An-Najah National University 

Faculty of Graduate Studies 

 

 

 

LIVED EXPERIENCE OF PATIENTS WHO 

UNDERWENT CORONARY ARTERY            

BYPASS GRAFT SURGERY IN WEST           

BANK – PALESTINE: HERMENEUTIC  

PHENOMENOLOGY STUDY 

 

By 

Ayman Abbadi 

 

Supervisor 

Dr. Adnan Sarhan 

 

 
 
 

 
 

This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of 

Master Critical Care Nursing, Faculty of Graduate Studies, An-Najah National 

University, Nablus - Palestine. 

2022 



 

II 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

LIVED EXPERIENCE OF PATIENTS WHO 

UNDERWENT CORONARY ARTERY             

BYPASS GRAFT SURGERY IN WEST            

BANK – PALESTINE: HERMENEUTIC  

PHENOMENOLOGY STUDY 

 

By 

Ayman Sameer Abbadi 

 

This Thesis was Defended Successfully on 19/2/2022 and approved by 

Dr. Adnan Sarhan 

Supervisor 

 

Signature 

Dr. Ahmed Alayde 

External Examiner 

 

Signature 

Dr. Aidah Alkaissi 

Internal Examiner 

 

Signature 



 

III 

 

Dedication 

I dedicate this work to: 

My father, who has always encouraged me to chase my dreams. Without his support, I 

would not be where I am today. I hope to make you always proud of me. 

 My mother, for her unconditional love, support and help.  

 My loving wife and her family, for their assistance and words of motivation that kept 

me moving forward. 

 My son, Kareem, my hope, sunshine, and soul. I look forward to watching you grow up 

and achieve your own dreams. 

My brother and sister for always being there whenever I needed them. 

My uncle, Prof. Jehad, for his encouragement and desire to see me continue to reach 

more. 

The cardiac surgeon Dr. Hasan AL Salman for his cooperation and support during the 

data collection. 

My friends and colleagues Mohannad Al-‗Arabi and Sameh Kanan for helping me to 

find participants for my research. 

Thank you all 

  



 

IV 

 

Acknowledgment 

The completion of this work would have been impossible if it weren‘t for the support of 

many people. I owe a great debt of gratitude to my supervisor, Dr. Adnan Sarhan, for 

his insightful guidance throughout the work and his confidence in me. He gave me 

much of his time, effort and knowledge to help me complete this thesis.  

Also, my great appreciation and enormous thanks go to the discussion committee for 

their valuable notes and recommendations. 

I cannot begin to express my heartfelt thanks to my family for all the love, support and 

encouragement throughout this process. I record my deep sense of gratitude to my 

uncle, Prof. Jehad Abbadi, for his support and help. His suggestions were valuable in 

improving the work and helped me put the pieces together. My appreciation goes to my 

wife for her continuous and endless support and patience. Special thanks go to my 

mother for giving me the strength to chase my dream. Thanks also extend to my 

brothers and sister for their support in words, actions and prayers. The cardiac surgeon 

Dr. Hasan AL Salman for his cooperation and support during the data collection. My 

friends and colleagues Mohannad Al-‗Arabi and Sameh Kanan for helping me to find 

participants for my research. 

Thank you all for helping me complete this work. 

  



 

V 

 
 



 

VI 

 

List of Contents 

 

Dedication ....................................................................................................................... III 

Acknowledgment ............................................................................................................ IV 

Declaration ...................................................................... Error! Bookmark not defined. 

List of Contents ............................................................................................................... VI 

List of Tables ................................................................................................................... X 

List of Appendixes .......................................................................................................... XI 

Abstract .......................................................................................................................... XII 

Chapter One: Introduction and Literature Review ........................................................... 1 

1.1 Introduction ................................................................................................................. 1 

1.2. Background ................................................................................................................ 2 

1.2.1 Historical background .............................................................................................. 2 

1.2.2 Coronary artery disease ........................................................................................... 3 

1.2.2.1 Pathophysiology .................................................................................................... 3 

1.2.2.3 Epidemiology. ....................................................................................................... 4 

1.2.3 Coronary Artery Bypass Graft Surgery (CABG) .................................................... 5 

1.3 Problem statement ....................................................................................................... 6 

1.4 Aim of the study ......................................................................................................... 6 

1.5 Significance and implications of the study ................................................................. 7 

1.6 Interview guide: .......................................................................................................... 7 

1.7 Literature review ......................................................................................................... 7 

Chapter Two: Methods ................................................................................................... 13 

2.1 Design ....................................................................................................................... 13 

2.1.1 Descriptive phenomenological research ................................................................ 13 

2.1.2 Interpretive phenomenology .................................................................................. 14 

2.1.3 Hermeneutical phenomenology ............................................................................. 15 

2.2 Population and sampling method .............................................................................. 15 

2.2.1 Population .............................................................................................................. 15 

2.2.2 Sample and sampling ............................................................................................. 15 

2.2.2.3 Inclusion criteria ................................................................................................. 16 

2.2.2.4 Exclusion criteria ................................................................................................ 16 

2.2.2.5 Sample distribution ............................................................................................. 16 



 

VII 

 

2.4 Data collection procedure ......................................................................................... 18 

2.4.1 Tool ........................................................................................................................ 19 

2.4.2 Analysis ................................................................................................................. 19 

2.5 Ethical consideration ................................................................................................. 20 

2.5.1 Establishing Rigor .................................................................................................. 21 

2.5.1.1 Credibility ........................................................................................................... 21 

2.5.1.2 Dependability ...................................................................................................... 21 

2.5.1.3 Transferability ..................................................................................................... 22 

2.5.1.4 Confirmability ..................................................................................................... 22 

Chapter Three: Analysis ................................................................................................. 23 

3.1 Data analysis ............................................................................................................. 23 

3.1.1 Naïve reading ......................................................................................................... 23 

3.1.2 Structural analysis .................................................................................................. 24 

3.2 Results ....................................................................... Error! Bookmark not defined. 

3.2.1 Various reactions towards the surgery event ......................................................... 25 

3.2.1.1 Normal reaction towards the surgery event ........................................................ 25 

3.2.1.2 Fear from the surgery .......................................................................................... 26 

3.2.1.3 Surprise from the surgery event .......................................................................... 26 

3.2.1.4 Shocked by the surgery event ............................................................................. 26 

3.2.1.5 Hesitation to undergo the surgery ....................................................................... 27 

3.2.1.6 Adaptation to the surgery event .......................................................................... 27 

3.2.2 Restricted life post-CABG ..................................................................................... 27 

3.2.2.1 Restricted daily life activities post-CABG ......................................................... 28 

3.2.2.2 Difficulties in maintaining sleep post-CABG ..................................................... 28 

3.2.2.3 Dependency on others post CABG ..................................................................... 29 

3.2.2.4 Restricted diet post-CABG ................................................................................. 29 

3.2.2.5 Quitting smoking post CABG............................................................................. 30 

3.2.3 The effects of living with coronavirus (COVID-19) on CABG patients . ............. 30 

3.2.3.1 Normal life during COVID -19 pandemic .......................................................... 30 

3.2.3.2 Restricted social life due to COVID-19 pandemic ............................................. 30 

3.2.3.3 Uncomfortable life because of COVID-19 pandemic ........................................ 31 

3.2.3.4 Fear of COVID-19 virus ..................................................................................... 31 

3.2.3.5 Being infected with COVID-19 .......................................................................... 31 



 

VIII 

 

3.2.4 Post CABG Psychological effects ......................................................................... 31 

3.2.4.1 Feeling like a new person ................................................................................... 32 

3.2.4.2 Feeling psychologically normal .......................................................................... 32 

3.2.4.3 Suffering from nightmares and insomnia ........................................................... 32 

3.2.4.5 Nervousness ........................................................................................................ 32 

3.2.4.6 Feelings of isolation ............................................................................................ 33 

3.2.5 Post CABG Physical changes ................................................................................ 33 

3.2.5.1 Physical improvement ......................................................................................... 33 

3.2.5.2 Pain ..................................................................................................................... 34 

3.2.5.3 Numbness ............................................................................................................ 34 

3.2.5.4 Itching ................................................................................................................. 34 

3.2.5.5 Changes in body weight ...................................................................................... 34 

3.2.5.6 Blood sugar irregularities .................................................................................... 35 

3.2.5.7 Shortness of breath .............................................................................................. 35 

3.2.6 Complications post CABG .................................................................................... 35 

3.2.6.1 Pleural effusion ................................................................................................... 35 

3.2.6.2 Pulmonary edema ............................................................................................... 36 

3.2.6.3 Bedsores .............................................................................................................. 36 

3.2.6.4 Wound infections ................................................................................................ 36 

3.2.6.5 Constipation ........................................................................................................ 37 

3.2.6.6 Urinary retention and dysuria ............................................................................. 37 

3.2.6.7 Cardiac arrest and arrhythmias ........................................................................... 37 

Chapter Four: discussion and Conclusion ……………………………………………..65 

4.1 Critical interpretation and discussion ....................................................................... 42 

4.1.1 The participants' reactions toward the event of going through a surgical 

intervention ..................................................................................................................... 42 

4.1.2 Daily life restrictions that the participants experienced post CABG ..................... 43 

4.1.3 The effects of living with coronavirus (COVID-19) on CABG patients ............... 44 

4.1.4 The psychological difficulties that the participants experienced post               

CABG ............................................................................................................................. 46 

4.1.5 Physical changes for the participants post CABG ................................................. 47 

4.1.6 Post - surgery complications for CABG patients ................................................... 49 

4.1.7 Support groups for CABG patients ........................................................................ 62 



 

IX 

 

4.1.8  CABG Patients‘ perspectives on the Palestinian healthcare system ..................... 63 

4.2 Conclusion ................................................................................................................ 64 

4.3  Recommendations .................................................................................................... 64 

