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Differences in uncertainty and quality of life between primary and reoperation coronary artery bypass… Simurda, Lori Anne 1988

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DIFFERENCES IN UNCERTAINTY AND QUALITY OF BETWEEN PRIMARY AND REOPERATION CORONARY ARTERY BYPASS PATIENTS  LIFE  By LORI ANNE SIMURDA B.A., Queen's U n i v e r s i t y , 1982 B.N.Sc., Queen's U n i v e r s i t y , 1983 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR  THE DEGREE OF  MASTER OF SCIENCE IN NURSING in THE FACULTY The We  accept to  OF GRADUATE  School this  thesis  Lori  as  conforming  standard  OF BRITISH COLUMBIA  July ©  of N u r s i n g  the r e q u i r e d  THE UNIVERSITY  STUDIES  Anne  1988 S i m u r d a , 1988  In presenting  this thesis in partial fulfilment  of the  requirements for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or  by  his  or  her  representatives.  It  is  understood  that  copying  or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3  DE-6f3/81)  ii Abstract  The  purposes of t h i s  relationships indicators  study  were t o e x p l o r e t h e  between u n c e r t a i n t y and q u a l i t y o f  i n patients recovering  bypass g r a f t differences  (CABG) s u r g e r y  from c o r o n a r y  the  artery  and t o i n v e s t i g a t e t h e  i n u n c e r t a i n t y and q u a l i t y o f l i f e  between p r i m a r y CABG p a t i e n t s and r e o p e r a t i o n indicators  of q u a l i t y of l i f e  patient's perception  life  indicators patients.  selected for this  o f h e a l t h s t a t u s and  study  The  were  life  satisfaction. A c o n v e n i e n c e sample reoperation  p a t i e n t s who were f i v e  postoperative Scale  o f 41 p r i m a r y CABG p a t i e n t s and 11  completed  the Mishel  (Community V e r s i o n )  Rating  Index  patient  Uncertainty, satisfaction  Uncertainty  life  Self-Anchoring  satisfaction,  d i d not s i g n i f i c a n t l y d i f f e r  p r i m a r y and r e o p e r a t i o n  patients.  Both groups of p a t i e n t s  low u n c e r t a i n t y , and were  satisfied  with  present  that  CABG s u r g e r y  satisfaction  and f u t u r e  and o p t i m i s m  future  perceptions  life  Trends  moderately  i n the r a t i n g s  satisfaction  was a s s o c i a t e d w i t h  suggested  an improvement  f o r the future  CABG p a t i e n t s and r e o p e r a t i o n patients'  lives. life  life  between t h e  moderately  present,  S c a l e , and a  and p r e s e n t  perceived  of p a s t ,  Health  sheet.  past  their  i n Illness  (MUISCV), t h e G e n e r a l  (GHRI), t h e C a n t r i l  information  t o t e n months  patients.  i n both  in life  primary  Reoperation  o f h e a l t h s t a t u s and p r o j e c t i o n s o f  satisfaction  were s i g n i f i c a n t l y  less  favorable  iii t h a n t h o s e o f t h e p r i m a r y CABG p a t i e n t s s u g g e s t i n g quality  of l i f e  reoperation  f o l l o w i n g CABG s u r g e r y  patients.  negatively associated present  Uncertainty with  was  perceptions  life  satisfaction,  and f u t u r e  This  finding  suggests that  higher  with  a lower q u a l i t y  t o t e n months The  of l i f e  f o r the  significantly of health life  status,  satisfaction.  uncertainty  i s associated  i n CABG p a t i e n t s who a r e f i v e  postoperative.  f i n d i n g s were d i s c u s s e d  expectations,  i s lower  that the  other  problems  inherent  findings  for nursing  Recommendations  research  in relation  s t u d i e s , and t h e  i n the study.  Implications  p r a c t i c e were  for future  to theoretical  research  suggested. were made.  methodological of the  iv Table  of Contents  Abstract Table  i i  of Contents  List  of Tables  List  of Figures  .v i i viii  Acknowledgements CHAPTER ONE:  ix  Introduction  Background t o t h e Problem Statement of the Problem Purpose of the Study T h e o r e t i c a l Framework Cognitive Appraisal Coping A d a p t a t i o n a l Outcomes Reappraisal Summary Research Questions S i g n i f i c a n c e of the Study t o Nursing D e f i n i t i o n o f Terms Assumptions Limitations Overview of the T h e s i s Content CHAPTER TWO:  iv  1 4 5 5 6 8 8 9 9 9 10 11 13 13 14  Review of S e l e c t e d L i t e r a t u r e  Introduction A p p r a i s a l of U n c e r t a i n t y Summary A d a p t a t i o n a l Outcomes Q u a l i t y of L i f e Life Satisfaction Perception of Health Status Summary Summary o f t h e L i t e r a t u r e R e v i e w  15 15 20 21 22 24 28 33 34  CHAPTER THREE: M e t h o d o l o g y Introduction Research Design Sampling Procedure Data C o l l e c t i o n I n s t r u m e n t s Mishel Uncertainty i n I l l n e s s Scale (Community V e r s i o n ) ( M U I S C V ) G e n e r a l H e a l t h R a t i n g Index (GHRI) C a n t r i l Self-Anchoring Scale  37 37 37 40 40 43 45  P a t i e n t I n f o r m a t i o n Sheet Data C o l l e c t i o n Procedure Ethical Considerations Data A n a l y s i s C H A P T E R FOUR:  Presentation  48 48 50 52  and D i s c u s s i o n  of  Results  Introduction C h a r a c t e r i s t i c s o f t h e Sample Demographic C h a r a c t e r i s t i c s o f t h e Sample .. S u r g i c a l C h a r a c t e r i s t i c s o f t h e Sample H e a l t h C h a r a c t e r i s t i c s o f t h e Sample Findings R e s e a r c h Q u e s t i o n 1: D i f f e r e n c e i n U n c e r t a i n t y B e t w e e n P r i m a r y CABG P a t i e n t s and R e o p e r a t i o n P a t i e n t s R e s e a r c h Q u e s t i o n 2: D i f f e r e n c e i n P a s t L i f e S a t i s f a c t i o n B e t w e e n P r i m a r y CABG P a t i e n t s and R e o p e r a t i o n P a t i e n t s R e s e a r c h Q u e s t i o n 3: D i f f e r e n c e i n P r e s e n t L i f e S a t i s f a c t i o n B e t w e e n P r i m a r y CABG P a t i e n t s and Reoperation P a t i e n t s R e s e a r c h Q u e s t i o n 4: D i f f e r e n c e i n F u t u r e L i f e S a t i s f a c t i o n B e t w e e n P r i m a r y CABG P a t i e n t s and Reoperation P a t i e n t s R e s e a r c h Q u e s t i o n 5: D i f f e r e n c e i n P e r c e p t i o n o f H e a l t h S t a t u s B e t w e e n P r i m a r y CABG P a t i e n t s and Reoperation P a t i e n t s R e s e a r c h Q u e s t i o n 6: R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y and Present L i f e S a t i s f a c t i o n . R e s e a r c h Q u e s t i o n 7: R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y a n d F u t u r e L i f e S a t i s f a c t i o n .. R e s e a r c h Q u e s t i o n 8: R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y and P e r c e p t i o n of Health Status Discussion of Results C h a r a c t e r i s t i c s o f t h e Sample Uncertainty Life Satisfaction Perception of Health Status The R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y a n d A d a p t a t i o n a l Outcomes Summary CHAPTER  FIVE:  Summary, C o n c l u s i o n s , Recommendations  54 54 55 57 59 60 61 61 62 63 63 64 64 65 65 66 67 71 76 77 79  I m p l i c a t i o n s and  Introduction Summary Conclusions Implications f o r Nursing Practice Recommendations f o r Future Research  82 82 88 89 90  vi References Appendices Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix Appendix  93  A B C D E F G H I J K L M  .  98 99 104 108 110 112 114 117 119 122 124 126 128 131  vii List  of  Tables  Table I II III IV  V  VI VII  VIII  IX  X  XI  Ages o f P r i m a r y C o r o n a r y P a t i e n t s and R e o p e r a t i o n  A r t e r y Bypass Patients  Graft 56  Employment S t a t u s o f P r i m a r y C o r o n a r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n  Artery Patients  ..  56  Educational Level of Primary Coronary Bypass G r a f t P a t i e n t s and R e o p e r a t i o n  Artery Patients  ..  57  Time P o s t o p e r a t i v e l y i n Weeks f o r P r i m a r y Coronary A r t e r y Bypass G r a f t P a t i e n t s and Reoperation Patients  58  Frequency of Bypass G r a f t s f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n Patients  58  U n c e r t a i n t y f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n P a t i e n t s  ..  61  Past L i f e S a t i s f a c t i o n f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n Patients  62  Present L i f e S a t i s f a c t i o n f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n Patients  63  Future L i f e S a t i s f a c t i o n f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and R e o p e r a t i o n Patients  64  Perceptions of Health Status f o r Primary Coronary A r t e r y Bypass G r a f t P a t i e n t s and Reoperation Patients  65  Comparison  o f Mean L i f e  Satisfaction  Ratings  ....  72  viii List  of  Figures  Figure 1  T h e o r e t i c a l Framework f o r U n c e r t a i n t y Q u a l i t y of L i f e  and 7  Acknowledgements  I would l i k e c o m m i t t e e , D r . Ann for t h e i r patience for answers t o the  t o t h a n k t h e m e m b e r s o f my thesis H i l t o n ( c h a i r p e r s o n ) and C a r o l J i l l i n g s , a n d g u i d a n c e t h r o u g h o u t my l o n g s e a r c h research questions addressed herein.  God b l e s s t h e e n t i r e S i m u r d a f a m i l y f o r t h e i r e n d l e s s s u p p o r t and e n c o u r a g e m e n t . My r o o m m a t e s , C a t h y a n d L o u i e , d e s e r v e s p e c i a l acknowledgement f o r t h e d o o r shows and f r i e n d s h i p t h a t k e p t me g o i n g . I am a l s o i n d e b t e d t o t w o o t h e f i n e s t g r a d u a t e s t u d e n t s , Peggy Bechard and T o n i S t o v e l I e x t e n d my t h a n k s t o D r . B u r r , D r . G e r e i n , D r . H a y d e n D r . J a m i e s o n , D r . J a n u s z , D r . L i n g , D r . M i y a g i s h i m a , and Dr Munro and t h e i r a s s i s t a n t s T h e r e s e , K a t h l e e n , S h e i l a , K a r e n P a t and Anne f o r t h e i r h e l p i n s e c u r i n g p a r t i c i p a n t s f o r t h i s study. who  F i n a l l y , I would l i k e t o acknowledge the so g e n e r o u s l y p a r t i c i p a t e d i n t h i s s t u d y .  individuals  1 CHAPTER  ONE  introduction Background In four  1982, c a r d i o v a s c u l a r disease  deaths  admitted  i n Canada, and over  to hospital  (Statistics disability alarming, with  Canada,  over  advance  surgery.  During  performed  i n Canada  communication,  failure  pharmacological One  a r t e r y bypass g r a f t  June  (CABG) were  (Statistics  Canada,  22, 1988).  U n f o r t u n a t e l y , a number o f  first  t o remain  four percent  CABG s u r g e r y  personal  CABG s u r g e r y  patent.  must  undergo  require reoperation July  5,  i s viewed  following  (Dr. J . Knight,  as a  stressful  treatment f o r  The e m o t i o n a l  impact  has on t h e p a t i e n t i s n o t s u r p r i s i n g  has l o n g been r e c o g n i z e d  that  1988).  a r t e r y bypass surgery  disease.  disease  I t i s estimated  o f p a t i e n t s who s u r v i v e  f o r the patient seeking  cardiovascular  heart  and  1 9 8 4 t o 1 9 8 5 , 8 , 3 0 7 CABG p r o c e d u r e s  of grafts  Coronary  surgery  decade by  i s coronary  communication,  experience  forpatients  due t o t h e m a n i f e s t a t i o n s o f p r o g r e s s i v e  approximately first  statistics  (Wenger, 1 9 8 4 a ) .  who h a v e h a d t h e i r  reoperation  personal  r a t e s and  have been s i g n i f i c a n t l y  the past  t e c h n o l o g i c a l advances  their  every  of cardiovascular disease the death  m o r b i d i t y and m o r t a l i t y  technological  or  While  cardiovascular disease  patients  one o u t o f  250,000 p a t i e n t s were  f o r treatment 1988).  caused  associated with cardiovascular disease are  favorably altered and  t o the Problem  that  CABG  f o r "as t h e  as an organ v i t a l  to  life...a  2 high  degree  threatened" addition factors  (Glaser,  to explain  i n physical  illness  be a k e y a n t e c e d e n t 1979; Jessop  Mishel,  more a d j u s t m e n t  cancer  (Mishel,  myocardial  problems  Hostetter,  In as  major  a recent  & Folkman, 1972).  t o lower  optimism  diagnosed  with  & Graham, 1 9 8 4 ) .  recovery  related t o emotional  In  has been  found  (Painter,  distress  study  by Dubyts  (1988),  uncertainty  i n the e x p e r i e n t i a l accounts and u n c e r t a i n t y  the reactions expressed  experienced  during  patients  of anger,  frustration,  uncertainty the event  were u n c e r t a i n  about  t o be a  vulnerability  f e a r , and  about what would  of having  emerged  of patients  was n o t e d  factor contributing t o the feelings of  addition,  considered  (Cohen &  & Lazarus,  patients, uncertainty  f o r CABG s u r g e r y  Patients  a central  e t . a l , 1988).  a c e n t r a l theme  waiting  and  King,  be i n v e r s e l y r e l a t e d t o p e r c e i v e d  (Christman  i s uncertainty.  1985; Lazarus  i n patients  type of  recovery  stress  t o be r e l a t e d  other  which  of this  and i t i s  of psychological  In  may b e  as having  and treatment  found  1981), and p o s i t i v e l y  impact  factor  identified  & Stein,  infarction  there  o f CABG s u r g e r y  1981a; Monat, A v e r i l l  has been  1964, p.377).  the patient's  One s u c h  has been  Uncertainty  to  influence  CABG s u r g e r y .  when i t s f u n c t i o n i s  itself,  the emotional  Uncertainty  Lazarus,  and  to life  a n d w h i c h may  following  1984;  & Lynn,  germane t o t h e e x p e r i e n c e  surgery  to  i s aroused  Harrison  to the threat  might help  role  of apprehension  anxiety.  be  the surgery. the short  In  and  long  3 term  outcomes o f t h e s u r g e r y . Little  i s known a b o u t  experienced surgery. course term  the degree  of uncertainty  b y p a t i e n t s who a r e r e c o v e r i n g  U n c e r t a i n t y may a r i s e  the underlying disease  prognosis  i s .  from  when i t i s u n c l e a r  will  follow,  may h a v e  immediate  I t i s n o t known how t h e e x p e r i e n c e  patients  less  this  may e x p e r i e n c e  effectiveness  However,  greater  of the  period since they  period before.  of  Reoperation  u n c e r t a i n t y about aspects  postoperative recovery  experienced  which  o r what t h e l o n g  CABG r e o p e r a t i o n i n f l u e n c e s u n c e r t a i n t y . patients  CABG  have  reoperation  u n c e r t a i n t y about the  o f t h e CABG s u r g e r y  and t h e i r  long  term  prognosis. Traditionally, measured Croog,  the  1984).  fail  surgery  However, t h e s e  of the overall to reflect  social  ignore  o f CABG s u r g e r y  by m o r b i d i t y and m o r t a l i t y  indicators they  the success  statistics  the patients' perceptions  1984a).  Therefore,  concept  of q u a l i t y  the  e f f e c t i v e n e s s o f CABG  capabilities, patient's  of l i f e  of l i f e  performance  has on  of a patient's l i f e  of t h e impact  and  o f CABG  are increasingly  t o broaden  as  (Wenger,  turning to  the evaluation of  surgery.  denotes  limitations,  surgery  w e l l - b e i n g and l i f e - s t y l e  researchers  the  Quality  are insensitive  the influence that this  personal  (Levine and  e f f e c t i v e n e s s o f CABG s u r g e r y  and p s y c h o l o g i c a l a s p e c t s  on t h e i r  statistics  has been  "...a wide  range of  and perceptions  t h a t may a f f e c t  or function i n a v a r i e t y  of  social  a  4 roles  and c o n s i d e r s  results p.3).  from that  status  satisfaction  of  been  to Lazarus  identified  and p e r c e p t i o n s  illness.  evaluate  Uncertainty,  affect  the l i f e  satisfaction  status  of patients  of  on t h e q u a l i t y o f l i f e and Holm  who w e r e r e c o v e r i n g with  o f t h e unknown" and u n c e r t a i n t y  Furthermore, uncertainty  by p a t i e n t s no s t u d i e s experienced  measure t h e l i f e  While  health O n l y one  lives  Influence  indicated  that  attributed  p r i o r t o surgery about  to a  the future.  of the Problem  i s known a b o u t  CABG r e o p e r a t i o n .  status  their  may  patients.  f r o m CABG s u r g e r y  "fear  experienced  o f CABG  (1984),  dissatisfaction  Little  of  the potential  their  Statement  are affected  f r o m CABG s u r g e r y .  which addressed  by Penckofer  life  strategies utilized,  found  That study,  1984b).  the stressors of  and p e r c e p t i o n s  recovering  of  by i n f l u e n c i n g t h e a p p r a i s a l  s t u d y has been uncertainty  perception  status  and cope w i t h  1984a,  of q u a l i t y of  (1984),  of health  that  as e s s e n t i a l  1984; Wenger,  and Folkman  t h e s i t u a t i o n and t h e coping  patients  (Wenger,  and t h e p a t i e n t ' s  (Patrick & Elinson,  t h e ways p e o p l e  physical  or function"  have  satisfaction  According  by  that  satisfaction  i n t h e measurement and a n a l y s i s  are life  health  of personal  performance  Two v a r i a b l e s  components life  the level  the degree  recovering have  been  satisfaction  uncertainty  f r o m CABG found  by p a t i e n t s there  of  which  address the  who a r e r e c o v e r i n g  are studies  documented  and perceptions  o f p r i m a r y CABG p a t i e n t s ,  surgery.  reoperation  of  from which  health  patients  have  5 been s y s t e m a t i c a l l y Uncertainty life is  may  excluded  Influence  from these  q u a l i t y of l i f e ,  s a t i s f a c t i o n and perceptions  a paucity  of research  between u n c e r t a i n t y recovering  which  purpose  purpose  has examined  status.  There  the relationship  measures  i n patients  surgery.  Purpose The  specifically,  of health  and q u a l i t y of l i f e  f r o m CABG  studies.  of this  of the Study  s t u d y was t w o - f o l d .  o f t h e s t u d y was t o i n v e s t i g a t e  The  first  the relationship  between u n c e r t a i n t y  and q u a l i t y of l i f e  indicators i n  patients  f r o m CABG s u r g e r y .  The s e c o n d  was  recovering  to investigate  quality  of l i f e  reoperation  the differences  Framework  (1984) t h e o r y  cognitive  a p p r a i s a l , and coping  framework  forthis  cognitive  processes  study.  reactions  to that  cognitive  appraisal  significance  The  event.  o f what  that  provided  According  intervene  event and t h e e m o t i o n a l ,  which  of stress, the theoretical  to this  theory,  between an encounter  p h y s i o l o g i c a l , and  importance  an  I t i s through the process of the person  i s happening  evaluates  the  i n the environment i n  a p p r a i s a l , a dynamic coping  i s continuously  with  behavioral  o f i t s e f f e c t on h i s o r h e r w e l l - b e i n g .  prime  and  patients.  Lazarus and Folkman's  cognitive  and  i n d i c a t o r s b e t w e e n p r i m a r y CABG p a t i e n t s  Theoretical  terms  i n uncertainty  purpose  mediated  process  by c o g n i t i v e  of cognitive  Based  appraisal  on  this  i s utilized  reappraisals. and coping  6 processes (see  i s that  figure  Cognitive  they a f f e c t adaptational  1).  Appraisal  There are  two  components to  p r i m a r y a p p r a i s a l and appraisal  i s an  encounter;  evaluation  that  cognitive  of  i s , whether or  when h a r m / l o s s ,  threat  what  the  stressful. or  challenge  appraised  as  person takes  available,  the  accomplish  what  one  can  apply  Person interact  for  to  of  the  threat  a  given  p a r t i c u l a r set  of  of  inability  the to  allowing  appraisal  implemented  by  of  of  the  a  Conversely,  influence  meaning  individual.  of  been appraisal,  or  that  commitments, cognitive necessary  unclear  Uncertainty threatening  uncertainty  coping  will  effectively.  and may  due  clear conception  the  are  option  information  a l t e r n a t i v e , perhaps the  has  p r o b a b i l i t y that  b e l i e f s and  s i t u a t i o n as  uncertainty,  the  coping  is insufficient  formulate  result Secondary  options  strategies  i s experienced.  is in store.  interpretations the  a  t o , and  appraisal  the  secondary  coping  s i t u a t i o n factors to  appraisal  by  that  the  In  i t i s supposed  uncertainty  person's exactly  likelihood  in  is irrelevant,  encounter  I n many s i t u a t i o n s , t h e  cognitive  state  into account  stake  is perceived.  challenge.  factors, specifically  with  appraisal.  or  Primary  Stressful appraisals  becomes s a l i e n t when t h e threat  i s at  encounter  appraisal  a  appraisal:  secondary a p p r a i s a l .  benign-positive  the  outcomes  may  of  a lead  to  the  what  reduce  reassuring,  situation. strategies  Based are  upon  7  PERSON  SITUATION  REAPPRAISAL  P r i m a r y CABG v s . R e o p e r a t i o n  Commitments Beliefs  COGNITIVE APPRAISAL Uncertainty COPING RESOURCES  Primary Appraisal(What i s a t S t a k e ) Irrelevant i  S t r e s s f u l Benign i -Positive  Harm/Loss  Challenge  COPING STRATEGIES  |~  \  COPING CONSTRAINTS  Threat  Secondary Appraisal(Coping Options) ADAPTATIONAL OUTCOMES - F u n c t i o n i n g i n Work and S o c i a l L i v i n g -Morale/Life Satisfaction -Somatic Health/ Perception of Health Status  COPING PROCESS ^^Cognitive  OVER T I M E  Appraisal,  Reappraisal^  Coping  Strategies  Outcomes Figure Note.  1.  Theoretical of l i f e .  framework  for uncertainty  and q u a l i t y  From Coping w i t h t h e U n c e r t a i n t i e s o f B r e a s t Cancer: A p p r a i s a l and Coping S t r a t e g i e s (p.7) by B. A. H i l t o n , 1 9 8 7 . A n n A r b o r , M I : University M i c r o f i l m s I n t e r n a t i o n a l , No. 8 7 - 0 0 , 2 0 5 . R e p r i n t e d by permission.  8 Coping Coping and  behavioral  internal the p.  i sdefined  as "...constantly  changing  e f f o r t s t o manage s p e c i f i c  demands t h a t  resources  are appraised  of the person"  external  as taxing  (Lazarus  constraints  has  been a p p r a i s e d  uncertainty generate  a r e implemented.  uncertainty  Social  importance  or l i f e  i s unclear  processes  itself.  as an opportunity uncertainty  of cognitive  and  i s limited.  When t o reduce  threat,  are utilized.  appraisal  with  satisfaction,  various  social  Interpersonal  conditions  and mental  and  outcomes.  coping Three  i n work a n d s o c i a l  and somatic  health.  i n which the  r o l e s and  includes  relationships.  r e f e r s t o how p e o p l e  and t h e i r  to physical  satisfaction,  r e f e r s t o t h e manner  fulfills  satisfaction  refers  uncertainty  i n s i t u a t i o n s which  they a f f e c t adaptatlonal  functioning  themselves  and  s t r a t e g i e s t o reduce  o f outcomes a r e f u n c t i o n i n g  morale  individual  When  f o ra c t i o n s  by t h e u n c e r t a i n t y  i s that  kinds  living,  resources  Outcomes  prime  processes  or exceeding  t h e e f f e c t i v e management o f t h e  strategies t o maintain  The  basic  However,  the focus  i s appraised  Adaptatlonal  use.  coping  the s e l e c t i o n of coping  generated  coping  their  as a threat,  may i n t e r f e r e w i t h  threat  life  inhibit  uncertainty,  therefore, This  that  and/or  & Folkman, 1984,  1 4 2 ) . Coping depends on a v a i l a b l e c o p i n g  the  cognitive  feel  of l i f e . well-being.  Morale, or  about  Somatic  health  9 Rsappraisa,!  Coping the  i sa dynamic, changing  person-environment  reappraisal event  o f what  process.  relationship will  i shappening,  made a n d t h e c o p i n g  for further  to a  a n d what c a n be done t o  C h o i c e s among c o p i n g  strategies utilized  outcomes. R e a p p r a i s a l basis  lead  thesignificance of the  f o r t h e person's well-being,  manage t h e s i t u a t i o n .  Any s h i f t I n  i san ongoing  alternativesare  affect  process,  adaptational  becoming t h e  coping.  Summary According a  situation  or event  uncertainty threat of  and Folkman's  lacks  i sgenerated.  information,  Uncertainty  may b e a p p r a i s e d  life.  This  perceived  adaptational  study explored  uncertainty  satisfaction recovering  and t h e adaptational  patients  were  research 1.  The a p p r a i s a l  as q u a l i t y of  outcomes o f l i f e  status  i n patients  In addition, the differences and perceptions  CABG p a t i e n t s  of health  and reoperation  explored. Research  The  of health  satisfaction,  between p r i m a r y  present  Questions  s t u d y was d e s i g n e d  t o answer  the following  questions: What  as a  s t r a t e g i e s used which, i n  outcomes such  f r o m CABG s u r g e r y . life  threat.  when  t h e r e l a t i o n s h i p between  and perception  uncertainty,  status  t o reduce  a f f e c t s t h e coping  influence  (1984) t h e o r y ,  sufficient  or as an opportunity  uncertainty  turn,  in  t o Lazarus  i st h ed i f f e r e n c e  i nuncertainty  between  p r i m a r y CABG p a t i e n t s 2.  and r e o p e r a t i o n  What i s t h e d i f f e r e n c e between  i n past  p r i m a r y CABG p a t i e n t s  life  patients? satisfaction  and  reoperation  patients? 3.  What i s t h e d i f f e r e n c e between  primary  i n present  CABG p a t i e n t s  life  and  satisfaction  reoperation  patients? 4.  What i s t h e d i f f e r e n c e between  primary  i n future  CABG p a t i e n t s  life  and  satisfaction  reoperation  patients? 5.  What i s d i f f e r e n c e between  i n perception  p r i m a r y CABG p a t i e n t s  of health  and  status  reoperation  patients? 6.  What i s t h e r e l a t i o n s h i p present  7.  8.  life  satisfaction  between  future  satisfaction  i n CABG  What i s t h e r e l a t i o n s h i p  between  life  of health  Significance Nursing uncertainty  research  status  Knowledge  t o understanding  u n c e r t a i n t y and patients? u n c e r t a i n t y and patients? u n c e r t a i n t y and  i n CABG  patients?  of t h e Study t o Nursing  has not addressed  experienced  CABG s u r g e r y .  surgery,  i n CABG  What i s t h e r e l a t i o n s h i p  perception  crucial  between  by p a t i e n t s  the extent of  who a r e r e c o v e r i n g  of the degree  of uncertainty i s  patients' responses  and t o i d e n t i f y i n g  nursing  from  t o CABG  interventions  that  alter  uncertainty. Quality  of l i f e  i s a salient  issue  i n the health  care  11 field.  This  surgery. of  life  i s particularly  Findings  generated  patients*  of health  provide  information  workers  i n designing  patients  influence  gaining  life  will  be u s e f u l  c a n be u t i l i z e d  knowledge  f o l l o w i n g CABG s u r g e r y  group  of patients care  patients  The c o m p a r i s o n  information these  and p e r c e p t i o n  two groups  designing specific  i n their  patients'  have been  One  factor  q u a l i t y of  systematically  i t i s n o t known and  whether  rehabilitative  of primary  of uncertainty, of health  be u s e f u l  of patients  CABG  will  life  provide  i n determining  have s p e c i f i c  approaches which a r e d i r e c t e d needs o f each  from  o f p r i m a r y CABG p a t i e n t s a n d  i n terms  which w i l l  recovering  workers  have s u p p o r t i v e  patients.  satisfaction,  programs  i s uncertainty.  a r e d i f f e r e n t from those  patients  care  which  q u a l i t y of l i f e .  needs t h a t  reoperation  will  surgery.  of the factors  and t h e r e f o r e ,  of patients  and  by h e a l t h  f r o m CABG  assist health  from study,  i n understanding  and supportive  has t h e p o t e n t i a l t o i n f l u e n c e  excluded  of q u a l i t y  s a t i s f a c t i o n and  rehabilitative  reoperation  o f CABG  f o l l o w i n g CABG s u r g e r y ,  t o improve p a t i e n t s '  Finally,  this  will  the quality of l i f e  CABG s u r g e r y  which  that  life  who a r e r e c o v e r i n g  Furthermore,  attempts  status,  quality of l i f e  i n the area  from an e x p l o r a t i o n  indices, specifically,  perception  for  true  baseline  whether  needs, and i n  toward  meeting the  group.  Definition Coronary a r t e r y bypass g r a f t  o f Terms  (CABG) s u r g e r y  i sa  procedure  that consists of suturing a segment of the saphenous vein to a small opening made i n the aorta at one end and to a coronary artery at the other end. This vein graft bypasses an obstructed portion of a diseased artery and permits blood to pass from the aorta to the myocardium (Meltzer, Pinneo, & K i t c h e l l , 1983). Primary coronary artery bypass graft (CABG) patients are patients who have undergone one CABG s u r g i c a l procedure. Reoperation patients are patients who have undergone their second CABG s u r g i c a l procedure. Uncertainty  i s a perceptual state that occurs i n a s i t u a t i o n  where the person i s unable to assign d e f i n i t e values to objects and events and/or i s unable to accurately predict outcomes (Mcintosh, 1974).  In t h i s study, uncertainty was  measured by the Mishel Uncertainty  i n I l l n e s s Scale  (Community Version) (MUISCV). Quality of l i f e i s a concept which denotes "...a wide range of c a p a b i l i t i e s , l i m i t a t i o n s , and perceptions  that may  a f f e c t a patient's performance or function i n a variety of s o c i a l roles and considers the level of personal s a t i s f a c t i o n that r e s u l t s from that performance or function" (Wenger, 1984a. p.3).  In t h i s study, q u a l i t y of l i f e was  measured by the variables of l i f e s a t i s f a c t i o n and perception of health status. L i f e s a t i s f a c t i o n i s the perceived discrepancy  between an  individual's aspirations in l i f e and the individual's achievements In l i f e  (Campbell, Converse, & Rodgers, 1976).  Past  life  satisfaction Present life  satisfaction  two y e a r s life  Is the patient's perceived  ago.  satisfaction  i s the patient's  life  life  satisfaction  satisfaction In  this  satisfaction Scale  two y e a r s  study,  past,  using  evaluation  of h i s or her general  General  and f u t u r e  the Cantril  life Self-Anchoring  1965).  of health status  study,  perceived  hence.  present,  were measured  (Cantril,  i s the patient's  Perception  the  perceived  satisfaction currently. Future  this  life  perception Health  i s the individual's  subjective  state of well-being.  o f h e a l t h s t a t u s was m e a s u r e d  Rating  Index  (Davies  & Ware,  In using  1981).  Assumptions For  the purposes  a s s u m p t i o n s were 1.  2.  valid  of h e a l t h s t a t u s and l i f e  Uncertainty  Subjects In  the following  i n d i c a t o r s of quality  f r o m CABG 3.  study,  made:  Perceptions are  of this  i s experienced  of  satisfaction  life.  by p a t i e n t s  recovering  surgery. will  respond  honestly  to the scales  used  the study.  Limitations This 1.  study  has t h e f o l l o w i n g  A convenience  limitations:  s a m p l e was u s e d ,  and t h e r e f o r e , t h e  s a m p l e may n o t b e r e p r e s e n t a t i v e o f t h e p o p u l a t i o n of  primary  CABG p a t i e n t s o r r e o p e r a t i o n p a t i e n t s .  2.  Due t o t i m e  and resource  sample s i z e  was u s e d  generalizability overview  This One,  i s comprised  t h ebackground  purpose, Two,  thesis  t o the  appraisal  outcomes.  Chapter  including procedure,  data  procedure,  ethical  procedures  used  theoretical  I n Chapter framework, I n Chapter  i s presented  t h er e s e a r c h  o f t h er e s e a r c h d e s i g n ,  collection  under two  instruments, data  methodology sampling  collection  c o n s i d e r a t i o n s , and s t a t i s t i c a l  i n data  analysis.  o f t h esample,  results  presented.  I n Chapter  findings,  Four, t h e  and d i s c u s s i o n o f the  The summary, c o n c l u s i o n s ,  for nursing practice,  research are  chapters.  were p r e s e n t e d .  Three addresses  description  implications  content  of five  problem,  findings,  o f u n c e r t a i n t y , anda d a p t a t i o n a l  a description  are  study  of selected literature  headings:  a small  decreases t h e  Thesis  and research questions  a review  future  which  o f the  o f the  constraints,  presented  and recommendations  i n Chapter  Five.  for  CHAPTER  TWO  Review of Selected  Literature  Introduction The  purpose  literature  under  theoretical  of t h i s  health  appraisal  outcomes.  outcomes, q u a l i t y adaptatlonal  Under  of l i f e  be  followed  by p r e s e n t i n g  by l i t e r a t u r e  uncertainty be  i n other  and  adaptatlonal  and t h e s p e c i f i c and p e r c e p t i o n  of  Uncertainty on u n c e r t a i n t y which  literature  groups  by p a t i e n t s ,  the relationship  outcomes.  i s specific  be  h i g h l i g h t the  experienced  which addresses  will  There  to uncertainty  which  focuses  of cardiovascular  i s a i n CABG  on  patients  will  emphasized. Uncertainty  or  of  references  that  and t h e r e f o r e ,  of  satisfaction  and a d a p t a t l o n a l  of l i t e r a t u r e  patients  the heading  of uncertainty  between u n c e r t a i n t y dearth  of uncertainty,  review of the l i t e r a t u r e  degree and nature  from the  addressed.  Appraisal  approached  selected  have e v o l v e d  i n general,  outcomes of l i f e  status, will  The  i s to review  two h e a d i n g s w h i c h  framework:  adaptatlonal  chapter  situation  because According  cannot  sufficient to Mishel  events which  state  created  be a d e q u a t e l y s t r u c t u r e d cues a r e l a c k i n g (1984),  inconsistent  s i t u a t i o n s where  (Budner,  uncertainty  are characterized  unpredictable, these  i s a cognitive  sufficient  or  event  categorized  1962).  i s generated  as vague,  or lacking  when a n  by  ambiguous,  information.  cues a r e l a c k i n g , a  In  16 c o g n i t i v e s t r u c t u r e i s not  formed, and  a b i l i t y to adequately a p p r a i s e appropriate  actions  Uncertainty illness 1984; Tsu,  and  illness  1988; Mishel  a s i t u a t i o n and  i s l i m i t e d (Mishel,  choose  1984).  been w i d e l y noted i n cases of p h y s i c a l  disability  Mishel, 1977).  has  the i n d i v i d u a l ' s  (Lazarus  & Folkman, 1984;  Monat, A v e r i l l ,  Mishel,  & Lazarus, 1972;  Moos &  (1988) notes that the events surrounding  r a r e l y meet the c r i t e r i a necessary f o r formation  a cognitive structure.  Symptoms are g e n e r a l l y novel  and  ambiguous.  In a d d i t i o n , p a t i e n t s r e c e i v e  information  from h e a l t h care p r o f e s s i o n a l s about t h e i r  c o n d i t i o n or r e c e i v e understand.  information  incomplete  t h a t they cannot  Furthermore, i n the h e a l t h care  environment,  p a t i e n t s encounter many u n f a m i l i a r s i t u a t i o n s . p a t i e n t s are o f t e n unclear not do,  and  the  of  Finally,  about what they should  and  should  lack of o b j e c t i v e markers of progress  impedes p a t i e n t s ' a b i l i t y to c l e a r l y gauge t h e i r  recovery  status. Wright (1960) suggested that the u n c e r t a i n t y with some I l l n e s s e s leads to the  associated  following:  [the person's] i n a b i l i t y to s t r u c t u r e h i s s i t u a t i o n i n a s t a b l e way because at any moment events could s h i f t dangerously beyond h i s control....Whenever a s i t u a t i o n occurs i n which the consequences of behaviour are seemingly u n p r e d i c t a b l e or u n c o n t r o l l a b l e , and i n which b e n e f i t s and harms occur i n an a p p a r e n t l y i n c o n s i s t e n t , f o r t u i t o u s , or a r b i t r a r y manner, i n s e c u r i t y of the deepest s o r t may be expected, (p.101). C e r t a i n forms of i l l n e s s  or d i s e a s e ,  serious, l i f e threatening,  and  such as those t h a t  are  i m p e r f e c t l y c o n t r o l l e d , are  replete  with  uncertainty  disease  which  reflects  cardiovascular Mishel  these  (1983) found  uncertainty  severity  of their  life-threatening invalidism,  Cardiovascular  One  characteristics i s  that  cardiovascular  illness. nature  This  patients  uncertainty  of the illness  patients  were a l s o  to clearly  relate  relates  to the  and f e a r s of  damage t o t h e h e a r t , found  about t h e e f f e c t i v e n e s s  inability  1981).  i n t h e form of ambiguity about the  continuing  uncertainty  & Macquire,  disease.  perceive  the  (Comaroff  and death.  to  perceive  of the treatment  the treatment  due t o  to specific  outcomes. In a study pervasive  theme  were w a i t i n g appeared their the  by Dubyts  f o r CABG s u r g e r y .  own b o d i e s .  related  of the i l l n e s s  about  the  surgery.  one w o u l d myocardial  uncertainty reasonable  experience  and t h e s h o r t there  the waiting  infarction  Dubyts'  experienced  including death.  Finally,  survive  Perceived  or  (1988) s t u d y i n patients  t o assume  of patients  wh  of trust i n  uncertainty  about  of an  Patients  illness  were  of the surgery  was u n c e r t a i n t y without  and  outcomes o f about  whether  having  a  dying. h i g h l i g h t s the salience of  waiting  that  loss  and long-term  period  emerged as a  uncertainty  and the p o s s i b i l i t y  the actual  hospitalization,  accounts  to the patients'  Patients  complication  uncertain  uncertainty  i n the experiential  t o be r e l a t e d  course  (1988),  f o r CABG s u r g e r y .  the uncertainty  I t seems  experienced  by  18 patients  awaiting  CABG s u r g e r y  does n o t d i s s i p a t e  following  surgery. Mishel of  (1981b) h y p o t h e s i z e d  uncertainty  changes over  experienced  The  death.  patients  move t h r o u g h a c o n t i n u u m o f  the experience  outcome o f s u r g e r y  The c o m p l e x t r e a t m e n t  critical  care  unit  postoperative uncertainty attentive  of cardiac  should  and nursing  period.  Mishel  tested  uncertainty  this  postoperative,  through  the  intermediate  the four  failed  adaptational  by e x p l o r i n g  what one  time  scores  Mishel  e v e n t s may e x p l a i n  has t h e p o t e n t i a l  outcomes  (Lazarus  as  immediate and  discharge  significantly  concluded  pattern  that  denial  surgery of  uncertainty.  to influence  & Folkman,  A review of the l i t e r a t u r e  patients  why c a r d i a c  t o show t h e e x p e c t e d  period.  t h e change i n  d i d n o t change  periods.  should  of the return of  surgery  postoperative,  less  Intermediate  i n the post-discharge  through the preoperative,  Uncertainty  1988).  hypothesis  Uncertainty  threatening  patients  dominate  i n a group o f open heart  they progressed  stages.  care  equipment and  The v a g u e n e s s a b o u t  uncertainty  i nthe  of i n s e c u r i t y and  n o t do, and t h e u n p r e d i c t a b i l i t y  symptoms g e n e r a t e  arethe  of the  of uncertainty  from the l o s s of monitoring  medical  stage  and environment  Feelings  surgery.  and t h e p o s s i b i l i t y of  are the sources  period.  postoperative  of  surgery  primary uncertainties of the preoperative  unpredictable  and  with  t h e degree and nature  by c a r d i a c  time as p a t i e n t s  events associated  that  1984; M i s h e l ,  by M i s h e l  (1988)  found  19 that  a  number o f  addressed  the  studies  Influence  using of  uncertainty  outcomes o p e r a t i o n a l i z e d as recovery,  and  Support and  poor  e x i s t s f o r the  gynecological  cancer  been  be  to  hospitalized students, found &  In Painter  area  a  strong  of  the  of  many m y o c a r d i a l adjustment  cardiovascular Christman  the  In  college  aversive  e f f e c t on  events  health  was  (Suls  uncertainty,  initiated  activity  hypothesized  patients to  group  significant and  have  of  inverse  (1988)  have  the  adaptatlonal infarction.  to  help  gain to  an  explain  why  psychosocial  fully  physical  despite  condition.  r e l a t i o n s h i p between  judgement of  in a  negative  the  by  myocardial  recover  in their  (1981) examined  uncertainty  a  on  i n v e s t i g a t i o n s was  fail  studies  colleagues  uncertainty  infarction  perceived  A  disease,  f a c t o r s which might  improvements  Painter  and  h a v e had  these  problems or  patients.  of  p a t i e n t s who  understanding  perceived  has  in  (Mishel, 1984).  negative  with  Uncertainty  stress  about c o n t r o l over  influence  impetus behind  objective  e t . a l , 1984).  patients  uncertainty  i n women d i a g n o s e d  p r e d i c t o r of  significant  (1981) and  outcomes of The  adjustment,  1981).  the  addressed  adaptatlonal  r e l a t i o n s h i p between  (Mishel  medical  have a  Mullen,  on  have  stress, psychosocial  adjustment  uncertainty  to  samples  health.  psychosocial  found  diverse  recovery,  myocardial  and  self-  infarction  r e l a t i o n s h i p between  perceived  recovery  was  found.  r e l a t i o n s h i p between u n c e r t a i n t y  The and  the  resumption  of d a i l y  Painter  suggested  process  i s hindered,  recovery In  status  that  activities with  uncertainty,  and t h e r e f o r e ,  may n o t b e  the study  emotional  d i s t r e s s and recovery  hours  the perception  by C h r i s t m a n and c o l l e a g u e s  of uncertainty  variables  the appraisal  were a s s e s s e d  (1988),  and t h e use of coping  were e x p l o r e d .  of  accurate.  influence  infarction  was n o t s u p p o r t e d .  following  methods  myocardial  a t three  time  periods:  the f i r s t  week  within  a n d , t h e f o u r t h week  following discharge.  three  periods,  and emotional  discharge physical .05),  uncertainty  and s i g n i f i c a n t l y uncertainty  activity  At a l l  d i s t r e s s were  One w e e k a f t e r  was s i g n i f i c a n t l y  (a measure  however, t h i s  related.  72  following  discharge;  positively  on  The r e l a t i o n s h i p s among t h e  of h o s p i t a l discharge;  time  the  inversely related to  of recovery)  ( r _ = - . 3 8 , p_ =  r e l a t i o n s h i p was n o t s i g n i f i c a n t  a t four  weeks. O n l y one s t u d y potential of  influence  CABG p a t i e n t s .  (1984),  patients  has been found  which examined the  of uncertainty  on a d a p t a t i o n a l  In that recovering  by Penckofer  f r o m CABG s u r g e r y  their  dissatisfaction  "fear  o f t h e unknown" and u n c e r t a i n t y  reported life  relief  with  study  their  of uncertainty  satisfaction  lives  prior about  and Holm attributed t o surgery  surgery.  Summary The  review  of the literature  points  to a  the future but  and a concomitant  f o l l o w i n g CABG  outcomes  to the  increase i n  21 pervasiveness and  of uncertainty  disability.  controlled, disease  and u n p r e d i c t a b l e  i s replete have been  severity  of t h e i r  effectiveness  with  illness  waiting  the  nature and extent  surgery  experience, studied, been  however,  this  found  outcomes  hypothesis  satisfaction uncertainty  prior  life  adaptatlonal  recovering  Uncertainty  on  has  adaptatlonal  adjustment,  stress,  life to  outcomes  Outcomes addressed  from t h e i r outcomes  first  adaptatlonal  Selected  literature  pertinent  patients  recovering  f r o m CABG s u r g e r y  will  i n this  of health or second  are specific  broader  This  patients  has been a t t r i b u t e d  and t h e perceptions  These a d a p t a t l o n a l  first.  cardiac  I n CABG p a t i e n t s , p o o r e r  t o surgery  that  of the surgical  surgery  as psychosocial  who  about the f u t u r e .  satisfaction  patients  the stages  influence  Adaptatlonal The  patients  hypothesized  was n o t s u p p o r t e d .  t o have a n e g a t i v e  and h e a l t h .  has been  changes as  i n t h e open h e a r t  operationalized  recovery,  I t has been  through  about the  about the  Uncertainty  of uncertainty  progress  uncertainty  of cardiovascular  f o r CABG s u r g e r y .  patients  Cardiovascular  and u n c e r t a i n t y  the accounts  are  cardiovascular  t o experience  treatment.  Illness  Imperfectly  disease,  uncertainty.  found  of their  t o pervade  of physical  As a l i f e - t h r e a t e n i n g ,  patients  found  i n cases  be f o l l o w e d  status CABG  were of  surgery.  indicators of a  outcome, namely, q u a l i t y to the quality will  study  be  of  life.  of l i f e  of  reviewed  by a review of s e l e c t e d  22 literature  on l i f e  satisfaction  and p e r c e p t i o n s  of  health  status. Quality  of Life  Quality health  care  quality in  of l i f e  h a s become a n i m p o r t a n t  and s o c i a l  of l i f e  policy.  These d i f f i c u l t i e s quality  of l i f e  (1984),  there  different  However, t h e i s s u e o f  i s complicated  d e f i n i n g and measuring  by the problems  i t (Ferrans  considerations.  ways t o d e r i v e  encountered  & Powers,  are r e l a t e d t o the broad  are several  concern i n  According  different life satisfaction  1985).  character  of  t o McCullough tasks,  a n d many  from various  life  tasks. Traditionally, life  studies  which  f o l l o w i n g CABG s u r g e r y  status  as the basic  investigated  focused  on p o s t o p e r a t i v e  i n d i c a t o r of improved  (Barnes,  Ray, Oberman, & K o u c h o u k o s ,  Stanton,  & Jenkins,  1982).  q u a l i t y of  q u a l i t y of  1977; Zyzanski,  However, as i n d i c a t e d  LaMendola  and P e l l e g r i n i  have used  work a s a n i n d i c a t o r o f q u a l i t y o f l i f e  failed  these  Furthermore,  studies  CABG s u r g e r y Pellegrini, (1982),  These  1979).  several  include  despite  have r e p o r t e d and f e l t  determinants  i n employment  with  p h y s i c a l l y improved  t o work  preoperative  which  CABG  unemployment, p a t i e n t s i n  t o be  f o l l o w i n g CABG  work s t a t u s ,  the r e s u l t s of  (LaMendola  t o Oberman a n d  c h a r a c t e r i s t i c s appear  of return  Rouse,  have  following  satisfaction  According  life  by  ( 1 9 7 9 ) , many o f t h e s t u d i e s  t o show an i n c r e a s e  surgery.  work  &  colleagues important surgery.  non-work  income,  occupation, and  relief  o f symptoms,  age, perception  education. Recognizing  indicator  and  social  results and  the inadequacy  of q u a l i t y  researchers  of l i f e  f o l l o w i n g CABG  moved t o c o n s i d e r outcomes  of these  colleagues  o f employment  a broad  (1980) found  that, despite  patients  were  social  and  favorable Klein, For  unemployment  other  outcomes results  showed less  improvements Current recovering wide  quality  delineate  i n j o b and f a m i l y  Frank,  have  shown  Wilson,  (1982) found  that, i n  f r o m CABG s u r g e r y  has continued  of patients  t o focus  which r e f l e c t s  on w h i c h v a r i a b l e s t o i n c l u d e Several  and s u b j e c t i v e  of l i f e  authors  components  on a  the lack of  i n t h e measurement  have a t t e m p t e d t o  that  &  & Malm, 1 9 8 2 ) .  roles.  on t h e q u a l i t y  the essential  In contrast  Savageau, Denlinger,  a n x i e t y and depression,  of l i f e .  with  improvements i n g e n e r a l  range o f p a t i e n t outcomes  consensus  disabled  p h y s i o l o g i c a l i m p r o v e m e n t , CABG  significant  research  good p h y s i o l o g i c a l  and d e p r e s s i o n .  example, K o r n f e l d and colleagues  patients  Gundle  dysfunction, constricted  (Jenkins, Stanton,  to significant  The  investigations of the psychological  1983; K o r n f e l d , H e l l e r ,  pleasure,  of l i f e .  proportion of  f o l l o w i n g CABG s u r g e r y  addition  of  and s e x u a l  low self-esteem,  findings,  social  a high  p s y c h o l o g i c a l l y and s o c i a l l y  lives,  these  range of p s y c h o l o g i c a l  s t u d i e s have been c o n t r a d i c t o r y .  f o l l o w i n g CABG s u r g e r y ,  significant  as the s i n g l e surgery,  as i n d i c a t o r s of q u a l i t y  outcomes  to  of health,  should  be  included  in  the  measurement and  Croog,  1984;  identify  Wenger, 1 9 8 4 b ) .  the  principal  performance state,  of  social  intellectual to  Wenger  described  i n terms of  with  Another whether  to  components of  (1984b),  i n the  objective  (1976) has  argued  experience  of  that  life  q u a l i t y of  authors  of  of  or  health  subjective  Ferrans  to  be  emotional  can  be  symptoms  status  and  and  that  q u a l i t y of  & Croog,  measures  1985).  whereas o b j e c t i v e  influence  has  1984;  of  life  that  Campbell the  indicators  experience.  i n the  The  measurement  been noted  by  McCullough,  is  Its  indicators assess  perceptions life  q u a l i t y of  & Powers,  subjective  patients'  (Levine  life  satisfaction.  life  measurement of  directly,  m e r e l y measure t h i n g s  analysis  life  &  (1984)  q u a l i t y of  functional capacity,  (Cohen, 1982;  of  Croog  (Levine  roles, physiological status,  dimensions  importance  and  life  life.  issue  use  q u a l i t y of  Levine  consequences, perception  satisfaction  of  f u n c t i o n i n g , and  According  their  analysis  many  1984;  and  other  Wenger,  1984b).  L i f e SatlsfflPfrlop Despite include  as  the  disagreement  standards  consensus that  life  seems t o  be  the  (Ferrans  & Powers,  satisfaction  most  of  life.  which  f o r q u a l i t y of  important  1985;  (1980) have c a l l e d l i f e quality  over  Horley,  Indicators  life,  i s the  there  one  i n d i c a t o r of 1984).  satisfaction  the  to  is a  growing  dimension  that  q u a l i t y of  L a b o r d e and barometer  life  Powers of  25 In  m e a s u r e m e n t s o£ o v e r a l l  concept  of s a t i s f a c t i o n  happiness 1976). that  quality  has been used  (Campbell, 1976; Campbell,  However, Campbell  while happiness  Converse,  a judgmental  suggesting  or cognitive  is  conceptually  dimension that a  specific  to distinguish  contrast,  i s likely  and t o s h i f t life  more o f a b a c k g r o u n d  enduring. concern  satisfaction  varied  over  approach among  assessed 1965). specific  Affect  over  satisfaction  and  state  unfolds.  that  that  that  in a  i nthe  the long term state  time  life  or emotion  In  i s likely to  i s relatively  the key questions  and c o p i n g processes a f f e c t  life  the long run. t o the study of l i f e  general or o v e r a l l  domains of l i f e  satisfaction  Some i n v e s t i g a t o r s life  have emphasized  have examined  happiness  however, a  t o be v e r y much  affective  investigators.  Others  life  encounter  Lazarus and Folkman s t a t e  how a p p r a i s a l  The  that  as the encounter  satisfaction  satisfaction  between t h e emotions  the long term.  encounter  foreground  and  over  with  in  Lazarus and Folkman  experiences i n a stressful  satisfaction  argued  have something  or emotion;  t h e two.  have  or a f f e c t .  note  to affect  distinguishes  i ti s crucial  person  be  linked  (1984)  Rodgers,  e x p e r i e n c e , and  an experience of f e e l i n g  Lazarus and Folkman  &  and c o l l e a g u e s (1976)  and s a t i s f a c t i o n  the  interchangeably with  common, t h e y a r e c o n c e p t u a l l y d i f f e r e n t implying  of l i f e ,  satisfaction  satisfaction  (e.g., health,  the relationship  has  have (Cantril,  i n a v a r i e t y of  family  l i f e , job)  between t h e s p e c i f i c  26 measures  of satisfaction  makes t o a n o v e r a l l et  a l . , 1976).  differences  measure  Noting  satisfaction life  (Ferrans  patients  of family,  also  satisfaction  been  compared  found  These  an  influence  on q u a l i t y  perceived  their  both  that  the difference  present time  better  life  of time  of l i f e .  satisfaction  on t h e r e c o v e r y  with  periods  past.  future  the specific  three  life to five  were  selected  surgery  would  three  to five  future than  months  and f u t u r e  and  s i xt o e i g h t  Patients  their  their  between  domains  surgery.  and sexual  since  s i xt o e i g h t  than  present,  were  two t i m e  present  life  t w o g r o u p s o f CABG  were  t o be s i g n i f i c a n t l y h i g h e r Patients  life  to the  f r o m CABG  satisfaction  perceived  satisfaction.  specific  are specific  (1984),  a n d 17 p a t i e n t s  whether length  significantly  that  occupational,  determine  satisfaction  of  of each domain t o t h e  i n terms of past,  to  months p o s t o p e r a t i v e  domains  with  Seventeen p a t i e n t s  months p o s t o p e r a t i v e .  individual  recovering  and Holm  social,  months p o s t o p e r a t i v e  (Campbell  1985).  Patients'  explored.  each  i n v e s t i g a t o r s have a d d r e s s e d  of patients  satisfaction.  domains were  were  of  of s p e c i f i c  importance  by Penckofer  satisfaction  the issue  & Powers,  have  satisfaction  In a study  life  other  by r e l a t i n g  Two s t u d i e s life  that  and t h e unique  individual  of l i f e  In the importance  has been n e g l e c t e d /  of  and the c o n t r i b u t i o n that  life  have  life their  past  life  postoperative satisfaction  The a u t h o r s  as  stated  the groups i n the assessment of  may b e r e l a t e d  process,  with  t o the effects of  patients  i n the early  months o f r e c o v e r y residual  affected  incisional pain.  significant  increase  satisfaction differences The  by l i m i t a t i o n s  Both groups reported  i n family,  postoperatively.  satisfaction  study which  sexual,  on t h e s e  i n their  subjects  and Holm's  Frantz first life  i n Penckofer  (1987) s t u d i e d CABG s u r g e r y  subjects  i n terms  satisfaction.  recovery  achievement  were a l s o  life  life  satisfaction  be  life  satisfaction  of past,  was  recovery  higher  than  significance comparison for  eight  highest  slightly  with  period. past  of rankings  between  domains r e v e a l e d  physical activity  relief  o f symptoms,  concluded  future  The support,  rated  their that  were  future  their  and demographic  than  their  present this  could  i n the their  life  satisfaction  however, t h e  importance  and  The  satisfaction  family relationships by r e l i e f  with  family  and  domain  was n o t r e p o r t e d .  that  followed  and  Subjects  satisfaction,  of the difference  Flynn  and s o c i a l  subjects  Perceived  life  than the  was e x a m i n e d .  higher  and t h e authors  i n importance  increased  present,  f o r recovery,  that  subjects  s i xt o t e n weeks a f t e r  examined.  attributed to the fact  early  process  satisfaction  of expectations  past  with  The r e l a t i o n s h i p b e t w e e n  between  characteristics  life  (1984) s t u d y .  importance and domain s a t i s f a c t i o n relationships  life  measures.  was c o n d u c t e d  who w e r e m u c h e a r l i e r  a  significant  has i n v e s t i g a t e d  i n CABG p a t i e n t s  by  and s o c i a l  There were no  between t h e groups  second  imposed  subjects  ranked  o f symptoms and most  satisfied  r e l a t i o n s h i p s , and s o c i a l  participation. material  wealth and r e l i e f  predictors  of l i f e  significantly than  Multiple regression  f o rp a t i e n t s  Life  f o rpatients  who h a d s o c i a l  who d i d n o t h a v e t h i s  achievement  of expectations  f o rrecovery  (r_ = 0 . 4 0 , p_ = . 0 5 ) .  significantly  Life  was  support  support.  p o s i t i v e c o r r e l a t i o n was f o u n d  not  mood,  satisfaction  significant  satisfaction  that  o f symptoms were t h e s t r o n g e s t  satisfaction.  higher  revealed  A  between  and present  life  satisfaction  was  r e l a t e d t o any of the demographic  characteristics. o f Health  Perception  Patients' been  ignored  substitutes indicators However, status has  of health  or perceived f o robjective  health  of q u a l i t y of l i f e  i n studies  that  have  & L u i k a r t , 1972),  patient's  that  perception  dimension  t o include  (Erikson,  1984; P a t r i c k  status,  but  questionable  measures or  included  health  objective  perception  recovery  of health  of l i f e  outcomes  several  of health  authors status  & Elinson,  (Garrity,  have  1982).  I t  identified  as an e s s e n t i a l  measurements  1984; Wenger,  (1972) s t u d i e d  status  satisfaction  (Mossey & S h a p i r o ,  activity,  frequently  1982).  of self-rated health,  performance  have  (Mossey & S h a p i r o ,  i n q u a l i t y of l i f e  Palmore and L u i k a r t influence  status  predictor  1973b), and m o r t a l i t y  not s u r p r i s i n g then  status  of as convenient  emerged a s t h e s t r o n g e s t  1973a,  the  perceptions  measures, t h e p a t i e n t ' s  (Palmore  is  Status  1984b).  the relative  physician  evaluation of  a n d a number o f  29 sociopsychological satisfaction health  was  and  socioeconomic  i n persons aged  found  to  life  satisfaction  than  two-thirds  be  (r =  of  the  the  45  to  variables  65  strongest  0.43,  p.  years.  explained  and  life  Self-rated  variable  -05)  =  on  related  accounted  variance  in  to  for  more  life  satisfaction. Two the in  studies  by  Garrity  c e n t r a l r o l e of the  explored morale  patients'  rehabilitation  myocardial  or  strongly  variables  happiness  perception  of  of  the  morale  e f f e c t s of  multiple  regression  remained  significantly  one  study,  proposed  as  of  patients  myocardial  one's h e a l t h  related to  controlling  In  1973b) have  perceptions  outcomes of  infarction. several  (1973a,  s i x months  infarction  (r_ = 0 . 6 2 ,  analysis, only  to  variables  morale  the  patients.  .01).  health  post-  (1973a)  found  p_ =  a l l other  status  p r e d i c t i v e of  " g o o d " was  related to  health  Garrity  as  highlighted  The  be After  using  perception (F  = 1 1 . 8 8 , p_ =  .001). In a  subsequent  patients,  Garrity  d e m o g r a p h i c , and purpose  of  only  v a r i a b l e which  work  (r =  shown t o  the  a  a  infarction  number  of  variables  strongest Perceived  correlated  p_ =  patient's be  myocardial  sociopsychological  rehabilitation.  0.59,  of  (1973b) analyzed  determining  vocational  The  study  medical, for  correlates health  significantly  the  of  status with  was  return  the to  .01). perception  strong  predictor  of of  health  status  mortality,  has  been  independently  of  objective  1982).  health  M o s s e y and  status  measures  Shapiro  (1982),  between s e l f - r a t e d h e a l t h persons  65  years  controlling  of  age  and  and  for objective and  mortality  significantly  their  was  health  health  as  as  studied  mortality  older.  health  satisfaction,  that  f o r p e r s o n s who  The  increased  risk  with  poor  self-rated health  associated  with  poor  objective  Little  low  i n c o m e , and  i s know a b o u t  perceptions  of  perceptions  have a  satisfaction, study  by  their  recovery  P a l m o r e and  variables  that  were e x p l o r e d .  of  physician's  rated the of  health  performance the  that  major  health  the  Shapiro  explanation  was  their  physician. (1982),  which  and  why,  be  risk  rated of  objective  Similarly,  p_ =  their  greater  than  poor  life  people  form  in fact,  that  these  i n terms of In  life  the  earlier,  .05).  health  was  association  status  for  over  status  study  with  self-  Furthermore,  respondents  i n the  self-rated health  rated  death  in self-rated health how  of who  predominant  performance  of  life  related to s e l f - r a t e d  and  0.43,  data,  sex,  (1972) a d d r e s s e d or  of  the  mortality.  r a t i n g accounted  variance  of  status,  ways by  A strong  (r_ =  group  male.  o u t c o m e s , and  r a t i n g of  status  being  was  p r e d i c t i v e value  Luikart  found  explained  the  their by  was  health  status  might e x p l a i n  health the  the  health  strong  the  relationship  for persons  associated  satisfaction,  in a  s t a t u s , age,  greater  "poor" than  Shapiro,  the  Analysis  income, r e v e a l e d  "excellent".  (Mossey &  by  80  percent  suggesting perceived as  measured  Mossey  and  substantially related  to  objective  percent rated  of  the  health In  the  an  and  patient's  indicator  of  the  of  himself  as  showed  only  five  sick and  health  determine of  open h e a r t sick  the the  sick five  extent  more  suggesting  well.  of  than  the  patients  s i c k r o l e before  role after surgery.  unexpected  were not  as  believed  that  people"  seriousness  "people  of  their i n t o the  as  that  a  on  or or  an  role  "myself  was  subjective  a  general and  to  Rawllnson  while  before  reject sex,  the  age,  since  surgery"  a  surgery  measure.  patients  sense  of  tendency  both  relinquish indicated believed  surgery  than  t h e y were m i n i m i z i n g  they  "most the  perceptions  of  patients  the that  preoperatively,  illness. health  number  analysis  sick  before  in general"  t h e y were b e t t e r suggesting  Research  that  of  retain  surgery,  rated  Brown and  f i n d i n g was  w e l l as  to  tendency to  experienced  to  and  Retaining  the  p r i o r to  there  influence  i n d i v i d u a l viewed  "myself  Furthermore,  sick  patients  r e l a t e d to  illness  favorably  r e j e c t the  influence  Multiple regression  variables  self-  personality variables  Overall, patients  that  Brown  conceptualized  which  improvement.  an  status,  surgery  to  33  ratings.  f a c t o r s which  relative and  with  identical  role postoperatively.  duration  depression.  sick  having  the  s i c k r o l e was  or  .001)  status  health  the  p_ =  v a r i a b l e s were p r e o p e r a t i v e  role,  surgery"  to  perception  relinquishing  The  objective  .34,  study  physical, social,  tendency  relinquish  (r_ =  in that  (1975) e x p l o r e d  selected  the  status  sample  attempt  Rawllnson of  health  they  32 following  CABG s u r g e r y  Flynn and F r a n t z  has been  (1987) d i s c u s s e d  present,  and f u t u r e p e r c e p t i o n s  patients  who w e r e  explored. assessed of  was  Patients rated their than  improvement  a significant  their  past  i n their  indicators  patients  who d i d n o t h a v e t h e s e noted  present  that there  also  shortness  and e x e r c i s e  state of health  h e a l t h and expected  difference i n health perceptions  experiencing angina  Frantz  were  angina,  illness,  were  an even  future state of health.  patients  and  the past,  s i xt o t e n weeks p o s t o p e r a t i v e  complications, chronic  higher  by  o f h e a l t h s t a t u s o f CABG  and i n c l u d e d r e h o s p i t a l i z a t i o n ,  tolerance.  greater  In the study  earlier,  Objective health status  breath,  slightly  limited.  or shortness  There  between  of b r e a t h and  symptoms.  However,  was a n o v e r a l l  Flynn  discrepancy  between s u b j e c t i v e r e p o r t s o f improvement and o b j e c t i v e health  indicators  attributed coupled  to a "halo" effect  coronary medical  one  artery disease or surgical  selected of  obtained  were  (CABG s u r g e r y )  therapy.  At t h e time  regarding  services.  i n a study  randomly assigned  f o l l o w - u p , p a t i e n t s were  medical  survived  may b e  surgery,  cure.  i n demographic and c l i n i c a l  questions  discrepancy  by  (1982) i n w h i c h p a t i e n t s w i t h  between t h e groups.  year  from having  f i n d i n g s were  and c o l l e a g u e s  differences found  that this  with a sense of perceived  Interesting Charles  and suggested  asked  perceived  At the time  No  to receive significant  characteristics of randomization  were and  t o respond t o h e a l t h s t a t u s and use  of randomization, the  surgical  group had t h e h i g h e s t  reported  themselves  lowest  percentage  worry about perceived themselves  health  o r good  that  status  By t h e s e  not uniform,  definitive  indexes  health  than  that  further  conclusions  (considered  group. t o be a n  care  health.  h e a l t h and  These  Charles  patterns  and  the d i r e c t i o n of the indexes  follow-up  could  often  the medical  follow-up.  because  and t h e  perceived  g r o u p was i n t h e b e s t  a t one y e a r  who  of s e l f -  measure) and medical  the medical  stated  health  the s u r g i c a l group  s u r g i c a l g r o u p was i n t h e w o r s t  colleagues  o£ I n d i v i d u a l s  they usually or  on bed d i s a b i l i t y days  were m a i n t a i n e d  was  status,  health  utilization, the  health.  t o be i n b e t t e r  However, based objective  i n excellent  who s t a t e d  their  percentage  was r e q u i r e d  before  be d r a w n .  Summary  A broad the  range  q u a l i t y of l i f e  surgery. studies social quality  of patients  Contradictory that  dimensions. of l i f e  analysis  been used  recovering  from  patients  along  Two m e t h o d o l o g i c a l  studies.  First,  which  there  issues  Life important  satisfaction  Secondly,  identified  indicator of q u a l i t y of l i f e .  and  arise i n  are essential to there i s to  indicators of q u a l i t y of has been  i n  i s a lack of  o f many v a r i a b l e s  of q u a l i t y of l i f e .  or subjective  CABG  psychological  d i s a g r e e m e n t among i n v e s t i g a t o r s a b o u t w h e t h e r objective  t o assess  f i n d i n g s have been o b t a i n e d  have a s s e s s e d  consensus regarding the  o f i n d i c a t o r s have  include life.  a s t h e most  Research  suggests  that  patients  about t h e i r life  future  The  examine  the perceptions  who w e r e  f r o m CABG s u r g e r y .  perceptions  their  present  their  past  predictor  health.  physician.  objective  status  health  perceptions  of their  requiring  further  CABG s u r g e r y .  who a r e  patients  found  t o have  but  perceived  slightly that  of health as rated  better a  strong  status i s by the of  a discrepancy and  than  health between  objective  measures.  review of the l i t e r a t u r e  be a c e n t r a l  were  health  Summary o f t h e L i t e r a t u r e The  CABG  of the perceptions  have r e v e a l e d  has been  of patients  found  status  life  few attempts t o  health,  perception  studies  o f CABG p a t i e n t s  have  been  satisfaction,  status  future  of  of health  of l i f e  t o be o n l y  Researchers  However,  patients*  health  status  has a l s o  of q u a l i t y  postoperative  of the patient's  patient's  status  health  status  I n one s t u d y ,  of their  t o be  surgery.  There have been  s i xt o t e n weeks  favorable  appears  perception  of health  future  s a t i s f a c t i o n of  of health  predictor  are optimistic  projected  since  component  The p a t i e n t ' s  and m o r t a l i t y .  recovering  the  perception  t o be a s t r o n g  recovery,  of time  as an important  assessments.  life  f r o m CABG s u r g e r y  by t h e length  patient's  identified  found  The p r e s e n t  recovering  influenced  f r o m CABG s u r g e r y  as i n d i c a t e d by t h e i r  satisfaction.  patients  the  recovering  theme  research.  reveals  Uncertainty  i n the accounts  However,  Review  little  a number o f a r e a s has been  of patients  found t o  waiting for  i s known a b o u t t h e d e g r e e o f  35 uncertainty surgery.  experienced  Findings  experienced heart that  patients,  uncertainty  period.  would  failed change  t o support over  experienced  the  recovering  open  hypothesis  patients  to the  i n v e s t i g a t i o n of the degree  by p a t i e n t s  CABG  namely,  time as  period  from  of the uncertainty  of p a t i e n t s ,  from the preoperative  Further  recovering  from an e x p l o r a t i o n  by a r e l a t e d group  surgery  progressed  by p a t i e n t s  discharge  of  uncertainty  f r o m CABG s u r g e r y  i s  needed. Support and  e x i s t s f o r t h e r e l a t i o n s h i p between  adaptatlonal  outcomes o p e r a t i o n a l i z e d  adjustment,  stress, recovery,  uncertainty  on t h e a d a p t a t l o n a l  recovering  f r o m CABG s u r g e r y  addressed.  O n l y one s t u d y  potential of  CABG  influence  Two  has n o t been  was f o u n d  that  patients  systematically pointed  on t h e l i f e  to the  satisfaction  status,  outcomes o f p a r t i c u l a r i n t e r e s t i n  are those  important  specifically,  life  tied  t o the concept  satisfaction  have n o t been w i d e l y  life  satisfaction  limited  comparability, stages  studied.  i n v e s t i g a t i o n s found  Findings  recovering  by two s t u d i e s  as patients  i n their  recovery that  life,  and p e r c e p t i o n s  of patients  have been g e n e r a t e d  different  of q u a l i t y of  indicators of q u a l i t y of  surgery  two  The i n f l u e n c e o f  outcomes o f  of uncertainty  adaptational  CABG p a t i e n t s  the  and h e a l t h .  psychosocial  patients.  The  life.  as  uncertainty  i n those periods.  examined  of  relevant  from  which  health to  CABG have  studies  were a t  I n one o f t h e  the perceptions  of  health  status,  postoperative  patients  and p a t i e n t s '  have been a d v e r s e l y the life  surgery  which  satisfaction  of health  further  of health  f r o m CABG s u r g e r y  and p e r c e p t i o n s  of health  influences  quality  present  study  then,  following:  identified  perceptions  these  life.  i n the literature  status  and perceptions  t o address  a  by e x p l o r i n g the  uncertainty  and t h e  s a t i s f a c t i o n and  i n patients  and, the d i f f e r e n c e s  p r i m a r y CABG p a t i e n t s  from  Reoperation  reoperation  was d e s i g n e d  indicators of l i f e  of health  CABG s u r g e r y ; satisfaction  of  o r how  t h e r e l a t i o n s h i p s between  of l i f e  o f CABG  CABG p a t i e n t s .  uncertainty  their  o f gaps  life  i t i s n o t k n o w n how t h e e x p e r i e n c e o f  perceive  This  quality  on p r i m a r y  status  have been s y s t e m a t i c a l l y e x c l u d e d  number  focused  the uncertainty,  patients  patients  status of  i s needed t o  have  reoperation  from  findings.  have a d d r e s s e d  Therefore,  may  i n v e s t i g a t i o n of the  patients  studies.  status  by r e s i d u a l d i s c o m f o r t  and perceptions  earlier  Studies  s i x t o t e n weeks  perceptions  Therefore,  recovering  substantiate  only  influenced  itself.  satisfaction  patients  were  recovering  i n uncertainty,  of health  and r e o p e r a t i o n  status  from life  between  patients.  CHAPTER  THREE  Methodology Introduction This  chapter  describes  procedure,  data  collection  procedure,  ethical  procedures  used  the research instruments,  i n data  the  researcher  variables allowed in  study.  and c o r r e l a t i o n a l  1983).  t o examine and d e s c r i b e  Originally,  this  study.  occur  A l l subjects  sample  differences  n a t u r a l l y (Burns  w e r e t o be v i s i t e d  f o r the purpose  of administering  of B r i t i s h  was  initiated,  the researcher  two  suitable reoperation of B r i t i s h  CABG  p a t i e n t s was t o be s e l e c t e d f o r  Lower M a i n l a n d  Columbia. learned  p a t i e n t s who  Columbia.  greater  number o f r e o p e r a t i o n  to  the questionnaire  mail  design  o f 20 p r i m a r y  f o r commuting purposes, a l l s u b j e c t s  Mainland  allowed  Procedure  a convenience  a n d 20 r e o p e r a t i o n  researcher and,  was  1987). Sampling  patients  component  The c o m p a r a t i v e  v a r i a b l e s between two groups t h a t  & Grove,  design  f u n c t i o n a l r e l a t i o n s h i p s among  & Hungler,  the researcher  Design  The c o r r e l a t i o n a l  to describe  (Polit  collection  analysis.  A d e s c r i p t i v e comparative i n this  data  sampling  c o n s i d e r a t i o n s , and t h e s t a t i s t i c a l  Research  utilized  design,  by the a  questionnaire,  had t o l i v e  After data that  Therefore,  collection  there  lived  were  only  i n t h e Lower  t o access  p a t i e n t s , i t became  to a l l suitable  i n the  a necessary  reoperation  38 patients  who  Columbia. also  i n the province  continued  to visit  f o r the purpose  Subjects following  of B r i t i s h  the questionnaire  t o a n u m b e r o f p r i m a r y CABG p a t i e n t s .  researcher  1.  anywhere  To h a v e c o m p a r a b l e d a t a ,  mailed  patients  lived  selected  a group of primary  of administering  for inclusion  was  The CABG  the questionnaire.  i n the study  met t h e  criteria: The s u b j e c t s CABG  had undergone t h e i r  first  or second  surgery.  2.  The s u b j e c t s  were  five  t o t e n months  3.  The s u b j e c t s  h a d no o t h e r  4.  The s u b j e c t s  were  5.  The s u b j e c t s  were a b l e  major  illnesses.  3 5 t o 75 y e a r s t o read,  postoperative.  of age. w r i t e , and speak  English. 6.  The s u b j e c t s  lived  i n the province  of B r i t i s h  Columbia. The  criterion  established illnesses  f o r the purpose  on t h e q u a l i t y  measurements. established stages  o f no o t h e r  Twenty-two p r i m a r y Mainland  of B r i t i s h  patients  refused  questionnaire reoperation  t o t e n months  of  other  was  were a t r e l a t i v e l y  CABG p a t i e n t s who l i v e d were c o n t a c t e d .  to participate  patients  t h e impact  similar  process.  Columbia  was m a i l e d  was  i n d i c e s and u n c e r t a i n t y  of five  a l l subjects  i n the recovery  illnesses  of l i m i t i n g  of l i f e  The c r i t e r i o n  so that  major  i n the study.  t o 18 r e o p e r a t i o n  (67%) returned  i n t h e Lower  O n l y two The  patients.  the questionnaire.  Twelve Of  the  twelve  questionnaires  documented was  deleted  that  the patient  to  f o r unknown  47 p r i m a r y  patients  incomplete, illnesses, respondents the  four  telephoned  The  and f i v e  Thirty-three  than  two p a t i e n t s  f o r unknown final  had d i e d ,  sample obtained  the purpose  subjects  into  the f e a s i b i l i t y  one g r o u p o f p r i m a r y  of the pooling  of the following: by the  researcher  the  who w e r e  the mailed  visited  primary  CABG  of pooling the  CABG p a t i e n t s .  analysis will  21  the questionnaire,  who w e r e m a i l e d  were compared w i t h  t o determine  characteristics  to  the questionnaire,  who w e r e m a i l e d  patients  patients  results  one  and 11 f a i l e d  T h e p r i m a r y CABG p a t i e n t s  the researcher  Of  he h a d r e c e n t l y had  consisted  of administering  11 r e o p e r a t i o n  questionnaire. by  had m u l t i p l e  reasons.  p r i m a r y CABG p a t i e n t s and  two-thirds  postoperative.  20 p r i m a r y CABG p a t i e n t s who w e r e v i s i t e d for  CABG  indicated that the  t e n months  that  mailed  O f t h e 33  the patients  to state  to  primary  CABG p a t i e n t s who d i d n o t r e s p o n d ,  the researcher  patients  was  two were a p p r o x i m a t e l y  documented t h a t  were g r e a t e r  respondent  failed  The q u e s t i o n n a i r e  and s i xof t h e q u e s t i o n n a i r e s  surgery,  respond  and t h i s  the questionnaire.  returned,  14 p r i m a r y  major  reasons.  CABG p a t i e n t s .  questionnaires  questionnaire  Of t h e s i x r e o p e r a t i o n  one had d i e d ,  (70%) returned  one  had cancer  from the study.  who d i d n o t r e s p o n d , respond  returned,  be p r e s e n t e d  of t h e sample i n Chapter  Four.  The with the  Data C o l l e c t i o n Instruments Four  data  collection  study.  The  Version  (MUISCV)  perceived  Mishel  Uncertainty  (Mishel,  uncertainty.  (GHRI) component Perceptions  (Davies  past,  present,  Patient  surgical,  Mishel Uncertainty (MUISCV) The items  The  life  S h e e t was  The  Scale  scale  f r o m t h e MUISCV a r e p r e s e n t e d  (Mishel,  To c o n s t r u c t  to identify  1981b).  illness-related  The  symptoms,  items  A. MUIS  for hospitalized MUIS, an  perceived  interviews  events:  Selected  exploratory  hospitalized patients  events  about  r e l a t i o n s h i p s with  the o r i g i n a l  i n which  28  during  uncertainty  from the o r i g i n a l  designed  Version)  c o n s i s t i n g of  i n Appendix  developed  1 9 8 1 b ) w h i c h was  interviewed  the  demographic,  of u n c e r t a i n t y  measures perceived  and p r o g n o s i s  conducted  Self-  Finally,  (Community  (Mishel, 1983).  was  Cantril  to collect  care-givers,  study  utilized  employed t o measure  treatment,  individuals.  Health  1 9 7 6 ) was  symptomatology, d i a g n o s i s ,  (Mishel,  Index  data.  to the experience  T h e M U I S C V was  (Community  Rating  satisfaction. used  In I l l n e s s  scale  Health  1 9 6 5 ) was  in this  t o measure  status.  MUISCV i s a L i k e r t - f o r m a t  relating  illness.  General  of health  and f u t u r e  and h e a l t h  used  Scale  (Ware & K a r m o s ,  (Cantril,  Information  in Illness  & Ware, 1981) o f t h e  Questionnaire  Scale  were u t i l i z e d  1 9 8 4 ) was  The  t o measure p e r c e p t i o n s Anchoring  instruments  centered  as  uncertain  around  treatment,  were  four  technical  environments and u n f a m i l i a r future and  and independence.  subjected  doctors,  routines,  A list  to content  and assessment  of statements  v a l i d a t i o n by a group  was  compiled  of nurses,  and p a t i e n t s .  Three  construct  validation studies  were c a r r i e d o u t u s i n g (Mishel,  a total  1981a; M i s h e l ,  of the o r i g i n a l  o f 259 h o s p i t a l i z e d  1981b).  The p u r p o s e  of the f i r s t  s t u d y was t o t e s t t h e h y p o t h e s i s  that  undergoing  "rule-out"  perceive  diagnostic  uncertainty  than  Significant  differences  diagnostic  predicted, greatest  patients  the diagnostic  s t u d y was t o c o n f i r m perceived in  level  his/her third  r a t i n g on t h e H o s p i t a l  v a l i d a t i o n study  construct a  validity  d i f f e r e n t method  that The  uncertainty  uncertainty  patients  a later  found  between  group demonstrated the  of stress  experienced  indicated that  Events  further  a  patient's  related to Scale.  evidence  The  of the  the scale  t h e same c o n s t r u c t ,  be r e l a t e d t o l a c k Interview  with  namely,  of comprehension.  were a d m i n i s t e r e d  and t h e c o r r e l a t i o n o f u n c e r t a i n t y  t o 26  and  i n the expected d i r e c t i o n .  study,  Mishel  As  r e l a t i o n s h i p between  Stress  f o r measuring  would  c o m p r e h e n s i o n was In  were  o f t h e MUIS b y c o n v e r g i n g  MUIS a n d C o m p r e h e n s i o n  cancer  diagnoses.  was s t r o n g l y  provided  more  of the second v a l i d a t i o n  and t h e degree Results  patients  and s u r g i c a l groups.  "rule-out"  the predicted  patients.  of perceived  medical,  The p u r p o s e  uncertainty  100 m e d i c a l  determined  i n uncertainty  "rule-out",  uncertainty.  with  procedures  MUIS  patients  validation  the  of the  (1983) a t t e m p t e d  t o develop  uncertainty various  scales  patient  with  showed  to reflect In  Items  item  the present  t h e 28 i t e m  provided  MUIS.  alpha  on t h e sample  MUISCV was  Hilton  alpha  f a c t o r s were Lack  experienced  The s c a l e  the  t h e MUISCV  o f t h e MUISCV  was  data. of  i n her doctoral  by p a t i e n t s  with  which resulted  had an I n t e r n a l  which  ranged  from  of Consistency  i n the S i t u a t i o n Regarding  Understanding  (personal  breast i n a  consistency  o f 0.87 a n d e a c h o f t h e s i x f a c t o r s h a d  consistencies  Clarity  Mishel  the community v e r s i o n  A f a c t o r a n a l y s i s was c o n d u c t e d  reliability  by  an i n t e r n a l  to obtain  (1987) u t i l i z e d  factor solution.  internal  to Mishel  used.  o f 0.84, b u t i n f o r m a t i o n  using  was  populations.  factor analysis  used  has r e p o r t e d  of the uncertainty  cancer.  According  according  of each c l u s t e r  of the s p e c i f i c  20, 1987),  reliability  One a u t h o r  of  a l l  lnterpretable  i n a one f a c t o r s o l u t i o n w i t h  consistency  six  study,  analyses  With the  r e l a t e d t o h o s p i t a l i z a t i o n were e l i m i n a t e d  resulted  six  out c l u s t e r  The c o n t e n t  t h e community v e r s i o n .  study  t r e a t m e n t , and  patients.  clusterings  the concerns  communication, J u l y  the  primary  of the g a s t r o i n t e s t i n a l population,  t h e f a c t o r s o f t h e MUIS.  found  not  lupus,  268 h o s p i t a l i z e d a n d c l i n i c  populations  for  cancer,  t o the concerns of  (cardiovascular,  c a t h e t e r i z a t i o n ) by c a r r y i n g  exception  to  were s p e c i f i c  populations  gastrointestinal, cardiac  that  Explanations,  0.50 t o 0 . 8 2 .  The  i n t h e S i t u a t i o n , Lack the Illness,  Indefiniteness  of the  Indeterminacy of the Treatment E f f e c t i v e n e s s ,  Not Illness,  and Not  Knowing About t h e S i t u a t i o n . about t h e content difficulty wording  alpha  answering  and/or  In  validity  this  concern  o f t h e s c a l e a s some s u b j e c t s h a d  some o f t h e i t e m s  because  of their  appropriateness.  study,  Health  The 1981)  the internal  consistency  Rating  General  index.  reliability  Health  (QHRH  Rating  Index  i sa s t a n d a r d i z e d measure used  overall  perceptions  GHRI e v o l v e d  of their  f r o m 26 i t e m s  Questionnaire  (HPQMWare  HPQ  items  HPQ  and s c o r i n g rules  a r e used  B and Appendix C The  prior  general  (GHRI)  (Davies  t o survey  & Karmos, 1976).  t o compute t h e GHRI.  & Ware,  people's  health status.  o f t h e 32-item  Health  The  Perceptions  Twenty-two o f t h e The t o t a l  f o r t h e GHRI a r e p r e s e n t e d  32-item  i n Appendix  respectively.  26 HPQ i t e m s  t h a t were  GHRI m e a s u r e a r e c o m p l e t e  assess  thefollowing  fielded  f o r development o f  statements  s i xdimensions  of health  of health  that  perceptions:  health, current health, health outlook, health-related  worry/concern, sickness  constructs assesses health To  resistance/susceptibility  orientation.  summary i n d e x ,  used  I n d i c a t e d some  o f t h e MUISCV was 0.89.  General  the  Hilton  a n d Ware  t h e GHRI, t h a t r e f l e c t s  assessed  both  Davies  (1981) c o n s t r u c t e d a thegeneral  by t h e s i xsub-scales  p h y s i c a l and mental  t o i l l n e s s , and  health  o f t h e HPQ a n d  h e a l t h components o f  status. c o n s t r u c t t h e GHRI, p r i n c i p a l  to identify  c o m p o n e n t s a n a l y s i s was  t h e underlying dimension  that accounted  for  44 most HPQ  o f t h emeasured v a r i a n c e (Davies  & Ware, 1981).  was e v a l u a t e d in  sites  correspondence  the  was f o u n d .  Items t h a t  thefirst  unrotated  from c o n s i d e r a t i o n All  (a = 3521),  Across  (health-related  items.  t o define Current  health-related substantial were  perception  0.30  prior  to defining  health,  dropped  deleted.  sub-scales were t h e 26  underlying  health  outlook,  t o i l l n e s s had  theprincipal  i t su n d e r l y i n g  health  were  orientation)  dimension  and r e s i s t a n c e  of current  component  measured by  items were  and sickness  correlations with  important  Perceptions  worry,  thefirst  i neach s i t e  Four  health  thegeneral  health,  degree of  of t h evariance  i n t h e GHRI.  concern,  and i n t e r p r e t a b i l i t y  sites,  component  of the  component  d i d notcorrelate a t least  b u t two o f t h egeneral  required  unrotated  and a high  30.6 t o 38.3 p e r c e n t  26 i t e m s .  with  The f i r s t  f o r equality of loadings  s i xstudy  explained  b y t h e 26 i t e m s  shared  appear  component and  dimension.  t o define  the core  concept. Content v a l i d i t y  f o r t h e GHRI  index  includes  a comprehensive  rating  items  represent  published validity into  that  literature studies  s i xc l a s s e s :  circumstances, services, showed  patient  those  items  & Ware, 1981).  were c o n d u c t e d physical  sample o f general  well  (Davies  i ssupported  mental  role propensity,  and age and l i f e  stresses.  health  fielded i n Bivariate  35 v a r i a b l e s  using  health,  i nthat the  health,  fell  social  use of health  T h e GHRI  s u b s t a n t i a l r e l a t i o n s h i p s where  that  consistently  significant  relationships  had been h y p o t h e s i z e d ,  age.  bivariate  Further  meaning  o f t h e index  relationship indicators three  scores  on t h e  specifically,  on t h e  scores  to clinically  relevant  of index  that defined  substantial health  and emotion  functioning.  o n t h e GHRI t h r o u g h o u t  The roughly  impairment.  i t s range  indicated that  reflect  differences  functioning.  distribution  has been  symmetrical  i na general  population  (Ware,  f o r time  intervals  coefficients  years  a r e 0.66,  0.59,  consistency  estimates  ranged  and three  Internal  Findings  The  chronic  GHRI s c o r e  median s t a b i l i t y  two,  studies focused  scores;  p h y s i c a l and emotional  The  theexception of  i n d i c a t o r s were p h y s i c a l f u n c t i o n i n g , s e r i o u s  illnesses,  in  validity  with  found  t o be 1984). of one,  a n d 0.56 r e s p e c t i v e l y . from  0.88  t o 0.90  (a = 3521). In t h i s alpha  study,  theinternal  The devised  Self-Anchorinq Cantril  t o measure a g e n e r a l  few instruments on t h e i r The  Scale  Self-Anchoring  to McKeehan, Cowling  based  reliability  o f t h e GHRI w a s 0 . 9 0 .  Cantril  the  consistency  scale  divisions.  Scale  sense  of well-being.  (1986),  and Wykle  thescale  According i s one o f  t h a t measures t h e p e r c e p t i o n s  own w o r l d s  of reality  i srepresented  According  as a v e r t i c a l  to Kilpatrick  t o describe  o f people  (see Appendix D). ladder  and C a n t r i l  respondent  i sasked  life  become t h e t o p a n d b o t t o m e n d p o i n t s  which  1965) w a s  (Cantril,  t h ebest  of t e n  (1960),  and worst  each  possible  of t h e ladder  46 respectively. these  The  anchors  minimal  and  represent  maximal  personally indicate  scale  defined  the  (past  life  subject's  on  the  points,  ladder  (present  terms  variety  of  life  satisfaction),  anchoring 1960).  of  content  populations  substantive  and  Using  which  are  they  years  that  of  these  subjects  two  sense  perceptions  asked  would  satisfaction),  points  hence  to  which measure cannot  be  by  1965;  to  place  two  years  (future  Kilpatrick  and  by  the  scale.  No  how  the  Cantril  scale  to  concerns are  not  subjectivity  of  Cantril  that  defined  &  Cantril  information  so  (1965),  applicable the  to  their  Cantril,  (1960), were  could  be  found  r e l a t e s to  other  concurrent  validity  ratings.  scales  "...are  psychologically directly  meaningfully  selected said  to  some o t h e r of  the  scale  the  by  a  be  higher,  data  because  obtained  comparable;  person...can lower,  individual...because  r e p l i e s are  reliability  However, K i l p a t r i c k  (1960) s t a t e d  level  that  traditional  this  Cantril  reference  obtain  d i f f e r e n t backgrounds  satisfaction,  wide  substantiated.  According  of  from a  Kilpatrick  of  life  to  clients  people  differentiated pertaining  to  subjects  interviewed  given  (Cantril,  According of  validity,  were  information  aspirations  level  at  i n the  satisfaction). In  scale  own  satisfaction.  anchoring  point  life  the  life  themselves c u r r e n t l y ago  is self-anchoring  in fact  of  the  and  with  the  scale  that  i s , the  be  specifically  and  or  equal  scale  the  to  the  frames  psychologically  of  47 similar"  (p. 161). cantril  endpoints  constant  of time,  According review  measured  i s t h e most  measure  life  life  and Wykle  of nursing  a  short  (1986),  a  reveals that the  has been w i d e l y  used  In nursing  v a r i a b l e measured Self-Anchoring  and p e r c e p t i o n  by F l y n n  and F r a n t z  Self-Anchoring  satisfaction  over  remain  variance.  satisfaction.  satisfaction  they  t o measure  and t h e predominant v a r i a b l e  The C a n t r i l  The C a n t r i l  measure  outside  frequent  i n the study  earlier.  the error  Scale  has been l i f e  Scale.  individual  t o McKeehan, C o w l i n g ,  perceptions,  Cantril  status  minimizing  Self-Anchoring  individuals'  health  f o ra given  of the l i t e r a t u r e  Cantril  that since the  of the scale are personally defined  relatively period  (1965) contended  using the  Scale  was u s e d t o  of health (1987)  Scale  i n the study  research,  noted  was a l s o u s e d t o  by Penckofer  and Holm  (1984). Two m o d i f i c a t i o n s w e r e made t o t h e C a n t r i l Anchoring ladder as  Scale  were numbered  suggested  because that  forthis  a zero  directed the  researcher  the divisions  who h a v e u s e d  (Laborde  the tool  & Powers,  and worst  w a s made t o m a i n t a i n  t o nine  have  be i n t e r p r e t e d a s 1980).  found being  The s e c o n d  instructions  t o t h i n k about r a t h e r  the best  of zero  of the  m o d i f i c a t i o n w a s made  made t o t h e s c a l e w a s t h a t  the subjects  modification  This  on t h e s c a l e c o u l d  synonymous w i t h death modification  (1965).  researchers  point  First,  f r o m o n e t o 10 I n s t e a d  by C a n t r i l  other  study.  Self-  than  possible l i f e . a consistent  describe to This  data  collection Patient  procedure  Information  A patient researcher  f o r mailed  information  sheet  was d e v i s e d  from the subjects  (see Appendix E ) .  through the information  establish  the s u i t a b i l i t y  the study,  the  groups  by t h e  demographic, s u r g i c a l and h e a l t h  collected  in  subjects.  Sheet  to elicit  information  and v i s i t e d  of subjects  data  s h e e t were used t o  of the subjects  and t o determine  The  for participation  the relative  comparability of  under i n v e s t i g a t i o n .  Data C o l l e c t i o n Procedure Potential through seven to data obtain by  participants forthis  local  collection  reoperation  To o b t a i n visited  participants  researcher.  approaches  and primary  researcher information  CABG p a t i e n t s  the office  surgeons contacted  and t e l e p h o n e  of each  to  by m a i l .  suitable potential  they would  number  being  consent released  the information  describing  participation contained  the study  (see Appendix F ) .  the telephone  number  to their to the  t o have  was g i v e n  a n d t h e p o t e n t i a l p a r t i c i p a n t was m a i l e d letter  were  of the seven  I f the p o t e n t i a l p a r t i c i p a n t agreed released,  to  visited  t h e g r o u p o f p r i m a r y C A B G p a t i e n t s who  information  letter  Two  a p p r o a c h was f o l l o w e d  t o i n q u i r e whether  name, a d d r e s s ,  his/her  surgeons.  obtained  One a p p r o a c h w a s f o l l o w e d  The s e c o n d  by t h e r e s e a r c h e r ,  cardiovascular  this  were used.  were  t h e g r o u p o f p r i m a r y CABG p a t i e n t s who w e r e  the researcher.  secure  cardiovascular  study  to the an  and t h e nature The  of  information  of the researcher  so  49 that  potential  they  had any q u e s t i o n s  information that  participants  letter  two weeks  time  participating  the  potential  letter  was  were v i s i t e d  reviewed,  the and, the  i f there  were  questionnaire  participants  delivered coded H), (see  form.  Appendix  researcher's  with  When t h e  obtained  the  Stamped  coded  on i t .  an e x p l a n a t i o n  The  i n the  were  was  was  with  used  to  letter  obtain  Each  (see Appendix  f o r Study Findings  of the study  the  were  offices.  information  given  questionnaire.  envelopes  surgeons'  reviewed  participants,  I ) , and a r e t u r n stamped envelope address  (see  i n obtaining  of the  collection  a Request  the consent  researcher  information  place  researcher  t o data  an  and  the p a r t i c i p a n t s  the completion  contained  a  so i n d i c a t e The  The  to the cardiovascular  the questionnaire,  a time  after  contacted  indicated  interested  could  t o complete.  by m a i l .  envelope  contained  were  no q u e s t i o n s ,  approach  the researcher  c o n s e n t was  instructions  in  two weeks  completion.  findings  throughout  A second participants  and  approximately  by t h e r e s e a r c h e r ,  who  The  participants  interested  and, i f they  on t h e c o n s e n t  questionnaire  in  i n the study,  Participants  provided  were  mailed,  and w r i t t e n  a summary o f t h e s t u d y  them  Approximately  for questionnaire  Appendix G).  space  i f they  to participate  participants  the researcher i f  the p o t e n t i a l  telephone  participants,  were arranged  f o r m was  would  i n the study.  information  willingness  informed  to inquire  the  contact  or concerns about the study.  also  the researcher  could  with  form the  letter  and t h e n a t u r e  of the  respondents* respondents  participation, that  cardiovascular  and  the envelope  surgeon's  was  office  anonymous t o t h e r e s e a r c h e r . letter  contained a statement  questionnaire consent also  informed that  letter  letter  that  In addition,  i n the study.  be  the  that had  The  respondents  J) would  about  potential  respondents  cardiovascular  offices  return  that  The  a  of  the their letter  reminder  to the  and  information  number  that  names a n d  were a f f i x e d  surgeons'  information  m a i l e d t o a l l non-  respondents  The  remain  expressed  and  they could  s h o u l d t h e y have any  the study.  their  information  i n a p p r o x i m a t e l y t h r e e weeks.  researcher collect  potential  they would  the respondent  to the p o t e n t i a l  concerns  call  q u e s t i o n s or  addresses  of  envelopes  by  mailed.  Three  the  weeks  t h e q u e s t i o n n a i r e s were m a i l e d , t h e r e s e a r c h e r  delivered to  so  contained the researcher's telephone  indicated  after  the  mailed through  indicating  potential  (see Appendix  respondents  the  meant t h a t  to participate  informed  stamped  envelopes  the c a r d i o v a s c u l a r  offices  of the coded  addresses  of  containing  surgeons* envelopes  offices s t i l l  the non-respondents  reminder  letters  surgeons  and  by  the  the  offices  reminder  and  informed  outstanding.  were a f f i x e d of the  letters  to  the  Names  and  these  cardiovascular  mailed. Ethical Considerations  Permission University Committee  to conduct  this  of B r i t i s h Columbia for Research  and  s t u d y was Behavioral  Other  obtained from  the  Sciences Screening  Studies Involving  Human  51 Subjects. the  Seven c a r d i o v a s c u l a r  researcher  to  ask  for their  patients  for this  study.  surgeons  received  a  review.  A l l cardiovascular  signing  a  consent  cardiovascular modifications obtain  an  of  given  each  by All  form  the  of  the  description  of  sample  the  the  study  A l l of  procedure  data  collection  t h e y were not  could  withdraw or  e f f e c t to  their  be the  that  added  to  raw a  nature  of  to  MUISCV t o  of  researcher  prior  to The  Arizona.  Arizona  establish a  populations.  procedure  to  future  medical  will  be  for a  raw  or  used  by  were g i v e n  the base  p a r t i c i p a n t s who a  informed  verbal  care. in would  project  submitted  to  developer for  the  questions  information  of  at  the the  clinical  were v i s i t e d  consent. to  informed  informed  d e s c r i p t i o n of  f o l l o w i n g methods were used  written  nursing  research  data  normative data  Only those  obtaining  data  was  their  answer any  identifying  The  a  participate in  refuse  of  to  Verbal  p a r t i c i p a n t s were  obliged  without  larger pool  U n i v e r s i t y of  University  the  data  the  surgeons.  F u r t h e r m o r e , a l l p o t e n t i a l p a r t i c i p a n t s were writing  by  required  the  the  for  the  explaining  A p p e n d i x M).  and  study  approval  potential participants received  writing that  any  their  (see  in  without  gave  letter  cardiovascular  by  securing  size  A l l prospective  and  in  for this  Appendix K). a  telephoned  cardiovascular  proposal  surgeons  participation.  study  the  collection  changes to  of  of  received  data  were  assistance  the  (see  surgeons  adequate  approval  Each  copy of  i n the  surgeons  ensure  the  by study  confidentiality: 1.  Names  of theparticipants  questionnaires.  Each  d i d n o t appear  participant  on t h e  was a s s i g n e d a c o d e  number. 2.  A list  of theparticipants'  numbers, and t h e consent the 3.  data and a c c e s s i b l e  Any i n f o r m a t i o n not  used  that  computer the  Social  Descriptive  was v e r i f i e d  because  a convenience  were coded,  theassumption  statistics  rests  statistics  distribution-free  of a small  of normality  be a s s u r e d  utilized  of the researcher.  coefficient.  to test  size  were  employed  was u s e d a n d  upon w h i c h p a r a m e t r i c  valid  i snot s a t i s f i e d  1987).  when t h e (Lehmann,  tests  used  1975). i n this  and t h e Spearman's  The Mann-Whitney U t e s t was  thedifference  between two groups  were u t i l i z e d t o  on t h e other hand, a r e  s t u d y were t h e Mann-Whitney U t e s t correlation  Package f o r  (Burns & Grove,  two nonparametric s t a t i s t i c a l  of patients.  a  program. A l l  statistics  and a r e therefore  of normality  entered into  theStatistical  by a colleague  sample  therefore,  Nonparametric  from  Analysts  Nonparametric  cannot  separate  t h e p a r t i c i p a n t s was  and nonparametric s t a t i s t i c s  thedata.  The  identify  and analyzed using  analyze  assumption  were k e p t  S c i e n c e s (SPSS:X) computer  key-punching  known) a n d code  only t o the researcher.  from the questionnaires file  (where  anywhere.  Pata  Data  forms  might  or revealed  names  i nselected  variables  The Spearman's r h o  correlation  c o e f f i c i e n t was  relationship  existed  satisfaction  and  The was  0.05.  level  between  perceptions  employed  t o determine whether  uncertainty of health  and  life  status.  of s i g n i f i c a n c e e s t a b l i s h e d  for this  study  54 CHAPTER Presentation  FOUR  and D i s c u s s i o n  of  Results  Introduction This  chapter  characteristics  i s arranged  under  of the sample;  three  headings:  f i n d i n g s ; and d i s c u s s i o n of  results. Characteristics Due  to the d i f f i c u l t y  reoperation British secure  patients  Columbia, a greater  a mailing  procedure  visited  10 o f t h e p r i m a r y  control mailed  f o r method  the  procedure  a total  The  Using  CABG p a t i e n t s .  by t h e researcher  subjects  were compared  researcher  i n terms  were  also  Primary  CABG  whether could  past  life  life  satisfaction,  status. variables the  uncertainty,  life  established  satisfaction,  and perceptions  T h e r e were no s i g n i f i c a n t between t h e two groups  be  of the following variables:  number o f b y p a s s g r a f t s , number o f weeks s i n c e present  data  t h e two groups o f  age,  satisfaction,  To  were compared t o  t o determine  t h e Mann-Whitney U t e s t ,  had  CABG p a t i e n t s .  o f p r i m a r y CABG p a t i e n t s  pooled.  The  after the researcher  the questionnaires  p r i m a r y CABG p a t i e n t s  from t h e two groups  patients.  o f 20 p r i m a r y  variance,  who w e r e v i s i t e d  mailed  was i m p l e m e n t e d t o  CABG p a t i e n t s .  t o a group of primary  patients  i n t h e Lower M a i n l a n d o f  was i m p l e m e n t e d  to visit  i n obtaining  of reoperation  mailing  continued  encountered  who l i v e d  number  o f t h e Sample  differences  of  surgery, future health  i n the eight  o f p r i m a r y CABG p a t i e n t s a t  significance level  o f .05.  Two o f t h e  variables,  past  respectively.  The r e m a i n i n g  significantly  0.05,  Since  differences  a tthe established  t h e twogroups o f p a t i e n t s  Therefore,  that exceeded  were  found  a n dt h e  mailed  significance level of  were p o o l e d  t o form one  patients.  41 p r i m a r y  constituted  CABG p a t i e n t s  a n d 11  t h e sample f o r t h i s  study.  Demographic, s u r g i c a l , andh e a l t h presented  o fp r o b a b i l i t y  p r i m a r y CABG p a t i e n t s  g r o u p o f p r i m a r y CABG  differed  s i xv a r i a b l e s d i f f e r e d  no s i g n i f i c a n t  patients  patients  and u n c e r t a i n t y ,  between t h e twogroups a t values  between t h e v i s i t e d primary  satisfaction  a t a .08 a n d .09 l e v e l  significantly  p_ = .30.  life  f o r the primary  reoperation  c h a r a c t e r i s t i c s w i l l be  CABG p a t i e n t s  andthe  reoperation  patients. Demographic C h a r a c t e r i s t i c s o f t h e Sample Demographic data sex,  marital  level. to  status,  c o l l e c t e d from the p a t i e n t s employment  primary  marital  three four  CABG p a t i e n t s ,  (78.0%).  male The  Reoperation  53 t o 72 (M=64.2) y e a r s  from  status, and educational  T h e a g e s o f t h e p r i m a r y CABG p a t i e n t s  72 (Mj=61.8) y e a r s .  status  of primary  married  were d i v o r c e d  primary  (see Table were  female  1).  f r o m 47  ranged  O f t h e 41  (22.0%) a n d 32 w e r e  patients  CABG p a t i e n t s  were  Of t h e r e o p e r a t i o n  (90.9%) a n d o n e w a s w i d o w e d .  male.  was a s f o l l o w s :  (7.3%), 34 w e r e m a r r i e d  (9.8%).  CABG p a t i e n t s  ranged  p a t i e n t s ' ages  A l lo f the reoperation  hadnever  were m a r r i e d  nine  were a g e ,  (82.9%), a n d patients, ten  The m a j o r i t y o f  (56.1%) a n d r e o p e r a t i o n  patients  56 (72.7%) were r e t i r e d primary  (see Table  CABG p a t i e n t s  (45.4%) had a t t a i n e d  I I ) .  The m a j o r i t y  (41.5%) and r e o p e r a t i o n an e d u c a t i o n a l  level  of  patients  of grade  12 t o 13  (see Table I I I ) . Table  I  Ages o f P r i m a r y C o r o n a r y Reoperation Patients Age  Artery  Bypass G r a f t  P r i m a r y CABG P a t i e n t s Frequency Percent  Patients  and  Reoperation Frequency  Patients Percent  45-49  5  12.2  0  00.0  50-54  1  2.4  1  9.1  55-59  8  19.5  0  00.0  60-64  10  24.4  5  45.4  65-69  12  29.3  3  27.3  70-74  5  12.2  2  18.2  Total  41  11  100.0  100.0  Table I I Employment S t a t u s o f P r i m a r y Coronary P a t i e n t s and R e o p e r a t i o n P a t i e n t s Employment Status Employed Unemployed Retired Disability pension Total  P r i m a r y CABG P a t i e n t s Frequency Percent  Artery  Bypass  Graft  Reoperation Frequency  Patients Percent  14  34.1  1  9.1  0  00.0  0  00.0  23  56.1  8  72.7  4  9.8  2  18.2  41  100.0  11  100.0  Table I I I Educational Level of Primary Coronary P a t i e n t s and R e o p e r a t i o n P a t i e n t s  Up t o  grade 8  Grade Grade  Graft  Reoperat ion P a t i e n t s Frequency Percent  P r i m a r y CABG P a t i e n t s Frequency Percent  Educational Level  A r t e r y Bypass  3  7.3  1  9.1  9-11  14  34.1  3  27.3  12-13  17  41.5  5  45.4  College or university  7  17.1  2  18.2  11  100.0  Total  41  100.0  Surcrical C h a r a c t e r i s t i c s of Surgical  data  t h e SamDle  c o l l e c t e d from  t h e p a t i e n t s were  postoperatively  i n weeks a n d number  Additional  c o l l e c t e d from  time and  data  i n months between t h e i r the reason  patients  w e r e 2 1 t o 39  Reoperation  in  the primary  Reoperation the  second  that  IV).  weeks  patients CABG  Primary  were  surgery  CABG  postoperative.  (M=27.1)  The number  CABG p a t i e n t s r a n g e d  from  weeks  of bypass  grafts  one t o s i x (M=3.7).  p a t i e n t s h a d t w o t o s i x (H=3.5) b y p a s s g r a f t s i n (see Table  t h e number  V).  from  40 t o 1 6 1  Ten o f t h e r e o p e r a t i o n  blockage  For the  reoperation  o f months between t h e i r  CABG s u r g e r y r a n g e d  SD=31.7).  surgery.  (M=28.4)  (see Table  recent surgery  patients,  and second  p a t i e n t s w e r e 22 t o 38  postoperative  grafts.  the reoperation  first  f o r the second  of bypass  time  of the coronary  patients  arteries  first  and  (M=111.2, (90.9%)  stated  o r g r a f t s was t h e  58 reason  f o r the second  patients needed Table  stated  was  that  "because  surgery.  One  the reason the doctor  of the  reoperation  t h e second told  me  surgery  was  I neededi t " .  IV  Time P o s t o p e r a t i v e l y i n Weeks f o r P r i m a r y C o r o n a r y Bypass G r a f t P a t i e n t s and Reoperation P a t i e n t s Weeks Postoperative  P r i m a r y CABG P a t i e n t s Frequency Percent  Reoperation Frequency  Artery Patients Percent  20-23  9  22.0  2  18.2  24-27  11  26.8  6  54 .5  28-31  10  24.4  1  9.1  32-35  5  12.2  1  9.1  36-39  6  14.6  1  9.1  Total  41  100.0  11  100.0  Table  V  Freauencv of Bypass G r a f t s for Primary Coronary A r t e r y B y p a s s G r a f t P a t i e n t s a n d !R e o p e r a t i o n P a t i e n t s Number o f P r i m a r y CABG P a t i e n t s Bypass Grafts Frequency Percent  Reoperation Frequency  Patients Percent  1  2  4.9  0  00.0  2  5  12.2  2  18.1  3  11  26.8  4  36.4  4  13  31.7  4  36.4  5  6  14.6  0  00.0  6  4  9.8  1  9.1  41  100.0  11  100.0  Total  59 Health  Characteristics  The h e a l t h d a t a number since  of heart surgery,  o f t h e Sample  collected  medications  primary  The number  CABG p a t i e n t s r a n g e d  The m a j o r i t y o f p r i m a r y one  t o three  medications  heart taken  The number primary  medical/health  of heart  from zero  medications.  medications  taken  t o s i x (M = 2 . 2 ) .  The number  of heart  by r e o p e r a t i o n p a t i e n t s ranged  f r o m one t o  o f p o s t o p e r a t i v e symptoms r e p o r t e d  t h e number  from zero  r e o p e r a t i o n p a t i e n t s ranged  reoperation  reported breath  symptoms.  by t h e primary  by three  fatigue,  patients),  (4 p a t i e n t s ) .  primary  no  Other  of symptoms  CABG p a t i e n t s w e r e l e g  and i n c i s i o n a l  tenderness.  by r e o p e r a t i o n p a t i e n t s were a n g i n a of breath  by t h e primary  t o t w o (M = . 4 ) . T h e n u m b e r or health problems  The (3  (4 p a t i e n t s ) .  The number o f n o n - c a r d i o v a s c u l a r  medical  having  CABG p a t i e n t s w e r e s h o r t n e s s  or fewer  and s h o r t n e s s  problems reported  t o t w o (& = . 6 ) .  The symptoms most f r e q u e n t l y  arrhythmias,  symptoms r e p o r t e d  by  CABG p a t i e n t s ( 5 6 . 1 % ) a n d  (8 p a t i e n t s ) and a n g i n a  reported  t o t w o (M_ = . 5 ) .  from zero  p a t i e n t s (54.5%) r e p o r t e d  postoperative  by  o f p o s t o p e r a t i v e symptoms r e p o r t e d  The m a j o r i t y o f p r i m a r y  zero  experienced  CABG p a t i e n t s ( 7 3 . 2 % ) w e r e t a k i n g  CABG p a t i e n t s r a n g e d  Similarly,  pain,  t h e symptoms  (H = 1 . 8 ) .  three  the  taken,  and n o n - c a r d i o v a s c u l a r  problems experienced. by  from t h e p a t i e n t s were t h e  medical  or health  CABG p a t i e n t s r a n g e d  from  of non-cardiovascular  reported  by t h e r e o p e r a t i o n  60 patients primary  ranged  from zero  CABG p a t i e n t s  (54.6%) r e p o r t e d The  (63.4%) and r e o p e r a t i o n  having  health/medical  insulin-independent  diabetes  hernias,  problems,  tendinitis  health/medical reoperation  hernias,  The  infection, problems.  pain  problems reported  were u l c e r s , h i a t u s  (4 p a t i e n t s ) a n d  frequently  was b a c k  and  by t h e  other  b y one o r two o f t h e  sternal  p r o b l e m most  problems.  reported  the following:  and prostate  patients  medical/health  included  of  patients  or health  (3 p a t i e n t s ) .  problems reported  thyroid  medical  were a r t h r i t i s  p r i m a r y CABG p a t i e n t s stones,  no o t h e r  p r o b l e m s most f r e q u e n t l y  p r i m a r y CABG p a t i e n t s  medical/health  t o o n e (M_ = . 5 ) . T h e m a j o r i t y  kidney ulcers,  hiatus  The  reported  by t h e  (2 p a t i e n t s ) .  Other  by the reoperation  patients  tinnitus.  Findings The to  each  findings  of the study w i l l  of the eight  uncertainty,  past  research  life  be p r e s e n t e d  questions.  satisfaction,  The d i f f e r e n c e s  present  future  health  b e t w e e n t h e p r i m a r y CABG p a t i e n t s a n d  reoperation test.  of  were examined  Spearman's rank  examine life  patients  satisfaction,  using  and perceptions  health  patients analyses.  status.  c o r r e l a t i o n c o e f f i c i e n t was u s e d t o  future  life  satisfaction,  P r i m a r y CABG p a t i e n t s  were combined  of  t h e Mann-Whitney U  t h e r e l a t i o n s h i p between u n c e r t a i n t y  satisfaction,  In  life  satisfaction, status  life  i n relation  i n t o one g r o u p  and  and present and  perceptions  reoperation  f o rthecorrelational  61 R e s e a r c h Q u e s t i o n 1: P r i m a r y CABG P a t i e n t s The the  total  primary  SD = 1 5 . 4 ) . ranged There the  from  score  Difference In Uncertainty and Reoperation P a t i e n t s on t h e u n c e r t a i n t y  CABG p a t i e n t s  For the reoperation 57 t o 85  (M = 65.2,  was no s i g n i f i c a n t  primary  ranged  CABG p a t i e n t s  from  scale  (MUISCV) f o r  32 t o 109  patients, SD = 9.7)  difference  Between  (M =  total  60.8,  uncertainty  (see Table V I ) .  i n uncertainty  and t h e r e o p e r a t i o n  between  patients  (Z. = -1.29, p_ = .20) . Table  VI  Uncertainty f o r Primary Coronary Artery P a t i e n t s and R e o p e r a t i o n P a t i e n t s T o t a l Score on MUISCV  P r i m a r y CABG P a t i e n t s Frequency Percent  Bypass  Graft  Reoperation Frequency  Patients Percent  30-39  2  4.9  0  00.0  40-49  6  14.6  0  00.0  50-59  13  31.7  3  27.3  60-69  10  24.4  6  54 .5  70-70  5  12.2  0  00.0  80-89  3  7.4  2  18.2  90-99  1  2.4  0  00.0  100-109  1  2.4  0  00.0  11  100.0  Total Note.  41  100.0  T w e n t y - e i g h t i t e m s s c o r e d f r o m 1 t o 5. Minimum s c o r e p o s s i b l e = 28. M a x i m u m s c o r e p o s s i b l e = 140.  R e s e a r c h Q u e s t i o n 2: Difference i n Past L i f e B e t w e e n P r i m a r y CABG P a t i e n t s a n d R e o p e r a t i o n For  p r i m a r y CABG p a t i e n t s ,  satisfaction  on t h e C a n t r i l  the ratings  Self-Anchoring  Satisfaction Patients  of past  life  Scale ranged  from  1 t o 10  (II = 5.6,  satisfaction (M = 5.0, life  SD = 2 . 4 ) .  of the reoperation  SD = 2.4)  satisfaction  reoperation  The r a t i n g s  (see Table  patients VII).  between t h e primary  patients  of past ranged  life  from  3 t o 10  The d i f f e r e n c e  i n past  CABG p a t i e n t s  was n o t s t a t i s t i c a l l y  and  significant  -.95, p_ = .34) .  (Z_ =  Table V I I Past L i f e S a t i s f a c t i o n f o r Primary Coronary G r a f t P a t i e n t s and R e o p e r a t i o n P a t i e n t s P r i m a r y CABG P a t i e n t s Percent Frequency  Rating  Artery  Bypass  Reoperation Frequency  Patients Percent  1-2  4  9.8  0  00.0  3-4  12  29.3  6  54.5  5-6  11  26.8  3  27.3  7-8  8  19.5  0  00.0  9-10  6  14.6  2  18.2  41  100.0  11  100.0  Total Note.  S c a l e ranged from 1 = v e r y worst 10 = v e r y b e s t w a y o f l i f e .  way o f l i f e  to  R e s e a r c h Q u e s t i o n 3: Difference i n Present L i f e S a t i s f a c t i o n B e t w e e n P r i m a r y CABG P a t i e n t s a n d R e o p e r a t i o n Patients The  ratings  CABG p a t i e n t s  of present  ranged  Reoperation  patients'  ranged  2 to 9  The  from  difference  CABG p a t i e n t s  from  life  satisfaction  3 t o 10  ( f t = 7.3,  ratings  ( f t = 6.3,  i n present  of present SD = 2.0)  life  and r e o p e r a t i o n  SD = 1.8).  life  satisfaction  (see Table  satisfaction patients  of the primary  VIII).  between  was n o t  primary  statistically  significant Table  (Z. = - 1 . 4 5 , p_ = . 1 5 ) .  VIII  Present L i f e Bypass G r a f t  S a t i s f a c t i o n for Primary Coronary A r t e r y P a t i e n t s and Reoperation P a t i e n t s .  Rating  P r i m a r y CABG P a t i e n t s Frequency Percent  1-2  0  3-4  3  5-6  6  Reoperation Frequency  00.0 7.3  Patients Percent  1  9.1  1  9.1  14.7  2  18.2  7-8  22  53.6  6  54 .5  9-10  10  24.4  1  9.1  Total  41  100.0  11  Note.  100.0  S c a l e r a n g e d f r o m 1 = v e r y w o r s t way o f l i f e 10 = v e r y b e s t w a y o f l i f e .  to  R e s e a r c h Q u e s t i o n 4; Difference i n Future L i f e Satisfaction B e t w e e n P r i m a r y CABG P a t i e n t s a n d R e o p e r a t i o n P a t i e n t s For life The  satisfaction ratings  patients IX).  the primary  Projected  CABG p a t i e n t s reoperation  ranged  of future  ranged  CABG p a t i e n t s , t h e r a t i n g s  from  from  life  satisfaction  life  future  5 t o 10 (M = 8 . 5 , SD = 1 . 3 ) . of the  reoperation  4 t o 10 (M = 6 . 8 , SD = 1 . 9 )  future  satisfaction  was s i g n i f i c a n t l y  patients  of  higher  (Z. = - 2 . 6 3 , p_ =  (see Table  of the primary  than  that  of the  .009).  R e s e a r c h Q u e s t i o n 5; Difference i n Perception of Health S t a t u s B e t w e e n P r i m a r y CABG P a t i e n t s a n d R e o p e r a t i o n Patients Perceptions 48  of health  status  using  t h e GHRI r a n g e d  t o 1 0 3 (M = 7 6 . 5 , SD = 1 5 . 2 ) f o r t h e p r i m a r y  patients.  The r e o p e r a t i o n  patients'  perceptions  from  CABG of  health  status X).  ranged  from  42 t o 9 1 ( f t = 6 4 . 7 , SD = 1 5 . 5 ) ( s e e T a b l e  P r i m a r y CABG p a t i e n t s '  significantly perceptions  more f a v o r a b l e  of health  status  perceptions than  of health  were  thereoperation  patients'  (z_ = - 2 . 1 1 , p_ . 0 4 ) . =  Table IX Future L i f e S a t i s f a c t i o n f o r Primary Coronary Artery Graft Patients and Reoperation Patients Rating  P r i m a r y CABG P a t i e n t s Frequency Percent  Bypass  Reoperation Patients Frequency Percent  1-2  0  00.0  0  00.0  3-4  0  00.0  2  18.2  5-6  4  2  18.2  9.8  7-8  15  36.6  5  45.4  9-10  22  53.6  2  18.2  Total  41  Note.  100.0  11  100.0  S c a l e r a n g e d f r o m 1 = v e r y w o r s t way o f l i f e t o 10 = v e r y b e s t w a y o f l i f e .  R e s e a r c h Q u e s t i o n 6: R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y a n d P r e s e n t L i f e S a t i s f a c t i o n i n CABG P a t i e n t s Using  t h e Spearman's rank  significant  negative  uncertainty  and present  p_ = . 0 0 9 ) .  Higher  present Research  and  life  life  satisfaction  uncertainty  between  (rho = -.33,  was a s s o c i a t e d  with  lower  7;  Relationship  Between  uncertainty  Life Satisfaction  A significant uncertainty  r e l a t i o n s h i p was f o u n d  a  satisfaction.  Question  Future  correlation coefficient,  negative  and future  life  r e l a t i o n s h i p was f o u n d satisfaction  between  (rho= -.43,  p_ =  .001).  Higher  expectations Table  uncertainty  of future  life  was a s s o c i a t e d  with  lower  satisfaction.  X  Perceptions of Health Bypass G r a f t P a t i e n t s GHRI Score  Status f o r Primary Coronary and Reoperation P a t i e n t s  P r i m a r y CABG P a t i e n t s Frequency Percent  Artery  Reoperation Patients Frequency Percent  40-49  3  7.3  2  18.2  50-59  4  9.8  2  18.2  60-69  6  14.6  3  27.2  70-79  9  22.0  2  18.2  80-89  8  19.5  1  9.1  90-99  9  22.0  1  9.1  100-109  2  4.8  0  00.0  41  100.0  11  100.0  Total Note.  T w e n t y - t w o i t e m s s c o r e d f r o m 1 t o 5. Minimum p o s s i b l e = 2 2 . Maximum s c o r e p o s s i b l e = 1 1 0 .  R e s e a r c h Q u e s t i o n 8; Relationship and P e r c e p t i o n o f H e a l t h Status A significant  negative  uncertainty  and p e r c e p t i o n  p_ =  Higher  .002).  perceptions  The d i s c u s s i o n major  life  satisfaction;  was f o u n d  status  between  (rho = -.38, with  status.  of the Results will  take  sample c h a r a c t e r i s t i c s ;  perceptions  of uncertainty  Uncertainty  was a s s o c i a t e d  of the results  headings:  relationship  of health  health  Discussion  five  relationship  uncertainty  of a poorer  Between  score  of health  place  uncertainty;  status;  to adaptatlonal  under  and the  outcomes.  The  66 results  of this  theoretical  study  expectations,  methodological  problems of, t h e  Characteristics The  small  sampling  sample  reoperation  inherent  found  sample size  group.  I t should  be n o t e d  forthis  study, only  55 y e a r s  performed  18 r e o p e r a t i o n  June  procedures  June  (Statistics  22, 1988).  health  study  subjects  No s t a t i s t i c s  contacted  1984 and  study  with  appears t o  could  be  found  o f t h e sample  demographic, s u r g i c a l ,  However, c o n s i d e r i n g  forthis  O f t h e CABG  Canada,  the representativeness  i n terms of other  characteristics.  (Statistics  Therefore,  the national trends.  this  ( 6 8 % ) were  i n Canada between  reflect  t o determine  patients study.  22, 1988).  t o age and s e x , t h e sample o f t h i s  of  surgeons i n  o f age and o l d e r  79% o f t h e c a s e s were male communication,  despite  f r o m 1984 t o 1985 i n d i c a t e t h a t t h e  communication,  procedures  acute  and m a i l i n g t h e  o f CABG s u r g i c a l  on p a t i e n t s  which  patients  that,  of seven c a r d i o v a s c u l a r  respect  with  CABG  t o be p o t e n t i a l p a r t i c i p a n t s f o r t h i s  Canada, p e r s o n a l  personal  method o f  i snot  of primary  sample s i z e  province-wide,  percentage  performed  1985,  and t h e convenience  i s particularly  Canadian s t a t i s t i c s  surgical  i n the study.  The s m a l l  subjects  questionnaires  largest  s t u d i e s , and t h e  t o t e n months  the assistance  obtaining  were  research  i n relation to  p a t i e n t s who a r e f i v e  the reoperation  having  other  of the populations  postoperative. in  be d i s c u s s e d  may h a v e r e s u l t e d i n a s a m p l e t h a t  representative and  will  study  that the  constituted a  large  or  percentage that  o£  the  seven c a r d i o v a s c u l a r surgeons'  were  five  to  the  sample  of  this  the  primary  their  level,  with  and  majority  of  respect  primary There this  primary  be  reoperation  females  due  to  group.  may  regarding  the  problems experienced similarity  of  the  two  nature  and  the  of lack  s e v e r i t y of  makes  the  the  the  CABG  primary the  case  greater  than  group;  of  the  number  of  age.  the  symptoms for  symptoms  and  information  to to  health  establish these  the  two  characteristics.  Uncertainty Both perceived  primary  CABG p a t i e n t s a n d  moderately  low  levels  of  and  both  symptoms and  respect  of  however,  size  similar the  in  retirement  sample  i t impossible  groups with  bypass Although  postoperative  p r o b l e m s was  broad  of  patients  the  small  were  reoperation  reoperation  number o f  problems reported,  obtained  reflect  were younger  health  However, the  of  patients  taken.  t h a n was  extremely  The  had  educational  weeks, number  medications  i n the  the  non-cardiovascular groups.  marital status,  employed  This  of  p a t i e n t s who  reoperation  percentage  CABG p a t i e n t s who  may  health  heart  greater  that  Vancouver.  CABG p a t i e n t s a n d  group.  w e r e no  health  in  I t seems  representative  reoperation  postoperative  were a c t i v e l y  reoperation  reasonably  t o age,  number o f  were r e t i r e d , a patients  was  CABG p a t i e n t s a n d  number o f  grafts,  study  performed  primary  similar  months p o s t o p e r a t i v e ,  CABG p a t i e n t s a n d  surgery The  ten  patients  reoperation  patients  uncertainty with  means  68 ranging  f r o m 60.8 t o 6 5 . 2 .  variability patients  i n the uncertainty  than  the reoperation  CABG p a t i e n t s  having  moderately high variance a  There  would  very  was a h i g h e r  perceived  by t h e primary  patients, with  low uncertainty  uncertainty.  some  that  i n the reoperation  CABG  primary  and others  I t i s possible  have been noted  degree of  a  having wider  group  with  l a r g e r number o f p a t i e n t s . O n l y one s t u d y was f o u n d  measured  uncertainty  CABG p a t i e n t s surgery  patients  the  observational  Mishel  f o r coronary utilized  o f open  uncertainty differs patients  following  i n this  after  contributed  suggesting  reoperation  I t i s unlikely  that  patients  the subjects  discharge I t i snot  had open  or s t r u c t u r a l  heart repair.  i n contrast  to  H o w e v e r , t h e mean  discharge  patients  to the difference  scores  s t u d y w h i c h makes t h e  f r o m t h e mean u n c e r t a i n t y and r e o p e r a t i o n  study  o f t h e MUIS  difficult.  of patients  to ten points.  studies  i n Mishel*s  insufficiency  of results  heart  two days p o s t o p e r a t i v e l y , i n  and two weeks  used  to the  ( 1 9 8 1 b ) , mean u n c e r t a i n t y  a 30-item version  28-item version  comparison  than  patients  that  i s comparable  7 5 . 8 , 7 2 . 0 , 7 7 . 1 , a n d 71.6 r e s p e c t i v e l y .  surgery  six  unit,  that  In the study  preoperatively,  known w h e t h e r  the  here.  by M i s h e l  for  were  i n a sample  studied  patients  i n the literature  i n Mishel's  study  of the primary  CABG  i n the present  study by  that  two items would  have  b e t w e e n t h e means o f t h e t w o  t h e p r i m a r y CABG p a t i e n t s a n d  i n this  i n Mishel's  s t u d y had lower study.  Mlshel's  uncertainty subjects  were  assessed to  two weeks  following discharge  t e n month p o s t o p e r a t i v e  Therefore,  the lower  interval  uncertainty  compared  used  CABG p a t i e n t s moderately  t h e MUISCV s c o r e s and r e o p e r a t i o n  represent  patients  i ti s possible  on  f r o m CABG s u r g e r y .  qualitative  methodology might  more p e r v a s i v e  t h e MUISCV does n o t  Further reveal  i n CABG p a t i e n t s  the primary  t o t e n months  a l l of uncertainties experienced  recovering  i n this  experienced  five  that  study.  uncertainty.  indicate that  low l e v e l s of uncertainty  postoperatively,  i n this  of the patients  s t u d y may b e d u e t o t h e e f f e c t s o f t i m e Although  to the five  by  patients  investigation using  that  a  uncertainty i s  who a r e f i v e  t o t e n months  postoperative. According study,  the appraisal  situation factor that  For  examined  of uncertainty  (Lazarus  i n this  CABG s u r g e r y .  uncertainty  controlling their primary  CABG s u r g e r y  & Folkman,  1984).  the effectiveness  symptoms and t h e i r  CABG p a t i e n t s , i s novel  of the first  reoperation may  long  the experience  uncertainty  about  whether  they are progressing  surgery, or patients,  perceive of the treatment term  prognosis.  of recovery  a n d u n f a m i l i a r , a n d t h e y may  greater  by  The s i t u a t i o n  had undergone t h e i r  f o r reoperation,  about  i n this  i s influenced  Postoperatively,  need  used  s t u d y was t h e n a t u r e  patients  v i r t u e of their  greater in  factors  i s , whether  second by  t o t h e t h e o r e t i c a l framework  from  have  what t h e y c a n and c a n n o t do,  term outcomes o f s u r g e r y a r e .  as expected,  and what t h e l o n g  In  this  uncertainty difference groups for  study,  than  the primary  i n the degree  of patients  t h e 28 i t e m s  whether  the reoperation  experienced  reoperation  patients.  the  There  two groups  Furthermore, consistency reflect of  The i t e m  of patients  t h e MUISCV was r e f e r r e d  by both  or nature  reoperation factor  of a f i r s t  influences five  The i t e m s  with  the unpredictability  analysis  higher  into the  i n the situation.  difference  of uncertainty  i nt h e  by t h e primary and that  the situation  i s one w h i c h i n patients  Rather,  that  who a r e f i v e  appraisals of  i n both groups  of the underlying  who a r e  i tappears  patients  have s i m i l a r  uncertainty  factor  tapped  CABG s u r g e r y  and r e o p e r a t i o n  to  to reflect  perceived  t o t e n months p o s t o p e r a t i v e .  scored  t o determine the  i tdoes not appear  t e n months p o s t o p e r a t i v e  items.  (1987)  of consistency  or second  between  degree of  items scored  of uncertainty  the appraisal  uncertainty,  differences  i n the items  of a s i g n i f i c a n t  p r i m a r y CABG p a t i e n t s  of the  means c a n be r e v i e w e d i n  Hilton's  groups.  patients,  Means  t o determine  i n the nature  t o i n order  those  and lack  Given the lack degree  significant.  t o be a h i g h  uncertainty.  unpredictability  between t h e two  on a n y o f t h e  appeared  underlying  higher  b y p r i m a r y CABG p a t i e n t s a n d  between t h e groups  uncertainty  by  existed  were no s i g n i f i c a n t  there  higher  dimensions  to  of uncertainty  o f t h e MUISCV were e x p l o r e d  uncertainty  had  CABG p a t i e n t s , b u t t h e  was n o t s t a t i s t i c a l l y  any d i f f e r e n c e s  A p p e n d i x M.  patients  being  illness  generated and the  71 lack  o£ c o n s i s t e n c y The  nature  lack  In the Illness  of a significant  of uncertainty  reoperation sample  patients  size,  p r i m a r y CABG p a t i e n t s  period  than primary  formulated  future  previous  life  satisfaction.  and future  i s , past  life  satisfaction  satisfaction,  five  other  less  preoperative  are familiar t o that  they  the actual  with  CABG  have surgery  surgery.  present  and the reoperation  i n terms o f t h e i r  that  for  period  experience  life  life  was r a t e d  life  life  was r a t e d  following surgery  than  past  This  life  and there  trend  patients; present  life  was r a t e d  trend  and reoperation  t o t e n months p o s t o p e r a t i v e ,  improved  t h e same  lowest,  satisfaction  satisfaction.  p r i m a r y CABG p a t i e n t s  showed  present,  of past,  and the reoperation  higher  patients  of past,  T h e mean r a t i n g s  satisfaction  and future  ratings  satisfaction  t h e p r i m a r y CABG p a t i e n t s  than  i nt h e  regarding  p r i m a r y CABG p a t i e n t s  compared  present, in  may p e r c e i v e  p a t i e n t s , a n d i t i s more l i k e l y  of their  during  satisfaction  The  and  that  between  particularly  CABG p a t i e n t s  clearer expectations  by v i r t u e  were  patients  group.  may d i f f e r  patients  experience,  as the events during  reoperation  Mfq  and reoperation  Reoperation  t o the small  of the reoperation  of uncertainty  o f t h e CABG s u r g i c a l  uncertainty  i nt h e degree and  t h e p r i m a r y CABG p a t i e n t s a n d  that  the appraisal  preoperatively.  difference  may h a v e b e e n r e l a t e d  particularly  Furthermore,  stages  between  course.  suggests  patients  higher that,  who a r e  satisfaction i s  i s optimism aboutt h e  future. The obtained and  findings  study  c a n be c o m p a r e d  i n s t u d i e s by Penckofer  Frantz  Cantril  of t h i s  (1987)  (see Table  Self-Anchoring Scale  and Holm  XI).  to findings  (1984) and F l y n n  I n each study, the  was u s e d  t o measure  life  satisfaction. Table  XI  C o m p a r i s o n o f Mean L i f e  Satisfaction  Present Study Primary Reoperation  Life Satisfaction  Ratings  Penckofer and F l y n n and Holm Frantz 3-5 m o s . 6-8 m o s . 6-10 w k s .  Past  5.6  5.0  3.6  3.4  6.5  Present  7.3  6.3  5.4  8.0  6.4  Future  8.5  6.8  7.9  8.8  7.8  The study  trend  i n life  was a l s o f o u n d  (1984) however, present  life  i n the study  i n the study  satisfaction  satisfaction. findings  satisfaction  found  i n the present  by Penckofer  and Holm  by F l y n n and F r a n t z  was v e r y s i m i l a r  (1987),  t o past  life  One p o s s i b l e e x p l a n a t i o n f o r t h e d i f f e r e n t  of F l y n n and F r a n t z  i s that patients i n that  study  were o n l y s i x t o t e n weeks p o s t o p e r a t i v e and r a t i n g s o f present by  residual The  patients to  life  satisfaction discomfort  may h a v e b e e n a d v e r s e l y i n f l u e n c e d  f r o m t h e CABG s u r g e r y  postoperative recovery  time  itself.  of the primary  and r e o p e r a t i o n p a t i e n t s i n t h i s  study  t h e s i x t o e i g h t month p o s t o p e r a t i v e p r i m a r y  was CABG  CABG similar group  in  the study  exception life in  by Penckofer  o£ p a s t  satisfaction  the present  postoperative the  life  patients  lower  postoperative  patients  and  satisfaction  Holm's In  the  this  higher than  study,  life  life  With  satisfaction  month a n d Holm.  i n the present  of the patients  noteworthy  finding  findings they  This  of past  study  were  i n Penckofer  reveal  t o past that  i n the l i f e  reoperation  patients.  future  life  patients  satisfaction  satisfaction Both  future  patients  satisfaction  However, as i m p l i e d life  of a  primary  earlier,  are important  p r i m a r y and  CABG a n d  reoperation  their  satisfaction  was s i g n i f i c a n t l y l o w e r satisfaction  with  of both  s a t i s f i e d with life  between  i s not a  CABG s u r g e r y w a s a s s o c i a t e d  were m o d e r a t e l y projected  The l a c k  and r e o p e r a t i o n  in itself.  related  life  differences i n  between t h e primary  patients.  i n the past  improvement  reoperation  satisfaction  and r e o p e r a t i o n  CABG p a t i e n t s  primary  projected  study.  reoperation  t h e r e w e r e no s i g n i f i c a n t  the  The  that  month  why t h e mean r a t i n g s  f o r the patients  difference  patients  their  i n s t u d y by Penckofer  to explain  past and present  that  rated  the  the s i x to eight  significant  in  patients  study.  CABG p a t i e n t s  the  CABG  and Holm's  satisfaction,  study  than  i s unable  substantially  t h e mean r a t i n g s o f  f o r the primary  i n Penckofer life  substantially  life  With the  study and t h e group of s i xt o e i g h t  i n the present  researcher  (1984).  satisfaction,  are similar  exception of past  patients  and Holm  present  of the than the  of the primary  CABG  an  lives.  patients. future also of  As c a n be s e e n  life  lower  satisfaction than  t h e mean r a t i n g  (1984) and F l y n n The  result.  progression and  their  future.  h a n d , may b e l i e v e leading  future  life  difference  that  health  perception  to feel  optimistic  life  and r e o p e r a t i o n  The l i t e r a t u r e  i s strongly  surgery  optimism  on t h e o t h e r well-being,  to the appraisal  of health  status,  with  1972).  In this  their  between t h e primary i s their  study,  there  status  patients  perception  of  health  between p r i m a r y  satisfaction & Luikart, difference i n  CABG  the reoperation  perception  patients  patients  t o be s i g n i f i c a n t l y l e s s  t h e p r i m a r y CABG p a t i e n t s '  life  health  related to life  was a s i g n i f i c a n t  with  perception  by the p a t i e n t ' s  1987; G a r r i t y , 1973a; Palmore  of health  reoperation  the significant  indicates that  influenced  & Frantz,  than  a guarded  responses  patients  (Flynn  perceiving  the return or CABG  promises  satisfaction  significantly positively  and  i s not a surprising  first  might e x p l a i n  status  perception  life  have e x p e r i e n c e d  CABG s u r g e r y  factor which  status.  satisfaction  by Penckofer and  satisfaction.  i n future  CABG p a t i e n t s  patients  following their likely  was  satisfaction  future  P r i m a r y CABG p a t i e n t s  them t o have  A second  of  more  life  of  (1987).  projected  patients  o f symptoms  are therefore  about  and Frantz  of the reoperation  Reoperation  of future  patients  i n the studies  s i g n i f i c a n t l y lower  satisfaction  X I V , t h e mean r a t i n g  of the reoperation  t h e p r i m a r y CABG p a t i e n t s  Holm  of  i n Table  favorable  of health.  The  75 reoperation may  lead  patients'  appraisal  them t o p e r c e i v e  resulting  i n less  that  favorable  of a poorer their  future  appraisals  health  status  i s In jeopardy  of their  future  life  satisfaction. Cantril  (1965) s u g g e s t e d  satisfaction Scale,  best  those  elements  way o f l i f e  future  life  study,  patients  describe  methodological mailed  points  anchor  become known.  asked  to think what  Since  to the researcher, life  satisfaction.  researcher,  this  felt  rather  t o be t h e b e s t a n d modification  have  Unfortunately,  explain  the differences  satisfaction  the anchoring  i twould  i n two  which might this  have  by C a n t r i l  who w e r e  resulted  results  from o b t a i n i n g  been  been  collection  researcher  n o t have  Although  suggested  visited  rated  with by the  different  have a f f e c t e d t h e  prevented the  some a d d i t i o n a l d a t a  with  which t o  and s i m i l a r i t i e s i n l i f e  between t h e p r i m a r y  was  were  they  approaches t o data obtained.  than  the questionnaires  CABG p a t i e n t s  would  and  o r t h e manner b y w h i c h  t o f o l l o w the approach  group of primary  t h e means  present,  The r a t i o n a l e f o r t h i s  i n nature.  i n terms of  In the present  about  they  to the  so that  h i s past,  life  Self-Anchoring  the scale  t o have t h e p a r t i c i p a n t s d e s c r i b e  possible the  that  of  to describe  t o some o f t h e p a r t i c i p a n t s i t w o u l d  possible  their  be a s k e d  t o the researcher  way o f l i f e .  the Cantril  evaluates  satisfaction were  when r a t i n g s  a n d w o r s t way o f l i f e  by which an i n d i v i d u a l  worst  using  p a r t i c i p a n t s should  researcher the  are obtained  that  CABG p a t i e n t s  and t h e  reoperation Perception The  of Health  were  of health  found  reoperation  While  Status  perceptions  patients the  patients.  perception  CABG p a t i e n t s  t o be b e l o w  The  finding  of perceptions  patients  reoperation  may h i g h l i g h t  incurability  reoperation as  poor  being  their  perceptions patients believe would  having  awaiting that  their  be r e c t i f i e d  perceptions patients  those  t o be  their  that  of health  progressiveness, to the  CABG s u r g e r y  primary  has  well-  CABG following  eradicated  found  that  had a tendency t o  was a t e m p o r a r y  one w h i c h  surgery. explanation status  and r e o p e r a t i o n  f o r the difference  between t h e p r i m a r y  patients  i nthe  CABG  may b e t h e d i f f e r e n c e s i n  symptoms a n d n o n - c a r d i o v a s c u l a r  problems experienced  health  favorable  (1988)  CABG s u r g e r y  illness  their  a r e symptom-free  Dubyts  first  current by  The need f o r  In contrast, that  i nthe  i n physiological  t h e m t o have more  their  health  them t o p e r c e i v e  health.  possible  postoperative  health  perceived  disease  an improvement  leading  of their  A second  the  leading  may b e l i e v e  disease,  of poorer  of the underlying  particularly  CABG s u r g e r y ,  than  status.  their  the seriousness,  f o l l o w i n g CABG s u r g e r y .  patients,  patients  was n o t u n e x p e c t e d .  patients  despite  CABG  average.  reoperation  and  of health  perceived  moderately good, t h e r e o p e r a t i o n health  of the primary  t o be s i g n i f i c a n t l y more f a v o r a b l e  patients*  the primary  status  by t h e two groups  health  of patients.  77 However, t h e broad reported  by each group, and t h e lack  regarding  The  data  health  construct  (Davies  assessed  & Ware, 1981).  status  possible  prior  t o CABG s u r g e r y ,  t o determine  an Improvement  whether  obtained  problems  this  claim.  b y t h e GHRI i s Unfortunately,  were c o l l e c t e d on t h e p a t i e n t s ' p e r c e p t i o n s  health  with  makes i t d i f f i c u l t t o s u b s t a n t i a t e  underlying  problems  of information  t h e s e v e r i t y o f t h e symptoms and h e a l t h  experienced  current  s p e c t r u m o f symptoms and h e a l t h  of their  and t h e r e f o r e  CABG s u r g e r y  was  no  i t i snot  associated  i n the patients' perceptions  of  their  health. The R e l a t i o n s h i p B e t w e e n U n c e r t a i n t y Outcomes In stress,  this  study,  and Folkman's  a p p r a i s a l , and coping  relationship  status.  satisfaction  According  appraised  to this  as a threat  d e t e r m i n e what appraised  formulate  (1984) t h e o r y  of  and t h e a d a p t a t i o n a l  and p e r c e p t i o n  theory,  of health  uncertainty  may b e  i n a b i l i t y to  Alternatively, uncertainty  as an o p p o r t u n i t y ,  allowing  The a p p r a i s a l o f u n c e r t a i n t y utilized  which,  i n turn  outcomes.  Although  the influence  appraisal  and coping  coping  adaptational  of uncertainty  on  i n the study,  t o use t h e t h e o r e t i c a l framework  of a  affects the  influence  was n o t e x p l o r e d  may  the individual to  i n t e r p r e t a t i o n s of t h e meaning  strategies  possible  Adaptational  t o understand the  due t o t h e p e r s o n ' s  i s a t stake.  favorable  situation.  was u s e d  between u n c e r t a i n t y  outcomes o f l i f e  be  Lazarus  and  i t i s  t o explain the  relationships  between  found  study.  i n this  Significant  uncertainty  negative  r e l a t i o n s h i p s were  uncertainty  and present  future  life  satisfaction,  health  status.  associated  with  poorer  of a poorer  perceptions  of poorer  five  suggest  life  and u n c e r t a i n t y  present  life  future  life  health  t o t e n months  that,  satisfaction,  More s p e c i f i c a l l y ,  projections  were  and a d a p t a t l o n a l  postoperative,  higher  found  u n c e r t a i n t y and  uncertainty  i n CABG p a t i e n t s  postoperative.  These  who a r e f i v e  l e v e l s of uncertainty  t o t e n months are perceived  association  of uncertainty  and q u a l i t y of l i f e .  the  coping  processes  by t h e u n c e r t a i n t y less  confident,  capable  Since and  needed  itself,  leading  on c o p i n g  t o a poorer  interfere  systematically  resources,  which  further  life.  i n CABG p a t i e n t s there  to feel  overwhelmed, and l e s s  q u a l i t y of  explored,  with  generated  t h e CABG p a t i e n t s  t h e r e l a t i o n s h i p between p e r c e i v e d  q u a l i t y of l i f e  uncertainty  has not p r e v i o u s l y  of the c o r r e l a t i o n a l analyses  study.  While  obtained  in this  the p o t e n t i a l association of uncertainty  satisfaction  Holm  (1984),  was n o t e d  namely, t h a t  been  i s no way o f c o m p a r i n g t h e  results  life  as  I t i s also  t o manage t h e s t r e s s  more e m o t i o n a l l y  of drawing  contributes  l e v e l s of uncertainty  who  findings  The s t r e s s m e d i a t e s t h e  higher  was  s a t i s f a c t i o n , and  or s t r e s s f u l .  that  of  satisfaction,  threatening  possible  between  and perception  higher  status  f o r CABG p a t i e n t s  outcomes  i n the study  CABG p a t i e n t s  and  by P e n c k o f e r and attributed  their  dissatisfaction of  with  their  lives  t h e unknown" and u n c e r t a i n t y  finding  was a n e c d o t a l  support  perceived this  i n the literature  (1984) found  that  cancer,  higher  "fear  that  with  motivation  t o t r y t o g e t what  provides  between  satisfaction  Mishel  found i n  experienced  and  were  more s a d f e e l i n g s a b o u t t h e f u t u r e ,  concerning  by  colleagues  levels of uncertainty  associated  expectations  life  of the uncertainty  gynecological  which  association  and f u t u r e  In a study  women w i t h  about the f u t u r e ,  f o r the negative  uncertainty  study.  to a  i n nature.  One s t u d y w a s f o u n d partial  prior to surgery  i s wanted, and  less  negative  the future. Summary  This and  chapter  method  f o r the pooling  CABG p a t i e n t s patients. of  began w i t h  with  a description of the rationale  of the v i s i t e d  the mailed  group  group  of primary  of primary CABG  Demographic, s u r g i c a l , and h e a l t h c h a r a c t e r i s t i c s  t h e p r i m a r y CABG p a t i e n t s  and r e o p e r a t i o n  patients  were  reported. Overall, patients  t h e p r i m a r y CABG p a t i e n t s  perceived  However, t h e r e patients*  moderately  was v a r i a b i l i t y  appraisal  experienced  reoperation  patients  to  noted  course.  uncertainty.  i n the primary The n a t u r e  by t h e primary  The l a c k  CABG  of the  CABG p a t i e n t s  was s i m i l a r a n d a p p e a r e d  t h e u n p r e d i c t a b i l i t y and l a c k  illness  reoperation  low l e v e l s of  of uncertainty.  uncertainty  and  t o be r e l a t e d  of consistency  of a s i g n i f i c a n t  and t h e  i nthe  difference  i nthe  80 degree and nature CABG p a t i e n t s  and r e o p e r a t i o n  one's  first  which  influences  patients The that  or second  trend  CABG s u r g e r y  patients  the  life  i n ratings  suggests  of uncertainty  with  i n primary  who a r e f i v e  and present  p r i m a r y CABG p a t i e n t s  Reoperation  patients  projections  of future  life  in life CABG  t o t e n months  differences i n  satisfaction  and r e o p e r a t i o n  satisfaction  between  patients.  had s i g n i f i c a n t l y l e s s life  factor  suggests  an Improvement  T h e r e were no s i g n i f i c a n t  satisfaction  having  i n CABG  satisfaction  f o rthe future patients  that  postoperative.  of l i f e  i s associated  and r e o p e r a t i o n  by the primary  i s not a situation  t o t e n months  and optimism  postoperative.  patients  the appraisal  found  experienced  CABG s u r g e r y  who a r e f i v e  satisfaction  past  of uncertainty  favorable  than  primary  CABG  patients. T h e r e was a s i g n i f i c a n t health  status  patients.  status  than  less  the  perceptions  life  of their  health  who a r e f i v e  found  between  outcomes o f p r e s e n t  satisfaction,  that  life  and perceptions  associations  outcomes suggest  are appraised  CABG p a t i e n t s  reoperation  t o have  c o r r e l a t i o n s were  The n e g a t i v e  adaptatlonal  found  and  of  patients.  negative  future  status.  uncertainty  favorable  were  and t h e a d a p t a t l o n a l  satisfaction, health  patients  p r i m a r y CABG  Significant uncertainty  i n perceptions  b e t w e e n p r i m a r y CABG p a t i e n t s  Reoperation  significantly  difference  of uncertainty  higher  as threatening t o t e n months  of  levels  or s t r e s s f u l  of by  postoperative.  and  The  results  direction. relation studies problems  The  of t h i s findings  study  i n the  of the study  to the theoretical found  were  were d i s c u s s e d i n  framework, other  i n t h e l i t e r a t u r e , and t h e  inherent  i n the  study.  expected  research  methodological  CHAPTER 5 Summary, C o n c l u s i o n s , Implications Recommendations  and  Introduction This  s t u d y was d e s i g n e d  uncertainty, status  between  patients.  study  satisfaction  primary  and perceptions  CABG p a t i e n t s  and l i f e  satisfaction  i n CABG p a t i e n t s i s presented  implications future  the differences i n  and  f o rnursing  chapter  health  between  and perceptions  were e x p l o r e d .  i n this  of  reoperation  In addition, the relationships  uncertainty status  life  to explore  of  health  An o v e r v i e w o f t h e  followed  by  conclusions,  p r a c t i c e , and recommendations f o r  research. Summary  A review of the l i t e r a t u r e is  a salient  patients found  feature  waiting  f o r CABG s u r g e r y .  influences research influence  the appraisal have  that  CABG s u r g e r y  are those  important  satisfaction  of particular that  surgery. of  reoperation  A number o f  uncertainty  on a wide r a n g e o f a d a p t a t i o n a l outcomes  Two  f r o m CABG  of uncertainty.  found  Adaptatlonal  life.  recovering  has been  uncertainty  i s n o t k n o w n how t h e e x p e r i e n c e  studies  uncertainty  No r e s e a r c h  a t the degree of  by p a t i e n t s  Furthermore,  that  of the e x p e r i e n t i a l accounts of  which has looked  experienced  suggests  has a  negative  outcomes.  interest  i n the area of  are indicators of q u a l i t y of  indicators of quality  and t h e p a t i e n t ' s  perception  of l i f e of health  are life status.  while  there  are studies  satisfaction  that  and p e r c e p t i o n s  CABG p a t i e n t s , n o s t u d i e s at  these  variables  research has  gaps  This was  this  sample  reoperation  patients  area  collection received  of  study,  found  group  of primary  Scale  an  to data patients  One g r o u p o f p r i m a r y f o r the purpos f o r method  CABG p a t i e n t s  were  the Mishel  were  differences  were  CABG p a t i e n t s  on a  v a r i a b l e s , and t h e r e f o r e  Questionnaire  obtaining  two a p p r o a c h e s  of primary  (Community V e r s i o n )  from  from t h e immediate  No s i g n i f i c a n t  completed  study  a n d 11  To c o n t r o l  o f p r i m a r y CABG p a t i e n t s  subjects  Perceptions  patients  by t h e researcher  between t h e two groups  Illness  CABG  t o address the  had d i f f i c u l t y  by m a i l .  the questionnaire.  All  from  t o t e n months  the questionnaire.  a second  groups  recovering  A l l of the reoperation  were v i s i t e d  number o f s e l e c t e d two  uncertainty  Data were c o l l e c t e d  and t h e r e f o r e ,  the questionnaire  variance,  that  and c o r r e l a t i o n a l  five  The r e s e a r c h e r  administering  mailed  who w e r e  were r e q u i r e d .  CABG p a t i e n t s  looked  Furthermore,  o f 4 1 p r i m a r y CABG p a t i e n t s  number o f r e o p e r a t i o n  forthis  have  i n the literature.  convenience  adequate  patients.  life  of primary  which  s t u d y was d e s i g n e d  i n w e s t e r n Canada.  postoperative.  status  found  of patients  d e s c r i p t i v e comparative  conducted  at the  the influence  of l i f e  Therefore,  identified  of health  i n reoperation  on t h e q u a l i t y  looked  have been  has not addressed  surgery.  have  data  from the  pooled.  Uncertainty  (MUISCV), t h e  (HPQ), t h e C a n t r i l  in  Health  Self-Anchoring  Scale,  and a p a t i e n t  analyzed  using  statistical The  sheet.  descriptive statistics  were  61.8 y e a r s  of primary  majority  o f p r i m a r y CABG p a t i e n t s  patients  (90.2%) were m a r r i e d .  CABG p a t i e n t s  p r i m a r y CABG p a t i e n t s (45.4%) had a t t a i n e d  a n d 64.2 y e a r s  an educational  level  and  reoperation  mean n u m b e r o f p o s t o p e r a t i v e  respectively.  The p r i m a r y  3.7 b y p a s s g r a f t s w h i l e  for  patients,  CABG s u r g e r y  of grade  12 t o 1 3 . (56.1%)  retired. weeks o f t h e p r i m a r y  patients  were  t h e mean n u m b e r patients  patients  28.4 a n d 27.1  had an average of of bypass  was 3.5.  grafts  For the  t h e mean number o f m o n t h s b e t w e e n t h e  and t h e second surgery  of reoperation  reoperation  reoperation  CABG p a t i e n t s  CABG p a t i e n t s  on t h e r e o p e r a t i o n  reoperation  majority  (72.7%) were  and r e o p e r a t i o n  The  The l a r g e s t p e r c e n t a g e o f  (41.5%) and r e o p e r a t i o n  patients  and t h e  (82.9%) and  largest percentage of the primary  CABG p a t i e n t s  patients  (78%) were male.  The  first  and nonparametric  A l l of the reoperation  majority  performed  were  o f t h e p r i m a r y CABG p a t i e n t s a n d  patients  respectively.  The  The d a t a  tests.  mean a g e s  reoperation  information  patients  t o blockage  was 1 1 1 . 2 .  The  (81.8%) a t t r i b u t e d t h e need  of the coronary a r t e r i e s or  grafts. The primary  mean n u m b e r CABG p a t i e n t s  1.8 r e s p e c t i v e l y .  of heart  medications  and r e o p e r a t i o n  The m a j o r i t y  (56.1%) and r e o p e r a t i o n  patients  taken  patients  of primary  by t h e were  CABG  (54.5%) r e p o r t e d  2.2 a n d  patients having  no  85 postoperative  patients having  The m a j o r i t y  of primary  (63.4%) a n d r e o p e r a t i o n p a t i e n t s  no o t h e r m e d i c a l  The  primary  experienced months  symptoms.  or health  CABG p a t i e n t s  moderately  postoperatively.  problems.  five  toten  T h e r e was h i g h e r v a r i a b i l i t y  i nthe  experienced  by primary  uncertainty  experienced  by r e o p e r a t i o n  and  i n uncertainty  reoperation  patients  The MUISCV i t e m s similar to  i n both  scored groups  CABG p a t i e n t s  of patients  higher  Trends similar  that  than  past  satisfaction  life  satisfaction.  CABG p a t i e n t s  5.6  a n d 5.0  respectively.  7.3 6.3.  while  t h e mean r a t i n g  indicating  satisfied life  the primary  with  that their  satisfaction  both  appeared  satisfaction  and  present  life  satisfaction  patients  of present  CABG p a t i e n t s  rated  life  life  and r e o p e r a t i o n I n terms  was  and f u t u r e  of past  life  h a d a mean r a t i n g patients  groups of p a t i e n t s  were  and present  lives. life  of  was  moderately  The d i f f e r e n c e s satisfaction  of  were  of the reoperation  present  were  reoperation  satisfaction  than  The mean r a t i n g s  primary  satisfaction,  life  higher  the  items  were  and l a c k of  of l i f e  satisfaction,  was r a t e d  significant.  uncertainty  and these  CABG p a t i e n t s  i s , present  patients  situation.  i n t h e mean r a t i n g s  f o r the primary  patients; higher  i n the illness  In the  The  CABG  was n o t s t a t i s t i c a l l y to reflect  than  patients.  between t h e p r i m a r y  be r e l a t e d t o t h e u n p r e d i c t a b i l i t y  consistency  patients  of uncertainty  uncertainty  difference  (54.6%) r e p o r t e d  and r e o p e r a t i o n  low levels  CABG  i n past  between t h e  p r i m a r y CABG p a t i e n t s statistically  significant.  satisfaction patients future  satisfaction  between  patients  significant  (Z. = - 2 . 6 3 , p_ =  was f o u n d  T h e r e was a s i g n i f i c a n t status  reoperation primary the  between  patients  CABG p a t i e n t s  reoperation  perceptions  CABG p a t i e n t s  8.5 a n d 6.8 r e s p e c t i v e l y .  reoperation  health  patients  T h e mean r a t i n g s  of the primary  were  life  and reoperation  and  life  reoperation  CABG p a t i e n t s a n d  statistically  .009). difference  i n perception  of  t h e p r i m a r y CABG p a t i e n t s a n d (Z. = - 2 . 1 1 , p_ = . 0 4 ) . W h i l e t h e rated  patients  of their  of future  The d i f f e r e n c e i n  primary  t o be  were n o t  their  health  as moderately  had s i g n i f i c a n t l y  health,  rating  their  good,  less  favorable  health  as below  average. A significant  negative  uncertainty  and p r e s e n t  p_ =  A significant  .009).  found (rho be  between  significantly status  The the  uncertainty  = - . 4 3 , p_ - . 0 0 1 ) .  health  theoretical  methodological  lower the  than  negative  Finally,  of this  that  uncertainty  was f o u n d t o  perceptions  discussed  research  of  i n earlier  i n relation  studies,  i n the study.  by t h e p a t i e n t s  experienced  also  satisfaction  uncertainty  were  problems inherent  found  was  .002).  framework, other  experienced  life  correlated with  study  between  (rho = -.33,  correlation  and f u t u r e  negatively  was f o u n d  satisfaction  ( r h o = - . 3 8 , p_ =  results  uncertainty  life  correlation  i n this  research  by c a r d i a c  which  surgery  to  and t h e  The study  was  addressed patients  who  87 were two weeks p o s t - d i s c h a r g e . uncertainty  may b e i n f l u e n c e d  significant  difference  uncertainty  experienced  reoperation  patients  second  CABG s u r g e r y  influences five  satisfaction trend  improvement in  both  of  need  less  having  one's  factor  i n patients  support  from e a r l i e r  of  or  who a r e  life  research.  CABG s u r g e r y  i s associated  i n life  satisfaction  and optimism  reoperation  and r e o p e r a t i o n  patients'  life  of reoperation  less  satisfaction patients five  f o r reoperation  favorable suggest  i s poorer  This  with  an  f o rthe future patients. perceptions  that  than  t o t e n months  disease  them t o p e r c e i v e  that of  postoperatively.  to the  their  health  and  reoperation and future  favorable. Lazarus  appraisal,  and Folkman's  and coping  significant  negative  the  of l i f e  quality  correlational uncertainty  (1984) t h e o r y  was u t i l i z e d  of stress,  to explain the  c o r r e l a t i o n s between u n c e r t a i n t y Indicators.  analyses  suggest  are appraised  The f i n d i n g s that  higher  as threatening  of  the quality  may h i g h l i g h t t h e s e r i o u s n e s s  of the underlying  leading  first  which  that  incurability patients  that  CABG p a t i e n t s a n d  i n t h e mean r a t i n g s  p r i m a r y CABG p a t i e n t s The  of a  postoperative.  gains  and f u t u r e  life  The l a c k  of uncertainty  p r i m a r y CABG p a t i e n t s  The health  by t h e primary  suggests  found  suggests  by time.  that  i n t h e degree and nature of  the appraisal  trend  suggests  i s not a situation  t o t e n months The  This  and  of the  levels of  or s t r e s s f u l  by  as  88 CABG p a t i e n t s this  who a r e  s t r e s s mediates  quality  of  five the  to  t e n months p o s t o p e r a t i v e  a s s o c i a t i o n of  uncertainty  and  and  life. Conqluslons  Due t o number o f the  the  s m a l l sample s i z e ,  reoperation  sampling p r o c e d u r e , the  generalized.  However,  some s i m i l a r i t i e s , Overall, who a r e  five  moderately appraisal the  patients,  this  s t u d y cannot  f i n d i n g s of  this  study suggest  of  uncertainty. is  five  and l a c k  of  uncertainty  e x p e r i e n c e d by t h e  reoperation  patients,  similarity  it  to  to  The n a t u r e  ten  i n the  months be r e l a t e d  to  patients  and r e o p e r a t i o n  postoperative. future  life  However,  d e g r e e and n a t u r e  that  the  i n f l u e n c e s the  of  and  experience  appraisal  of  postoperatively.  the  patients the  the  illness  CABG s u r g e r y i s a s s o c i a t e d w i t h an improvement s a t i s f a c t i o n and o p t i m i s m f o r  of  and  p r i m a r y CABG p a t i e n t s  which  t e n months  patients  CABG p a t i e n t s  does not appear  is a factor  five  be  the  c o n s i s t e n c y i n the  Given the  uncertainty  However,  and a p p e a r s t o  situation.  reoperation  of  experience  individualized.  who a r e  is similar  unpredictability  of  and r e o p e r a t i o n  e x p e r i e n c e d by p r i m a r y  patients  postoperative  of  CABG p a t i e n t s  uncertainty  uncertainty  reoperation  results  small  non-random nature  t e n months p o s t o p e r a t i v e  low l e v e l s of  and t h e  the  d i f f e r e n c e s and t r e n d s among s u b j e c t s .  primary to  the  particularly  future  in primary  who a r e  five  significantly  s a t i s f a c t i o n and l e s s  favorable  to  lower  in  life  CABG  ten  months  ratings  appraisals  of  of  health  of the reoperation  months p o s t o p e r a t i v e l y , patients  may b e l o w e r  Finally, adversely  than  that  of l i f e  with  projections  satisfaction,  and p e r c e p t i o n s  i n CABG p a t i e n t s  of  five  Higher  poorer  of poorer  patients.  of a less  who a r e f i v e  may b e  levels of  present  future  toten  reoperation  o f CABG p a t i e n t s  by u n c e r t a i n t y .  are associated  that,  o f p r i m a r y CABG  of l i f e  satisfaction,  status  suggest  the quality  the quality  influenced  uncertainty  patients  life  life  favorable  health  t o t e n months  postoperative. Implications The  findings  implications involved and  of this  f o r nursing  CABG s u r g e r y .  programs  patients.  perceptions  of poorer  life  that  than  postoperatively educational, differ  interventions patients* to  adapt  for patients  health  that  quality  primary  patients  should  from  patients q u a l i t y of  t o t e n months  reoperation  are directed  programs  o p t i m i s m and  have a lower  five  of the primary  t o the chronicity  t o these  from  CABG p a t i e n t s  and r e h a b i l i t a t i v e  of l i f e  supportive  of the reoperation  CABG p a t i e n t s  supportive  nurses are often  recovering  the approach  and t h e r e f o r e ,  from those  First,  However, t h e lower  reoperation  primary  two major  of educational,  distinguishing  reoperation  suggest  practice.  Traditionally,  not involved  Practice  study suggest  i n the implementation  rehabilitative  has  f o r Nursing  patients needs  CABG p a t i e n t s . toward focus  improving  which Nursing reoperation  on a s s i s t i n g  of the underlying  have  patients  coronary  artery  disease. the  Reoperation  positive aspects  life the  satisfaction,  patients of their  c a n be a s s i s t e d health.  reoperation  s e t t i n g of long-term goals  I n terms  patients that  t o focus of  on  future  c a n be a s s i s t e d  are both  realistic  with and  attainable. Secondly, appears  poorer  q u a l i t y of l i f e  t o be a s s o c i a t e d  with  Nurses working  with  individualized  assessments  uncertainty nursing  interventions  managing  to  must  e i t h e r reduce or that  Uncertainty  generated  education.  On t h e o t h e r  t h e u n p r e d i c t a b i l i t y and lack  and degree of and  assist the patient i n where  may n e e d  through  helping  the patient  information,  of consistency  patient  on t h e p a t i e n t ' s  of  through  hand, u n c e r t a i n t y  s i t u a t i o n i s a form of uncertainty  uncertainty  i t i snot  c a n be r e d u c e d  illness  t o endure,  implement  the uncertainty  by a lack  or misconceptions  uncertainty.  perform  of the nature  the a f f e c t s of uncertainty  of c l a r i t y ,  patient  that  patients  levels of  b y CABG p a t i e n t s  by t h e p a t i e n t  reducible. lack  CABG p a t i e n t s  experienced  experienced  higher  o f CABG  that  however, t h e impact q u a l i t y of l i f e  related  of the t h e CABG of  that  may b e  t o develop s u i t a b l e  lessened  coping  strategies. Recommendations Given sampling, the  the small this  findings  would  provide  study  f o r Future  Research  sample  s i z e and convenience  should  be r e p l i c a t e d t o  obtained.  A prospective  a more c o m p r e h e n s i v e  time  substantiate  series  assessment  method o f  design  of the a f f e c t s  of  CABG s u r g e r y  patients  and r e o p e r a t i o n  prospective changes by  on t h e q u a l i t y  time  patients.  series design  i n the degree  primary study the  difference  and r e o p e r a t i o n  and r e o p e r a t i o n  postoperative  Future  by these  measures of t h e o b j e c t i v e  objective  and r e o p e r a t i o n health  responsible status  status  Investigations  procedure  life  the  described  health  over  found  of the l i f e  satisfaction  of primary  should Having life  of  health  of primary  patients  describe  satisfaction contribute  of uncertainty  used  would  to the patients.  experienced  patients  t o measure  investigation of the uncertainty CABG p a t i e n t s  CABG  follow the  and r e o p e r a t i o n  been r e l a t e d t o t h e i n s t r u m e n t  primary  whether  CABG a n d r e o p e r a t i o n  low level  CABG  variable i s  of patients.  their  health  of primary  i n perceptions  by C a n t r i l .  i n this  comprehensive  to identify  patients  time.  of patients.  two groups  p r i m a r y CABG p a t i e n t s  postoperative  status  of the f a c t o r s which  moderately  Qualitative  experienced  i n the s e v e r i t y of  more  o r some o t h e r  they rate  knowledge  satisfaction The  include  patients  and r e o p e r a t i o n  means b y w h i c h  increase  for exploring  between  patients  two groups  f o r the difference  between these  patients  a  symptoms a n d n o n - c a r d i o v a s c u l a r  investigations should  patients  CABG  patients  of health  may b e a t t r i b u t e d t o d i f f e r e n c e s  problems experienced  the  be u s e f u l  of uncertainty  i n perceptions  CABG p a t i e n t s  of primary  In addition,  would  and nature  p r i m a r y CABG p a t i e n t s The  of l i f e  may  by  have  uncertainty.  experienced  and r e o p e r a t i o n  by  patients  92 would  be u s e f u l  nature  of uncertainty  patients quality  between  experienced  and t h e impact of  significant  uncertainty  explored  that  i n this  uncertainty  negative  study.  I t could  b y CABG p a t i e n t s  uncertainty  their  c o r r e l a t i o n was  interfere with  only  are appraised  and t h a t  higher  the coping  indicators  Therefore,  future  i n v e s t i g a t i o n s should  more f u l l y  t h e r e l a t i o n s h i p s between  or  l e v e l s of  by t h e u n c e r t a i n t y  i n CABG  that  as threatening  processes  generated  and q u a l i t y of l i f e  found  be i n f e r r e d  manage t h e s t r e s s  coping,  two groups o f  has on  and t h e q u a l i t y of l i f e  l e v e l s of uncertainty  stressful  by these  and  life.  A highly  higher  f o r substantiating the pervasiveness  attempt  needed t o itself. to  uncertainty, patients.  explore  appraisal,  93 References B a r n e s , G., R a y , M., O b e r m a n , A., & K o u c h o u k o s , N. (1977). Changes i n working s t a t u s of p a t i e n t s f o l l o w i n g coronary bypass s u r g e r y . J o u r n a l of the American M e d i c a l A s s o c i a t i o n . 238, 1259-1266. B r o w n , R., & R a w l i n s o n , M. ( 1 9 7 5 ) . R e l i n q u i s h i n g t h e s i c k r o l e f o l l o w i n g open h e a r t s u r g e r y . J o u r n a l of H e a l t h and S o c i a l B e h a v i o u r 16, 12-27. f  B u d n e r , S. (1962). I n t o l e r a n c e of a m b i g u i t y as a personality variable. J o u r n a l of P e r s o n a l i t y , 29-50.  30,  B u r n s , N., & G r o v e , S. ( 1 9 8 7 ) . The p r a c t i c e o f n u r s i n g r e s e a r c h : C o n d u c t , c r i t i q u e , and utilization. P h i l a d e l p h i a : W.B. Saunders. C a m p b e l l , A. ( 1 9 7 6 ) . S u b j e c t i v e m e a s u r e s o f w e l l - b e i n g . American P s y c h o l o g i s t , 31, 117-124. C a m p b e l l , A., C o n v e r s e , P., & R o d g e r s , W. q u a l i t y of American l i f e . New Y o r k : Foundation. C a n t r i l , H. ( 1 9 6 5 ) . T h e Brunswick: Rutgers  ( 1 9 7 6 ) . The R u s s e l l Sage  p a t t e r n o f human c o n c e r n s . University Press.  New  C h a r l e s , E . , W a y n e , J . , O b e r m a n , A., R e e d , B., H a y n i e , C, K o u c h o u k o s , N., R o g e r s , W., & R u s s e l l , R. ( 1 9 8 2 ) . Cost and b e n e f i t s a s s o c i a t e d w i t h t r e a t m e n t f o r c o r o n a r y artery disease. C i r c u l a t i o n , 6_6.(supp. I l l ) , 8 7 - 9 0 . C h r i s t m a n , N., M c C o n n e l l , E . , P f e i f f e r , C , Webster, K., S c h m i t t , M., & R i e s , J . ( 1 9 8 8 ) . Uncertainty, coping and d i s t r e s s f o l l o w i n g m y o c a r d i a l i n f a r c t i o n : T r a n s i t i o n f r o m h o s p i t a l t o home. Research i n Nursing and H e a l t h l l 71-82. r  r  C o h e n , C. ( 1 9 8 2 ) . On t h e q u a l i t y o f l i f e : Some philosophical reflections. C i r c u l a t i o n , 66 (supp. I l l ) , 29-33. C o h e n , F . , & L a z a r u s , R. ( 1 9 7 9 ) . Coping w i t h the s t r e s s e s of p h y s i c a l i l l n e s s . I n G. S t o n e , F. C o h e n , & N. A d l e r ( E d s . ) , H e a l t h p s y c h o l o g y : A handbook (pp. 217-254). San F r a n c i s c o : J o s s e y - B a s s . C o m a r o f f , J . , & M a c q u i r e , P. ( 1 9 8 1 ) . A m b i g u i t y and t h e s e a r c h f o r meaning: C h i l d h o o d l e u k e m i a i n t h e modern c l i n i c a l context. S o c i a l S c i e n c e and M e d i c i n e , 15B, 115-123.  94 D a v i e s , A., & W a r e , J . ( 1 9 8 1 ) . Measuring h e a l t h perceptions i n t h e h e a l t h i n s u r a n c e e x p e r i m e n t ( R e p o r t No. R - 2 7 1 1 H H S ) . S a n t a M o n i c a , CA: R a n d C o r p o r a t i o n . D u b y t s , D. ( 1 9 8 8 ) . The e x p e r i e n c e a r t e r y bypass g r a f t surgery. t h e s i s , U n i v e r s i t y of B r i t i s h  of w a i t i n g f o r coronary Unpublished master's Columbia, Vancouver.  E r i k s o n , P. ( 1 9 8 4 ) . F u n d a m e n t a l p e r s p e c t i v e s on h e a l t h r e l a t e d q u a l i t y of l i f e . Q u a l i t y o f L i f e and C a r d i o v a s c u l a r C a r e , i . , 31-35. Ferrans, C, & P o w e r s , M. ( 1 9 8 5 ) . Development and p s y c h o m e t r i c N u r s i n g S c i e n c e , 8., 1 5 - 2 4 .  Q u a l i t y of properties.  l i f e index: Advances i n  F l y n n , M., & F r a n t z , R. ( 1 9 8 7 ) . Coronary a r t e r y bypass surgery: Q u a l i t y of l i f e d u r i n g e a r l y convalescence. H e a r t and L u n g , 16, 159-167. G a r r i t y , T. ( 1 9 7 3 a ) . S o c i a l i n v o l v e m e n t and a c t i v e n e s s as p r e d i c t o r s of morale s i x months a f t e r f i r s t m y o c a r d i a l infarction. S o c i a l S c i e n c e a n d M e d i c i n e , 1_, 1 9 9 - 2 0 7 . G a r r i t y , T. ( 1 9 7 3 b ) . V o c a t i o n a l adjustment a f t e r first m y o c a r d i a l i n f a r c t i o n : Comparative assessment of s e v e r a l v a r i a b l e s suggested i n the l i t e r a t u r e . Social S c i e n c e and M e d i c i n e . 7_, 7 0 5 - 7 1 7 . G l a s e r , H., H a r r i s o n , G., & L y n n , D. ( 1 9 6 4 ) . I m p l i c a t i o n s of c o n g e n i t a l h e a r t d i s e a s e P e d i a t r i c s . 33, 367-379.  Emotional in children.  G u n d l e , M., R e e v e s , B., T a t e , S., R a f t , D., & M c L a u r i n , L. (1980). P s y c h o s o c i a l outcome a f t e r c o r o n a r y a r t e r y surgery. A m e r i c a n J o u r n a l of P s y c h i a t r y , . 137, 1591 -1594. H i l t o n , B. A. ( 1 9 8 7 ) . Coping w i t h the u n c e r t a i n t i e s of breast cancer: A p p r a i s a l and c o p i n g s t r a t e g i e s . University Microfilms International. (University M i c r o f i l m s No. 87-00,205) H o r l e y , J . ( 1 9 8 4 ) . L i f e s a t i s f a c t i o n , h a p p i n e s s , and morale: Two p r o b l e m s w i t h t h e u s e o f w e l l - b e i n g i n d i c a t o r s . G e r p t r t Q l Q g l s t , 2JL, 124-127. Jenkins, C, S t a n t o n , B., S a v a g e a u , J . , D e n l i n g e r , P., & K l e i n , M. ( 1 9 8 3 ) . Coronary a r t e r y bypass surgery: P h y s i c a l , p s y c h o l o g i c a l , s o c i a l , and e c o n o m i c outcomes s i x months l a t e r . J o u r n a l of the American M e d i c a l  AsspclaUon,  25_fJ_,  782-788.  95 J e s s o p , D., & s t e i n , R. ( 1 9 8 5 ) . U n c e r t a i n t y and I t s r e l a t i o n t o t h e p s y c h o l o g i c a l and s o c i a l c o r r e l a t e s chronic illness in children. S o c i a l S c i e n c e and M e d i c i n e , 20 993-999.  o£  r  K i l p a t r i c k , R., & C a n t r i l , H. ( 1 9 6 0 ) . Self-anchoring scaling: A measure of i n d i v i d u a l s ' unique reality worlds. J o u r n a l o f I n d i v i d u a l P s y c h o l o g y , 16., 1 5 9 - 1 7 3 . K o r n f e l d , D., H e l l e r , S., F r a n k , K., W i l s o n , S., & M a l m , J . (1982). P s y c h o l o g i c a l and b e h a v i o r a l r e s p o n s e s a f t e r coronary artery surgery. Circulation, 66(supp.Ill), 24-28 . L a b o r d e , J . , & P o w e r s , M. ( 1 9 8 0 ) . Satisfaction with l i f e for p a t i e n t s u n d e r g o i n g h e m o d i a l y s i s and p a t i e n t s s u f f e r i n g from o s t e o a r t h r i t i s . Research i n Nursing a n d H e a l t h , 3, 1 9 - 2 3 . L a M e n d o l a W., & P e l l e g r i n i , R. ( 1 9 7 9 ) . Q u a l i t y of l i f e coronary a r t e r y bypass surgery p a t i e n t s . Social S c i e n c e and M e d i c i n e , 13, 19-23. L a z a r u s , R., coping.  & F o l k m a n , S. ( 1 9 8 4 ) . New Y o r k : S p r i n g e r .  L e h m a n n , E. ( 1 9 7 5 ) . on r a n k s . San  Stress,  appraisal,  Nonparametric s t a t i s t i c a l Francisco: Holden-Day.  methods  and  and based  L e v i n e , S., & C r o o g , S. ( 1 9 8 4 ) . T h e p r i m a r y c a r e p h y s i c i a n and t h e p a t i e n t ' s q u a l i t y of l i f e . Q u a l i t y of L i f e and C a r d i o v a s c u l a r C a r e , 1, 2 0 - 2 7 . McCullough, of t h e care. 19 .  L. ( 1 9 8 4 ) . P h i l o s o p h i c a l and e t h i c a l dimensions q u a l i t y of l i f e : R e l a t i o n s h i p t o c a r d i o v a s c u l a r Q u a l i t y o f L i f e a n d C a r d i o v a s c u l a r C a r e . 1, 1 5 -  Mcintosh, J . (1974). Processes of communication, i n f o r m a t i o n - s e e k i n g and c o n t r o l a s s o c i a t e d w i t h c a n c e r : A s e l e c t i v e r e v i e w of the l i t e r a t u r e . Social Science a n d M e d i c i n e , 8., 1 6 7 - 1 8 7 . M c K e e h a n , K., C o w l i n g , W., & W y l k e , M. ( 1 9 8 6 ) . Cantril self-anchoring ladders: Methodological considerations for nursing. I n P. C h i n n ( E d . ) , N u r s i n g r e s e a r c h methodology (pp. 285-294). Maryland: Aspen Publication. M e l t z e r , L., P i n n e o , coronary care: J. Brady.  R., & K i t c h e l l , J . ( 1 9 8 3 ) . Intensive A manual f o r n u r s e s . Maryland: Robert  96 M i s h e l , M. ( 1 9 8 1 a ) . The m e a s u r e m e n t illness. N u r s i n g R e s e a r c h . 30 f  of u n c e r t a i n t y 258-263.  In  M i s h e l , M. ( 1 9 8 1 b ) . P e r c e i v e d a m b i g u i t y of e v e n t s a s s o c i a t e d w i t h the e x p e r i e n c e of i l l n e s s and h o s p i t a l i z a t i o n : D e v e l o p m e n t and t e s t i n g o f a measurement t o o l . Dissertation Abstracts I n t e r n a t i o n a l . 41. 3235B-3236B. ( U n i v e r s i t y M i c r o f i l m s No. 8103821). M i s h e l , M. ( 1 9 8 3 ) . A d j u s t i n g the f i t : Development of uncertainty scales for specific c l i n i c a l populations. W e s t e r n J o u r n a l o f N u r s i n g R e s e a r c h , 5, 1 6 3 - 1 7 1 . M i s h e l , M. ( 1 9 8 4 ) . P e r c e i v e d u n c e r t a i n t y and i l l n e s s . R e s e a r c h i n N u r s i n g and H e a l t h ,  stress in 1, 1 6 3 - 1 7 1 .  M i s h e l , M. ( 1 9 8 8 ) . Coping with uncertainty in illness. Stress, coping processes, and health o u t c o m e s : New d i r e c t i o n s f o r t h e o r y a n d d e v e l o p m e n t and r e s e a r c h . Symposium c o n d u c t e d a t t h e m e e t i n g of t h e U n i v e r s i t y of R o c h e s t e r and Sigma T h e t a Tau I n t e r n a t i o n a l E p s i l o n XI C h a p t e r , R o c h e s t e r , NY. M i s h e l , M., H o s t e t t e r , T., K i n g , B., & G r a h a m , V. (1984). P r e d i c t o r s of p s y c h o s o c i a l adjustment i n p a t i e n t s newly diagnosed with gynecological cancer. Cancer Nursing, 1, 2 9 1 - 2 9 9 . M o n a t , A., A v e r i l l , J . , & L a z a r u s , R. ( 1 9 7 2 ) . Anticipatory s t r e s s and c o p i n g r e a c t i o n s u n d e r v a r i o u s c o n d i t i o n s of uncertainty. J o u r n a l of P e r s o n a l i t y and S o c i a l P s y c h o l o g y , 24, 237-253. M o o s , R., & T s u , V. ( 1 9 7 7 ) . C o p i n g w i t h p h y s i c a l New Y o r k : P l e n u m M e d i c a l Book Company.  illness.  M o s s e y , J . , & S h a p i r o , M. ( 1 9 8 2 ) . Self-rated health: A p r e d i c t o r o f m o r t a l i t y among t h e e l d e r l y . American J o u r n a l o f P u b l i c H e a l t h , 72, 800-806. O b e r m a n , A., W a y n e , J . , K o u c h o u k o s , N., C h a r l e s , E., R u s s e l l , R., & R o g e r s , W. (1982). Employment s t a t u s a f t e r coronary a r t e r y bypass surgery. C i r c u l a t i o n , 65 (supp. I I ) , 115-119. P a i n t e r , P. ( 1 9 8 1 ) . P e r c e i v e d u n c e r t a i n t y a n d i t s r e l a t i o n s h i p t o p e r c e i v e d r e c o v e r y and a c t i v i t y i n the post-myocardlal Infarction patient. Unpublished m a s t e r ' s t h e s i s , C a l i f o r n i a S t a t e U n i v e r s i t y , Los Angeles. Patrick,  D.,  & Elinson,  J.  (1984).  Sociomedlcal  approaches  97 t o d i s e a s e and care. Quality 45-54.  t r e a t m e n t outcomes In c a r d i o v a s c u l a r o f L i f e a n d C a r d i o v a s c u l a r C a r e . 1,  P a l m o r e , E . , & L u i k a r t , C. ( 1 9 7 2 ) . H e a l t h and social factors related to l i f e s a t i s f a c t i o n . J o u r n a l of H e a l t h a n d S o c i a l B e h a v i o u r , 13., 6 8 - 8 0 . P e n c k o f e r , S., & H o l m . K. ( 1 9 8 4 ) . c o r o n a r y r e v a s c u l a r i z a t i o n on N u r s i n g R e s e a r c h , 33., 6 0 - 6 3 . P o l i t , D., Ed.),  & H u n g l e r , B. Philadelphia:  E a r l y a p p r a i s a l of q u a l i t y of l i f e .  (1983). Nursing research J.B. L i p p i n c o t t .  S t a t i s t i c s Canada. (1988). M i n i s t r y of S u p p l y and  Canada yearbook. Services.  (2nd  Ottawa:  S u l s , J . , & M u l l e n , B. ( 1 9 8 1 ) . Life events, perceived c o n t r o l , and i l l n e s s : The r o l e o f u n c e r t a i n t y . J o u r n a l o f Human S t r e s s , 7., 3 0 - 3 4 . Ware, J . ( 1 9 8 4 ) . General Health Rating Index. I n N. W e n g e r , M. M a t t s o n , C. F u r b e r g , & J . E l i n s o n (Eds.), Assessment of q u a l i t y of l i f e i n c l i n i c a l trials of c a r d i o v a s c u l a r d i s e a s e (pp. 1 8 4 - 1 8 8 ) . New Y o r k : L e Jaq P u b l i s h i n g . W a r e . J . , & K a r m o s , A. ( 1 9 7 6 ) . D e v e l o p m e n t a n d v a l i d a t i o n o f s c a l e s t o measure p e r c e i v e d h e a l t h and p a t i e n t r o l e p r o p e n s i t y : Volume I I of a f i n a l r e p o r t (Report No. PB 2 8 8 - 3 3 1 ) . S p r i n g f i e l d , VA: National Technical Information Services. W e n g e r , N. ( 1 9 8 4 a ) . Q u a l i t y of l i f e and t h e c a r e of p a t i e n t s w i t h c a r d i o v a s c u l a r d i s e a s e . Q u a l i t y of a n d C a r d i o v a s c u l a r C a r e . 1, 2-4.  Life  W e n g e r , N. ( 1 9 8 4 b ) . The c o n c e p t o f q u a l i t y o f l i f e : An appropriate consideration in c l i n i c a l decision-making affecting patients with cardiovascular disease. Q u a l i t y o f L i f e a n d C a r d i o v a s c u l a r C a r e , 1, 8-13. W r i g h t , B. ( 1 9 6 0 ) . approach. New  Physical disability: York: Harper.  A  psychological  Z y z a n s k i , S., R o u s e , B., S t a n t o n , B., & J e n k i n s , C. (1982). E m p l o y m e n t c h a n g e s among p a t i e n t s f o l l o w i n g c o r o n a r y bypass surgery: S o c i a l , m e d i c a l , and psychological correlates. P u b l i c H e a l t h R e p o r t s , 97, 559-565.  98  Append Lees  99  A p p e n d i x A: Selected in Illness Scale  Items from (Community  the Mishel Uncertainty Version) (MUISCV)  100 S e l e c t e d Items from t h e M i s h e l U n c e r t a i n t y i n I l l n e s s S c a l e (Community V e r s i o n ) (MUISCV) Instructions:  1.  I don't Strongly Agree (5)  5.  Agree (4)  Agree (4)  When I h a v e p a i n , condition. Strongly Agree (5)  8.  know what  i s w r o n g w i t h me. Undecided  Agree (4)  Disagree  (3)  The e x p l a n a t i o n s t h e y g i v e about t o me . Strongly Agree (5)  7.  P l e a s e read each statement. Take your time and t h i n k a b o u t what e a c h s t a t e m e n t s a y s . T h e n p l a c e a n d "X" u n d e r t h e c o l u m n t h a t m o s t c l o s e l y m e a s u r e s how y o u a r e f e e l i n g TODAY. I f you agree w i t h a statement, then you would mark u n d e r e i t h e r " S t r o n g l y A g r e e " o r "Agree". I f you disagree with a statement, t h e n mark u n d e r e i t h e r " S t r o n g l y D i s a g r e e " o r "Disagree". I f y o u a r e u n d e c i d e d a b o u t how y o u f e e l , t h e n mark u n d e r " U n d e c i d e d " f o r that statement. Please respond t o every statement.  (2)  my c o n d i t i o n  Undecided (3)  I know what t h i s  Undecided (3)  Disagree (2)  means a b o u t  Disagree (2)  Strongly Disagree (1)  seem  hazy  Strongly Disagree (1)  my  Strongly Disagree (1)  My s y m p t o m s c o n t i n u e t o c h a n g e u n p r e d i c t a b l y . Strongly Agree (5)  Agree (4)  Undecided (3)  Disagree (2)  Strongly Disagree (1)  © 1 9 8 4 M e r l e H. M i s h e l . May n o t be r e p r o d u c e d o r distributed without written permission of the author. Reprinted by p e r m i s s i o n .  101 9.  I understand strongly Agree (5)  everything explained to Agree  Undecided  (4)  (3)  Disagree  14.  The and  16.  17.  Undecided  (4)  (3)  c o u r s e o f my bad d a y s .  Strongly Agree (5) 15.  Agree  illness  strongly Disagree (1)  (2)  13. Because o f t h e u n p r e d i c t a b i l i t y plan f o r the future. Strongly Agree (5)  me.  o f my  illness,  Disagree  Agree  Undecided  (4)  (3)  changing.  cannot  Strongly Disagree (1)  (2)  keeps  I  I have  Disagree  good  Strongly Disagree (1)  (2)  I h a v e b e e n g i v e n many d i f f e r i n g w r o n g w i t h me.  o p i n i o n s about what i s  Strongly Agree (5)  Disagree  Agree  Undecided  (4)  (3)  I t i s not c l e a r  what  i s going  Strongly Agree (5)  Agree  Undecided  (4)  (3)  I usually  k n o w i f I am  Strongly Agree (5)  Agree  Undecided  (4)  (3)  going  Strongly Disagree (1)  (2)  t o happen t o Disagree (2)  t o have  a good  Disagree (2)  me. Strongly Disagree (1)  o r bad  day.  Strongly Disagree (1)  © 1 9 8 4 M e r l e H. M i s h e l . May n o t b e r e p r o d u c e d o r d i s t r i b u t e d without w r i t t e n permission of the author. R e p r i n t e d by p e r m i s s i o n .  102 19.  The e f f e c t i v e n e s s Strongly Agree (5)  20.  24.  Agree  (4)  the course  o f my  not find  Agree  (2)  anything else  Undecided  Disagree  (3)  (2)  Undecided  Disagree  (3)  Undecided  (4)  Agree (4)  Strongly Disagree (1)  wrong  with  Strongly Disagree (1)  a specific diagnosis.  (3)  My d i a g n o s i s i s d e f i n i t e Strongly Agree (5)  illness.  Disagree  (3)  will  Strongly Disagree (1)  (2)  Undecided  (4)  Agree  Disagree  (2)  My p h y s i c a l d i s t r e s s i s p r e d i c t a b l e , going t o get b e t t e r or worse. Strongly Agree (5)  26.  predict  (4)  they  i s undetermined.  (3)  T h e y h a v e n o t g i v e n me Strongly Agree (5)  25.  Agree  I'm c e r t a i n me. Strongly Agree (5)  Undecided  (4)  I can generally Strongly Agree (5)  22.  Agree  of the treatment  and w i l l  Undecided (3)  Strongly Disagree (1)  I know when Disagree (2)  i t i s  Strongly Disagree (1)  not change. Disagree (2)  Strongly Disagree (1)  (c) 1 9 8 4 M e r l e H. M i s h e l . M a y n o t b e r e p r o d u c e d o r d i s t r i b u t e d without written permission of the author. Reprinted by p e r m i s s i o n .  103 27.  The  s e r i o u s n e s s o£  strongly Agree (5)  28.  Agree (4)  my  Illness  has  been  Undecided (3)  determined.  Disagree (2)  The d o c t o r s a n d n u r s e s u s e e v e r y d a y u n d e r s t a n d what t h e y a r e s a y i n g .  language  Strongly Agree (5)  Disagree  Agree (4)  Undecided (3)  Strongly Disagree (1)  (2)  so  I  can  Strongly Disagree (1)  © 1 9 8 4 M e r l e H. M i s h e l . May n o t be r e p r o d u c e d o r d i s t r i b u t e d without w r i t t e n p e r m i s s i o n of the author. R e p r i n t e d by p e r m i s s i o n .  104  Appendix  B:  General  Health  Perceptions  Questionnaire  (HPQ)  105 General  Health Perceptions Questionnaire  instructions:  The p u r p o s e o f t h e f o l l o w i n g i t e m s i s t o f i n d o u t how y o u f e e l a b o u t y o u r h e a l t h . T H E R E ARE NO R I G H T OR WRONG ANSWERS. I just w a n t t o k n o w how t r u e e a c h s t a t e m e n t i s f o r you. I w o u l d l i k e y o u t o t e l l me whether you t h i n k the s t a t e m e n t s a r e t r u e or f a l s e . I s i m p l y w a n t y o u t o t e l l me w h a t y o u believe. C i r c l e t h e number b e s i d e e a c h i t e m w h i c h b e s t c o r r e s p o n d s t o how t r u e o r f a l s e t h i s statement i s f o r you. C i r c l e o n l y one number f o r e a c h i t e m . l=Definltely False 2=Mostly F a l s e 3=Don't Know 4=Mostly True 5=Definitely  1. 2. 3. 4. 5.  A c c o r d i n g t o t h e d o c t o r s I've my h e a l t h i s now e x c e l l e n t . I t r y to avoid interfere with  I feel better before.  now  little  than  p r o b a b l y be  sick  I never  7.  Most people than  worry about  my  get sick  a  I don't  9.  I am  like  somewhat  t o go  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  l o t i n the  health. little  easier  I do.  8.  3  have  future. 6.  1 2  easier  I ever a  True  seen,  letting illness my l i f e .  I seem t o g e t s i c k a than other people.  I will  (HPQ)  to the doctor.  i l l .  I n t h e f u t u r e , I e x p e c t t o have b e t t e r h e a l t h t h a n o t h e r p e o p l e I know. 1 1 . I was s o s i c k o n c e I t h o u g h t I m i g h t die. 1 2 . I'm n o t a s h e a l t h y now a s I u s e d t o b e .  1  2  3  4  5  10.  1 2 1 2 1 2  3  4 3 3  5  4  4 ! 5  106 l=Definitely False 2=Mostly False 3=Don't Know 4=Mostly True 5=Definitely 13. 14. 15. 16.  I w o r r y a b o u t my h e a l t h m o r e t h a n other people worry about t h e i r h e a l t h .  1 2  3  4  5  When I'm s i c k , as u s u a l .  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  1 2  3  4  5  I t r y to just  My b o d y s e e m s t o r e s i s t well. Getting part  sick  once  keep  illness  i n a while  going  very  i sa  o f my l i f e .  17.  I'm a s h e a l t h y  18.  I t h i n k my h e a l t h w i l l b e w o r s e i n t h e f u t u r e t h a n i t i s now. I ' v e never had an i l l n e s s t h a t lasted a long period of time.  19. 20. 21.  Others health  as anybody  I know.  seem more c o n c e r n e d a b o u t t h a n I am a b o u t m i n e .  When I'm s i c k  I t r y t o keep  their  i t to  myself.  1  22.  My h e a l t h  i s excellent.  23.  I expect  t o have a v e r y  24.  My h e a l t h  i s a concern  25.  I accept going  that  sometimes  healthy  I have been  27.  I t doesn't  feeling bother  life.  i n my l i f e . I'm  2  just  t o be s i c k .  26.  bad l a t e l y .  me t o g o t o a  doctor. 28.  I have never  29.  When t h e r e i s s o m e t h i n g g o i n g around, I u s u a l l y catch i t . D o c t o r s s a y t h a t I am n o w i n poor h e a l t h .  30.  True  been s e r i o u s l y  i l l .  107 l=Definitely False 2=Mostly False 3=Don't Know 4=Mostly True 5=Definitely 31. 32.  When I t h i n k fight i t .  I am  I f e e l about as ever have.  Note-  getting sick,  good  now  as  True  I 1 2  3  4  5  1 2  3  4  5  I  From M e a s u r i n g H e a l t h P e r c e p t i o n s i n the H e a l t h I n s u r a n c e E x p e r i m e n t ( R e p o r t No. R - 2 7 1 1 - H H S ) ( p . 8 2 - 8 3 ) b y A. D a v i e s a n d J . W a r e , 1 9 8 1 . Santa Monica, CA: Rand C o r p o r a t i o n . R e p r i n t e d by p e r m i s s i o n .  108  Appendix C: Scoring Rules for the General Health Rating Index (GHRI) Component of the Health Perceptions Questionnaire  109 S c o r i n g R u l e s f o r t h e G e n e r a l H e a l t h R a t i n g I n d e x (GHRI) Component o f t h e H e a l t h P e r c e p t i o n s Q u e s t i o n n a i r e Item 1 2 3 4 5  = = = = =  Definitely true Mostly true D o n ' t know Mostly false Definitely false  1 2 3 4 5  = = = = =  Definitely false Mostly false Don't know Mostly true Definitely true  Scoring  3, 5, 9, 1 1 , 1 2 , 1 3 , 1 8 , 2 6 , 2 9 , 30  1,  4,  GHRI  6, 7, 1 0 , 1 5 , 1 7 , 1 9 , 2 2 , 2 3 , 2 8 , 32  Scoring  (Sum t h e s e items a f t e r s c o r i n g as above) 1 6 11 17 23 30 Note.  + + + + +  3 7 12 18 26 32  + 4 + 9 + 13 + 19 + 28  + + + + +  5 10 15 22 29  +  + + + +  Questionnaire responses are p r i n t e d l = D e f i n i t e l y F a l s e , e t c . , so o n l y items i n f i r s t s e t a r e recoded t o score General Health R a t i n g Index.  110  A p p e n d i x D:  Cantril  Self-Anchoring  Scale  Ill Cantril Instructions:  Self-Anchoring Scale  T h i n k a b o u t what y o u f e e l w o u l d be t h e v e r y b e s t o r i d e a l way o f l i f e . Next, t h i n k about what y o u f e e l i s t h e v e r y w o r s t way o f l i f e . Below i s a p i c t u r e of a ladder. The b e s t way of l i f e t h a t you have j u s t t h o u g h t about i s a t t h e t o p o f t h e l a d d e r ( i . e . 1 0 ) . The w o r s t way o f l i f e t h a t y o u have j u s t t h o u g h t about i s a t the bottom of the l a d d e r ( i . e . 1) .  10  Very  Very  b e s t way o f  worst  1. W h e r e o n t h i s now?  l a d d e r would  2. W h e r e o n t h i s  l a d d e r were y o u two y e a r s ago?  3. W h e r e o n t h i s f r o m now?  l a d d e r do y o u e x p e c t  Note.  you s a y you a r e  way o f  right  t o be two  years  F r o m T h e P a t t e r n o f Human C o n c e r n s ( p . 2 2 ) b y H. C a n t r i l , 1 9 6 5 . New B r u n s w i c k : R u t g e r s University Press. Modified f o ruse.  life  life  112  Appendix E:  Patient  Information  Sheet  113 Patient  Information  Sheet  B e l o w a r e a number o f q u e s t i o n s . Please i n d i c a t e your answer t o each q u e s t i o n i n t h e space p r o v i d e d . Some o f t h e q u e s t i o n s may n o t a p p l y t o y o u . I f t h e q u e s t i o n d o e s n o t a p p l y t o y o u , p l e a s e w r i t e "Not A p p l i c a b l e " i n t h e space beside that question. Are  you male  or female?  Did y o u have your surgery?  first  What i s y o u r or second  coronary  age?  a r t e r y bypass  I f you have had your second c o r o n a r y a r t e r y bypass why was t h e s e c o n d s u r g e r y n e e d e d ? How may c o r o n a r y a r t e r i e s w e r e b y p a s s o n t h i s last operation? What was t h e d a t e surgery?  of your  first  What was t h e d a t e surgery?  of your  second  What i s y o u r  What l e v e l  What  marital  status?  of education  i s your  coronary coronary  a r t e r y bypass a r t e r y bypass  Never m a r r i e d Marr ied Separated Divorced Widowed  do y o u have?  employment s t a t u s ?  Up t o g r a d e 8 G r a d e 9-11 Grade 12-13 College or university  P r e s e n t l y employed P r e s e n t l y unemployed Retired Disability  What  i s your  pension  occupation?  What m e d i c a t i o n s a r e y o u c u r r e n t l y What s y m p t o m s h a v e y o u b e e n h a v i n g angina, shortness of breath)? What o t h e r  surgery,  medical/health  What i s t h e d a t e questionnaire?  taking? s i n c e your  surgery (e.g.  p r o b l e m s do y o u have?  t h a t you completed  this  114  A p p e n d i x F: Patient Information for V i s i t e d Subjects  V  Letter  A p p e n d i x G:  Consent  Form  119  A p p e n d i x H: Patient for Mailed  Information Subjects  Letter  Appendix  I:  Request  f o r Study  Findings  Request f o r Study F i n d i n g s I am interested i n receiving a summary of the study findings so I am including my name and mailing address below. (name) (address)  If you have completed t h i s form, please remember to include i t with the completed questionnaire in the return stamped envelope.  Appendix J :  Reminder  Letter  A p p e n d i x K:  Physician  Consent  Form  Physician  I, the  , agree  names o f p a t i e n t s  who  surgery  within the past  include  both  artery  patients  problems. patients  interested  "Differences  understand  questionnaire patients  Lori  Lori  Postoperative months.  interval  medical  contact  i f they  Between  Bypass P a t i e n t s " . t o complete  a  be w i t h t h e  administered.  extended  these  entitled  of L i f e  Simurda w i l l  (signature  Note.  major  i n her study  i s  would  them t o i n q u i r e  be a s k e d  when t h e q u e s t i o n n a i r e  bypass  coronary  Simurda w i l l  and Q u a l i t y  will  with  have had one  Coronary Artery  patients  and t h a t  who  telephone  i n Uncertainty  that  Simurda  This  first  n o t have o t h e r  i n participating  P r i m a r y and R e o p e r a t i o n  months.  have had t h e i r  that  and then  Lori  have had c o r o n a r y a r t e r y  will  I understand by m a i l  t o provide  and p a t i e n t s  Patients  Form  s i xto eight  who  bypass surgery  reoperation.  are  consent  of  physician)  to five  to ten  I  A p p e n d i x L:  Physician  Information  Lette  A p p e n d i x M: MUISCV Item Means f o r P r i m a r y P a t i e n t s and R e o p e r a t i o n P a t i e n t s  CABG  132 M U I S C V I t e m M e a n s f o r P r i m a r y CABG and R e o p e r a t i o n P a t i e n t s MUISCV Item  P r i m a r y CABG P a t i e n t s I t e m Mean  Patients  Reoperation Item  Patients Mean  1 2  1.8 2.2  1.5 2.2  3 4  2.1 2.0  2.1 2.9  5 6  2.0 2.2  1.7 1.6  7 8  2.4 2.1  2.0 2.8  9 10  2.2 2.1  1.9 2.3  11 12  1.8 2.1  2.1 2.3  13 14 *  2.4 2.6  1.9 3.4  15 16  *  1.7 2.7  1.9 3.1  17 * 18  2.8 2.2  3.3 2.1  19 20  *  2.0 2.9  2.4 3.1  21 22  *  2.1 3.0  2.4 3.0  1.7 1.9  1.9 1.9  2.7 2.6  2.8 3.1  2.0 1.9  1.7 1.7  23 24 25 26  * *  27 28  Note. * = Items scored t o r e f l e c t h i g h e r u n c e r t a i n t y CABG p a t i e n t s a n d r e o p e r a t i o n p a t i e n t s .  by  primary  

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