Preoperative self-efficacy and postoperative behaviors

Family support, perceived self-efficacy and self-care behaviour of Turkish patients with chronic obstructive pulmonary disease

AIM

The purpose of this study was to describe family support, self-efficacy perception and self-care behaviour among patients with chronic obstructive pulmonary disease and to ascertain the relationship between these variables.

BACKGROUND

It is important to work at improving confidence in the patients' ability to follow a self-care regimen by increasing self-efficacy. Family support also plays an important role in self-care activities.

METHOD AND DESIGN

The study design is descriptive and correlational. Of 230 patients with chronic obstructive pulmonary disease who were recruited for the study, 200 agreed to participate. The patients were recruited by the first author from an outpatient clinic in the Department of Chest Disease of a university hospital and a pulmonary hospital in Erzurum, eastern Turkey. Data were collected by using a demographic data form, the Perceived Social Support from Family Scale, the Chronic Obstructive Pulmonary Disease Self-efficacy Scale and the Alberto Chronic Obstructive Pulmonary Disease Self-care Behaviour Inventory.

RESULTS

Although most participants (91.5%) perceived that they had family support and more than three quarters (73.0%) of the participants engaged in an adequate amount of self-care behaviours, only twenty five participants' (12.5%) perceived self-efficacy as high. There were statistically significant positive relationships between family support and self-care behaviour (r=0.302; p=0.01) and between self-efficacy and self-care behaviour (r=0.186; p=0.01). There was also a statistically significant positive relationship between family support and self-efficacy (r=0.412; p=0.01).

CONCLUSION

The results of the study demonstrated weak to moderate, but statistically significant, relationships between family support and self-care behaviours, self-efficacy and self-care behaviour and family support and self-efficacy in Turkish patients with chronic obstructive pulmonary disease.

RELEVANCE TO CLINICAL PRACTICE

The assessment of the family support, self-efficacy and self-care behaviours of the patients with chronic obstructive pulmonary disease should be an essential part of nursing practice. The study also provides the foundation for the conduct of future studies of self-care training for managing patients with chronic obstructive pulmonary disease.

[Chronic pain and the belief in self-efficacy]

The treatment of chronic pain patients includes beliefs, attitudes, values and behavior modifications. Dysfunctional beliefs about pain and management can become the central problem and determine the treatment's outcome. Among the important beliefs for the management of chronic pain, self-efficacy deserves to be highlighted. The concept of self-efficacy, developed by Bandura, is the belief on the individual ability to perform successfully certain tasks or behaviors in order to produce a desired outcome. This study is a critical review of the literature on the belief of self-efficacy related to chronic pain and about the methods to assess self-efficacy. Studies listed in Medline (1992 to 2002), Lilacs and Dedalus (the entire databases) were analyzed. The key words were pain and self-efficacy, dor and auto-eficácia.

Effect of education on self-efficacy of Turkish patients with chronic obstructive pulmonary disease

This study was designed to compare the effect of structured education on self-efficacy in patients with chronic obstructive pulmonary disease (COPD). The study was carried out with an experimental group on which a structured education was provided, and a control group on which only educational advice was provided. There were 30 patients in both groups. Control and experimental group measurements were obtained on the COPD Self-Efficacy Scale (CSES). There was a significant difference between control group and experimental group scores on the CSES. Self-efficacy, as it affects managing or avoiding breathing difficulty, was measured before and after the structured education program and the nursing care. Patients' self-efficacy scores significantly improved after the structured education and remained significantly improved 1-month later. Standard nursing care alone was also effective in significantly improving self-efficacy scores, but patients' scores 1-month later were not significantly better than pre-program scores. This study indicates that a planned education program that is more effective in improving self-efficacy in patients with COPD.

Preoperative teaching and hysterectomy outcomes

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Body image and quality of life after head and neck cancer surgery

OBJECTIVES

The purpose of this paper is to describe the process of body image reintegration as it relates to quality of life in the surgical head and neck cancer patient.

MATERIALS AND METHODS

To illustrate the course of body image reintegration after head and neck cancer surgery, the results of two major studies are presented. In the first study, a cohort sample of 75 adults about to undergo disfigurative surgery for head and neck cancer was examined to determine levels of anxiety before and after the procedure. The State Trait Anxiety Inventory was administered before and after surgery on postoperative days 4 through 6. In the large study, from which the cohort sample was derived, 117 adults about to undergo disfigurative surgery were investigated to determine the relationship between coping with surgical disfigurement/dysfunction and length of hospital stay. The Ways of Coping Checklist was administered before surgery. Disfigurement/dysfunction, as measured by the Disfigurement/Dysfunction Scale, and postoperative coping behaviors, as measured by the Coping Behaviors Score, were accounted for in both samples. Self-care and resocialization behaviors were observed and measured on postoperative days 4 through 6.

