FACING LIFESTYLE CHANGES IN THE PROCESS OF GOING THROUGH
A CORONARY ARTERY BYPASS GRAFT1
CALLEGARO, Giovana Dorneles2; KOERICH, Cintia3; LANZONI, Gabriela
Marcellino de Melo4; BAGGIO, Maria Aparecida5; ERDMANN, Alacoque
Lorenzini6
ABSTRACT
Introduction: Contemporary world conveys the era of information technology, thus, the
human being enjoys increasingly sophisticated and advanced treatments and health
interventions. Scientific evidence points to coronary artery bypass graft (CABG) as an
important resource for the surgical treatment of coronary artery disease, resulting in longer
survival and better quality of life for patients. Objectives: Understanding the way patients
realize their experience process of living after coronary artery bypass graft. Methods: It has
been a qualitative study, resulting from an extension project, entitled: "realizing the surgical
experience and the process of living in patients undergoing coronary artery bypass graft"
Twelve patients have taken part in data collection, six health professionals (doctors, nurses,
physical educator, nurse technician) and five family members, comprising three different
sample groups. The interviews were semi-structured and took place from October 2010 to
August 2011. Data were analyzed and interpreted by grounded theory (GT). Results and
discussion: After analyzing the data, a category with seven subcategories have been found.
The changes meant to relate to aspects of social and sexual life, work, diet, physical activity,
and drug treatment. Conclusion: Coronary artery bypass surgery experience encourages
reflecting and (re)considering the lifestyle, points out limitations and difficulties that challenge
adaptations in daily habits of patients and families for a process of living healthier.
Keywords: Thoracic Surgery, Coronary artery bypass graft, Nursing, Lifestyle.
1
Trabalho de Pesquisa. Universidade Federal de Santa Catarina (UFSC). Grupo de Estudos e
Pesquisas em Administração e Gerência do Cuidado em Enfermagem e Saúde (GEPADES).
2
Enfermeira. Mestranda em Enfermagem pela UFSC. Brasil. E-mail: [email protected].
3
Acadêmica de Enfermagem da UFSC. Brasil.
4
Enfermeira. Doutoranda em Enfermagem pelo Programa de Pós Graduação em Enfermagem da
Universidade Federal de Santa Catarina (PEN/UFSC). Bolsista CAPES. Brasil.
5
Enfermeira. Doutoranda em Enfermagem pela Universidade Federal de Santa Catarina (UFSC).
Bolsista do CNPq. Brasil.
6
Enfermeira. Doutora em Filosofia da Enfermagem. Professora Titular do Departamento de
Enfermagem e PEN/UFSC. Pesquisadora do 1A CNPq. Coordenadora do GEPADES. Brasil.
1
ENFRENTANDO MUDANÇAS NO ESTILO DE VIDA NO PROCESSO DE VIVER A
CIRURGIA DE REVASCULARIZAÇÃO MIOCÁRDICA
RESUMO
Introdução: A contemporaneidade representa a era da tecnologia e da informatização, por
sua vez, o ser humano usufrui cada vez mais de sofisticados e avançados tratamentos e
intervenções de saúde. Tão logo, as evidências científicas apontam a cirurgia de
revascularização do miocárdio (CRM) como um importante recurso cirúrgico para o
tratamento da doença arterial coronariana, resultando em maior sobrevida e melhor
qualidade de vida dos pacientes.Objetivo: compreender como os pacientes significam seu
processo de viver após experiência cirúrgica de revascularização miocárdica. Métodos:
Trata-se de um Estudo de natureza qualitativa, fruto de um projeto ampliado, intitulado:
“Significando a experiência cirúrgica e o processo de viver do paciente submetido à
revascularização do miocárdio” Participaram da coleta de dados doze pacientes, seis
profissionais de saúde (médicos, enfermeiros, educador físico, técnico de enfermagem) e
cinco familiares, constituindo três grupos amostrais. As entrevistas foram semi-estruturadas
e ocorreram no período de outubro de 2010 a agosto de 2011 Os dados foram analisados e
interpretados pela teoria fundamentada nos dados (TFD). Resultados e discussão: Após a
análise dos dados encontrou-se uma categoria com sete subcategorias. As mudanças
significadas relacionam-se aos aspectos da vida social e sexual, trabalho, alimentação,
atividade física e tratamento medicamentoso. Conclusão: a experiência cirúrgica de
revascularização incita o refletir e o (re)pensar o estilo de vida, apresenta limitações e
dificuldades que desafiam adaptações nos hábitos cotidianos dos pacientes e familiares
para um processo de viver mais saudável.
Descritores: Cirurgia Torácica , Revascularização miocárdica, Enfermagem, Estilo de vida.
1.INTRODUCTION
Contemporary world conveys the era of information technology, thus, the human
being enjoys increasingly sophisticated and advanced treatments and health interventions.
Scientific evidence points to coronary artery bypass graft (CABG) as an important resource
for the surgical treatment of coronary artery disease, resulting in longer survival and better
quality of life for patients(1).