4.3.1 Recommendations for the healthcare system ......................................................... 65 

4.3.2 Recommendations for the government .................................................................. 65 

4.3.3 Recommendations for the community ................................................................... 65 

4.3.4 Recommendations for CABG patients .................................................................. 66 

4.3.5 Recommendation for future research ..................................................................... 66 

List of Abbreviations ...................................................................................................... 67 

References ....................................................................................................................... 68 

Appendices ...................................................................................................................... 81 

 ب  ............................................................................................................................... اىَيخض

 

 

  



 

X 

 

List of Tables 
 

Table 1: Demographic Characteristics of the participants .............................................. 17 

Table 2: Structural analysis of the data .…………………………………..…………...86 

Table 3: Themes and subthemes of the study …………………………………….……95 

 

 

 

 

  



 

XI 

 

List of Appendices 

 

Appendix A: Question guide: ......................................................................................... 81 

Appendix B: ٍِ83 ......................................................................... ٍؼيىٍاخ حىه اىذساسح ىيَشرشم 

Appendix C : َّىرج ٍىافقح ػيى اىَشاسمح فً اىذساسح  ................................................................. 85 

Appendix ( D ): Study‘s Tables ………………………………………………………..86 
  



 

XII 

 

LIVED EXPERIENCE OF PATIENTS WHO UNDERWENT CORONARY 

ARTERY BYPASS GRAFT SURGERY IN WEST BANK – PALESTINE: 

HERMENEUTIC  PHENOMENOLOGY STUDY 

By 

Ayman Abbadi 

Supervisor 

Dr. Adnan Sarhan 

Abstract 

Introduction: Coronary Artery Bypass Graft (CABG) surgeries are now very common 

for the treatment of Ischemic Heart Disease (IHD). In fact, IHD is a common and 

serious disease that affects people all around the world. Furthermore, if not handled 

properly and promptly, it can have fatal consequences. The main objective of the study 

is to investigate the lived experiences of IHD patients who had CABG surgery in 

Palestine. 

Methods: Qualitative hermeneutic phenomenology design was used to conduct this 

study, as it describes and interprets the participants' experience more deeply. The data 

was collected through interviewing 21 participantsand by using Paule Ricours 1976 for 

analysis. 

Results: The results of this study revealed that the patients had various reactions to the 

surgery, including fear, surprise, hesitation, and adaptation. In addition, they suffered 

from restrictions on their daily life activities due to the surgery. Moreover, Corona virus 

affected the patients' lives; as they were afraid of getting infected. The patients also 

went through physical and psychological changes and many complications related to 

CABG like plural effusion and cardiac arrest. The operation had some financial effects 

on the patients' lives. Finally, the results identified the support groups for CABG 

patients and the participants' perspectives regarding the healthcare system. 

Conclusion: the findings revealed that CABG patients experienced physical, 

psychological and financial changes. They also had restrictions on their lives and 

developed many complications related to the surgery. Thus, they need support from the 



 

XIII 

 

government, the community and healthcare providers to meet their needs and improve 

their quality of life. 

Keywords: Ischemic Heart Disease, Coronary Artery, Bypass graft surgery, 

Experience, Hermeneutic. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

1 

 

Chapter One 

Introduction and Literature Review 

1.1 Introduction 

Ischemic heart disease (IHD) is a common and serious disease that affects people all 

over the world. If it is not handled properly and promptly, it can have fatal 

consequences (Schwartz, 2012). In fact, 17.9 million people died each year as a result of 

a chronic heart disease (CHD), with the figure expected to rise to 23 million by 2030 

according to World Health Organization (WHO, 2019). Based on  WHO statistics, more 

than 17 million people died due to CHD in 2015 (WHO, 2017). This finding 

demonstrates that the number is rising. Death rates from coronary vascular diseases 

(CVDs) were up to 42%, 38%, 32% and 23%, respectively, in Saudi Arabia, the United 

Arab Emirates, Bahrain and Qatar (WHO, 2017). 

Generally, non-communicable diseases (NCDs) are the leading cause of death in the 

Palestinian community, accounting for up to 50% of all deaths (WHO, 2017(. The 

incidence is higher in the West Bank (57%) than in Gaza (40%) (Shahwan et al., 2019). 

 In 2014, CVD was reported as the first cause of deaths in Palestine accounting for 

29.5% of all deaths (WHO, 2017). The number is rising according to WHO statistics 

2017. The estimated rate of deaths caused by CAD or IHD amounted to 31% (WHO, 

2017). 

Mainly, IHD causes the following symptoms: severe chest pain, also known as angina, 

shortness of breath, fatigue, and serious physical conditions that affect one‘s ability to 

perform daily activities. Consequently, many interventions, such as medications or, in 

severe cases, invasive operations, should be made to relieve the symptoms and treat the 

heart. If IHD is not managed and treated immediately, CABG surgery becomes 

inevitable (Peterson et al., 2004).  

Invasive procedures combined with medical treatment to cure IHD are superior to 

medical treatment alone. Hence, the use of cardiac catheterization and surgical 

intervention such as CABG for revascularization in severe ischemia yield better results 

(Maron, 2020). 



 

2 

 

CABG is a surgical procedure used to treat ischemic heart muscle that is affected by a 

blocked coronary artery by re-perfusing that area with blood via a vascular graft that 

bypasses and connects that area with blood (Birim, Bogers, & Kappetein, 2012). It 

treats the heart by re-perfusing the cardiac muscle, making it one of the most effective 

interventions for relieving IHD symptoms (Schwartz, 2012). 

Incontrovertibly, the surgical intervention is needed in complex cases to keep the heart 

pumping and save the patient's life CABG improves the quality of life, increases life 

expectancy, and alleviates IHD symptoms such as angina (Tsay, 2013). On the other 

hand, it affects the mental, psychological, social and emotional aspects of the patients' 

lives after the operation; considering some patients developed nervousness, anxiety and 

isolation post the operation (Lingehall, 2013). 

During the first three months post the surgery, it is common that some patients develop 

physical and psychological signs and symptoms such as pain in the surgical site, fluid 

retention, fatigue short term cognitive impairment, nervousness, depressed feelings, lack 

of control, and dependency (Bergvik, Sørlie, & Wynn, 2010). 

After the researcher reviewed the available literature regarding the lived experience of 

CABG patients, he found that there is a lack of researches regarding their experience, 

especially in Palestine. Thus, it is important to deeply investigate the lived experience of 

IHD patients after CABG surgery. 

Understanding their experience, will help healthcare providers meet  their needs. As a 

result, they will provide better services to those patients. They will also assist their 

families and support groups care for them to meet their specific needs. 

1.2 Background 

1.2.1 Historical background  

CABG is listed as the most common  cardiac surgery performed in the world today. In 

the United States, they perform approximately 200,000 cases per year (Weiss, 

Elixhauser, 2006). 

It has a history that dates back more than a century. It started in 1910 with Alexis 

Carrel's idea about coronary circulation and the ability to make a surgical intervention. 



 

3 

 

The first successful application was made on dogs with intrathoracic aortic and cardiac 

anastomosis (Carrel, 1910). 

Then in 1935, doctors began testing on humans in order to relieve chest pain in CAD 

patients. Claude Beck, who‘s a doctor, was able to improve perfusion to the heart 

muscle (myocardium) in CAD patients by inserting muscle pedicles, omentum, and 

pericardial fats into the pericardium (Beck et al., 1958). 

In 1946, the concept of CABG improved when ―Vineberg procedure‖ was first applied 

by Arthur Vineberg. He implanted a Left Internal Thoracic Artery (LITA) in the left 

ventricle frontal wall to increase the blood supply to the left ventricle (Vineberg, Miller, 

1951). Then, Robert Getz performed the first successful CABG surgery in 1960, in New 

York. He used Rosenak (tantalum) rings to anastomose the Right Internal Thoracic 

Artery (RITA) to the Right Coronary Artery (RCA) (Goetz et al., 1961). 

Then, in 1962, David Sabiston firstly used Saphenous Vein Graft (SVG) for 

anastomosis. He used the off-pump technique to anastomose SVG to RCA (Sabiston, 

William & Rienhoff, 1974)  .  

Afterwards, the first usage of LITA to Left Anterior Desinding coronary artery (LAD) 

anastomosis manner was applied by Dr George Green in 1968. It is now regarded as a 

standard procedure for modern CABG surgery (Green, Stertzer & Reppert, 1968). 

In essence, the first CABG surgery in Palestine was performed in Ramallah, West Bank, 

in 1999, and it was successful (Salameh et al., 2013). 

1.2.2 Coronary artery disease  

1.2.2.1 Pathophysiology 

Coronary artery disease means narrowing of the coronary arteries (arteries that supply 

blood to the heart). This narrowing takes place due to an accumulation of plaque 

(deposits of cholesterol, other fats, and calcium) in the artery walls. This mechanism is 

known as atherosclerosis, which means (a hardening in the arteries) (Parmet, Glass, 

2004). If the plaque softens and breaks down, it immediately forms a blood clot, which 

can cause a blockage in the coronary arteries and reduce blood flow to the cardiac 

muscle. This can result in a myocardial infarction (death of the cardiac muscles supplied 

by the blocked artery), also known as a heart attack (Parmet et al., 2004). 



 

4 

 

1.2.2.2 Risk factors 

Many factors play a significant role in developing coronary artery disease such as 

physical and psychological risk factors.  

These risk factors include an increase in the concentration of low-density lipoprotein 

(LDL) in the blood and a decrease in the concentration of high-density lipoprotein 

(HDL) in the blood. In addition, they include a rise in triglyceride levels in the blood, 

Diabetes Mellitus (DM), hypertension, and smoking (Foody, et al., 2013). 

Besides the physical risk factors, anxiety plays a significant role in the development of 

CAD. In other words, psychological disorders such as major depression and anxiety 

disorders can also lead to CAD (Sheps, Sheffield, 2001). 

In order to relieve the symptoms and treat the heart, many interventions must be 

performed, such as using medications or, in severe cases, invasive procedures. 

Therefore, if IHD is not managed and treated immediately, CABG surgery becomes 

inevitable (Peterson et al., 2004). 

