Comparisons of American-Chinese and Taiwanese patients’ perceptions of dyspnea and helpful nursing actions during the intensive care unit transition from cardiac surgery

Abstract

Objective: To compare perceptions by American-Chinese and Taiwanese patients who received ventilatory assistance of acute episodes of dyspnea and the related helpful nursing actions in the intensive care unit (ICU) after cardiac surgery. Design: A descriptive qualitative design. Setting: Two medical hospitals in northern California and Taiwan. Patients: A purposive sample consisting of 30 adult Chinese patients who experienced acute episodes of dyspnea while receiving assistance from a volume-cycled ventilator following cardiac surgery in the ICU from one study site in the United States (n = 10) and one study site in Taiwan (n = 20). Outcome Measures: The perceptions, natures, helpful nursing actions, and conceptual definition of the acute episode of dyspnea from the patients’ perspective. Intervention: Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. Results: All American-Chinese and Taiwanese subjects experienced physical discomforts, including tightness and congestion in the chest, labored breathing, sweating, palpitations, pain, and loss of vitality. Seventy percent of American-Chinese subjects and 90% of Taiwanese subjects reported having a mortal fear of death during and after the acute episode of dyspnea. The nature of the patients’ perceptions of dyspnea revealed in this study can be categorized as unpredictability, sequence, intercorrelation, and exhaustion. Data analysis shows that the acute dyspneic process includes the immediate, following, later, and final transitions. Helpful nursing actions were identified as comforting, companionship, allowing self-concentration, and providing information. Conclusion: Both American-Chinese and Taiwanese patients’ perceptions of acute episodes of dyspnea and helpful nursing actions were identified and compared. Finally, the conceptual definition of patients’ perceptions of acute dyspnea and a conceptual framework for this phenomenon were further tentatively developed to depict and delineate this phenomenon. (Heart Lung ® 1999;28:41-54)