Relationships among selected antecedent variables and coping effectiveness in postmyocardial infarction patients

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

Exploratory Factor Analysis of the Mishel Uncertainty in Illness Scale Among Adolescents and Young Adults With Chronic Medical Conditions

OBJECTIVE

To identify a developmentally relevant factor structure of the Mishel Uncertainty in Illness Scale-Community form (MUIS-C) among adolescents and young adults with chronic medical conditions.

METHODS

Data on college students with a self-reported chronic medical condition (N = 238) were collected between November 2013 and May 2015. Participants completed the MUIS-C as part of a larger questionnaire battery. An exploratory factor analysis and a confirmatory factor analysis were conducted.

RESULTS

The exploratory factor analysis resulted in a 22-item model with two factors termed: (a) Ambiguity/Future Uncertainty (α = .93), and (b) Unpredictability (α = .89). The confirmatory factor analysis and a correlated uniquenesses model, which evaluated method effects, supported the two-factor model.

DISCUSSION

These findings highlight the unique nature of illness uncertainty among adolescents and young adults and show the clinical and research utility of the MUIS-C for this population. Future investigations should examine how the two factors relate to distress among adolescents and young adults.

Phenomenon of Uncertainty as a Subjective Experience

The phenomenon of uncertainty in illness of patients is discussed and analyzed in this article. Uncertainty in illness is a condition that accompanies the patient from the moment of appearance of the first somatic symptoms of the disease and could be strengthened or weakened thanks to many psychosocial factors. The level of uncertainty is related to the level of stress, emotional disadaptation, affective states, coping strategies, mechanisms of psychological defense, etc. Uncertainty can perform destructive functions, acting as a trigger for stressful conditions and launching negative emotional experiences. As a positive function of uncertainty, one can note a possible positive interpretation of the patient's disease. In addition, the state of uncertainty allows the patient to activate the resources of coping with the disease, among which the leading role belongs to social support.

Uncertainty and Its Antecedents in Patients With A trial Fibrillation

The aim of this descriptive, correlational, and cross-sectional survey was to explore uncertainty in patients with atrial fibrillation and to examine the relationships between uncertainty and its antecedents, including education, social support, and perceived seriousness of illness in patients newly diagnosed with atrial fibrillation. The theoretical framework of the study was Mishel’s middle-range nursing theory of uncertainty in illness. A convenience sample of 81 participants recruited from two academic medical centers over 10 months was interviewed. Uncertainty was moderately high in patients with atrial fibrillation compared to other clinical populations. Among antecedents of uncertainty, higher education was significantly associated with less uncertainty (= -.21 to -.25). Except for tangible support, persons with greater social supports perceived less uncertainty (= -.25 to -.27), and individuals with greater perceived seriousness of illness reported greater uncertainty (= .30 to .33).

The social environment and illness uncertainty in chronic obstructive pulmonary disease

PURPOSE

Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty.

METHODS

Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress.

RESULTS

Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010).

CONCLUSIONS

The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.

Participants' experiences of hospital-based peer support groups for stroke patients and carers

PURPOSE

The aim was to examine stroke patients', carers' and volunteer supporters' experiences of peer support groups during hospital rehabilitation.

METHODS

Semi-structured interviews and questionnaires were analysed by inductive thematic analysis. Participants also answered a standardised Therapeutic Factors Inventory (TFI).

RESULTS

Five superordinate themes emerged for patients, carers and volunteer supporters. Three themes related to group processes; 'practical issues' (five subthemes), 'staff presence', 'similarity-difference', and comparison with other group members. 'Value of peers' (five subthemes) described beneficial outcomes. The 'similarity-difference' theme and four subthemes under 'value of peers' were related to items from the TFI which drew agreement from most participants. The supporters had some unique themes; two were concerned with group organisation, one was the experience of 'being helpful to others' and one described the experiences of training. As well as its links with themes, agreement with TFI items revealed experiences that did not emerge as themes; feeling secure, expressing emotions and increased independence.

