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Clinical Nursing Research
20(3) 263 –275
© The Author(s) 2011
Reprints and permission: http://www.
DOI: 10.1177/1054773811405520
ecartin and CarrollClinical Nursing Research
© The Author(s) 2011
Reprints and permission: http://www.
1Massachusetts General Hospital, Boston
Corresponding Author:
Diane L. Carroll, Munn Center for Nursing Research, POB 426, Massachusetts General
Hospital, Boston MA 02114, USA
Email: dcarroll3@partners.org
Nursing Interventions
for Family Members
Waiting During
Cardiac Procedures
Kelly Trecartin1 and Diane L. Carroll1
Anxiety is shared by patients and family members (FMs) and can increase
throughout the FMs waiting during invasive cardiac procedures (ICP). The
purpose of this study was to measure the effects of an informational report (IR)
and a postprocedure visit (PPV), on the anxiety of waiting FMs. There were
151 FMs assigned to 3 groups; Group 1 (50 FMs: standard of care [SOC]),
Group 2 (50 FMs: SOC + IR), and Group 3 (51 FMs: SOC + IR + PPV). Pre/
postvariables measured were: blood pressure (BP), heart rate (HR), skin
temperature (ST), and anxiety. When comparing the BP, HR, ST, and anxiety
there were no differences between groups with either SOC or IR. There
was a significant reduction in anxiety, from baseline to the PPV in Group 3
(F = 10.1; p < .000). A PPV had an impact on FMs and a PPV should be incorporated
as a nursing intervention during ICP.
anxiety, family visitation, nursing intervention
Hospitalizations can be a precipitant of anxiety for patients and their family.
For family members (FMs), idle time spent waiting for the completion of the
patient’s scheduled tests and procedures can add to their anxiety. Regardless
264 Clinical Nursing Research 20(3)
of the intent of the hospitalization, the patient and family are separated, removed
from their conventional routine and support, and are now in unfamiliar surroundings.
With the absence of familiar environmental safeguards, FMs are
at risk for heightened anxiety, as well as feelings of vulnerability, loss of control,
fear, and isolation (Leon & Knapp, 2008).
Specifically, patients undergoing invasive cardiac procedures (ICP) are
separated from their family on admission to the procedure area. FMs are asked
to remain in the waiting room during the ICP. There FMs have to tolerate long
waiting periods before they receive any information about their loved one or
have the opportunity to see them on completion of the ICP. Prolonged waiting
periods may add to anxiety already felt by family members. Therefore, the
purpose of this study was to compare the effects of two nursing interventions,
informational report (IR) and a postprocedure visit (PPV) to standard of care
(SOC), on the anxiety level of waiting FMs during a loved one’s ICP.
Family system theory offers a framework for understanding the relationship
between the person and their environment within the context of family. The
central theme of family system theory is the family. Family is viewed as an
interdependent, continually interacting whole that is greater than the sum of
its parts. For those individuals within the context of a family, FMs have been
viewed as a part of a system that is interacting with all its members (Litman,
1974; Van Horn & Kautz, 2007).
The alteration of an individual’s internal environment during an illness experience
can cause mind modulations that affect the equilibrium within the person
and within their family. Mind modulations are the natural process by which
perceptions, thoughts, attitudes, and emotions are converted in the brain to neurohormonal
messages sent to the autonomic nervous system (ANS) (Dossey,
Keegan, & Guzzetta, 2005). The ANS responses to these neurohormonal messages
can alter the cardiovascular, respiratory, immune, and neurological systems.
Anxiety has been described as a subjective, consciously perceived feeling of
apprehension or tension that is associated with ANS arousal expressed in both
psychological and physiological measureable responses.
Researchers consider a hospitalization of a family member, no matter how
short the hospital stay, a crisis that can cause an acute emotional upset within
the family (Eggenberger & Nelms, 2007; Leon & Knapp, 2008). Therefore,
FMs, as a unique part of the patient’s environment, can also suffer mind modulations
from a FM’s illness experience, which can alter the FM’s ANS and
can present as alterations in their body systems.
Trecartin and Carroll 265
Nursing interventions are needed to reduce the contextual stimuli of a
FM’s illness experience. These interventions can potentially be effective in
modulating the responses of FMs (Chien, Chui, Lam, & Ip, 2006; Paavilainan,
Salmin-Toumaala, Kuirakka, & Paussu, 2009). Previous research has documented
that informational nursing interventions have reduced FM’s anxiety
in intensive care units (Chiu, Chien & Lam, 2004; DeJong & Beatty, 2000;
Verhaeghe, Van Zuuren, Duijnstee, & Grypdonck, 2004). These interventions
were in the form of progress reports or attention from a supportive person.
For those FMs in the waiting room during a surgical procedure, Leske
(1995, 1996) studied the use of in-person (nurse) and a nurse telephone call
intraoperative report. The report included progress of the surgical procedure,
patient condition, plans for postoperative care, and they would be notified
when patient arrived on the unit compared to standard of care no information
to family members during surgical procedures. Anxiety was measured by the
Spielberger State Anxiety Inventory, heart rate (HR), and mean arterial blood
pressure (BP). There were significant reductions in state anxiety, heart rate,
and mean arterial BP in the FMs who received the in-person only intraoperative
reports (Leske, 1995, 1996).
There is no research addressing the unique needs of the waiting FMs while
a loved one is undergoing a diagnostic/treatment ICP. There are no nursing
intervention studies with waiting FMs during an ICP using IR and/or a PPV
that evaluate the psychological and physiological responses during that time.
With limited data on effectiveness for IR from the surgical arena, this study
tested the effectiveness of an IR and a PPV nursing intervention compared to
SOC; on the anxiety of waiting FMs by measuring state anxiety, BP, heart
rate (HR) and skin temperature (ST).The research hypotheses were:
Hypothesis 1: An IR will reduce BP, HR, and state anxiety in FMs
compared to those family members who receive SOC.
Hypothesis 2: An IR will increase ST in FMs compared to those FMs
who receive SOC.
Hypothesis 3: An IR plus a PPV will reduce BP, HR, and state anxiety
in FMs compared to those FMs who receive SOC.
Hypothesis 4: An IR plus a PPV will increase ST in FMs compared to
those FMs who receive SOC.
This study was quasi experimental using a pre and postdesign to examine the
effectiveness of two nursing interventions, an IR or IR and PPV, for families
266 Clinical Nursing Research 20(3)
that are waiting while a loved one undergoes an ICP. The investigation conformed
to the principles outlined in the Belmont Report and was approved
by the Human Research Committee.

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