The Role of the Patients’ Companion in the Transitional Care from the Open Heart Surgery ICU to the Cardiac Surgery Ward: A Qualitative Content Analysis

Document Type: Original Article


1 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;

2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;


Background: The patients’ companions can help improve transitional care as an important missing
link, but their role is not clear. The aim of this study was to explore the role of the patients’ companion
in the transitional care from the open heart surgery intensive care unit (OH-ICU) to the cardiac surgery
Methods: This was a qualitative descriptive study using conventional content analysis that was
conducted from September 2019 to February 2020 in Tehran, Iran. Purposeful sampling method with
maximum variation was performed among the patients eligible for transfer to the cardiac surgery
ward, their companions, nurses, and physicians in charge of transferring from the OH-ICU to the
ward. 27 in-depth and semi-structured interviews were conducted with 25 participants , and data were
analyzed using the Granheim and Lundman method. The data were managed using the MAXQDA
software (version 10.0).
Results: Based on our analysis, the theme “Dual role of the patients’ companion” and its two categories,
“Companion as a facilitator” and “Companion as an inhibitor”, were extracted. Emotional support,
satisfaction of basic needs, care arm, alarm bell, and communication bridge were the sub-categories of
the first category, and Interfering with care and creation of tension were those of the second category.
Conclusion: We concluded that the patients’ companions can play an important role in transitional
care, especially as emotional support and system assistants due to the structure of the health care
system and Iranian cultural context . Therefore, it is suggested that the patients’ companion should be
considered as a member of the transition team and accompany them in this process by informing and
supporting them.


  1. World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. [Cited 17 July 2020]. Available from:
  2. Bakaeen FG, Blackstone EH, Pettersson GB, et al. The father of coronary artery bypass grafting: René Favaloro and the 50th anniversary of coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery. 2018;155:2324-8.
  3. Herbst LA, Desai S, Benscoter D, et al. Going back to the ward-transitioning care back to the ward team. Translational Pediatrics. 2018;7:314-25.
  4. Stelfox HT, Lane D, Boyd JM, et al. A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest. 2015;147:317-27.
  5. Jodaki K, Ghyasvandian S, Abbasi M, et al. Effect of liaison nurse service on transfer anxiety of patients transferred from the cardiac surgery Intensive Care Unit to the general ward. Nursing and Midwifery Studies. 2017;6:e33478.
  6. Dos Passos Antonio S, Bernardino E, Bueno Lelli Tominaga L, et al. Transition of patients from intensive care units. Journal of Nursing. 2018;12:3320-6.
  7. Jeffs L, Kitto S, Merkley J, et al. Safety threats and opportunities to improve interfacility care transitions: insights from patients and family members. Patient Prefer Adherence. 2012;6:711-8.
  8. Ghiyasvandian S, Zakerimoghadam M, Peyravi H. Nurse as a facilitator to professional communication: a qualitative study. Global Journal of Health Science. 2014;7:294-303.
  9. Buck HG, Harkness K, Wion R, et al. Caregivers’ contributions to heart failure self-care: a systematic review. European Journal of Cardiovascular Nursing. 2015;14:79- 89.
  10. Miranda J, Underwood D, Kuepfer‐Thomas M, et al. Exploring transitions in care from pulmonary rehabilitation to home for persons with chronic obstructive pulmonary disease: A descriptive qualitative study. Health Expectations. 2020;23:414-22.
  11. Grood C, Leigh JP, Bagshaw SM, et al. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. Canadian Medical Association Journal. 2018;190:E669-76.
  12. Coleman EA, Roman SP. Family caregivers’ experiences during transitions out of hospital. The Journal for Healthcare Quality. 2015;37:12-21.
  13. Jeffs L, Saragosa M, Law MP, et al. The role of caregivers in interfacility care transitions: a qualitative study. Patient Preference and Adherence. 2017;11:1443-50.
  14. Gibson MJ, Kelly KA, Kaplan AK. Family caregiving and transitional care: a critical review. CA: Family Caregiver Alliance; 2012.
  15. Hasandoost F, Momeni M, Dehghankar L, et al. Family Needs of Patients Admitted to the Intensive Care Units. International Journal of Epidemiologic Research. 2018;5:128-32.
  16. Alimohammadi N, Jokar M, Khalili A, Aghamohammadi M. The requirements of the caregivers of patients hospitalized in intensive care units. National Journal of Physiology, Pharmacy and Pharmacology. 2018; 8:1078-83.
  17. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences. 2013; 15:398-405.
  18. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105-12.
  19. Lincoln YS, Guba EG. Naturalistic Inquiry. US: Sage Publications; 1985.
  20. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19:349-57.
  21. Reinhard SC, Levine C, Samis S. Home alone: family caregivers providing complex chronic care. US: AARP; 2012. [Cited 30 May, 2020]. Available from:
  22. Benzein E, Johansson P, Franzén Arestedt K, Saveman BI. Nurses’ attitudes about the importance of families in nursing care: a survey of Swedish nurses. Journal of Family Nursing. 2008;14:162-80.