgery. ⬵ ⬵ ⬵
Emptying the bladder before entering
the operating room.
⬵ ⬵ ⬵
Need for catheterization. ⬵ ⬵ ⬵
Item Content
Implementation Status
Ye
s
No Not
Applicable
Goods
Preparation
Inform family members to prepare water cups
straws and urinal pad.
⬵ ⬵ ⬵
Air mattress for patients undergoing lower limbs
PCI.
⬵ ⬵ ⬵
Prepare resuscitation items and drugs. ⬵ ⬵ ⬵
Drug
Instruction
Give anticoagulants anti-anginal drugs and
other drugs correctly as prescribed by the
doctor and observe the efficacy and adverse
effects of the drugs.
⬵ ⬵ ⬵
Give sedation if necessary as prescribed by the
doctor.
⬵ ⬵ ⬵
Inform patients of oral drug usage and
precautions.
⬵ ⬵ ⬵
Item Content
Implementation Status
Ye
s
No Not
Applicable
Mental
Nursing
Explain to patients about the surgery
and inform them about precautions.
⬵ ⬵ ⬵
Explain to family members to relieve
their tension and anxiety.
⬵ ⬵ ⬵
Assess the patient's psychological
state.
⬵ ⬵ ⬵
Adequate psychological nursing care
for nervous anxious and fearful
patients.
⬵ ⬵ ⬵
Postoperative -PCI nursing care checklist for CTO
Item Content
Implementation Status
Yes No Not Applicable
Clinical
Observatio
n
24 h postoperative ECG monitoring and vital signs
monitoring.
⬵ ⬵ ⬵
Observation of blood flow and arterial pulsation in
the operated limb.
⬵ ⬵ ⬵
Observe whether the patient has low back pain
abdominal pain chest tightness and chest pain.
⬵ ⬵ ⬵
Monitor blood routine kidney function and
coagulation function.
⬵ ⬵ ⬵
Prepare resuscitation items and drugs. ⬵ ⬵ ⬵
Item Content
Implementation Status
Yes No Not Applicable
Wound
Care
Bandage the puncture site with pressure for 24
h and decompress and exhaust pressure every 3
h for a total of 2 times.
⬵ ⬵ ⬵
Observe the puncture wound for bleeding and
hematoma
⬵ ⬵ ⬵
Patients with femoral artery puncture are placed
on hover bed and given lower limb restraint
brakes if necessary
⬵ ⬵ ⬵
Dietary
guidance
Patients without heart failure should drink more
water to promote the excretion of contrast
media.
⬵ ⬵ ⬵
Low-salt and low-fat diet more crude fiber food
to prevent.
⬵ ⬵ ⬵
Item Content
Implementation Status
Yes No Not
Applicable
Health
Education
Patients with femoral artery puncture are advised to
stay in bed absolutely for 12 h and the limb on the
operated side can be turned axially after 12 h to
prevent pressure sores.
⬵ ⬵ ⬵
Defecate in bed defecate without using too much
force.
⬵ ⬵ ⬵
Do not over-flex the operated limb move the fingertips
appropriately and do not lift more than 5 kg of weight
for 3 months.
⬵ ⬵ ⬵
Drugs instruction: Long-term oral anticoagulants are
required watch for nosebleeds bleeding gums black
stools etc.
⬵ ⬵ ⬵
Regular blood tests.
Item Content
Implementation Status
Yes No Not
Applicable
Mental
nursing
Listen to the patient's chief complaint ⬵ ⬵ ⬵
Assess the patient's psychological state. ⬵ ⬵ ⬵
Adequate psychological nursing care for
anxious patients.
⬵ ⬵ ⬵
Cont…
38
The patient’s clinical observation, wound care,
postoperative education etc were conducted regularly
according to the doctor’s postoperative advice.
The preoperative and postoperative SAS scoring was
performed within 24 h of admission and before discharge,
respectively.
The doctor satisfaction survey and the patient satisfaction
survey was conducted after surgery and the occurrence of
adverse events was recorded.
Quality control
39
A checklist for quality control team was also
established. The head nurse served as the
team leader, and the team members were the
head nurse assistant and two senior primary
nurses with more than 5 years of experience.
The team members were trained with the
contents of the checklist, overall process of
the study, and when to conduct checks to
ensure the implementation of the checklist.
The quality team measuring the occurrence of
adverse events was blinded to the study
allocation groups for the patient outcomes
they were assessing
Training organization. The head
nurse organizes trainings for all
nurses in the department to study
the content of the checklist,
understand the overall process of
scientific research, and ensure
complete data collection
Implementation of supervision and inspection.
Members of the quality control team strictly check
whether the study content is implemented on
time before and after the surgery, and in any case
of omission, the primary nurse is required to
further complete the tasks to ensure appropriate
implementation.
Validity and reliability
Validity
0.82
Nursing care
checklist for CTO
SAS SCALE
Doctor nursing
care
questionnaire
patient
nursing care
questionnaire
0.85 0.83
Reliability
Tool
Method Reliability
Nursing care checklist for CTO Internal Consensus
reliability
Cronbach’s alpha
0.859
SAS SCALE Cronbach’s alpha 0.932
Doctor nursing care questionnaire
patient nursing care questionnaire
Internal Consensus
Cronbach’s alpha
Internal Consensus
Cronbach’s alpha
0.893
0.898
Statistical analysis
SPSS 26.0 software was used for statistical
analysis. Measurement data were expressed as
(‾x ± s), and the t test was used for comparison
between groups. Count data were expressed as
number of cases or percentage, and the χ2 test
was used for comparison between groups. The
difference was considered significant at P < 0.05
Statistical Tests
Use
Statistical Tests Example Use Case
t-Test Compare means of 2
group
Compare test score of two
teaching methods
Anova Compare means of
more than 2 group
Compare test score among
three teaching methods
Chi-Square-
Test
Test Independence
between categorical
variable
Test if there’s an association
between gender and
preferences for tea or coffee
Pearson
Correlation
Measure Linear
association between 2
continuous variable
Examine The
Relationship age and
income
Regression
Analysis
Predict a continuous
dependent variable based
on 1 or more independent
variable
Predicting House prices
based on square
footage
Mann-Whitney
U Test
Compare Distribution of 2
independent group
Compare test scores
between 2 different
school
Kruskal-
Wallis Test
Compare Distribution of
more than 2 independent
group
Compare performance
of different teaching
methods across
multiple school
Wilcoxon
Signed-Rank
Test
Compare distributions
of 2 related group
Compare pre-test and post-
test scores within a group
McNemar’s
Test
Compare paired
proportions or
frequencies in a 2*2
contingency table
Compare the
effectiveness of two
treatments on a binary
outcomes
Fisher’s
Exact Test
Compare proportions in
a 2*2 contingency table
Access the information
between gender and
smoking status in a
small sample
The basic information between the two groups
Among the 120 patients, 109 completed the study, and
11 patients did not complete the questionnaire due to
early discharge from the hospital. The final intervention
group included 56 patients with mean age of (65.05 ±
10.14) years, and the control group included 53 patients
with mean age of (65.02 ± 10.73) years.
Table 1 The basic information between the two groups
Item
Intervention
group
(n = 56)
Control
group
(n = 53)
χ 2 or t P
Age( x
̄ ± s , years) 65.05 ± 10.14
65.02 ±
10.73
0.017
0.371
0.986
0.542
Male 39 34
Female 17 19
Ethnicity (cases)
0.000 1.000
Han 55 52
Other 1 1
Marriage status
(cases)
0.320 0.572
(Married) 55 50
Item
Intervention group
(n = 56)
Control
group
(n = 53)
χ 2 or t P
Profession(cases)
0.966 0.326
Retired 41 43
On-the-job 15 10
Medical Insurance
Type(cases)
2.810 0.094
In the city 50 41
Out of the city 6 12
Days of
hospitalization
( x
̄ ± s, days)
6.18 ± 2.39 6.85 ±
3.18
-1.260 0.210
Table 2 Comparison of preoperative care time between two groups of patients
Item
Intervention
group (n = 56)
Control group (n
= 53)
χ 2 or t P
Preoperative nursing
care time (x ± s,mins)
37.61 ± 5.15 50.98 ± 5.61 -12.965 <0.001
Preoperative nursing
care time grouping
79.971 <0.001
< 40 min 40(71.0%) 2(3.8%)
40–50 min 16(28.6%) 20(37.7%)
> 50 min 0 31(58.5%)
Table 3 Comparison of the incidence of nursing-related adverse events in the
two groups [n(%)]
Item
Intervention group
(n = 56)
Control
group
(n = 53)
χ 2 or
t
P
Preoperative
Intravenous
Access
Related
2(3.57) 7(13.21) 2.187 0.139
Skin
preparation
in the
operating
area related
1(1.79) 6(11.32) 2.686 0.101
Omission
goods
1(1.79) 8 (15.09) 4.731 0.030
Vomiting 35 2 0.001 0.978
Item
Intervention
group
(n = 56)
Control
group
(n = 53)
χ 2
or t
P
Intraoperat
ive
Postoperati
ve
Defecation 16 20
0.56
7
0.451
Puncture
site related
1(1.79) 3 (5.66)
0.32
0
0.572
Difficulty in
urination
0 2 (3.77)
0.56
7
0.451
Skin
Related
0 1 (1.89)
0.00
1
0.978
Total
occurrence
5(8.93) 30(56.60)
28.3
91
< 0.001
Table 4 Comparison of SAS scores in the two groups
Item
Intervention group
(n = 56)
Control
group
(n = 53)
χ 2 or t P
Preoperative
score
(x ± s, scores)
65.58 ± 8.20 66.27 ± 9.73 -0.403 0.688
Preoperative
score
grouping
2.892 0.409
< 50 1 3
50–59 12 11
60–69 26 18
> 69 17 21
Item
Intervention group
(n = 56)
Control group
(n = 53)
χ 2 or t P
Postoperative
score
(x ± s, scores)
53.03 ± 10.24 60.87 ± 8.97 -4.236 < 0.001
Postoperative
score
grouping
20.471 < 0.001
< 50 21 4
50–59 20 18
60–69 13 18
> 69 2 13
t 11.624 4.782
P < 0.001 < 0.001
Table 5 Comparison of doctor and patient satisfaction in the two
groups (‾x ± s, scores)
Groups Cases
Doctor
satisfaction
Patient
satisfaction
Intervention
group
56
112.89 ±
12.11
93.64 ± 6.89
Control group 53
100.09 ±
8.34
84.32 ± 7.46
t 16 6.392 6.780
P 0 < 0.001 < 0.001
Discussion
Similarly study
Previous studies have shown that
nursing intervention in the
interventional treatment of
chronic
complete occlusion of coronary
artery disease has a very
significant clinical effect, not only
can improve the success rate of
surgery, but also can reduce
complications, so as to make
patients satisfied
Dissimilarly study
NOT MENTIONED
Similarly study
This study showed that the nurses
in the intervention group spent
significantly less time on
preoperative nursing care than
those in the control group.The
nurses in the intervention group
used a preoperative nursing care
checklist and completed the
checklist item by item to ensure
the continuity of nursing care.
