xxxxxxxx

2009, 48(2): 164172 NOSILEFTIKI 2009, 48(2): 164172

R E V I E W

,1 -,2
Patient Education
Abstract at the end of the article

, MSc,
,
,
,
,
2
, PhD,
, ,
,

: 15.12.2008
: 24.4.2009
: 27.4.2009

o :

5, 117 43
.: 210 92 24 029, 697 37 93 489
e-mail: kgiakoumidakis@yahoo.gr

, .

, , , , ,
, , , .
,

. Medline, Chinahl Cochrane.

19912009.
, ,
. , ,
,
, ,
, , ,
,
. ,


,
.
: , , ,
,

(,
Coronary Heart Disease) 16

. , 2004
451.326 ,
1 5 . T 2008
770.000
, 430.000
.
26 sec
, 1 min
.
40 (lifetime risk), 49%
32% .1
, ATTICA,2
5% 3% ,

20012006 11%
6,1% .3 , ,
3574 , 164,8 100.000
43,1 100.000
.4

.
,
,

, B6
12, ,

, , -,
. ,

.5
(Coronary Artery Bypass Grafting, CABG)

,
.6

(National Center for Health Statistics, NCHS), 2005
469.000
261.000 ,
325.000 145.000 ,

165

56,7%
65 .
30.000 $ .1,6
, , >10.000
.
,


,
. ,
,

, , ,
.

(CABG)
,

. ,
,
, laser,
(stents)5 (. 1).



.

.5

(Internal Mammary Artery, IMA),
(Radial Artery, RA),
(Saphenous Vein Graft,
SVG).
1. .

(CABG)

(PTCA)
laser
o
(stents)

166

.6


, .5,7 5
, 7080%
,
10 4060%.
, 90%
10
.6

. , ,
(off-pump coronary artery bypass, OPCAB).8


(Cardiopulmonary Bypass pump, CPB pump),
(extracorporeal circulation).
,

. ,
CPB , ,
.

.5,8,9
,

.

.9
,
,
. , ,



. ,



.
,

.5,8,9

. , . -

.

,
.
,

,
.

.10
,11
,
.12
(International Council of Nurses, ICN),13


. ,
,14
,
.15


, ,
, , ,
,

.1621 ,
,
,
.22,23 -
1 $
34 $.24
,

.8
,
.

,

. ,
(state anxiety)
514 ,
.25

(. 2)

,
,
,
.

, ,
, , ,
, , ,
, , ,
( ,
..).8

,
,
.8

167

,

,
,
,

.8


, 3060%

,
,

,
.26 ,
,
,
, ,
, ,
.8,2729
,17
:

2. .
: , , , ,
, , , monitoring, ,

, , ,
,
-

,

: ,

168

.

,

,
.
,17 :

,
, .
,
.


.
, ,

,
.8,27,28
,

.

, :27,30
,
, , ,
57
57

4
, 1
,
.

. , . -

(. 3).

(. 3)

,
.17

, ,
, ,
, , , , ,

, , ,



.
,

,8
.
,

, -

3.
.

,

:
2 ,
, ,
,
.

(>2 )
(23 )

,

. ,

,
.8,27,28

. ,


,
.8,28
,
.
,
23 .31
,

, ,
3235
,


,

. ,
.
,
, ,
, , ,
, , . ,
,
.28

,
,
46 . ,
,

,
.6,28

,

169

, , ,
, ..

,

.6,28
- ,

,
6
3 .28 ,
68 ,
1012
.36
, ,
, .
>4,5 kg ,

46 68 ,
.28,31,36
,
,
,
(follow up).36 ,

, ,
, , , ,
,
, 36 ,
,
.

, ,
,
.

, , ,

170

,
,
. ,
,
.
,
.

, ,

,
,

. , . -

.


,

,
. , ,
, -, ,

.