1.2.2.3 Epidemiology  

According to the American heart association statistics, the rate of CAD deaths in the 

United States in 2016 was 236.6/100000 males and 117.5/100000 females between the 

ages of 35 and 74 (WHO, 2019). 

In fact, 17.9 million people died each year from CHD, with the figure expected to rise to 

23 million by 2030 (WHO, 2019). According to WHO statistics, over 17 million people 

died from CHD in 2015 (WHO, 2017). Moreover, in 2009, the age-adjusted rate of 

CHD deaths was 116.1 per 100,000 population. CHD was listed as the primary 

underlying cause of death in 386,324 people in the United States (Gillespie, 2013). The 

rates of Coronary Vascular Diseases (CVDs) deaths were up to 42%, 38%, 32% and 

23% in Saudi Arabia, the United Arab Emirates, Bahrain and Qatar, respectively 

(WHO, 2017). 

Non-communicable diseases (NCDs) are the leading causes of death in the Palestinian 

community, accounting for up to 50% of all deaths (WHO, 2017). The incidence is 

remarkably higher in the West Bank (57%) than in the Gaza Strip (40%) (Shahwan, et 

al., 2019). 



 

5 

 

CVD was reported as the leading cause of death in Palestine in 2014, accounting for 

29.5% of all deaths (WHO, 2017), and it is increasing. According to WHO statistics 

2017, the estimated rate of deaths related to CAD or IHD was found to be 31% (WHO, 

2017). Statistically, cardio vascular disease was considered the leading cause of death in 

2011 in Palestine representing 22.4% of all deaths that year (WHO, 2017). 

1.2.3 Coronary Artery Bypass Graft Surgery (CABG) 

In progressive coronary artery disease cases, CABG surgery is a surgical intervention 

used to return the blood flow in the infarcted area in the heart by revascularizing that 

area. 

This surgery is considered cost-effective and is used for the long-term treatment of 

CAD. Generally, it improves the quality of life for those patients (Birim et al., 2012). 

During the first three months following CABG surgery, the patient is likely to 

experience physical and psychological symptoms such as pain at the surgery site, fluid 

retention, general weakness, shortness of breath, heart rhythm abnormalities, short-term 

cognitive impairment, depressed feelings, nervousness, lack of control, and dependency 

(Bergvik, Srlie& Wynn, 2012). 

After CABG, approximately 16–38 percent of patients experience depressive 

symptoms, and approximately 31–46 percent of patients experience anxiety. Besides, 

Posttraumatic Stress Disorder (PTSD) may develop in 3–18% of patients (Tully & 

Baker, 2012). In fact, some patients may suffer from mental illnesses, which can have a 

negative impact on their health and lead to a bad prognosis (Waight, et al., 2015). 

Depression, for example, will slow the wound healing process, cause cardiac symptoms, 

and lengthen hospital stays and hospital visits (Tully & Baker, 2012). Hence, it is 

obvious that stress is common among most IHD patients, particularly after surgery, due 

to the patient's condition and the hospitalization itself. 

Many studies investigated the physical and mental stressors associated with CABG 

surgery and its consequences. For example, a study conducted in 2017 focused on the 

stressors associated with CABG surgery. Given the seriousness of the surgery and the 

nature of life after it, this study found that most patients experienced some stressors 

associated with CABG surgery waiting. These patients were aware that they may 



 

6 

 

experience insomnia, sleep difficulties, loss of appetite, and concentration difficulties 

following the surgery. They were also concerned about the consequences of the surgery, 

such as pain and a distorted body image (Morowatisharifabad et al., 2017). 

Nooreddine Mohammadi, on the other hand, conducted a study that focused on the 

positive outcomes of this surgery. His research provided hope to IHD patients awaiting 

surgery. He explained that the surgery improves IHD patients' quality of life by 

reserving more attention and support from family members. The surgery gave the 

participants hope for the future and increased their spiritual well-being and faith in God 

(Mohammadi, et al, 2015). 

1.3 Problem statement 

Phenomenological research focuses on describing the lived experience of individuals 

who face a specific phenomenon of interest to capture their lived experience. In other 

words, it entails comprehending the impact of a particular experience within the context 

of people's lives (Hirst, 2010). 

The Palestinian Ministry of Health (MOH) is working to strengthen the health system. It 

has developed a strategic plan for the management of cardiovascular disease and 

prioritized CVD patients in the West Bank and Gaza (Shahwan et al., 2019). However, 

no published studies on patients from the West Bank have been published, as the 

available research on the coronary care system is based on data from East-Jerusalem 

Arab and Jewish citizens (Salameh et al., 2013). 

The researcher chose to study this phenomenon due to the lack of specific studies 

related to the lived experience of patients after CABG in Palestine. 

As mentioned above, phenomenology is a suitable method for conducting this type of 

study. While many researchers used to conduct it in a descriptive manner, the researcher 

chose to use a more advanced method to conduct and interpret the phenomenon by 

using hermeneutic phenomenology. 

1.4 Aim of the study 

The main aim of the study is to explore the lived experience of ischemic heart disease 

patients who underwent CABG surgery in Palestine. 



 

7 

 

1.5 Significance and implications of the study 

Provided the literature review and previous studies on the lived experience of patients 

after CABG, there is a lack of knowledge and experience about those patients' lived 

experiences and coping strategies, particularly in Palestine. The contribution of this 

study is that it will add to the literature a new experience of Palestinian patients 

following CABG. Hermeneutic design is used to elicit a more profound experience. 

Healthcare providers can benefit from this research by better understanding the 

difficulties that IHD patients face following CABG. This will aid in the improvement of 

care quality and the healthcare system in Palestine by adding new hospital policies that 

emphasize on providing special care to cardiac patients post CABG. Accordingly, the 

patients' quality of life following CABG will improve. That is, the goal of this research 

is to achieve good health and well-being, which is one of the United Nations' 

sustainable development goals (UNSDG). 

1.6 Interview guide 

1. What was your first reaction when you heard that you should undergo coronary 

artery bypass graft surgery, and how did you cope with the news? 

2. How did the surgery affect your life? Explain. 

3. Who is supporting you psychologically and physically post the surgery? 

4. How did the health care system focus on your care and healing as a cardiac patient? 

5. Please explain any suggestions you have to improve the health care system 

regarding cardiac patients. 

1.7 Literature review 

In this chapter, the researcher presents the literature related to the lived experience of 

CABG patients. 

Before undergoing CABG, patients may experience a variety of issues. A study 

conducted in Canada revealed how patients face psychological problems while still on 

the waiting list. There psychological problems include, but aren‘t limited to stress, 

which leads to angina and, in some cases, deterioration in their health condition 

(McCormick et al., 2006). That is, their journey with CABG begins here. Following an 



 

8 

 

angiography, the doctor realizes that the surgical intervention (CABG) is required, and 

he should advise the patient to make this decision and proceed with the surgery 

(Fonseca et al., 2018). Patients generally must wait between a week and several months 

for the surgery to be performed. Meanwhile, they experience a variety of reactions and 

feelings toward the surgery, including anxiety and fear of the procedure (Kathania et al., 

2021). Some patients also get unsure and frustrated about CABG, while others get 

shocked, especially when the doctor informs them that the surgery is critical to their 

survival (Feuchtinger et al., 2014). Eventually, most patients accept the surgery after 

receiving special support from their families and healthcare providers who explain the 

significance of the surgery. 

However, some patients hesitate to undergo CABG and prefer to receive medical 

treatment or PCI. Hyun conducted a study in 2020 comparing the survival effect of 

either performing CABG or using PCI alone for 5 years in patients with left main CAD. 

They carried out a study on patients who went through CABG surgery and others who 

used drug-eluted stent alone for 5 years. They found that CABG surgery relieves angina 

pectoris and improves the patients' quality of life. In other words, the results showed 

that CABG had a significant mortality risk reduction in the first five years when 

compared to medical treatment alone (Hyun et al., 2020). Nevertheless, the difficulties 

the patients face do not end once they decide to have the surgery. For instance, studies 

have shown that patients experience physical and psychological effects following 

CABG. Pourghane and others explained that CAD is a very dangerous and serious 

disease that, if not treated properly, can lead to death. Furthermore, they stated that the 

most effective treatment for IHD is CABG surgery. They conducted a study to explore 

the lived experience of patients who underwent CABG by using a qualitative design to 

analyze the experience of 18 patients post operation. The results demonstrated that most 

patients experienced fear from the recurrence of a heart attack, performing daily life 

activities, and travelling.. The study also showed that the participants were tired of 

living within the confines of the therapeutic framework. They found it difficult to take 

many drugs and follow a specific diet. They were torn between accepting or rejecting 

the treatment (Pourghane et al., 2014). 

 



 

9 

 

It can be said that CABG patients face numerous challenges. In addition to the 

aforementioned difficulties, Sun found that disability is the most common complication 

for CABG patients one year after the operation. Disability is defined as the significance 

of variations in physical and mental functioning for human performance and well-being 

(Wasserman, 2017). It occurs frequently for both men and women, and women are more 

affected than men. The risk of disability rises with Heart Failure (HF) (Sun et al., 2018). 

 The difficulties are not only physical, but also financial. Vila used an ethnographic 

interpretative approach to evaluate the experience of patients with ischemic heart 

disease, especially the meaning of their condition during the rehabilitation period post 

CABG surgery. He used in depth interviews with 11 participants to elicit the meaning of 

their experience. The main result was the commonness of financial difficulties among 

the patients due to drug costs, transportation costs to reach the healthcare center and the 

surgery itself (Vila, 2018). 

With all these challenges and in order to relieve themselves from the negative feelings 

and consequences, some patients pay more attention to the spiritual aspect. Heravi-

Karimooi, Rejeh, & Abbasi focused on spirituality after coronary artery bypass grafting, 

as they determined the experience of CABG patients from the spiritual aspect. They 

interviewed 11 CABG patients using qualitative hermeneutic phenomenology. From the 

theme and sub themes, the researchers found that most of those patients tended to be 

closer to God. They focused on using spirituality and faith to be stronger to face the 

world and accept their new condition in an optimistic way (Heravi-Karimooi, Rejeh, & 

Abbasi, 2017). 

