Phychological well-being and coping with surgical stress of the patients after open heart surgery

Abstract

Psychological well-being (PWB) and coping strategies for surgical stress in patients after major surgery are the less explored areas in countries with low and moderate incomes. The aim of this research is to find out the status of PWB and coping of the patients after open heart surgery (OHS). This Mixed methods study was carried out at Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj including patients who underwent OHS from June 2022 to July 2023 and their caretakers. Four hundreds and twenty four patients were recruited by using the Cochran formula (n= z 2 pq/d 2 ) with a 5% error and a confidence interval of 95% for the QUAN part of the study. Six caretakers were included in the in- depth interview for the QUAL part. Caretakers were interviewed from day 4 to day 10 after OHS. Ryff PWB scale and coping with OHS stress scale were used to collect data for the QUAN portion. The Institutional Review Committee (IRC) of the Institute of Medicine provided ethical approval, and administrative approval from the hospital before the data collection. Informed consent and assent (for those under 18) were taken both from the patients and caretakers. The study result found the patient‘s average age in years of 48.8 (±16.93) ranging from 13 to 88 years. Among them 232 (54.71%) were male, and 344 (81.13%) were married. 240 (56.61%) of patients were living in the municipality, 245 (58.02%) were physically inactive, 248 (58.49%) of patients had age-appropriate body physique, and 275 (64.86%) of caretakers were their spouses. Regarding their vital signs, 220 (51.89%) had normal vital signs without using medicine to increase blood pressure, and 300 (70.75%) of patients experienced no incisional pain postoperatively at the time of data collection. Likewise, 185 (43.64%) had to pay from their pocket for their surgery and service charges. The study showed that 301 (72.17%) of patients had high psychological well- being, out of this, 293 (69.11%) in personal growth, and 288 (67.93%) in autonomy had high PWB. Whereas, 266 (62.73%) of OHS patients had moderate coping skills, followed by 118 (27.83%) of them had effective coping skills and 40 (9.43%) had ineffective coping skills in five coping strategies such as reflecting, believing and supporting, reassurance, religious, and acceptance. The PWB of OHS patients was significantly associated with sex, living location, incisional pain, and age-appropriate physique. Male patients (OR=2.199), patients living in the municipality (OR=1.751), patients with no incisional pain (OR=5.102), and age- appropriate physique (OR=1.729) had higher PWB than females, patients living in the rural municipality, those having incisional pain, and no age-appropriate physique respectively. However, sex, incisional pain, and respiratory rates were significant predictors of PWB. Regarding coping with OHS stress, the marital status and vital signs of the patients were nsignificantly associated with the coping. Effective coping skill was adopted by the patients who were married (OR=2.278), and those with normal vital signs without using medicine to increase blood pressure (2.331) were higher than in single patients, and those vital signs were normal with using medicine to increase blood pressure. Regarding the QUAL aspect, the changing pattern of behaviors among the patients started from seeking information, experiencing stress, making decisions for OHS with peak levels of fear and anxiety, to gradually adapting to the stress levels. The common thought of the OHS patients was related to operation and its success rate, medication, incisional pain, fear of death, financial burden, and physical health issues. The relationships between the OHS patient and caretaker were that of openness and emotional intimacy. Reflection, belief and support, reassurance, religious, and acceptance were common strategies that patients used to cope the OHS stress. The majority of OHS patients have high PWB, and moderate to effective coping skills to cope the OHS stress. They often go through successive stages starting from seeking information to making a big decision to undergo OHS. Various high-risk groups (females, rurality of origin, single status, incisional pain, use medicine to increase blood pressure, and less than ideal age-appropriate body physique) need attention regarding PWB and coping respectively. Key Words: Coping with surgical stress, health psychology, Nepal, open heart surgery, psychological well-being