Dissimilarly study
NOT MENTIONED
Similarly study
This study also showed that the
patients in both groups had
different anxiety levels before
surgery and that their anxiety
scores decreased after surgery.
However, compared with the
scores of the control group, the
scores of the intervention group
decreased more significantly.
Dissimilarly study
NOT MENTIONED
Clinical implementation
The nursing checklist used in this study can be applied to
the perioperative care of clinical CTO patients
undergoing PCI. Nurses refer to the checklist to
implement nursing measures for patients one by one,
and mark the completed items before completion to
avoid omissions and confusion. And it is concluded that
using checklists to care for CTO patients can improve
work efficiency and reduce the occurrence of
Research recommendation and future
considerations
This study is the first time that Checklist-based Nursing
has been applied to the care of patients undergoing CTO
interventional operation. Therefore, more randomized
controlled trials should be conducted using other feasible
nursing methods to identify the best and most effective
nursing methods for CTO interventional operation.
strength
According to author According to Presentar
1-This studies on improving
nurses’ work efficiency before and
after PCI
2-This study is the first to apply
the checklist to patient nursing for
CTO interventional procedures to
explore effective working methods
that can reduce the nursing staff’s
preparation time and reduce
nursing errors.
1. Approval for this study was
mentioned.
2. Aims were mentioned cleary
3. Study Design was mentioned clearly
4. Intervention well designed and well
explained.
5. Sample selection well explained
6. Inclusion and exclusion criteria
mentioned
7. Validity and reliability were
mentioned
Conclusion
The application of a checklist-based standard nursing care process
in patients undergoing CTO interventions can significantly reduce
the preoperative nursing care time, alleviate patient anxiety,
improve patient and doctor satisfaction with the nursing care, and
effectively reduce the occurrence of adverse events caused by
nurses’ omissions or inadequate instructions. The proposed
checklist based standard nursing care process is worthy of clinical
promotion and application.
limitation
According to author
• The main limitation of this
study is that it was a
single-center experiment,
which reduces
generalizability
• The selected patients were
patients with standard
condition of CTO interventional
operation.
According to Presentar
Use of term quasi randomized
Table not well explain
Consolidated Standards
of Reporting Trail
Article 2:
Qualitative
Research
76
77
TITLE
Home care experience and
nursing needs of caregivers of
children undergoing congenital
heart disease operations: A
qualitative descriptive study
Article details
78
•Author : Zhi Hong Ni, Hai Tao Lv, Sheng Ding,
Wen Ying Yao
•Journal: PLoS ONE
•Editor: Felipe Hada Sanders, University of São
Paulo, BRAZIL
•Published: March 14, 2019
•DOI:https://doi.org/10.1371/journal.pone.0213154
•Impact factor: 2.7
Introduction
Cont…
Congenital heart disease (CHD) is defined as having defect(s)
(present since birth)in the structure of the heart.
CHD includes several types of structural heart defects that develop
prenatally, including ventricular septal defect (VSD), atrial septal defect
(ASD), patent ductus arteriosus(PDA), and Tetralogy of Fallot (TOF).
The worldwide prevalence of CHD is estimated at 1.35 million
annually, and the incidence of children born with CHD is 1%, with
over 100,000 new cases in China each year.
With the development of medicine, when women are 18–20 weeks
pregnant, fetuses can be screened for congenital heart disease
under cardiac ultrasound. 80
Cont…
If a fetus has complex congenital heart disease, pregnant
women can choose to terminate pregnancy at this stage.
The detection rate of complex congenital heart disease by
prenatal ultrasound screening is less than 50%
To provide better care for CHD children, parents need certain levels
of postoperative knowledge, including how to understand children’s
medical information, reduce anxiety, help children, and get support
and comfort
In addition,health care professionals need to provide parents with
disease management and treatment information
81
Aims & Objectives
To explore the home care experiences of
caregivers taking care of CHD children before and
after cardiac surgery.
82
Methodology
• Approach: Qualitative descriptive study
Design- Phenomenological study
• Sampling technique: Purposive Sampling
• Population: CHD Childs
• Setting: University Children hospital of soochow, Suzhou
China
• Sample size: 22 caregivers, CHD Childrens
83
84
Participants
Age - 23 and 40 years
caregiver including
17
mother
5
father
Ethical considerations
85
This study was approved by the Ethics
Committee of Children’s Hospital of
Soochow University in Suzhou City,
Jiangsu Province, China (Approval
#2011002). The interviewees were
informed of the purpose, methodology,
content, and significance of this study.
Why Ethics matters in
research ?
Criteria
Inclusion criteria
Children who accepted cardiac
surgery for CHD treatment
Children older than 1 month but
less than 60 months
Caregivers who were the
children’s parents
Caregivers who had normal
cognition and expression ability
Exclusion Criteria
Caregivers who had a mental
illness
Children who had heart, lung, or
brain functional failure or other
serious complications
Data collection
semi-structured interview
Consulting six pediatric cardiac nurse
Referring to systematic literature reviews
modified interview outline on the basis of the outcome
conducted a preliminary interview of five caregivers
Final Interview Outline
1-What the
caregivers
knew about
the CHD
operation
procedures
2-How they knew
about the CHD
operation
procedures
6-What was the most
difficult problem they
encountered during
the home care
process
3-How they felt
when they learned
that their children
had to undergo
operations
4-whether the nurses
told them everything
they needed to know
and did they want to
know anything else
about the operation
5-How they felt
during the home
care process
Cont…
10-Whether their
relatives supported
them
9-How they
arranged their daily
lives
8-what was the most
significant help they
needed
7-How they
solved those
difficulties they
encountered
Data saturation
Study data were continuously collected
until no new events emerged. Thus, data
saturation was achieved
In this study, we took
measures to ensure the
credibility, transferability,
consistency, and
confirmability
Rigor Credibility
To increase
credibility, we
included all possible
considerations and
representations of
study subjects who
were chosen
according to their
age, sex, and level
of education.
Transferability
To increase
transferability, all
caregivers were
interviewed by the
same interviewers who
remained neutral and
encouraged the
interviewees to clearly
express their feelings.
. Consistency
Consistency was
demonstrated by
providing detailed
descriptions of all
phases of the analysis
process. The interview
duration and the
number of interviews
were extended after
considering the actual
situation
Confirmability
To increase the confirmability of data obtained
from the actual content of interview, we
included two investigators who had either very
limited or no clinical experience with CHD
children.
Data analysis
The investigators extracted sentences containing
information about home care experiences after the
operation.
The process continued with the completion of coding sheets, data
grouping, category creation, and finally abstraction of categories.
The various descriptions were placed under corresponding
codes. The investigators worked together several times
categorizing data. Thereafter, they segregated the data
into five main categories
Finally, they went back to the caregivers of CHD children who
participated in this study and validated their findings. All the
interviewees agreed that the investigators had presented
accurate results. 97
Table 1. Demographic data of the children with congenital heart
disease.
Variables n F (%)
Gender
Male 13 59.1
Female 9 40.9
Age (months)
2–20 13 59.1
21–40 5 22.7
41–60 4 18.2
Residence
City 8 36.4
Country 14 63.6
Only child
Yes 17 77.3
No 5 22.7
CHD type
VSD 8 36.4
ASD 5 22.7
PDA 5 22.7
TOF 4 18.2
Table 2. Demographic data of the caregivers.
Variables n F (%)
Education
Middle School 7 31.8
Junior College 9 40.9
University 6
Income (yuan)
<4000 5 27.3
4000–6000 11 50.0
>6000 6 27.3
Occupation
Unemployed 3 13.6
Company worker 8 36.4
Agricultural
worker (poor)
6 27.3
Office clerk 5 22.7
Caregiver
Mother 7 77.3
Father 15 22.7
Analysis of the data identified five main themes, and
each theme was supported by verbatim quotes from the
study participants.