On top of the patients‘ needs, care plans must be given adequate attention to reduce the 

negative consequences of the surgery, especially among the elderly. Sheridan et al. 

conducted a study among elderly patients who are undergoing CABG and found that 

they may experience ups and downs in their health condition. Therefore, achieving 

calmness is the goal of their care plan (Sheridan et al., 2010).  

 In the same vein, Karen Theobald and Anne McMurray investigated the needs of 

patients after CABG for their family and healthcare providers, mainly after discharge. 

They interviewed a sample of 30 patients and found that half of them considered the 

open-heart surgery a huge personal shock. They found returning to the normal life very 



 

11 

 

difficult and experienced pain. The researchers stated that there is a need for post-

operative physical adjustment. In addition, the study found that the surgery affected 

some of the patients financially and there was a need for adjustments on the lifestyle 

from their family or healthcare providers. Hence, the researchers concluded that there is 

a need to improve the quality of discharge planning from the healthcare providers or the 

family after discharge (Theobald & McMurray, 2004). 

More precisely, in the first year after discharge, healthcare providers and family 

members should take responsibility for improving the CABG patient's quality of life. 

Phillips-Bute demonstrated that there is a link between post-operative cognitive decline 

and decreased quality of life in CABG patients in the first year. In other words, by 

focusing on post-operative cognitive improvement, we can improve the quality of life 

for CABG patients (Phillips-Bute et al., 2006). 

Interestingly, Palestinian hospitals are working hard to provide the highest quality of 

care to their patients. Salameh compared post-CABG outcomes between the Palestinian 

Ministry of Health, specifically Ramallah Hospital, and Ghent University Hospital in 

Belgium between 2009 and 2011. The findings revealed that there are similarities in the 

success rate and patient satisfaction after surgery between the European and Arab 

groups, with slightly significant differences. The mortality and readmission rates among 

Palestinian patients were higher than in the Belgium group due to infections, primarily 

respiratory infections related to diabetes and smoking, which were more prevalent 

among Palestinian patients than in Europe (Salameh et al., 2013). 

From the same perspective, Hulzebos highlights that Post-operative Pulmonary 

Complications (PPC) are the leading cause of morbidity, mortality, and length of stay in 

the hospital following the operation. Therefore, reducing the respiratory effects of 

CABG, he suggests that patients should engage in inspiratory muscle training and use a 

spirometer to reduce PPC (Hulzebos et al., 2006). Thus, the health of the pulmonary 

system is essential to the success of the CABG surgery. However, corona virus 

(COVID-19) is currently regarded as the disease of the century. Undoubtedly, COVID -

19 pandemic is a major public health crisis globally. It has put a hard challenge on the 

international healthcare system and its resources (Gates, 2020). Some researchers 

conducted studies to determine the effect of COVID- 19 on the CABG patients. In his 

study, Salenger explained the outcome of COVID-19 patients post cardiac operations 



 

11 

 

across North America. The research showed that COVID-19 had serious consequences 

on CABG patients. Among COVID-19 infected patients who underwent CABG, 8% 

died as a result of COVID-19 complications after the surgery, and 1% developed 

cardiorespiratory failure and needed special respiratory management, so they were 

placed on Extracorporeal Membrane Oxygenation (ECMO), and 18% of those who 

were placed on ECMO died while the rest still depend on ECMO since the time of the 

surgery. The researchers pointed out that the current trend in North America is to 

decline the volume of cardiac surgeries on COVID-19 infected cases to 45% of 

baseline. This trend aims to reduce the cardiopulmonary complications associated with 

COVID-19 post cardiac surgeries (Salenger et al., 2020). 

Shifting gears to the Arab world, there have been few studies in some Arab countries 

that have focused on some aspects of the experience of patients who have had CABG or 

are waiting for the surgery. For example, a study conducted in Saudi Arabia in 2019 

examined the psychological status of patients awaiting CABG. The findings revealed 

that the majority of patients suffered from anxiety. The level of anxiety was higher in 

patients with low incomes or who belonged to a lower social class (Ali et al., 2019). 

Their fear can be justified by the high cost of CABG. This finding was demonstrated in 

a study conducted in Iraq which found that CABG is a very expensive surgery for both 

the government and the patients in public hospitals. The costs of the surgery are higher 

for patients undergoing complicated procedures, as well as those suffering from 

diabetes or cancer (Pangano et al., 2020). 

Another study conducted in Saudi Arabia in 2021, highlighted the psychological and 

physical rehabilitation post-CABG. The results showed that home based cardiac 

rehabilitation is more effective than outpatient based cardiac rehabilitation after the end 

of the hospital intervention. This can be related to the presence of support systems such 

as family members and the comfortable environment which patients feel at home 

(Takroni et al., 2021). 

 

 



 

12 

 

Lastly, there are many challenges that the patients experience through their CABG 

journey according to the literature. Unfortunately, these challenges are not being 

addressed in the Palestinian community. Therefore, this study will provide significant 

data for the literature by focusing on the special experience of patients who underwent 

CABG in Palestine. 

 

  



 

13 

 

Chapter Two 

Methods 

2.1 Design  

In this study, a qualitative hermeneutic phenomenology design was used. This design is 

appropriate for this study because it deeply describes and interprets the lived experience 

of people who have undergone CABG surgery. 

According to literature, phenomenological research is a type of qualitative research that 

investigates the experiences of those who have experienced a specific phenomenon 

(Creswell, 2007). It seeks to describe a human's lived experience in relation to time, 

space, and relationships (Finlay, 2009). As for the tool used in this study, individual 

participant interviews were conducted to achieve an understanding of each participant's 

world and experience. Phenomenological studies are classified into two types: 

descriptive and interpretive. 

2.1.1 Descriptive phenomenological research 

This design is developed by Husserl. Its central question is ―What do we know as 

people?‖ It is used to describe the lived experience of humans as it is ―understood and 

described from the perspective of those who have lived experiences and can describe 

them‖ (Polit & Beck , 2014). Husserl believed that in order to obtain the phenomena 

correctly, the researcher should separate his own experience and feelings from the 

method, a practice known as bracketing (Lewis, 2010). 

The four steps of descriptive phenomenology are bracketing, intuiting, analysis, and 

description (Polit & Beck, 2014). Intuiting means that the researcher ―remains open to 

the sentences attributed to the phenomenon of those who have experienced it‖ (Polit & 

Beck, 2014). By employing this method, the researcher attempts to approach the 

phenomenon in a healthy, although somewhat naïve, manner (Finlay, 2009). 

 

 



 

14 

 

In the analysis step, the researcher must focus on identifying and extracting important 

statements and reflections from the interviewees, categorizing and evaluating them 

according to their contribution to understanding of the studied phenomenon. In the final 

step, scientists simply describe their findings based on the data analysis. 

Husserl's student, Heidegger, believed that researchers could not fully establish their 

own experience, preconceptions, and theoretical gradients. As a result, he rejected 

bracketing. Instead, he asserts that interpretation must be carried out in order to obtain 

accurate interpretative research. 

Historically, individuals used their background, which was formed by what they 

perceived from their culture since birth, to understand the world. Through this 

understanding, people determine what is ―real‖ (Laverty, 2003). Consequently, 

Heidegger believes that an individual's background is essential to correctly obtain 

hermeneutic (interpretative) phenomena. To put it another way, understanding the 

phenomenon requires taking into account the individual's own lived experience. The 

goal of Heidegger is to let ―the things of the world speak for themselves‖ (Manen, 

1990). 

2.1.2 Interpretive phenomenology 

Interpretative phenomenology was developed by Heidegger and Gadamer's philosophies 

and aims to understand the importance of being in the world (Smythe, 2008). The 

primary question in this type of research is ―What is it?‖ (Polit & Beck, 2014). From 

this question, the concept of interpretation is freedom. ―Located freedom means that 

individuals are free to make choices, but their freedom is not absolute; it is limited by 

the specific conditions of their daily lives (Lopez, 2004). The concept of liberated 

freedom leads the researcher to ―focus on describing the meaning of the individual's 

existence in the world and how these meanings affect the choices they make‖ (Lopez, 

2004). 

Another concept of Heidegger is that the researcher's knowledge contributes to the co-

constitutionality. Co-constitutionality means that the meaning developed by the 

researcher in the interpretative research is a ―mixture of meanings formulated by both 

participants and researchers within the focus of the study‖ (Lopez, 2004). 



 

15 

 

2.1.3 Hermeneutical phenomenology 

Hermeneutical phenomenology focuses on both the interpretation and description of the 

lived experience. ―It is a descriptive (phenomenological) methodology because it pays 

attention to how things work, but it is also an interpretive (hermeneutic) methodology 

because it argues that there are no such things as uninterpreted phenomena‖ (Manen, 

1990). 

 The interpretation is based on working in a circle. This means that the researcher 

should move from parts to the whole and front to back in the experience in order to 

increase the depth of the lived experience (Laverty, 2003).  

In aims to gain a thorough understanding of the phenomenon, the process should be 

repeated several times. The text should be read and reread to elicit themes and 

subthemes. Then, it should be examined and re-examined to identify any patterns that 

may emerge. The researcher should repeat this process of analysis until no new themes 

emerge; this is known as saturation (Laverty, 2003). 

Following the previous steps, interpretation will be completed by reviewing the text 

several times with additional exploration and clarification of themes that emerge. 

Accordingly, hermeneutic phenomenology is the best method for accurately obtaining 

the lived experience of CABG patients. Given the seriousness of CABG operation, 

using the hermeneutic method is the best way to elicit the lived experience at all stages 

because it addresses all the aspects of the lived experience (Laverty, 2003). 

2.2 Population and sampling method 

2.2.1 Population 

The population of the study is all accessible patients in Palestine – West Bank with IHD 

who underwent CABG in the assigned hospitals. 

