Elsevier

Heart & Lung

Volume 40, Issue 3, May–June 2011, Pages 226-235
Heart & Lung

Care of Patients Recovering from Cardiac Surgery
Patients' discharge experiences: Returning home after open-heart surgery

https://doi.org/10.1016/j.hrtlng.2010.01.001Get rights and content

Abstract

Purpose

This study explored patients' narratives of technology in heart surgery and recovery.

Methods

A narrative inquiry was conducted with a sample of 16 individuals. Interviews were completed 2 to 4 days after transfer from cardiovascular intensive care, and 4 to 6 weeks after discharge. Participants completed journals between these 2 time periods.

Results

Discharge and the return home were highlighted as key transitions. These transitions were driven by a technological script that included teachings and texts provided upon discharge. Complicating participants' narratives were their own personal dramas and self-characterizations of vulnerability, as they struggled to incorporate this script into the particularities of their daily lives.

Conclusion

Comprehensive conceptualizations of technology that involve the associated logics and pathways of recovery provide deep insights into patients' stories of recovery from heart surgery. It is salient that discharge programs consider the ways that technology enters into patients' narratives, and also consider dialogical approaches to communication, education, and supportive interventions that are offered at multiple intervals and continue in the home.

Section snippets

Methods

In this study, we used narrative inquiry as the methodology. Narrative inquiry involves a focus on stories.20, 21 We drew on the concept of “narrative emplotment.”22, 23, 24 This concept directs attention to active processes of constructing a plot line. It involves depicting interrelationships among characters, events, interactions, and outcomes.22, 23, 24 Focus on emplotment was key to this study, because it drew attention to how meaning was constructed in storytelling and to an analysis of

Results

Discharge and going home were noteworthy components of participants' stories. Vulnerability at discharge and upon returning home were enfolded into 4 main plot developments that were contingent on personal context and were reflected in varying degrees and ways. These developments frame the Results: (1), “Thrown to the wolves,” (2), “Double-edged sword,” (3), “I don't know what is normal now,” and (4) “Walk that fine line.” Variations of these plot developments are present in the literature

Discussion

In this narrative inquiry, we explored patients' experiences of technology during heart surgery and recovery. By using a broad and inclusive definition of technology, including the associated logics and practices of care, we could more thoroughly elicit and analyze narrative accounts. This theoretical construction offered an opening into storytelling that unfolded according to participants' particular experiences, as opposed to limiting their stories. As a result, the use of this theoretical

Conclusions

Over a decade ago, Radley61 reported that heart surgery becomes part of patients' identity, i.e., “a mark on their biography” (p. 135). Uniquely, our study illuminated ways in which individuals were marked by technology as they were discharged home. Close involvement with technology in the hospital and the technologically driven scripts prompted a recasting of identity. Individuals characterized themselves as vulnerable, and believed that they required close surveillance. Understanding this

Acknowledgments

This article was based on J.L.’s doctoral research. She acknowledges, and is thankful for, the fellowships that supported her doctoral education: a Heart and Stroke of Canada Nursing Research Fellowship, a stipend from the Strategic Training Program for Cardiovascular Nurse Scientists (a partnership between the Canadian Institutes of Health Research, Institute of Circulatory and Respiratory Health and the Heart and Stroke Foundation), a Senator Norman M. Paterson Fellowship from the Canadian

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