Excessive
mental
burden
Adapting
roles
constantly
Under
pressure
and
agony
The
impact
on
personal
life Self-
fulfillmen
t in
caring
activities
Theme 1
Remorse
and guilt
Excessive mental burden
Fear of
Disclosure
Frightened
and restless
Theme-2
Under Pressure and agony
Physical
strength
overdraft
Heavy
economic
burden
Disharmony in
family relation
Theme -3
The impact on personal life
Social impact
Breaking the good life
Forgetting self
Integrated care role
Seeking knowledge
and help
Theme -4
Adapting roles constantly
Theme-5
Self -fullment in caring activities
Self affirmation
Get satisfaction
Theme -1
Excessive mental burden
Frightened and restless
At first, the ability of the caregivers of CHD children
to withstand sudden life changes was poor, which
affected their mental health to a great extent.
Because of China’s one-child policy, most CHD
children were the only child in the family, and 19
caregivers of these 22 believed that the child was
significant to the family.
Cont…
There is a CHD child in the
family, just like a stone
pressed in the heart, and it
is difficult to relax. I’ve never
had sound sleep since my
baby underwent surgery.
When I took a nap, I was
often awakened by
nightmares. (Caregiver #2)
Sometimes I went out and
bought something, I always
worried about the child at
home. I am afraid he will
have sudden difficulty
breathing, and be rushed
to hospital for treatment.
(Caregiver #6)
Remorse and guilt
Some caregivers
appeared to suffer
from feelings of
remorse and
uneasiness due to
their child having
CHD. Five caregivers
blamed themselves
for their children’s
illnesses.
When I was pregnant at an early
stage, I had very bad cold with a
fever, and I took a lot of
medications. My child obtained this
disease because of that. The doctor
said the some medications may
cause congenital defects of
embryos. (Caregiver#5)
Caregivers of CHD children were often reluctant to
disclose their children’s condition to colleagues or
friends for fear that their children and the entire family
would receive discrimination thus affecting the
children’s future growth, both psychologically and
physiologically. Seven caregivers believed that
information about cardiac surgery should be kept
confidential.
Fear of disclosure
Cont…
I take the child to the
hospital, and I do not want
to let others know.
Sometimes when I met
acquaintances in the
hospital, I said that the
child is only having a cold,
just a minor illness.
(Caregiver #7)
My child underwent heart surgery,
but I didn’t even tell my closest
relatives and friends. If the
information spreads out, other
people will look at my children in a
different way, which will affect his
psychological health. CHD children
who go to school and hunt for jobs
in the future may be discriminated
against. (Caregiver #4)
Theme 2: Under pressure and agony
Physical strength overdraft
CHD children who underwent surgery sometimes had
difficulty breathing and feeding, and cried uneasily.
Caregivers had to perform a lot of manual labor,
including feeding children, changing diapers,
administering medicine, and bathing, and they often felt
powerless. Seven caregivers felt physically and mentally
exhausted and physically overdrawn.
Cont…
I’m busy all day,no time to rest.
Sometimes I only slept 2–3 hours each
night, and I can’t stand it anymore, but
I cannot break down, because my child
is so small.What can he do if I break
down? (Caregiver #9)
I am just like a machine, taking care of my child from
morning till night, including feeding milk and helping
taking medicine. It is difficult for him to drink 30 ml of milk
at one time; he needs to spit some out; bedding and
clothing are often wet, so I must change his clothes,
otherwise he will catch a cold again, which will exacerbate
his illness. I think I’m going to break down. (Caregiver #1)
For the family of a CHD child, the economic
pressure is very great. Indeed, the cost of cardiac
surgery is as high as 6000 yuan (US$10,000), and
much money is spent on monthly visits to the
hospital. In addition, dispensing and inspection
expenses are also very large. Six caregivers
believed that the children’s surgery had a strong
impact on the family’s budget.
Heavy economic burden
Cont…
My family income is low, and
we spent all our money on
my son. I also feel
embarrassed borrowing
money from relatives and
friends. Since the child’s
illness, the family’s money
has been used up. I hope our
child could get better soon.
(Caregiver #7)
In order to provide the child
with appropriate medical
treatment and ensure his
medical fees are paid, I save
every penny. Since he became
ill, I have not bought a new
dress for myself, and never
bought anything expensive.
(Caregiver #8)
Disharmony in family relations
Caregivers of CHD children often have friction with
other family members because of the family chores
and the heavy burden of home care. Moreover, the
child is young, cannot communicate with parents, and
cannot offer comfort. Caregivers lack emotional
support and suffer great pain themselves. Five
caregivers could not cope with family conflicts
appropriately.
I take care of the child every day,
and have no-one to discuss anything
with. The child can- not talk and just
cries. My husband works late every
day, so he has no time to take care
of our baby. I am so depressed!
(Caregiver #3)
Theme 3:The impact on personal life
Social
Impact
Caregivers of CHD children
usually had no space and
time for themselves, and did
not participate in social
activities. Five caregivers
gave up their original
responsibility and role in the
work.
Cont…
Ever since I heard that children had the
disease, I have no mood to do my own
thing. Originally, I planned to pursue
postgraduate studies in 2 years and look
for new career development opportunities,
but the child is not well and I don’t have
time and energy to learn. (Caregiver #7)
Breaking the good life
Many young parents had an optimistic
vision and plan for family and life, but when
the child was diagnosed with CHD, all hope
vanished like soap bubbles.
Cont…
I had planned to save
much money so that I
may travel abroad with
my family for a holiday.
Now that my child
underwent cardiac
surgery, the plan was
ruined. (Caregiver #4)
I planned to buy a new
house in 2 years, so that
my retired parents may
come and live in it. Now all
the money has been spent
on the child’s operation; I
can’t afford to buy the
house anymore. (Caregiver
#8)
Forgetting self
Caregivers of CHD
children usually
devoted all their
energy and time to
care for child and
often neglected their
own health needs.
My friend said“you
take care of the child
every day except
yourself. You didn’t do
that before!”
Sometimes I feel I’m
really forgetting
myself. (Caregiver
#15)
Theme 4: Adapting roles constantly
Seeking knowledge and help:
When caregivers learned that their children had
CHD, it came as a ‘bolt from the blue’ for many
of them. However, over time, they gradually
accepted the reality.
When I was in the
hospital, I consulted the
doctors and nurses about
some of the knowledge of
cardiac surgery, and the
nurses were very patient
with me. (Caregiver #3)
I hope professionals will
continue to help and care
for us. I will do my best
to take care of my child
so that he can recover
soon. (Caregiver #9)
Integrated care role
While taking care of
CHD children,
caregivers gradually
acquiesced to their
roles.
Cont…
I have to take good care of
my child. He’s so weak. I
want to protect him. I know
I am the backbone and the
hope of this family, and I
can’t count on anyone else.
It’s my duty. (Caregiver
#13)
When I was young, my
parents doted on me and I
never did any housework. My
parents are old now, their
health is not good, and they
can’t help me anymore. Now I
am the pillar of the family; I
must be strong; I’m going to
prop up my family. (Caregiver
#21)
Theme 5: Self-fulfillment in caring activities
Caregivers of CHD children often bore a
heavy burden on their body and mind, but at
the same time they gained similar happiness
to other people.
Self-affirmation:
Cont…
I feel as a mother
especially great; whether
or not society needs me,
whether or not my
company needs me, my
child definitely needs
me. (Caregiver #20)
I never felt the
responsibility of being
a mother like I do now.
Now I think the most
successful thing is that
the baby smiles at me.
I think it feels precious.
(Caregiver #17)
Get satisfaction
A very important reason that caregivers of
CHD children try their best to take care of
their children is to fulfill their
responsibilities. Moreover, they achieved a
sense of satisfaction when the children
gradually recovered.
Cont…
When the baby calls me
‘mum’, I feel so happy.
When I saw him
recovering gradually, I
felt it was worthwhile to
pay a lot more [money].
(Caregiver #22)
I am the father of my
child, and my child is
the continuation of my
life. Thus, it is my duty
to take care of my child.
I see the future in him.
(Caregiver #14)
Discussion
(Preoperative Period) Shock and Denial
Present Study
In the present study, we found
that caregivers were most
strongly aware of their
emotional reactions and
psychological distress (including
shock, denial, and
hopelessness) when they first
learned that their children had
CHD, which was consistent with
other reports
Similar Study
Not Mentioned
Discussion
(Operational Period) Inner fear & Suffering
Present Study
Lawoko et al investigated the
anxiety level of parents of CHD
children who underwent open
chest surgery, and found that
these parents were generally
anxious. Cardiac surgery was
associated with high risk and
great trauma, and the efficiency
of the cardiac operation as part of
the CHD treatment as well as the
risk of complications were the
caregivers’ biggest concerns
Similar Study
. Cardiac surgery was associated
with high risk and great
trauma, and the efficiency of
the cardiac operation as part of
the CHD treatment as well as
the risk of complications were
the caregivers’ biggest
concerns
Discussion
(Convalescence Period) Postoperative period
Worries about the future
Present Study
in the present study, we found
that caregivers felt regretful
and inferior for failing to have
a healthy child, and almost all
caregivers blamed themselves
for their children’s suffering
from CHD, and were extremely
self-critical.
