The relationship between uncertainty and coping after coronary bypass surgery

Understanding Uncertainty Among Critically Ill Patients in the Intensive Care Unit Using Mishel's Theory of Uncertainty of Illness

BACKGROUND

The concept uncertainty has been explored in critical care but only among patients with myocardial infarction and post-cardiac catheterization using the Uncertainty in Illness Theory. Uncertainty is also a finding of numerous studies conducted in intensive care units (ICUs) that included only family members as participants of the research.

OBJECTIVES

The purpose of this article is to explore, describe, and understand the concept of uncertainty among patients and family members during critical illness in the ICU from the perspective of a phenomenological study with support from other studies published in the literature using Mishel's Theory of Uncertainty in Illness.

METHODS

The concept "uncertainty" as the topic for this article is one of the specific themes illuminated from a qualitative phenomenological study conducted in the ICU in 2010. Five from each category of patients, family members, and nurses were interviewed until data saturation was achieved. The data were analyzed using van Manen's wholistic, selective, and detailed line-by-line approach until themes were illuminated.

RESULTS

Uncertainty is a patient-specific theme illuminated in this qualitative phenomenological study not noted among the family members. The patients perceived that they "do not know what is going to happen," "if they are progressing or not," or "if they will make it or not."

DISCUSSION

Uncertainty among patients related to critical illness should be further explored. Patients with different critical care diagnosis should be included as participants.

The experience of caring for a partner with young onset dementia: how younger carers cope

A growing body of literature suggests that the social context of experiencing dementia at a younger age may influence carers' and particularly partners' subjective experience and coping strategies. The current paper aims to explore the coping strategies adopted by six carers in order to adapt to changes in their relationship with their partner with young onset dementia. All were recruited from the north west of England and interpretative phenomenological analysis was used to analyse the data. Four major themes were evident: (1) 'this is not happening': the use of denial as a coping strategy; (2) 'let's not have anymore of this demeaning [treatment]': stigma in young onset dementia; (3) 'I've had to fight every inch': struggling to maintain control of events and emotions; (4) 'what will become of me?': carers' adaptation to loss. Comparisons with existing literature are made and implications for clinical practice are considered.

A comparative study of uncertainty, optimism and anxiety in patients receiving their first implantable defibrillator for primary or secondary prevention of sudden cardiac death

BACKGROUND

Increasingly, patients are receiving implantable cardioverter defibrillators (ICDs) for prevention of sudden cardiac death. ICDs are implanted for primary prevention (patients at risk for ventricular arrhythmia [PP]) and secondary prevention (patients who have had/survived a sustained ventricular arrhythmia or cardiac arrest [SP]). Few prospective studies have examined psychosocial factors associated with these patients.

OBJECTIVES

To determine if patients receiving their first ICD for PP versus SP differed in uncertainty, anxiety, and optimism, before, 1 week, and 1 month after implant.

DESIGN

Prospective, descriptive, correlational pilot.

PARTICIPANTS AND SETTING

Fifteen PP and 15 SP patients receiving their first ICD were enrolled. Mean ages (+/- SD) were 65.7+/-11.3 and 67.9+/-7.7 respectively.

METHODS

Mishel's Uncertainty in Illness Scale (MUIS-C), State-Trait Anxiety Inventory (STAI) and the Life Orientation Test (LOT-R) were taken pre-implant, at the first post-implant visit, and at 1 month. Measures were compared using Student't-tests and ANOVA.

RESULTS

Pre-implant, both groups had moderately high MUIS-C scores (mean+/-SD; PP=67.67+/-13.36; SP=70.27+/-6.80; t=0.67; t(df)=28; p=0.507). LOT-R scores were 15.67+/-3.8 for PP and 16.47+/-3.6 for SP; t=0.59; t(df)=28; p=0.557. Pre-implant state anxiety scores were (mean PP=37.40+/-10.0, SP=37.73+/-13.6; t=0.076; t(df)=28; p=0.940). At 1-month PP patients had significantly lower uncertainty scores than the SP group (mean 62.33+/-4.17 versus 67.87+/-4.61; t=3.45; t(df)=28; p=0.002). A main effect for time, between pre-implant and 1-month, was found for uncertainty (F(2,56)=3.26; p<0.05) and state anxiety (F(2,56)=3.61, p<0.05), where both groups showed lower scores.