RESULTS

In the cohort study, anticipation of disfigurative facial surgery was associated with extremely high levels of anxiety. In the large sample, coping effectiveness was diminished. The degree of surgical deficit ranged from mild to severe disfigurement and dysfunction. Preoperative coping effectiveness predicted postoperative coping behavior. It was concluded that body image reintegration was characterized by self-care, resocialization, and reduced anxiety. Further, that these components, when taken together, constitute assimilation of the surgical defect into self.

CONCLUSIONS

Body image reintegration is critical to subsequent quality of life after head and neck cancer surgery. When disfigurement/dysfunction is associated with treatment, quality of life may be profoundly and adversely affected. Findings from the studies presented indicate a significant correlation between postoperative self-care and reduction in level of anxiety. The implications of this findings are important to care during the early period after surgery and to long-term follow-up after hospital discharge.

Effects of extended preoperative information on perioperative stress: an anaesthetic nurse intervention for patients with breast cancer and total hip replacement

An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre- and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P < 0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information.

Postoperative education that works

Perioperative nurses have acquired greater responsibility for patients' and family members' postoperative education. Recent nursing research indicates that patients may not be getting specific information about dealing with the everyday practical matters they encounter while recovering at home from their surgical procedures. This article addresses some of these issues (e.g., food, sex, driving, bathing, wound care, return to work, limits on activities). The authors answer questions most often asked by patients and their family members.

Self-efficacy enhanced preoperative instruction

Perioperative nurses traditionally have helped patients cope with the adversities of surgery through preoperative instruction. The authors conducted a study to determine whether an efficacy-enhancing preoperative teaching protocol was effective in increasing preoperative self-efficacy in patients scheduled to undergo laparoscopic cholecystectomy procedures with general anesthesia. The subjects were 60 surgical patients in a 156-bed community hospital located in the midwestern United States. Analysis of covariance indicated there were no significant differences between groups after controlling for preoperative self-efficacy. Further research is needed to determine whether an efficacy-enhancing teaching protocol can improve selected short- and long-term outcomes in surgical patients.

The role of self-efficacy in assisting patients with chronic obstructive pulmonary disease to manage breathing difficulty

The purpose of this study was to examine changes in self-efficacy after attending a pulmonary rehabilitation program. Twenty-nine subjects with chronic obstructive pulmonary disease (COPD) were enrolled in the program, which was designed to increase patients' confidence in their own ability to manage or avoid breathing difficulty in certain situations. Results showed a significant improvement (p < .05) in scores on the COPD Self-Efficacy Scale between preprogram and postprogram attendance. These findings were still evident at 6 months following program attendance. Incorporation of self-efficacy theory should be considered in the rehabilitation of individuals with COPD.

Evaluating a revised self-efficacy scale for preoperative patients

Nurses conduct preoperative teaching to help patients cope with the adversities of surgery. Self-efficacy can predict an individual's behavior in aversive situations (eg, surgery); therefore, assessing patients' self-efficacy is one way perioperative nurses can plan patient care and help patients through the surgical experience. This study expands on the results of a previous evaluation of a preoperative self-efficacy scale. The content and face validity of the revised 15-item scale used in this study were assessed before the instrument was administered to preoperative patients. Evidence supports the validity of the multidimensional instrument. Internal consistency estimates > or = .84 support the subscales' reliability.

Evaluation of a self-efficacy scale for preoperative patients

Self-efficacy has been validated as a predictor of an individual's behavior in aversive situations. Traditionally, nurses have conducted preoperative instruction to help patients cope with the adversities of surgery. Assessing patients' self-efficacy is an additional way to assist them through the experience of surgery and plan their care. This study developed and tested an instrument to measure self-efficacy in adult preoperative patients. The instrument consists of two subscales: a 16-item efficacy expectation subscale and a 16-item outcome expectation subscale. The instrument was administered to 200 surgical patients to obtain descriptions of item characteristics, internal consistency reliability, and beginning construct validity. Evidence supports the validity and reliability of both self-efficacy subscales. The revised instrument can assist perioperative nurses in assessing preoperative patients' self-efficacy.