Similar Study
As well.Mahle et al believed
that parents’ positive coping
techniques can provide children
with very good psychological
support and promote their
rehabilitation. Therefore, health
care professionals should pay
close attention to the mental
health of caregivers and give
them extra emotional support.
Discussion
(Convalescence Period) Postoperative period
Worries about the future
Present Study
. In this study, since all the
children were infants,
caregivers had to live with a
heavy burden of care,
including night time feeding,
and pacifying the crying
children to enable them to
sleep.
Similar Study
, caregivers spent nearly all
of their time taking care of
children, resulting in
termination of work, lack of
social roles, and fewer
opportunities to participate
in recreational activities
Discussion
(Convalescence Period) Postoperative period
Worries about the future
Present Study
In the present study, we found
that caregivers were more
concerned with the surgical
arrangements before the
operation, and how to take good
care for children after the
operation. Nurses should inform
caregivers about the medical
treatment, surgery, and nursing
information, and promptly appease
any anxiety and confusion
Similar Study
Recent research has shifted
from an emphasis on the
psychopathology of family to a
focus on the resilience of
families in coping with the
challenges presented by a
young child’s condition
Study limitations
Only those caregivers recruited whose CHD
children were aged between 1 month and 60
months
Themes had some overlapping, which appeared to
be inevitable in this study.
Relevance to clinical practice
This study describes the home care experiences and
needs of caregivers whose children underwent CHD
operations. The experiences of caregivers providing
care to CHD children are complex, Hence, we need
to sufficiently train healthcare staff so that they
identify the needs of caregivers and provide them
with targeted intervention that meets their demands.
The findings from this study highlight the need for
more effective and individualized nursing
intervention for CHD caregivers.
Conclusions
The study demonstrated that caregivers of CHD children who
underwent cardiac surgery are under great psychological
pressure during the home care rehabilitation period post
operation. To further strengthen the care and emotional support,
health care professionals should develop care plans for both CHD
children and their caregivers, and reduce the intensity of stress
effectively so that caregivers can maintain their physical and
mental health
CONSOLIDATED CRITERIA FOR
REPORTING QUALITATIVE RESEARCH
(COREQ)
GUIDELINES
Item
no.
Topic
Guide
Questions/Description
Reported
Domain 1: Research team and reflexivity
PERSONALITY CHARACTERISTICS
1. Interviewer/facilitator
Which author/s conducted
the interview or focus
group?
Mentioned
2. Credentials
What were the researcher’s
credentials? E.g. PhD, MD
NOT Mentioned
3. Occupation
What was their occupation
at the time of the study?
NOT Mentioned
Item
No.
Topic Guide Questions/Description Reported
4. Gender
Was the researcher male or
female?
MALE
5.
Experience
and training
What experience or training did the
researcher have?
NOT MENTION
Relationship with participant
6.
Relationship
established
Was a relationship established prior
to study commencement?
First author
provided
information
about
Item
No.
Topic Guide Questions/Description Reported
7.
Participant
knowledge of the
interviewer
What did the participants know
about the researcher? e.g.
personal goals, reasons for
doing the research
Yes, First
author
provided
information
about her
background
8.
Interviewer
characteristics
What characteristics were
reported about the
interviewer/facilitator? e.g.
Bias, assumptions, reasons and
interests in the research topic
caregiver
Item
No.
Topic Guide Questions/Description Reported
Domain-2 Study Design
Theoretical framework
9.
Methodological
orientation and
Theory
What methodological orientation
was stated to underpin the study?
e.g.
grounded theory, discourse analysis,
ethnography, phenomenology,
content analysis
Phenomenologica
-
Participant selection
10. Sampling
How were participants selected?
e.g. purposive, convenience,
consecutive, snowball
Purposive
Sampling
Item
No.
Topic
Guide
Questions/Description
Reported
11.
Method of
approach
How were participants
approached? e.g. face-to-face,
telephone, mail, email
Face-to-
face
12. Sample size
How many participants were
in the study?
22
caregiver
13.
Non-
participation
How many people refused to
participate or dropped out?
Reasons?
Not
reported
Item
No. Topic
Guide
Questions/Description
Reported
Setting
14.
Setting of data
collection
Where was the data collected?
e.g. home, clinic, workplace
University
children
Hospital in
china
15.
Presence of non-
participants
Was anyone else present
besides the participants and
researchers?
16.
Description of
sample
What are the important
characteristics of the sample?
e.g. demographic data, date
Table 1 and
Table 2
Item
No
Topic
Guide
Questions/Description
Data collection
17. Interview guide
Were questions, prompts,
guides provided by the
authors? Was it pilot tested?
Prompts shared
in
supplementary
data
18.
Repeat
interviews
Were repeat interviews carried
out? If yes, how many?
Not repeat
19.
Audio/visual
recording
Did the research use audio or
visual recording to collect the
data?
Yes
Item no Topic
Guide
Questions/Description
Reported
20. Field notes
Were field notes made
during and/or after the
interview or focus group?
Yes Page 5
21.
Duration
What was the duration of
the interviews or focus
group?
Table 3
22.
Data saturation
Was data saturation
discussed?
Yes Page 3
23. Transcripts
returned
Were transcripts returned
to participants for comment
and/or Correction?
Not reporte
Item
No.
Topic
Guide
Questions/Description
Reported
Domain 3: Analysis and Findings
Data analysis
24. Number of data
coders
How many data coders
coded the data?
Not
mentioned
25. Description of
the coding tree
Did authors provide a
description of the coding
tree?
Page 6
26. Derivation of
themes
Were themes identified in
advance or derived from
the data?
Identified
Item
no
Topic Guide Questions/Description Reported
27.
Software
What software, if applicable,
was used to manage the data?
Not reported
28. Participant
checking
Did participants provide
feedback on the findings?
Not reported
Reporting
29. Quotations
presented
Were participant quotations
presented to illustrate the
themes/findings?
Was each quotation identified?
e.g. participant number
Quotations are
marked “V” for
video and “I”
for interviews.
Item
No
Topic
Guide
Questions/Description
Reported
30. Data and findings
consistent
Was there consistency between
the data presented and the
findings?
Page 5,6,7
illustration of
invitations to
participants
31. Clarity of major
themes s
Were themes identified in
advance or derived from the
data?
Page 6
32.
Clarity of minor
themes
Is there a description of diverse
cases or discussion of minor
themes?
Page 6
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Sonia Journal club presentation (2).pptx

  • 1. Journal Club Presentation 1 Presented By Sonia Pal M.Sc. Nursing 2nd year
  • 3. 3 TITLE Application of checklist- based Nursing care process in patients undergoing intervention for coronary chronic total occlusion :A Quasi-randomized
  • 5. Article details • Author : Xia Ge , Haiyang Wu, Zhe Zang and Jiayi Xie • Journal: BMC Nursing • Publishing year: 2023 • DOI: https://doi.org/10.1186/s12872-023-03627-8 • Trial registration: ChiCTR 2200056804 • Impact factor: 3.18 5
  • 7. Cont.. 7 However, only a few nursing methods are specifically applied to patients undergoing CTO interventions. the conventional nursing effect is not ideal, urgent need to explore more effective nursing methods. Coronary chronic total occlusion (CTO) interventions are more complex than general percutaneous coronary intervention (PCI) procedures.
  • 8. 8 The checklist is a simple and effective tool for error management and performance improvement that has been widely used in many fields. But there have been no reports of the checklist being used to improve care for CTO patients. Cont..
  • 9. Objective 9 This study aimed to investigate the effectiveness of a checklist-based nursing care process in patients undergoing Coronary chronic total occlusion (CTO) interventions.
  • 10. Aims This study aimed to investigate the effectiveness of a checklist-based nursing care process in patients undergoing Coronary chronic total occlusion (CTO) interventions, including duration of care, patient anxiety, improved patient satisfaction, and occurrence of adverse events. 10
  • 11. Methodology • Approach: Quantitative Research • Design: Quasi Randomized ( Chinese Clinical Trial Registry (registration number ChiCTR2200056804, reg date17/02/2022). • Study setting: Department of Cardiology, Shengjing Hospital, China Medical University, in Shenyang, China, from December 2020 to July 2021 • Population: Patients who underwent CTO intervention • Sample Size: 120 patients 11
  • 12.
  • 13. 13 Two Groups are intervention group (n = 60, adopted the checklist-based nursing care process for patient care) and a control group (n = 60, adopted nursing care according to the existing workflow) according to different nursing interventions. Cont..
  • 14. Inclusion criteria The clinical symptoms and coronary angiographic results were in accordance with the international diagnostic criteria for CTO Age ≥ 18 years and the disease was within the scope of indications for intervention Exclusion Criteria Patients with serious chronic diseases or major organ dysfunctions such as diseases of the liver and kidney Patients with unopened vessels requiring secondary surgery or bypass Criteria
  • 15. Inclusion criteria physically able to receive cardiac treatment interventions No relevant contraindications Normal cognition, hearing and intelligence, and basic communication and understanding ability Exclusion Criteria Patients who are not undergoing PCI for the first time Patients who cannot communicate effectively Patients with psychiatric disorders, psychiatric history, visual and hearing impairment, or cognitive impairment Criteria
  • 16. Inclusion criteria Complete data collection, voluntary participation, and good compliance in this study Exclusion Criteria Patients who develop serious mental or physical illnesses during hospitalization Patients who are breastfeeding or pregnant. Criteria
  • 17. ETHICAL CONSIDERATIONS 17 This study followed the Declaration of Helsinki, and patients signed informed consent.The study was approved by the ethics committee of Shengjing Hospital of China Medical University (approval no. 2020PS795K).
