Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders

As the number of elderly patients undergoing cardiac surgery (coronary artery bypass and valve replacement) continues to increase, evidence is growing that they can do so with improved health status, functional status, longevity, and life quality. In this article, we used self-efficacy theory to explore one of the most common recovery behaviors--walking various distances. In preoperative data collected in-hospital through data collection at one, two, three, six, and twelve months postoperatively, we explored: (a) the trajectories of self-efficacy expectation (SEE) and self-reported (SR) behavior performance over the first postoperative year; (b) the relationships between SEE and SR behavior; (c) predictors of SEE; and (d) using hierarchical multiple regression, identified predictors of SR behavior at each point of time. The sample (N = 199) was primarily male (76%) with a mean age of 75.8 years. SEE and SR behavior increased over time though with different trajectories; at all points in time, females had lower scores. Correlations between SEE and SR behavior were statistically significant (r values ranging from 0.67 to 0.89; p < .01) for both males and females. Predictors of SEE and SR identified were a mix of physiologic and psychologic constructs. The amount of explained variance in SR behavior scores ranged from a low of 23% at one month to a high of 64.7% at six months. The gender differences sustained one year after cardiac surgery are striking; elder females may need targeted interventions to enhance recovery.

Patterns of recovery among Norwegian heart surgery patients

Utilizing a prospective longitudinal design, the recovery pattern of 91 heart patients was followed for the first 8 weeks following coronary artery by-pass graft surgery. The patients' perceived and actual performance of walking, their resumption of roles, and social support and family functioning were measured pre-operatively and at 4 and 8 weeks postoperatively. Findings indicate that recovery is swift in terms of health and physical functioning, somewhat more time-consuming in terms of role functioning, and delayed with regard to work-related role activities. Contrary to American findings, the heart surgery recovery process did not significantly affect family functioning in this Norwegian sample. Social support was experienced as high throughout the recovery period, with spouses and children being the main providers.

Predictors of physical activity in patients with chronic heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy

To identify predictors of physical activity levels in patients with chronic heart failure, 43 patients, aged 33 to 91 years, who had well-compensated heart failure were asked to perform a symptom-limited exercise treadmill test and to complete activity logs for 2 consecutive days while wearing an ambulatory heart rate activity monitor. Activity logs included information on the type of activity, duration, rating of perceived exertion, symptoms experienced, and the intensity of symptoms. Subjects also completed the Duke Activity Status Index, a brief self-administered questionnaire that assesses physical functioning, and a self-efficacy for general activity questionnaire. Simultaneous multiple regression analysis was used to predict physical activity levels from a model that included: personal variables of physical fitness (peak oxygen consumption); knowledge, attitudes, and beliefs including self-efficacy for general activity, and rating of perceived exertion during daily activity; and environmental factors such as social support (marital status). The overall model explained 38% of the variance (p < 0.001). Self-efficacy (p = 0.015) was the strongest predictor of physical activity in this group. From this initial descriptive study, we conclude that self-efficacy is a better predictor of performance of physical activity than measures of physical fitness or rating of perceived exertion during activity. Additional studies are needed to examine other behavioral and physiologic mediators as well as behavioral strategies that may be used to increase participation in physical activity programs. Particularly promising are strategies to enhance self-efficacy for exercise.

Functional capacity after cardiac surgery in elderly patients

OBJECTIVES

This study was performed to determine whether cardiac surgery improves functional capacity in patients > 70 years of age and to identify factors associated with good and poor functional results in this age group.

BACKGROUND

Cardiac surgery has been used increasingly among older patients, but the effectiveness of surgery in this age group remains controversial.

METHODS

Self-reported functional capacity was assessed by the Duke Activity Status Index preoperatively and again 1 year after coronary artery bypass or valve replacement surgery in a total of 199 patients with a mean age of 76 years (range 70 to 91).

