Edition 129 - February 2013 - Interior Health

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Bringing the Patient Experience into Cardiac Care C arol Laberge has literally helped save thousands of lives. But in three decades as a critical care nurse, half of them working in the cardiac angioplasty program at Fraser Health, there was always one nagging question. “I always wondered what the patients were thinking about as they were going through the experience,” says Carol, now Interior Health’s Director of Cardiac Services. “On one hand we told patients they could potentially die if they didn’t have the procedure done, and then a few short days later, we would tell them they’re okay and send them home.” “The health-care system has always really been a ‘provider-centred system.’ What would it be like if it were more patient-centred” wondered Carol. “How do we get inside a person’s head to really understand how patients make meaning of their experiences How might that change the care we provide” She got the chance to investigate the answers to some of those questions when she enrolled in the applied doctorate program in Human and Organization Development at the Fielding Graduate University in Santa Barbara, California. The result A PhD dissertation entitled The Lived Experience of a Heart Attack: Individual Accounts of Primary Coronary Intervention Survivors. The thesis looked at what sense and meaning rural residents make of their experience of having a heart attack and receiving an angioplasty procedure. Carol Laberge spent 15 years in cath labs like the one at KGH, wondering how the patients' experience might inform the kind of care we provide and the way we provide it. The findings won’t surprise anyone from a rural area who has received health care in an urban setting and then returned home. There are the consequences of weather and geography in remote locations. And then there are the post-procedure consequences. Feelings of operating in a fog. Disbelief. Reconciliation with one’s mortality. A sense of not knowing, or of not being given enough information to understand what to do next.
In the course of the research, Carol asked study subjects to write poetic compositions to describe the emotions they felt. What she received was heart-wrenching. Damaged animals in a cage, Illness infects my heart. Two companions, life and death, walk together. Expose my body, expose my heart, but don’t expose my soul, I’m not dead yet. Now Carol and her colleagues are beginning to apply the learnings from her thesis in the development of the Interior Health Cardiac Program. The necessity of medical evacuations of patients like this one illustrate the geographical challenges rural and remote patients face. A more robust transport system has been set up to ensure all patients receive access to the care they need. But much of the work has focused on how to help rural patients deal with the aftermath of a cardiac incident. The KGH-based cardiac program has established a 1-800 number for patients to get follow-up support. They’re working at improving communications with referring physicians and other service providers. And they wrote their own cardiac education booklet to complement the Heart and Stroke Foundation’s Recovery Road book for patients having undergone cardiac surgery, now taking place at Kelowna General Hospital. “My idea is I want patients to have a toolkit that they can take home with them that will help address the real needs they have and the experience they are going through,” says Carol. There is a lot more work to be done, but by bringing patient stories to life, Carol and the future researchers who will build on her work are moving the health-care system to a place where patients are the true centre of care.
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Edition 129 - February 2013 - Interior Health

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