2.2.2 Sample and sampling 

Nonprobability purposive sample was taken for this study from the entire population to 

conduct the study in depth until saturation. 



 

16 

 

The researcher took 21 participants to ensure the sample saturation. Saturation in 

qualitative research refers to the point at which each participant repeats the ideas of 

others without adding any new information to the subject (Guest, Bunce & Johnson, 

2006). 

As for the sample size, Guest, Bunce and Johnson (2006) suggest that conducting six to 

twelve interviews with the target population is adequate to achieve saturation (Guest, 

Bunce, & Johnson, 2006). 

2.2.2.3 Inclusion criteria 

 Patients who are adults: more than 18 years; 

 Patients who are conscious, oriented, can speak, mentally intact, and clinically well;  

 Patients who had the operation for over 1 month, because one month is enough for 

the participant to create a full experience about his condition in a holistic manner 

and will be able to share his experience with others. 

2.2.2.4 Exclusion criteria 

 Patients who are still in the ICU, mentally ill, or in severe pain.  

 Patients out of the West Bank like Gaza.  

 Patients who performed the operation for less than 1 month. 

2.2.2.5 Sample distribution 

The researcher conducted the interviews with a nonprobability purposive sample of 21 

participants. The table below shows the distribution of the sample according to gender, 

age, religion, marital status, place of the surgery, time of the surgery, medical history, 

number of children and occupation. 

 

 

 

 



 

17 

 

Table 1  

 Demographic Characteristics of the participants 

Variable Number Percentage 

 

Age 

< 40 1 4.8 

40 – 60 7 52.3 

>60 13 42.9 

Gender Male 20 95.2 

Female 1 4.8 

Religion Muslim 21 100 

Christian 0 0 

Education Literal 2 9.5 

School 13 61.9 

University 6 28.6 

Occupation Working 18 85.7 

Not working 3 14.3 

Marital status Single  0 

Married 21 100 

Number of children 0 2 9.5 

1-4 3 14.3 

>4 16 76.2 

Date of the surgery Less than 2 months 3 14.3 

2 to 3 months 9 61.9 

More than 3 months 9 23.8 

Place of surgery Ar-Razi Hospital 13 66.7 

An-Najah National University 

Hospital 

1 4.8 

Specialized Arab Hospital 2 9.5 

Palestine Medical Complex 5 19 

Medical history Diabetes 5 23.8 

Hypertension 1 4.8 

Diabetes and hypertension 2 9.5 

None 13 61.9 

 

As presented in the table above, the sample consists of 20 males and 1 female. This 

means that males made up 95.2 percent of the sample and females made up 4.8 percent. 

As for the age, the table shows that the participants under the age of 40 composed 4.8 

percent of the total sample, while those between the ages of 40 and 60 composed 52.4 

percent, and those over 60 composed 42.9 percent.  

In terms of education, the majority of participants (61.9 percent of the total sample) had 

a high school diploma (Tawjehi). However, 28.6 percent of those interviewed had a 

university degree, while 9.5 percent were illiterate. 

Regarding the occupation before the surgery ,18 participants were employed while 3 

were unemployed. With regard to the surgery itself, the collected demographic data 

focused on the time and place of the surgery. As the table presents, 9.5% of the 



 

18 

 

participants had undergone the CABG surgery at Specialized Arab Hospital, whereas 

19% of them had it at Palestine Medical Complex (PMC). Moreover, 4.8 % of them had 

it at An-Najah Hospital while the majority 66.7% of them had it at Ar-Razi Hospital. 

Moving on to the time of surgery, 61.9% of the participants underwent the surgery 

within 2 to 3 months before the start date of the study. 14.3% of them underwent it in 

less than 2 months before the time of the study, and 23.8% underwent it before more 

than 3 months of the study date. 

Concerning the medical history, the table presents that 61.9% of the participates had no 

medical history. However, 23.8% of them have diabetes, 4.8% of them have 

hypertension and 9.5% of them have both diabetes and hypertension. 

In terms of the number of children, 9.5 percent of the participants have no children, 76.2 

percent have more than four children, and 14.3 percent have one to four children. As for 

the occupation, the table shows that 14.3% of the participants are unemployed while 

85.7 % of them are working. Finally, the table presents that all of the participants were 

Muslims and married. 

2.3 Site and setting 

The study was conducted in hospitals that perform CABG surgery in the West Bank, 

Palestine. Particularly, it included An-Najah National University Hospital, Specialized 

Arab Hospital, PMC and Ar-Razi hospital. All of these hospitals are referral centers 

doing thoracic surgeries. 

2.4 Data collection procedure 

Agreements from the Institutional Review Board (IRB) of An-Najah National 

University and the Palestinian Ministry of Health were taken. Then, the phone numbers 

of the accessible participants based on the inclusion and exclusion criteria were 

obtained from the assigned hospitals after taking the permission from the institutions.  

Data was collected from January 2021 to April 2021. The researcher contacted the 

available participants who met the inclusion criteria to take their permission to be 

interviewed. All the interviews were conducted by the researcher. At the time of each 

participant's interview, the purpose, significance and nature of the current study were 

explained. Then, a consent form was signed by the participants. The total number of the 



 

19 

 

participants was 21: ten of them were interviewed face to face in separate places like a 

private room in the hospital after clinical visits, and eleven patients were interviewed 

over the phone due to corona virus pandemic that prevented reaching them. All the 

interviews were conducted by the researcher in the mother tongue (Arabic) and using 

the slang language to allow the participants to speak freely  and express themselves. The 

duration for each interview ranged between 45 – 60 minutes until all the interview 

questions were covered.  The participants were encouraged to explain their answers and 

express themselves freely in their own words by using an interview guide which 

consists of a series of open ended questions that allow the researcher to investigate 

different areas in their experience. Of course, the interview guide was handed to three 

qualitative researchers to review its content validity and their feedback was taken into 

consideration. Moreover, during the interviews, probe questions were used by the 

research to clarify or seek elaboration of the participants' answers. In addition, field 

notes were immediately taken by the researcher after each interview including tone of 

voice, facial expressions movement and physical status and they were added to the 

transcriptions. The prospect of follow up interview, if necessary to explain the answers, 

was discussed with the participants at the end of the interview. The interviews were 

recorded using two high quality phone recorders to guarantee a comprehensive, precise 

and true reflective descriptions of the participants' experience. Then, the data was 

transcripted verbatim. Then, the data was coded and themes and sub themes were 

elicited using the hermeneutic phenomenological design.  

2.4.1 Tool 

The study was conducted using interviews with the selected participants in the 

aforementioned hospitals. An interview guide was used to control the interview and  

recorders to record the data as an audio form before being transcripted on paper. 

2.4.2 Analysis 

The hermeneutic method, also known as the interpretation method, was used to analyze 

the data. In fact, it is appropriate for analyzing this research in order to gain a thorough 

understanding of the text. According to Paule Ricours, the hermeneutic method is best 

used for achieving a complete understanding of texts. He also claims that this method is 

divided into three levels: naïve reading, structural analysis and critical interpretation and 

discussion (Ricoeur, 1976, 1984). Naïve reading refers to reading the text to achieve an 



 

21 

 

initial understanding and elicit the general meaning. This is an important step in 

developing the data analysis (Pedersen, 2005). Thus, transcripts were read several times 

during this step to achieve a first understanding of all the transcripts before transforming 

the meaning from natural language to phenomenological language for scientific 

research. Then, in structural analysis, the primary researcher should write what is said/ 

observed by the participants in another language ―unit of meaning‖, then, convert their 

speech to ―units of significance‖. This way, the researcher elicits subthemes and main 

themes from the data (Ricoeur, 1970). In this research, the researcher carried out this 

level of analysis by starting with what was said or observed by the participants about 

their lived experience post CABG surgery. Undoubtedly, body language, the tone of 

voice and facial expression were included too. 

As data analysis progresses to the final level, the researcher moves from the individual 

to the universal level by emphasizing ―what the text is about,‖ which can be 

accomplished by connecting the finding with other theories and studies (Pedersen, 

2005). Applying this measure, the researcher achieved a comprehensive understanding 

of the lived experience of ischemic heart disease patients after CABG surgery in their 

real lives. 

2.5 Ethical consideration 

Because this study is concerned with human medical issues, the researcher followed a 

procedure that protects human subjects. The procedure is approved by An-Najah 

National University‘s Research Ethics Boards. 

As previously stated, CABG is a very sensitive and serious issue in Palestine. As a 

result, before beginning data collection, the researcher obtained permission from the 

Ministry of Health. The participants also expressed their desire to be included in the 

study and signed a consent form after receiving verbal and written information about the 

study and its purpose. 

Some interviews were conducted face-to-face in a private room, while others were 

conducted over the phone at a convenient time. The interviews were recorded and all 

the information were kept strictly confidential. 

 

https://journals.sagepub.com/doi/full/10.1177/2333393618807395


 

21 

 

2.5.1 Establishing Rigor 

To ensure rigor of data analysis, the transcripts were handed to three qualitative 

research experts who read the transcripts many times and identified the themes and 

constitutive patterns. Then, they discussed  the differences in their data analysis and 

continuous analysis and discussion were repeated until agreement was reached. 

As a result, the researcher followed those criteria to ensure establishing rigor as follows; 

2.5.1.1 Credibility  

Credibility focuses on the trustworthiness of the data collection, analysis and conclusion 

(Connelly, 2016).  The researcher used use of peer debriefing, which relies on 

transcripts and themes identified by other researchers.  Particularly, Three qualitative 

researchers participated in analyzing the transcripts and eliciting themes and sub 

themes. Namely, Dr. Adnan Sarhan, Prof. Jehad Abbadi, and the researcher himself. 

The purpose of showing rigor is to legitimize naturalistic investigation.  The researcher 

relied on them as a critic and they reviewed the interview guide too. All participants 

were asked to sign a consent form and were informed that they could request written 

feedback on the research findings. Moreover, The researcher attempted to establish 

credibility by clearly defining the purpose of the study and asking open-ended and non-

directed questions. To support credibility, the researcher contacted some of the 

participants and showed them the results of the study to make sure that the results 

reflect their true experience. 

