Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders.

As the number of elderly patients undergoing cardiac surgery (coronary artery bypass and valve replacement) continues to increase, evidence is growing that they can do so with improved health status, functional status, longevity, and life quality. In this article, we used self-efficacy theory to explore one of the most common recovery behaviors--walking various distances. In preoperative data collected in-hospital through data collection at one, two, three, six, and twelve months postoperatively, we explored: (a) the trajectories of self-efficacy expectation (SEE) and self-reported (SR) behavior performance over the first postoperative year; (b) the relationships between SEE and SR behavior; (c) predictors of SEE; and (d) using hierarchical multiple regression, identified predictors of SR behavior at each point of time. The sample (N = 199) was primarily male (76%) with a mean age of 75.8 years. SEE and SR behavior increased over time though with different trajectories; at all points in time, females had lower scores. Correlations between SEE and SR behavior were statistically significant (r values ranging from 0.67 to 0.89; p < .01) for both males and females. Predictors of SEE and SR identified were a mix of physiologic and psychologic constructs. The amount of explained variance in SR behavior scores ranged from a low of 23% at one month to a high of 64.7% at six months. The gender differences sustained one year after cardiac surgery are striking; elder females may need targeted interventions to enhance recovery.

Patterns of recovery among Norwegian heart surgery patients.

Utilizing a prospective longitudinal design, the recovery pattern of 91 heart patients was followed for the first 8 weeks following coronary artery by-pass graft surgery. The patients' perceived and actual performance of walking, their resumption of roles, and social support and family functioning were measured pre-operatively and at 4 and 8 weeks postoperatively. Findings indicate that recovery is swift in terms of health and physical functioning, somewhat more time-consuming in terms of role functioning, and delayed with regard to work-related role activities. Contrary to American findings, the heart surgery recovery process did not significantly affect family functioning in this Norwegian sample. Social support was experienced as high throughout the recovery period, with spouses and children being the main providers.

Predictors of physical activity in patients with chronic heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy.

To identify predictors of physical activity levels in patients with chronic heart failure, 43 patients, aged 33 to 91 years, who had well-compensated heart failure were asked to perform a symptom-limited exercise treadmill test and to complete activity logs for 2 consecutive days while wearing an ambulatory heart rate activity monitor. Activity logs included information on the type of activity, duration, rating of perceived exertion, symptoms experienced, and the intensity of symptoms. Subjects also completed the Duke Activity Status Index, a brief self-administered questionnaire that assesses physical functioning, and a self-efficacy for general activity questionnaire. Simultaneous multiple regression analysis was used to predict physical activity levels from a model that included: personal variables of physical fitness (peak oxygen consumption); knowledge, attitudes, and beliefs including self-efficacy for general activity, and rating of perceived exertion during daily activity; and environmental factors such as social support (marital status). The overall model explained 38% of the variance (p < 0.001). Self-efficacy (p = 0.015) was the strongest predictor of physical activity in this group. From this initial descriptive study, we conclude that self-efficacy is a better predictor of performance of physical activity than measures of physical fitness or rating of perceived exertion during activity. Additional studies are needed to examine other behavioral and physiologic mediators as well as behavioral strategies that may be used to increase participation in physical activity programs. Particularly promising are strategies to enhance self-efficacy for exercise.

Women's short-term recovery from cardiac surgery.

Cardiac surgery is becoming more prevalent in women. Previous knowledge and understanding regarding the process of recovery following cardiac surgery have been based predominantly on what has been known about men. Knowledge is needed regarding factors which may be particular to women's recovery from cardiac surgery and which include both biophysical and psychosocial components. A longitudinal study was conducted to describe, from both objective and subjective perspectives, women's short-term recovery from cardiac surgery. Preoperative (baseline) data were collected from 31 women who presented for cardiac surgery at two Northern California hospitals. Following discharge from the hospital, 27 women were followed monthly by telephone for three months to obtain subjective responses regarding postoperative symptoms, perceptions of recovery, activity, and health status. The findings indicate that women's perceptions of recovery are independent of NYHA functional classification, and these perceptions improve before other more objective measures of activity or health state demonstrate improvement.

Functional capacity after cardiac surgery in elderly patients.

OBJECTIVES: This study was performed to determine whether cardiac surgery improves functional capacity in patients > 70 years of age and to identify factors associated with good and poor functional results in this age group. BACKGROUND: Cardiac surgery has been used increasingly among older patients, but the effectiveness of surgery in this age group remains controversial. METHODS: Self-reported functional capacity was assessed by the Duke Activity Status Index preoperatively and again 1 year after coronary artery bypass or valve replacement surgery in a total of 199 patients with a mean age of 76 years (range 70 to 91). RESULTS: Functional capacity improved significantly after surgery (mean Duke Activity Status Index 27.9 at baseline vs. 36.8 at 12 months, p < 0.001), with improvements in most patients (74%). Six preoperative factors were independent predictors of less improvement in functional capacity between baseline and 1 year: smoking, female gender, higher Charlson comorbidity index, syncope, previous cardiac operation and older age. Postoperative complications were also a highly significant predictor of lower functional capacity at 1 year. CONCLUSIONS: Most older patients have meaningful improvements in functional capacity after cardiac surgery, and clinical factors appear to modify the degree of improvement attainable.

Management of an elderly, multi-center cohort: strategies for conducting longitudinal research.

This paper describes a longitudinal study in which a cohort of cardiac surgery elders from several hospital sites has been followed. Issues related to retention of the cohort over time are identified. Low-cost and reliable strategies for cohort management are suggested.

Nursing's syntax revisited: a critique of philosophies said to influence nursing theories.

Lodged within the syntax of a discipline are the value systems and research constraints that influence theory development and research strategies. Humanism and postmodern philosophy have challenged natural science philosophical influences on nursing's syntax. This paper examines the construction of nursing's syntax from empiricist, hermeneuticist, feminist, and critical social theory views. In this critique, two requirements are placed on the world views: (1) they must accommodate theoretical (realist) terms important to nursing; and (2) they should provide explanatory power for these terms within nursing's disciplinary substance. Arguments are continued for a "within-the discipline" structure, a substantive and syntactical structure for the discipline of nursing that recognizes the centrality of biobehavioral processes in the practice of nursing [Gortner, IMAGE: J. Nurs. Scholarship 22, 101-105 (1990)].

Daily physical activity levels in congestive heart failure.

To determine the level of daily physical activity routinely performed by patients with congestive heart failure (CHF) and the ability of clinical and laboratory assessments of function to predict peak daily activity levels, 45 patients with CHF were evaluated in the laboratory and during 2 days of usual activity. Subjects performed symptom-limited treadmill exercise tests with respiratory gas analysis and wore a Vitalog activity monitor with continuous measurement of heart rate and body motion. Mean maximal oxygen uptake for this sample was 16.8 ml/kg/min. Peak daily physical activity involved walking on a flat surface (44%), or general activities (housework/yardwork, 42%). Most subjects were asymptomatic (49%) during daily physical activity, 22% noted dyspnea, 16% fatigue and 13% sore muscles/joints. Perceived intensity of peak daily physical activity (mean = 4.19, SD = 2.21) was similar to perceived exertion (mean = 3.73, SD = 1.37) reported at ventilatory threshold measured during treadmill exercise testing. Subjects may control their peak daily physical activity to minimize symptoms experienced. It was further observed that current methods of assessing functional capacity in these patients were inadequate for estimating the peak level of daily activity. In conclusion, daily physical activity levels are low in patients with congestive heart failure and a gap exists between exercise capacity and actual performance of daily physical activity.

A randomized clinical trial of nursing care for recovery from cardiac surgery.

OBJECTIVE: To determine the efficacy of a psychoeducational nursing intervention in patients who receive coronary artery bypass graft and valve repair surgery. DESIGN: A cluster-randomized controlled trial design. SETTING: Two hospitals in the western United States--a large community hospital with an active cardiovascular surgery practice and a health-sciences research center. SUBJECTS: 156 patients between 25 and 75 years of age, 125 (81.1%) men, and 31 (19.9%) women, all with primary care givers. OUTCOME MEASURES: Self-efficacy expectations, activities (behavior performance), quality of life, mood state. INTERVENTION: Supplemental in-hospital education followed by telephone contact from discharge to eighth week after discharge. RESULTS: Patients in the experimental group reported significantly greater self-efficacy expectations for walking and behavior performance for walking, lifting, climbing stairs, general exertion and, where applicable, for working. CONCLUSION: This trial suggests that a low-intensity psychoeducational nursing intervention can promote self-efficacy expectations for walking in recovery and is associated with more self-reported walking and lifting behavior after cardiac surgery.

The road to recovery for elders after CABG.

One year later, 88% of these octogenarians said they would undergo CABG again. Here's how nursing care set them on the right course.

(Mis)conceptions and reconceptions about traditional science.

"Traditional" science (ie, scientific work that has evolved from the natural sciences) is still said to rely on theory-neutral facts, quantitative data, and the search for universal laws. This depiction of science is incongruent with much contemporary thinking. This article examines three shifts in recent philosophy that are relevant for nursing science philosophy: the move from foundationalism to an understanding of the fallibility of science, the shift in emphasis from verification to justification of knowledge claims, and the recent examination of explanation by scientific realists. It is suggested that scientific realism may be a fruitful area of inquiry for philosophers of nursing science.

Predictors of general activity 8 weeks after cardiac surgery.

In this secondary analysis, the influence of mood states and self-efficacy beliefs on recovery of general activities 8 weeks after cardiac surgery were investigated. Study data were taken from a randomized clinical trial with 156 subjects who were either in an efficacy enhancement nursing care group (n = 75) or in a routine care group (n = 81). It was found that self-efficacy beliefs at time of hospitalization regarding ability to resume general activities after discharge, measured tension/anxiety at 4 weeks after surgery, and experimental group status explained 21% of the variation in self-reported recovery at 8 weeks.

Historical development of doctoral programs: shaping our expectations.

The history of doctoral education for nurses in the United States is reviewed with emphasis on the nurse scientist training model, changing student characteristics, and developing scientific perspectives and programs. Recommendations are made for cross-disciplinary training in a revised nurse scientist model and for greater research emphasis on fundamental processes (for example, host factors) to understand human ecology in health and illness.

Self-efficacy and activity level following cardiac surgery.

Self-efficacy expectations were measured in 149 recovering cardiac surgery patients to determine whether in-patient education and telephone monitoring during convalescence enhanced perceptions of cardiac efficacy and reported activity. Significant differences were found for experimental patients in self-efficacy expectations for walking between 4 and 8 weeks (P = 0.02) and between 8 and 24 weeks (P = 0.05) following surgery. Experimental patients also reported higher levels of general activity at 4 weeks (P = 0.05) and 8 weeks (P = 0.02) as well as more walking and lifting at 8 weeks (P = 0.01 and P = 0.0008, respectively). By 12 weeks, treatment differences were no longer significant except for continued higher general activity levels (P = 0.03) for experimental patients. Self-efficacy expectations, summed for all physical activities, at at 8 weeks were found to be a significant predictor of self-reported activity at 12 weeks, contributing 14.8% of the 34.8% explained variance (R2 change = 0.1479; F = 26.58; P less than 0.0001). Self-efficacy expectations summed for all physical activity at 8 weeks were also significant predictors of self-reported activities at 24 weeks, contributing 8.5% of the variance (R2 change = 0.0847; F = 14.48; P = 0.0002). A New York Heart Association functional class at 4 and 8 weeks was an independent predictor of self-reported activity at 12 weeks, as was 8 week functional class for self-reported activity at 24 weeks. Mood state did not contribute to explained variance in the regression models.(ABSTRACT TRUNCATED AT 250 WORDS)