Halvtidsseminarium: Patients' experiences of recovery after complex aortic repair - a person-centred approach

  • Datum: –16.30
  • Plats: Akademiska sjukhuset Hedstrandsalen, BV, ingång 70
  • Föreläsare: Doktorand Linda Haakseth
  • Kontaktperson: Linda Haakseth
  • Telefon: 0722050619
  • Halvtidsseminarium

Halvtidsseminarium med Linda Haakseth.

Background: Endovascular aortic repair (EVAR) for complex aortic pathologies often involves multiple procedures over a long period of time with little time for recovery, and at the same time a high risk of complications. Current outcome measures and follow-up routine is limited to registration of death and major complications requiring re-hospitalization and re-operation. There is limited knowledge about how patients are affected from undergoing complex EVAR. The overall aim of this project is to investigate the patients’ experiences of recovery after elective complex EVAR. A further aim is to develop a research protocol for the development, implementation and evaluation of an intervention focusing on the issues identified in the first phase of the investigation.

Methods: The population in focus is men and women, ≥18 years of age, with aortic aneurysms or type B dissections who were planned to be treated by means of complex EVAR. In study I the patients’ lived experiences of recovery after complex staged EVAR was investigated through interviews and analysed using descriptive phenomenology.  In study II the health and quality of life effects of complex EVAR in relation to patients’ demographic and health characteristics was investigated through self-administered questionnaires conducted preoperatively, one and six months postoperative. Three case descriptions representing different outcome trajectories was searched for fundamental care needs and conducted nursing interventions, using the fundamentals of care framework, to illustrate heterogeneity of the sample. Study III and IV will revolve around the development and implementation of an intervention that can improve patients’ experience of recovery after elective complex endovascular aortic repair. Study III will be an experienced based co-design concluding in an intervention. The fourth study will be a research protocol for development, implementation and evaluation of a contact nurse intervention for patients undergoing complex EVAR. The nature of the contact nurse role will be based on current evidence and the findings from study III.

Results: In the first study the patients’ experiences was described as: a necessary, overwhelming, hard, and prolonged process with life changing consequences. The patients struggled with overwhelming tiredness, pain and complications, and could after years gradually recover back to ‘yourself’ and having to accept life with permanent setbacks and limitations. In the second study overall, there was a significant increase in the patients’ health disability levels at 1 month to later recover at 6 months postoperative. Minimal changes could be seen for QoL outcomes or symptoms of anxiety and depression. However certain individuals were not fully or at all recovered at 6months postoperative. The identified fundamental care needs were mainly physical, and documented nursing interventions did seldom meet these needs, which led to secondary psychosocial and relational care needs.

Conclusion: Some patients struggle with physical and psychological setbacks, continuing long-term after undergoing complex EVARTaking a more person-centred fundamental care approach can help address the complex and individual health care needs of the patient undergoing complex EVAR, while also considering the context and environment in which the patient and health care professionals interact.