CONCLUSION

This study identified moderately high uncertainty in PP and SP patients prior to receiving their ICD. Though uncertainty was high, both groups reported an optimistic disposition and normal anxiety. At 1-month, SP patients had higher uncertainty scores than PP patients. This post-intervention uncertainty among patients who experienced an arrhythmic event warrants attention from nurses caring for ICD patients. Interventions to ameliorate uncertainty should be tailored to consider ICD indication.

Gender differences in coping and anxiety in patients after coronary artery bypass graft surgery in Taiwan

BACKGROUND

Greater use of coping strategies and lower anxiety levels may be related to positive outcomes after coronary artery bypass graft surgery; however, the relationship between them, including by gender, has not been examined in Taiwan.

METHODS

Cross-sectional survey research design and purposive sampling were used in this study, for which 50 men and 50 women were recruited from a medical center in northern Taiwan.

RESULTS

After coronary artery bypass graft surgery, both male and female patients used more problem-focused coping strategies than emotion-focused coping strategies. In comparison with men, women tended to use more blaming of self and had slightly higher scores on both state and trait anxiety.

CONCLUSION

Clinicians need to be aware that the use of appropriate coping strategies can reduce patient anxiety, a finding that needs to be considered when designing effective interventions for these patients.

Uncertainty in illness. An integrative review

The purpose of this article is to report an integrative review of uncertainty in the illness experience, describe the uncertainty in illness theory, and to discuss the importance of assessing the appraisal of uncertainty experienced in illness with individuals and families faced with illness.

The influence of coronary bypass graft surgery on the marital relationship and family functioning of the patient

The primary aim of this study was to assess the effect of coronary bypass graft surgery on certain aspects of the marital relationship and on family functioning of patients. The secondary aim was to determine which coping strategies families used postoperatively. An experimental pre- and posttest research design was used. We collected data using the Enriching and Nurturing Relationship Issues, Communication and Happiness Scale, the Family Adaptability and Cohesion Evaluation Scale II, and the Family Crisis Oriented Personal Evaluation Scales. The results indicated that bypass surgery had a negative effect on the patients' marital satisfaction, communication, and attitudes toward the division of roles in the marriage and family. Bypass surgery had a further negative influence on the emotional bonding of the patients and their spouses with other members of the family. The patients' adaptability regarding new challenges facing the family was also affected negatively. The patients who were still working also showed a greater decline in some of the measured variables than the retired patients. The coping strategies used most often by the families were the seeking of spiritual support and the reframing of the problem. The results also indicated that if passive appraisal was used as a coping strategy, the patients' marital satisfaction would decrease, and if reframing of the problem was used, the patients' adaptability regarding new challenges facing the family would increase.

The association of coping to physical and psychological health outcomes: a meta-analytic review

We performed a series of meta-analyses examining the associations between coping and health-related outcomes in nonclinical adult samples. Results revealed that problem-focused coping was positively correlated with overall health outcomes, whereas confrontive coping, distancing, self-control, seeking social support, accepting responsibility, avoidance, and wishful thinking were each negatively correlated with overall health outcomes. Neither planful problem solving nor positive reappraisal was significantly associated with overall health outcomes in our analyses. However, type of health outcome (i.e., physical vs. psychological) and situational characteristics (i.e., stressor type, controllability, and duration) moderated many of the overall associations.

Fear and anxiety in patients at different time-points in the coronary artery bypass process

The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients awaiting CABG, especially women and patients who do not have partner relationship.