  • 18. Declaration of Helsinki Set of ethical principles regarding human experimentation developed by the World Medical Association (WMA). Goal-New knowledge Helsinki is a city name Started -1964 Amendment- 1975,1983,1983,1989, 1996,2000,2002,2008, 2013 18
  • 19. GENERAL PRINCIPLES 1. Risks, Burdens and Benefits 2. Vulnerable Groups and Individuals 3. Scientific Requirements and Research Protocols 4. Research Ethics Committees 5. Privacy and Confidentiality 6. Informed Consent 7. Use of Placebo 8. Post-Trial Provisions 9. Research Registration and Publication and Dissemination of Results 10.Unproven Interventions in Clinical Practice
  • 20. Sample size 20 Group sample sizes of 43 and 43 achieve 90% power to reject the null hypothesis of equal means when the population mean difference of preoperative nursing care time is 5 min and - with a standard deviation for both groups of 7 min and with a significance level (alpha) of 0.050 Assuming a 20% potential dropout rate, the final sample size was increased to 120 subjects, with 60 subjects in each intervention group.
  • 21. RANDOMIZATION Doctors use random sequence software to generate 1 to 120 random serial numbers. Random serial numbers and then in the order in which the patients were treated, from front to back. Odd-numbered patients were included in the intervention group, while even-numbered patients were included in the control group. the intervention group and the control group were arranged in wards A and B respectively. 21
  • 22. Blinding They are unaware whether the evaluated patients are in the experimental group or the control group; The nurses in the control group used a blind method, that is, they were unaware that the ward had become the control group and still used existing working ● Single blind trail use:
  • 23. TOOL FOR DATA COLLECTION 1- Preoperative -PCI nursing care checklist for CTO Patients 2-Postoperative -PCI nursing care checklist for CTO Patients 3-Zung self -Rating Anxiety scale 4-Doctors and Patient Satisfaction Nursing Care Questionnaire 5-Doctors Satisfaction Nursing Care Questionnaire 6-Patient Satisfaction Nursing Care Questionnaire
  • 24. Zung self -Rating Anxiety scale There were 20 items in total, and the 4-level scoring method was adopted, with 15 positive scores and 5 negative scores. <50 => no anxiety 60–69 => moderate anxiety >69 => severe anxiety.
  • 25. Zung Self-Rating Anxiety Scale (SAS) 1 I feel more nervous and anxious than usual 2 I feel afraid for no reason at all. 3 I get upset easily or feel panicky. 4 I feel like I’m falling apart and going to pieces. 5 I feel that everything is alright and nothing bad will happen 6 My arms and legs shake and tremble. 7 I am bothered by headaches neck and back pain 8 I feel weak and get tired easily. 9 I feel calm and can sit still easily. 10 I can feel my heart beating fast.
  • 26. 11 I am bothered by dizzy spells. 12 I have fainting spells or feel like it. 13 I can breathe in and out easily. 14 I get numbness and tingling in my fingers and toes. 15 I am bothered by stomach aches or indigestion. 16 I have to empty my bladder often. 17 My hands are usually dry and warm. 18 My face gets hot and blushes. 19 I fall asleep easily and get a good night’s rest. 20 I have nightmares.
  • 28. Interventions 28 The primary nurse will create a checklist for patient admitted in the hospital, fill in the complete patient information, and manage the admitted patient according to the checklist. Within 24 h of admission, the primary nurse will score the patient based on the Self-Rating Anxiety Scale (SAS) All contents of the preoperative nursing care checklist for patients with CTO should be completed 1 day before surgery to 1 h before surgery . The checklist-based nursing care process was used to provide care and education to patients with CTO before and after PCI
  • 29. Cont… 29 The members of the quality control team should check quality of all the activity and reports to the primary nurse in case any issue. The primary nurse provided care to the patient following the“CTO patient postoperative nursing care list,” The primary nurse completed the postoperative nursing care checklist for patients with CTO within 24 h after surgery Members of the quality control team checked the completion of the checklist before the patients were discharged and checked the completion of various questionnaires
  • 30. Preoperative-PCI nursing care checklist for CTO patients Item Content Implementation Status Ye s No Not Applicable Dietary guidance Low-salt and low-fat diet before surgery. ⬵ ⬵ ⬵ Diabetic diet for Diabetic patients. ⬵ ⬵ ⬵ Patient Preparati on Left arm preferred for indwelling needle left foot for special cases. ⬵ ⬵ ⬵ Skin preparation: assess whether the patient needs skin presentation ⬵ ⬵ ⬵ Dress code: wear wristbands on left hand female patients take off underwear with steel ring. ⬵ ⬵ ⬵
  • 31. Item Content Implementation Status Yes No Not Applicable Patient Preparation Get enough sleep the night before surgery. ⬵ ⬵ ⬵ History of allergy to contrast media. ⬵ ⬵ ⬵ Fasting or eating less before surgery. ⬵ ⬵ ⬵ Emptying the bladder before entering the operating room. ⬵ ⬵ ⬵ Need for catheterization. ⬵ ⬵ ⬵
  • 32. Item Content Implementation Status Ye s No Not Applicable Goods Preparation Inform family members to prepare water cups straws and urinal pad. ⬵ ⬵ ⬵ Air mattress for patients undergoing lower limbs PCI. ⬵ ⬵ ⬵ Prepare resuscitation items and drugs. ⬵ ⬵ ⬵ Drug Instruction Give anticoagulants anti-anginal drugs and other drugs correctly as prescribed by the doctor and observe the efficacy and adverse effects of the drugs. ⬵ ⬵ ⬵ Give sedation if necessary as prescribed by the doctor. ⬵ ⬵ ⬵ Inform patients of oral drug usage and precautions. ⬵ ⬵ ⬵
  • 33. Item Content Implementation Status Ye s No Not Applicable Mental Nursing Explain to patients about the surgery and inform them about precautions. ⬵ ⬵ ⬵ Explain to family members to relieve their tension and anxiety. ⬵ ⬵ ⬵ Assess the patient's psychological state. ⬵ ⬵ ⬵ Adequate psychological nursing care for nervous anxious and fearful patients. ⬵ ⬵ ⬵
  • 34. Postoperative -PCI nursing care checklist for CTO Item Content Implementation Status Yes No Not Applicable Clinical Observatio n 24 h postoperative ECG monitoring and vital signs monitoring. ⬵ ⬵ ⬵ Observation of blood flow and arterial pulsation in the operated limb. ⬵ ⬵ ⬵ Observe whether the patient has low back pain abdominal pain chest tightness and chest pain. ⬵ ⬵ ⬵ Monitor blood routine kidney function and coagulation function. ⬵ ⬵ ⬵ Prepare resuscitation items and drugs. ⬵ ⬵ ⬵
  • 35. Item Content Implementation Status Yes No Not Applicable Wound Care Bandage the puncture site with pressure for 24 h and decompress and exhaust pressure every 3 h for a total of 2 times. ⬵ ⬵ ⬵ Observe the puncture wound for bleeding and hematoma ⬵ ⬵ ⬵ Patients with femoral artery puncture are placed on hover bed and given lower limb restraint brakes if necessary ⬵ ⬵ ⬵ Dietary guidance Patients without heart failure should drink more water to promote the excretion of contrast media. ⬵ ⬵ ⬵ Low-salt and low-fat diet more crude fiber food to prevent. ⬵ ⬵ ⬵
  • 36. Item Content Implementation Status Yes No Not Applicable Health Education Patients with femoral artery puncture are advised to stay in bed absolutely for 12 h and the limb on the operated side can be turned axially after 12 h to prevent pressure sores. ⬵ ⬵ ⬵ Defecate in bed defecate without using too much force. ⬵ ⬵ ⬵ Do not over-flex the operated limb move the fingertips appropriately and do not lift more than 5 kg of weight for 3 months. ⬵ ⬵ ⬵ Drugs instruction: Long-term oral anticoagulants are required watch for nosebleeds bleeding gums black stools etc. ⬵ ⬵ ⬵ Regular blood tests.
  • 37. Item Content Implementation Status Yes No Not Applicable Mental nursing Listen to the patient's chief complaint ⬵ ⬵ ⬵ Assess the patient's psychological state. ⬵ ⬵ ⬵ Adequate psychological nursing care for anxious patients. ⬵ ⬵ ⬵
  • 38. Cont… 38 The patient’s clinical observation, wound care, postoperative education etc were conducted regularly according to the doctor’s postoperative advice. The preoperative and postoperative SAS scoring was performed within 24 h of admission and before discharge, respectively. The doctor satisfaction survey and the patient satisfaction survey was conducted after surgery and the occurrence of adverse events was recorded.