RESULTS

Functional capacity improved significantly after surgery (mean Duke Activity Status Index 27.9 at baseline vs. 36.8 at 12 months, p < 0.001), with improvements in most patients (74%). Six preoperative factors were independent predictors of less improvement in functional capacity between baseline and 1 year: smoking, female gender, higher Charlson comorbidity index, syncope, previous cardiac operation and older age. Postoperative complications were also a highly significant predictor of lower functional capacity at 1 year.

CONCLUSIONS

Most older patients have meaningful improvements in functional capacity after cardiac surgery, and clinical factors appear to modify the degree of improvement attainable.

Nursing's syntax revisited: a critique of philosophies said to influence nursing theories

Lodged within the syntax of a discipline are the value systems and research constraints that influence theory development and research strategies. Humanism and postmodern philosophy have challenged natural science philosophical influences on nursing's syntax. This paper examines the construction of nursing's syntax from empiricist, hermeneuticist, feminist, and critical social theory views. In this critique, two requirements are placed on the world views: (1) they must accommodate theoretical (realist) terms important to nursing; and (2) they should provide explanatory power for these terms within nursing's disciplinary substance. Arguments are continued for a "within-the discipline" structure, a substantive and syntactical structure for the discipline of nursing that recognizes the centrality of biobehavioral processes in the practice of nursing [Gortner, IMAGE: J. Nurs. Scholarship 22, 101-105 (1990)].

Daily physical activity levels in congestive heart failure

To determine the level of daily physical activity routinely performed by patients with congestive heart failure (CHF) and the ability of clinical and laboratory assessments of function to predict peak daily activity levels, 45 patients with CHF were evaluated in the laboratory and during 2 days of usual activity. Subjects performed symptom-limited treadmill exercise tests with respiratory gas analysis and wore a Vitalog activity monitor with continuous measurement of heart rate and body motion. Mean maximal oxygen uptake for this sample was 16.8 ml/kg/min. Peak daily physical activity involved walking on a flat surface (44%), or general activities (housework/yardwork, 42%). Most subjects were asymptomatic (49%) during daily physical activity, 22% noted dyspnea, 16% fatigue and 13% sore muscles/joints. Perceived intensity of peak daily physical activity (mean = 4.19, SD = 2.21) was similar to perceived exertion (mean = 3.73, SD = 1.37) reported at ventilatory threshold measured during treadmill exercise testing. Subjects may control their peak daily physical activity to minimize symptoms experienced. It was further observed that current methods of assessing functional capacity in these patients were inadequate for estimating the peak level of daily activity. In conclusion, daily physical activity levels are low in patients with congestive heart failure and a gap exists between exercise capacity and actual performance of daily physical activity.

A randomized clinical trial of nursing care for recovery from cardiac surgery

OBJECTIVE

To determine the efficacy of a psychoeducational nursing intervention in patients who receive coronary artery bypass graft and valve repair surgery.

DESIGN

A cluster-randomized controlled trial design.

SETTING

Two hospitals in the western United States--a large community hospital with an active cardiovascular surgery practice and a health-sciences research center.

SUBJECTS

156 patients between 25 and 75 years of age, 125 (81.1%) men, and 31 (19.9%) women, all with primary care givers.

OUTCOME MEASURES

Self-efficacy expectations, activities (behavior performance), quality of life, mood state.

INTERVENTION

Supplemental in-hospital education followed by telephone contact from discharge to eighth week after discharge.

RESULTS

Patients in the experimental group reported significantly greater self-efficacy expectations for walking and behavior performance for walking, lifting, climbing stairs, general exertion and, where applicable, for working.

CONCLUSION

This trial suggests that a low-intensity psychoeducational nursing intervention can promote self-efficacy expectations for walking in recovery and is associated with more self-reported walking and lifting behavior after cardiac surgery.

The road to recovery for elders after CABG

One year later, 88% of these octogenarians said they would undergo CABG again. Here's how nursing care set them on the right course.

