The psychological and social effects of myocardial infarction on wives

Needs of recovering cardiac patients and their spouses: compared views

Identifying the needs of patients and spouses following an acute cardiac event is an essential first step in the development of nursing interventions to facilitate couples' psychosocial adaptation. Therefore, the self-perceived needs of 49 couples were compared 5 months following the patients' hospitalization for an acute cardiac event (i.e. myocardial infarction or coronary artery revascularization). Both patients and spouses identified the need for information as being most important compared with all other needs; however, significant discrepancies were found in ratings between patients and spouses. Needs which spouses rated as having a high priority included receiving information about the patient's feelings during the recovery period, having time alone, talking with the patient about concerns, and receiving information about the expected psychological recovery. Patients did not consider these same needs as they related to their spouses particularly important. Rather, they rated the need for information about their condition, the need to have honest explanations, and the need to talk with a health professional about their problems as having the highest priority. Many of the needs that both patients and spouses ranked as being important or very important were unmet in 40-70% of the cases. In this study, both patients and spouses expressed similar needs for information, but the type of information that they wanted differed and, in the majority of cases, these needs were not met by nurses and physicians.

Resuscitation training for cardiac patients and their relatives--its effect on anxiety

It is feared by many doctors that teaching basic life support (BLS) to high risk cardiac patients or a member of the family increases their anxiety. We trained a group of patients with recurrent ventricular tachycardia in BLS together with a friend or family member. Measurement of anxiety before and three months after training demonstrated a reduction in anxiety in both groups. This suggests that basic life support training can be targeted to high risk groups without fear of increasing anxiety.

Adjustment to Heart Disease: Helping families cope

Many cardiac patients experience compromised psychologic and social adjustment, which can persist for a significant period. Worsened marital and family functioning have also been reported. This paper reviews the literature, provides a framework to identify adjustment problems, and discusses strategies to facilitate recovery and enhance the well-being of the patient, couple, and family.

Psychosocial adjustment of patients and spouses to severe cardiomyopathy

Severe cardiomyopathy (SCM) imposes considerable psychosocial stress on families; however, little is known about the effect of SCM from the point of view of the marital couple. In this study, adjustment to SCM of 90 patients and their spouses was compared. Patients reported more vocational, domestic, and sexual problems than spouses. Spouses reported more problems in health care orientation, family relationships, and psychological distress than patients. The findings indicate that severe cardiomyopathy impacts on the psychosocial integrity of both partners. Therefore, one should plan interventions to support spouses as well as patients. Because problems of spouses and patients may differ, both partners should be assessed to appropriately target interventions.

Crisis theory: a paradigm of effective intervention with families of critically ill people

Admission to a critical care unit often causes a great deal of distress and anguish, not only for the patient but also his or her family. If one believes in the holistic approach to care, then it is essential that the critical care nurse is able to identify the specific needs of family members, and demonstrate appropriate intervention techniques with those in need of support. It is suggested that crisis theory can provide an effective tripartite framework on which to base such nursing care. Following a brief description of its development and basic principles, application of its approach will be demonstrated in relation to the specific needs and concerns which have been identified from responses of family members themselves. Suggestions are offered which may assist the nurse in further developing basic communication skills which can assist the intervention process at this difficult time. Awareness of such principles is of value to all workers in critical care areas.

Myocardial infarction and patients' wives

When a patient has a myocardial infarction (MI), all aspects of marital function are affected. Soon after the MI, patients' wives experience psychological distress that decreases with time. Illness behaviors among the MI patients' wives increase, and aggressive and sexual impulses are often inhibited. Many families experience changes in members' work status after the husband has an MI, and wives are faced with increased chores. Marital interaction also changes. Dysfunctional marital relationships are associated with a poor psychosocial outcome. Additionally, spousal factors such as dependency are also likely to affect patients. Intervention strategies are best directed to wives at risk for problems.

Wives' responses to counselling early after myocardial infarction

Self-ratings of anxiety and depression were studied over six months in 60 wives of first time myocardial infarction patients. Couples were randomly assigned to either a treatment group, where they received a simple programme of education and psychological support in addition to routine care, or to a control group, where they received routine care only. All wives completed the Hospital Anxiety and Depression scale and a battery of visual analogue scales measuring anxiety on a range of topics related to recovery from a heart attack. Wives in the treatment group reported statistically significantly less anxiety than controls. This effect was sustained for six months after the counselling. It is concluded that a simple programme of in hospital counselling is efficacious and should be routinely offered to the wives of coronary patients.

Measuring quality of life in cardiac spouses

The purpose of this study was to develop an objective instrument to measure changes in quality of life of spouses of post-myocardial infarction (MI) patients, and to determine its responsiveness and validity. A 70-item list of potential areas of concern was compiled; the 25 most frequent and important concerns comprised the framework of the final questionnaire. The questions on the Quality of Life Questionnaire for Cardiac Spouses (QL-SP) were categorized into the Emotional Function Dimension (EFD), and the Physical and Social Function Dimension (PSFD). Subjects (n = 39) completed the QL-SP and a battery of established questionnaires at home, 1-2 weeks post-hospital discharge for the patient, and 8 weeks later. Scores on the QL-SP between visits were improved for both the EFD (t = 5.56, p less than 0.001), and the PSFD (t = 6.11, p less than 0.001). The agreement between predicted and observed relationships between the dimension changes and other index changes, as measured statistically by a kappa with Cicchetti weights, was significant (kappa w = 0.43, p = 0.0012). The QL-SP appears to be responsive and valid, and may be useful in evaluating clinical and research intervention strategies.