Depression during exacerbations in multiple sclerosis: the importance of uncertainty

The following correlates of depression were examined in a sample of 166 patients with clinically definite relapsing-remitting (n=140) or secondary progressive (n=26) multiple sclerosis: (a) the present state of the patients' illness (i.e., whether or not they were currently experiencing an exacerbation of their symptoms); (b) their level of uncertainty concerning their illness; and (c) their strategies for coping with their illness. A current exacerbation in symptoms, greater uncertainty of illness, and greater use of emotion-centered forms of coping were all related to depression. Multivariate analyses revealed that uncertainty of illness played a pivotal role as a mediating variable. Exacerbations in illness appeared to heighten patients' levels of uncertainty, and it was largely through this heightened uncertainty that the increases in depression came about.

Lifestyle pattern change in males following percutaneous transluminal coronary angioplasty/intracoronary stenting

Utilizing a naturalistic inquiry approach, a semi-structured interview schedule and non-probability purposive sampling, this study provided detail on the rationale and influences behind the decisions of four males participants to change or not change their lifestyle patterns 3 months after a percutaneous transluminal coronary angioplasty/intracoronary stent procedure. One of the participants made a noticeable lifestyle pattern change in this period. The remaining participants failed to exhibit any discernible lifestyle pattern change or had continued with their previous behaviours. Results suggest a new 'positive' psychological health perspective, family considerations, return-to-work issues and a reluctance to participate in cardiac rehabilitation as the major factors influencing lifestyle pattern change. Because nurses spend the greatest amount of time with percutaneous transluminal coronary angioplasty/intracoronary stent patients during hospitalization, they have the best opportunity to provide up-to-date and relevant information to patients that will enable them to then make decisions concerning cardiac healthy lifestyle changes.

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.

Redefinition: coping with normal results from predictive gene testing for neurodegenerative disorders

The purpose of this qualitative study was to describe the psychosocial impact and coping processes of normal (negative) results from predictive testing for an inherited neurodegenerative disease. Ten adults with normal results of predictive testing for the Huntington disease (HD) or the Pallido-Ponto-Nigral Degeneration (PPND) gene mutation participated in semi-structured interviews 1 month after receiving results, and seven of these participants were interviewed 6 months later. The major theme of Redefinition was derived using Knafl and Webster's analysis method (1988). People who received normal gene results experienced loss of former beliefs about themselves and developed new self definitions, relationships with family, and roles in society. This coping process evolved from a personal focus at 1 month to a broader future perspective at 6 months after testing. Identifying components of the redefinition process may be an important consideration in planning interventions to promote coping with normal gene results in persons within at-risk families.

Uncertainty and expectations: taking care of a cardiac surgery patient at home

Family members of postsurgical patients are, by necessity, taking on the caregiving role sooner without any specified resources to help them. The input of these caregivers is essential so nurses can understand their concerns, needs, and struggles and develop strategies to support the caregivers in their caregiving role. This study was designed to increase nursing knowledge regarding the experiences of being a caregiver of a cardiac surgery patient during the immediate postdischarge period. The qualitative research method of Interpretative Description, first described by Thorne, Kirkham, and MacDonald-Emes in 1997 guided the study. In-depth interviews were held with eight spousal caregivers. Findings revealed that the experience was molded by caregivers' past participation as a caregiver, as well as caregivers' and care recipients' outlook on life, their interpersonal relationship, and their expectations. Caregivers engaged in the process of caregiving that involved being vigilant and monitoring the care recipient's recovery, implementing strategies to assist the recovery process, and taking on a role to provide care and seek help as required. The encounter with caregiving affected all realms of caregivers' lives, and they experienced feelings of stress, vulnerability, and having to put their lives on hold; these feelings were often compounded by uncertainty.

Facing uncertainty and possible death: the Christian patients' experience

This paper presents the hospital experience of a group of coronary artery bypass graft surgery patients. A description of the qualitative methodology is given. The participants' experience was identified as facing uncertainty and possible death. Excerpts from interviews are given. The participants coped with the situation by praying or having others pray on their behalf. Their uncertainty and possible death was affected by the conditions of: available support; environment; credible authority; information; belief; and their psychophysiological status at the time.

