CABG teaching

[atomic_pedal]

hello everyone

:)

i'm a charge nurse on a cv-pcu unit and am currently working on a project to improve our cabg teaching. i will be redoing our cabg video that will be on a channel that they can flip to (instead of an old vhs tape lol).

i am thinking of beginning with an introduction by one of our cv surgeons and then follow through the process from the day/night before surgery all the way through outpt cardiac rehab. i want to show nurses from each area (tele, preop, icu, pcu, cardiac rehab) i have an employee who recently had a cabg that has agreed to be our "actor". not every section will be acted, ex. the cvor nurse will just be talking and telling what will happen the morning of surgery, where the family can wait and how and when they will be contacted. the icu nurse will be shown in the icu room talking about the experience of coming out of anesthesia and how she will assist with communication and a brief overview of the many tubes/lines etc. she will also talk about when the family can visit and general icu visitation rules. the acting will happen as the pt comes to pcu and i want to show our actor doing cardiac rehab (chest tube and all) and how to get up from the bed/chair (sternal precautions) and goals: is, pain mgt, wound care etc. also i want one of our cardiologist to discuss the percentage of patients that go into an irregular rhythm and how we manage this. finally i want to show outpt rehab with the nurse giving a brief description.

i am looking for any suggestions for the video. what does your hospital use to help with cabg teaching?

[OnlybyHisgraceRN, ASN, RN]

My hospital does not do this but this is an awesome idea. Maybe you can go on youtube to get ideas.

[nurseprnRN, BSN, RN]

we did preop teaching in the cv unit i worked in for five years. :redbeathe we did it in a group, all tomorrow's cases together, with significant others or anyone else. we had great visual aids-- a flip chart with transparencies-- if you're into video this would be easy-- showing the different tubes, vent, etc., describing the sounds they all made, and then removing them one by one. we explained that everyone would get out of bed that night or the next morning, start walking, is, c&db, etc.

the group session gave us a priceless opportunity to see them in person and pick up any clues of future difficulties, and to get them to see us before the situation was scary. it also gave the families a chance to meet before they met in the waiting room the next day.

we could answer questions as the class went along (you can't do that with just a video on the tube). i'll never forget the one guy who appeared more and more fidgety and then frankly anxious as i went thru my spiel. i finally stopped and asked if there was something i said that had upset him, or did he have a question? "i saw my doctor for chest pain," he said, "but i'm not having open heart surgery!?!?!" i hurriedly checked the list and there he was, cabg at 0700. i excused him from class saying i'd send his doctor down to explain to him-- leetle problem with informed consent there, eh?

you're trying to include too much info. i'd leave off on the cardiologist-- not everyone, or even most of everyone, has a significant dysryhthmia problem, and this will just introduce unnecessary worry at a time when they are already overloaded. i think i'd leave off on cardiac rehab for now, too, because the patients are totally focusing on the surgery. we did discover that the patients didn't remember a dang thing that happened to them in the first two or three postop days, so we didn't try to teach them much that we expected them to retain more than an hour or so. so cardiac rehab might be a great topic to review on the day of discharge, because by then they'll be remembering things.

i'm interested to see what others' experience has been.

[OnlybyHisgraceRN, ASN, RN]

I may ask my NM if we can implement this. As a new CVICU nurse I find that many patients really don't know what to expect pre and post op. Everything is so hurried. Education is power, and nurses do need to empower our patients better. It will lesson everyones' anxiety.

[atomic_pedal]

Thanks for your reply, I've been trying to find good video's everywhere! (including youtube) I just haven't been able to find anything that really focuses on inpatient teaching I'm also thinking about making a thick laminated poster that can be put up and taken down that has all of the main goals for every open heart pt. Cardiac Rehab, Pain Mgt, IS. That way if it's put up in a CABG pt's room it is a constant reminder of what they should be doing and it helps the family stay involved and it gives the nurse something to point to and ask how they are doing that day.

I would also like some pictures to show during our preop teaching of what a midsternal incision looks like directly post op and then healed, what a chest tube looks like, pacer wires, etc... all the things that are hard to explain. Any ideas? I can't find any good midsternal pics and my hospital wont allow pictures to be taken even with a pt's permission.

[nurseprnRN, BSN, RN]

draw them. ours were all drawn by a staffer with a good hand. if you don't have a nurse who can do a good line drawing (less scary than photos anyway), ask your med school medical illustration department. pluses: no need to get permission to use someone else's work.

[atomic_pedal]

Thanks so much for your input! Group teaching sounds fantastic and I really wish that we could do something like that. It's certainly something to consider :)