CONCLUSIONS

Participation in the group was experienced as beneficial by participants. Benefits included helpful information, advice, making new connections and increased awareness of stroke. Participants identified important group processes such as upward and downward comparison. Responses to the TFI suggested that attendance brought therapeutic gains.

Protecting the health of employees caring for family members with special health care needs

Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special health care needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs.

Paid health and family leave: the Canadian experience in the global context

OBJECTIVES

Two thirds of Canadian adults participate in the workforce. Their health and that of their families can be markedly affected by the availability of paid sick leave, paid leave to care for family members' health and paid parental leave.

METHODS

We gathered data from all Canadian provinces and territories on these essential leave policies and compared Canadian policies with data collected on 186 United Nations (UN) countries.

RESULTS

While Canada pays sickness benefits for 15 weeks for serious illnesses, globally at least 90 countries provide benefits for at least 26 weeks or until recovery. Moreover, within Canada only Saskatchewan and Quebec guarantee job protection if sick leave lasts over 12 days. The federal government guarantees Canadian workers six weeks of paid leave to provide care or support to gravely ill family members. Only 39 countries guarantee such leave with pay. Most, but not all, provinces guarantee workers' job protection during compassionate care leave. Eligibility for job protection during parental leave varies across the country from having no restrictions to requiring at least one year of service.

CONCLUSION

Compared with Canada, many countries offer a longer duration of paid sick leave for employees and replace a higher percentage of wages lost. Internationally, Canada performs well in having policies that guarantee paid leave to care for dependants with serious illnesses, but it lags behind in the provision of paid leave to address the health needs of children or family members' with non-life-threatening conditions. Finally, while paid parental leave is of adequate duration, the wage replacement rate lowers its accessibility to families with limited means.

Ensuring a healthy and productive workforce: comparing the generosity of paid sick day and sick leave policies in 22 countries

National paid sick day and paid sick leave policies are compared in 22 countries ranked highly in terms of economic and human development. The authors calculate the financial support available to workers facing two different kinds of health problems: a case of the flu that requires missing 5 days of work, and a cancer treatment that requires 50 days of absence. Only 3 countries--the United States, Canada, and Japan--have no national policy requiring employers to provide paid sick days for workers who need to miss 5 days of work to recover from the flu. Eleven countries guarantee workers earning the national median wage full pay for all 5 days. In Ireland and the United Kingdom, the full-time equivalent benefits are more generous for low-wage workers than for workers earning the national median. The United States is the only country that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment. Luxembourg and Norway provide 50 full-time equivalent working days of leave, while New Zealand provides the least, at 5 days. In 6 countries, paid sick leave benefits are more generous for low-wage workers than for median-wage workers.

Role of Health Locus of Control Between Uncertainty and Uncertainty Appraisal Among Patients With Atrial Fibrillation

The purpose of this study was to determine the role of health locus of control in the model of uncertainty in illness among patients with atrial fibrillation. This study employed a descriptive, correlational survey. A total of 81 patients with atrial fibrillation were recruited from two large medical centers in the United States. Only the interaction term of uncertainty and internal health locus of control had a significant moderating effect on appraisal of danger. Greater internal health locus of control was associated with greater appraisal of danger at the given degree of uncertainty. Therefore, the internal health locus of control played a significant role in magnifying the relationship of uncertainty on appraisal of danger. However, health locus of control did not moderate the relationship between uncertainty and appraisal of opportunity. Finally, this study concluded that internal health locus of control had a moderating effect on the relationship between uncertainty and appraisal of danger.

Coping, distress, and marital adjustment in couples with cancer: an examination of the personal and social context

We examined the links between coping and psychological outcomes in 53 patients who had undergone radiotherapy for cancer. Patients completed a coping survey and a measure of perceived support during a six-week course of radiation therapy and reported about their mental health and marital satisfaction one month following treatment. The prospective associations between coping and psychological distress and martial satisfaction depended upon the supportive context in which patients were coping. Seeking emotional support and using positive reappraisal were more effective (i.e., were significantly and positively correlated with marital satisfaction) for people low in spousal support than for people high in such support. Although men and women reported coping similarly with the cancer and had similar levels of adjustment, the association between coping and outcomes differed by gender; the associations for women were significantly stronger than they were for men. Results thus suggest that both individual and environmental characteristics moderate the associations between coping and outcomes in cancer survivors.