  • 39. Quality control 39 A checklist for quality control team was also established. The head nurse served as the team leader, and the team members were the head nurse assistant and two senior primary nurses with more than 5 years of experience. The team members were trained with the contents of the checklist, overall process of the study, and when to conduct checks to ensure the implementation of the checklist. The quality team measuring the occurrence of adverse events was blinded to the study allocation groups for the patient outcomes they were assessing Training organization. The head nurse organizes trainings for all nurses in the department to study the content of the checklist, understand the overall process of scientific research, and ensure complete data collection
  • 40. Implementation of supervision and inspection. Members of the quality control team strictly check whether the study content is implemented on time before and after the surgery, and in any case of omission, the primary nurse is required to further complete the tasks to ensure appropriate implementation.
  • 42. Validity 0.82 Nursing care checklist for CTO SAS SCALE Doctor nursing care questionnaire patient nursing care questionnaire 0.85 0.83
  • 43. Reliability Tool Method Reliability Nursing care checklist for CTO Internal Consensus reliability Cronbach’s alpha 0.859 SAS SCALE Cronbach’s alpha 0.932 Doctor nursing care questionnaire patient nursing care questionnaire Internal Consensus Cronbach’s alpha Internal Consensus Cronbach’s alpha 0.893 0.898
  • 44. Statistical analysis SPSS 26.0 software was used for statistical analysis. Measurement data were expressed as (‾x ± s), and the t test was used for comparison between groups. Count data were expressed as number of cases or percentage, and the χ2 test was used for comparison between groups. The difference was considered significant at P < 0.05
  • 45. Statistical Tests Use Statistical Tests Example Use Case t-Test Compare means of 2 group Compare test score of two teaching methods Anova Compare means of more than 2 group Compare test score among three teaching methods Chi-Square- Test Test Independence between categorical variable Test if there’s an association between gender and preferences for tea or coffee
  • 46. Pearson Correlation Measure Linear association between 2 continuous variable Examine The Relationship age and income Regression Analysis Predict a continuous dependent variable based on 1 or more independent variable Predicting House prices based on square footage Mann-Whitney U Test Compare Distribution of 2 independent group Compare test scores between 2 different school Kruskal- Wallis Test Compare Distribution of more than 2 independent group Compare performance of different teaching methods across multiple school
  • 47. Wilcoxon Signed-Rank Test Compare distributions of 2 related group Compare pre-test and post- test scores within a group McNemar’s Test Compare paired proportions or frequencies in a 2*2 contingency table Compare the effectiveness of two treatments on a binary outcomes Fisher’s Exact Test Compare proportions in a 2*2 contingency table Access the information between gender and smoking status in a small sample
  • 48.
  • 49. The basic information between the two groups Among the 120 patients, 109 completed the study, and 11 patients did not complete the questionnaire due to early discharge from the hospital. The final intervention group included 56 patients with mean age of (65.05 ± 10.14) years, and the control group included 53 patients with mean age of (65.02 ± 10.73) years.
  • 50. Table 1 The basic information between the two groups Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Age( x ̄ ± s , years) 65.05 ± 10.14 65.02 ± 10.73 0.017 0.371 0.986 0.542 Male 39 34 Female 17 19 Ethnicity (cases) 0.000 1.000 Han 55 52 Other 1 1 Marriage status (cases) 0.320 0.572 (Married) 55 50
  • 51. Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Profession(cases) 0.966 0.326 Retired 41 43 On-the-job 15 10 Medical Insurance Type(cases) 2.810 0.094 In the city 50 41 Out of the city 6 12 Days of hospitalization ( x ̄ ± s, days) 6.18 ± 2.39 6.85 ± 3.18 -1.260 0.210
  • 52. Table 2 Comparison of preoperative care time between two groups of patients Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Preoperative nursing care time (x ± s,mins) 37.61 ± 5.15 50.98 ± 5.61 -12.965 <0.001 Preoperative nursing care time grouping 79.971 <0.001 < 40 min 40(71.0%) 2(3.8%) 40–50 min 16(28.6%) 20(37.7%) > 50 min 0 31(58.5%)
  • 53. Table 3 Comparison of the incidence of nursing-related adverse events in the two groups [n(%)] Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Preoperative Intravenous Access Related 2(3.57) 7(13.21) 2.187 0.139 Skin preparation in the operating area related 1(1.79) 6(11.32) 2.686 0.101 Omission goods 1(1.79) 8 (15.09) 4.731 0.030 Vomiting 35 2 0.001 0.978
  • 54. Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Intraoperat ive Postoperati ve Defecation 16 20 0.56 7 0.451 Puncture site related 1(1.79) 3 (5.66) 0.32 0 0.572 Difficulty in urination 0 2 (3.77) 0.56 7 0.451 Skin Related 0 1 (1.89) 0.00 1 0.978 Total occurrence 5(8.93) 30(56.60) 28.3 91 < 0.001
  • 55. Table 4 Comparison of SAS scores in the two groups Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Preoperative score (x ± s, scores) 65.58 ± 8.20 66.27 ± 9.73 -0.403 0.688 Preoperative score grouping 2.892 0.409 < 50 1 3 50–59 12 11 60–69 26 18 > 69 17 21
  • 56. Item Intervention group (n = 56) Control group (n = 53) χ 2 or t P Postoperative score (x ± s, scores) 53.03 ± 10.24 60.87 ± 8.97 -4.236 < 0.001 Postoperative score grouping 20.471 < 0.001 < 50 21 4 50–59 20 18 60–69 13 18 > 69 2 13 t 11.624 4.782 P < 0.001 < 0.001
  • 57. Table 5 Comparison of doctor and patient satisfaction in the two groups (‾x ± s, scores) Groups Cases Doctor satisfaction Patient satisfaction Intervention group 56 112.89 ± 12.11 93.64 ± 6.89 Control group 53 100.09 ± 8.34 84.32 ± 7.46 t 16 6.392 6.780 P 0 < 0.001 < 0.001
  • 58. Discussion Similarly study Previous studies have shown that nursing intervention in the interventional treatment of chronic complete occlusion of coronary artery disease has a very significant clinical effect, not only can improve the success rate of surgery, but also can reduce complications, so as to make patients satisfied Dissimilarly study NOT MENTIONED
  • 59. Similarly study This study showed that the nurses in the intervention group spent significantly less time on preoperative nursing care than those in the control group.The nurses in the intervention group used a preoperative nursing care checklist and completed the checklist item by item to ensure the continuity of nursing care. Dissimilarly study NOT MENTIONED
  • 60. Similarly study This study also showed that the patients in both groups had different anxiety levels before surgery and that their anxiety scores decreased after surgery. However, compared with the scores of the control group, the scores of the intervention group decreased more significantly. Dissimilarly study NOT MENTIONED
  • 61. Clinical implementation The nursing checklist used in this study can be applied to the perioperative care of clinical CTO patients undergoing PCI. Nurses refer to the checklist to implement nursing measures for patients one by one, and mark the completed items before completion to avoid omissions and confusion. And it is concluded that using checklists to care for CTO patients can improve work efficiency and reduce the occurrence of
  • 62. Research recommendation and future considerations This study is the first time that Checklist-based Nursing has been applied to the care of patients undergoing CTO interventional operation. Therefore, more randomized controlled trials should be conducted using other feasible nursing methods to identify the best and most effective nursing methods for CTO interventional operation.
  • 63. strength According to author According to Presentar 1-This studies on improving nurses’ work efficiency before and after PCI 2-This study is the first to apply the checklist to patient nursing for CTO interventional procedures to explore effective working methods that can reduce the nursing staff’s preparation time and reduce nursing errors. 1. Approval for this study was mentioned. 2. Aims were mentioned cleary 3. Study Design was mentioned clearly 4. Intervention well designed and well explained. 5. Sample selection well explained 6. Inclusion and exclusion criteria mentioned 7. Validity and reliability were mentioned
  • 64. Conclusion The application of a checklist-based standard nursing care process in patients undergoing CTO interventions can significantly reduce the preoperative nursing care time, alleviate patient anxiety, improve patient and doctor satisfaction with the nursing care, and effectively reduce the occurrence of adverse events caused by nurses’ omissions or inadequate instructions. The proposed checklist based standard nursing care process is worthy of clinical promotion and application.
  • 65. limitation According to author • The main limitation of this study is that it was a single-center experiment, which reduces generalizability • The selected patients were patients with standard condition of CTO interventional operation. According to Presentar Use of term quasi randomized Table not well explain
  • 67.
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  • 77. 77 TITLE Home care experience and nursing needs of caregivers of children undergoing congenital heart disease operations: A qualitative descriptive study
  • 78. Article details 78 •Author : Zhi Hong Ni, Hai Tao Lv, Sheng Ding, Wen Ying Yao •Journal: PLoS ONE •Editor: Felipe Hada Sanders, University of São Paulo, BRAZIL •Published: March 14, 2019 •DOI:https://doi.org/10.1371/journal.pone.0213154 •Impact factor: 2.7
  • 80. Cont… Congenital heart disease (CHD) is defined as having defect(s) (present since birth)in the structure of the heart. CHD includes several types of structural heart defects that develop prenatally, including ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus(PDA), and Tetralogy of Fallot (TOF). The worldwide prevalence of CHD is estimated at 1.35 million annually, and the incidence of children born with CHD is 1%, with over 100,000 new cases in China each year. With the development of medicine, when women are 18–20 weeks pregnant, fetuses can be screened for congenital heart disease under cardiac ultrasound. 80
  • 81. Cont… If a fetus has complex congenital heart disease, pregnant women can choose to terminate pregnancy at this stage. The detection rate of complex congenital heart disease by prenatal ultrasound screening is less than 50% To provide better care for CHD children, parents need certain levels of postoperative knowledge, including how to understand children’s medical information, reduce anxiety, help children, and get support and comfort In addition,health care professionals need to provide parents with disease management and treatment information 81
  • 82. Aims & Objectives To explore the home care experiences of caregivers taking care of CHD children before and after cardiac surgery. 82
  • 83. Methodology • Approach: Qualitative descriptive study Design- Phenomenological study • Sampling technique: Purposive Sampling • Population: CHD Childs • Setting: University Children hospital of soochow, Suzhou China • Sample size: 22 caregivers, CHD Childrens 83
  • 84. 84 Participants Age - 23 and 40 years caregiver including 17 mother 5 father
  • 85. Ethical considerations 85 This study was approved by the Ethics Committee of Children’s Hospital of Soochow University in Suzhou City, Jiangsu Province, China (Approval #2011002). The interviewees were informed of the purpose, methodology, content, and significance of this study.