(Mis)conceptions and reconceptions about traditional science

"Traditional" science (ie, scientific work that has evolved from the natural sciences) is still said to rely on theory-neutral facts, quantitative data, and the search for universal laws. This depiction of science is incongruent with much contemporary thinking. This article examines three shifts in recent philosophy that are relevant for nursing science philosophy: the move from foundationalism to an understanding of the fallibility of science, the shift in emphasis from verification to justification of knowledge claims, and the recent examination of explanation by scientific realists. It is suggested that scientific realism may be a fruitful area of inquiry for philosophers of nursing science.

Predictors of general activity 8 weeks after cardiac surgery

In this secondary analysis, the influence of mood states and self-efficacy beliefs on recovery of general activities 8 weeks after cardiac surgery were investigated. Study data were taken from a randomized clinical trial with 156 subjects who were either in an efficacy enhancement nursing care group (n = 75) or in a routine care group (n = 81). It was found that self-efficacy beliefs at time of hospitalization regarding ability to resume general activities after discharge, measured tension/anxiety at 4 weeks after surgery, and experimental group status explained 21% of the variation in self-reported recovery at 8 weeks.

Historical development of doctoral programs: shaping our expectations

The history of doctoral education for nurses in the United States is reviewed with emphasis on the nurse scientist training model, changing student characteristics, and developing scientific perspectives and programs. Recommendations are made for cross-disciplinary training in a revised nurse scientist model and for greater research emphasis on fundamental processes (for example, host factors) to understand human ecology in health and illness.

Self-efficacy and activity level following cardiac surgery

Self-efficacy expectations were measured in 149 recovering cardiac surgery patients to determine whether in-patient education and telephone monitoring during convalescence enhanced perceptions of cardiac efficacy and reported activity. Significant differences were found for experimental patients in self-efficacy expectations for walking between 4 and 8 weeks (P = 0.02) and between 8 and 24 weeks (P = 0.05) following surgery. Experimental patients also reported higher levels of general activity at 4 weeks (P = 0.05) and 8 weeks (P = 0.02) as well as more walking and lifting at 8 weeks (P = 0.01 and P = 0.0008, respectively). By 12 weeks, treatment differences were no longer significant except for continued higher general activity levels (P = 0.03) for experimental patients. Self-efficacy expectations, summed for all physical activities, at at 8 weeks were found to be a significant predictor of self-reported activity at 12 weeks, contributing 14.8% of the 34.8% explained variance (R2 change = 0.1479; F = 26.58; P less than 0.0001). Self-efficacy expectations summed for all physical activity at 8 weeks were also significant predictors of self-reported activities at 24 weeks, contributing 8.5% of the variance (R2 change = 0.0847; F = 14.48; P = 0.0002). A New York Heart Association functional class at 4 and 8 weeks was an independent predictor of self-reported activity at 12 weeks, as was 8 week functional class for self-reported activity at 24 weeks. Mood state did not contribute to explained variance in the regression models.(ABSTRACT TRUNCATED AT 250 WORDS)

Nursing values and science: toward a science philosophy

Several premises are proposed for nursing science philosophy in contrast to nursing practice philosophy. These include human understanding, a critical tradition that views science as public knowledge, and use of observation, rationality, explanation, and prediction as a guide to therapy. No argument is made for or against a particular philosophy of science (e.g., positivist, historicist, critical theorist). The debates on the fit of philosophic paradigms with research strategies may soon run their course on the North American continent, as they appear to have done in Scandinavia.

Improving recovery following cardiac surgery: a randomized clinical trial

To enhance individual and family health during recovery from heart surgery, this study employed nursing interventions based on self-efficacy and family stress theory during the hospitalization period and for 3 months thereafter. The effectiveness of the interventions were assessed through a randomized trial in which 67 prospective bypass and valve surgery patients, aged 30-77 years, and their spouses, were allocated either the experimental interventions or usual care and followed for 6 months. At 3 months post-surgery, the only statistically significant differences between the experimentals and controls were on perceived self-efficacy for lifting and tolerating emotional distress. At 6 months no significant differences were found on individual or family measures. Analyses revealed that age, gender and preoperative cardiac status significantly affected individual recovery. The study is continuing with a larger sample in order to explicate the recovery process and to better determine whether a low intensity nursing intervention can effect changes in individual and family recovery.