Predictors of Perceived Coping Effectiveness in Patients Awaiting a Heart Transplant

BACKGROUND

The wait for a heart transplant (HT) is a very stressful time for patients; how well they cope is essential to quality of life. However, in previous research, factors that contribute to perceived coping effectiveness in HT candidates have not been identified.

OBJECTIVE

To identify predictors of perceived coping effectiveness during the wait for a HT.

METHODS

Adult HT candidates (N = 535) completed a booklet on multiple factors impacting on quality of life (coping, stressors, symptoms, disability, social support, interventions), plus medical data were collected from charts. The Jalowiec Coping Scale assessed coping behavior. Hierarchical regression was used to analyze five sets of predictors (total = 34) based on Lazarus' theory of stress and coping.

RESULTS

The regression model explained 23% of the variance in perceived coping effectiveness. Coping styles explained the most variance, followed by coping resources, illness-related situation factors, stress appraisal, and person factors. Nine predictors were significant: less use of emotive, evasive, and fatalistic coping styles; feeling that the interventions of the HT team were very helpful; longer wait for the HT; foreseeing a favorable post-HT prognosis; more use of optimistic coping; urgent transplant status; and greater satisfaction with social support resources.

CONCLUSION

Coping styles, social support, HT wait, perceived prognosis, and transplant status contributed the most to predicting perceived coping effectiveness.

Predictors of quality of life in patients with implantable cardioverter defibrillators

Few studies have prospectively examined characteristics of implantable cardioverter defibrillator (ICD) patients as predictors of postimplant outcome. In this study the authors considered the association between preimplant psychological characteristics, ICD shocks, and postimplant quality of life at short- and long-term follow-ups, controlling for age and ejection fraction (N=88). Hierarchical regression analyses revealed that history of depression, trait anxiety, optimism, social support, and ICD shocks accounted for 41.8% to 64.5% of the variance in quality of life indices at 8- and 14-month follow-ups, depending on the outcome assessed. Further, psychological variables were as strong as, or stronger than, age, ejection fraction, and ICD shocks in predicting quality of life outcomes.

Peer support. An under-recognized resource in cardiac recovery

BACKGROUND

Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery.

AIMS

To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions.

METHODS

A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions.

RESULTS

Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery.

CONCLUSIONS

Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.

Illness Representation After Acute Myocardial Infarction: Impact On In-Hospital Recovery

• Background Despite significant progress in the treatment of coronary artery disease, myocardial infarction is still the leading cause of death in the United States. As suggested by Leventhal’s Self-Regulation Model of Illness, the continued high morbidity and mortality may be due to a failure to address the role of psychosocial factors such as illness representation, depression, and anxiety in recovery.

• Objective To determine the relationship between illness representation of myocardial infarction and the occurrence of in-hospital complications and if anxiety and depression mediate this relationship.

• Method A prospective correlational design was used to measure illness representation, depression, and anxiety 24 to 48 hours after admission for myocardial infarction in 49 patients and the frequency of complications during the acute event. Logistic regression was used to determine the likelihood of experiencing a complication.

• Results When demographic and clinical variables were controlled for, the more negative the representation of illness, the greater were the odds of experiencing a complication (χ2 = 16.9, df = 6, P=.01). The odds of experiencing a complication increased 5.1% for each 1 unit increase in the score on the Illness Preparation Questionnaire (B = 0.05, Wald = 4.442, Exp(B) = 1.051, 95% CI = 1.003–1.1010). Neither anxiety (χ2 = 3.0, df = 1, P = .09) nor depression (χ2 = 2.5, df = 1, P = .11) were significant predictors of the occurrence of complications.