Whenever diseases do not cease the life of an individual, they might cause physical
organic, physiological, psychological disorders and imbalances, complications and
disabilities, which directly affect the deficit of human productivity in their workplace, familiar
and professional environments
(2)
. Thus, it is essential to understand the processes that
2
underlie heart disease and coronary artery bypass surgical experience, by nurses and health
professionals as constituting an important step to meet the individual in his multiple
dimensions of being.
2. OBJECTIVE:
The following research aimed to understand how patients mean the process of
living after the surgical experience of coronary artery bypass graft, in order to build
up a theoretical explicative model.
3. METHODOLOGY:
It has been a qualitative, exploratory and descriptive study resulting from an
extension project entitled: "The meaning of surgical experience and the process of life in
patients undergoing coronary artery bypass graft."
The scenario for the development of the research was a hospital in the state of Santa
Catarina, a reference in cardiac surgery, taking place from October 2010 to August 2011.
Twenty-three subjects were interviewed, twelve patients who underwent CABG, six health
professionals (doctors, nurses, physical educator, nurse technician) and five family
members, comprising three different samples. The development of the project was approved
by the Ethics in Human Research under number 001/2010. The ethical aspects were
respected at all stages of research, as envisaged in Resolution 196/96, of the National
Health Department (3).
Data were collected through semi-structured interview, and the process of collection
and analysis guided by theoretical sampling, as advocates the Grounded Theory (GT). The
codes were grouped and the categories and subcategories defined and developed in terms
of their properties and dimensions, followed by the process of open, axial, and selective
coding(4). The analytical process was built on the paradigmatic perspective, consisting of five
components (context, cause, intervening conditions, strategies, and consequences),
explaining the phenomenon.
4. RESULTS AND DISCUSSION
3
In the study, the phenomenon Perceiving the process of experiencing coronary
artery bypass surgery as an opportunity for the maintenance of life associated with
coping with significant changes in lifestyle. Following it will be presented and discussed
the category and subcategories that are part of the consequences of the phenomenon.
The category is composed of seven subcategories. The first, called "Making
changes in eating habits”, showing that after the CABG, it is beneficial for the patient to
change his eating habits. While sometimes this change represents thwart crave for certain
foods on benefit of their health cardiology, the patient ends up accepting the new eating
habits.
The second category, entitled "Having to stop working" concerns the need to
abstain from labor exercising. The change in routine occupational affects the emotional
aspect and also the economic and financial condition of the individual, family, home, because
often financial providers were family. Due to the risk of imminent death, instrumental use of
the functions of the body for the job is abolished, a significant break designed as disability
and loss of autonomy 5).
Having physical limitations that generate dependence. The third category refers
to physical limitations and consequent dependence on family members for activities that
require physical effort in the early rehabilitation. It is noticed that the majority does not
resume work activities, a significant disruption in their lives, which generates suffering,
sorrow, despondency, helplessness and consequent social isolation(5).
The fourth category, Revealing changes in sexual practice, presents another
limitation, the restriction of sexual activity, a fact that affects the marital relationship, when it
not discussed by the couple. It is a difficult subject to approach for professionals and for
patients and their spouses, the latter probably feel intimidated in the face of professionals to
inquire about when to resume sexual activities and what limitations will have to face and / or
live ( 6).
The fifth category, named Performing drug treatment, elucidates the reasons for
the (dis)compliance with drug therapy. The medication is not available when the public
health service represents a cost to the patient, which may affect the continuity of treatment
when your income is already committed. However, even facing financial difficulties, family
prioritizes the purchase of medicines and food, ensuring that they consider essential (7).
In the sixth category, Realizing the gap of social life, the statements illustrate that,
gradually, family members perceive the removal of the individual separated from family life;
4
children, grandchildren, friends. It is important the need of attention from nurses and health
care with the patient after the surgery in order to identify changes such as anxiety,
depression, nervousness which may hinder the recovery of the patient (8).
The seventh sub-group In need of physical exercise contemplates the difficulty on
the part of the cardiac patient to accept the need for physical activity. One of the biggest
obstacles for the patients who underwent surgery is to adapt to the practice of moderate
physical activity such as walking, as a life habit. It is important to reduce inactivity and make
physical activity a daily habit of living in the process of patients who underwent surgery (6).
For cardiac patients, the CABG has become like a real possibility for prolongation of
life of cardiac patients with coronary artery disease, meaning increased life expectancy of
these individuals, who need to live longer seek best practices that add to their daily habits
and healthy quality, to promote their welfare
5. CONCLUSION
Regarding the data analyzed, it is important to highlight - adequate diet, medication,
physical activity - characterizing a chance for the maintenance and extension of life of
individuals who underwent surgery. However, these habits to adapt to daily life seem to be
the biggest challenge for these individuals. Thus, there must be a reflection on the part of the
patient and his family, as well as professionals, particularly nursing, to enhance the care and
guidance on health, minimizing the risk for new events and disease contributing to the
improvement of the living process in such individuals.
It is possible to say that there is a gap in the production of studies aimed at
understanding the experience and changes in lifestyle after CABG from the perspective of
that experience. Then, nursing might contribute to the construction of this and other studies
aiming at the improvement of human care, considering the complexity and totality of the
human being in their multiple dimensions.
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