Values in the choice of treatment: replication and refinement

The Gortner Values in the Choice of Treatment Inventory is a set of statements based on the moral principles of autonomy and beneficence/nonmaleficence (Beauchamp & Childress, 1979). The inventory was developed and used with cardiac surgery patients and spouses (Gortner, Hudes, & Zyzanski, 1984) and has been replicated with a new sample of coronary artery bypass surgery or value replacement surgery patients and spouses. Significant patient-spouse correlations were obtained for the Autonomy, rs = .26, p = .03, and Beneficence/Nonmaleficence scales, rs = .38, p = .002. Repeated measures analysis of variance showed a significant main effect for the value preference of Autonomy over Beneficence/Nonmaleficence, p = .001, when the family score (arithmetical mean of patient-spouse score) was used as the unit of analysis. A refinement was done on the combined samples from this and the early trial through a separate factor analysis. The final two-factor solution suggests that a common factor and scoring solution, based on 12 inventory items, fits both family and patient data.

Events leading to the treatment of coronary artery disease: implications for nursing care

The selection of a particular treatment for CAD was found to be related to the severity of illness, patients who were more severely disabled by angina elected surgical treatment after vessel blockage was documented by angiography. Differential access to treatments was not described by study subjects and therefore cannot be evaluated as a contributing factor to the selection of treatment. Although most subjects participated in a therapeutic pharmacologic regimen, few patients in either group employed dietary or exercise programs to ameliorate CAD. Most patients received information about CAD and about surgery as a treatment option. This educational communication was directed by the cardiologist for a large majority of patients. Nurses were cited as information sources for surgical subjects only. In retrospect, more than half of the surgical subjects indicated a need for additional information. The decision regarding which type of treatment to have was made autonomously by most subjects, unlike the usual decision-making styles of families of surgical patients. A significantly greater proportion of surgical patients identified their family as a source of support during the elected treatment. Both groups described family changes specific to the illness and selected treatment.

Appraisal of values in the choice of treatment

The Gortner Values in the Choice of Treatment Inventory is a set of declarative statements to which respondents can indicate agreement or disagreement in a Likert-type format. The statements are based on the moral principles of Autonomy, Beneficence/Nonmaleficence, and Justice as conceptualized by Beauchamp and Childress (1979). The first trial was reported for 15 families in 1980. The second trial was part of a larger study in June 1981 to April 1982 of 100 families, of whom 70 had a member undergoing coronary artery bypass surgery, and 30 had a member under medical treatment for coronary artery disease. Spearman rank order correlations were used to evaluate responses within families and between groups at Time 1 and Time 2. Surgical family correlations for Autonomy were weak, but were moderately strong for Beneficence/Nonmaleficence. A highly significant main-effect finding, using repeated measures ANOVA, was that all patients and spouses showed mean Autonomy scores that were significantly higher than those for Beneficence/Nonmaleficence and Justice. Principal components factor analysis followed by varimax rotation supported two of the three hypothesized constructs. Surgical families emerged as the key reference group for further analysis.

Nursing science in transition

Nursing science, the base of knowledge underlying human behavior and social interaction, under normal and stressful conditions, across the life span, is distinguished from its inquiry (research). Inquiry and, especially, methodology have been afforded greater attention than science. The requirements for increased science are noted: communality, colleagueship, and competition among scientists and continuity and confirmation of scientific activity and evidence.

An overview of nursing research in the United States

In a four-part article, historical perspectives (part I) are reviewed, the development of nursing research in education (part II) is outlined, the contribution of nursing research to practice (part III) is traced, and research resources (part IV) which made the growth possible are described.