• Conclusion In these patients, illness representation was predictive of the likelihood of experiencing a complication. Thus, illness representation appears to be an important psychosocial factor in acute recovery from myocardial infarction.

Illness uncertainty, perceived control, and psychological distress among adolescents with type 1 diabetes

This study examined the relationship between illness uncertainty, perceived control, and psychological distress among adolescents with type 1 diabetes. Sixty-eight adolescents age 13 to 18 years with type 1 diabetes completed the Children's Uncertainty in Illness Scale, the Perceived Control Scale Media Relations, and the Brief Symptom Inventory. Increased uncertainty was significantly associated with both decreased perceived control and increased psychological distress. Further analyses indicated that the relationship between illness uncertainty and psychological distress was direct and was not mediated or moderated by perceived control. These findings suggest that interventions aimed at managing uncertainty may help decrease psychological distress among adolescents with diabetes.

Comparison of family stresses, strengths, and outcomes after trauma and surgery

This study aimed to compare family stresses, strengths, and outcomes after motor vehicle crashes, gunshot wounds, and coronary artery bypass graft surgery. A multivariate descriptive design based on the resiliency model of family stress was used. A convenience sample of 127 family members participated within 2 days of admission to the intensive care unit. Family stresses were measured using the Family Inventory of Life Events and the Acute Physiology, Age, and Chronic Health Evaluation Scale (APACHE III). Family strengths were measured by the Family Hardiness Index and the Family Crisis Oriented Personal Evaluation Scale. Family outcomes were measured by the Family Member Well-Being Index and the Family Adaptation Scale. Family members ranged in age from 18 to 80 years (Mean, 42 years). Most of the participants in the study were women (64%) with previous intensive care unit experience (83%). The patients ranged in age from 19 to 78 years (Mean, 44 years). Multivariate analysis of variance was used to control for group differences in family member age, education, and income along with patient age and race. The results indicated that family members of patients who have experienced motor vehicle crashes, gunshot wounds, or coronary artery bypass graft surgery reported no significant differences in family strengths of hardiness and family outcomes of well-being and adaptation. However, families of patients with gunshot wounds reported significantly more stress (F = 7.94; P< 0.01) and less use of coping strategies (F = 4.33; P< 0.01) than families of patients who have experienced motor vehicle crashes or coronary artery bypass graft surgery. Interventions that address family stress and develop or mobilize coping are needed for selected families after admission of a family member to the intensive care unit.

Sources of Emotional Support for Adolescents With Cancer

The significance of emotional social support in the lives of children and adoles cents with cancer is now being recognized as a significant determinant in their psychosocial response to the experience of cancer and treatment outcomes. The purpose of this study was to identify whom adolescents perceived as providing emotional support and how helpful these individuals were in helping them cope through the experience of cancer. Forty-five adolescents with cancer responded to the following open-ended questions regarding their perceived emotional social support: "Who or what are your primary sources of emotional support?" "How helpful are these resources to you in dealing with your experiences with cancer?" Descriptive analyses of participants' responses indicated that the adolescents' mothers and their friends were the two most often cited sources of emotional support. In addition, while responses varied among adolescents, they described their identified sources of emotional support to be very helpful to them as they lived through the experience of cancer. These findings support past research that has determined that adolescents' social support systems extend beyond the family, but that mothers continue to have a significant, meaningful role in the lives of adolescents with cancer.

A framework for care during the stroke experience

This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.

Emotions and illness

AIM

This paper discusses issues central to emotional expression in illness. Its aim is to challenge the psychopathological paradigm currently utilized within healthcare and propose an alternative model based on healthy emotions.