ABSTRACT
Patient Education for Coronary Artery By-pass Grafting
Konstantinos Giakoumidakis,1 Hero Brokalaki-Pananoudaki2
1
MSc, PhD(c), RN, Faculty of Nursing, National and Kapodistrian University of Athens, Cardiac Surgery Intensive Care Unit,
Evangelismos Hospital, Athens, 2 PhD, RN, Associate Professor, Faculty of Nursing, National and Kapodistrian University of Athens,
Athens, Greece
Coronary artery by-pass grafting (CABG) is the surgical treatment of coronary heart disease, which is the most common cause
of death worldwide. The patients undergoing CABG have the right to receive information and education in a variety of relevant
topics, such as the nature of the operation, the expected outcome, the possible risks and complications, the direct postoperative
environment, the expected sensations, and the immediate and long-term treatment, monitoring and rehabilitation. The aim of
this review is to demonstrate the necessity and the right of the patient for education and to delineate the role of the nurse in the
information and education of the CABG patient and his/her significant others. A narrative review was carried out and evidence
was collected through the electronic databases Medline, Cinahl and Cochrane covering articles and the books published from
1991 to 2009. Patient education is a widespread subject of discussion, which indicates its importance for the patient and his/her
family. Registered nurses, responsive to their role and professional and ethical responsibility, provide education to patients,
and this can have a variety of positive effects, such as ensuring normality of the postoperative condition, increasing patient
satisfaction, reduction of complications, anxiety, pain and curtailment of the length of hospital stay, preparation of the patient
for the direct postoperative environment and determination of the discharge planning. In conclusion, individualized patient
education, when provided at the appropriate time, comprises an important and independent nursing intervention that can
ensure a positive nursing outcome for the CABG patient and his/her family. NOSILEfTIKI 2009, 48 (2): 164-172.
Key-words: coronary artery by-pass grafting nursing care patient education preparation rehabilitation.

* Corresponding Author: Konstantinos Giakoumidakis, 5A Eudoxou street, GR-117 43, Neos Kosmos, Greece,
tel.: +30 210 92 24 029, +30 697 37 93 489, e-mail: kgiakoumidakis@yahoo.gr

1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N et

al. Heart disease and stroke statistics 2008 update. A report
from the American Heart Association Statistics Committee
and Stroke Statistics Subcommittee, 2008. American Heart

Association Web Site. Available at: http://circ.ahajournals.

org/cgi/reprint/CIRCULATIONAHA.107.187998. Assessed: July
1st, 2008
2. Pitsavos C, Panagiotakos DB, Chrysohoou C, Stefanadis C.
Epidemiology of cardiovascular risk factors in Greece: Aims,


design and baseline characteristics of the ATTICA study. BMC
Public Health 2003, 3:32
3. Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas I, Stefanadis C. Five-year incidence of cardiovascular disease and
its predictors in Greece: The ATTICA study. Vasc Med 2008,
13:113121
4. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson
TB, Flegal K et al. Heart disease and stroke statistics 2009
update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 2009.
American Heart Association Web Site. Available at: http://circ.
ahajournals.org/cgi/content/full/119/2/e21. Assessed: April
25th, 2009
5. Lemone P, Burke K.
. In: Lemone P, Burke K (eds)
.
. 3 . , , 2006:1036
1118
6. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner
TJ et al. ACC/AHA 2004 guideline update for coronary artery
bypass graft surgery: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to update the 1999 Guidelines
for Coronary Artery Bypass Graft Surgery). American Heart
Association Web Site. Available at: http://circ.ahajournals.
org/cgi/reprint/110/14/e340. Assessed: July 1st, 2008
7. Bojar RM. Synopsis of adult cardiac surgical disease. In: Bojar
RM (ed) Manual of perioperative care in adult cardiac surgery. 4th
Ed. Blackwell Publishing, Malden, Massachusetts, 2005:158
8. Martin CG, Turkelson SL. Nursing care of the patient undergoing coronary artery by-pass grafting. J Cardiovasc Nurs 2006,
21:109117
9. Bojar RM. Cardiopulmonary by-pass. In: Bojar RM (ed) Manual
of perioperative care in adult cardiac surgery. 4th Ed. Blackwell
Publishing, Malden, Massachusetts, 2005:177204
10. Caress A. Giving information to patients. Nurs Stand 2003,
17:4763
11. . 2071/1992 ( 123/1992, , 47).