  • 86. Why Ethics matters in research ?
  • 87.
  • 88. Criteria Inclusion criteria Children who accepted cardiac surgery for CHD treatment Children older than 1 month but less than 60 months Caregivers who were the children’s parents Caregivers who had normal cognition and expression ability Exclusion Criteria Caregivers who had a mental illness Children who had heart, lung, or brain functional failure or other serious complications
  • 89. Data collection semi-structured interview Consulting six pediatric cardiac nurse Referring to systematic literature reviews modified interview outline on the basis of the outcome conducted a preliminary interview of five caregivers
  • 90. Final Interview Outline 1-What the caregivers knew about the CHD operation procedures 2-How they knew about the CHD operation procedures 6-What was the most difficult problem they encountered during the home care process 3-How they felt when they learned that their children had to undergo operations 4-whether the nurses told them everything they needed to know and did they want to know anything else about the operation 5-How they felt during the home care process
  • 91. Cont… 10-Whether their relatives supported them 9-How they arranged their daily lives 8-what was the most significant help they needed 7-How they solved those difficulties they encountered
  • 92. Data saturation Study data were continuously collected until no new events emerged. Thus, data saturation was achieved
  • 93.
  • 94. In this study, we took measures to ensure the credibility, transferability, consistency, and confirmability Rigor Credibility To increase credibility, we included all possible considerations and representations of study subjects who were chosen according to their age, sex, and level of education.
  • 95. Transferability To increase transferability, all caregivers were interviewed by the same interviewers who remained neutral and encouraged the interviewees to clearly express their feelings. . Consistency Consistency was demonstrated by providing detailed descriptions of all phases of the analysis process. The interview duration and the number of interviews were extended after considering the actual situation
  • 96. Confirmability To increase the confirmability of data obtained from the actual content of interview, we included two investigators who had either very limited or no clinical experience with CHD children.
  • 97. Data analysis The investigators extracted sentences containing information about home care experiences after the operation. The process continued with the completion of coding sheets, data grouping, category creation, and finally abstraction of categories. The various descriptions were placed under corresponding codes. The investigators worked together several times categorizing data. Thereafter, they segregated the data into five main categories Finally, they went back to the caregivers of CHD children who participated in this study and validated their findings. All the interviewees agreed that the investigators had presented accurate results. 97
  • 98.
  • 99. Table 1. Demographic data of the children with congenital heart disease. Variables n F (%) Gender Male 13 59.1 Female 9 40.9 Age (months) 2–20 13 59.1 21–40 5 22.7 41–60 4 18.2
  • 100. Residence City 8 36.4 Country 14 63.6 Only child Yes 17 77.3 No 5 22.7 CHD type VSD 8 36.4 ASD 5 22.7 PDA 5 22.7 TOF 4 18.2
  • 101. Table 2. Demographic data of the caregivers. Variables n F (%) Education Middle School 7 31.8 Junior College 9 40.9 University 6 Income (yuan) <4000 5 27.3 4000–6000 11 50.0 >6000 6 27.3
  • 102. Occupation Unemployed 3 13.6 Company worker 8 36.4 Agricultural worker (poor) 6 27.3 Office clerk 5 22.7 Caregiver Mother 7 77.3 Father 15 22.7
  • 103. Analysis of the data identified five main themes, and each theme was supported by verbatim quotes from the study participants. Excessive mental burden Adapting roles constantly Under pressure and agony The impact on personal life Self- fulfillmen t in caring activities
  • 104. Theme 1 Remorse and guilt Excessive mental burden Fear of Disclosure Frightened and restless
  • 105. Theme-2 Under Pressure and agony Physical strength overdraft Heavy economic burden Disharmony in family relation
  • 106. Theme -3 The impact on personal life Social impact Breaking the good life Forgetting self Integrated care role Seeking knowledge and help Theme -4 Adapting roles constantly
  • 107. Theme-5 Self -fullment in caring activities Self affirmation Get satisfaction
  • 108. Theme -1 Excessive mental burden Frightened and restless At first, the ability of the caregivers of CHD children to withstand sudden life changes was poor, which affected their mental health to a great extent. Because of China’s one-child policy, most CHD children were the only child in the family, and 19 caregivers of these 22 believed that the child was significant to the family.
  • 109. Cont… There is a CHD child in the family, just like a stone pressed in the heart, and it is difficult to relax. I’ve never had sound sleep since my baby underwent surgery. When I took a nap, I was often awakened by nightmares. (Caregiver #2) Sometimes I went out and bought something, I always worried about the child at home. I am afraid he will have sudden difficulty breathing, and be rushed to hospital for treatment. (Caregiver #6)
  • 110. Remorse and guilt Some caregivers appeared to suffer from feelings of remorse and uneasiness due to their child having CHD. Five caregivers blamed themselves for their children’s illnesses. When I was pregnant at an early stage, I had very bad cold with a fever, and I took a lot of medications. My child obtained this disease because of that. The doctor said the some medications may cause congenital defects of embryos. (Caregiver#5)
  • 111. Caregivers of CHD children were often reluctant to disclose their children’s condition to colleagues or friends for fear that their children and the entire family would receive discrimination thus affecting the children’s future growth, both psychologically and physiologically. Seven caregivers believed that information about cardiac surgery should be kept confidential. Fear of disclosure
  • 112. Cont… I take the child to the hospital, and I do not want to let others know. Sometimes when I met acquaintances in the hospital, I said that the child is only having a cold, just a minor illness. (Caregiver #7) My child underwent heart surgery, but I didn’t even tell my closest relatives and friends. If the information spreads out, other people will look at my children in a different way, which will affect his psychological health. CHD children who go to school and hunt for jobs in the future may be discriminated against. (Caregiver #4)
  • 113. Theme 2: Under pressure and agony Physical strength overdraft CHD children who underwent surgery sometimes had difficulty breathing and feeding, and cried uneasily. Caregivers had to perform a lot of manual labor, including feeding children, changing diapers, administering medicine, and bathing, and they often felt powerless. Seven caregivers felt physically and mentally exhausted and physically overdrawn.
  • 114. Cont… I’m busy all day,no time to rest. Sometimes I only slept 2–3 hours each night, and I can’t stand it anymore, but I cannot break down, because my child is so small.What can he do if I break down? (Caregiver #9)
  • 115. I am just like a machine, taking care of my child from morning till night, including feeding milk and helping taking medicine. It is difficult for him to drink 30 ml of milk at one time; he needs to spit some out; bedding and clothing are often wet, so I must change his clothes, otherwise he will catch a cold again, which will exacerbate his illness. I think I’m going to break down. (Caregiver #1)
  • 116. For the family of a CHD child, the economic pressure is very great. Indeed, the cost of cardiac surgery is as high as 6000 yuan (US$10,000), and much money is spent on monthly visits to the hospital. In addition, dispensing and inspection expenses are also very large. Six caregivers believed that the children’s surgery had a strong impact on the family’s budget. Heavy economic burden
  • 117. Cont… My family income is low, and we spent all our money on my son. I also feel embarrassed borrowing money from relatives and friends. Since the child’s illness, the family’s money has been used up. I hope our child could get better soon. (Caregiver #7) In order to provide the child with appropriate medical treatment and ensure his medical fees are paid, I save every penny. Since he became ill, I have not bought a new dress for myself, and never bought anything expensive. (Caregiver #8)
  • 118. Disharmony in family relations Caregivers of CHD children often have friction with other family members because of the family chores and the heavy burden of home care. Moreover, the child is young, cannot communicate with parents, and cannot offer comfort. Caregivers lack emotional support and suffer great pain themselves. Five caregivers could not cope with family conflicts appropriately.
  • 119. I take care of the child every day, and have no-one to discuss anything with. The child can- not talk and just cries. My husband works late every day, so he has no time to take care of our baby. I am so depressed! (Caregiver #3)
  • 120. Theme 3:The impact on personal life Social Impact Caregivers of CHD children usually had no space and time for themselves, and did not participate in social activities. Five caregivers gave up their original responsibility and role in the work.
  • 121. Cont… Ever since I heard that children had the disease, I have no mood to do my own thing. Originally, I planned to pursue postgraduate studies in 2 years and look for new career development opportunities, but the child is not well and I don’t have time and energy to learn. (Caregiver #7)
  • 122. Breaking the good life Many young parents had an optimistic vision and plan for family and life, but when the child was diagnosed with CHD, all hope vanished like soap bubbles.
  • 123. Cont… I had planned to save much money so that I may travel abroad with my family for a holiday. Now that my child underwent cardiac surgery, the plan was ruined. (Caregiver #4) I planned to buy a new house in 2 years, so that my retired parents may come and live in it. Now all the money has been spent on the child’s operation; I can’t afford to buy the house anymore. (Caregiver #8)
  • 124. Forgetting self Caregivers of CHD children usually devoted all their energy and time to care for child and often neglected their own health needs. My friend said“you take care of the child every day except yourself. You didn’t do that before!” Sometimes I feel I’m really forgetting myself. (Caregiver #15)
  • 125. Theme 4: Adapting roles constantly Seeking knowledge and help: When caregivers learned that their children had CHD, it came as a ‘bolt from the blue’ for many of them. However, over time, they gradually accepted the reality.
  • 126. When I was in the hospital, I consulted the doctors and nurses about some of the knowledge of cardiac surgery, and the nurses were very patient with me. (Caregiver #3) I hope professionals will continue to help and care for us. I will do my best to take care of my child so that he can recover soon. (Caregiver #9)
  • 127. Integrated care role While taking care of CHD children, caregivers gradually acquiesced to their roles.
  • 128. Cont… I have to take good care of my child. He’s so weak. I want to protect him. I know I am the backbone and the hope of this family, and I can’t count on anyone else. It’s my duty. (Caregiver #13) When I was young, my parents doted on me and I never did any housework. My parents are old now, their health is not good, and they can’t help me anymore. Now I am the pillar of the family; I must be strong; I’m going to prop up my family. (Caregiver #21)
  • 129. Theme 5: Self-fulfillment in caring activities Caregivers of CHD children often bore a heavy burden on their body and mind, but at the same time they gained similar happiness to other people. Self-affirmation:
  • 130. Cont… I feel as a mother especially great; whether or not society needs me, whether or not my company needs me, my child definitely needs me. (Caregiver #20) I never felt the responsibility of being a mother like I do now. Now I think the most successful thing is that the baby smiles at me. I think it feels precious. (Caregiver #17)
  • 131. Get satisfaction A very important reason that caregivers of CHD children try their best to take care of their children is to fulfill their responsibilities. Moreover, they achieved a sense of satisfaction when the children gradually recovered.
  • 132. Cont… When the baby calls me ‘mum’, I feel so happy. When I saw him recovering gradually, I felt it was worthwhile to pay a lot more [money]. (Caregiver #22) I am the father of my child, and my child is the continuation of my life. Thus, it is my duty to take care of my child. I see the future in him. (Caregiver #14)
  • 133. Discussion (Preoperative Period) Shock and Denial Present Study In the present study, we found that caregivers were most strongly aware of their emotional reactions and psychological distress (including shock, denial, and hopelessness) when they first learned that their children had CHD, which was consistent with other reports Similar Study Not Mentioned
  • 134. Discussion (Operational Period) Inner fear & Suffering Present Study Lawoko et al investigated the anxiety level of parents of CHD children who underwent open chest surgery, and found that these parents were generally anxious. Cardiac surgery was associated with high risk and great trauma, and the efficiency of the cardiac operation as part of the CHD treatment as well as the risk of complications were the caregivers’ biggest concerns Similar Study . Cardiac surgery was associated with high risk and great trauma, and the efficiency of the cardiac operation as part of the CHD treatment as well as the risk of complications were the caregivers’ biggest concerns
  • 135. Discussion (Convalescence Period) Postoperative period Worries about the future Present Study in the present study, we found that caregivers felt regretful and inferior for failing to have a healthy child, and almost all caregivers blamed themselves for their children’s suffering from CHD, and were extremely self-critical. Similar Study As well.Mahle et al believed that parents’ positive coping techniques can provide children with very good psychological support and promote their rehabilitation. Therefore, health care professionals should pay close attention to the mental health of caregivers and give them extra emotional support.
  • 136. Discussion (Convalescence Period) Postoperative period Worries about the future Present Study . In this study, since all the children were infants, caregivers had to live with a heavy burden of care, including night time feeding, and pacifying the crying children to enable them to sleep. Similar Study , caregivers spent nearly all of their time taking care of children, resulting in termination of work, lack of social roles, and fewer opportunities to participate in recreational activities
  • 137. Discussion (Convalescence Period) Postoperative period Worries about the future Present Study In the present study, we found that caregivers were more concerned with the surgical arrangements before the operation, and how to take good care for children after the operation. Nurses should inform caregivers about the medical treatment, surgery, and nursing information, and promptly appease any anxiety and confusion Similar Study Recent research has shifted from an emphasis on the psychopathology of family to a focus on the resilience of families in coping with the challenges presented by a young child’s condition
  • 138.
  • 139. Study limitations Only those caregivers recruited whose CHD children were aged between 1 month and 60 months Themes had some overlapping, which appeared to be inevitable in this study.
  • 140. Relevance to clinical practice This study describes the home care experiences and needs of caregivers whose children underwent CHD operations. The experiences of caregivers providing care to CHD children are complex, Hence, we need to sufficiently train healthcare staff so that they identify the needs of caregivers and provide them with targeted intervention that meets their demands. The findings from this study highlight the need for more effective and individualized nursing intervention for CHD caregivers.
  • 141. Conclusions The study demonstrated that caregivers of CHD children who underwent cardiac surgery are under great psychological pressure during the home care rehabilitation period post operation. To further strengthen the care and emotional support, health care professionals should develop care plans for both CHD children and their caregivers, and reduce the intensity of stress effectively so that caregivers can maintain their physical and mental health
  • 142. CONSOLIDATED CRITERIA FOR REPORTING QUALITATIVE RESEARCH (COREQ) GUIDELINES
  • 143. Item no. Topic Guide Questions/Description Reported Domain 1: Research team and reflexivity PERSONALITY CHARACTERISTICS 1. Interviewer/facilitator Which author/s conducted the interview or focus group? Mentioned 2. Credentials What were the researcher’s credentials? E.g. PhD, MD NOT Mentioned 3. Occupation What was their occupation at the time of the study? NOT Mentioned
  • 144. Item No. Topic Guide Questions/Description Reported 4. Gender Was the researcher male or female? MALE 5. Experience and training What experience or training did the researcher have? NOT MENTION Relationship with participant 6. Relationship established Was a relationship established prior to study commencement? First author provided information about
  • 145. Item No. Topic Guide Questions/Description Reported 7. Participant knowledge of the interviewer What did the participants know about the researcher? e.g. personal goals, reasons for doing the research Yes, First author provided information about her background 8. Interviewer characteristics What characteristics were reported about the interviewer/facilitator? e.g. Bias, assumptions, reasons and interests in the research topic caregiver
  • 146. Item No. Topic Guide Questions/Description Reported Domain-2 Study Design Theoretical framework 9. Methodological orientation and Theory What methodological orientation was stated to underpin the study? e.g. grounded theory, discourse analysis, ethnography, phenomenology, content analysis Phenomenologica - Participant selection 10. Sampling How were participants selected? e.g. purposive, convenience, consecutive, snowball Purposive Sampling
  • 147. Item No. Topic Guide Questions/Description Reported 11. Method of approach How were participants approached? e.g. face-to-face, telephone, mail, email Face-to- face 12. Sample size How many participants were in the study? 22 caregiver 13. Non- participation How many people refused to participate or dropped out? Reasons? Not reported
  • 148. Item No. Topic Guide Questions/Description Reported Setting 14. Setting of data collection Where was the data collected? e.g. home, clinic, workplace University children Hospital in china 15. Presence of non- participants Was anyone else present besides the participants and researchers? 16. Description of sample What are the important characteristics of the sample? e.g. demographic data, date Table 1 and Table 2
  • 149. Item No Topic Guide Questions/Description Data collection 17. Interview guide Were questions, prompts, guides provided by the authors? Was it pilot tested? Prompts shared in supplementary data 18. Repeat interviews Were repeat interviews carried out? If yes, how many? Not repeat 19. Audio/visual recording Did the research use audio or visual recording to collect the data? Yes
  • 150. Item no Topic Guide Questions/Description Reported 20. Field notes Were field notes made during and/or after the interview or focus group? Yes Page 5 21. Duration What was the duration of the interviews or focus group? Table 3 22. Data saturation Was data saturation discussed? Yes Page 3 23. Transcripts returned Were transcripts returned to participants for comment and/or Correction? Not reporte
  • 151. Item No. Topic Guide Questions/Description Reported Domain 3: Analysis and Findings Data analysis 24. Number of data coders How many data coders coded the data? Not mentioned 25. Description of the coding tree Did authors provide a description of the coding tree? Page 6 26. Derivation of themes Were themes identified in advance or derived from the data? Identified
  • 152. Item no Topic Guide Questions/Description Reported 27. Software What software, if applicable, was used to manage the data? Not reported 28. Participant checking Did participants provide feedback on the findings? Not reported Reporting 29. Quotations presented Were participant quotations presented to illustrate the themes/findings? Was each quotation identified? e.g. participant number Quotations are marked “V” for video and “I” for interviews.
  • 153. Item No Topic Guide Questions/Description Reported 30. Data and findings consistent Was there consistency between the data presented and the findings? Page 5,6,7 illustration of invitations to participants 31. Clarity of major themes s Were themes identified in advance or derived from the data? Page 6 32. Clarity of minor themes Is there a description of diverse cases or discussion of minor themes? Page 6