A randomized controlled trial of in-hospital nursing support for first time myocardial infarction patients and their partners: effects on anxiety and depression

This study monitored and compared levels of anxiety and depression reported by first myocardial infarction (MI) male patients and their partners, throughout the patients' hospital stay. An independent variable of a programme of supportive-educative counselling provided by a coronary care nurse was introduced to determine whether it significantly affected reactions. Sixty couples were randomly assigned to one of two groups: (a) the treatment group (in which they received the systematic programme of nursing support in addition to routine care), or (b) the control group (in which they received routine care but no other intervention). Anxiety and depression were measured by the Hospital Anxiety and Depression (HAD) scale at 24 hours and 5 days after the patient's admission to hospital. At 5 days there were statistically significant differences between both groups with respect to the HAD scale mean scores. These findings strongly suggest that a simple programme of in-hospital couple counselling, provided by a coronary care nurse, statistically significantly reduces anxiety and depression in first MI male patients and anxiety in their partners.

Support of wives of myocardial infarction patients

Seventy-six wives of patients suffering a first myocardial infarction were studied by questionnaire 6 weeks after their husbands went home. Despite the routine provision of support and information to spouses during their husband's stay in hospital, a high proportion reported physical and emotional symptoms of stress. The majority of wives felt they were poorly informed about myocardial infarction, had not had enough opportunity to ask the experts questions, and had received most support from relatives. The reasons for these findings are discussed and suggestions for early and systematic nursing intervention are made in an attempt to reduce stress and prevent the development of unhealthy patterns of behaviour.

Patient and spouse responses to education early after myocardial infarction

The impact of a post myocardial infarction education programme was assessed by comparing the increase in knowledge of patients and spouses about CHD in two hospitals, one (A) with and the other (B) without such a programme. Subjects completed the same two questionnaires twice, once within 4 days of admission and again within 16 days of leaving hospital. Q1 contained 83 questions about CHD and Q2, consisted of seven questions of immediate practical relevance to their convalescence. When the two hospitals were compared the only significant changes were observed in the responses of spouses and patients from hospital A. Spouses in A increased their scores on Q1 by a mean of 7.13% (p 0.001) in contrast to a fall of 2.01% in B. The mean increase in scores on Q2 for patients in A was 19.3% (p 0.001). It is concluded that an education programme increases the knowledge of patients and spouses but that their learning ability differs. Whilst it is suggested that spouses are included in patient education it appears likely that their educational needs may differ from those of the patient.

Social and psychological responses to myocardial infarction: multiple determinants of outcome at six months

Thirty one married men, under 65 yr of age, who were admitted to hospital with a suspected myocardial infarction, were interviewed on four occasions over six months. The patients' social and psychological responses during the course of his rehabilitation were elicited using a semistructured interview schedule. Determinants of outcome were assessed using multiple regression analysis. Return to work, exercise, leisure and sexual activity were all strongly influenced by somatic symptoms of chest pain, breathlessness, and tiredness. Lack of depression, not smoking, and support from the family doctor were important contributors to successful rehabilitation. Cardiac damage sustained at the time of admission did not appear to have any consistent influence on outcome. Half of the smokers had not resumed their habit at six months. Fewer men were working at six months than on admission. Somatic symptoms, anxiety and depression were considerable.

Physical disability in 1986 and beyond. A report of the Royal College of Physicians

This Report puts forward a plan for the management of physical disability. It recognises that the subject is administratively complex and that many different organisations, including Social Services, are involved. The Report concentrates upon the role of the NHS in general, and upon the position of physicians in particular. The Report starts by reviewing some of the evidence that services for the physically disabled are in many respects deficient. The evidence includes accounts given by disabled people themselves, the fact that many patients are 'follow-up' by inexperienced junior hospital staff, and the lack of agreed standards of provision in many areas (see Section 3) such as pressure sores, incontinence, wheelchairs, and the care of head injured patients. Disabled people between the ages of 15 and 65 are identified as requiring particular attention (Paediatric and Geriatric Services probably cater reasonably well for the young and the old). The 'size' of the problem of physical disability is examined. For instance, the average Health District (of 250,000 persons) will contain 25,000 physically disabled people, of whom 6,250 will be severely, or very severely disabled; and 1,800 will have a wheelchair; 40 per cent of disabled people are under the age of 65. The Working Party on Rehabilitation Medicine of the Royal College of Physicians (1978) was of the opinion that rehabilitation is an integral part of total patient care, and is therefore the concern of all clinicians. The implication of this view is that Medical Disability Services should be developed without a major specialty of Rehabilitation or its equivalent, such as exists in most western countries. The Report explores the practical implications of this principle in the light of evidence discussed above.