Information needs, uncertainty, and anxiety in women who had a breast biopsy with benign outcome

A retrospective, descriptive study to determine the information needs of women who underwent a breast biopsy with a benign outcome and to ascertain the levels of uncertainty and anxiety they experienced was conducted in two community health care sites in Winnipeg, Manitoba. A sample of 70 women completed a four-part survey after learning the benign breast biopsy diagnosis. The survey consisted of an Information Needs Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, State-Trait Anxiety Inventory, and a Demographic Questionnaire. Before the study, nine information needs were identified in a focus group composed of women (n = 9) who had a benign breast biopsy. The nine information needs were arranged in 36 pairs in the Information Needs Questionnaire. Profiles of information needs were developed through Statistical Analysis Systems analysis using Thurstone's Law of Comparative Judgement--Case V. The most important information need of women who underwent a benign breast biopsy was knowing when they would learn the diagnosis. The next four information needs were categorized as information about the risks of developing breast cancer. Information about follow-up and diagnostic tests were less important than information about the threat of breast cancer. Women experienced heightened uncertainty and anxiety levels related to the benign breast biopsy experience. Profiles of information needs were developed for women experiencing various levels of uncertainty and anxiety, women of different age groups, and women who experienced with a loved one with breast cancer.

Gaining a new perspective on life as a consequence of uncertainty in HIV infection

HIV infection affects the lives of hundreds of thousands of North Americans. The experience of those infected is one of enormous upheaval. An HIV diagnosis can disrupt both daily life and the ability to plan for the future. Central to this experience is the uncertainty of a disease with vague symptomatology, changing medical management, and social stigma. This qualitative study explores the experience and consequences of uncertainty in the lives of 10 people with HIV infection. In-depth focused interviews were conducted to explore uncertainty after HIV diagnosis. Findings reveal that individuals living with HIV infection form a new perspective on life, which is maintained through five core experiences: surviving the HIV diagnosis, taking care, living in the present, seeking support, and appreciating the positive. Each core experience is comprised of a number of actions used by the individual to formulate and maintain the new perspective on life.

A comparative analysis of coping behaviors in persons with multiple sclerosis or a spinal cord injury

Coping behaviors in individuals with multiple sclerosis (MS) or a spinal cord injury (SCI) were compared. Data were collected on 433 subjects with MS and 257 with SCI. Coping and illness uncertainty were measured by the Ways of Coping Checklist (revised) and the Mishel Uncertainty in Illness Scale. Results of the multivariate analysis of covariance indicated that there was no significant difference between the groups for the use of emotion-focused coping (EFC) or problem-focused coping (PFC). However, there was a significant difference in coping depending on illness uncertainty and the appraisal of life with a disability. Subjects used more EFC at high uncertainty and more PFC at no uncertainty compared to the other levels. When situations were appraised as dangerous, EFC was used more often, and when situations were appraised as an opportunity, PFC was used. The construct of vulnerability emerged as an important antecedent variable. When vulnerability was not included in the analysis, a spurious difference in EFC was found between the groups. Multiple regression results indicated that, for both groups, the choice of coping strategies had no significant effect in explaining emotional well-being while controlling for selected sociodemographic and disability-related variables.

Symptoms reported by older and middle-aged adults after coronary bypass surgery

Knowledge of the most prevalent symptoms after coronary artery bypass surgery (CABS) can be used to assist patients to anticipate recovery. The purposes of this study were to describe the prevalence of symptoms during the first 6 weeks after CABS, to assess changes in the number and types of symptoms, and to compare symptoms in older and middle-aged adults. The most prevalent symptoms during hospitalization (Time 1) were pain, edema, wound drainage, fever, and fatigue. In the third through fifth postoperative weeks (Time 2), the most prevalent symptoms were pain, edema, sleep problems, fatigue, and wound drainage. At 6 weeks (Time 3), sleep problems, edema, pain, fatigue, and shortness of breath were the most common. Number of symptoms decreased significantly between Times 1 and 3. All symptoms were more prevalent at Time 2 than at Time 1 and less prevalent at Time 3, with the exception of sleep problems, which were reported more frequently at Time 3 than at Time 1. The most persistent symptoms were edema, fatigue, sleep problems, pain, and shortness of breath. Significantly more middle-aged adults than older adults reported anxiety at Time 2. No other age-related differences were found. Implications for nursing practice and research are discussed.