2.5.1.2 Dependability 

Dependability means stability of the data over the time and condition of the study (Pilot 

& Back, 2014). Wherever credibility exists, dependability is also ensured. 

Dependability encompasses the reliability of the findings.  

The findings of this study are dependable as they are similar to previous researches, as 

evidenced by the studies used in the literature review. Thus, the results are predictable 

and stable over time.  The process is described in sufficient detail to facilitate another 

researcher to repeat the work.  

 



 

22 

 

2.5.1.3 Transferability  

Transferability refers to the generalizability of the inquiry. In qualitative research, this 

concerns only case-to-case transfer (Tobin & Begley, 2004). Thus, in the current study, 

the site, selection criteria, methodology, and implementation of interviews and analysis 

of the collected material were thoroughly explained to facilitate the replication of the 

research in another context. In addition, the transcripts and interpretative notes  support 

the research capabilities of being repeated. 

2.5.1.4 Confirmability  

Confirmability is concerned with ensuring that the researcher's interpretations and 

findings are derived from the collected data without bias on the part of the researcher 

(Pilot & Back, 2014). Actually, the researcher followed the analysis model described by 

Ricoeur, 1976, 1984 and tried to be true to the stories of the participants and express 

their experience without bias. The researcher chose a phenomenological approach to the 

theme, which provided additional information about the findings. Non-directed 

questions were also used to allow participants to speak freely and without any pressure.  

In addition, using audio tapes through interviews, detailed prints, and notes taken during 

the interviews with the settings and non-verbal gestures of the participants and a 

systematic track for the experience of data processing and interpretation supports 

conformability. Finally, the researcher documented how conclusions and interpretations 

come from data in order to demonstrate the conformability. 

 

  



 

23 

 

Chapter Three 

Analysis 

3.1 Data analysis 

The researcher picked the hermeneutic technique, also known as the interpretation 

method, to achieve a full comprehension of the acquired data. This decision was based 

on Paule Ricours' recognition of the hermeneutic technique as the most effective 

method to fully understand texts. The hermeneutic technique, according to Paule, 

consists of three levels: naïve reading, structural analysis and critical interpretation, and 

discussion (Ricoeur, 1976, 1984). 

3.1.1 Naïve reading  

Naïve reading means reading a text with the purpose of gaining an initial understanding 

of its content and eliciting the broad meaning of it. This step is crucial in the 

development of the data analysis (Pedersen, 2005). The text should be read several 

times at this point to gain a basic knowledge of all of the transcripts. Researchers should 

allow books to speak to them and engage with their minds; then, transfer the meaning 

from natural language to phenomenological language, so that it can be used in scientific 

research. In other words, naïve reading is the first step in fully understanding the lived 

experience of ischemic heart disease patients post coronary artery bypass surgery. 

The following is a formulation of the naïve understanding of the interview texts: 

After reading the transcripts multiple times, the researcher found that the patients had a 

wide range of emotions about their new life post the surgery. 

To begin with, the patients' reactions to the news that the surgical intervention is 

unavoidable differed from one participant to another. 

In terms of daily life activities post the surgery. The patients stated that they had 

difficulty sleeping, and that they had pain in the surgical site. Moreover, the patients' 

diets were restricted post the surgery, which was stressful for some. 



 

24 

 

The surgery affected the participant psychologically and physically too. There is no 

such thing as a complication-free surgery. Given CABG is a major operation, some 

participants experienced respiratory problems and some gastrounirary complications.  

As for the patients‘ support groups, the researcher noticed that all participants had a 

familial support system during their stay at hospital and at home as well. 

Besides, most hospitalized patients, whether in private or public hospitals, received the 

best quality of care from healthcare providers including doctors and nurses. However, 

some patients reported financial difficulties in the private hospitals. 

At the end of the interviews, the participants proposed some suggestions to the 

healthcare system and the government in order to better meet the needs of the patients 

and promote their health. 

3.1.2 Structural analysis 

This level is used to open up the whole text to facilitate interpretation. The primary 

researcher should write what is said /observed by the participants in other words ―units 

of meaning‖, then convert their speech to ―units of significance‖, or what the text 

discusses. This process leads the researcher to elicit subthemes and eventually main 

themes (Ricoeur, 1970). 

In the current study, the researcher performed structural level analysis by beginning 

with what the participants said or what the researcher observed about the participants' 

lived experience following CABG surgery. Furthermore, body language, voice tone, 

and facial expressions were observed. 

Hence, after the researcher read the transcript many times using naïve reading, he 

started to divide the text into units of meaning, then condensed it to units of significance 

to facilitate the emergence of subthemes and themes. The following table demonstrates 

the structural analysis for the current study in Appendix (D). 

 

 

 



 

25 

 

3.2 Results  

After interviewing 21 participants: 20 males and 1 female, transcripts were written and 

read many times by the researcher. Then, a full understanding of the text as a whole was 

established. Following that, various themes and sub themes were extracted. Exactly, the 

following 9 themes and 43 subthemes were identified in Appendix (D).  

3.2.1 Various reactions towards the surgery event  

The first theme derived from the lived experience of ischemic heart disease patients post 

the surgery was their reaction to the news that they would have to undergo the surgery. 

It is critical to understand the participants' reactions toward the news that going through 

a surgical intervention is inevitable, and that treating the occluded coronaries by stents 

or medication no longer works. The participants had different feelings and emotional 

conflicts toward the event. The researcher identified various reactions from the 

participants when they learned from their doctor that they would have to undergo the 

surgery. Their reaction ranged in scope from reacting normally to the news or event to 

suffering from fear, surprise, or hesitation. However, in the end, all of them adapted to 

the fact that having the surgery is a must. 

3.2.1.1 Normal reaction towards the surgery event 

During the interviews, the researcher found that two participants were very relaxed and 

even happy when the doctor spoke with them about the necessity to have the surgery. 

They accepted that option without much thought because they were aware of their 

health condition, and it was predicted that they would undergo CABG surgery sooner or 

later. As a result, they reacted normally. One of the participants (P10) said, ―Really, I 

knew I had problems in my vessels. I wasn't surprised and expected the surgery.‖ 

Given all participants were Muslims and have a great faith in God, they reacted 

normally. Hence, the researcher found that spirituality and faith offered people hope and 

optimism about the surgery. This finding can be exemplified with what one participant 

(P12) stated, ―It was normal, and I was happy and laughing (thank God). I wasn't 

afraid.‖ 

 

 



 

26 

 

3.2.1.2 Fear from the surgery 

One participant was terrified when the doctor told him he had to undergo the surgery 

even though the doctor told him that open-heart surgeries in our Palestinian hospitals 

have a success record of over 95%. However, surgical operations in general, particularly 

open-heart surgery, are stressful for patients, especially after the surgeon clarified that it 

is a serious operation. It necessitates general anesthesia and, in some situations, the 

heart must be stopped during the procedure. Thus, the patient get terrified of the 

surgery. For example, one participant (P14) admitted, ―I was terrified, but when the 

individual is sick, he seeks help.‖ 

3.2.1.3 Surprise from the surgery event 

In the medical field, certain news is regarded surprising for patients when they hear it 

for the first time from a healthcare practitioner, due to a variety of factors. According to 

the participants, 13 of them had no prior medical history or cardiac symptoms, such as 

chest discomfort or shortness of breath, and sought medical treatment after becoming 

weary due to minor symptoms that were not typical of a heart attack. One participant 

(P12) reported ―I was surprised because I had no history of illness or heart disease. The 

occurrence was unexpected and developed rapidly.‖ Furthermore, three of the 

participants were surprised when the doctor informed them that they needed CABG 

surgery despite the fact that they were already aware that they had cardiac problems. 

They did not expect, however, that the surgery would be unavoidable and necessary for 

their survival. One of the participants (P3) stated, ―I didn't think it would get to open-

heart surgery.‖  

3.2.1.4 Shocked by the surgery event 

When they learned that they needed open-heart surgery, two of the participants were 

shocked. They already had doubts about their diagnosis and didn‘t believe that they 

need an operation, so the decision to undergo the surgery was shocking to them. 

Moreover, it was clear from their facial expressions in the interview that they were 

astonished when the doctor broke the news to them; one participant (P3) commented, ―I 

was a little bit shocked then I adapted.‖ 



 

27 

 

The event was shocking not only to the patients, but also to the patients' relatives, as one 

participant (P10) said, ―My reaction was that I got shocked, since I am just 42 years old 

and have never had any previous diseases. It was a shock to me and my family.‖ 

3.2.1.5 Hesitation to undergo the surgery 

8 participants were hesitant whether or not to have the surgery. In general, the cardiac 

surgeon gives the patient time to think before signing the consent form, and he 

thoroughly explains the procedure to the patient, including the risks and benefits. They 

took a long time to make a decision, meanwhile, there were conflicting ideas in their 

mind, such as whether or not to have the surgery. One of them (P11) stated, ―I was 

really hesitant to go through the surgery because the open-heart surgery is such a huge 

operation.‖  

3.2.1.6 Adaptation to the surgery event 

The data gathered from the interviews revealed that people had varying emotions to 

hearing about the surgery and what the doctor told them about their health after 

checking their heart. When the doctor told them that CABG surgery was absolutely 

necessary for them to survive, they recognized that their lives would be jeopardized if 

they didn't undergo it. One participant (P13) said, ―Eventually, I agreed because the 

doctor explained the importance of the surgery for me.‖ 

Eventually, all the participants agreed to undergo the surgery. Despite their fears and 

concerns, all of them ultimately adapted to the news; due to their faith in God and their 

belief that life and death are in God's hand. All the participants were Muslim and 

religious, which gave them the strength to go on in life. Thus, they accepted to undergo 

the surgery and signed the consent form. One participant (P3) said, ―I have a deep faith 

in God.‖ 

3.2.2 Restricted life post-CABG 

The patients faced some limitations in their lives during the post-surgery period, and 

their experiences with these limitations differed from one participant to another. The 

interviews revealed that all of the participants' lives were restricted on various levels, 

including restrictions on daily life activities, sleep difficulties, dependency on others, 

and finally quitting smoking. 