12. Manning M. The advanced practice nurse in gastroenterology serving as patient educator. Gastroenterol Nurs 2004,
27:220225
13. International Council of Nurses. Position Statement: Scope of
nursing Practice. 2004. International Council of Nurses Web
Site. Available at: http://www.icn.ch/psscope.htm. Assessed:
July 1st, 2008
14. .. 351/1989.
() , () , ()

()


15. .. 216/2001.
16. Lamarche D, Taddeo R, Pepler C. The preparation of patients
for cardiac surgery. Clin Nurs Res 1998, 7:390405

171
17. Lemone P, Burke K.
. In: Lemone P, Burke
K (eds) .
. 3 .
, , 2006:211247
18. Cebeci F, Celik SS. Discharge training and counseling increase
self-care ability and reduce postdischarge problems in CABG
patients. J Clin Nurs 2008, 17:412420
19. Deyirmenjian M, Karam N, Salameh P. Preoperative patient
education for open-heart patients: A source of anxiety? Patient
Educ Couns 2006, 62:111117
20. Devine EC. Effects of psychoeducational care for adults surgical
patients: meta-analysis of 191 studies. Patient Educ Couns
1992, 19:129142
21. Johnson JE. Self-regulation theory and coping with physical
illness. Res Nurs Health 1999, 22:435448
22. Bourie PQ. Costing the nursing service of patient education.
Nurse Manag 1993, 24:4648
23. Wichter RM, Katz P, Showstack J, Bindman AB, Goldman
L. Reorganizing an academic medical service: Impact on
cost, quality, patient satisfaction and education. JAMA 1998,
279:15601565
24. Bartlett EE. Cost benefits analysis of patient education. Patient
Educ Couns 1996, 27:279
25. Cupples SA. Effects of timing and reinforcement of preoperative
education on knowledge and recovery of patient having coronary artery bypass surgery. Heart Lung 1991, 20:654660
26. Kjaergaard S, Rees SE, Gronlund J, Nielsen EM, Lambert P,
Thorgaard P et al. Hypoxemia after cardiac surgery: Clinical
application of a model of pulmonary gas exchange. Eur J
Anaesthesiol 2004, 21:296301
27. Bojar RM. Preoperative considerations and risk assessment.
In: Bojar RM (ed) Manual of perioperative care in adult cardiac
surgery. 4th ed. Blackwell Publishing, Malden, Massachusetts,
2005:91128
28. Mullen-Fortino M, OBrien N. Caring for a patient after coronary
artery by-pass graft surgery. Nursing 2008, 38:4652
29. Hulzebos EH, Helders PJ, Favi NJ, De Bie RA, Brutel de la Riviere
A, Van Meeteren NL. Preoperative intensive inspiratory muscle
training to prevent postoperative pulmonary complications in
high-risk patients undergoing CABG surgery: A randomized
clinical trial. JAMA 2006, 296:18511857
30. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM,
Casey DE et al. ACC/AHA 2007 guidelines for the management
of patients with unstable angina / Non-ST-elevation myocardial
infarction. American College of Cardiology Web Site. Available
at: http://content.onlinejacc.org/cgi/content/full/50/7/e1.
Assessed: July 14th, 2008
31. Bojar RM. Post-ICU care and other complications. In: Bojar
RM (ed) Manual of perioperative care in adult cardiac surgery. 4th ed. Blackwell Publishing, Malden, Massachusetts,
2005:509570
32. Theobald K, McMurray A. Coronary artery by-pass graft surgery:
Discharge planning for successful recovery. J Adv Nurs 2004,
47:483491

172
33. Doering L, McGuire A, Rourke D. Recovering from cardiac
surgery: What patients want to know? Am J Crit Care 2002,
11:333334
34. DiMattio M, Tulman L. A longitudinal study of fuctional status
and carrelates following coronary artery bypass graft surgery
in women. Nurs Res 2003, 52:98107
35. Garza J, Gantt D, Van Cleave H, Riggs M, Dehmer G. Hospital

. , . -
disposition and long-term follow-up of patients aged 80
years undergoing coronary artery revascularization. Am J
Cardiol 2003, 92:590592
36. .
. : (.) .
. 1 . ,
, 2003:869890

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxx