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Women’s perceptions of their illness experience with myocardial infarction Dunn, Penelope Claire 1985

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WOMEN'S P E R C E P T I O N S  OF  THEIR  WITH M Y O C A R D I A L  ILLNESS  EXPERIENCE  INFARCTION  By Penelope B.Sc.N.,  The U n i v e r s i t y  A T H E S I S SUBMITTED THE  Claire  Dunn  of Western O n t a r i o ,  IN PARTIAL FULFILLMENT  REQUIREMENTS  FOR  THE  MASTER OF S C I E N C E  DEGREE  I N NURSING  in THE  FACULTY  OF GRADUATE  The S c h o o l  We  accept to  THE  this  of Nursing  thesis  as  conforming  ijhe r e q u i r e d . s t a n d a r d  U N I V E R S I T Y OF October,  ©  STUDIES  Penelope  BRITISH  COLUMBIA  1985  Claire  Dunn,  1985  OF  1976 OF  In  presenting  degree freely  at  this  the  available  copying  of  department publication  of  in  partial  fulfilment  of  the  University  of  British  Columbia,  I  agree  for  this or  thesis  reference  thesis by  this  for  his thesis  and  scholarly  or for  her  of  T h e U n i v e r s i t y of British 1956 M a i n Mall Vancouver, Canada V6T  DE-6(3/81)  1Y3  Columbia  1 further  purposes  gain  be  It  is  shall  that  agree  may  representatives.  financial  permission.  Department  study.  requirements  not  that  the  Library  an  by  understood allowed  advanced  shall  permission  granted  be  for  the that without  for head  make  it  extensive of  my  copying  or  my  written  ABSTRACT This their  illness  purpose this  study  of  was  experience  exploring  illness  to  direct  The  data  were  years  age.  husbands.  from  hospital  analysis once data  Women  within  myocardial prominent  to  rehabilitation their  loss  and  everyday  for  the  meaning  of The  qualitative  research,  was  a  semi-structured  were  illness  need not  cardiac and a for  home  and  and  following  validated  sets  with  central  selected  for  women  is  information lack  of  data ceased  and  the  a  heart  the  stage  for  gain  myocardial  loss  of  following is  a  attack. potential  especially  enactment. to  dominant  energy  after  strategy  women w i t h  and  myocardial  and  rehabilitation, role  with  in-depth.  the  life  71  discharge  collection  experience  and  36 t o  living  collection  and  for  met  women w e r e  data  experience  socialization  support  experience  rich  everyday  women's  not  and  of  married  identified  attack  in  The  Data  phenomenon and  is  series  at  14 w e e k s .  their  role  is  been  sufficiently  feature  in  infarction  of  life.  women w e r e  Women's  sex  perceptions  nature  on  women.  simultaneously  infarction  Traditional  relation  2 to  heart  predictability.  problems  women h a d  loss  the  eight the  themes  a  of  through  The  were  as  the  impact  type  of  explain  infarction loss  with  proceeded  collected  a  Six  for  consistent  myocardial  its  compiled  interviews  their  and  women's  study.  intensive of  elicit  describing  method,  the  to  with  and  experience  phenomenological used  designed  in  Physical control  infarction.  over  The of  findings  implications  for  myocardial  relation the  to  value  patients  increase and  to  help  women  psychological has  specific  cardiac  meet  There the  of  This  loss  for  programmes  study  care  focus  and  family  women in  reinforces care  for study  women  with  Interventions  educational  needs, and  This  study  development the  to  physical  infarction.  addressing  of  this  normal  the  direction  to  for  on  number  problems  and g r i e f  nursing should  a  clear  Also,  myocardial  implications  is  potential  anticipate  to  suggest  rehabilitation  address  patient  to  rehabilitation  study  infarction.  nurses  responses  this  enactment.  planning  support,  in  concepts  infarction,  to  also  the  in  to  role  myocardial  that,  myocardial  care  infarction and  of  practice.  nursing  using  with  conclusions  nursing  support of  indicates  of  structured  special  needs  women. In  to  for  family-centered  with  of  and  relation  assess,  infarction directs  equip  and  issues nurses  changes  in  and  their  to  support,  and  counsel  families.  sensitize  nurses  the  further  strategies  infarction.  patients  provide to  this  care.  control  with  work  field  necessary  of to  Implications  exploration for  must  importantly, course  understanding  health  nurses  Most  to  women's  include  education,  educators  with  research  myocardial  nursing  teach,  nursing  health  to  of in  be  prepared  myocardial this in  study  women's  study  and  to  facilitate for  future  information  needs,  relation  to  women _  with  i v  TABLE OF CONTENTS ABSTRACT  i i  TABLE OF CONTENTS  iv  L I S T OF FIGURES ACKNOWLEDGEMENTS CHAPTER 1  13 14 18 21 23  METHODOLOGY  I n t r o d u c t i on S e l e c t i o n of P a r t i c i p a n t s Criteria forSelection S e l e c t i o n Procedure Data C o l l e c t i o n C o n s t r u c t i o n of Accounts Data A n a l y s i s Ethical Considerations Summary CHAPTER 4  1 ...6 7 8 8 10 10 11  REVIEW OF SELECTED LITERATURE  I n t r o d u c t 1 on Women W i t h MI: R e s e a r c h D i r e c t l y S t u d y i n g Women Women w i t h MI: S t u d i e s I n c l u d i n g Women MI a n d P a t i e n t P e r c e p t i o n s Summary CHAPTER 3  v i i  INTRODUCTION  Background to the Study C o n c e p t u a l Framework Problem Statement Purpose of the Study I n t r o d u c t i o n t o t h i s Study's Methodology D e f i n i t i o n o f Terms Assumptions and L i m i t a t i o n Summary CHAPTER 2  vi  24 24 25 .....25 26 28 29 30 31  PRESENTATION OF THE STUDY'S FINDINGS  I n t r o d u c t i on The S t u d y ' s A n a l y t i c Framework C h a r a c t e r i s t i c s of the P a r t i c i p a n t s The Women's P e r c e p t i o n s o f T h e i r I l l n e s s E x p e r i e n c e Loss of Healthy State Loss of P r e d i c t a b i l i t y Lack of Energy Lack of A n t i c i p a t e d Support Change i n U s u a l R o l e E n a c t m e n t Strategies f o r Control Summary  32 32 35 36 36 40 47 51 61 67 73  CHAPTER  5  DISCUSSION  OF THE  FINDINGS  I n t r o d u c t i on MI a s a L o s s P h e n o m e n o n Loss of Healthy State Loss of P r e d i c t a b i l i t y Lack of Energy Lack of A n t i c i p a t e d Support Change i n U s u a l R o l e E n a c t m e n t Strategies f o r Control Summary CHAPTER  6  SUMMARY, C O N C L U S I O N S , AND  I n t r o d u c t i on Summary o f t h e S t u d y C o n c l us i ons Implications f o r Nursing Implications f o r Nursing Implications f o rNursing Summary  75 76 77 79 84 86 94 95 97 I M P L I C A T I O N S FOR  Practice Education Research  REFERENCE L I S T  NURSING 98 98 102 103 105 106 106 108  APPENDICES Appendix Appendix Appendix Appendix  A B C D  Patient Information Letter C o n s e n t Form Sample I n t e r v i e w Q u e s t i o n s Key t o B l o c k Q u o t a t i o n s  114 115 116 117  L I S T OF  Figure  1  The S t u d y ' s  Analytic  FIGURES  Framework  ACKNOWLEDGEMENTS I  would  women  who  experience For to and  thank  like so  willingly  with  myocardial  their kind my t h e s i s  Dr. Margaret I  family,  would  Bruce  Finally,  Bovey  typing  of this  and  openly  gratitude shared  to the  their  eight illness  i n f a r c t i o n t o h e l p o t h e r women.  support committee  like  and s c h o l a r l y members,  Dunn, to this I would  t o express Stephanie  counsel,  I would  C l a r i s s a P. G r e e n  like  (chair)  my l o v e  and a p p r e c i a t i o n  Dunn, a n d W i l l i a n Dunn  t o my  fortheir  endeavour. like  for her friendship  Angela  my s i n c e r e  Campbell.  also  contributions  Streuser  to extend  to say a special i n the writing  thank  of this thesis  f o r e f f o r t and commitment beyond manuscript.  you t o  request  Hallna and t o i n the  CHAPTER 1 I n t r o d u c t i on  Background Statistical that  myocardial  men  only,  obscures  that  health  in  accounts 1981;  was  enormity For  that  of  sex  rise  the  f o rboth  19,552  of this  men.  the  i n t h e 65-69  increase  in  declines  10,858 These  cause  particular, (Szklo,  1982;'Statistics f o r 1982 due  female  deaths  numbers  of the problem  year  80-84,  confirm  with  increment  d u e t o MI  age group  Canada  age because In  i n mortality rate  i s s i m i l a r to in  women  and continues  a n d 85+ a g e g r o u p s , t h e  (Statistics  decrease age  major  problem.  f o r t h e 75-79,  The s e x r a t i o s  MI,  The number o f d e a t h s  are minimal  i n women,  mortalities  1982, p.68).  health  problem f o r  the leading  & Brody,  and  myth  MI a s a  number o f d e a t h s  deaths  women, t h e m a g n i t u d e  so that  accelerated  The t o t a l male  dramatically  of  health  i n men t h a n  and  for  This  Despite recent  sexes  myth  problem  MI.  establishes  Feinleib,  Canada 84-203,  older  slope  of this  number o f t h e s e  Palesch,  differences  p.69).  to  i s much m o r e common  1982).  older  increases to  MI  f o rthe greatest  (Statistics the  and s i g n i f i c a n c e  Canada  Patrick,  MI  are invulnerable  believed  health  ischemic heart disease remains  Canada 84-206, to  (MI) i s a potent  f o r men a n d f o r women.  rates,  death  t h e commonly  of the mortality rates  problem  in death of  women  Although  examination  refutes  infarction  the r e a l i t y  women. an  evidence  to the Study  men,  with  84-203,  1982,  of a decrease i n rather  a g e i n women  than  an  (Szklo,  1981). Generally,  these  significance  of  documenting  the  emphasizing  that  illness health An  of  perspective The  risk  problem  of death  of  morbidity  by  lives  lost  and  of  this  i s the r e l a t i o n s h i p of  this  to  i s a prominent  ln  examine  women  Therefore,  (Fogel  are  morbidity  &  putting  lower,  statistics  give  in  health  women  into  problems. is  and m o r t a l i t y  1981).  men  problems?  statistics  morbidity  while  health  MI  health  Woods,  feature  f o r common  morbidity  r e l a t i o n s h i p between  rates  of  statistics  assists  the  women  o f t h e number  MI  i n women t o women's o t h e r  women  and  of  support in  a m o n g women's r e c o g n i z e d  paradoxical  mortality  statistics  However, what  reason  men  health  magnitude  o f MI  examination  problems  for  this  experience. problem  mortality  a more  rates  For  exhibit  the  women,  the  reverse.  complete  picture  w h e n d i s c u s s i n g women's h e a l t h . Hospital associated  morbidity  with  impressive  16,811  Canada  women  hospitalized  with This  health  In nature  82-206,  MI  in  further  problem.  women who m u s t c o p e cardiac  i s that  with  f o r health  & Woods,  1978). breast  closely  example,  most  that  MI  recent is  an  are a substantial  the process  usually  of rehabilitating  The  parallel there  c a n c e r a n d 14,379  the  Implies There  are  For  1978,  problems  1981) were r e v i e w e d .  t h e numbers  h o s p i t a l i z e d with  statistics. women's  women ( F o g e l  finding  (Statistics  statistics  were women  available Important number o f ;  from  this  statistics,  the  event. a d d i t i o n t o the m o r t a l i t y and morbidity of  the i l l n e s s  experience  itself  imparts  an  important  significance. extreme  The  uncertainty  consequences  of  contribute  this  The  this  suddenly,  is  A feeling  one o f  of  and  describes  integral  differential Edwards, If  the  to  this  is  (Hurst,  a period  little  excruciating  with  of the  event  III,  o r no w a r n i n g .  and  that  unrelenting something  the  chest  is  so  a necessary  King  type  of  care  precarious  intensive  is  to  time  another  intensive  care,  consequences  of  pain.  Is How  characteristic  component  Walter,  of  the  Friesinger &  initial care  phase o f  follows.  monitor p a t i e n t s  the  The  closely  infarction,  and/or  threaten.  during  individual  heart  complications,  Following  attack:  then the  is  this  and  this  of  the  especially period  faced  physical  illness  rationale  p o s t - i n f a r c t i o n when e x t e n s i o n  the  the  this  of  arrhythmias,  with  of the  psychosocial  of MI.  The a f t e r m a t h  of  complex and d i f f i c u l t Doehrman, physical  1977; and  psychosocial heart.  with  accompanies  it  individual survives  infarction,  impact  living  pathophysiological  MI p a i n e p i s o d e  MI t h a t  diagnosis  experience,  fatal  period  1982). an  highly  the  i m p e n d i n g doom,  wrong, c h a r a c t e r i s t i c a l l y  of  the  significance.  symptom  patient  and t h e n ,  life-threatening  predominant pain.  way MI p r e s e n t s ,  follows,  MI o c c u r s  the  for  that  Typically,  chest very  to  dramatic  MI i s  w i d e l y viewed  experience  Wilson-Barnett,  psychosocial responses  Because  (Croog,  the  is  1979),  effects. the  heart  is  i n the  literature  Levine, & Lurie, encompassing One  reason  a  1968;  profound for  s y m b o l i c meaning a t t a c h e d commonly s y m b o l i z e d as  as  to  the  the the "seat  of  our emotions"  and as  life-threatening dimension This  is  event,  added  to  symbolization,  death,  contributes  attack. literature  as  one  predominate  (Cay,  1977).-  It  is  to-day  living  feelings  of  the r e a l  to  the  of  with  women.  on  men;  illness  feelings  of  & Philip,  that  this  the  direct  the  on l i f e s t y l e  The  for  extensive  h e a l t h care  is  assumed care  of  women's  experience  illness  situation is  an  dissatisfaction health  activists.  i n the  to  the MI  that  it  however, it  relates  under  research  explore  women's  and c o n c e r n s  using in  studies care  identifiable  relates  of  women  on men  that need  is to  to not  study  with MI. health sciences  illustration with  lifestyle  date,  subsumed  needs  women may r e s u l t an  the  following  on MI as To  studies  be r e p r e s e n t e d ,  exists  day-  professionals.  women a r e  the  the  the  linked  work d i r e c t l y s t u d y i n g MI as  Because to  plus  experience  and w r i t i n g  a d e a r t h of  in  precipitate  is  literature.  generally,  heart  depression  f r e q u e n t l y means  illness  research  There  above  reality  impact  this  a  Cassem & H a c k e t t ,  of death  and  appropriate.  The  threat  attack  experience. be  1972;  fearsome  to  a n x i e t y and  A heart  been l i m i t e d  cannot  sudden  in which  with  there  of  been d e s c r i b e d  suggested  Instead,  threat  has  Vettner,  a  1977).  response  men i n t h e h e a l t h s c i e n c e s  to  Hackett,  this  a challenge  has  &  MI,  psychological  responses  anxiety.  is  when an  compelling  coupled  presents  there  a  (Cassem  of d e p r e s s i o n .  to  occurs,  life,"  the e x p e r i e n c e  feelings  There  " f o u n t a i n of  psychosocial  The n a t u r e  adjustment  the  women's  of  one  of  h e a l t h care  The p r e d o m i n a n c e o f  the  literature the voiced  described  reasons by  for  women's  male p e r s p e c t i v e  to  the  apparent e x c l u s i o n of the p e r s p e c t i v e  a research accurate  bias. data  concerning  Marieskind and  the  ( 1 9 8 0 ) r e m a r k s on t h e p a u c i t y  limited  validity  h e a l t h s t a t u s o f women  nursing  literature,  research  has p a i d  as a s e p a r a t e  the  Stevenson  little  of  what  does  i n general.  t o study  studying  describing  the p a t i e n t s ' views of t h e i r  t h i s area  i s by e x p l o r i n g  and  i l l n e s s experience  as  This  i s c o n g r u e n t w i t h a m a j o r t h r u s t o f t h e Women's H e a l t h egalitarian  (Marieskind,  rather  than  1980; R u z e k ,  understanding  of  the  1978).  illness  Focusing  experience  communicates  t o the p a t i e n t a genuine respect  experience  d i r e c t i o n provided provision Studying with  the  of  with a heart  the  is  care  on t h e p a t i e n t ' s the  professional  power and  f o r h e r views and  For nurses, attack  Movement,  understanding  important  f o r the  i n p a t i e n t assessment and i n t h e p l a n n i n g and  meaningful  nursing  and  effective  of view  profession's  (Swanson & C h e n i t z ,  values  and  involvement.  the p a t i e n t ' s point  h o l i s t i c care profession  patient  approach  health  reduces  between  for her  the  hierarchical  differential  women's  needs  MI i n women, a n  a n d e x p r e s s e d by t h e women t h e m s e l v e s .  support  nursing  entity.  way t o b e g i n  a  exist  a t t e n t i o n t o women's h e a l t h c a r e  appropriate  with  of  In the  (1979) p o i n t s o u t t h a t  Given the s t a t u s of the l i t e r a t u r e  perceived  o f women d e m o n s t r a t e s  goal  rehabilitative  i salso highly of  the c o l l a b o r a t i v e process  provision of nursing  care.  compatible  patient-centered  1982).  Further,  care.  and  the nursing  i n t h e p l a n n i n g and  6  Conceptual The study  conceptual i s Kleinman,  (1978).  f r a m e w o r k t h a t was s e l e c t e d t o Eisenberg,  These t h e o r i s t s  in s o c i e t y , emphasize  Framework  a n d Good's  identify  Explanatory  this Model  t h r e e domains of h e a l t h  each h a v i n g an e x p l a n a t o r y model. the importance  direct  of e l i c i t i n g  care  Kleinman e t a l .  the p a t i e n t ' s explanatory  model, so t h a t n e g o t i a t i o n o f d i s c r e p a n c i e s between p r o f e s s i o n a l and can  p a t i e n t m o d e l s may o c c u r a n d m e a n i n g f u l  care  be p r o v i d e d . In  this  betweed that  and e f f e c t i v e  model,  d i s e a s e and i l l n e s s .  "disease  illness  diseases  to  paradigm  personal,  disease or  the  therefore,  is  and/or  constitutes follows,  is  discomfort""  human  experience  cultural  cultural  Simply  put, Illness  Illness,  constructed.  c o n s t r u c t i o n of the i l l n e s s  that variation  i l l n e s s experience  and  sickness.  s o c i a l l y and/or c u l t u r a l l y  contend  whereas  experienced.  of  made  malfunctioning  (p.252).  t h e p a t i e n t ' s e x p l a n a t o r y model o f  then,  (1978)  interpersonal,  are t r e a t e d and i l l n e s s e s a r e  represents  Is  o f b i o l o g i c and p s y c h o l o g i c p r o c e s s e s ;  represents  reactions  distinction  Kleinman e t a l .  i n the Western medical  or maladaptation  social  a sharp conceptual  experience  sickness.  i n d e s c r i b i n g and c o p i n g  may o c c u r a c r o s s c u l t u r a l ,  This  social,  It  w i t h an  and f a m i l y  boundaries. The described  three by  professional, and  3)  experience  folk  structural Kleinman  et  2) p o p u l a r  domains o f h e a l t h a l .  (family,  (nonprofessional  i s perceived  (1978) social  are  care as  network,  healers).  How  in society follows:  1)  community), an  illness  i s d e p e n d e n t upon o n e ' s d o m a i n .  Kleinman  et a l . s t a t e t h a t , f o r the p a t i e n t and h e a l t h care p r o f e s s i o n a l , "interactions (p.254),  a r e t r a n s a c t i o n s between  between  the popular  explanatory  models..."  and t h e p r o f e s s i o n a l  explanatory  model. It well  i s not s u r p r i s i n g that discrepancies as i n values,  occur  between  expectations,  these  perceptions  and  negotiation  between  competent c a r e . model t o e l i c i t may  truly  information  and o b j e c t i v e s of care  explanatory  explanations  affect  models. patient  care  as  often  Different  care  models i s a p r e r e q u i s i t e t o  Health  outcomes;  relevant  and  p r o f e s s i o n a l s a r e d i r e c t e d by t h i s  their patients' explanatory  strive  appropriate  two  in  models so t h a t  they  t o understand t h e i r p a t i e n t s and p r o v i d e  care  t o t h e meaning o f t h e i l l n e s s e x p e r i e n c e  for  those  individuals.  Problem The  general  empirical  and expressed  the n a t u r e  this is only  study  by women.  addressed  i s the  The s t a t i s t i c s  of the i l l n e s s experience  t h i s h e a l t h problem  accentuate  f o r women.  r e l a t e d to the popular and  women's  t o t h e more g e n e r a l research.  together  focus  on  the  attacks are  of  of the nursing individuals;  to  literature  I t Is c o n s i s t e n t with both the  perceptions  with  attention  f o r men  problem o f male-dominated  h e a l t h a c t i v i s m and the g o a l s  of  the s i g n i f i c a n c e  The l i m i t e d  view t h a t heart  lack  w i t h MI a s  h e a l t h p r o b l e m f o r women i n t h e h e a l t h s c i e n c e s  sciences  to  problem t h i s  k n o w l e d g e a b o u t women's i l l n e s s e x p e r i e n c e  perceived  of  Statement  health  goals  of  profession this  focus  acknowledges their  their  experience.  framework  for  emphasize  the  personal data  and  will  illness  importance  et  nurses  experience  of  describe  with  MI  the  MI.  The  perceptions  following  They  view,  understanding  basis  plan  nursing attack  care  the These  for of  their women's  and  provide  which  reflects  experience  for  women.  Study  this  specific  problem.  their  the  of  useful  experience.  to  of  a  valid  order  value  patient's  illness  heart  of  the  the  provide  research  care,  of  also  more  in  nursing  purpose  women's  a  develop  meaning of  overall  the  and  (1978)  eliciting  Purpose The  al. this  with  must  effective  and  of  meanings  Nurses  nature  individuals  conceptualizing  equip  appropriate,  as  Kleinman  social  practice.  the  worth  study  their  was  to  illness  questions  were  explore  and  experience derived  with  from  this  for  women  purpose: 1.  2.  What  is  with  MI?  What  is  women illness daily leisure  the  nature  the  of  the  meaning of  following  MI?  experience living,  illness  experience  the  illness  What  is  on e v e r y d a y  interpersonal  activities,feelings,  the  experience impact  life?  to  of  this  (activities  relationships, emotions,  and  of  work,  outlook  on  life).  Introduction The  to  phenomenological  methodology,  was  selected  This  Study's  method, for  this  a study.  Methodology type  of  This  qualitative methodology  is  consistent questions the  the  of t h i s  to  i n everyday  care.  construction  of  Anderson  support  framework"  the r e s e a r c h e r  subject's  considers  explanation  ( 1983)  (Rist,  of  a  of events,  method  also method  study  from  defines the goal  Oiler  (1981)  Inquiry  women's  the  states  focus  these  women,  (Rist,  1979,  o r phenomena  that  the  experience  of t h i s  i l l n e s s experience  of  and  of t h i s methodology  i s to "describe  Because  behaviours,  i s experienced"  i n contrast to traditional feature of t h i s  afforded.  "enables  within  with  i t was  study MI  under  purpose as  as  of  i t is was  from  an the  appropriate  to  methodology.  Further,  study  studied  under  1979).  d e s c r i p t i o n o f the experience  perspective  distinctive  social  The p h e n o m e n o l o g i c a l  t o see the s i t u a t i o n  o r "how t h e w o r l d  (p.178).  this  the  and s t r e s s e s  phenomenological  select  identifies  a l l phenomena t o be s o c i a l l y c o n s t r u c t e d  (p.61).  personal  contributions  methodology  accurate  lived"  concrete  Kleinman  This  Ornery  study"  Further,  is  (p.130).  study.  perspective  surroundings"  "an  life.  (1981)  "inner or s u b j e c t i v e understandings  p.19).  research  sickness  and purpose o f the phenomenological  i t s use i n t h i s  requires  the  how  i l l n e s s as a t o p i c " p r o f i t a b l y  the phenomenological The n a t u r e  and  elucidate  t h a t such s t u d i e s would p r o v i d e  patient  the  framework  K l e i n m a n ( 1 9 7 7 ) a r g u e s f o r t h e use o f  method  constructed  asserts  conceptual  study.  phenomenological  socially  to  with  As R i s t  methodology  q u a n t i t a t i v e methods, a i s the sheer  (1979) s t a t e s ,  depth  this research  c o m p r e h e n s i o n o f human b e h a v i o u r  i n greater  of  method depth  than  i s possible  and  pencil  tests,  Giorgi  (1975a)  method  to  be  interrogating The  the study and from  identifies  the value  "the direct  phenomenological values  1 9 8 2 ; Ornery,  the  individual  the  human e x p e r i e n c e  of surface  access  and goals  women:  this  study,  adult a  perceptions: the illness  who h a v e  and  been d i a g n o s e d  An with  that  can  phenomenological  1981;  v a l u i n g of  the reverence f o r  apply: under  the care  by t h a t  of  physician,  the patient's  understanding,  the patient's  explanation,  e t a l . (1978,  The r e a c t i o n s  p.252)  reactions to  o f women t o MI  life.  and L i m i t a t i o n  guided  understanding MI  Anderson,  nursing  w i t h MI.  on e v e r y d a y  Assumptions  1.  study  by Kleinman  or discomfort."  assumptions  the  i n t e r p e r s o n a l , and c u l t u r a l  t o i t s impact  by  methodology.  patient's perspective,  disease  meaning  profession's  i n t h e Lower Mainland  as defined  to  o f Terms  p a t i e n t ' s view,  experience:  (p.20).  phenomenological  with  1978;  the following definitions  females  the  well  function parallel  central to this  "...personal,  The  fits  physician, referred to this  and  the  paper  (p.101).  The n u r s i n g  and nurturant  from  interviews"  i tp r o v i d e s  (Davis,  Definition In  of  aspects"  method  1984).  behaviour,  standardized  its qualitative  profession's Oiler,  from  this  study  of the i l l n e s s be method.  determined  were: experience by  of  using  women the  2.  Women's p e r c e p t i o n s MI d i f f e r  3.  The  from  illness  MI a f f e c t s The  following  The r i c h n e s s of  the  number  those  study  w i t h MI has  These  selected  experience  with  meaning f o r women.  life.  l i m i t a t i o n was  researcher.  interviews  illness  o f men.  everyday  the d a t a  women  their  experience  of  of  of  is  identified:  limited  by the  time c o n s t r a i n t s  as  participants  time  constraints  account  and  the  for number  the of  conducted.  summary MI by  is  the  mortality  chapter It  Is  a significant  and the o v e r a l l d e v a s t a t i n g  treatment  of  perspective,  perceptions  of  address  the  lack  problem  for  the  a p p l y here proposed  their of  of  a  is  From  basis,  illness  total  lays  explore  and  experience  attack. research  fraught  with  many  use  the  male  of  s t u d y i n g women.  describe  w i t h MI  women's  and  and r e l e v a n t  health  thus  problems  a sound f o u n d a t i o n f o r  phenomenon o f  nurses  are  this  women w i t h M I .  Understanding  perspective the  to  heart  traditional  exclusive  for  in  e m p i r i c a l knowledge c o n c e r n i n g t h i s  women.  understand this  the  evidenced  reviewed  s u b s u m i n g women u n d e r men, and n o t  study  patient's  nature  h e a l t h problems  including  These d i f f i c u l t i e s This  recognized that  women's  difficulties,  women as  and m o r b i d i t y s t a t i s t i c s  increasingly  empathic  h e a l t h problem f o r  the  directed  nursing care.  Illness to  This  plan  to  health  from nurses  the to  experience. and  provide  means n u r s i n g  care  which  reflects  experience nursing's unique  with  the MI.  beliefs  nurturant  nature It in  the  function.  and is  meaning  also  worth  to  nursing of  women o f care  their  which  individuals  and  illness  reinforces nursing's  CHAPTER 2 Review o f  Selected  Literature  Introduction This to  chapter  this  review  study's is  to  experience of  usually  rationale  further  professional researcher  body o f of  locate  method,  so  knowledge.  researcher  of  mind s e t  or presuppositions  illness It  the  must  be  ischemic heart & Tibblin,  The  explanation  of  noted  disease  study  within  this  women's  the  literature  the r e s u l t s  context  about  review  is  when u s i n g  the  explanations  1981).  However, which  works t o d a t e  with MI.  the  The  further  studies nature  about  women's  there  review emphasizes  These  1980;  sex  there  concerning for  is  this  a  lack  f o u n d by  the  findings  of  investigations  do n o t g e n e r a t e and meaning o f  of  differential  1982; this  a  small  women and  & Gordis,  Salonen, focus  is  example:  Tonascla,  research the  a  need f o r  that  (see  Szklo,  Haynes & F e l n l e i b ,  of  a the  f o r women.  literature  1973;  to  "bracket"  total  limitations.  experience  epidemiological  1983).  to  (Oiler,  the  because  MI  as  The l i t e r a t u r e  highlight  study  need study  that  on women's e x p e r i e n c e  studies  pertinent  The i n t e n t  n o t a phenomenon a b o u t  a t t e n t i o n by p r e s e n t i n g  these  the  this  recognizes  w i t h MI i s  literature  literature.  phenomenon u n d e r s t u d y  experience  the  and p u r p o s e .  woven i n t o the d e s c r i p t i o n o f  phenomenological the  a review of  substantiate  w i t h MI and t o  related The  presents  of  coronary  Bengtsson, 1976;  body  Hallstrom,  Waldron,  and R o s e n b e r g e t literature  in incidence rates  or  is for  1978; al., an heart  disease.  These  factors  sexes.  i n women  effects i n men  of psychosocial  i s investigated  of  and  risk  women.  variables  in  an  t h e r e a s o n s f o r t h e marked d i f f e r e n c e s  to  effort  between  to the  The f i n d i n g s t o d a t e f r o m t h e s e w o r k s a r e i n c o n c l u s i v e .  differences  associated and  the r e l a t i v e  the r e l a t i o n s h i p  disease  determine  The  study  i n the development o f h e a r t disease  Additionally, heart  works  with  between  sex d i f f e r e n c e s  a r e , a t present,  within  this  area  women's  illness  events,  these  men a n d women a r e n o t t h o u g h t inrisk  factors  not understood.  experience with studies  MI,  (Szklo,  Because  are not designed to address  1980)  the  any  but only  are not included  t o be  studies  facets  of  p r e - i n f a r c t ion  in this  literature  review. The  review  sections. this  of  the l i t e r a t u r e  The f i r s t  writer  found  section  i n the l i t e r a t u r e  and  o f MI s t u d i e s  that  d i r e c t l y and  MI.  of  the  included  literature  women i n t h e The f i n a l  on p a t i e n t  perception  view  and  from w h i c h t o  view  this  is a  samples  section  s e c t i o n speaks t o t h e need t o s t u d y t h e p a t i e n t ' s a basis  that  specifically  This  provides  three  The s e c o n d s e c t i o n  d i f f e r e n t i a t e d t h e a n a l y s i s by s e x .  discussion  into  i s a summary o f t h e s t u d i e s  a d d r e s s i n g women's e x p e r i e n c e w i t h presentation  i s organized  i sa  and MI. p o i n t of research  problem.  Women W i t h M I : R e s e a r c h D i r e c t l y S t u d y i n g Women Peter, women  with  Luxton, acute  and Harper (1974) r e s e a r c h e d m o r t a l i t y MI d u r i n g  a four  year period  in  in Australia.  The  researchers  which  suggested  women  than  for  significantly compared It  is  to  were that  of  small  the  higher  mortality  total to  this  one  note  investigation  or  investigation acute  rate  was  different  p o s t - i n f a r c t ion  year  women c o m p r i s e d  of  years)  is  this  and  have  mortality  17% o f  This  to  for  one  p o s t - i n f a r c t ion  (four  figures  shown  strengths  period  MI  by  women w e r e  154 w o m e n .  The  time  of  study,  year  that  903 p a t i e n t s , size.  this  prognosis  In  the  sample  to  men.  important  sample  prompted  total  relatively  study  the  rate.  the  a  a  are  total  the  sample  s i ze. Papadopoulos, more  recent  work,  patients. subject  These as  the of  component  the  of  & Mehta,  within  context  and,  provided. of  process  of  lack  and  The  viewed  sexuality,  their  Johansson  et  of is  research  study  al.  did  (1984)  characteristics  and  of  research  data  on  a  this  was  on r e s u m p t i o n of  symptoms how  feelings  and  researched term  a  women on  this a  critical (McLane,  concerning  women's to  note  study. patients  women's  sexuality  explore  long  as  significant of  in  Because  130 women  impact on  of  rehabilitation  problem  reports  their  paucity  highly  focused  not  activity  established  interviewed  counselling  activity  the  cardiac  had a n e g a t i v e  that  sexual  (1983),  investigation.  well  attack  al.  activity.  infarction  of  and L a r r i m o r e  the  cited  is  Data c o l l e c t i o n  sexual  and  their  this  the  et  a n MI  further,  for  a heart  Papadopoulos that  MI  researchers  1980),  after  found  Shelley,  sexuality  sexuality the  studied  impetus  consideration  Krop,  Beaumont,  not and  and  sexuality, adequately frequency  during  sexual  women p o s t - i n f a r c t i o n thoughts.  sex  differences  survival.  The  in  prestudy  spanned 1,259  eleven  men.  had  an  y e a r s and t h e sample c o n s i s t e d  Their  MI,  significant  the r i s k  o f 262 women  f i n d i n g was t h a t  of death  and  once a woman h a s  i s a t l e a s t as high  as t h a t  for  men. Griffo  et a l .  (1983) conducted a comparative study o f the  effects  o f a p h y s i c a l r e h a b i l i t a t i o n programme  i n 179 men a n d 49  women  post-MI.  that  physical an  However,  this poor  investigators automatically programmes.  In and  improvement  to  conclude  that  excluding This  i n women.  the  programme  these  rates,  work d i s a b i l i t y  women.  They  r e t u r n t o work  work  not  o f the The support  rehabilitation  t o f i t women i n t o t h e male  inclination perspective  women's u n i q u e p r o b l e m s a n d n e e d s . work t h a t  this writer  that,  despite  due t o h e a r t  infer  that  disability  i s frequently  found,  disease  this  from r e c e n t  heart United  incidence  i s t h e same i n men  i s due disease force.  i s important t o  utilized  Chirikos  from c o r o n a r y  the quite d i f f e r e n t  o f women r e s p o n d i n g t o h e a r t  that  do  in  i n men.  home.  i s an example o f the  behaviour o r dropping out of the labour assert  at  results  These a u t h o r s c o n c l u d e  statistics  likelihood  s i m i l a r to that achieved  ( 1 9 8 4 ) r e s e a r c h e d work d i s a b i l i t y  States  and  f r o m a n MI r e s u l t e d  women f r o m s u c h p h y s i c a l  statement  t h e most r e c e n t  controlled  was n o t m a i n t a i n e d b e c a u s e  compliance  than to c o n s i d e r  Nickel  disease  demonstrated  i n work c a p a c i t y  w i t h i n t h e MI l i t e r a t u r e rather  study  t r a i n i n g I n women c o n v a l e s c i n g  improvement  women's  The  to  an  increased  by c h a n g i n g work Chirikos et a l . examine  because  a s a measure o f s u c c e s s f u l  c a r d i a c r e h a b i l i t a t i o n a n d b e c a u s e c h a n g e s i n work a c t i v i t y  have  social  and economic  These a u t h o r s on  women  and  literature To  heart  disease  i n the face  this point,  of  and  1964-1982. subjects  post-coronary  Chirikos et a l .  and a n a l y z e d  The  goal  determine  disease;  of  the  withdrawal  i n these  presence  after acute  a  and  MI was s e l e c t e d .  (1984)  similar  work-disabled men  (work  likely  earnings  episode  counterparts by  in this  study  as  of  heart  g o a l was t o s t u d y withdrawal.  that a s i g n i f i c a n t l y  market  persons  t o r e t u r n t o work.  of  not  shown  women  in this  as  to  women  work).  Another  who r e p o r t e d  was  the  the  situation  return  were  working  activity  I n t e r e s t i n g l y , expected influence  to  force  i n t h e e a r l y p o s t - h o s p i t a l p e r i o d were f o u n d  were  behaviour  labour  p r e v i o u s l y employed working  f i n d i n g was t h a t t h o s e  limitations  was  subsequent t o a h e a r t a t t a c k compared w i t h  defined  important  less  of  find  limitation.  in  f a c t o r s a f f e c t i n g women's h i g h e r r a t e s o f work  percentage  from  i n c l u d e d women  research  A secondary  C h i r i k o s e t a l . (1984) d i d indeed  of  They f u r t h e r n o t e d t h e  sex d i f f e r e n c e s  discrete  the  resumption  w o r k s t o be a m a j o r  of  f o r men.  on t h e t o p i c  only seven  Chirikos et al.'s  of  (1984) r e p o r t  a r t e r y b y p a s s work  r e s u l t s by s e x .  research  expanse  to heart disease  Of t h e 33 s t u d i e s f o u n d ,  sample s i z e s  larger  an  of t h e i r b i b l i o g r a p h i c search conducted  post-MI  small  speak e m p h a t i c a l l y t o t h e d e a r t h o f  on b e h a v i o u r a l a d j u s t m e n t s  illustrate  results  effects.  to  be  market  to  f o r the  work male  s t u d y a n d f o r men i n o t h e r s t u d i e s a s c i t e d  Chirikos eta l . These  work  authors  disability  conclude  that s i g n i f i c a n t l y  i n women a r e n o t due t o d i s e a s e  higher rates severity,  of but  to  the behavioural  experience. explore  The r e s u l t s the  illness  understanding  of  experience  experience  of  study  was r e v i e w e d  This  study  of  with  their  these  An attack  findings  into  i n d e t a i l because  i tis  supports  and  empirical  the  contention  t h i s p r o b l e m s t a t e m e n t t h a t MI i s a h i g h l y s i g n i f i c a n t  problem  illness  MI. heart  sound (sample s i z e  powerfully  the  h i g h l i g h t t h e need t o  women  i n putting  methodologically  model d e s i g n ) . of  of t h i s research  assist This  and  to the course  t h e m e a n i n g t o women o f  may  perspective. current  response  health  f o r women.  The  research  experience  d i r e c t l y and s p e c i f i c a l l y s t u d y i n g  w i t h MI i s a s t o n i s h i n g l y l i m i t e d  —  the f i v e  women's studies  r e v i e w e d a b o v e c o m p r i s e t h e t o t a l w o r k s t h i s w r i t e r was a b l e locate  i na health sciences  represent  very  mortality, physical  2)  results  sexual  to  activity,  point  different  and  3) 5)  note that a l l f i v e  in relation  These  f a c e t s o f women's e x p e r i e n c e  rehabilitation,  important findings  diverse  l i t e r a t u r e search.  long  work  to a post-infarction period  yielded with that  f o r women a n d e m p h a s i z e t h e n e e d  1)  survival,  disability.  t o women's e x p e r i e n c e  studies  w i t h MI:  term  studies  to  4)  It is  significant MI.  These  i s d i f f i c u l t and  to  study  women's  exper ience.  Women W i t h M I : S t u d i e s There heart  attack  differentiate  a r e a few r e p o r t e d which  I n c l u d i n g Women  s t u d i e s on t h e a f t e r m a t h  i n c l u d e women s u b j e c t s  the research  a n a l y s i s by s e x .  i n the samples  of  a  and  These s t u d i e s a r e  now  briefly A  reviewed.  Japanese  psychological  study  aspects  a  driving,  competitive)  finding  (1961),  sample  than  They h a d n o t e d  stress,  differ  "A"  (hard  "B" p e r s o n a l i t y  women w i t h c o r o n a r y  I n an  i n Sweden ( B e n g t s s o n  to  "A" a n d t y p e  t o be more t y p e  o f h e a l t h y women.  noted  Women who h a d  t h e e a r l i e r work o f F r i e d m a n a n d Rosenman  specifically)  conducted  researched  t h e c o n t r o l g r o u p o f h e a l t h y women.  the o r i g i n a t o r s o f the type  MI  1970)  a t t a c k were f o u n d t o be more t y p e  supported  typologies. (not  (Hinohara,  of cardiac r e h a b i l i t a t i o n .  suffered  This  heart  i n 1970  "A" t h a n  extensive  heart  disease  their  matched  longitudinal  e t a l . , 1 9 7 3 ) , women w i t h MI were  f r o m h e a l t h y women i n t h e i r h i g h e r  aggressive  and  study  neurotic  self-assertion  levels  of  (type  "A"  behaviour). Moss, factors their  De C a m i l l a ,  and Davis  i n t h e e a r l y p o s t - h o s p i t a l phase study,  female  literature  however, t h a t  i n both  s i z e s o f women. total the  review  prognostic  f o l l o w i n g an  s e x was a s s o c i a t e d w i t h  increased mortality rate. in t h i s  (1976) r e s e a r c h e d  a  MI.  significantly  T h i s marks t h e s e c o n d s t u d y with this  finding.  p o p u l a t i o n o f 518 p a t i e n t s ,  reported  I t must be  s t u d i e s , there are r e l a t i v e l y  The women i n t h i s s t u d y  small  represented  a limitation  In  noted, sample  18% o f t h e  in generalizing  results. Stern,  study  over  a one y e a r  also reported their  Pascale,  study.  problematic.  and Ackerman ( 1 9 7 7 ) , period of l i f e  a significantly Again, The  their  occurrence  higher  in their  extensive  adjustment p o s t - i n f a r c t ion, m o r t a l i t y f o r t h e women i n  s m a l l sample s i z e of t h i s  finding  of  women  i n yet  is  another  20  s t u d y , however, Stern  i s important to note.  et  challenging  a l . ' s (1977)  finding"  study reported  as  a  "new  ( p . 1 6 8 4 ) t h e c o m p a r a t i v e l y more  difficult  r e h a b i l i t a t i o n c o u r s e e x p e r i e n c e d by t h e p o s t - i n f a r c t i o n They  noted  t h e women t o be s i g n i f i c a n t l y  both  in hospital  women s a m p l e d t o o k functioning.  a n d a t t h e one y e a r longer to return  Chirikos et a l .  follow-up.  (1984),  al.'s  s t u d y o f women's s e x u a l a c t i v i t y  To  account  postulate  this  i srelated assertion  b e h a v i o u r measured study.  These  above. type  of sexual  results,  that both  rehabilitation call  sample relation  The r a t i o n a l e of  r e s u l t s a r e more a l a r m i n g t h a n t h o s e  p o s t - i n f a r c t ion  findings,  a l . (1977)  f o r t h e women i n  from t h e h i g h degree  type  "A"  women  are  more  This study type  "A"  than  to  test  "A" f i n d i n g s a n d t h e s e e m i n g l y f o r women.  a  these poorer  T h i s w r i t e r assumes  that  f o r f u r t h e r r e s e a r c h i s s t i m u l a t e d b o t h by t h e  small  size  outcome  suggests  These r e s e a r c h e r s  f u r t h e r research i s warranted the type  discussed  f o u n d p o s t - i n f a r c t i o n women t o be more  c o r r e s p o n d i n g g r o u p o f p o s t - i n f a r c t i o n men.  this  et  i n t h e women, h i g h e r e v e n t h a n t h e men i n t h e  Previous studies  acknowledge  et  activity.  Stern  "A" i n a c o m p a r i s o n w i t h o t h e r women.  that  previously,  p o s t - i n f a r c t ion  to psychosocial aspects. stems  the  Papadopoulos  that the poorer r e h a b i l i t a t i o n course  t h e i r study for  for their  Also,  as reviewed  t o work f i n d i n g a n d  i n resumption  anxious  t o work a n d t o r e g a i n s e x u a l  the  supports d i f f i c u l t i e s  women.  d e p r e s s e d and  substantiated ( 1983)  return  and  o f women s u b j e c t s a n d t h e s e  t o women.  important  findings  in  In coronary  a  study  events,  of convalescent Speegle,  patients' expressions significant discomfort  in  society.  study  This study  Small  sample  findings  the  suggests  sizes  a  the course  psychological patient, researchers possible  outlined  experience.  as i t i s the of  including  rehabilitation limit  only  women's  women  in  group  post-infarction.  generalization, evidence  concerned  a n d outcome o f MI. of  the  but the  of the  need  to  directions  w i t h the v a r i a b l e s  Croog e t a l .  literature  i n the recovery  on  process  f o r future  (1968),  social of  and  the  heart  research.  These  t h e p a u c i t y o f work on p a t i e n t p e r c e p t i o n a n d  relationships  work  men  with a heart attack.  review  noted  t o women's  and P a t i e n t P e r c e p t i o n s  factors  rehabilitation. empirical  of  i s a body o f l i t e r a t u r e  classic  higher  t h a t women may be a n a t - r i s k  here g i v e d e f i n i t e  MI  in  this  some a s p e c t  of studies  clearly  s t u d y women's e x p e r i e n c e  affecting  i s important  researched  review  course  reported  There  and  a  experience.  samples and a n a l y s e s of  female  t o be  i n v e r b a l i z i n g d i s c o m f o r t compared w i t h  literature  terms  T h e r e was f o u n d being  acute  (1979) q u a n t i f i e d  The r e s e a r c h e r s a t t r i b u t e d  view o f the i l l n e s s  in  between  o f women w i t h MI t h a t  This  following  and Greene  of discomfort.  scores.  acceptance  our  Bayer,  association  greater  discomfort  These  between authors  perception emphasized  and  outcome  the  f o c u s i n g on how t h e p a t i e n t v i e w s  need  the  of for  illness  T h e i r o b s e r v a t i o n s s t i m u l a t e d a number o f s t u d i e s  on p a t i e n t p e r c e p t i o n a n d o u t c o m e .  Garrity perhaps  be  (1973)  concluded  considered  status  status al.  (1973)  physical to  identified  work p a t t e r n .  perception. model  (1982)  s t u d y , the  proposed  found  behaviour  of  was  with  return  Garrity  and  others  this  variable  works  of  patient  a  conceptual  I n a more r e c e n t  relationship  study,  between  illness In  i s s i m i l a r to  noted that  in  this  patient  as r e p o r t e d  return  p a r t i c i p a n t s ' view  to of  in  work their  limitations.  patient  literature  perception  MI.  f i n d i n g s support a r e l a t i o n s h i p  and  the  c o u r s e of  If  perception  behaviour,  it  is clearly a priority  point  view.  of  rehabilitation  provide  determined t h e i r  months p o s t - i n f a r c t i o n .  the  et their  the d e v e l o p m e n t of  earlier,  associated  health  of  i l l n e s s behaviour  review  of  Cay  opinions  C h i r i k o s et a l . ' s (1984) r e s e a r c h ,  These  patient  clinical  r e p l i c a t e d many e a r l i e r  strong  d e f i n i t i o n of  literature  physical  a  outcome a t e i g h t  perception.  own  of d i s a b i l i t y  correlates  They  b e h a v i o u r and  with  patients'  of p a t i e n t h e a l t h p e r c e p t i o n .  Byrne  this  that  extent  intervening  patient's perception  In a subsequent s t u d y ,  several  major  should  t o work p o s t - i n f a r c t i o n .  Somes, & M a r x , 1978)  finding  a  more i m p o r t a n t t h a n e v e n  to r e t u r n  s t a t u s and  (Garrity,  G a r r i t y f o u n d the  t o be  in r e l a t i o n  "health perception  t h e o r e t i c a l l y as  variable..."(p.715). health  that  sees  is the  meaningful  is strongly  Because lifestyle  a  the  illness  linked  major  adjustment,  subsequent  the  component  of  patient's cardiac  k n o w l e d g e o f how  i l l n e s s e x p e r i e n c e would help.  experience  with  to r e s e a r c h  between  assist  nurses  the to  Summary The  importance  underrated. However,  MI  women  professional conducted well  literature.  The  to  women  h e a l t h problem  w i t h MI have r e c e i v e d  limited  findings of  how  challenge  individuals  model d i r e c t s  view  so t h a t  perceive  their  health professionals  social  of care.  women.  attention  i n the  the  studies  w i t h MI w o u l d p r o v i d e  rehabilitation.  that  As inquiry  described i s the  i n Chapter appropriate  framework and purpose  of this  implementation of the s e l e c t e d  1,  socialization experiences.  to e l i c i t  the p a t i e n t ' s  i n the planning  In c a r d i a c  of t h e i r  a more v a l i d b a s i s  few  t h a t women may  b a s e d upon a n u n d e r s t a n d i n g o f t h i s p r o c e s s  u n d e r s t a n d i n g o f women's p e r c e p t i o n s  be  illness  factors are considered Current concepts  cannot for  i n cardiac  e t a l . ' s ( 1 9 7 8 ) model a s s e r t s  This  provision  in relation  is a significant  present a p a r t i c u l a r  affects  MI  o f women's e x p e r i e n c e w i t h MI i n t i m a t e  Kleinman  are  of  and  rehabilitation in  men.  An  i l l n e s s experience  f o r nursing  practice.  t h e p h e n o m e n o l o g i c a l method o f  methodology study.  f o r the  conceptual  Chapter 3 o u t l i n e s  methodology  in this  study.  the  CHAPTER 3 Methodology  lRtr°dMCt;iqn, This  chapter  phenomenological  describes  method  of  researcher's  interpretation  methodology  are  participants,  application  inquiry and  presented  data  the  in  this  implementation  in  relation  collection,  data  of  the  study. of  to  The  the  study's  selection  analysis,  and  of  ethical  cons i d e r a t i o n s .  Selection The collect  phenomenological data  Further,  the  natural  most  informant's conducive  (Oiler,  to  1982). for  this  of  who  MI were  or  the  is  of  to  be  life  home the  to under  considers  home e n v i r o n m e n t  returned  determined  that  methodology  perceptions had  researcher  experience  research  setting  sharing  the  the  to  be  events  following appropriate  source. Consistent  theoretical study's were  directs  who l i v e  Women  hospitalization data  the  Participants  method  from s u b j e c t s  investigation.  of  sampling  participants  selected  research  with  by the  methodology,  technique  was  (Swartz & J a c o b s ,  according  questions.  determined  this  to  their  In t h i s meeting  of  five  purposive  utilized 1979).  ability  study,  a  to  to The  address  participant  criteria.  select  or the  participants the  study's  competency  was  Criteria  for Selection  The the  s e l e c t i o n of p a r t i c i p a n t s  following  five  f o rthis  s t u d y was g u i d e d  by  criteria:  1. O v e r 18 y e a r s o f a g e , 2. A b l e  t o speak and r e a d E n g l i s h ,  3. A l e r t  and o r i e n t e d t o t i m e , p e r s o n ,  and p l a c e ,  4. D i a g n o s e d w i t h a n M I , and  5. Home f o l l o w i n g h o s p i t a l 16  Selection  from  the r e s e a r c h e r sought p o t e n t i a l the  community  i n the Greater  were n o t f o r t h c o m i n g ,  practices  the sources  selected  f r o m one Homecare f a c i l i t y  Vancouver When subject, criteria nurse  process.  care h o s p i t a l s ,  through  participating  Because  subjects  f o r s u b j e c t s were e x p a n d e d t o  the  acute  research  subjects  of  Vancouver a r e a .  expedite  two  2 to  Procedure  cardiologists  in  for approximately  weeks.  Initially, referral  discharge  Consequently,  women  and from t h e c e n s u s  a l l located within  the  were  records Greater  area. the  researcher  suitability and  involved.  r e c e i v e d the  was  determined  name as  of  per  a  potential  the  selection  the p r o f e s s i o n a l opinion of the p h y s i c i a n Following this  and/or  s t e p , the r e s e a r c h e r mailed out  the P a t i e n t I n f o r m a t i o n L e t t e r < Appendix A ) .  F o r some o f t h e  potential  contact.  subjects,  this  others, their cardiologist  l e t t e r was t h e i n i t i a l and/or nurse  e x p l a n a t i o n of the study and determined participate.  Approximately  one  to  For  p r o v i d e d an i n t r o d u c t o r y a general two  w i l l i n g n e s s to  weeks  later,  the  researcher telephoned the p o t e n t i a l assess  a willingness  to participate,  convenient appointment one  departure  Homecare. the  recruited  in  In  subject  Only  participating  referred  total,  nurse h a n d - d e l i v e r e d two  women  cardiologists,  women  the  the census  readily  agreed  to  be  The women seemed t o a s k  these  of  their  s t u d y a n d what was e x p e c t e d o f them.  questions.  The s u b j e c t ' s r o l e  safeguards aloud.  encounter easily  The  s u b j e c t s were g i v e n a n o p p o r t u n i t y t o  signing,  The  questions  the  interview.  Consent P r i o r to  again  ask  i n t h e s t u d y was r e i t e r a t e d a n d  were o u t l i n e d .  The r e s e a r c h e r  The s u b j e c t t h e n r e r e a d t h e c o n s e n t  read  the  and s i g n e d  The i n t e r v i e w t h e n commenced.  Data The interviews first  of  involved.  B> was s i g n e d a t t h e f i r s t  it.  woman  for participation.  Form ( A p p e n d i x  consent  not  records  c o n t a c t b y t e l e p h o n e was a p o s i t i v e  a l l instances.  ethical  were  In the case  e i g h t women were a p p r o a c h e d  researcher's f i r s t  the  by  i n the study.  eight  about  Letter.  T h e r e was  the r e s e a r c h e r informed t h e i r c a r d i o l o g i s t s  involvement  in  the  of the acute care h o s p i t a l s .  subjects,  mutually  f o r t h e home i n t e r v i e w .  by Homecare a n d a n o t h e r woman f r o m  one  All  a n d t o s e t up a  i n s t a n c e , t h e Homecare  Information through  referred  time  from t h i s p r o c e d u r e ,  In this  Patient  s u b j e c t t o answer q u e s t i o n s ,  data over  Collection  were c o m p i l e d t h r o u g h a s e r i e s o f a t h r e e month t i m e f r a m e .  i n t e r v i e w s and t h r e e second  interviews.  11  intensive  T h e r e were  eight  The l e n g t h  of  the  interviews  were  semi-structured.  adapted C).  the  procedure  where  the  striving researcher (Giorgi,  methodology women  be  tape  Once  recorder  clicked  terminate  the  the were  women, no  rapport of Most  the of  o p t i o n of  not  one o f  apparent with  the  the  experience  women o f t e n off  the  methodology,  unfolds. the  and  in The  actual  data"  out,  the  "empathic  and  research  process  in  i n some  surprised  indicate to  taping  a  answer  the  seemed  when  completed  the side.  to  women made  Before  there  seemed  the  with  any time was c l e a r l y c o m m u n i c a t e d  the  was a  for  any q u e s t i o n s  such a  request.  in e s t a b l i s h i n g  and  There  maintaining  and f o l l o w i n g the  taped  time  conversation.  feeling  for  social  pleased  women's e x p e r i e n c e  researcher  uninhibited  to  difficulties  of  and  or  women e x p r e s s e d  was  to  refusing  women.  interview, the  to  interview.  points  i n t e r v i e w commenced,  interview at  t o an u n d e r s t a n d i n g thanked  the  and t h e  the  integral  determined  involvement  it  (1983)  "exploited"  comfortable  forgotten  Although  as  beginning  first  active as  (Appendix  for  or d e l e t e d  c o n s t i t u t i o n of Oiler  questions  (p.179). seemed  audiotaping.  a basis  perspective  is  are  o n l y as  one o f  As  interviews  questions  f o l l o w i n g the  is  " i n the  involvement  six  with phenomenological  role  p.101).  The  was g u i d e d by  were a d d e d  subject's  awareness"  The  to  the  1975a,  intuitive  served  consistent  participates  researcher's  this  is  see  (1978)  during and/or  researcher's to  al.'s  Questions  researcher  90 m i n u t e s .  The r e s e a r c h e r  questions  collection.  This  from 45 to  from K l e i n m a n e t  The a d a p t e d  data by  ranged  h e r time and  way b e n e f i c i a l  to  t o be  contributing  with MI.  Many  indicated them.  portion  that  After  also the  leaving  the p a r t i c i p a n t ' s home, an  addendum  to  the  the r e s e a r c h e r r e c o r d e d taped  interview.  c o n s i s t e d of s p e c i f i c d a t a r e l a t e d participants  and  p a r t i c i p a n t and data  the  interjected  noted. taped  The  general  These  o b s e r v a t i o n s and  the non-taped  field  notes  i n t e r v i e w s comprised  and  notes  field  t o the c h a r a c t e r i s t i c s  interview process. in  field  impressions Also,  social  any  as notes  of  the  about  the  significant  conversation  were  the  verbatim  t r a n s c r i p t s of  the d a t a  for this  study.  the  c o n s t r y c t i o n o f Accounts The  researcher  the r e s e a r c h p r o c e s s  i s i n t i m a t e l y and  in phenomenological  s o c i a l l y constructed nature the  phenomenological  accepts  the  researcher reference is  experience  as  " a l w a y s one  ( 1979)  regards  meaning t o the e x p e r i e n c e "  as  a loose  study,  using "tell  r e f l e c t i o n and me  those  more."  which the  subject. the  frame  of  situation  meaning of  that  (Ornery,  t a s k of the  of and  Both  unique  "the  1983,  researcher  i n v o l v e d i n t e r p r e t e d and  as gave  (p.20).  t h e r e s e a r c h e r u s e d the  The  the  and  participant"  the  interview structure.  o p e n - e n d e d way.  through  researcher explores  o f l e a r n i n g how  this  researcher  s u b j e c t b r i n g t h e i r own  The  Because  research.  t o phenomena i n a vacuum.  i t u n f o l d s f o r the  Rist  In  of  to the r e s e a r c h s i t u a t i o n  interpreted.  p. 5 4 ) .  the  in  t h i s methodology acknowledges  intersubjectivity  and  involved  o f a l l phenomena i s a b a s i c t e n e t  method,  Meanings are not a t t a c h e d  actively  Questions  interview questions were p o s e d  r e s e a r c h e r responded to the c l a r i f i c a t i o n and  Through t h i s  frequent  interview style,  in  participants  suggestions the  an  to  participants  guided  the  c o n s t r u c t i o n of the  m a j o r r o l e was t o a s s i s t to  them  of  proceeded, the  their  the  accounts.  the p a r t i c i p a n t s  illness  The  researcher's  to explore  experience.  As  t h e meaning  data  collection  r e s e a r c h e r was a b l e t o become s u b m e r g e d  experience.  The  quality  of the data  r e s e a r c h e r ' s enhanced u n d e r s t a n d i n g  within  increased with  of the i l l n e s s  the  experience.  Data A n a l y s i s To a n a l y z e procedure  the c o l l e c t e d data,  by  synthesizing  phenomenological Loflund  researchers  the  (Giorgi,  &  Loflund,  1984).  researcher  listened  t o t h e tape  (Giorgi,  1975b).  r e s e a r c h e r then immerse each  herself  piece  meaning  of  The  this  step,  dominated  each  unit  relation this the  At  this  t o the study's  analysis, second  and r e a d  The n e x t  categories.  or  verbatim.  s t e p was t o thinking  point,  using  t h e themes  researcher  decided  (Giorgi,  1975b).  the  the were  theme  same  that  "maximum  considered  in From  q u e s t i o n s and t o p i c s f o r  f o r other subsequent  and  interviews.  i n t e r v i e w i n g when i t became  c o n s i s t e n t themes were b e i n g  or  carried  p u r p o s e s and r e s e a r c h q u e s t i o n s .  to stop  to  consider units  interview with the p a r t i c u l a r p a r t i c i p a n t guidelines  The  was  researcher stated  category,  the  whole"  the t r a n s c r i p t  o f "maximum o p e n n e s s " the  selected  interview,  This step  the r e s e a r c h e r planned  formulated  that  each  d a t a and t o a s s i g n n a t u r a l  Following  a  1 9 7 5 a , 1975b; Ornery, 1983;  was t r a n s c r i b e d  i n the data.  out assuming an a t t i t u d e  of  t o g e t a "sense o f t h e  t o the tape  units or content  openness."  writings  Following  tape  listened  the researcher developed  also The  evident  i d e n t i f i e d and v a l i d a t e d  and  the  data  study's this  c o l l e c t e d were analytic  process  analysis  framework  of  over  sufficiently the  a n a l y z i n g the  final  study's  product  data  and  rich.  The  derived  from  refining  that  time.  Ethical The r i g h t s 1.  is  i n - d e p t h and  of  Written  the  Considerations  subjects  consent  of  were p r o t e c t e d  the  subject  was  as  follows:  obtained  prior  to  readily  available  interviewing. 2.  The for  3.  questions  The the  4.  researcher about  researcher study  The  made  each  reiterated  Interview  Subjects not  to  participation  in  involved.  answer any q u e s t i o n s 5.  study.  c l e a r l y o u t l i n e d what  researcher  to  the  herself  were  their or to  the  right  subjects  to  terminate  informed that  participate  to  choose  the  not  prejudice  told  the  to  interview.  t h e i r d e c i s i o n at  would n o t  prior  any  their  time health  care . 6. The  subjects  anticipated of  7.  risks  understanding  MI to the  were  the  guards  them.  women's  n u r s i n g care  future  The  to  that  of  was a r t i c u l a t e d  by the  informed  would  utilized  confidentiality  of  the  illness  women h e a r t  researcher be  The  study  potential  attack  no  benefit  experience  with  victims  in  researcher.  subjects to  involved  ensure  interview  data.  that anonymity The  safeand tapes  would  be c o d e d and t h e n e r a s e d  study. and  Written  to  these  researcher's 8.  materials  discarded.  access  The  only  data  would be  advised  assess  health  professional,  to  prior  to  the  the  researcher  and  the  be  individuals the  of  the  shredded  who  would  researcher  have  and  the  committee.  researcher  back  would  The  thesis  researcher  care  upon c o m p l e t i o n  subjects need  for  the  subject  referral  would  should  intervention  participating subject  that  the by  a  w o u l d be  referred  physician.  The  discuss  the  situation  step.  Summary This  chapter  methodology,  discussed  the  perceptions  of  participated  illness  the  study  conducted over a three The  data,  analysed  to  collection from  the  and  transcribed  experience.  exploration  The r e s e a r c h e r  construction  researcher's  The  of  the  women's  E i g h t women  interviews  and  shaped  the  researcher of  field and  were  the  these  notes,  The  data c o l l e c t e d assumed the  meaning o f  participants Chapter accounts.  were  themes.  intertwined.  and t h e  of  with MI.  units  accounts.  interpretation  selected  elicit  in-depth  tapes  were  interviews  to  the  period.  thinking  interviews. i n the  11  month time  determine  beginning  facilitator  the  the  method,  experience  and d a t a a n a l y s i s  subsequent  implementation of  phenomenological  their  in  the  4  this  Data analysis in  the  role  of  illness  contributed describes  to the  CHAPTER  Presentation  of  the  4  Study's  Findings  Introduction This  chapter  characteristics their the  illness  of  analytic  analytic  interpretation  Giorgi  in  the  of  investigator in The  the  with  MI.  framework  is  of  1975b)  that  this  data.  should  of  be  the  the  able  the  the  data,  researcher's  data. is  a  control of  in  critical  the  method.  qualitative researcher's  this  same  framework,  also  see  what  the  describe  the  nature  to  of  delineated.  phenomenological  communication Adopting  and  the  accounts  discussing  framework  the  study,  women's  represents  asserts  this  introduced  researcher's  from  the  Before  implementation  the  and  of  another  researcher  saw  data.  Study's The  their  participants  the  comes  perspective  findings  and c o n c e p t u a l i z a t i o n  (1975a,  research  the  framework  Explicating criterion  the  experience  study's  This  presents  Analytic  women's  heart  experience  on  distinct  their  themes  experience. analytic  accounts  attack  participating  Framework  experience  and  everyday  lives.  women r e f l e c t  unique  run These  framework  through themes (Figure  the  the  While illness  data  are 1 "The  impact  that  the  of  the  meaning this  point  to for  Analytic  of  illness  accounts  experiences  basis  Study's  and  of  the  with  MI,  their  common  the  study's  Framework").  Figure  The  1  S t u d y ' s A n a l y t i c Framework A L o s s Framework  Loss of Healthy  State  (leads to) lack  Loss  P r e d i c t a b i 1 i t # L _ l a c k of ant i c i p a t e d support  of  I  (leads to)  Strategies  The was  core  loss.  being  fraught  focus  on  of  that  meaning  f o r them  The women p e r c e i v e d changes s i n c e  t h e i r accounts around these  through  the losses analytic  the  context  inherent  framework  of  i n these  their their  changes.  of the concept of l o s s .  framework c o n s i s t s o f s i x state,  had  the  data  c o m m u n i c a t i o n by t h e women o f  change t h a t d i r e c t e d t h e r e s e a r c h e r  perceptions  study's  which  loss).  from t h e p e r s p e c t i v e  grieving  for Control  T h e r e was a d e f i n i t e  w i t h many s i g n i f i c a n t  constructed  ;hange i n u s u a l r o l e enactment  theme t h a t e m e r g e d f r o m a n a n a l y s i s o f  without  definition  of energy  change, changes.  (a lives  usual to  MI a n d t h e y I t was t h i s  t o see  the  In sharing the  data their  women  2) l o s s o f p r e d i c t a b i l i t y ,  were  Given t h i s , the  i s b a s i c a l l y a l o s s framework. component p a r t s :  be  The  1) l o s s o f h e a l t h y  3) l a c k o f e n e r g y , 4) l a c k  of  anticipated  support,  strategies  for  Within  i n usual  role  framework,  loss  d e f i n e d as a r e l i n q u i s h i n g  one's  self  as a h e a l t h y person.  result  of the r e a l for,  enactment,  a n d 6)  control.  this analytic  operationally  basis  5) c h a n g e  impetus  This p a r t i c u l a r  f o r the  I t i s the loss  is  of a former concept of  e v e n t o f c a r d i a c damage,  and/or  predictability.  of healthy state  loss  is a  the s t a r t i n g  point,  subsequent  of t h e i r  loss  former h e a l t h y  of state  t h a t g r o u n d s t h e women's i l l n e s s e x p e r i e n c e w i t h MI. The  loss  leads to refers  of healthy state  a loss  of  t h a t o c c u r s w i t h a n MI e x p e r i e n c e  predictability.  Loss  of  predictability  t o t h e women's p e r c e p t i o n o f t h e p r e c a r i o u s n e s s o f  i l l n e s s experience. perplexed.  The women f e l t  suspended,  uncertain,  I t was a s i f t h e y were a d r i f t a n d f l o u n d e r i n g  their and i n an  u n f a m i l i a r r e a l i t y , t h i s new a n d u n p r e d i c t a b l e r e a l i t y o f  facing  the  Since  impact  of  perceptions dominated  their  MI  reflecting the  data,  in  a loss this  their  everyday  lives.  of p r e d i c t a b i l i t y  loss  permeated  and  c h a r a c t e r i z e s and c a p t u r e s  the  e s s e n c e o f t h e women's i l l n e s s e x p e r i e n c e w i t h MI. Loss of p r e d i c t a b i l i t y energy,  anticipated  experienced They and  a  lack  was f e l t  particularly  s u p p o r t , and r o l e of  energy,  i n r e l a t i o n to  enactment.  physical  and  The s u b j e c t s psychological.  d i d n o t have t h e s t r e n g t h o r e n d u r a n c e t h e y u s e d t o they f e l t  lives. their  that t h e i r  zest  forliving  The women a l s o  felt  a lack of anticipated  families,  especially  their  was m i s s i n g  husbands.  deserved  full  illness  e x p e r i e n c e a n d were d i s a p p o i n t e d  from  their  support  from  They f e l t  that  support because of the c o m p e l l i n g nature of that t h i s  have  support  they their was  not  entirely realized.  usual r o l e s  that  T h e r e were a l s o  contributed  i n performing  t o t h e i r sense of u n p r e d i c t a b i l i t y .  This  i l l n e s s experience  usual  s o c i a l a n d homemaker r o l e s . Strategies  changes  influenced  for control  t h e e n a c t m e n t o f t h e women's  are defined  as  women t o g a i n c o n t r o l  the  p r o f o u n d s e n s e o f n o t k n o w i n g what t o e x p e c t d a y - t o - d a y , t h e used a wide v a r i e t y  control  within  The  their daily  of s t r a t e g i e s  for control.  model o f t h e i r  The s t u d y ' s a n a l y t i c  All  o f t h e women's e x p l a n a t o r y  were E n g l i s h  speaking  interview  r a n g e d f r o m 36 with  to  their  Of t h e two r e m a i n i n g  one was widowed a n d one d i v o r c e d .  Two o f t h e women h a d  still  l i v i n g a t home w i t h  children  them.  l i v i n g away f r o m them,  Five  One women d i d n o t have c h i l d r e n .  mother l i v i n g  with  of  o f t h e women h a d  some w i t h  families One woman  of had  h e r i n a basement a p a r t m e n t .  O n l y two o f t h e women were e m p l o y e d o u t s i d e time  Canadians.  S i x o f t h e women were m a r r i e d a n d l i v i n g  t h e i r own. her  then,  during the i l l n e s s experience.  children grown  participants  ages a t t h e time o f t h e f i r s t  husbands  framework,  of the P a r t i c i p a n t s  eight  years.  and t h e i r  i l l n e s s e x p e r i e n c e w i t h MI.  Characteristics  women,  t o engender f e e l i n g s of  lives.  is the researcher's conceptualization  71  Because o f  women's a c c o u n t s d e s c r i b e d b o t h t h e i r l o s s e s  strategies  Their  losses.  by  the  women  over experienced  b e h a v i o u r s used  t h e i r heart attacks.  The o t h e r s i x women  homemakers f o r most o f t h e i r l i v e s . w o r k i n g a n d t h r e e were r e t i r e d .  t h e home a t t h e had  been  Of t h e s p o u s e s , t h r e e  were  All Five  participants  women l i v e d  in apartments. of  lived  in single  class inrelation  The  timing  of  to socioeconomic  to  be h o m o g e n e o u s l y  status.  months b e i n g  t h e r e m a i n d e r were b e i n g  programme ( e . g . five  of  women  t h i s was t h e i r  had e x p e r i e n c e d  one  first  rehabilitation  MI.  The  For  remaining Most  Two women r e p o r t e d  women was d i a b e t i c ;  of  being  a n d one h a d s u r g e r y f o r  year  an e x t e n s i v e h i s t o r y o f past  surgeries.  scheduled  treated medically.  structured  illnesses.  o f t h e bowel i n t h e p r e v i o u s  disclosed  case.  discharge  one t o t h r e e M i ' s p r e v i o u s l y .  t h e women h a d a d d i t i o n a l  cancer  four  The Y.M.C.A. C a r d i a c E x e r c i s e P r o g r a m m e ) .  t h e women,  hypertensive;  to  the usual  O n l y one woman was  o f t h e women was i n v o l v e d i n a  lived  observations  i n t e r v i e w was f r o m one  with three  Area.  women  very general  t h e women seemed  f o r 2 t o 14 w e e k s .  bypass surgery;  None  the  three  means t h a t t h e women h a d b e e n a t home f o l l o w i n g  from h o s p i t a l for  Vancouver  family dwellings,  the f i r s t  months p o s t - i n f a r c t i o n , This  Greater  From t h e r e s e a r c h e r ' s  the p h y s i c a l s e t t i n g ,  middle  i n the  (1984).  illnesses,  Two o f t h e women were r e a d m i t t e d  One  woman  i n c l u d i n g 29  f o r angina  during  interview period.  The Women's P e r c e p t i o n s  Loss of Healthy The  first  their perceived  of Their I l l n e s s  Experience  State aspect  o f t h e MI e x p e r i e n c e  l o s s of healthy s t a t e .  their  heart attack experience  lives  from  health to i l l n e s s .  f o r these  women  was  The women made s e n s e o f  by d e s c r i b i n g t h e s h i f t This s h i f t  in  their  was marked by t h e  37  heart  attack  subsequent  itself,  event that c a t a l y s e d  specifically  data  concerning  sought,  pain  the heart  experiences  experience  They s t r i v e d various tend  of  within  their  the event  heart  accounts.  E a c h woman v i v i d l y  and d e s c r i b e d  not  about t h e i r  These  remembered  ina truly  unique  t o a c c u r a t e l y r e c o u n t what h a d h a p p e n e d ,  and  her way. used  d e s c r i p t i o n s t o i s o l a t e a n d i d e n t i f y what p r o f e s s i o n a l s  to  call  distinctly  "pain."  i n the  way  attack  pain  I t was  more  interface with  emphatically  episode  was  perceived  and  of loss.  The  the professional sector  served  b u t i t a l w a y s marked t h e b e g i n n i n g  women's s u b s e q u e n t even  The h e a r t  individual  experienced,  to  series  a t t a c k p e r se were  t h e women c h o s e t o t e l l  d e s c r i p t i o n s were d i v e r s e . pain  a  changes.  Although  attack  the  b r i n g home t h e i r  loss  of  healthy  state. For initially women  two as  of  women,  "heartburn"  d i d not  related,  the  initially  they d i d perceive  or  their  heart  "indigestion."  perceive  their  attack  Although  discomfort  a need f o r m e d i c a l  presented  as  these heart  assistance.  And i t was j u s t l i k e a b a d c a s e o f h e a r t b u r n . That's a l l i t was. (See Appendix D f o r key t o the p r e s e n t a t i o n of the block q u o t a t i ons.) You know, I t h o u g h t n o t h i n g o f i t . I d i d n ' t know what i t was, t o t e l l you t h e t r u t h . I t h o u g h t i t was i n d i g e s t i o n and I was t a k i n g t h a t a n t i - a c i d t h i n g , you know. And I did l e t out a belch or so. Then i t went away. Then i t came b a c k a n d i t d i d n ' t go away a n d I s a i d t o my husband, well, this i s an a w f u l , you know, b u r n i n g sensation. Maybe I ' d b e t t e r g o . I s t a r t e d t o p e r s p i r e , you know, t h e back o f my n e c k a n d t h a t a n d I knew t h a t i t w a s n ' t just anything, you know. S o , I s t a r t e d g e t t i n g r e a d y t o go t o the h o s p i t a l .  Two pain  other  women p u t f o r t h g r a p h i c d e s c r i p t i o n s  experiences  descriptions women  of  related  e x p r e s s i o n and  that  are  a  sharp  gastrointestinal  scenarios  contrast  discomfort.  that stand  out  of  their  to  the  prior  Both  of  these  for their  colourful  unusualness.  I got t h i s , s o r t of t h i s t i g h t n e s s — side here and a l s o well, I'd had t h e h o s p i t a l , i t was j u s t l i k e a p i e c e s o r t of a t i g h t n e s s r i g h t i n here.  well, i t was i n t h e e v e n when I was i n o f wet l e a t h e r , l i k e  I was s i t t i n g i n a c h a i r and t h e whole room s t a r t e d s p i n n i n g around. T h i s i s my e x p e r i e n c e . The w h o l e f r o n t room spinning a r o u n d a n d I c a l l e d my h u s b a n d a n d t h e n I became n a u s e a t e d . The familiar using  remaining  women  d e s c r i b e d symptoms  t o the p r o f e s s i o n a l domain. terminology  heaviness,  such  radiating,  as  and/or  that  They d e s c r i b e d  crushing,  choking,  excruciating.  The  are  most  their  pain  pressure, experience  i n c l u d e d symptoms s u c h a s n a u s e a , p e r s p i r a t i o n , a n d s h o r t n e s s o f breath.  The  following  two women s e r v e  as  examples of such  descriptions. Yeah, w e l l , i t h a p p e n e d a b o u t 2:00 o ' c l o c k i n t h e m o r n i n g and I was I broke out i n p e r s p i r a t i o n a l l over. Igot real wet on my c h e s t , on my n e c k a n d my h e a d a n d a l i t t l e later on I g o t t h a t h e a v y f e e l i n g a n d k i n d o f a little p a i n w i t h i t , you know. It isn't really, y o u know, a p a i n . It's a — it's a choking f e e l i n g not a choking. I t ' s a s t h o u g h somebody is pushing. I t ' s p r e s s u r e , you know.  I h a d s u c h a p a i n i n my h e a r t t h a t I was i n t e a r s a l l t h e way [ t o t h e h o s p i t a l ] a n d i t j u s t f e l t l i k e my h e a r t was t e a r i n g i n two. Well, t h e p a i n was r i g h t i n t o my a r m , r i g h t down t o my wrist a n d I j u s t f e l t l i k e someone was s i t t i n g on my c h e s t and t h e p a i n i n s i d e was r e a l l y -- i t was r e a l l y tearing.  You  know,  These healthy The  early  state  felt  them  attack  and  episode  illness.  plus  sector That  the  that  their  of  the  event.  marked  them  the a c t u a l  interaction  health  nature  said walk  This  of t h i s  do n o t h i n g , half a block  The  during  is  result  "doing  loss  the e a r l y  The  experience changes  state.  with  i n t h e way  phases  illness  t o t h e women by  the  you know. Don't do a n d t h e n come b a c k .  well  mean  prescription feature  of  to carefully of  cardiac  from  but,  their  lives.  illness  monitor  "doing  their  illness too  much"  f o r t h e MI p a t i e n t ,  clearly  F o r t h e women,  lived  this  other  then,  MI w a s c h a r a c t e r i z e d b y a b r u p t they  for regaining  pain, re-infarction  f o r wellness  Don't suppose  rehabilitation.  many  experiences,  of exhaustion,  prescription  of healthy  told  different  I n many  in feelings  this  special  women w e r e  t o 6 much" c o u l d  death.  a  distinctly  experiences. may  advice,  accentuates  experience. activity  to  redefinition  Well, as they warn you, don't overdo anything. overwork. Don't over e a t . Don't over walk, I and a l l t h a t .  wellness,  the  sector.  Well, they just a n y t h i n g b u t maybe  The  or  heart  with  from  s t a t e had undergone given  of  experience.  t h a t warned  the t r a n s i t i o n  by the a d v i c e  the end  illness  I t was  subsequent  pain.  represent  experiences  healthy  f u r t h e r entrenched  professional  prior this  Terrible  i t seems,  the beginning  anticipate  professional  terrible.  experiences,  women d i d n o t r e l a t e  helped  was  i t just  or possible  reinforced their and  the  Illness important  Loss  of  Predictability  This  section  analytic  framework  predictability identified The  in  heart  bewildered Yes, just from  central  the  framework  as  feeling to  shift loss  tried  to  health  to  sense  had c a t a p u l t e d the  feel,  or  do.  them  into  a  from  health  shift  the  carry  of  from  women  on  in  It  it Is q u i t e u p s e t t i n g e m o t i o n a l l y . w o n d e r w h a t s o r t o f l i f e am I g o i n g h e r e on i n , you k n o w .  of  illness  of  not  was  as  different  felt  their  study's Loss  an o v e r w h e l m i n g  attack  they  the  state.  think,  unexpected,  in  healthy  what  Because  loss  predictability.  knowing  and as  the of  from  reality.  sudden  °  stems this  not  unfamiliar was  loss  women r e l a t e d  knowing, their  describes  to  and  illness  suspended  everyday  if  and  lives.  You know, you h a v e , you know,  to  I t k i n d o f l e a v e s y o u h a n g i n g In m i d - a i r , sort of. You know, if you f e e l l i k e - - I ' d l i k e to f e e l I s t i l l have a f u t u r e a n d t h i s way y o u d o n ' t know t h a t . You're just sort of l i v i n g e v e r y day f o r i t s e l f . P e r h a p s t h a t ' s t h e way t o do i t , you know. I don't really know.  Y o u ' r e j u s t s o r t o f i n l i m b o f o r a w h i l e u n t i l you c a n p i c k up where you l e f t o f f , w h i c h w o u l d be s o r t o f a gradual process I imagine. You s o r t o f w o n d e r t o a d e g r e e , w h e r e t o go f r o m h e r e . But I d o n ' t know. You're just in limbo w a i t i n g to c a r r y o n . "Hanging conjure  in  vivid  mid-air"  images  reality.  Loss  the  had p r e v i o u s l y  state  women of  yielding even  know  of  of  health. a  they're  being  "in in  limbo a  predictability  After  new c o n f u s i o n . what  and  relied the Now,  bodies  the  were  to  carry  on"  foreign  and  unpredictable  extended  even  to  on a s  MI,  waiting  barometers  these  changed  women  felt  saying  to  that  them.  the  about in  cues their  meaning,  they  didn't  I  think  you've  had  a heart  attack  and  you  come home a n d  you  k n o w , y o u c a n c o n v a l e s c e f o r f o u r m o n t h s a n d y o u d o n ' t know --you're a l i t t l e a p p r e h e n s i v e b e c a u s e - - s a y you g e t a p a i n in the c h e s t or a p a i n somewhere, an ache or whatever it is, now, c o n c e i v a b l y , I had those p a i n s or those aches always before and you r e a l l y t h o u g h t n o t h i n g about them b e c a u s e we a l w a y s h a v e a c h e s a n d p a i n s i n o u r b o d y . But I think after a heart attack, you s o r t o f think, is that r e l a t e d to a h e a r t a t t a c k ? Is t h a t a n g i n a ? What i s t h a t ? And w h a t e v e r i t is, you d o n ' t e v e r g e t t h e a n s w e r s really, you know. I say you d o n ' t g e t the answers probably because l i k e the net r e s u l t of i t i s n ' t serious enough. I mean, I g u e s s i f you had a n o t h e r h e a r t a t t a c k , then you'd know.  So, - - then the other thing that I'm struggling with perhaps in my m i n d p e r h a p s i s I h a v e t o b e l i e v e t h a t I'm e i t h e r e n t e r i n g or going through, whatever, the menopause and knowing as little — i t ' s my own fault because I haven't got a book and r e a d a n y t h i n g a b o u t i t - - I think t h e r e ' s p r o b a b l y a s p e c t s o f t h e menopause I'm g o i n g through that I'm a l s o c o n f u s i n g m y s e l f a s t o w h e t h e r t h a t h a s got s o m e t h i n g t o d o w i t h my h e a r t . C a n y o u g i v e me a n e x a m p l e o f s o m e t h i n g ?  Q. A.  Yeah, b e c a u s e I g e t q u i t e warm, f o r e x a m p l e , now, I d o n ' t know whether that is a hot f l u s h or f l a s h or if it has something - - i t ' s a l s o a symptom o f t h e h e a r t , that I've come to find out. I get quite l i g h t - h e a d e d at times. T h a t a g a i n i s a symptom o f h e a r t . I t c a n be a s y m p t o m o f many o t h e r t h i n g s . So, I d o n ' t know w h a t i t is. But I d o know t h a t I w a s , y o u k n o w , g e t t i n g my m e n s t r u a l p e r i o d s essentially up until September, October - - October, I t h i n k , b e f o r e my h e a r t a t t a c k a n d I h a v e n o t h a d o n e s i n c e . So - - a n d I'm f i f t y . So, I think that something in my physical a n d m e n t a l m a k e - u p i s t h e menopause b u t I'm also not f o o l i n g myself that there is a post heart attack that I'm c o p i n g w i t h a s w e l l . This  in  their  their  loss  decision  everyday  relates  the  out  at  her  the  predictability making  This side  and  lives.  feeling  experience. be  of  at  of  in  This being  profoundly  their  woman e x p r e s s e d her  interaction  doctor's with  the  perceptions  following  totally  affected  account  "unhinged"  the  need  appointment physician.  of  for to  Note  women  reality  in  dramatically  by  this  her  help  the  illness  husband her  this  to  to sort  woman's  description  of  familiarity to  process  her  has  mind as  resulted  information,  to  "a  little  in a  loss  bit of  mushed."  confidence  The l o s s in her  of  ability  think!  Now, when I went t o my g e n e r a l p r a c t i t i o n e r e a c h week or e v e r y two weeks o r however o f t e n I w e n t , f o r the most p a r t , I a s k e d my h u s b a n d t o go w i t h me. And I - - y e s , and he d i d go and I wanted t h a t s p e c i f i c a l l y b e c a u s e y o u ' r e going to go i n ; y o u ' r e g o i n g t o ask the d o c t o r q u e s t i o n s o r he can v o l u n t e e r i n f o r m a t i o n o r w h a t e v e r and you come o u t and y o u r mind i s a l i t t l e b i t mushed. Y o u ' r e not sure whether they've answered your question. In many cases they h a v e n ' t b u t you a l s o may g e t an i m p r e s s i o n o f what they've said and i t may n o t n e c e s s a r i l y be what t h e y ' v e said or what t h e y meant. S o , t h a t ' s why I wanted my h u s b a n d t o go because I t h o u g h t i f I g o t o f f base o r t r a c k on what it was, he c o u l d s a y n o , B., t h a t i s n ' t what the d o c t o r was tel1ing. Because specific,  of  concrete  wanted s t r a i g h t , their  MI.  and d i l e m m a  the  loss  predictability,  i n f o r m a t i o n about  definite  To n o t g e t in t h e i r  of  answers about  their  the  women  needed  condition.  They  t h e i r home management  these answers r e i n f o r c e d  everyday  the  of  uncertainty  lives.  You know, another thing, I — that has confused me, p e r h a p s , o r I ' v e been a p p r e h e n s i v e a b o u t , i s I d o n ' t r e a l l y u n d e r s t a n d o r know what I c a n do p h y s i c a l l y and nobody has answered t h a t . L i k e I ' v e a s k e d i t r e a l l y o f , n o t so much the c a r d i o l o g i s t as I have o f my g e n e r a l p r a c t i t i o n e r , and he has s a i d w e l l , j u s t do t h i n g s s l o w l y l i k e j u s t do t h e m , just do them s l o w l y . Well, what i s d o i n g them slowly. Like, do you know what I'm s a y i n g ? L i k e i f you vacuum, what i s vacuuming s l o w l y . E i t h e r you vacuum o r you d o n ' t vacuum. C l e a n i n g windows, r e a c h i n g say t o c l e a n windows o r be i t c u t t i n g a lawn o r w h a t e v e r , you know, l i k e I j u s t don't know and I t h i n k to m y s e l f , I don't want to do something that, you know, i s wrong and y o u ' r e going to j e o p a r d i z e y o u r s e l f f o r d o i n g i t and y e t on the o t h e r h a n d , you d o n ' t want t o , you know, c o d d l e y o u r s e l f to the p o i n t you t h i n k , w e l l , I c a n ' t d o . And you d o n ' t r e a l l y g e t t h e answers f o r t h a t . You know, s o , as a r e s u l t , you know, i t can get a l i t t l e b i t depressing.  And I walk b u t I d o n ' t do any o t h e r e x e r c i s e s because I h a v e n ' t y e t been t o l d by my d o c t o r o r the c a r d i o l o g i s t that I can e x e r c i s e beyond w a l k i n g . They s a y , well, take i t  easy.  Well,  Although their The  illness  I don't  there  was  know what e a s y a need  experience,  consequences  even  deeper  their  perceived  of  it  living  feeling  of  ability  was  of  specific  not  with  loss to  for  is.  met t o  information their  unanswered  satisfaction.  questions  predictability  about  were  which  an  affected  cope.  And I'm f e e l i n g v e r y u n e d u c a t e d a b o u t i t . And a t y p i c a l example was I take a medicine — only one medicine fortunately. And i t ' s c o r g a r d © and i t ' s a b e t a b l o c k e r . O k a y , when I was t o l d t h i s was a b e t a b l o c k e r , I s a i d to my doctor, what i s a b e t a b l o c k e r and he s a i d , B. - - w e l l , he said, well, it's a drug, of c o u r s e , t h a t ' s taken for a heart condition and he s a i d i t d o e s a lot of things. W e l l , I l o o k e d a t him and I t h o u g h t , now, I d e c l a r e . Now, that wasn't any k i n d o f an answer to the q u e s t i o n I was asking, t o me. P o s s i b l y i t was t o h i m . And I n e v e r d i d g e t an a n s w e r . Like I d i d n ' t f e e l equipped at a l l , t o come home from h o s p i t a l and cope w i t h h a v i n g had a h e a r t a t t a c k . Accompanying characterized felt  by t h e  MI,  the  loss  women.  to  These of  pervasive were  i n c l u d e d the  of  fears  emotions  particular  possibility  sudden d e a t h , These  loss  stimulated  and  predictability  normal.  perceived  discomforts  profound  of  possibility  returning women's  the  and  concerns  the  an  concerns a  repeat for  reflect  the  clearly  impending  that  potential  predictability. of  of  the  Even  minor  attack.  At t i m e s you g e t , you know, n o t r e a l l y a p a i n b u t you j u s t s o r t o f g e t t h a t — l i k e a funny f e e l i n g and a l m o s t l i k e a s t i t c h or something l i k e t h a t , you know, and I t h i n k - - i t k i n d of makes me s t o p now and t h i n k , you know, oh, is i t g o i n g t o happen a g a i n ? Despite incident,  the  a recognition nagging  dread  that of  things another  were  proceeding  attack  without  persisted.  But I ' v e had no p r o b l e m s so I j u s t keep my f i n g e r s crossed hoping that's the way i t ' l l s t a y . But t h e n I went two months and n e v e r had any p a i n and t h e n a l l o f a s u d d e n I ' v e got i t a g a i n , you know, so I n e v e r know when I'm g o i n g to  44  ge t  it.  The  poignant  contributed had  to  the  experienced  particularly  of  memories fear  more  of  than  another one  the  heart  attack.  cardiac  attack For  event,  the  these  itself  women fears  who were  heightened.  My c o n c e r n s a r e t h a t I ' d be v e r y f r i g h t e n e d t o h a v e a n o t h e r one. T h a t ' s one t h i n g I'm c o n c e r n e d a b o u t . I've h a d two v e r y b a d o n e s , one a y e a r ago l a s t O c t o b e r a n d t h e n O c t o b e r a n d t h e n when my h e a r t l o s t i t ' s rhythm, t h a t was q u i t e a n experience in i t s e l f . I'd d o a n y t h i n g t o s t a y away from it. It's so dreadful. It's really a dreadful experience. Nobody knows u n t i l t h e y e x p e r i e n c e j u s t how dreadful it is. You just feel like your heart is shredding. The  fear  of  realized  that  and  a  to  characterizes  dying  her  reluctance  friend's loss  sudden of  was  to  go  shared. out  death.  predictability  was The is  The linked  following to  this  uncertainty strikingly  woman fear that  clear  in  A.  It h a s c u t down o n my a c t i v i t i e s t h a t I would l i k e to you know, and I c a n ' t d o . That's a problem. And other i s t h a t i t l e a v e s you w i t h a — at l e a s t i t does i t l e a v e s me w i t h a c e r t a i n f e a r . Just a fear.  do, the me,  Q.  Tell  A.  Well, I g u e s s you f e e l l i k e y o u ' r e g o i n g t o s l i p away a n d you're not ready to go, y o u know a n d b u t on the other hand, I f e e l t h a t I s h o u l d n ' t f e e l t h a t way because the Good L o r d knows what h e ' s d o i n g . You k n o w , I s h o u l d t a k e that into c o n s i d e r a t i o n but it s t i l l doesn't stop that fear of t h a t h a p p e n i n g to you. You go t o b e d a t n i g h t a n d y o u think well, am I g o i n g t o be h e r e i n t h e m o r n i n g and I think that's one o f t h e r e a s o n s I f e a r g o i n g out. I'd hate t o j u s t d r o p somewhere b e c a u s e a good f r i e n d o f mine j u s t h a d g o n e down t o t h e s t o r e a n d s h e was d o i n g f i n e and she made it in her driveway and p r a c t i c a l l y to her front door a n d t h e n e i g h b o u r s saw h e r l y i n g o u t o n t h e pavement and s h e was g o n e . Mrs. L. So, you know, i t was a terrible t h i n g to happen to an o l d buddy, i f she knew. I h o p e I d o n ' t know when i t c o m e s b u t i t l e a v e s y o u w i t h t h a t feeling. So - - i t ' s k i n d o f a s c a r y b u s i n e s s b u t that's about a l l I can t e l l you a b o u t it.  this  the  suddenly  excerpt.  me more  about  that.  It's j u s t t h a t y o u t h i n k , y o u h a d o n e ; now y o u r e a l l y don't know how s t r i c t y o u h a v e t o d o t h e s e t h i n g s o r how l o n g it takes. I t h i n k in the back of a p e r s o n ' s mind, they think t h e y ' v e had o n e ; n o w , j u s t how l o n g i s i t b e f o r e t h e y h a v e a n o t h e r o n e a n d how many do y o u h a v e . b e f o r e t h a t ' s s o r t of t h e e n d o f w h a t e v e r l i f e be it. Concern voiced  by  about  the  potential  for  of  the  women.  In  their  old  healthy  several  grieving  for  self  returning essence, and  to  they  their  normal  was  seemed to  former  be  familiar  reality. I r e a l l y wonder about t h a t , whether I ' l l e v e r get back to where I c a n do j u s t a n y t h i n g . Or want t o do i t . O r be a b l e t o do i t . You k n o w . T h e r e ' s a d i f f e r e n c e r i g h t now o f w a n t i n g t o do i t a n d b e i n g a b l e t o do it.  I w o u l d j u s t l i k e t o be t h e way t h a t I was b e f o r e b u t I'm not. I know t h a t . I'm n o t t o t h e p o i n t t h a t I haven't got the strength t o do t h i n g s . I still want to do everything. I still w o u l d l i k e t o do e v e r y t h i n g .  Well, there's always the unanswered q u e s t i o n s , until I'll be n o r m a l a g a i n . My c o n c e r n i s t h a t happen a g a i n .  how long it doesn't  Well, I think of, you know, g e t t i n g t h i s a l l h e a l e d and g e t t i n g back t o , you know, normal. I d o n ' t know when - if I'll have to take m e d i c a t i o n s a l l the time or what. I d o n ' t know. B u t I'm j u s t t h i n k i n g a b o u t g e t t i n g b a c k to normal activities. You k n o w , I l o v e t o go t o t h e - to the horse r a c e s . I love gambling. I l o v e t o go t o R e n o . I p r o b a b l y c o u l d n ' t p u l l t h a t s l o t m a c h i n e t o o many times yet but no, I — I j u s t t h i n k of g e t t i n g myself a l l better again. Part normal to  use  measure  of  was  this  concern  a comparison of  data their  about  others  own p r o g r e s s .  about self in  the with  similar This  potential  for  returning  others.  The  women  situations  appeared  as  a  seemed to  to  seemed  means give  to them  46 a  reference  evaluate  point  their  in  their  own c a r d i a c  world  of  unknowns  from  which  to  rehabilitation.  I t was a v e r y s c a r y e x p e r i e n c e a n d i t ' s s o m e t h i n g t h a t you hope will n e v e r h a p p e n t o you a g a i n and s t i l l you we have had d i f f e r e n t f r i e n d s a n d you t h i n k , well, gee w h i z , they t h e y s e e m e d t o be o n t h e mend a n d a l l a t o n c e , they were gone l i k e t h a t and I've had q u i t e a number o f them. T h e y seem t o — a n d s t i l l , you s h o u l d n ' t f e e l t h a t way.  So, but as I say, beyond t h a t , I d o n ' t know how l o n g a n d I suppose the time w i l l come, i t ' s k i n d of like a death perhaps, the t i m e w i l l come when y o u f o r g e t t h a t y o u had o n e , p r o v i d i n g t h i n g s go a l o n g r e a s o n a b l y w e l l . I mean, I have friends — I have a v e r y good f r i e n d — he was our best man a t o u r w e d d i n g . He h a d a m a s s i v e h e a r t attack ten y e a r s ago and l i k e , h e ' s never had a n y t h i n g s i n c e and he, you know. You know, as I say i t ' s k i n d of l i k e a death. I think for some t i m e y o u d o think about it whether you want t o o r n o t a n d h o p e f u l l y a s t i m e g o e s on, you'll t h i n k l e s s and l e s s about i t , and get back to d o i n g t h i n g s a s you d i d them b e f o r e .  But now, I d o n ' t know, you're not you're a l i t t l e a l i t t l e b i t weaker and a l i t t l e b i t — but I hope I c a n get b a c k t o my n o r m a l . I think heart patients do. I'm not so s u r e , b u t I'm t r y i n g t o t h i n k o f a p e r s o n t h a t h a d h e a r t p r o b l e m s i n my t i m e . I know my a u n t d i d . She h a d a n g i n a problems but she — she c o n t i n u e d p r e t t y g o o d . She was strong and s h e d i d t h i n g s t h e way s h e n o r m a l l y did, you know. In the  summary,  basis  for  predictability. of  the  women's  involving loss and  of role  loss the  a complex  of  state,  pervasive  predictability  experience  following  pattern  emotions  precltabilIty enactment.  healthy  subsequent  Loss loss  of  was  of  felt  in  the  MI  event  itself,  and c o m p e l l i n g constitutes MI. and  relation  In  the  energy,  of  essence  addition  specific to  loss  is  to  concerns, support,  The  women's  physical their  and  lives  were  the  of  of  their  energy  women e x p l o r e d  lives,  they  body's  response  altered  energy  as  to  influenced  For  the  unexpectedly energy  as  was  of  energy their  as  to  patterns  their women,  these  troublesome.  a reaction  and  from  in  their  feature  hospital.  These  indicators  very  changes of  Lack and  the  of  attitude  both  in  energy  of  the  ways.  As  health.  lack  exertion.  in  a prominent  potent  manifested  their  changes  as  discharge and  approach well  energy  state  described  their  activities  after  tangible  precariousness Lack  identified  psychological  everyday  changes  accounts  dramatic  within  energy of  and  sleeping.  changes The  outlined  in  terms  energy,  pace  towards  their  scope  as  a  their  example, of  their lack  of  life.  their  women d e s c r i b e d it  of  Further,  daily in  for  everyday  energy their  sequence  of  lack  were of  physical  man i f e s t a t i o n s . Yeah and I s t i l l g e t t i r e d . I still get t i r e d . My l e g s , t h e l o w e r p a r t o f my l e g s , b e l o w my k n e e s , g e t s q u i t e weak at times and I've t o l d my d o c t o r s a b o u t t h a t . I have no idea what t h a t i s . Sometimes, you know, you j u s t feel like your legs a r e n ' t going to h o l d you. And then it p a s s e s and then we're okay.  I f i n d t h a t I w a n t t o d o some t h i n g s a n d I c a n ' t . Because it's a m a z i n g how w e a k e n i n g i t i s r e a l l y b e c a u s e t h e other day, I was d o i n g some i r o n i n g a n d I - - r e a l l y I s t a y e d at it a little l o n g e r a n d I n o t i c e d I was s t a r t i n g to get tired. I h a d n ' t done an a w f u l l o t , j u s t o n e o r two t h i n g s I wanted to do. B u t you know, my l e g s were actually rubbery. I c o u l d h a r d l y get from t h e r e to t h e r e , in the house h e r e . I t was a n o d d f e e l i n g , you know, like, you feel like y o u r l e g s a r e g o i n g t o go o u t f r o m under you. The  women  realized  that  they  could  no  longer  push  48 themselves This  to g e t  things  represented  done  a new  once  they  sensed  l i m i t a t i o n for  t h e y were  them to  face  tiring.  in  daily  1 i v ing.  Q.  What happens - - how do you know when - - to gauge activity? T e l l me how you d e t e r m i n e when you have to and when you c a n ' t do s o m e t h i n g .  your stop  A.  I j u s t g e t f e e l i n g a l i t t l e washed o u t . Maybe an h o u r and a half, an h o u r and whereas b e f o r e , I would k e e p on g o i n g regardless, u n t i l what I wanted t o do was d o n e . Now, I think I'd better not. I f e e l I'm g e t t i n g tired. I'd better s i t down. Or I b e t t e r l i e down now. F o r a few minutes b e f o r e I c a n go o n . But you j u s t s o r t o f g e t a r e a l drawn t i r e d f e e l i n g . I'm g o i n g to have to s i t down.  I find I get t i r e d very e a s i l y , that I j u s t run out of e n e r g y and I r u n o u t o f i t t o an e x t e n t where I j u s t can't do a n o t h e r t h i n g . I'm j u s t a b s o l u t e l y f l a t u n t i l I go and l i e down f o r a b o u t a h a l f an h o u r o r s o .  You know, I never f e l t I r a n out of e n e r g y . tired but I c o u l d p u s h m y s e l f and now I c a n ' t m y s e l f t o do a t h i n g . The women's activities. the  heart  slowed  down  lack  of  T h e r e was attack. as  energy  affected  a definite  feeling  The women were  a way o f  the  coping with  the  quickness  of  unable  I might g e t even push  being to  risk  slower  keep of  of  pace  their since and  overextending  themselves. I go g r o c e r y s h o p p i n g now, p r o v i d i n g he d r i v e s me. I f the c a r t g e t s t o o f u l l , n a t u r a l l y he has to t a k e o v e r the c a r t . I u s e d t o be a v e r y f a s t w a l k e r . Now, I'm n o t . And I'm a l w a y s t r a i l i n g way b e h i n d him somewhere. This is what's irritating. All o f a sudden he r e a l i z e s I'm n o t beside him and h e ' s w a l k e d away t o o f a s t .  I did things a lot quicker. You know, when I went to do s o m e t h i n g , i t was j u s t now and now, I j u s t I t h i n k about i t and I'm s l o w e r now, you know. If I t u r n around f a s t , I t h i n k I ' d get d i z z y . But I was v e r y q u i c k b e f o r e . I was quick at e v e r y t h i n g . I d i d n ' t walk, I r a n .  I know t h a t I o p e r a t e s l o w e r , but I t h i n k t h a t the r e a s o n a g a i n t h a t I do i t , a s I s a i d t o y o u , a t w o r k , for example, which i s w h e r e i t c o m e s maybe m o r e , y o u g e t t h e adrenalin f l o w i n g and r e a l l y , you know, g e t i n t o i t a n d do w h a t e v e r it is that you're doing. Now, i t ' s t h e same a s a t h o m e , i f I do t h a t I c a n f e e l i t p h y s i c a l l y . If I really, you know, get into doing something, I can feel it physically. So I you know, I d i s c i p l i n e myself not to let that happen. In was  addition  affected.  everyday the  to  speed,  Now,  a  activities.  activity  would  their  thinking  The  affect  whole  approach  through  heart  and  activities  process  women p r e - e v a l u a t e d  their  to  their  preceded  whether  or  not  rehabilitation.  You a l m o s t g e t t o t h e p o i n t b e f o r e you do something, you think, oh, boy, is t h i s g o i n g to s e t something o f f a g a i n or is i t o k a y t o go a h e a d a n d do t h i n g s , you know, like do some i r o n i n g o r d o a b i t o f c l e a n i n g .  The no A. 0.. A. Q. A.  Yes, think  it is about  Loss  of  different it. You  energy  women r e p o r t e d longer  "gung  ho"  also  because I well, [before] j u s t g e t down a n d d o it.' meant  feeling to  do  loss  "less  of  one's  enthused  zest  about  for  you  don't  living.  everything"  and  things.  And t h e n ' j u s t g u n g ho a n d go a h e a d a n d do i t a l l . Uh-hum. I just I c a n ' t do t h a t any m o r e . Uh-hum. But now I f i n d - - e v e n j u s t i f I do t h i s a r e a a n d g e t it c l e a n e d up t h e n u s u a l l y I h a v e t o s i t down a n d h a v e a rest for half an h o u r o r so and t h e n I ' l l g e t up and go do something e l s e .  - - and another thing, you know, s o m e t i m e s you f e e l less enthused about e v e r y t h i n g . Your e n t h u s i a s m , l i k e b e f o r e , I h a d more e n t h u s i a s m . Like, I'm g o i n g t o do t h i s , I'm going t o do t h a t . And I went a h e a d a n d d i d i t a n d now, you d o n ' t have t h a t . You k n o w , you j u s t g o t t o think, w e l l , g e e , t a k e one t h i n g a t a t i m e ; do t h i s , do t h a t . Overall,  the  women  described  a general  state  of  feeling  fatigued,  exhausted,  sleeping  patterns  of  energy  their  and  were  zapped  clear  of  energy.  signals  to  the  The  changes  women o f  the  in  extent  losses.  I've b e e n t h i n k i n g a b o u t t h a t a n d I'm n o t t o o s u r e what it means. It's very f r u s t r a t i n g because I l i k e to I've been in h o s p i t a l . I f e e l I s h o u l d be w e l l a n d I want to carry on w i t h my l i v i n g a n d I c a n ' t . You t r y a n d do a little b i t a n d y o u f e e l y o u h a v e t o s i t down because you h a v e t o g e t more e n e r g y b e f o r e y o u c a n go o n a g a i n .  You know y o u g e t t i r e d q u i c k e r t h o u g h . You know, like some nights, if you t h i n k y o u ' d l i k e t o go o u t and you think, well, I'd b e t t e r n o t b e c a u s e you j u s t f e e l a l i t t l e bit tired, you know. I'll go t o b e d a t 8 : 0 0 o ' c l o c k or 8:30 or whatever.  Q.  Tell  A.  Well, I u s e d t o go bed at 7 : 3 0 , 7 : 0 0 . Why i s that? J u s t too e x h a u s t e d .  Q. A.  It  me m o r e .  seems,  then,  of  both  of  predictability  The  physical  women w e r e  physical  self.  physical  self  struggle because  to of  quandary  about  and  to  with  this  at  this  abilities  to  these  The the  know  and  energy  to  this  Loss  of  energy  characterizes  the  with  women  This  a  new  the  old  a  their  struggle  woman's  struggle.  real  j  then - - I attack?  pervasive  lack loss  shared  changes,  in  accounts.  understand  You know, if I ' m s t r o n g e n o u g h t o do i t know. How s t r o n g a r e t h e y a f t e r a h e a r t s a y , you know, [ y o u ] get back to n o r m a l .  a  underlying  comparison The  I'm  meant  women's  situation.  speaks  sleeping.  experience  in  ensued.  their  your  1:00 a . m .  energy.  a constant  with  and  midnight,  apparent  process  of  diet  illness  getting  was  terms  unknowns her  bed  clearly  There  to  your  psychological  was  as  about  that  faced  come the  More  loss  don't They  of  pred ictab i 1 i t y .  Lack  of  Anticipated  Lack the  of  central  anticipated  loss  they  could  this  critical  of  count  experienced  Support represents  predictability. on  their  time  in  varying  were,unprepared  support  husbands  their  degrees  because  The  this  to  a  women h a d  wholly  lives.  of  second  thought  support  Instead,  disappointment  expected  aspect  quality  of  that  them the  for  of  women  which  support  at  they  did  not  materiali ze. This from  lack  A  hospital.  competing health  status. that  women a l s o  the  roles  attack.  were  the  MI  one  for  a  influenced  time  this  lives  within  situation  difficulty a  less  the  lack  their  the  different the  the  heart  significant  anticipated at  if  perception  and  rehabilitation  own  forthcoming.  had had was  the  women was  be  valid  of  and  not  would  home  between  the  was  husbands  was  cardiac  think  home  period  in  their  accepted  feeling I  Lastly,  women's  at  recalled  their  experience  developed  expected  their  returned  support  home  in  a  was  a  ways.  significant  they  if  underlying  woman.  they  women  family  struggle  the  reversed,  the  situation  this  that  when  home a n d  support  sensed  illness  the  of  The  women'  the  Further,  that  their  Fueling  The  number  conflict  demands of  recognition  when  became a r e a l i t y  state  probably  the  women's  illness  what as  following  was  discharge  illness  experience.  experience  happening  relatively it's  hospital  the  free  fact  to of  in  hospital  them.  as  They  The a  time  described  emotions.  sometimes  how  should  I  put this. W h i l e I was i n t h e h o s p i t a l , I didn't really h a v e t h a t many f e e l i n g s a b o u t i t . I just felt something had h a p p e n e d , you know, t o t h e r e b e i n g a h e a r t a t t a c k . I a c c e p t e d t h e f a c t t h a t i t was a h e a r t a t t a c k . I t didn't upset me. I t d i d n ' t -- I w a s n ' t d e p r e s s e d . I didn't r e a l l y h a v e t h a t many e m o t i o n s a b o u t i t . The  impact  realized  when  Re-entering this was  their  a push  into  meant  problems work  event  became  would  with  evident.  much  home  F o r these  from  A very  fully  hospital.  into  them.  work  more  from  brought  affect  their  in rehabilitating  immediately  lives  new r e a l i t y .  interfacing  o n e woman  attack  home a n d f a m i l y  their  inherent  were  heart  t h e women w e r e d i s c h a r g e d  pathophysiological  home  As  of their  focus  how  Coming  home  women, b e i n g  environment.  a n MI acute  The  i n one's p l a c e dilemma  at  of  developed.  explained:  I suppose t h e f i r s t t h i n g you n o t i c e i s h a l f an inch of dust on e v e r y t h i n g . The b a t h r o o m s no one h a s touched. You k n o w . Newspapers stacked h i g h . A n d y o u know that you won't e v e n go a h e a d a n d do i t [ u n l e s s ] you want t o k i l l yourself and i t ' s k i l l i n g you t o go l o o k a t i t a l lthe time. My husband realizes there's something wrong. Can't you a t l e a s t g e t a l l these newspapers out? Must they l i e there i n a stack like that? You know, t h e dishwasher, everything, there's n o r e a s o n why men can't think a little. I d o n ' t k n o w w h a t m o s t women's a t t i t u d e is. N o t s o much t o h a v i n g a h e a r t a t t a c k . I t ' s what h a p p e n s a f t e r y o u come home. I t ' s worse, I imagine, f o r those women who h a v e s m a l l c h i l d r e n a t home a n d t h e r e are several women t h a t I k n o w o f who s t i l l h a v e children at home. Even  though  and  frustrating  sense the was  that  the d e s c r i p t i o n s o f the impact throughout  recuperating  doing  organizing realization  to  her usual get  that  striking  there  definite  was a  a t home w a s n o t a s m o o t h p r o c e s s .  f o l l o w i n g woman, t h e r e not  the accounts,  were n o t a s  was t h e a w a r e n e s s work,  i t done.  the support  that, although  s h e was s t i l l Furthermore, she had hoped  responsible there  For she for  was  the  f o r was w a n i n g  and  53 trying  Q. A. Q. A.  to  keep  it  going  was  not  always  w o r t h the  effort.  Yes. And t h e n you t r y t o o r g a n i z e e v e r y b o d y t o sort of take o v e r and t h a t ' s v e r y d i f f i c u l t b e c a u s e t h e y ' r e i n and out. In fact, I t h i n k i t ' s one of the more difficult parts of raising children. I t ' s j u s t when t h e y reach t h a t age t o g e t them t o r e a l i z e t h a t i t ' s s o r t o f communal living and t h e y a l l have to c h i p i n . And t h e y were w e l l o r g a n i z e d when I was away b u t when you come home, t h e y s o r t of s l a c k o f f a l i t t l e b i t . How do you f e e l a b o u t I g u e s s what I want t o say i s do you feel y o u r f a m i l y u n d e r s t a n d s the k i n d of difficulty y o u ' r e fee 1 i n g ? No. No. They d o n ' t . T e l l me a b o u t t h a t . Well, I've n e v e r s p o k e n t o them a b o u t i t f o r one thing. And l i k e most young p e o p l e when t h e y see M o t h e r s t a r t i n g to get w e l l , they s l a c k off a b i t . No, t h e y ' r e normal k i d s . They d o n ' t r e a l l y want to g e t up and s t a r t s u p p e r i f t h e i r favourite T . V . programme i s on. And I ' d r a t h e r do it myseLf than h a s s l e them t o do i t . And I think that's normal t o o . In  addition  therapeutic perception  to  things  difference  understanding. reversed, utmost  sharp  environment of that  essential  the  was  to  the  and r e l a x a t i o n ,  identified  husbands  efforts  to  w o u l d be d i f f e r e n t  There  their  rest  contrast  was  a belief  would have  facilitate  the  that,  a of  if  benefited the  there  for  level  prescribed was  man.  The  support  and  the  roles  were  from t h e i r  process  the  wives'  of  cardiac  due  to  rehab i 1 i t a t i on. One  woman  traditional this the  as  suggested  role  a possible  support  women's  she  difficult  where for  understanding  the  this  She  felt  market these  was that  but  then q u i c k l y  more c l o s e l y it  d i d not  fit  to it  provide  seems,  her  dismissed  implied  aligned  work s u p e r c e d e s .  but,  was  A n o t h e r woman  husbands  and s u p p o r t ,  difference  home,  explanation.  had e x p e c t e d  roles.  perspective  within  that  with  usual  the  male  with  Not o n l y the  that  was  it  expected  they c o n t i n u e d  within  their  lives  acknowledging women w a n t e d  as  if  their more  nothing wives'  had  happened,  illness  and e x p e r i e n c e d  experience.  a bitter  without  overtly  Clearly,  these  disillusionment.  My f e e l i n g w a s , God f o r b i d , b u t h a d i t b e e n my h u s b a n d , I f e l t I would have c o p e d w i t h i t d i f f e r e n t l y . L i k e I would have been in a p o s i t i o n , i f you w i s h , or a c o n d i t i o n to have really g o n e a n d e d u c a t e d m y s e l f a s t o how t o handle this, f o r my h u s b a n d , okay, to cook f o r him, to encourage him, t o do w h a t e v e r , b u t y o u come home a s a w i f e who d o e s the c o o k i n g and does the housework, e t c e t e r a and etcetera and y o u ' r e not f e e l i n g t h a t good to s t a r t w i t h and you're n o t e q u i p p e d a t a l l a s t o h a n d l e i t a n d you d o n ' t f e e l , you k n o w , j u s t g u n g ho a n d f u l l o f w h a t e v e r t o d o t h i s . Again, it m i g h t be j u s t t h e i n d i v i d u a l b u t I mean all I ' m s p e a k i n g f o r i s my own h u s b a n d , o k a y . To my k n o w l e d g e he has done — like he h a s d o n e nothing to find out anything about a heart a t t a c k , okay. I t h i n k he t h i n k s to himself, w e l l , she has done i t . B ' s done i t . You k n o w , B's f o u n d out or s h e ' s t a l k e d to the d o c t o r o r she phoned the H e a r t F o u n d a t i o n o r she d i d t h i s . But you know, he h a s t o go t o w o r k a n d I ' m s u r e , l i k e i f I s a i d s o m e t h i n g t o him, he'd say, well — l i k e he g o e s t o w o r k a t t w e n t y a f t e r s e v e n a n d he g e t s home a t 5 : 3 0 a t n i g h t . L i k e what i s it I want him t o d o . You k n o w . So, i f I was a career woman, and my h u s b a n d h a d o n e , i t m i g h t be d i f f e r e n t but no, I don't think so. B e c a u s e , I'm j u s t i n t h a t e r a where t h a t i s the w i f e ' s r o l e , okay. S o , some h u s b a n d s may b u t I t h i n k f o r t h e most p a r t [not]  I d o n ' t know. It's different for a man. They worry about, what, you know, g o e s on a t the o f f i c e o r whatever job t h e y h a p p e n t o be a t . They're t o t a l l y dependent on t h e i r wife f o r moral s u p p o r t , p h y s i c a l c o m f o r t , everything. I d o n ' t know. F o r some r e a s o n , men j u s t d o n ' t u n d e r s t a n d . When I come home f r o m t h e h o s p i t a l , he a u t o m a t i c a l l y sits and w a i t s f o r d i n n e r t o be s e r v e d . Finally i t dawns on him, hey, wait a minute. But s t i l l , it never really, really r e a c h e s down d e e p i n s i d e , I don't think. Look, she's restricted i n what she c a n do o r a t l e a s t what she's t o l d she c a n d o . They n e v e r t h i n k t h a t way. S o , you a s k a few t i m e s a n d t h e n y o u f i n a l l y j u s t g i v e up a n d forget about i t . A n d e v e r y now a n d t h e n t h e y d o t h i n k , w e l l , you know - - t h e y g e t t h e v a c u u m c l e a n e r a n d v a c u u m o r some s u c h thing. I c o u l d h a v e s o m e o n e come i n b u t b y t h e t i m e you get through showing them, t e l l i n g them, e x p l a i n i n g to them, why that's equally as bad on you a s i t is to do it yourself, I think. I t h i n k when a woman h a s a heart attack, the man, the husband, and if there are any children, t h e r e s h o u l d be some c l a s s , some s o m e t h i n g t h a t  can  really  expected  of  make  them aware  them.  Contributing  How  to  anticipated  support  heart  attack  was  woman  shared:  a  the was  less  the  it  what  has  actually  women's stated  significant  has  happened, to  perceptions or  unstated  event  for  a  what  is  go. of  lack  premise woman.  that As  of a this  L i k e t h e o n e t h i n g my h u s b a n d s a i d , for example, he s a i d , well, you're lucky - i f I'm u s i n g t h e w o r d s c o r r e c t l y , he said, w e l l , y o u ' r e l u c k y i n c o m p a r i s o n , he s a i d . There's been men down a t t h e m i l l f o r e x a m p l e , who h a d a heart attack. There was two t h a t h a d t h e m a n d t h e y w e r e off work f o r s o m e t h i n g l i k e s i x m o n t h s . S o , he s a i d , c a n y o u imagine, he s a i d , t h e s t r e s s a n d t h e a n x i e t y a n d e t c e t e r a , that t h e y were u n d e r b e c a u s e t h e y were t h e providers and they had to worry about t h e i r job and t h i n k about, like when am I g o i n g t o g e t b a c k t o my j o b w h e r e a s , he s a i d , you d i d n ' t have to worry about that. A n y w a y , when he s a i d t h a t , I d i d n ' t s a y a word to him but I took r a t h e r o f f e n c e of t h a t . Because I d i d n ' t need to hear that. You know, i t was s o r t o f l i k e , I got the f e e l i n g t h a t , l i k e y o u ' v e h a d one b u t you r e a l l y d o n ' t h a v e anything to worry about s o , l i k e j u s t g e t on w i t h i t and get better. Do y o u know w h a t I ' m saying? Because I didn't have to there d i d n ' t have to be stress or whatever a b o u t me g o i n g b a c k t o w o r k . I d i d n ' t e v e r have to go back to work, i f my h e a l t h w o u l d n ' t a l l o w me to, okay. B u t i t h a p p e n s t o be t h e work t h a t I — because I work, it's something t h a t I do b e c a u s e I want t o do it. If i t ' s a s e l f i s h t h i n g , t h a t ' s what i t is. I certainly d o n ' t have to do i t . J u s t f o r the monetary a s p e c t of it. But that was j u s t a t y p i c a l r e m a r k a n d he d i d n ' t mean it unkindly. I know he d i d n ' t , b u t I g u e s s when he s a i d it, I w i s h e d t h a t he h a d n ' t a n d I j u s t t a l k e d t o a girlfriend o f m i n e a b o u t i t a n d I t h i n k , y o u know - - a n d I ' m n o t b e i n g chauvinistic t h e o t h e r way a r o u n d b u t I t h i n k i t ' s rather — i n my f e e l i n g r a t h e r , t y p i c a l l y male t h a t - - and y e t the tables would be q u i t e t u r n e d i f i t was t h e y who had the heart attack. Because he said to me like these people that he supposedly knows t h a t had a h e a r t a t t a c k , they were off work a n d he s a i d t o me, you know, a man t h a t h a s a h e a r t attack, some of t h e m d o n ' t know i f t h e y ' r e job will be there when t h e y g o b a c k ; others do. L i k e what he was saying, I guess is say t h e y ' r e a plumber or a c a r p e n t e r or that s o r t of t h i n g t h a t , you know, they d o n ' t n e c e s s a r i l y have benefits. It w o u l d j u s t be t h e s t r e s s they'd be u n d e r by b e i n g o f f work. I understand a l l that. But it was j u s t t h e way I f e l t , I j u s t f e l t I d i d n ' t need to hear  that. I guess I d o n ' t want s y m p a t h y so to speak because I'm not t h a t type of a p e r s o n . Perhaps just a little bit more understanding or an attempt of understanding what h a s h a p p e n e d . B u t he j u s t h a d my husband happens to be t h e t y p e o f person that - like n a t u r a l l y he w i s h e s i t d i d n ' t h a p p e n b u t he r e a l l y doesn't want to t a l k a b o u t i t . He d o e s n ' t r e a l l y w a n t t o yeah, discuss it. He j u s t w a n t s me t o g e t b e t t e r a n d l e t ' s get on w i t h t h e way t h i n g s w e r e . L i k e y o u s h o u l d be a b l e t o be o k a y . Within MI  was  the  poignantly  validation  of  component women's  above  of  women's lack  to  possible  of  lifestyle  the  support,  changes  heart  attack  anticipated  illness  process  was  to  over-exertion there effect  a  experience  was  was  because  incomplete an  inherent the  Influenced.  In  wear of  difficulty  successful  with  Consequently  negatively emotional  experience This  support.  considerable  physical  anticipated  women's  m i n i m i z e d and d i s m i s s e d .  rehabilitation  addition  excerpt,  cardiac  and  tear  and  lack  of  actualizing  the  the  rehabilitation.  And see, my h u s b a n d was a l s o a smoker. Now, I'm not smoking and I h o p e t h a t I ' m n o t a b o u t t o a n d he was good when I f i r s t come home f r o m t h e h o s p i t a l . L i k e he d i d n o t smoke i n the home. And I t h o u g h t , l i k e he was cutting down a n d h o p e f u l l y he w o u l d s t o p b u t w e ' l l be sitting in the den a n d h e d o e s smoke i n t h e d e n a n d I don't really like it, but I t h i n k to myself — like, I g e t up a n d w a l k out of the den b e c a u s e once a g a i n , I j u s t t h i n k to m y s e l f , l i k e he k n o w s a n d I ' v e told him, you know, t h a t it bothers me and I g u e s s , e x - s m o k e r s are the w o r s t . But i t does b o t h e r m e , p l u s I know t h a t i f I ' m g o i n g t o s i t in t h a t den a t n i g h t a n d i n h a l e t h e smoke o f t e n c i g a r e t t e s , I m i g h t a s w e l l h a v e f i v e o f my o w n . I m e a n , t h a t ' s how much d a m a g e is being done. So - - b u t you know, I'm n o t g o i n g t o s a y to h i m , you c a n ' t s m o k e . T h i s i s h i s home t o o . I guess if he w a n t s t o s m o k e , you know, I'm t h e one t h a t h a s to make t h e c h o i c e . Now, I t h i n k i n my m i n d , i f t h e t a b l e s w e r e t u r n e d a g a i n , I wouldn't smoke i n the home. I f he wasn't smoking, I w o u l d n ' t do t h a t t o h i m . But I o n l y t h i n k t h a t . I mean, I d o n ' t know. I w o u l d hope I w o u l d n ' t . Because smoking i s o b v i o u s l y such a b i g p a r t of it. Thus,  not  validating  the  experience  seemed to  extend  as  well  into  a  directly  lack  of  related  modifications). changes  been  Q. A.  not  following  and c o o k i n g that easy  she to  two  was  put  it  the  meals  was  diet  to  first  of  daily  dietary  support  difficult  was  for  her  seemed  illness  her her.  increased energy It  not  because  prescribed  expend. when  living  (lifestyle  smoking,  husband's  meant a n  unwilling  herself  the  of  recovery  cessation  woman r e l a t e d ,  output that  it  experience  nullified.  But the c o o k i n g , I f i n d the c o o k i n g very d i f f i c u l t . And I think i t ' s because i t ' s for myself. B e c a u s e I'm c o o k i n g for m y s e l f a n d I w o u l d be c o o k i n g o n e way f o r myself and o n e way f o r my h u s b a n d , i f I r e a l l y d i d w h a t I was s u p p o s e d to do. And I f i n d t h a t d i f f i c u l t . S o , a l l I'm d o i n g i s - - as opposed to c o o k i n g f o r m y s e l f , I ' m j u s t c u t t i n g some things out that I cook f o r h i m . Because I don't like cooking t h a t much t o s t a r t w i t h . I'm a r e a s o n a b l y good cook but I d o n ' t r e a l l y l i k e i t and i t ' s j u s t not in me. I h a v e n ' t g o t t h e i n t e r e s t t o c o o k two d i n n e r s . Do y o u t h i n k t h a t i f i t was r e v e r s e d , y o u w o u l d c h a n g e y o u r eating habits. Yeah. No q u e s t i o n . Now, the — yeah, because I would cook for him and I would e a t w h a t ' s there because I know that what I ' d be c o o k i n g f o r h i m i s f o o d t h a t I s h o u l d be e a t i n g myself anyway. But, you know, when I came home from the h o s p i t a l , I s a i d to him, you know, c o u l d we s i t down a n d p l a n a m e n u , you k n o w , s o m e t h i n g t h a t w o u l d a p p e a l t o h i m , y o u k n o w , t h a t w o u l d be w i t h i n t h i s . O h , y e a h , he t h o u g h t t h a t was a g o o d i d e a , b u t l i k e i t ' s n e v e r h a p p e n e d . So, l i k e I'm n o t g o i n g t o p u s h . I just think i t ' s wrong to push somebody e l s e i n t o s o m e t h i n g t h a t even though it w o u l d be t h e b e s t t h i n g f o r t h e m , i f t h a t i s n ' t what they want. The  of  to  this  her  had  addition  As was  facets  positive  p r o b l e m a t i c when  Planning  not  In  a  those  also  husband  was  to  for  were  felt.  from  support  women c o u n t e r e d  anticipated  support  responses  to  universal  opinion  impaired  in  their  their  by  their  trying  illness among  felt  the  abilities  to  disappointment understand  experience. women to  that  help.  their  There their Both  in  was  the  husbands' an  husbands their  lack  almost were  husbands'  difficulties  in  not  how  knowing  the  quality  of  coming to  their  to  terms  with  their  MI  effectively  help  out,  were  husbands'  and  their  thought  simply to  limit  support.  He's, you know — and as I s a y , h e h a s n ' t - - t h e r e was a programme on, P., l a s t Wednesday. I t came o n a t 9:00 o'clock. I t h i n k i t was o n C h a n n e l 9 a n d i t was t h i s c h a p who'd had a h e a r t a t t a c k . I t was o n f o r a n h o u r . Okay, i t was — well, i t was o n l y t h a t h o u r a n d o f c o u r s e , I - my Mom h a d t o l d me a b o u t i t a n d I j u s t made a point of watching i t . A c t u a l l y i t was q u i t e g o o d . I mean I w a t c h whatever I can and r e a d whatever c e r t a i n l y I can and I told my h u s b a n d i t was c o m i n g o n a n d t h i s w i l l j u s t g i v e y o u a n example, when i t f i r s t f l a s h e d o n a t 9 : 0 0 o ' c l o c k , he g o t up and I d i d n ' t know w h e r e he was g o i n g o r what he was d o i n g b u t he w e n t a n d r a n t h e b a t h t u b a n d h a d a b a t h . It was like he d i d n ' t w a n t t o s e e ; he d i d n ' t want t o know. So, you know, when a p e r s o n - - when y o u g e t t h a t feeling t h a t a p e r s o n i s t h a t way, i t ' s d i f f i c u l t b e c a u s e you d o n ' t want l i k e I d o n ' t want t o p u t s o m e t h i n g o n t o him t h a t ' s g o i n g to d i s t r e s s h i m . I mean, you know, I t h i n k you have t o h a v e I t w i t h i n y o u r s e l f a n d we you know, we'll have been married twenty-nine years t h i s year. So, it's not l i k e we s o r t o f d o n ' t know e a c h o t h e r o r know e a c h other's moods and what have you, you know. Willingness on  some  being  level, wholly  takeover lack  was  of  for  help the  and  almost  reasonable  women.  supported,  the  expectations.  to  There  because  responsibilities always As  these  linked women  to  effort was  there  perceived their  were  still was to  a  not be  husbands'  comforting, sense a  theirs.  of  not  complete This  gender-related  explained:  A n d he d o e s t h e c o o k i n g a n d i n f a c t , he was b r a g g i n g , well, I won't get k i c k e d out of the k i t c h e n any more now, he says. He l o v e s t o c o o k . A n d he d o e s t h e v a c u u m i n g a n d he does the laundry b u t he d r a w s t h e l i n e at ironing. of course [underlining added].  He's n o t o n e o f t h o s e men t h a t w i l l j u m p i n t o the lady's work a n d a l l t h a t , you know, b u t he t r i e s v e r y h a r d t o — to o b l i g e . L i k e he c e r t a i n l y d o e s n ' t v a c u u m w e e k l y . He d i d i t o n c e a n d t h e n he d i d i t a g a i n t h e o t h e r d a y . Ach, I d o n ' t t h i n k he was v e r y t h o r o u g h b u t i t d o e s n ' t matter. He's doing it. So, there it is. You k n o w , w h a t c a n v o u ask of him [ u n d e r l i n i n g added].  59  There's things that I shouldn't be doing like maybe vacuuming off the c h e s t e r f i e l d or d o i n g e x t r a vacuuming, t h a t a woman d o e s [ u n d e r l i n i n g a d d e d ] y o u k n o w , he d o e s n ' t - I j u s t f e e l l i k e I'm i m p o s i n g on him an a w f u l l o t and — It's just t h a t I f e e l t h a t I'm e x p e c t i n g t o o much of him. You k n o w , o f b e i n g a man a n d n o t u s e d t o t h a t sort of t h i n g [ u n d e r l i n i n g a d d e d ] . And I c a n ' t do i t . I have found that out. I nearly knocked myself out. One d a y I thought well, I can a t l e a s t vacuum the chesterfield. Well, I g o t t h e c h a i r d o n e b u t I f o l d e d up b e f o r e I g o t to the c h e s t e r f i e l d . Clearly, support  then,  had  to  freed  The get  of  their  it  was  of  related  to  the  women n o t  of  support  to  felt  profound  in  these  within  excerpts  of  of  their  illustrate  anticipated  issue  MI the  than  total  physical  emotional  or  and  physical  They  could  The  of  of  in  terms  did  them.  were  not  focus  The  support  women w i t h  support  was  represented  a  illness  was  on  magnitude  of  the  strongly to  be  example,  the  perceive  women with  their  most  retired  visible  fundamental The  area  husbands'  employed  impact  the  with  developed  experience.  how  seemed For  not  disappointment  the  of  variation  circumstances.  for  of  and  both  they  varied  anticipated  accounts  so  relationships  lack  less  MI.  family  accounts  women,  their  dimension  an  the  satisfaction.  women.  partner  be  the  either  their  support  some d e g r e e  Lack  to  their  women's in  input.  For  from  that  consequences,  responsibilities  among t h e  two  husbands  done  anticipated  felt  evident  women e x p e n d e d  things  rehabilitating Lack  is  deleterious  emotional. energy  it  husbands. extensively  and  critical  following  of  and  this  lack  two of  support.  He finds that does, that's  support d i f f i c u l t to give. s o m e t h i n g t h a t I e i t h e r have  to  Well, live  if with  he or  make a d e c i s i o n . You k n o w . But t h i s h e a r t attack, I just g e t t h e f e e l i n g t h a t he d o e s n ' t know how t o c o p e w i t h it a n d maybe d o e s n ' t know how t o c o p e w i t h i t b u t doesn't want t o . He j u s t s o r t o f w a n t s t o he w a n t s t o a v o i d it a s much a s he c a n . I think, h e ' s j u s t as g l a d to get out o f h e r e a t t w e n t y a f t e r s e v e n a n d g o t o w o r k a n d come home and I make d i n n e r . L i k e he i s n ' t o n e t o help around. L i k e he n e v e r s a i d , l i k e , c a n I vacuum f o r you o r c a n I do something for you, when he k n o w s t h a t t h e s e things are important to me because I've always been a fussy housekeeper.  He can't understand or accept that jeepers, after two months, she s h o u l d be a b l e t o d o s o m e t h i n g . You know. Well anything. You s h o u l d be a b l e t o w a s h w i n d o w s . You should be a b l e t o d o j u s t a b o u t a n y t h i n g y o u e v e r d i d do. A n d he d o e s n ' t s e e m t o u n d e r s t a n d w h y . W e l l , Dr. L. tried to e x p l a i n p a r t of i t the o t h e r day. W e l l , we u s e d t o be friends. Not o n l y husband and w i f e , but f r i e n d s . It's a little different. It's much d i f f e r e n t n o w . We u s e d t o make a b i g t h i n g out of g o i n g g r o c e r y s h o p p i n g . But up until — I don't know how it affects other couples. Everybody's d i f f e r e n t , of c o u r s e . H e ' s so used to coming home t o a v e r y t i d y h o u s e . And h e ' s so u s e d t o h a v i n g h i s laundry and h i s meals meals are always d i n n e r to us was a ceremony. Now h e ' s d o i n g m o s t of the cooking. It's - - I c a n see where t h i s s o r t o f s i t u a t i o n , depending on the people of c o u r s e [ c o u l d ] a c t u a l l y t o t a l l y d e s t r o y a marriage. The  time  period  characterized  by  recalled  their  illness  terms  dealing  of  day-to-day different  with  This of  the  sensed  that the  Additionally, inherent  home of  the  impact  Coming  home  meant  not  who  would had  validating  component  hospital their  a  immediate  of  this  of  women  attack  on  immersion the  in  illness  to a  a  work  conflicting  seems,  the  in  their  transition  it  is  interlude  been d i f f e r e n t  women's lack  The  an  experiencing  suffered the  as  heart  marked  have  discharge  support.  Concomitantly,  situation  husband  in of  Home m e a n t contact  hospital  anticipated  situation. the  following  experience  reality.  demands  an  lack  lives.  setting.  been  at  heart  the if  women  it  attack.  experience  anticipated  had  was  support.  Overall,  the  affected.  women's The  terms o f t h e i r and  their  cardiac  women e x p l a i n e d  difficulty  not knowing  anticipated  support  participants.  rehabilitation  facing  their  some o f t h e women,  formed  a  models  of their  illness  experience.  Change  i n Usual  Role  change change their The  of  in  accounts,  The for  change  role  illness  this of  in  experience  The l a c k  intensity  across  aspect  of the  of loss of  their  was a l s o f e l t  enactment.  usual  social  t h e women f o c u s e d  be e x p e c t e d  explanatory  This  in  relation  section  speaks  to to  a  the  a n d homemaker r o l e s .  Within  on these  roles.  two p a r t i c u l a r most  fully  by  the  c o n s i d e r i n g t h a t a l l e i g h t women  were  homemakers. change  regaining  physical  behaviour  help.  o n t h e homemaker was d e v e l o p e d  women a s w o u l d primarily  portion  negatively  Enactment  i n performing  impact  major  predictability  usual  wives'  in varying  predictability  Loss  husbands'  how t o e f f e c t i v e l y  was f e l t  For  their  was  inactivity wellness  effects from  a  busy, Because  social  were  women e x p e r i e n c e d  from  because  of  the  the professional  o f t h e MI w a s v e r y  adjustment. roles  level  sector  troublesome.  activity-filled  day  was  of the prescribed a c t i v i t y  perceived  uncomfortable  t o be  prescription  adversely  and  The a  the  sudden  difficult  restrictions,  affected.  The  boredom.  The worst part I think i s s i t t i n g around. You're not allowed t o do t h i s ; y o u ' r e n o t a l l o w e d t o do that; you can't go a n y w h e r e . Y o u n e e d t o be a b l e t o g e t i n t o y o u r own c a r a n d d r i v e t o t h e g r o c e r y s t o r e . Do y o u h a v e any idea what a p r i v i l e g e t h a t i s . I t ' s one o f t h o s e t h i n g s y o u t a k e a s -- b e f o r e t h i s , i t w a s s o m e t h i n g t h a t h a d t o b e done t h a t you d i d n ' t r e a l l y c a r e a b o u t , b u t y o u h a d t o do  it because you had t o have f o o d Now I c o n s i d e r i t a p r i v i l e g e .  But the b o r e d o m . me i s j u s t b e i n g Depression  was  also  i n the  house,  etcetera.  T h a t ' s what - - t h a t ' s r e a l l y what b o r e d , n o t b e i n g a b l e to do a n y t h i n g .  tied  to  a change  in s o c i a l  gets  roles.  W e l l , I g e t down a l i t t l e , you know, b e c a u s e I c a n ' t go out and do the same as I used t o . You know, you f e e l a l i t t l e down b u t o t h e r t h a n t h a t , i t d o e s n ' t b o t h e r me. The  tremendous  typifies  loss  relation  to  their  of  sense  predictability  usual  precarious  overriding  social  health  of  not  knowing  generated  feelings  Going  meant  roles.  out  of  which fear  in  confronting  status.  No, I h a v e n ' t been r u n n i n g around s h o p p i n g l i k e I usually do b e c a u s e I was r e a l l y g o i n g s t r o n g b e f o r e , you know. Well, I t h i n k t h a t , you know, you k i n d o f f e e l i f you want t o go a l o n g ways, you k i n d o f h e s i t a t e . You e i t h e r ask y o u r h u s b a n d o r go w i t h a f r i e n d o r s o m e t h i n g . Because I wouldn't l i k e to have i t [ a n o t h e r h e a r t a t t a c k ] happen in the c a r .  I c o u l d n ' t go i n t o a sure my h u s b a n d was off and go and shop didn't - - I couldn't I c o u l d n ' t go i n t o a  s t o r e by m y s e l f . I a l w a y s had to be i n the s t o r e . I might k i n d of take f o r something for myself, but that e v e n do my C h r i s t m a s s h o p p i n g b e c a u s e s t o r e and t h a t was a f t e r we g o t home.  The  energy  women's  their  usual  even  casual  social  of  roles.  entertainment  p e r c e i v e d as identified  lack  a negative  i n f l u e n c e d how  T h e r e was but  outcome  in a matter-of-fact  But I j u s t d o n ' t - - like have it i n me enough, t o [entertaining] either.  it of  way,  they  a definite  seems  their  MI.  that  performed  curtailment this  This  without emotional  of  was  not  change  was  overtones.  I don't feel, you know, that I p a r t i c u l a r l y want to do anything  About  the  same,  yeah,  but  you  don't  really  you're  not  the same. Say, i f you want t o c a l l s o m e b o d y f o r dinner and t h a t , a t l e a s t , I h a v e n ' t been a b l e to s a y , w e l l , gee, come on over for d i n n e r , because I d o n ' t r e a l l y f e e l like c o o k i n g , you know, a l l t h a t much. The  women's  response  their  homemaker r o l e  guilty  about  role  within  their the  was  to  a change  emotionally  husbands  stepping  in  the  usual  laden. into  The  their  enactment women  burden  home.  and  guilt  to  their  felt  long-established  I d i d at f i r s t , when I f i r s t came home I f e l t v e r y a b o u t l e t t i n g h i m do t h a t [ h o u s e w o r k ] , you know. I I r e a l l y f e l t t h a t I s h o u l d be d o i n g t h a t . You f e e l i n g y o u s h o u l d be d o i n g t h a t b e c a u s e y o u ' v e d o n e t h o s e many y e a r s . I m i n d e d more n o t b e i n g a b l e t o things, you know, and I s t i l l d o . I still mind much, you know, t h a t t h i n g s t h a t I ' d l i k e t o do a n d have to l e t it pass. The  of  was  also  related  partners,  an  to  the  Imposition  perception on  their  of  guilty just - have a it all do t h e it very still I  being  husbands'  a  time  energies. I f e l t v e r y down b e c a u s e I j u s t — you know, you c a n f e e l that y o u ' r e g o i n g t o be a b u r d e n t o s o m e o n e a n d I thought, well, poor S . , h e ' s g o t s o much t o d o a n d n o w , who k n o w s whether I ' m g o i n g t o r e a l l y be a b l e t o p u l l o u t o f it or n o t , b u t I t h i n k I am n o w .  I j u s t g e t down. I feel you're a burden.  feel  I  ought  to  be  doing  more.  You  He's learning to cook. So t h a t he can share more, a l t h o u g h h e ' s very busy h i m s e l f . And i t ' s not too f a i r to w o r k a l l d a y a n d h a v e t o come home a n d h a v e t o w o r k a t your meals, is it? In  this  last  communicated. is  another  competing  excerpt,  an  Ambivalence dimension  demands  rehabilitation  of  described  of the in  underlying  about the  accepting  conflict  household the  sense  previous  or  of  rejecting  situation and  ambivalence  their  section.  support  between own  is  the  cardiac  Although  the  heart  attack  priority even  need t o  take  selfishness  about of  experience  care  of  in her  This  minor t h r e a t s  usual  standards  The dust is p i l i n g up. You c a n keep the s u r f a c e corners. Putting  themselves  despite  the  and d e c i s i v e l y  themselves,  surfaced.  comparatively  a change  clearly  first  powerful  feelings  woman s h a r e d  of  feeling  to  her sons'  of  housecleaning.  not  for  an e a s y  this  and  guilty  health,  change  the  guilt  The b o y s a r e a l l e r g i c c l e a n b u t you c a n ' t g e t  was  reasons  established  because  to dust. into the  to  effect,  need.  And you realize y o u ' r e g o i n g t o have t o take time for yourself, which I haven't done. And t h e n you feel selfish. Because I have an e i g h t y - f o u r y e a r o l d mother 1 i v i n g w i t h me. In power  addition  feeling  and a u t h o r i t y ,  role. in  to  Even  the  women's  required  because  though t h i s lives,  a definite  guilty, of  change  letting  effort  the  the  women f e l t  change  loss  in t h e i r  was a p o t e n t i a l l y  go e n g e n d e r e d  a  homemaker  positive  a sense  of  of  loss  one and  from the women.  You have mixed f e e l i n g s b e c a u s e I t e n d e d t o do too much f o r them. And I ' v e done t o o much f o r t h e m . And i t ' s h a r d to sit back and r e a l l y continue encourage them to continue what they s t a r t e d when I was i n the hospital. You t e n d t o s o r t o f want t o t a k e o v e r . Whereas i t ' s not good f o r them and i t ' s n o t good f o r me. So, we're going to have t o - - I'm g o i n g to have to back o f f and l e t them c o n t i n u e d o i n g more o f the c h o r e s and so o n . There's six p e o p l e so t h e r e ' s a f a i r amount. Relinquishing  their role  way to do r o u t i n e  meant  household  power s t r u g g l e s  about  the  best  chores.  We r u n head on t o o s o m e t i m e s . You know, I ' l l say, well, t h i s i s the way I do i t ; t h a t ' s the way I want i t done b u t h e ' l l say, oh, you're getting b e t t e r . Y o u ' r e s t a r t i n g to compla i n . The relying  women on t h e i r  described husbands  a new d e p e n d e n c y a r i s i n g t o do the  housework.  The  from  their  incidental  details  of  control  they  day-to-day had  lost  life  because  repeatedly of  this  established  how  much  change.  Well, I find that he's taken quite a lot of my responsibility in the home. F o r one t h i n g , he's retired and he h a s no h o b b i e s s o i t k e e p s h i m b u s y a n d he really enjoys i t a n d l o v e s t o do i t . He h a s d o n e t h e shopping p r e t t y w e l l s i n c e he r e t i r e d . I u s e d t o l i k e t o do i t but y o u k n o w , y o u d o h a v e t o make c h a n g e s when t h a t t i m e c o m e s , as you'll find out. But I f i n d I g e t quite resentful about t h a t , you know. I just feel well, I don't think there's anything w r o n g w i t h me m e n t a l l y t h a t I shouldn't have - - be a b l e t o make my d e c i s i o n s i n the house, you know. T h e o t h e r d a y he was t e l l i n g me a b o u t s o m e t h i n g t h a t should be d o n e a c e r t a i n way a n d I s a i d , well, listen here, I did it for forty-eight y e a r s a n d e v e r y t h i n g was o k a y so why isn't i t now? O h , I d o n ' t mean t h a t . I d o n ' t mean t h a t . But o f t e n o u r ways o f t h i n k i n g a r e d i f f e r e n t , of course; we're two d i f f e r e n t p e o p l e a f t e r a l l . But n o t h i n g very earth shaking. It's j u s t m o s t l y a b o u t t h e way t h i n g s a r e cooked and w h a t we w a n t t o h a v e . And you know, that kitchen part has been taken over by him. Well, I'm getting used to i t and at f i r s t , I d i d n ' t t h i n k v e r y much of i t , you know. I j u s t f e l t l i k e , I was b e i n g p u s h e d o u t of the o n l y t h i n g I had any a u t h o r i t y i n a n d you kind of f e e l you l o s e y o u r a u t h o r i t y . You r e a l l y d o .  I can't anything that. Part to A. Q. A.  new  of  e v e n go i n t o t h e g a r a g e a n d l i f t t h e d o o r o r get out of the f r e e z e r . I h a v e t o h a v e my h u s b a n d d o  the  standard  loss of  of  power  and a u t h o r i t y  was  the  adjustment  housekeeping.  You know, you have y o u r — you have y o u r s y s t e m d a i l y a n d you t h i n k , w e l l , you g o t t o do t h i s a n d you do it. Yes. But now, you d o n ' t . You k n o w . It b o t h e r s you a l i t t l e bit b e c a u s e you f e e l u n c o m f o r t a b l e , t h a t y o u r f l o o r isn't vacuumed on t i m e o r s o m e t h i n g l i k e t h a t , you know. And I p i l e d up a w h o l e b u n c h o f ironing.  I accepted it because I thought i t ' s the o n l y t h i n g I can do. S o , I j u s t l e t h i m d o h i s own t h i n g . He d i d t h i n g s differently, m i n d , a n d t h a t , maybe I d i d n ' t c a r e a b o u t b u t then, that doesn't matter, as long as i t gets done. You know.  66  I d o n ' t do t h a t m u c h . M a i n l y because I t h i n k to myself, well, I can't wash w a l l s a n d I c a n ' t c l e a n windows, at least I think I c a n ' t . I c a n ' t vacuum. S o , you know, I do my p l a n t s and I keep t h i n g s t i d y and do drawers and things because I've always l i k e I've always been a good housekeeper and I l i k e h o u s e k e e p i n g but i f I c a n ' t do it all or do i t t h e way I w a n t t o d o i t t h e n I just don't bother doing it. So, I've had somebody e l s e come in. Like I h a d t h e [ h o m e m a k i n g ] s e r v i c e when I f i r s t g o t home from the h o s p i t a l . I h a d t h e m come i n . W e l l , t h e y were okay to a p o i n t , b u t d i d n ' t d o t h i n g s p a r t i c u l a r l y t h e way I wanted. So, I d o n ' t have them b u t I have a young l a d y that comes i n now e v e r y s e c o n d week a n d I just overlook things t h a t were t h a t i m p o r t a n t b e f o r e . I just think, w e l l , I g u e s s t h e y ' r e n o t so i m p o r t a n t , you know. Feeling over  the  guilty  the  anticipated  doing the  was  a  loss  women a s  doing  the  of  the  the  anticipated then  women  understanding  in  only  grieved  about  their  because  of  their  husbands  did  in  of  their work.  power  Added  about  illness  to  this  did  terms  their  get  of  their  these  although  the  However,  doing of  that  not  support husbands lack  housework.  apparent  of  These  contradiction.  husbands'  experience.  it  quandary  Therefore,  difficulty.  area  wondered  and whether  and a u t h o r i t y  in  beyond  and  condition  support  one  participate  uncomfortable  they  extended  lack  their  because  a  about  by  and c o n t r o l l e d .  also  overtly  rehabilitation  their  arena  also  role  cardiac  of  represent  homemaker  authority  their  validity  accepting  support  and  disappointed  felt  was  power  women f e l t  disappointed  housework  of  presented  women  one  loss  previously  when  homemakers owned  expected,  findings  yet,  assistance  women w e r e  they  The  and  about such  The  of  their  supporting  housework,  themselves  the  support.  housework  of  findings  weren't  justified  sense  relinquishing  contradicts  husbands  and a  Perhaps  lack  of  emotional  support meant  i n terms o f t r y i n g day-to-day  would  to appreciate  have  been  what  more r e a d i l y  this  heart  accepted  attack by  the  women. The their  women e x p e r i e n c e d  social  depression  were  identified  While  enactment  i n terms  of  there  be p r o b l e m a t i c  role  enactment loss  study's  in their  a n d homemaker r o l e s .  roles.  to  a change  were d e f i n i t e  of e n t e r t a i n i n g , these  loss  changes  in  and  social role  d i f f e r e n c e s seemed n o t  The c h a n g e  These  i n usual  and a  changes  reflect  Women's  alterations  homemaker  feelings  of predictability.  meant u n f o r e s e e a b l e  boredom  differences in social  o f power and a u t h o r i t y .  experience  to  was c h a r a c t e r i z e d b y g u i l t  central  enactment of  Feelings of  in relation  f o r t h e women.  usual  sense  MI  the  illness  i n t h e women's  daily  living.  Strategies The control  f o rControl women  over  employed  their  loss  a wide  range  of  experience.  strategies These  to  gain  strategies  for  control  were e v i d e n t  i n t h e women's d i s c u s s i o n s o f t h e c a u s e a n d  their  projections  of  Personal  p h i l o s o p h i e s and l i f e  strategies families  for control. served  experience feelings The  the  away  to  of  their  experiences  t h e impact  t h e women a n d  heart  attack.  were a l s o s o u r c e s f o r  Additionally,  deflect  from  outcome  of  the  reactions  the  heart  provide  the  of  attack  women  with  of control. women  made  sense  identifying  what  they  seemed  this  causal  that  thought  of  their  caused  attribution  illness  their  heart  provided  experience  by  attack.  It  a degree  of  order  in  this  unpredictable  And I still properly for happened.  Q. A.  illness  think high  experience.  to t h i s day t h a t blood pressure,  had I this  been treated wouldn't have  I'm w o n d e r i n g what you - - what you f e e l c a u s e d y o u r heart attack? My f a m i l y . It's mostly hereditary. My s i s t e r d i e d in her sleep. S h e was a b o u t f o r t y - f i v e . A n o t h e r one n o t long ago, j u s t a c o u p l e o f y e a r s o l d e r t h a n I. My dad. My b r o t h e r .  I have r e a d a l l the m a t e r i a l . T h e y g a v e me a l i t t l e bit at the hospital and I got a b i t more from the Heart A s s o c i a t i o n on B r o a d w a y . The b o o k s s a y s m o k i n g , which I don't do. Diabetes. W e l l , t h e r e ' s l a t e n t d i a b e t e s i n my mother's family, but I have been c a r e f u l . We s w i t c h e d t o vegetable margarines and so o n . T r i e d to be careful. The only t h i n g that I can think of is that perhaps I was r a i s e d o n a f a r m a n d t h a t was t h e c a u s e , b u t a l s o my f a t h e r died at s i x t y - f i v e . Heredity is a big item, I understand. He d i e d a t s i x t y - f i v e o f c o r o n a r y t h r o m b o s i s . A  second  perceptions  strategy  of  the  for  outcome  voiced  feelings  of  their  illness  experience.  project responses tone  of  the  future  were the  hope  in  of the  was,  was  their face When  positive  apparent  heart of  the  of and  however,  in  the  attack. many  a s k e d by  implications  generally  replies  control  unknowns  the  their  The  women within  researcher  MI,  the  optimistic. tempered  women's  with  The  to  women's hopeful  feelings  of  uncertainty. Q. A.  How d o y o u t h i n k t h e n — how d o y o u t h i n k s a y two m o n t h s down t h e r o a d ? Great. I think I'll feel better. I d o n ' t have the h i g h b l o o d p r e s s u r e l i k e I f e e l i n g much b e t t e r t h a n I w a s .  I'm hoping don't know  that I'll get whether i t ' l l  you'll  be  feeling  t h i n k i f maybe had, then I ' l l  s t r o n g e r a n d be w h a t I come t o t h a t , b u t I'm  was. hoping  I be  I it  does. hoping  Q. A.  I can feel that t h a t my s t r e n g t h  i t ' s t a k e n a l o t o u t o f me, b u t I'm w i l l come b a c k .  I'm w o n d e r i n g now how y o u t h i n k y o u ' l l be d o i n g o r s a y t w o m o n t h s f r o m now. How d o y o u s e e y o u r s e l f ? Oh, s t r o n g e r a n d h e a l t h i e r . Two m o n t h s f r o m now. three months. I should be.  feeling That's  But t o a n s w e r y o u r q u e s t i o n , I j u s t hope t h a t two months f r o m now t h a t -- y o u k n o w , t h a t I g e t o n my l i t t l e p o n y a n d get on w i t h l i f e t h e way i t was b e f o r e a n d t h a t you know, i ts o r t of i s n ' t , y o u know, I ' v e h a d a h e a r t attack or I ' v e g o t t o be c a r e f u l i n c a s e I hope by that time t h a t I k n o w e n o u g h w i t h t h e h e l p o f my d o c t o r s , r e a d i n g a n d whatever, to feel comfortable a b o u t i t a n d know i n m y s e l f w h a t I c a n d o a n d w h a t t h e c o n s e q u e n c e s o f s o m e t h i n g may o r may n o t b e i f I d o t h a t . Personal strategies  for gaining  encompassing used  their  strategies Two  control.  basic  experiences  In order  unknowns o f t h e i r  of  experience. helpful  manageable  and l i f e  illness  a t t i t u d e s towards  also  to deal  with  experience,  life  and past  served  as  the a l l -  the  women  experiences  as  for control.  experiences  as  philosophies  t h e women d i r e c t l y with  their  ability  They c l e a r l y in  putting  viewed  their  associated to their  heart  cope past  attack  their  past  illness  with  this  illness  illness experience  experiences into  a  perspective.  I t was j u s t , o h , w e l l y o u k n o w , w h e n y o u g r o w up k n o w i n g t h a t you have a h e a r t p r o b l e m . I think your a t t i t u d e i s a lot d i f f e r e n t than i f i t ' s a l l of a sudden, bang, you've got a heart problem. I d o n ' t t h i n k i t s c a r e s y o u a s much. I wasn't scared a t a l l . I t d i d n ' t b o t h e r me.  So, t o me, I didn't think nothing of i t . You know, I ' v e h a d a l o t o f t h i n g s w r o n g w i t h me b e f o r e , y o u k n o w a n d I ' v e had pain before. S o , i t j u s t s e e m e d t o come a s a n o t h e r sort of a t h i n g w i t h me. When I w a s a k i d , I had osteomyelitis a n d y o u know, I was i n t h e h o s p i t a l f o r a  year with that, about. And t h e n I h a d a c y s t i c m a s s in my, you know, f e m a l e o r g a n s a n d h a d a n o p e r a t i o n on that and it just, you know, a l l through my years, I had something wrong. B u t I h a v e come o u t o f i t a l l right. A n d o f f I ' d go a g a i n . But t h a t ' s a b o u t i t . The utmost  women's p e r c e p t i o n to  promote  encouragement. to  engender  their  This  that  were  striving  rehabilitation  feeling  f e e l i n g s of  they  of  comfort  to  do  operated  in their  their  as  efforts  an  seemed  control.  But t h e n i t j u s t g o e s w h s s s a n d I g u e s s I -- I'm trying -- I k n o w t h a t I'm t r y i n g m y s e l f t o do e v e r y t h i n g that can to p r e v e n t i t . That — and as l o n g as I f e e l t h a t doing the b e s t t h a t I can, i f i t happens, i t ' s going happen.  So, it's — i t ' s a p r e t t y hard t h i n g to t a l k about. think t h a t w h a t I f e e l t h a t I h a v e t o do i s j u s t l i v e it, not t a l k about i t . J u s t l i v e w i t h i t a n d do t h e I can. T h a t ' s t h e way I f e e l about i t . Religion terms  of  how  spiritual  played  an  they  beliefs  important  coped. helped  role  These them  to  for a  few  women  of  the  shared  make s e n s e  of  I with best  women  how  their  my I I'm to  in  their illness  experience. I am b a s i c a l l y a v e r y r e l i g i o u s p e r s o n and I found that was one t h i n g t h a t p r a y e r g o t me t h r o u g h q u i t e a in the h o s p i t a l . When y o u ' r e j u s t l y i n g t h e r e w i t h e y e s c l o s e d , y o u do a l o t o f p r a y i n g a n d w h i c h I d i d .  I just figured, God t a k e c a r e o f Specific attack expended "get  the  on  well, you the rest.  s t r a t e g i e s were  a day-to-day to  best"  I think g o i n g to  ensure of  that  employed  basis. this  know,  There heart  you to  say  deal  was  attack  a  prayer  with  and  their  considerable experience  that bit your  let heart  effort did  not  them.  it — I t h i n k i t ' s me. g e t t h e b e s t o f me. I'm  It's just — it's not going to f i g h t . It's  71  I'm not going to l i v e around doing n o t h i n g .  the r e s t  o f my l i f e  laying  just  And I think you're a lot better off, i f y o u ' r e not sitting worrying about your h e a r t a t t a c k . You k n o w , if you're sitting stewing or worrying about whether y o u ' r e g o i n g to take one, t h e n I t h i n k t h a t ' s a l o t h a r d e r on you a n d m e n t a l l y as well as p h y s i c a l l y . You k n o w , I just don't think about it.  Like I've said, I've on. t h e s o a p b o x a n d y o u  been bound and d e t e r m i n e d know, go on a b o u t it.  not  to  get  W e l l , I - - I j u s t t r i e d to l i v e as c l o s e — as n a t u r a l l y as I possibly could, y o u know a n d n o t - - n o t t o let myself pity myself. I d i d n ' t want you know, I t h i n k t h a t you can p i t y y o u r s e l f a n d make a w r e c k o f y o u r s e l f t o o . You know, y o u c a n be r e a l l y s i c k i f y o u l e t i t g e t t o y o u too much. The  women  experience befallen  disclosed  with  MI.  them  The  seemed to  feeling awareness serve  gaining  control.  Further,  a  attack  other  heart  over  fortunate  the  as  that an  worse  in  things  additional  women w e i g h e d  their  the  illness  could  have  strategy  for  advantages  of  illnesses.  You know, apart from a l l t h a t I've said, I guess - - my feeling is that something has happened to me that has happened to a l o t of p e o p l e . For whatever reason, it h a p p e n e d , I d o n ' t know. I j u s t g o t f i n i s h e d s a y i n g t o you what I t h i n k and I f e e l v e r y f o r t u n a t e from the p o i n t of view t h a t I o b v i o u s l y d i d n ' t have a m a ss i v e h e a r t attack. I f e e l f o r t u n a t e t h a t I got in through the emergency door of the hospital a n d I came o u t t h e front door of the hospital and I'm h o m e . For whatever reason different things affect different people, o r c a u s e s them t o have a heart attack l i k e I've made t h e s t a t e m e n t , for example, if you know, s o m e t h i n g h a s t o h a p p e n t o you — something e l s e c o u l d h a p p e n t o me, n o t t o s a y t h a t i t w o n ' t , b u t this heart attack, I said, y o u know I f e l t s o g r a t e f u l that t h a t ' s a l l that i t was. I made t h a t s t a t e m e n t a n d when I w e n t t o t h e h o s p i t a l , the t h o u g h t o c c u r r e d t o me, what i f t h e y d i a g n o s e d I h a d c a n c e r and I can t r u t h f u l l y s a y t h a t w e n t t h r o u g h my m i n d a n d so,  when  I was t o l d  i t was a h e a r t  attack  and c e r t a i n l y  and the  result o f t h e h e a r t a t t a c k a n d where i t was, e t c e t e r a , I just f e l t very f o r t u n a t e and I thought, t h o u g h I'm n o t a r e l i g i o u s person, I thought, y o u know t h e Good L o r d has done something h e r e t h a t h a s g i v e n me a n o p p o r t u n i t y to change my l i f e s t y l e a l i t t l e b i t that could conceivably give me q u i t e a few y e a r s o f a v e r y h e a l t h y l i f e that I wouldn't n e c e s s a r i l y have had o t h e r w i s e .  Anyway, so far you know, what c a n you s a y . I don't r e a l l y know f r o m h e r e o n o u t , what l i f e h o l d s . B u t t h e n -and on t h e o t h e r h a n d , you f e e l , w e l l , i t c o u l d have been s o much w o r s e w h a t h a p p e n e d . You know y o u c o u l d h a v e h a d something that's g o i n g t o g i v e you a l o t o f p a i n a n d no r e l i e f from i t , you know, b u t t h i s way y o u f e e l -- . If y o u ' r e g o i n g t o be w i p e d o u t , i t ' l l a t l e a s t b e f a s t .  I f e e l I was f o r t u n a t e . B u t I s o r t o f have a c c e p t e d i t a l l i n my s t r i d e a n d I I d o n ' t f e e l -- y o u k n o w , I d o n ' t -- y o u k n o w , I f e e l f o r t u n a t e . The to  women d e s c r i b e d  their  seemed  that  deflectors, themselves.  heart the  attack women  directing This  their  families'  a s more p r o f o u n d used  their  the impact  than  families  of their  d e f l e c t i o n acted  and f r i e n d s ' r e a c t i o n s  heart  their and  own. friends  attack  as yet another  away  It as from  strategy f o r  control. Oh, they [ f a m i l y ] were q u i t e u p s e t , you know. worried a n d one t h i n g and another. In w o r r i e d more t h a n I d i d . You know.  And were fact, they  This i s t h e t i m e o f l i f e where i t ' s p r e t t y h a r d t o l o s e a partner. Y o u k n o w , i t ' s n o t e a s y t o make a n o t h e r l i f e a n y more. S o , we've a l w a y s h a d a g o o d m a r r i a g e s o , i t ' s — you know, y o u d o n ' t f e e l t h a t i t d o e s n ' t m a t t e r i f one o r the o t h e r goes, because i tmatters a l o t . So, i t ' s q u i t e u p s e t t i n g a n d I g u e s s i t was v e r y u p s e t t i n g f o r h i m for him, f r o m w h a t I h e a r f r o m my f a m i l y . So, f o r h i s sake too, I have t o keep t h i s t h i n g on an even k e e l , y o u know. N o t j u s t f o r my o w n . S o — b e c a u s e h e ' s a p r e t t y g o o d g u y . S o , I h o p e t o s e e my g r a n d c h i l d g r o w u p .  Yes, they've [family, f r i e n d s ] been q u i t e c o n c e r n e d a b o u t me. You know, you c a n t e l l by the p h o n i n g and that. Friends, the same way. Some o f them were r e a l l y s h o c k e d . L i k e I s a y , I t h i n k e v e r y b o d y was more s h o c k e d t h a n I was. Strategies control  in  this  strategies  for  something this  to  control  families  were  used  control"  onto,  and  and f r i e n d s  to  gain  experience.  seemed  to g i v e  The  the  women of  Clarifying  the  illness  experience  control.  The s p e c i f i c  strategies  i n the  philosophies,  women  s o m e t h i n g t o h e l p them make s e n s e  p e r c e p t i o n of  cause  by the  illness  c o n t r o l o u t l i n e d here  apparent  of  Personal  of  experience.  the  assigning  control  "out  hold  illness  conferred for  for  women's a c c o u n t s  the life  projection  of  experiences,  were a l s o  arose illness  and the  i d e n t i f i e d as  from  the  outcome.  reactions  specific  of  strategies  used by the women.  Summary This loss  chapter  framework.  interpretation The  presented The  their  illness  alterations of  their  grieving  framework  of  The women's a c c o u n t s , to  the  the  analytic  represents  study's  experience  illness  analytic  losses  inherent  lives. context  framework,  the  were  of  accounts.  then  with MI,  described.  were  discussed  F o r the women,  fundamental  and  extensive  By e x p l o r i n g  the  change,  women  in these changes.  a  researcher's  women's  framework.  w i t h MI meant  t h r o u g h the  the  participants  t h e i r experience  in t h e i r everyday  the  study's  and c o n c e p t u a l i z a t i o n o f  characteristics  in r e l a t i o n  the  the  meaning were  As t h e s e women  explained: Yes,  its  --  its  — you have  — actually  you a l m o s t  have  to  live  a different  way  of  life  for  a  while.  Well, when y o u s t a r t t o r e c u p e r a t e , you j u s t w o n d e r , you know, how you're g o i n g to - - w e l l , I've always been a p e r s o n t h a t l i k e s t o work a n d I t h o u g h t , well, am I g o i n g t o be a v e g e t a b l e f r o m now o n t h a t t h e l e a s t l i t t l e t h i n g I do is g o i n g to u p s e t the a p p l e c a r t . But because you really don't know w h a t y o u ' r e g o i n g t o be a b l e t o d o and w h a t y o u ' r e n o t g o i n g t o be a b l e t o d o . Loss women's  of loss  powerful  set  predictability support, used these  a  and  wide  predictability  represents  experience  MI,  of  emotions  was usual  variety  findings  in  with  felt role of  and  involving  specific  particularly enactment.  coping  relation  to  the  the  pervasive  and  relation  gain  strategies. current  a  of  concerns.  in  To  essence  related  Loss to  control, Chapter  of  energy, the  women  5 discusses  literature.  CHAPTER 5 Discussion  Chapter context this  of  the  current  discussion  the  present  recorded care.  is  in  the  paucity  professional  to  of  findings  the  is  MI w i t h men's In  study  of  study's  this  a  cardiac  was  study  with  to  as  cardiac  understanding  is  w i t h MI b e c a u s e  health  discussion,  the  of  experience  related  problem a  in  comparison  professional  cardiac  women's e x p e r i e n c e  pertinent  also  specific reviewed  to  The r e v i e w  professional  study is  Additional  literature,  this  experience  reviewed.  same l i t e r a t u r e  the  of  this  the  with  with MI.  need t o  are  within  The p u r p o s e  present  comparison of  related  the  literature  considered,  study  literature  the  works,  men's  with  2,  findings.  theoretical  this  this  and p u r p o s e  substantiated  of  study  illness  literature  in t h i s  experience  within  the MI  Therefore,  really  Chapter  rationale  some  of  this  findings  work a d d r e s s i n g  women.  literature  of  literature.  the  i n C h a p t e r 2,  of  Findings  findings  of  upon an u n d e r s t a n d i n g  the  the  professional  understanding  relation  Some  the  t o compare  As c o n c l u d e d  based of  5 discusses  of  i n the  literature,  to  in this women's  literature especially  is  study's  located  this  literature  and  women's e x p e r i e n c e  used  used  the  discussion both  experiences  cardiac  MI.  of  the  research  discussion.  limited  with  and  Although is  primarily  also to  rehabilitation  literature. The  purpose  of  this  study  was  to  explore  and  describe  women's  perceptions  study's  analytic  interpretation their  of their  MI  framework  is  used  In  as  an  experience  represents  and c o n c e p t u a l i z a t i o n  experience.  framework  illness  this  of  organizing  the  the  chapter,  with  researcher's  women's the  structure  The  MI.  accounts  study's for  of  analytic  discussing  the  f ind ings.  MI The  data  grieving their  the  from  this  losses  everyday  As  study  inherent  lives  of  existing  and  are  used  and  Hackett  Phenomenon indicated  in  since  reflective grief  A Loss  the  many  their  literature  repeatedly  the  women  significant  MI.  o n MI  to  that  This where  changes  finding  concepts  understand  were  the  is  of  MI  in  loss illness  experience. Cassem theorists  and  (1977,  researchers  aspects  of  cardiac  anxiety  and d e p r e s s i o n  1982,  on  the  topic  rehabilitation, as  1984),  these  writers  (1984)  state  of  due  a  (p.437),  part  of  oneself.  MI,  they  Regarding  advocate  using  identify  pathological  frame  mourning  of  associated In a and  the  process grief.  with  a  the  nursing of  loss"  one  of  The  are  loss  of  a normal  grief same  applied  responses  to  as  a  to  MI.  as  "a  valued  response a  model  intensity mourning  and  the  to to  time  losses  experience.  literature,  adaptation  They  concept  depression.  loved MI  the  identified  depression  the as  major  psychological  repeatedly  define  depression  example,  the  common p s y c h o l o g i c a l  recently,  to  of  have  Most  sadness  for  identify  to  MI  Scalzi based  behavioural  and  upon  Burke the  (1982)  concepts  adaptation  outline of  responses  loss that  characterize that  grief  MI.  is  She  as  "loss  the  phases  each "the  of  grief  study  and  in  basic  are  all  fundamental  This  grief  (p.87)  following  experience response  states  with  MI  to  MI  using  as  a  loss  framework. experience  with  current  works in  somewhat  then  towards  the  these  concepts  illness  a  of  in  this  concepts  understanding  represents  the  perspectives  differently  here,  writer's  finding  MI  Although  described  each  with  theoretical  literature.  perspective  loss  (1981)  of  are  the  MI  common  experience  and  for  both  women.  In  this  episode,  for  the  to  be  Also,  the  women's  perception This surprising  Healthy  the  MI  event  transition  losses  diversely  clearly  is  in  consistent that  health  ill to  with  to  illness  The  perceived  interaction  relation  experienced  followed.  transition  establish  itself,  uniquely  as  State  from  nature  themselves  finding and  and  the  marked t h i s of  that  subsequent  especially  discharge,  of  the  found  sector,  Loss study,  marked  impetus  (1982)  the  operationalized  three  emotion"  patient's  women's  ingredients  experience.  the  a  professional  and  underlying  the  consistent  loss  men a n d  as  viewing  the  Delaney-Naumoff  and d e s c r i b e s  crisis  is  loss.  dominant  heart"  of  phenomenon  the  of  conceptualizes  Thus,  within  phase  with  pain  as  a  pain  and  was  episode  was  and  experienced.  the  professional  of  the  advice  given  by  reinforcing  the  prior  to  women's  new  individuals. the the  MI  pain  episode  literature.  individuality  was  Hurst  characterizes  et the  not al. MI  pain  experience.  patient's feeling urge  description  - -  a  softly  clinicians  describe  their  may p r e s e n t directive  in  that  themselves In  to  itself.  The  to  promote  findings  that,  marked other  by  dimension"  In  carefully of  with  MI  after  heart  rather  than  events  concur  and  to  that  "do's" with  Mullen  the  their  of  women w e r e  of  by  the that  which reflect  literature Wenger,  Mullen's  (1978)  situation  separates term  patient  MI  "the  exists  similarly  of  attack  not  the  the  loss  example,  with  the  attune  advice,  patient's  MI  to  this  emphasis  the  MI  heart  in  coined  with  the  advocated  the  to  must  sense  for  al.  words  women  does  concur  et  experience.  the  by  threat  for  activity  from  harder because  could  mean  cautioned  and e x p e r i e n c e d  is  the  to  ominous  it."  women's impact mark the  the  pain,  women's  (see,  own  one fuzzy  Hurst  section,  this  "faint  support  pain  to  quote  patients  add  MI  nature  next  limits  study,  that  her  triggered  attack,  describe  activity  the  the  however,  experiences.  both  to  a  their  however,  instructions  a  "overdoing  and  the  does,  use  given  rehabilitation  monitor  Thus,  been  in  to  describes  as  Further,  assessing  proscriptive  fully  finding  this  In  advice  had  and  (p.298)  overextending  threat  the  proscriptions  illness  death.  patient  does,  they  pain  stressing  contributed  cardiac  This  patients  It  professionals,  detailed  1982).  word."  ways.  more  precise,  sternal  many  that  point,  attack  experience,  the  this  heart  pain  vague  discussed  his  encourage  sector  state  the  of  study,  healthy  illustrate  spoken  to  how  this  professional  is  To  perceptions of  the  vague loss  literature.  of  of  their  advice healthy Unlike  pain  focused state. the  experience on  "don'ts" Both  precise,  these  detailed  instructions  so  widely  literature,  these  recommended in  women r e p o r t e d  the  cardiac  encountering  rehabilitation  vague  and  general  admon i t i o n s .  Loss  It  was  pervasive lives  found  after  their  to  Although  there  In  a  found  sense  of  "the  part  (1977)  of  their  predominated following  (sic)  as  loss  of  experience  that  feelings by  a recent  define  depression  as  "desolation,  weeks  after  feelings  within  the  women's  all  in  that  her  life  control  (p.1293)  work,  Delaneydirection  and  and  same  sadness,  during of  these  early  these  or  also  Hackett  depression referrals  authors resentment describe  convalescence.  works  echo  home  ambiguous  of  Cassem  for  experienced  and  loss  anxiety  They  at  (p.298). and  Cassem  unprepared  a new  post-MI. of  and  subjects  in  and  literature.  Hackett,  resulted"  used,  accounts  the  "altogether  in  enactment.  descriptors  present  felt  (p.438).  a difficulty  described  the  a  everyday  particular,  documenting p s y c h i a t r i c  In  as  is  in  their  and r o l e  uncertainty"  loss  infarction"  in  which  MI.  vulnerable  out  in  experienced  in  felt,  support,  resuming  ascertained  women  Wishnie,  noted  of  identifies  found  set  subjects  of  was  variations  (1978)  task  the  loss  as  the  predictability  study,  conditions  (1981)  that  framework  foundering  under  Naumoff  loss  quoted  difficult  state  slight  Mullen  of  This  study's  that  study  anticipated  this  the  post-MI.  as  of  frequently  (1971) the  in  are  Predictability  loss  MI.  energy,  essence  defined  this  and p o w e r f u l  relation  the  in  of  the  (1984) in  the  feeling The  sentiments  of  the  women  One  in  this  aspect  of  study. the  women's  difficulty  interpreting  feelings  confusion  the  of  precariousness  documented  in  the  of  their  after  MI.  She  speak  ache  and  pain  condition. an  unusual  seems  a  response  for to  and d e t a i l e d  sensations  would  after  MI  the  problem  a  to  that  is  a process  of  each  difficult  in  Sivarajan and  every heart  difficulty  is'not  However,  are  sorting  (p.301)  their  post-MI.  patients  instructions,  finding  and  to  this  of  difficulty  Newton  connection  if  less  noted  as  attention  women  generated  sensations"  (p.301).  surmise  This  (1978)  bodily  men a n d  the  increased awareness  of  new  was  which  status.  suggests  become  predictability  and an  possible  literature  appropriate  precise  patients'  for  The  aware  indicators"  about  cues  Mullen  identified  vague  of  health  literature.  "self-consciously  (1982)  bodily  and a n x i e t y  being  "interpreting  loss  it  equipped  out  various  with bodily  and  less  anxiety  section,  the  women's  provok ing. As  discussed  perceptions the  vague  prior need  to  their  leaving  and  their  that  contributed  to  cardiac and  loss  stand  their  of  Once  state  the home,  the  information  feelings  was of  contrast  not loss to  literature. practitioners  met of  the  influenced  they  were  by  given  women p e r c e i v e d  about  their  It  was  and  that  the  women's  this  recommendations literature  provide  their  a  heart  predictability.  This to  were  advice  rehabilitation.  need  sharp  urges  healthy  nature  cardiac  rehabilitation  strongly  of  concrete  this  in  previous  hospital.  specific,  perception  findings  the  and p r o s c r i p t i v e  for  condition  of  in  lack These  in  the  frequently post-MI  81  patients  with  particularly Naumoff,  concerning  1981; Hackett  Sivarajan, of  specific,  physical  & Cassem,  1982; Wenger,  individualized  has  activity  is  prescribed  in  duration,  and  upon  the  stress  patient's exercise  the  health  his  or  her  (Sivarajan, home, through  "the  Sivarajan at  the  However,  vague  (1982)  for  and  services.  Newton  patients  guidelines  are  to  support  in  early  widely  often  for  the  written  goal  part,  them  identifiable  to to  findings  to  phase  (1982)  so  in  phase.  home.  that  It  patients they  are  (p.298). period  health  care  information also  the  lack  work  insufficient  They  through.  at  to  structured  that  follow  once  time  a  in  without  concerning  own  by  gap  a  assess  that,  early  state  to  easy'"  "relax"  provide  instructions  this  based  guidelines  found  it  the  enables  how  their  'take  that  discharge  told  on  the  Further,  concrete  characterized  an  early  convalescence  advocated  detailed,  the  patient  and e n r o l l m e n t  and S i v a r a j a n  enable  offers the  in  is  stated  discharge  (1978)  warning,  hospitalization programme  need  most  because  interests.  using  concept  medication;  precisely  the  Mullen  "the  goal  a  after  teach  and a s s e r t s  and r e p r e s e n t s  that  the  ominous  agrees  soon  activity,  information  major  to  1982).  home b e t w e e n  a  or  to  rehabilitation  is  to  and  of  1982;  rehabilitation"  a workable  are  (Delaney-  & Sivarajan,  in  manner a s  needs,  professional  were,  this  instructions home  development  intensity  prior  at  exercise  same  responses  patients  The  made  abilities,  test  care  activity  prescriptive  1982, p.1153)  written  1984: Newton  1982).  (Wenger,  frequency,  detailed,  remark  necessary This  of  information  seems with well  study  that  the  specific, equipped  to  cope  effectively  consistently One felt  with  achieved  can  only  versus  in  with  as  the  sector.  In  white-collar  MI  illness  experience  to  why  the  information Hackett  workers  with  and MI  they  knowledgeable  than  white-collar  patients.  felt  and  ultimately  resulting  in  a poorer  this  of  be  applied  chain  there  events  a parallel  collar  workers  to  physician  the  Corea the sex  (1985) quality  role  argues of  could  that  only  health  problems vital  information"  there  may w e l l  with  MI  women w i t h  There  and  are  certainly  explanations example,  for  health referred  care to  This  a  clear finding  perceptions finding for  Sivarajan  the  contends  cut in  that  the  this  also  (1982).  less  helpless,  be  Could  Blue-  information. influence  commonly  held  beliefs  about  about  work  Is  relationship  class do  women's to  give  then  suggests  blue-collar  workers  and  most  other  altered  women a n d  were  information  and  be  that  physicians  Corea's between  found  study?  of  sexist  of  blue  women?  perceptions  answers  could  could  both  vis  as  of  and  power  social  willingness  a  and  the  blue-collar  this  exchange  in  study  outcome.  in  similar  (p.81).  vis  women  interactions  parallel  MI  no  services by  be  this  women's  experience.  "the  The  uncertain  workers  differences  physicians'  also  that  the  affect  Corea  affect but  to  women a  doctor-patient  stereotypes.  not  with  and  rehabilitation  blue-collar  may s h a r e  women  patients  between  which  not  from  study  t'hey  questions  anxious  this  received  ( 1984),  asked  consequently  in  Cassem's  workers  patients  fewer  women  blue-collar  the  is  practice.  speculate  dissatisfied  professional  their  provided.  probably  many  studies. by  the  For illness  indicative  of  a gap  men s i m i l a r  to  the  in one  The to  loss  (b)  women of  the  in  possibility to  others  similar  in  the  concern  about  (1978)  reported well  former  he  way  of  progress  towards  also  compared  noted in  study his ways  was of  gauge  their  with  others  women's this  strategy.  the to  to  normal,  literature. predict  how  concluded  men a n d  of  be  with  consistent  identified  fear  early  of  study.  and  patterns.  adds Mullen  concerning  salvaged  by  as  found  from  that  comparing  his  with  heart others  this this  process  fits  a  well  with his  noted  that  variety It  of  seems,  process  indicative  Cowie  their  in  comparing  identifying equally  in  MI.  comparison  as  subjects  (1978)  in  study,  oneself  attack  their  study,  measure  this  progress  Cowie  his  to  (1978)  would  researcher  differently,  in  they  "normalize"  In  others  Mullen's  of  women u s e  the  with  unpredictability.  somewhat This  or  post-MI.  viewed  feelings  are  questions  (p.300).  perception  "typify"  progress was  can  for  themselves  their  living  MI,  potential  and r e - i n f a r c t i o n  asked  "what  compared themselves to  (1971) in  a repeat  the  concerns  comparing oneself  "normatively"  both  process  and  (c)  related  (p.298).  patient's  order  that  death  of  comparing  al.  subjects  returning in  and  established  live?"  She  used  the  then,  her  order  subjects in  that  of  concerns  possibility  These et  three  sudden death  fear of  of  rehabilitation. others  of  loss  life?"  process  the  involved  Wishnie fear  will  The  was  which  names  the  (a)  situations.  and  also  identified  sudden d e a t h ,  literature.  (1978)  "how  of  normal,  r e - i n f a r c t ion Cay  study  predictability:  returning  with  this  to  oneself of  the  and M u l l e n  see  it  as into  a  coping either  conceptual The  category.  description  consistent current  with  of  loss  men's  professional  however,  is  extensive  a  patients  with  receive section,  and  experience  Lack  of  for  could  was  found  in  this  feature  in  lack  energy  reinforced  of  predictability. precariousness  of  to  new  learn  their  an  literature. sympathetic  daily  can  increase  in  the  information,  and  men,  is  considering  as  the  do  the  provide If  argued  women in  intensity  the  women's  this  of  Also,  activity  limits,  the  attack. of  the as  felt  is  This loss  of  women o f  the  they  they  a  attempted  were  living  self.  Both  deleterious  the  arousal  due  to  this  effect  they  energy  sense  status.  post-MI  1979; Wenger, al.'s  to  noted  are  the in  energy  well effects  established of  immobility  psychological the  literature  drain  in  stress to  (Cassem &  the  and  the  of  the  operate  Hackett,  in  1977;  1982). (1971)  distressing this  heart  health  changes  et  a  of  their  concert  interpreted  after  lack  reminded  are  most  life  that  changes  experience  Wishnie  study  energy  illness  the  for  These  unfamiliar  Energy  as  recorded  instructions.  than  study  women.  prominent  Wenger,  this  Energy  It  within  as  finding  detailed  information  in  need  professionals  difference  loss  MI  The  surprising  that  helpful  this  with  literature.  precise  less  predictability  experience  somewhat  evidence  of  early  complaint  symptom a s  research voiced  evidence  of  by  identified their  worsening  weakness  subjects of  their  who heart  condition. study  The  is  study. and  description  similar  to  (1977)  response  to  day  following  life  definition  & Cassem,  response,  and e a r l y  cardiac  decline. fatigue  adjustment  to  performing (1984)  is  In  subsequent  fatigue"  the  activities that  of  the  of  energy  al.'s  in  this  introduced  by  subjects'  emotional  realities to  of  lack  of  of  these  Cassem  day-to-  energy  in  researchers  depletion  which  is  and S i v a r a j a n  often  (1982)  psychological  the  et  "homecoming d e p r e s s i o n "  sense  (p.439)  and  Wishnie  papers,  define  added  illness  the  analogous  subjective  Newton  the  note  1984)  lack  their  facing  also  in  a concept  MI,  to  of  describe  home a n d  1982,  "the  weakness  marked  to  returning  study.  (Hackett a  weakness  "Homecoming d e p r e s s i o n , " Hackett  this  the  of  increased  daily  living.  fatigue  is  along  with  perceived  the  of  home  physical  demands  Cornett  and  both  as  attribute  stress  as  of  Watson  unanticipated  and  troubling. These this  study.  study  did  cardiac of  descriptions  the  One not  discouraging energy For  seem  of  to  the  divergence  view  energy  women's  is  that  lack  as  accepted  trajectory,  albeit  a  part.  the  changes  example,  Also,  more the  their  thinking  through  overextend  but  with  rather,  affected  could  point  deterioration, MI  coincide  fully  women  approach process their  women's  than  is  explained to to  limits  accounts  apparent how  activities assess  the  women  an  indicator  this  somewhat  in  symptom a s  in this of  part  unexpected  and  developed  these  the  literature.  their  lack  of  which  now  whether  and a d v e r s e l y  in  perceptions  or  not  affect  energy  included the their  a  activity heart.  86  Lack  of  Anticipated  The  women  support  from  finding  is  in  Support this  their  families,  congruent  with  literature  concerning  addressing  the  this  into  could  assume  uniformly  characterized  states or  effect  function  1984;  the  follow  their  home,  and  house. quality the  the  Croog,  In of  men b u t  support not  the  increase  of  This  the  recent  literature  men a n d  women  puts  they  to  the  their  is  MI  to  patient's This  study  wives  that  of  MI  are  finding  is  as  In  dependency  or  may  "overprotective"  and  MI  (Cornett  1982;  and L e v i n e ' s  helping  their  husbands'  former  duties  "waited  on."  to  in  the  around  the  disappointed  Boogaard's  (1982)  husbands  situations  In  &  Delaney-  stress  received.  a The  with  a  be  wife.  Croog  women w e r e  and  rehabilitation  avoid  the  (1981)  study  support  & Levine,  by  with  this  a husband  Croog  support  women w e r e  but  husbands  1971).  patients  activity.  evidence  spouse  their  study,  of  rehabilitation  Delaney-Naumoff  comparative  regimen,  assuming this  of  spouses.  1984;  provided  medical by  husbands.  cardiac  spouses  describes  Wishnie,  wives  of  return  towards  1981;  anticipated  Women's  current  women a r e  whether  "oversolicitous"  MI.  over-support,  female  recent  extensively  study,  by  premature  of  Naumoff,  from  either  men a n d  literature  Watson,  of  (1984)  in  of  thrust  socialization  responses  spouses a  Boogaard's post-MI  the  studies  that  lack  their  general with  a  perspective.  that  upon  especially  women  literature  based  experienced  the  traditional  finding One  study  (1984)  in  the study  For  the  between their  the  perhaps  cardiac  related  enrolled  in  this  opposing  own  These  women  in  lend  and  a conflict their  rehabilitation. none  of  structured  findings  contentions  demands of  that  a  study,  It  the  women  cardiac  support  to  Boogaard's  Newton  (1984)  claim  that  limiting  self-care  during  early  convalescence  the  demands  Boogaard's standard  study,  of  physical  relaxing,  and in  their  50%  the  of  higher.  structured  men a n d cardiac  10% o f  such  difficulties  with  their  are  their  then  they  energy  left  These and  may for  time  not  see  their  rehabilitation  lack  the  work the  work  or  as  in  sense  the  at  home a f t e r  MI,  their  be  In  for  in  the  the  time  whereas  their  types  resting,  women  were  women d i d  activity.  attended  related  lack to  MI.  energy  not  Also,  Women's  having  on  a of  their  If  women  housework,  enough  time  and  rehabilitation.  situation  of  because  computed  subsequently  in  to  were  homemakers a f t e r  participation  home  equivalents),  programme.  conflict  make  the  and  recouperation.  period  physical  (1982)  problematic  Increased  as  programme.  Newton  within  house,  women  themselves  study  Sivarajan's  women d i f f e r e d  and expending  programmes,  was  (metabolic  programmes c o u l d  women's of  this  Interestingly,  participation  findings,  in  men s p e n t  rehabilitation  in  spending  about  as  and  may be  initial  Men a n d  housework.  housework  participation  the  and  interesting  expenditure,  performed:  walking  light  perceive  energy  during  activities  METS  homemakers  findings.  during  existed  is  and  activities  cease  approximate  performed  women s c o r e d  engaged  not  measurement of  activities and  do  as  rehabilitation  Sivarajan  role  work  situation  within  structured Stern  et  al.'s  the  home  cardiac (1977)  research than  that  men w i t h M I .  Stern  (1984)  complex" He  found  Stern's  In a  defines  which  refers  the  women w i t h MI a r e  later  "type  includes  to  A" behaviour  "a c h r o n i c  fits  activities  to  even  more  of  this  re-examination  women i n h i s  description  household  that  as  as  with post-MI  women's  the  detriment  apparent  emotion  struggle"  study  (p.457).  "super  needs of  A"  finding,  "an a c t i o n  incessant  1977  "type  women."  to  maintain  their  cardiac  rehabilitation. Shaevitz's contributes health. 'Saw' and  to  (1984)  book,  an u n d e r s t a n d i n g  Shaevitz's  chart  these  to  and a r e 1.  as  d i l e m m a between  "How T r a d i t i o n a l  sex  the  role  particularly  Syndrome, home  Men and Women  differences  between  socialization.  applicable  to  and  men  Some of  women w i t h  MI  follows:  Traditional  women f i n d  own  whereas  homes,  place 2.  are  Superwoman  this  outlines  traditional  differences  of  titled  The Home" < p . 2 8 - 3 0 ) , women due  The  of  refuge  Traditional whereas  it  traditional  from the  women f e e l  traditional  difficult  stresses  to  men see of  the  responsible  men do n o t ;  relax  if  for  in  the  their  home as  outside the  a  world.  household,  anything,  they  "help  out." 3.  Traditional things  4.  that  women a r e need  to  traditional  men a r e  Traditional  women  tasks,  whereas  less  the  of  tasks  now-and-detai1 be  future  done and  complete  traditional to  oriented,  immediately,  macro 95 p e r  whereas  oriented. cent  men c o m p l e t e  keep a h o u s e h o l d  seeing  of 5  household percent  functioning.  or  Statistics  on  differences.  For  examination per  cent  cent"  of  of  the  In  in  women  indicate  view  and  their  of  women s e e  with  MI,  findings continue  to  of  difficult of  rest  the  MI  full  support  their  reversed  patients. if  then, heart  husbands  if  experienced  and  out  concludes  outside  these from  an  do  70  wives  children  do  the  at  this if  15  per  home  were  they  to  study  double  way a  standard.  that  women  statistics  on  usual  time  one  wonders  a  that  rather  to  they  heart The  quite  a  environment  situation than  they  attack, cardiac  were provide  attack.  nurtured would  would  they,  would  a heart  be  in  MI.  the  that  support  seems  therapeutic  suffered  that  why  It  women w i t h  women e x p e c t e d  experienced  suggest  The  what  husbands,  same  between  matter  women p r e d i c t e d  the  women  no  create  had  that  men  household  asserted  husbands  socialized  rehabilitation.  anticipated.  for  the  socialized.  situation  study  the  on  traditional  understandable  (1984)  even  as  traditionally  the  focus  traditionally  cardiac  for  home  their  the in  themselves  on h o u s e w o r k , is  primary  a conflict  given  then,  their  attack  a  bear  average  their  quite  own  responsible  The  that  is  their  Also,  in  of  how  Boogaard's  relaxation  been  seems,  and  and  ages,  experience  objective,  have  husbands  likely  in  it  housework  women  the  "on  women w o r k i n g  most  home,  men s p e n d  and  The  were  them.  doing  that  assessment  home,  feel  traditional terms  the  this  to  happens  own  demands of  (1983)  women's  differences  once  household  the  they  the  housework  determination.  study,  and  on  on  Pogrebin  while  Studies  home,  In  works  housework  this  this  spent  instance,  several  (p.145).  included  time  It  following  nurture but  their instead  literature  reviewed  to  validates  this  of  MI  this  point  in  this  prediction  of  full  patients,  Levine's  tend  (1982) cardiac  levels.  Croog with  services, The this  suggest, and  minimally  lack  of  of  "macro  of  needs  asked  The  to  do  result as  in  that  is  the  expectations  as  that  "Housework  is  consistenty  inept..."  socialization The  the  has  as  to  women  "work"  be  their  family  (meaning  social  support,  comes  lack  response  to  first  men  men's  (1983)  men a r e  It  seems  that  support  is  when  men  detail. precise of  the  does  not  out  are  that  involved.  allowed  when not  are  part  points  only  men  less  socialization  of  this  possess  for  "work"  which  lack  that  Also,  at  of  are  home a n d  eye  and  in  resultant  a problem  an  out.  women  differences.  the  creates  for  women's  men's  contends  requires  reasons and  the  and  in  she  traditional  (p.143).  the  these  done  help  only ;act i v ity  emotional  and  physical  traditional  Pogrebin  occurred  Croog  and  sexes As  interpret  to  on  the  for  that  which  home. well  and  nurturance.  orientation  a reluctance  ideology  happen  this  the  light  between  Further,  housework  is  orientation male  and  some  account  notes  oriented"  that  spouses  promoted  emotional  socialization  (1984)  homemaking s k i l l s .  on  "emotional  sheds  skills  what  In  clearly  states  nurturance  to  lack  aware  wives  as  and  (p.634).  traditional  Shaevitz  are  in  response  attitudes  later  literature  difference  study  the  aid"  Women,  over-supportive.  provides  material  women's  emotional  few  (1984)  demonstrates  support.  rehabilitation  a wife)  and  be  research,  husbands'  family  to  discussion  to  be  traditional  surprising.  anticipated  support  from  their and  husbands  in  frustration.  nurturing" upset  they  and of  an  situations.  disappointed"  that  women's  others" the  and  needs  (p.9).  Loss  confusion, in  this  of  descriptions, apparently  of  MI easy  is  not  illness to  more  to  orientation" tuned  deal  is  nurturance rage  responded their  forgotten  and  with  them  upset,  (1983)  must  state  "defer  to  in  giving"  tremendous (p.52).  women  with  these  behaved  pattern.  unrealisitic,  pain,  The  accordance  socialized  to  anticipating  imbalance  also  most  emotional  "rejected,  lead  husbands,  them"  in  an  Further,  man  while  in a  terms  lack  of  both  to  occur. for  lack  and  the  of  support  "may  not  may r e l a t e  invisibility  (1978),  invisibility MI  need  they  non-nurturant  sadly  to  intense  feel  in  traditionally  Mullen  the  wives  and g u i l t . . . "  difficult  that  give  comfortable  "causes  may be  states  they  "an  experience  Pinneo  and  that  nuances  this  treated  that  subtle  to  "unfairly  with  into  speak  less  not  women  result  seems  likely  dismiss.  easily  a  "men a r e  what  antennae"  men,  explanation  (1984)  be  The  housework  "macro  men a r e  emotional  from  that  their  dictates  certainly  support  Another men's  role  the  when  disillusionment  Eichenbaum and Orbach  expected  and  out  men a r e  that  characteristically  doing  support  is  disappointment, study  expecting  result  others.  back  to  (p.36).  "have  of  withdraw  social  feeling  that  inability  The  by get  adds  often  disappointment,  (1984) p o i n t s  don't  Shaevitz  because  was  women r e s p o n d  because  dependency  study  Shaevitz  and  (p.36).  and  this  and  be  old.patterns  to  discern  its  Because  their and  (1984)  effect  readily of  MI.  details,  Boogaard and  of  therefore  and on  accepted  family  wives'  Pinneo support.  or  it  may  interaction  or  expectations attribute  of  of  orientation"  the to  Another women's by  society even it  finding  (Corea,  follows  Further, homes  clearly  powerlessness  with  MI  this  and  the  is  less  For  some  anticipated Marital  literature. conflict (1980) conflict  is  significant the  support  Wishnie was  was  research Although  from  a prevalent to  clarify  the  it  al.  their  post-MI the  family  nature is  breadwinner 1983).  has be  study,  widely  and  MI,  lack  of  in  the  serious  marital  McLane  et  that papers  discord  soundly  her  marriages.  sequela  Both  logical  a man.  their  review  and  experience  the  that  marital  A  an  for  problem.  of  traditional  woman  outcome.  then  1984).  woman's  literature  not  (Shaevitz,  a post-MI  potential  is  housework  the  found  and  our  from  i m p a c t e d on  (1971)  in  homemaker.  within  would  viewed  1982),  the  a  this  documented as  a definite  concluded  in  a  the  because  1982)  identity  of  was  valued  to  (Pogrebin,  than  women  et  not  apply  with  when  negatively  is  is  them  invalidation that  "macro  was  significant  1983; W i l s o n ,  their  with  support  Wilson,  also  power  men's  experience  less  1983;  homemaker  belief  of  relationships  the  the  lack  (Pogrebin,  power  the  to  housework  women g e t  with  This  support.  and  descriptors  of  of  conflict  that  identified  with  of  illness  valid  work"  locate  of  experience  more  is  MI  Deckard,  these  theories  extension  less  socialized  housework  lack  their  (p.463-464).  may c o m b i n e  relation  Given  "real  that  Traditionally and  as  1977;  considered  to  in  that  women.  resumed"  experience  contribute  husbands  are  patient  MI  perception  their  they  the  cited  al.  marital call  for  post-MI. in  the  literature  as  a pivotal  1978;  Boogaard,  1984;  1984;  Delaney-Naumoff  especially  from  affect  women's  both  the  physical  towards  Stern  finding  in  cardiac  Chirikos'  and  lack  of  may be  support  their  programmes Griffo  et  an  was  as  for  the  was  were  later  in  a problem  participation  than in  of  market MI  this  to  can  Boogaard's  search  section,  out  She  may b e  additional for  to  women  rehabilitation  (1984)  study.  to  physical  benefit  derived.  to  noted  of  a  as to  Lower  participation give a  many  programme,  further  programmes.  related  less  An  women  programmes,  and  linked  women's  that  longer  be  director  commitment  meals.  (1975)  were  compliance the  and  (1977)  outcomes  and  the  explain  role  women too  the  anxiety  a l . ' s  structured  stated  may  sick  et  affected  and  Rawlinson's  in  their  husbands, men  work  programme,  maintain  directed  patients.  with  director  not  support  that  women's  which  expended  tear  rehabilitation  rehabilitation this  Stern  adversely  women  increased  the  women a s  noted  can't  and  Croog, support,  to  was  of  maintain  participation  children,  beginning  to  rehabilitation  they  lack  (1984) f i n d i n g s  affecting  The  that  and  surgery.  conversation  cardiac  why  to  The  Brown's  (1983) f o u n d t h a t  al.  example,  women of  was  discussed.  reasons  tended  return  of  informal  Mainland  women a n d  for  lack  This  of  factor  rehabilitation In  energy  findings  Nickel's  noted  rehabilitation.  (1977)  bypass  anticipated was  wear  men t o  contributing  husbands,  (Acker,  1984;  & Watson,  of  physical  women  following  than  lack  and  post-MI  that  likely  cardiac  rehabilitation  Cornett  rehabilitation.  a l . ' s  depression  1981), women's  emotional  et  cardiac  1978;  Cay,  the  in  and p s y c h o l o g i c a l  their  resultant  force  This  discussed the  that lack at  women's  conflict  situation  household  and  Lack  of  concerning insight the  into  affecting  the  the  of  MI  and  patients. for  the  ultimately  poorer  the  competing  fits  with  The  women's  this  finding  family  is  spousal  largely  in  demands  of  the  based  current  for  viewed  as  suggested  findings  in  the  that  is  force  the  of  norm.  women  lack  literature  of  women's  programmes  outcomes  noted  as  support  about  rehabilitation  rehabilitation  Within  a pivotal  studies  is  provides  women.  over-support  upon  studies  literature  It  structured  the  and  for  women  MI.  Change  in  Usual  Changes women  in  and  sense  a  over  in  this  their  Role  others  Within  study.  of  loss  first  identified household needs  of  and  as  others  from  (1984) their  their  traditionally feel  were  and a u t h o r i t y  to  guilty  husbands  (Boogaard, women n o t families.  in  husbands  if  they  upsetting  guilt  relation  to  giving  families.  they  put  with  MI,  to  giving  and  or  to  1984; only  Newton  &  felt  guilty,  This  guilt  the  (Shaevitz,  concomitant families  the  of  don't  women  for  feelings  and  socialized,  concerning  an e m o t i o n a l to  enactment  women e x p e r i e n c e d  power  roles  literature  roles  Boogaard's  The of  household  the  Enactment  homemaker r o l e  When women a r e  help  for  rehabilitation  participation  of  MI.  literature,  may a c c o u n t  with  support  reasons  is  the  rehabilitation.  with  literature  spouses  own  anticipated  women  cardiac  This  their  between  not  1984).  guilt over  also  reaction  is  usual  meeting  Sivarajan, but  needs  the  1982). resisted  helps  to  explain  the  study. were  overtly  The  not  women  comfortable  Apparently, take For  on  their  men,  as  their  to  their  the  loss  for  feel  The  as  and  usual sex  usual  role  role for  gain  this  for  the  prime  1984). role  of  are  predominant Wenger  the  over  their  that  exercise  disease  after  and  yet  wives  Levine,  roles  is  1982).  identified  most  threatening  Cassem  & Hackett,  then  appear and  (Wishnie  to  be  therefore,  et  a l . ,  1971;  household.  states  identity  from  MI,  Further,  the  household (Wilson,  power  and c o n t r o l  Because  of  these  perceptions,  power  threatens  and a u t h o r i t y  for  experienced  the there  change  self-esteem.  expressed  by  the  Control  women u s e d a w i d e  that,  women's  a  explained.  one  selected  alters  their  of  literature,  strategy  (1982)  &  1971;  enactment  this  their  source  thus  study,  rehabilitation  a l . ,  women d e r i v e  enactment  loss  study  control  when  socialization,  Strategies In  support  therefore  men p o s t - M I  socialized  of  this  and  sexual  in  over.  guilt  (Croog  women  1977).  their  feelings in  breadwinner  et  the  took  experience  losses,  of  anticipated  roles  women t h a n  Shaevitz,  women  not  of  husbands  (Wishnie  to  responsible  functions  lack  stances  household  in  & Hackett,  this  do  of  Traditionally  in  their  post-MI  attached  1982;  when  self-concept  different  and  a  men  Changes  Cassem  felt  former  major  1977). firmly  contradictory  would and  although natural are  range  losses.  there  the  exercise  by  post-MI  is  no  progression  numerous  strategies  From  expect used  of  clear of  benefits.  to  cardiac  to  be  the  patients. evidence the  heart Overall  patients  feel  depressed Cassem  better:  and  and  anxious,  Hackett  rehabilitation depression. et  a l . ' s  Lower  As  (1984)  this study  of  programmes offers  are  women's  lack  There study  of  is  that  control  for  support  (1982)  it  (Cowie,  aspects  MI  illness  as  a  strategy dwelling  for  study and  1978;  on  their  Similarities in  this  rehabilitation, rehabilitation  (1984) being  literature  denial  and c a p i t a l i z i n g  on  control  and  are  study the  this  as  defined  similar  using MI  In  personal  noted and  the  major  literature,  the  perceived  home  that  these  This the  study  benefits,  is  finding  both  of  their  of  for  illness  Cassem and  Hackett  minimizing aspects  may b e  of  The  using  the the  interpreted  study. in  this  strategy  positive  this  of  a  philosophies,  hope  such  women as  as  a not  fortunate.  between  the  literature. strategy was  the  denial  in  tactics,  feeling  for  means  way,  local  unfortunate.  1978). a  a  in  adds  out  make s e n s e  Mullen,  Griffo  section,  given  patients  to  and  of  utilized.  Also,  post-MI  participate  to  points  well  MI  to  previous  seems most  for  study,  director  related  as  used in  is  patients  experience.  strategy this  the  cause  helps  conceptualize  negative  named  in  assigning  the  assertion.  participation  because  experience  this  in  The  cardiac  counteract  not  less  self-esteem.  structured  (1984)  women t e n d  participation  not  a  means t o  Boogaard's  dependent,  increased  that  best  cited  Croog  less  an  programmes.  generally  support  the  found,  rehabilitation  lack  possess state  study,  responsibilities.  in  is  M a i n l a n d programme,  that  confident,  and  programme  (1984)  physical  more  strategies  However,  advocated  neither  for  in  identified  control physical  the  cardiac  nor  selected  as  a  strategy  for  control  by  the  women  in  this  study.  Summary This the was  chapter  context to  of  the  compare  understanding derived  current the  of  largely  dissimilarities Women's  discussed  in  summarizes  women's this  and  outlines  and  research.  the  study,  of  the  was  of  illness  studies  within  literature  findings  MI  findings  professional  findings  the  from  the  used  this  of  this  literature. study  experience,  sense  of  experience  with  MI.  The  for  nursing  present  understanding  were  make  implications  intent  Similarities  experience  conclusions  the  an  to  draws  within  The  with  men p o s t - M I .  MI  study  from  and  discussed.  the  divergent  next  these  practice,  chapter findings,  education,  CHAPTER Summary,  Conclusions,  and  6  Implications  for  Nursing  Introduction Chapter the  6 summarizes  findings  Implications nursing  this  delineated for  research  and  nursing are  then  study  was  perceptions  of  statistical  evidence  health  problem  knowledge  about  exploration popular  of  myth  fundamental sciences  needs  problem  on  result of  conceptual  et  al.'s  framework  the  is  5.  education,  and  a  guide  care  that  MI.  women. is  women's  This  to  of  to  the  and  cardiac  this  lack  attributable and  the  empirical  researcher  to  of  of  medicine  this  failed  women's  Despite  dearth  men o n l y  by  explore  significance  women  to  and  with  the  to  to  argued  to  and  facilitates  the  Explanatory  for to  total  experience,  instance,  was  health  professionals  consider  describe  male-dominated  MI  Chapter  Study  there  happens  It  from  the more  health  that  using  rehabilitation  address  the  special  used  as  women.  Kleinman  care  to  relation  of  men w i t h in  the  relation  MI  research.  research could  in  that  in  nursing  experience  women,  in  conclusions  discussed  establishing  MI MI  of  illness  for  draws  outlined.  designed  their  and  practice,  Summary This  study  not  elicit  study. the  phenomenon just  planning  nursing  this  care,  the and that  Model  was  This  model  directs  patient's  point  of  of  illness,  disease provision is  (1978)  or  entity. of  health  appropriate  to  view the  the  health and  to  illness  This  approach  care,  in  and  this  effective  f o r women. The  phenomenological  methodology f o r t h i s for  The  suitable  phenomenological  the best  method c o n s i d e r s  sources  for accurate was a b l e  from t h e s u b j e c t s ' p e r s p e c t i v e  accurately describe  conceptual  experience  as  the  Using  t o v i e w t h e MI  illness  and t o h e l p  their perceptions.  Both  t h e women  the  literature  both  review  on t h i s  l o c a t e d t h i s study  literature  difficult  and  further substantiated  t o p i c o f MI i n r e l a t i o n  w i t h i n t h e body o f c u r r e n t  the  t o women,  but  professional  experience  are  experience  than  men's.  rehabilitation,  based  w i t h MI,  t h a t women's p o s t - M I e x p e r i e n c e  different  in cardiac  literature,  women's  not only  p e r t a i n i n g t o MI, and l e d t o the c o n c l u s i o n , from the  available studies,  concepts  and i t s  function.  need f o r r e s e a r c h  few  study's  framework and t h e s e l e c t e d methodology a r e c o n g r u e n t  unique n u r t u r a n t  also  expert  and r i c h d a t a .  with the nursing p r o f e s s i o n ' s v a l u i n g of the i n d i v i d u a l  The  for  the i n d i v i d u a l s  t h e phenomenon u n d e r s t u d y  methodology, the r e s e a r c h e r  experience to  I t was d e t e r m i n e d t o be  study.  are experiencing  witnesses, this  research  i n v e s t i g a t i n g t h e m e a n i n g o f t h e MI i l l n e s s  women. who  method was s e l e c t e d a s t h e  largely  as  Because presented  upon a n u n d e r s t a n d i n g  i t was a s s e r t e d  t h a t an  w i t h MI w o u l d p r o v i d e  may  current in of  understanding  a more v a l i d  be  the men's of  basis f o r  nursing practice. The  data  were c o l l e c t e d by means o f 11 i n t e n s i v e  w i t h 8 women o v e r a 3 month p e r i o d . structured,  with  The i n t e r v i e w s were  loose guidance provided  (1978) s i x q u e s t i o n s  (Appendix  C).  interviews  by K l e i n m a n e t The  interviews  semial.'s were  100 audiotaped data  and  analysis  role  was  them  of  were  then  occurred  to  assist  their  being  MI  to  be  The  verbatim.  Data  simultaneously.  the  women's  illness  identified  determined stopped.  transcribed  exploration  experience.  and  validated  sufficiently  study's  The  researcher's of  the  and  the. d a t a  meaning  framework  is  the  the  to  themes  collected  and r i c h ,  and  major  When c o n s i s t e n t  in-depth  analytic  collection  were  interviews  researcher's  i  conceptualization from  this  that  process  analysis The  and  over  women's  interpretation  of  analysing  accounts  illness  experience  their  everyday  lives.  was  loss.  The  The  changes  their  MI.  doing,  in  these  changes.  essentially The loss to  of  first  was  experienced the  advice  contributed The  MI  redefinition  episode  to  by  given the  central  predictability  that  they  framework of  state, The  MI  study's  data  the  and  core  in  Therefore,  aspect  healthy  this  pain  of  loss  illness.  for  and  a  data  and  is  derived  and  of  found the to  women's loss was  to  refining  be  as  vague the  sense  loss  experienced  by  characterized  1,  their  by  the  event  of  inherent  framework  experience shift  from  was  catalyst This expressed  proscriptive  healthy women was of  a  health  individuals.  feelings  is  p.33).  professional  the  on  around  significant  and  of  MI  the  losses  and d i v e r s e l y  women b y of  the  of  from  the  analytic  ill  uniquely The  since  a  their  emerged  illness  was  of  meaning  accounts  Figure  MI  experience  women. the  lives  represented  themselves to  their  study's  women's  which  that  grieving  (refer  the  pain  were  and  impact  theme  their  the  nature  the  women c o n s t r u c t e d  significant so  describe  with  many  In  the  time.  their  data  the  of  nature  sector  also  state. a  loss  of  uncertainty  101 and  an awareness  from  an MI.  a  met. to  and  to  comparing  themselves  their It  normal.  daily  life  MI  loss  of  addition  to  of  disappointing The  women  demands  and  for  of  own h e a l t h  needs  related  their  attack to  these  give.  experience are  changes,  (c)  not  gave  rise  MI,  (b)  potential  for  a repeat  the  involved  of  was  a process  predictability anticipated  a prominent  lack  realize  reinforced  dynamic  of was  support  feature the  in  women's  receive  MI.  the less  their more  This  husbands.  the  competing  support  and  and  their  situation  structured  cardiac  women p r e d i c t e d  husbands  suffered  than  that  a  their  conflict  in  the  women f e l t valid  experienced  responsibilities  participation  if  from  between  Further,  that  as  women a l s o  especially  their  of  Additionally, viewed  the  household  to  lack  men w o u l d  was  This  programmes.  to  of  energy,  energy  a push-pull  perceived  upset  of  support,  their  were  n e e d was  enactment.  women.  energy  reported  rehabilitation  this  specific,  predictability  Loss  to  for  were  predictability.  lack  explain  of  process  predictability  that  concern  others.  lack  of  recovery  and a need  and  last  role  the  possibility  relation  of  might  loss  the  with  that  after  feelings In  found  cues  perception  This  in  husbands,  was  the  of  loss  sudden d e a t h ,  returning  from  bodily  (a)  of  particularly  central  and p o t e n t  concerns:  possibility  felt  the  interpreting  pervasive  three  precariousness  of  information  The  the  the  Aspects  difficulty  concrete  of  they  their  significant  a  heart  were MI  and  able illness  because  they  women. Changes  uncomfortable  in by  homemaker the  women.  role  enactment The  were  described  women e x p e r i e n c e d  guilt  as as  102 well  as  a  loss  were  a s s u m e d by Finally,  range  of  losses.  of  their in  this  feeling  past  experience.  current  was  ascertained  in  this  experience  for  discussion  control  found  over  on  to  women's  study,  with  men a s  recorded  that  the  there  between  literature  tasks  The  in are  and  these  their  purpose  of  with  MI,  as  of  the This  but  women's  to this  literature.  unique  and  relation  commonalities  men's  puts  for  understanding  the  wide  experienced  in  experience  current  a  philosophies  discussed  MI.  use  a cause  personal  were  to  their  relying  study  homemaker  families.  assigning  compare  Women's  their  women w e r e  pertaining  differences  MI.  clearer  to  the  when  included  this  concluded  significant with  of  and  gain  and  1iterature  discussion  MI  to  hopeful,  findings  authority  study  strategies  MI,  the  and  husbands  strategies These  The  power  also  experience  findings  into  a  perspective.  Conclusions The as  conclusions  from  the  findings  of  this  study  are  follows: 1.  Women  experienced  explain  their  need  3. L a c k  energy,  4.  of  for  problems  relation  illness  experience  in  terms  of  to  for is  information a  prominent  following feature  MI  is  not  of  the  MI  sets  the  stage  met.  illness  women.  Traditional  potential  MI  losses.  2. W o m e n ' s  experience  in  drawn  sex in  support  role  women's and  socialization cardiac  role  rehabilitation,  enactment.  for  especially  103  5.  Although  the  variety  of  losses,  physical  strategies  recommended  in  with  to  gain  cardiac  Therefore,  strategy  for  control  findings  and  for  their  strategy was  experienced  a  wide  experienced  most not  strongly even  rehabilitation  nurses  implementation,  and  evaluation  and  are  1.  as  is  losses  once not  for  a  women  family-centered  the in  study  therefore,  to  MI.  of  involved of  Practice  this in  the  study  the  suggest  a  assessment,  nursing  care  of  number  planning, women  with  follows:  Clearly,  this  Nursing  conclusions  for  with  the  over  articulate  over  literature,  implications  of  control  to  MI.  The  MI  able  physical  Implications  of  were  rehabilitation, the  identified. selected  women  As  nursing  order  to  address  concerning provide  one  care  so  the  support  effective  women  of  women w i t h findings  and  and  strongly  role  meaningful  MI  and  must  be  conclusion  enactment care  for  and, women  urged:  I think when a woman h a s a h e a r t attack, the man, the husband, and i f t h e r e are any c h i l d r e n , there should be some c l a s s , some s o m e t h i n g t h a t c a n r e a l l y make t h e m a w a r e what has happened, what is expected of them, how it a c t u a l l y has to g o . 2. as  a  Because  loss  phenomenon,  with  MI  using  what  is  the  losses provide losses  women  are  it  is  concepts  nature  of  involved?  nurses for  the  explain  with  women w i t h  important of  the  loss  loss  The a guide MI.  their  for  and  experience  nurses  the  to  grief.  experience?  losses to  illness  identified assessment  with  assess  MI  women  For  example,  What  specific  in of  this  study  individual  104 3. gives  The  study's  nurses  a clear  especially  once  What  this  does  Does-she if  findings  nurses  again  about  5.  should  support,  t o meet  to develop  to  specific,  develop  is  lack  home?  determine  of energy  to  and  home  psychological specific  stressors  an e a s y  and  the  should c o l l e c t  and p o t e n t i a l  post-  to d i s c h a r g e  adjusting  to f a c i l i t a t e  rather to  in  the  transition  from  This  study  physical  an a p p r o a c h rather  over  rehabilitation,  physical  and  their and to  psychological  emphasizing  than  do's  rather  proscriptions, is  women and f a m i l i e s ,  to  educational  for control  t h a n vague a d v i c e  and  indicated. nurses  i n problem  and i n p r o v i d i n g e m p a t h i c ,  need  to  solving  optimistic,  care.  directs  rehabilitation  and f a m i l y ' s  strategies  normal  interventions  implementing n u r s i n g c a r e ,  in teaching  nursing  nursing  the p a t i e n t ' s  Further,  In r e l a t i o n skill  include  prescriptions  precise  and s u p p o r t i v e  cardiac  at  Can she  about  the n u r s e  especially  w i t h women and f a m i l i e s ,  7.  hospital.  activity  changes p r i o r  patient  anticipate  to MI.  don'ts,  6.  energy  t h e women's  losses,  women  responses than  from  needs,  limits?  tolerance  Planning  experienced help  information  t o home.  increase needs,  home  of the p h y s i o l o g i c a l  in order  of  learning  are permitted?  depletion,  activity  home e n v i r o n m e n t hospital  the  specific  t o know a b o u t  and c o n c l u s i o n s  Because  f o r energy  data  her  to l a c k  is discharged  need  to a s s e s s  when  environment. bases  patient  related  to a s s e s s  the p a t i e n t  overextending  The  MI d i r e c t then  mandate  know what a c t i v i t i e s  she i s 4.  conclusion  nurses  programmes  to  evaluate  in r e l a t i o n  to  the  present  the  special  105 needs  of  women.  structured to  meet  Nurses  cardiac  women's  function  as  should  rehabilitation  needs.  a  seriously  Such  combined  consider  programmes  programmes  support  and  for  setting  women,  could  be  physical  up  tailored  designed  to  rehabilitation  group. The basis  findings  for  with  MI  women's  nurses that  and to  develop  could  cardiac  conclusions a  from  1.  is to  recommended  teach in  the  preparation  and  psychology  the  application  adjustment  of  Most  to  Education  for  nursing  patients  with  MI  a  women  impact  education  of  the  to  of care  MI,,  upon  are  drawn  develop of  of  for  actual  as  in  in  in  must  be  families  as  rehabilitation. pathophysiology  clinical  practice  and  MI. the  and  This  problems  in  skill  community,  potential  in  learning.  interviewing  with  nurses and  cardiac  teaching  skill  patients  their  content  well  nurses  in and  the is the the  plans.  course  understanding  as  principles  importantly,  this  include  that  and  concerning  then  essential  provide  nurses  for  Nursing  study  should  must  identification  to  caring  positively  this  literature  assessment  particularly  3.  in  provide  and  from  related  Nurses  physical  for  implications  evident  This  2.  role  study  study:  It  prepared  this  rehabilitation.  following  this  pivotal  significantly  Implications The  from  work  field  necessary  this in  of to  study  women's study  and  directs  health to  facilitate  nursing  issues  equip changes  to  nurses in  educators sensitize with  women's  the  health  106 care .  Implications The  findings  number o f with  1.  Selected The  area  investigation.  for  of  lack  Are t h e r e  between  associated  with e f f e c t i v e  vary with  support  needs  Also,  research for  for  strategies  per  perspective  information in  future  to  are:  requires  further and  What v a r i a b l e s  are  receiving?  concerning  research.  a  to women  information giving  conclusions  suggest  point  in r e l a t i o n  i n f o r m a t i o n g i v i n g and  lack  How does  What s o u r c e s  for  of  support  support  fit  post-MI? the  control, se  and  study  nursing research  differences  and  because  strategies  effective  from t h i s  family circumstances?  w i t h women's 3.  of  Research  men and women w i t h MI?  findings  anticipated  further  implications  receiving  2. The  Nursing  and c o n c l u s i o n s  implications  MI.  for  women i d e n t i f i e d it  in order to  would be  to expand  isolate  useful  the  strategies  s u c h a wide r a n g e to  investigate  professional that  are  of  sector's  particularly  f o r women.  summary In requires  conclusion, continued  understanding and  the  evident  investigation.  v a l i d i t y of  cardiac  care.  illness  experience to  is  women's e x p e r i e n c e  increase  available  it  Eliciting makes use  understand  this  MI i n r e l a t i o n  This  study  w i t h MI i s the  women's of  that  the  illness  current  most  suggests  necessary knowledge  perceptions valuable  phenomenon.  t o women  of  to  that  augment  base  for  their  MI  data  source  REFERENCE L I S T  108  REFERENCE  Acker, J.E. (1978). rehabilitation.  LIST  Psychological aspects of cardiac Advances i n C a r d i o l o g y . ££, 116-119.  Anderson, J.M. (1981). 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A review of r e s e a r c h into the experience of p a t i e n t s s u f f e r i n g from c o r o n a r y t h r o m b o s i s . I n t e r n a t i o n a l J o u r n a l o f N u r s i n g S t u d i e s . j£, 183-198. Wishnie, H.A., Hackett, T.P., & Cassem, N.H. (1971). P s y c h o l o g i c a l hazards of convalescence f o l l o w i n g myocardial infarction. Journal of the American M e d i c a l A s s o c i a t i o n . 2 1 5 . ( 8 ) . 1292-1296.  APPENDIX  Q9fl5enA  B  Form  I v o l u n t e e r to p a r t i c i p a t e in "Women's P e r c e p t i o n s of T h e i r Infarction".  Penny D u n n ' s t h e s i s s t u d y entitled I l l n e s s Experience With Myocardial  I u n d e r s t a n d t h a t the purpose of t h i s view t h e i r h e a r t a t t a c k e x p e r i e n c e .  study  is  to  learn  how  women  I have r e c e i v e d the " P a t i e n t I n f o r m a t i o n L e t t e r " which outlines what my p a r t i c i p a t i o n w i l l i n v o l v e a n d how c o n f i d e n t i a l i t y will be m a i n t a i n e d . Penny  Dunn h a s  answered  my q u e s t i o n s  about  her  study.  I u n d e r s t a n d t h a t my d e c i s i o n w h e t h e r o r n o t t o p a r t i c i p a t e o r t o withdraw a t a n y t i m e W i l l h a v e n o e f f e c t w h a t s o e v e r o n my f u t u r e health care.  date  s ignature  1 16  APPENDIX Sample  1.  What d o e s  2.  Tell to  3.  How  i t mean  me a b o u t  have  Questions  for Initial  t o you t o have  your  illness.  had a h e a r t  has i t a f f e c t e d family  C Interview  had a h e a r t  attack?  What h a s i t b e e n  like  f o r you  attack? your  everyday  relationships,  life?  relationships  with  friends,  acquaintances dally  activities  feelings, leisure work 4.  How  o u t l o o k on  life  activities  activities  do y o u t h i n k  you w i l l  be f e e l i n g  one t o two m o n t h s  from  now? 5.  What do y o u s e e y o u r s e l f  6.  What  are  recovery?  d o i n g one t o two months  your concerns about about  dealing  with  your  illness?  your  illness?  from about  now? your  1 17 APPENDIX  Key:  1)  A change  2)  The  same  in  speaker  is  process  is  (no  between  the  dots)  indicated  women s p e a k i n g  interview  D  at  fay  10  dots.  a different  presented entries.  fay  double  point  in  spacing  the only  

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