Teaching and adaptation of patients with myocardial infarction

The role of teaching in facilitating adaptation were examined in 60 patients with myocardial infarction (MI) of working age (under 65 years). Recovery of three different patient groups were followed for one year at three times: at discharge and three months and one year after it. Data for evaluating the effects of the teaching program on the patients and their close relatives were collected by questionnaires from the patients at discharge and by interviewing the patients three months after discharge. Information on patients' recovery during the first year after MI was collected from patients' records. Impact of teaching was prominent on several outcome measures. Patients' knowledge of illness and care increased, they also perceived having received more information and support. The time devoted to exercise increased after myocardial infarction and amount of butter used on bread decreased in the follow-up state. No impact was observed on the outcome variables measuring patient's use of alcohol and smoking. Some of the impacts at the early stages of the convalescence were not lasting. After one year of MI patients had partly returned to their old life styles, for example some patients had resumed the smoking habit. Teaching of close relatives improved only slightly.

Psychosocial outcome one year after a first myocardial infarction

Psychosocial outcome in terms of mental state, health preoccupation, leisure activity, avoidance behaviour, sexual activity and attitude towards life and the future one year after a myocardial infarction (MI) was studied in 177 consecutive male, able-bodied patients below 61 yr of age with a first MI. Questionnaires and a brief interview covered the psychological and social data while the somatic variables were recorded in a standardized medical examination. Emotional distress, self-reported symptoms, avoidance behaviour, overprotection, pessimism and a diminished sexual activity were frequent, indicating a poor adaptation. These disturbances were apparent two months after the MI and remained stable. Psychological factors were stronger determinants of maladjustment than smoking, angina pectoris and recorded somatic illness. Neither severity of the infarction nor social and demographic factors determined maladjustment. Intervention must take place early and be directed to psychological factors as well as to the cardiac condition.

Need for instruction and support of the wives of patients with myocardial infarction

The study investigates the need for instruction and support among wives of patients with myocardial infarction, applying the 'stress' theory. The data were gathered by questionnaires completed by 59 wives of patients with myocardial infarction. Feelings and symptoms indicative of stress did occur among wives of the patients. They assessed instruction especially concerning home care, as being inadequate. They stated that the support they received had come largely from their own relatives; more than one third of the respondents said they had received support from a nurse; one fifth said they had not received it from anyone. The 'instruction' model for wives and other relatives of patients with myocardial infarction, introduced at the end of the article, emphasizes the importance of relevant information and support to the close relatives of patients with myocardial infarction.

Rehabilitation of post MI depression and psychological invalidism: a pilot study

The majority of survivors of myocardial infarction experience an array of psychological and emotional reactions. Often, persistent anxiety and depression impair recuperation and rehabilitation. A behaviorally based treatment approach is utilized which consists of a combination of deep muscle relaxation, imagery based desensitization, social reinforcement, stress management, activity scheduling and shaping technics. The spouse is utilized as a facilitator/co-therapist. This approach is shown to be effective in increasing adaptive function, decreasing depressive symptomology and facilitating return to acceptable premorbid levels of activity.

The spouses of your heart attack patients: ways of helping with their emotional response

The family physician must be prepared to deal with the emotional responses of the spouses of heart attack patients. The family physician has much useful prior knowledge of the family and can positively affect the patient's rehabilitation by involving the spouse. Marital partners' overprotectiveness or emotional inhibition can be prevented by the family physician's interventions. Spouses should be actively involved in the rehabilitation program from the outset. The physician should listen for the spouses' feelings and explore their perceptions of the illness. They should be involved through followup.

The course and determinants of reactions to myocardial infarction

The growth of speculative theories about response to physical illness has not been backed by quantitative information. The introduction of standardized measures of psychological and social adjustment has allowed description and analysis of disability for 100 patients and their spouses two and twelve months after a first myocardial infarction. (1) Global measures of social outcome were found to be inadequate and misleading and therefore work, leisure, marriage and family relationships, sex and compliance were separately examined. (2) There was considerable continuity in individual reactions throughout convalescence and it was possible (3) to identify factors in the premorbid psychosocial state predictive of outcome and (4) to describe characteristic patterns of coping. (5) Outcome for spouses can be similarly described and understood. The findings have clinical applications for diagnosis, prophylaxis, treatment and the evaluation of medical care. The conclusion also extend our understanding of the basic principles underlying response to physical illness.

Psychological rehabilitation after myocardial infarction

The value of psychological counselling in rehabilitating patients after myocardial infarction was assessed. A total of 143 men who had recently had a myocardial infarction were randomly allocated to either a group receiving intensive rehabilitation or a control group, their outcome being examined after six months. Patients with neurotic, introverted personalities had a poor outcome in the control group but a satisfactory outcome when rehabilitated. Neurotic personalities responded to help, and rehabilitative measures did not increase neurosis. In addition all patients with a negative attitude towards their illness and future had a poor outcome but those with a positive attitude did well. Selection by simple methods of patients who would benefit from psychological rehabilitation seems desirable.