BACKGROUND

Emotions are important to human survival. It is argued that most patients will have an emotional response to their illness but anxiety and depression are unlikely to be representative of most patients experience. The paper focuses on two important negative emotions, fear and sadness, and their psychopathological associates, anxiety and depression. Problems of diagnosing anxiety and depression in practice are highlighted. It is contended that emotional reaction to illness is normal and that emotions expressed are likely to hold clues to individual adaptation. It is argued that in health care, emotions should be assessed as healthy reactions to a survival threat and merit study from this perspective if we wish to understand individual patient illness reaction and adaptation better. Literature from cardiology is used to illustrate clinical problems.

RATIONALE

Given the present knowledge of emotions, it should be possible to utilize emotion theory as a paradigm for studying human reaction to illness. This in turn could help shape studies on adherence and adaptation.

CONCLUSION

The reaction and experience of patient illness is unlikely to be understood through the psychopathology paradigm. A better understanding of patient reaction to their illness is more likely to emerge through the study of basic emotions during acute life-threatening episodes.

An exploration of the relationships between uncertainty, psychological distress and type of coping strategy among Chinese men after cardiac catheterization

The experience of cardiac catheterization (CC) has included feelings of uncertainty, stress, fear and anxiety in many patients. However, conflicting findings from previous research have been reported. Chinese patients who undergo CC may experience psychological distress in a different way to other cultures as a result of traditional beliefs. Moreover, little research examining the impact of CC among Hong Kong Chinese has been carried out. Therefore, the aim of the study was to explore relationships between uncertainty, psychological distress and coping strategy in Chinese men after CC, using Mishel's model of uncertainty in illness as a framework. A convenience sample of 27 men hospitalized for cardiac catheterization participated in this study using a descriptive, correlational research design. Ethical approval was obtained from the Ethics Committee of the Medical Faculty at the Chinese University of Hong Kong and from the Executive Committee of the hospital. Participation was on a voluntary basis with patient confidentiality assured. Self-report questionnaires included Chinese versions of Mishel's Uncertainty in Illness Scale (MUIS), the Profile of Mood States (POMS), the State-Trait Anxiety Inventory (STAI) and the Chinese Coping Scale (CCS) for data collection. Data were analysed using the Statistical Package for Social Sciences. High mean scores for uncertainty (mean=101.4, SD=11.49) and variables measuring psychological distress (mood disturbance mean=36.6, SD=33.6, state-anxiety mean=39.1, SD=8.95, trait-anxiety mean=43.7, SD=8.1) among these participants suggest that Hong Kong Chinese men experience uncertainty and psychological distress when undergoing cardiac catheterization. Strong relationships between uncertainty and mood disturbance (r=0.57, P=0.01), trait-anxiety and mood disturbance (r=0.65, P=0.01) and state-anxiety and external coping strategies (r=0.50, P=0.05) were found. These findings suggest that relationships between uncertainty, psychological distress and external coping strategies exist in Chinese men hospitalized for cardiac catheterization. Moreover, these findings may help nurses' design culturally specific interventions for their patients.

Waiting for coronary artery bypass surgery: a qualitative analysis

Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients' health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list - referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience - uncertainty, chest pain and anxiety; with six secondary themes - powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self-esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients' skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients' anxiety levels. This is the first known qualitative study which specifically examines patients' perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.

Self-care strategies for symptom management in patients with chronic heart failure

BACKGROUND

The troublesome symptoms experienced by patients with chronic heart failure are associated with diminished quality of life, frequent hospitalizations, and mortality.

OBJECTIVES

To describe the symptoms experienced by patients with heart failure, to detail the self-care strategies used by these patients in managing their symptoms, and to categorize the self-care strategies.

METHODS

Six focus groups were used with 23 patients who had heart failure, along with six focus groups with 18 family members of the patients. Data analysis was performed by transcription of audiotape recordings of the group sessions and review of field notes.

RESULTS

The patients reported a large number of troublesome symptoms, many consistent with past empirical findings, but some not reported in previous studies. Self-care strategies to manage the symptoms clustered into 11 categories.

CONCLUSIONS

Results from this study provided direction for future studies to (a) identify the prevalence, severity, and etiologies of the commonly reported symptoms, particularly cognitive impairment, loss of balance, and depression; (b) evaluate the emotions reported by women with heart failure; and (c) test the strategies as part of an intervention program to improve symptom management in patients with heart failure.

Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion

BACKGROUND

Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion.

METHODS

Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status.

RESULTS

The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables.

CONCLUSIONS

Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.

A longitudinal causal model of cardiac invalidism following myocardial infarction

BACKGROUND

Invalidism has been discussed in the cardiovascular literature for decades. Researchers have studied health perceptions, emotional distress, and dependency in patients after acute myocardial infarction in an attempt to understand the phenomenon. However, no theory of the manner in which these variables interact has been proposed.

OBJECTIVES

Using previous research, a model of invalidism was specified in which individuals' perceptions that their health is poor lead to emotional distress and increased dependency. As health perceptions improve over time, emotional distress and dependency decrease.

METHOD

Survey data were collected from 111 men and women 1 and 4 months after a first myocardial infarction and were tested using structural equation modeling.

RESULTS

The model was rejected using a confirmatory approach (chi2(89) = 141.40; p= .00034). The fit indices, however, suggested an adequate fit of the model to the data (CFI = .96; NNFI = .94).

CONCLUSION

The conclusion is that the model is reasonable and serves as a starting point for a theory-based empirical exploration of the invalidism process.

Correlates of fatigue in survivors of breast cancer

The purpose of this report is to describe variables associated with fatigue for disease-free survivors of breast cancer. On the basis of Mishel's theory of illness uncertainty and the antecedents of uncertainty, a cross-sectional, descriptive, correlational design was used to examine (a) the relationship of fatigue with cancer-related variables and the presence of concurrent illness and (b) whether fatigue and educational level explained a significant proportion of the variation in illness uncertainty. The Mishel Uncertainty in Illness Scale (MUIS) and a single fatigue item on the McCorkle & Young Symptom Distress Scale were used as variable measures. Data were collected from 109 women 1 to 6 years after treatment for Stage I to III breast cancer with no known metastasis. Findings showed that low to moderate fatigue persisted for women, which was related significantly to the presence of concurrent illness. When concurrent illness was taken into account, fatigue was significantly related to treatment with chemotherapy, irrespective of length of time since treatment, age, disease stage, or tamoxifen use. Finally, fatigue and education level explained a significant level of the variation in illness uncertainty. Nurses can identify and assist women who are at risk for fatigue and illness uncertainty after treatment for breast cancer ends.

Development of an instrument to measure cardiac illness dependency

OBJECTIVE

Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health.

DESIGN

Instrument development study.

SAMPLE

Convenience sample of 311 patients with cardiac disease.

RESULTS

The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal.

CONCLUSION

Internal consistency reliability, content validity, and discriminant validity of the Illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Development of an instrument to measure threat related to cardiac events

The purpose of this study was to evaluate the reliability and validity of the Cardiac Event Threat Questionnaire (CTQ). The CTQ is a 31-item instrument specific for cardiac events that was developed from a literature review and self-reports of persons who had experienced a recent cardiac event. A convenience sample (N = 270) of persons hospitalized for angina, myocardial infarction, or cardiac surgery completed the CTQ. Satisfactory internal consistency and test-retest reliabilities were found. Results of confirmatory factor analysis and correlation with the Profile of Mood States provide initial support for construct validity of the CTQ.

Appraisal, moods, and coping among individuals experiencing diagnostic exercise stress testing

Appraisal, coping, and negative moods were examined in a convenience sample (N = 77) of individuals experiencing exercise stress testing to evaluate cardiac disease. Only three types of coping patterns--self-controlling, escape-avoidance, and confrontive coping--were significantly related to appraisal and negative moods. Only a small proportion of the variance in negative moods was accounted for through a mediating effect by the type of coping pattern. Appraisal had a direct effect on negative moods when self-controlling and escape-avoidance were entered as the coping patterns. Negative moods decreased and appraisals became more positive after the procedure. Appraisals, but not negative moods, were influenced by the results of the procedure.