 

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3.2.2.1 Restricted daily life activities post-CABG 

Daily life activities were a major concern for the participants post-CABG surgery 

because they faced some restrictions and limitations on smoothly performing them. The 

majority of participants stated that pain is the primary reason for their limitations on 

daily activities. All the participants reported that they had numerous wounds and scars 

in their bodies because of the surgery. Thus, pain in the surgical site in the sternum and 

legs prevented them from moving freely, wearing their clothes without assistance, and 

even driving for long periods of time, as one participant (P2) stated, ―Really, the pain 

prevented me from doing my daily life activities smoothly, and I have difficulties 

driving my car for long periods of time.‖  

As a result of the surgery, the participants‘ range of motion was severely limited, and 

they were unable to lift heavy objects as they used to in the past. For example, one 

participant (P3) said, ―At first, my movement was limited, and I couldn't carry heavy 

objects.‖  

Restrictions on daily life activities extended to include religious practices too, like 

praying. All of the participants were Muslims. They reported that after the surgery, they 

began to have difficulties in praying smoothly because it demands various movements 

that they found it difficult to perform, such as sitting and binding. One participant (P19) 

stated, ―After my discharge to home, the doctor advised me to rest totally, and I couldn't 

bind while praying. As a result, I began to pray on the chair. I had trouble putting on my 

clothes as well.‖  

3.2.2.2 Difficulties in maintaining sleep post-CABG 

The presence of pain, particularly during the first month following CABG surgery, 

affected the quality of sleep of the most participants, which in turn affected their quality 

of life. To illustrate, one participant reported that he had sleeping problems that affected 

his quality of life and limited his day-to-day activities because he was always tired and 

lethargic. There were numerous factors that limited and disrupted his sleep including 

chest pain, sternum pain, and back pain, medications, hormonal changes and 

psychological effects. 

 



 

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Aiming to maintain his sternal wound integrity, the doctor advised him to stay and sleep 

on his back to prevent opening the sternum, sternal friction and pain. It was difficult for 

him to sleep on his backs, so he woke up frequently during the night. He (P2) put it, ―In 

terms of sleeping, the doctor advised me to sleep on my back for three months. 

Yesterday, I awoke twice because I discovered I was sleeping on my side, which 

increased the pain of the wound.‖ 

3.2.2.3 Dependency on others post CABG 

After CABG surgery, performing daily life activities became extremely difficult without 

the assistance of others. Thus, being dependent on others for an extended period of time 

was a major concern for the participants. During their hospitalization, the majority of 

them relied on healthcare providers, particularly nurses, and family members. Even 

after discharge, they still relied on their families to help with small tasks like getting out 

of bed, dressing, walking, eating, and bringing their medicine. They needed this 

assistance especially in the first month after surgery. One participant (P14) commented, 

―After the surgery, my daughters helped me in my work at home.‖ While another 

participant (P6) stated, ―The wound is still fresh. You need help from your family to put 

on your clothes and do simple things.‖ 

3.2.2.4 Restricted diet post-CABG 

Some participants reported that they had a history of hypertension and hyperlipidemia, 

which was a risk factor for developing their condition. Therefore, the doctor advised 

them to limit their salt and fat intake to protect their health from developing serious 

consequences, particularly after CABG. Unfortunately, the participants reported that 

they used to eat unhealthy foods, before the CABG making it difficult for them to 

follow the dietitians‘ and doctors' advice to restrict their diet after the operation. 

According to one participant (P3), ―I should mainly avoid fat in my diet and eat white 

meat, soups, and vegetables.‖ Another participant (P14) remarked, ―The doctor advised 

me to avoid fat, lamb meat, and fried foods in my diet.‖ 

 

 

 



 

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3.2.2.5 Quitting smoking post CABG 

All the participants, who were smokers, reported that they had to stop smoking after the 

operation because they were informed about the dangers of smoking on their health. 

One participant (P3) said, ―The doctor advised me to quit smoking, and I committed.‖  

3.2.3 The effects of living with coronavirus (COVID-19) on CABG patients . 

The researcher found that the COVID-19 pandemic had a significant impact on the 

majority of the participants' lives in Palestine. However, one participant reported that 

COVID-19 had no effect on their lives and that they were living a normal life. Though 

others reported that COVID-19 pandemic impacted all aspects of the participants' lives. 

It hampered their social life and made their lives more difficult and uncomfortable. In 

addition, some of the participants became afraid of COVID-19, and unfortunately, one 

of them got infected with the virus. 

3.2.3.1 Normal life during COVID -19 pandemic 

Unfortunately, one participant was not used to living with all of the preventative 

measures that were implemented by the Palestinian Ministry of Health to combat the 

spread of COVID-19 throughout society, such as wearing gloves and masks most of the 

time, staying at home day and night, and limiting his socialization with others. Hence, 

he chose not to follow the measurements and continued to live his normal life as he had 

before the COVID-19 pandemic broke out. He (P12) stated, ―Nothing, I sit with people 

normally, even without a mask, and I actually stay away from large gatherings.‖ 

3.2.3.2 Restricted social life due to COVID-19 pandemic 

COVID-19 pandemic had arrived at the time that the CABG was fresh for most of the 

participants that had many restrictions imposed on their life. These restrictions were 

especially related to socialization to prevent the disease from spreading and putting 

them in danger. COVID-19 posed a significant challenge to social life. One participant 

(P4) said, ―Thank God, I avoid socialization, I sit in my garden and even sleep there, 

and I contact people through massages.‖ 

 

 



 

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3.2.3.3 Uncomfortable life because of COVID-19 pandemic 

The participants remarked that the protection from COVID-19 requires a strict 

commitment to the ministry of health instructions like wearing the mask and gloves all 

the time and this makes life uncomfortable for them. That is, they feel uncomfortable 

and suffer from dyspnea when they wear the facemask for long periods of time. One of 

the participants (P7) said, ―Because of corona virus, I must wear a mask, and this makes 

me feel tired and short of breath.‖ 

3.2.3.4 Fear of COVID-19 virus 

The researcher found that fear was common among the participants. For example, one 

participant (P10) was aware of the danger of COVID-19 on his health and became 

obsessed with the protection measures against the COVID-19 pandemic during his daily 

life, which had a negative impact on his psychological well-being. He became really 

scared of getting the disease and his commitment turned into a phobia in the process. He 

admitted, ―I am really scared. I am afraid of socialization. I have to wake up earlier to 

go to work, and I wear double masks too. I am really scared.‖  

3.2.3.5 Being infected with COVID-19 

One of the 21 participants was infected with COVID-19. He was interviewed over the 

phone, and he coughed for the majority of time during the interview. He said, 

―I had been infected with coronavirus, which was transmitted to me by my wife. 

Although my body has been free of coronavirus for 22 days, I still suffer from chest 

infection and I am taking medications and analgesics, as well as hopping from one 

hospital to another, which is truly harmful.‖ (P17) 

3.2.4 Post CABG Psychological effects  

The researcher found that the psychological status of patients who had CABG in 

Palestine ranged from hope and feeling like a new person to normal feelings. 

Furthermore, some participants experienced insomnia and nightmares, as well as 

feelings of nervousness and isolation. 

 

 



 

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3.2.4.1 Feeling like a new person 

The participants believed that God had given them a new life through this surgery and 

that they were now a new person with better health and integrity. One of the participants 

(P15) expressed gratitude to God by saying, ―Thanks God, I was so glad. I felt like I 

was a new person.‖ 

3.2.4.2 Feeling psychologically normal  

One participant, had a stable psychological status with no signs of psychological 

distress. He commented, ―No, my psychological status was not affected. I am strong and 

don't fear anything, and I have a strong faith in God.‖ (P21) 

3.2.4.3 Suffering from nightmares and insomnia  

Furthermore, insomnia was a common complaint among the participants after CABG, 

and one of them came to despise the night period because he believed it was too long 

without sleep. He said, ―I despise sleeping, and I despise the night as well. I think it's far 

too long.‖ (P2). In addition, nightmares were another nighttime issue that harmed both 

the quality of sleep and the psychological well-being of the participants. In the words of 

another participant, ―In the first stage after the surgery, I experienced plenty of negative 

feelings at night, and I developed nightmares that began after discharge and lasted for 

one month, then it disappeared.‖ (P7). As a result of all this, CABG patients were 

unable to maintain sleep. In reality, they only sleep for a few hours at a time and wake 

up frequently throughout the night. Accordingly, one of the participants (P6) stated, ―I 

have trouble staying asleep; I sleep for 5-6 hours but wake up frequently throughout the 

night.‖ Fortunately, all of these sleeping difficulties usually subside after a short period 

and never persist. For example, one of the participants (P11) stated that ―sleeping was 

almost non-existent for the first 10 days following the surgery, then it became limited, 

and it has now improved.‖  

3.2.4.5 Nervousness 

CABG surgery had a significant impact on the patients' psychological well-being. In 

fact, the researcher noticed that stress and nervousness were major psychological issues 

that the participants faced after the surgery and lasted for a period of time. This can be 

linked to a variety of factors, including hormonal changes, pain, drugs, and the fear of 



 

33 

 

relapse after recovery. One of the participates (P14) stated, ―At first I was nervous, I get 

angry from everything.‖ 

3.2.4.6 Feelings of isolation  

Unfortunately, isolation had a negative impact on the participants' psychological and 

mental health, leaving them with depression symptoms and feelings of loneliness. For 

example, one participant (P3) remarked, ―I was isolated after the surgery because the 

doctor advised me to limit contact with people due to the fact that my immune system is 

weak due to the surgery, and I am committed, as is my family, so I feel lonely.‖ 

3.2.5 Post CABG Physical changes 

In this study, the researcher found that CABG played a significant role in improving the 

participants' quality of life and relieving angina and shortness of breath symptoms. It, on 

the other hand, had negative physical consequences and changes, particularly during the 

early postoperative period, such as pain, numbness in the legs and hands, itching at the 

wound site, changes in body weight, blood sugar irregularities, and in some cases, 

shortness of breath. 

