Factors influencing uncertainty and health status outcomes in coronary artery bypass graft surgery patients

Burke, Catherine M. (2003) Factors influencing uncertainty and health status outcomes in coronary artery bypass graft surgery patients. Masters thesis, Memorial University of Newfoundland.

[English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (17MB)

Abstract

The purpose of this study was to examine the pattern of recovery up to 6 weeks in patients post-CABG surgery who were under the care of an acute care nurse practitioner (ACNP) while in hospital and to explore relationships among variables as hypothesized in Mishel's theory of uncertainty in illness. -- A repeated measures design was used to investigate changes in symptom distress, uncertainty, and health status outcomes over three time periods (48 to 96 hours post CABG surgery, 1 week after discharge, and 6 weeks after discharge). The relationships among four antecedent variables in Mishel's theory (symptom distress, coordination of care, patient participation in care with the ACNP, and patient education level), and uncertainty and physical and mental health status were also explored along with the best predictors of uncertainty and health status outcomes. -- Participants in this study (n =51) were comparable to other study samples in terms of age and gender, marital status, work/retirement status, and most surgically related variables, but differed on level of education and number of grafts. In terms of recovery over time, patients had significantly less symptom distress at 1 and 6 weeks compared to in-hospital scores. Likewise, physical health status (as measured by the PCS of the SF-36) was significantly improved by 6 weeks, but there was no improvement in mental health status (as measured by the MCS of the SF-36). Total uncertainty scores that were in the moderate range did not change significantly over time. Patient participation in care and coordination of care scores were reported as high by patients. -- Results indicated that the predicted relationships in Mishel's theory of uncertainty in illness were supported by the findings in this study with the exception of education level, which was positively associated with in-hospital symptom distress but not associated with uncertainty. At 1 week, the best predictors of uncertainty were in-hospital uncertainty and coordination of care, explaining 39% of the variance. As well, higher patient participation in care was associated with lower symptom distress and higher perceived coordination of care at 1 week. The best predictor of physical health at 1 week was symptom distress (r = -0.41). No variables were found that significantly predicted mental health at 1 week. At 6 weeks, 56% of the variance in uncertainty was explained by symptom distress at 6 weeks and uncertainty scores at 1 week. Physical health at 1 week and symptom distress at 6 weeks explained 67% of variance in physical health at 6 weeks. Mental health status at 1 week was the best predictor of mental health at 6 weeks. -- In conclusion, findings suggest that the ACNP may have an indirect influence on uncertainty through his/her role as coordinator of care. As well, symptom distress at 1 and 6 weeks were significant predictors of physical health status, a finding that has implications for early assessment and intervention. Mental health did not improve in this study, nor did any variables predict mental health suggesting that other variables not studied influenced mental health post-CABG surgery.

Actions (login required)

View Item