3.2.5.1 Physical improvement  

The results showed that the participants' physical condition had improved after the 

surgery when compared to before and that they believed they were getting better now. 

One of the participants stated, ―Yes, the surgery improved my health, and now I can go 

upstairs and feel the difference.‖ (P5). In general, symptoms of CAD such as shortness 

of breath were resolved, as another participant reported, ―Before the operation, I was 

complaining of shortness of breath. I couldn't keep walking for more than 2 meters. 

Now all of this has improved, and no shortness of breath is there any longer.‖ (P6). 

Besides, one participant complained of vomiting due to cardiac origin and myocardial 

infarction, but the problem was resolved after the operation; as he stated, ―before the 

surgery, I was complaining of vomiting, but now I am not.‖ (P4). The most common 

symptom that IHD patients complained about was chest pain, which was also resolved, 

according to another participant, who said, ―Chest pain improved and got resolved 

now.‖ (P8). Generally speaking, the participants' overall physical condition has 

improved post CABG. 



 

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3.2.5.2 Pain  

The researcher found that all of the participants were in pain even after being discharged 

to their homes. Pain in the chest, legs, and muscles was reported by one participant as 

he complained,  

I still have pain in the site of the surgery in my chest and leg too, and still have general 

pain and muscle cramps in my arm and chest and muscles, it continued for more than 20 

days after the surgery, and sometimes it happens even now. (P13).  

Therefore, pain management is critical for the patients following CABG both in the 

hospital and after discharge until their condition improves. 

3.2.5.3 Numbness  

The researcher noted that numbness is common among participants post CABG 

particularly in the wound site, in the leg that is related to the surgeon's incision in the 

leg to harvest the saphenous vein for use as a graft in the affected coronary artery. He 

reported, ―I had numbness in my leg.‖ (P4) 

3.2.5.4  Itching  

Postoperative itching or pruritus was a common health condition that the researcher 

observed in some participants after CABG. One of the participants reported itching at 

the surgical wound site, particularly in the chest. He stated, ―after the surgery, I 

developed itching in my chest, and it is still happening now.‖ (P7).  

3.2.5.5 Changes in body weight 

According to the researcher's findings from the collected data, changes in body weight 

were common among the participants. In general, the researcher found that the 

participants lost weight while they were in the hospital, particularly those who stayed in 

the hospital for an extended period due to loss of appetite and decrease in oral intake, as 

one participant reported, ―I developed weight loss when I was in the hospital. I 

developed a loss of appetite and anemia. Now my appetite is better and my weight is 

rising. Actually, before the surgery, I was 90 kg and now I am 85 kg.‖ (P18). In fact, 

after being discharged from the hospital, the participants were able to eat normally 

again, and their appetites returned to normal. Because of their sedentary lifestyles at the 

time, they put on weight quickly after the surgery; as another participant explained,  



 

35 

 

―I put on approximately 11 kg after the surgery. My belly is obvious now. My appetite 

got better may be due to the sedentary life these days. I used to go to work from 

morning to sunset, and now I stopped going‖ (P9). 

3.2.5.6 Blood sugar irregularities  

The researcher found that one participant experienced irregularities in his blood sugar 

levels while he was in the hospital's in cardiac care unit. He reported, ―My blood sugar 

was irregular inside the hospital due to medications and fluids, but at home it became 

stable in the range between 100 and 140.‖ (P17) 

3.2.5.7 Shortness of breath  

Shortness of breath, also known as dyspnea, was a common health problem that affected 

the participants after CABG, particularly in the first few weeks after being discharged 

from the hospital. The following is what one of the participants said: ―I was 

complaining of shortness of breath, after walking in slop ups, I rest for a while before 

continuing.‖(P15). To treat dyspnea, breathing exercises and the use of a spirometer are 

recommended both before and after surgery. 

3.2.6 Complications post CABG  

The researchers found that the participants who underwent CABG in Palestine, West 

Bank experienced numerous complications following the surgery. These complications 

include pulmonary complications like pleural effusion and pulmonary edema; cardiac 

complications such as arrhythmias and cardiac arrest; urinary complications such as 

dysuria; gastrointestinal complications such as constipation; and skin complications like 

bedsores, wound infections and finally leg swilling. 

3.2.6.1 Pleural effusion  

One of the participants experienced pleural effusion after CABG, necessitating 

readmission and fluid withdrawal to alleviate the symptoms. He said, 

―After two weeks of the surgery, I developed water around my lungs, as my doctor 

stated in the clinic visit. Thus, he has withdrawn around one bag from my chest and 

gave me a spirometer. I worked hard on the spirometer, and on the second visit, he told 

me that my chest is dry now.‖ (P9) 



 

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3.2.6.2 Pulmonary edema  

The researcher noted that one of the participants had developed pulmonary edema 

following the operation. This condition was detected and immediately treated by the 

doctor during a routine clinic visit. Using a spirometer and taking prescribed 

medications after a CABG procedure help reduce the risk of developing pulmonary 

edema after the procedure. He said, 

―After two weeks of surgery, I developed water in my lungs with few symptoms. My 

doctor took an image of my lungs and informed me that I had water in my lung tissue. I 

was given a spirometer and some medications, and it was resolved.‖ (P8).  

3.2.6.3 Bedsores  

The research findings revealed that bedsores occurred in CABG patients and persisted 

for a period after they were discharged to their homes. One of the participants shared 

the following information: ―Because I was sleeping on my back, I developed bedsores. 

It was in the hospital and continued at home.‖ (P11). The truth is that early mobilization 

following the surgery, good nutrition, and changing the patient's position numerous 

times while sleeping on their backs can all help to relieve the soreness. 

3.2.6.4 Wound infections  

The findings of this study highlighted that wound infections and open wounds due to 

the infection are serious complications that may occur in patients who have undergone 

CABG in Palestine. The findings necessitate immediate medical attention, as well as 

surgical intervention in severe cases. The following is what one of the participants said: 

After being admitted to the intensive care unit, my wound was open on the open ward, 

where the doctor took a swap culture from my wound. Then, he informed me that I had 

bacteria in the wound, so he advised me to stay at the hospital for another 14 days. 

Meanwhile, I was required to do daily dressings. Then, they repeated the swap culture, 

and the doctor stated that there were no bacteria anymore (P17).  

 

 

 



 

37 

 

3.2.6.5 Constipation 

One of the participants suffered from constipation after the surgery that made him feel 

uncomfortable and restricted his eating and drinking. He reported, ―I got constipated in 

the hospital and could not pass stool for 25 days. My abdomen will distend if I eat or 

drink anything.‖ (P17).  

3.2.6.6 Urinary retention and dysuria  

In fact, one of the participants reported urinary retention and dysuria post-CABG as a 

result of the removal of the foley catheter, as he stated, ―I couldn't pass urine after the 

foley catheter was removed.‖ (P17) 

3.2.6.7 Cardiac arrest and arrhythmias  

The current study showed that Cardiac arrest and arrhythmias occurred with one of the 

participants. Fortunately, he survived. He said, 

One day after the operation, I developed cardiac arrest. I woke up while they were 

resuscitating me, and the doctor gave me an electrical shock. I stayed in the intensive 

care unit for six days before being discharged to my home. (P20) 

3.2.6.8 Leg swelling  

One of the participants reported having swollen legs while he was in the intensive care 

unit and after he was sent home. He underwent a saphenous vein graft, which resulted in 

swelling in his leg. He stated, ―I developed swelling in my right leg due to 

immobilization for some time, and the doctor removed the vein from my right leg.‖ 

(P17) Edema and bed rest also play a role in developing leg swelling. 

3.2.7  Support groups for CABG patients  

Indeed, the researcher found that the support groups for patients who underwent CABG 

in Palestine could include family, friends, or relatives, as well as healthcare providers 

who help the patients physically, psychologically, and financially post CABG. 

 

 

 



 

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3.2.7.1 Family and friends as a support group for CABG patients 

The researcher found that all of the participants were supported by their families, 

relatives and friends. For example, one participant said that his family and friends were 

always beside him and he said, ―My son came from Saud Arabia to support me‖ (P2). 

Proving that people in Palestinian communities are very connected. The following is 

what another participant stated: ―my friends, my wife, my neighbors, relatives and my 

mom supported me.‖ (P3). 

3.2.7.2  Healthcare providers as a support group for CABG patients 

Based on the interviews, the researcher found that, in general, the medical team and 

healthcare providers, whether in private or public hospitals, were supportive, 

knowledgeable, and experts in dealing with cardiac patients. They provided their help 

and support throughout their hospitalization, their stay in the cardiac intensive care unit, 

their discharge, and their clinic visits. One of the participants commented , 

Visiting the cardiac unit exceeded my expectations in terms of nursing experience, 

politeness, and level of care provided. The doctors kept in touch with me after the 

surgery on a regular basis. They all kept an eye on me, and they all supported me during 

my hospital and clinic visits as well. (p3). 

3.2.8 CABG Patients’ perspectives on the Palestinian healthcare system 

3.2.8.1 The healthcare system was integrative 

Two of the participants reported that the Palestinian healthcare system was integrative 

while treating them: from the first diagnostic visit to the experience of admission and 

hospitalization, to dealing with procedures and policies in the institution, management, 

and quality of services that were provided to them during and after hospitalization. They 

expressed that there were no obvious differences between private hospitals like Ar-Razi 

Hospital, Specialized Arab Hospital, An-Najah National University Hospital, and the 

public sector that was represented by Palestine Medical Complex. One of them 

reported, ―Really, I haven't seen any healthcare system like this. The doctors, nurses, 

workers and cleaners were working in an integrative way.‖ (P17). And another 

participant said, ―I didn‘t face any difficulties in entering the healthcare centers. I was 

admitted smoothly and directly. Everything was perfect and facilitated starting from the 

insurance to the financial issues t