The effects of fellow patients on the emotional well-being and satisfaction with care of postoperative cosmetic surgery patients.

This article reports the findings of a quasi-experimental study that represents the first attempt to systematically examine the possibility that contact with fellow patients after cosmetic surgery significantly influences a patient's postoperative emotional well-being and satisfaction with care. Patients were assigned to rooms that either facilitated ample postoperative contact with other patients (n = 70) or to rooms that were physically located in a manner that afforded little inter-patient contact (n = 9). The results indicate that whereas postoperative depression levels did not differ, patients in the high-patient-contact condition experienced less postoperative anxiety and greater overall satisfaction with their quality of care than did patients in the low-patient-contact condition. Analyses of patients' reported postoperative affiliations suggest several additional benefits of inter-patient contact, such as added emotional support, reduction of uncertainty about what to expect, and the opportunity to compare progress and emotional reactions. The results are consistent with a growing literature that suggests fellow patients can and do serve a useful, adjunctive role in health care. Questions for future research are considered.

Effects of a videotape information intervention at discharge on diet and exercise compliance after coronary bypass surgery.

BACKGROUND: This study evaluated the relative effects on compliance with recommended lifestyle changes of two experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for the posthospital recovery period. The tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression versus a series of "ups and downs." METHODS: Two hundred sixteen male and female CABG patients were assigned randomly either to view one of the two videotapes before discharge from the hospital or to receive only the standard discharge preparation provided by the hospital. All patients completed measures of anxiety and self-efficacy at discharge, 1 month and 3 months after discharge from the hospital. Patients also completed measures of dietary fat consumption and activity level 1 and 3 months after discharge. RESULTS: Relative to controls, patients who viewed either of the videotapes before hospital release reported higher self-efficacy for adhering to the recommended low-fat diet both at discharge and 1 month after surgery. Viewing either of the videotapes also resulted in significantly less dietary fat intake 1 month after hospital release compared with controls. Patients who viewed the tape that portrayed the recovery period as consisting of ups and downs also reported significantly more frequent moderate exercise at 1 month and more frequent strenuous exercise 3 months after discharge. CONCLUSIONS: The experimental videotapes proved to be an effective method for increasing dietary and exercise compliance during the first 3 months after CABG.

Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery.

This study evaluated the relative effects of three experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for surgery and the inhospital recovery period. One of the tapes conveyed information via a health care expert only. The other two featured the same health care expert and also included clips of interviews with patient models. These latter two tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression or as consisting of "ups and downs". Two hundred fifty-eight male CABG patients were randomly assigned to view one of the three videotapes on the evening prior to surgery or to a control condition. Overall, patients who viewed any of the videotapes felt significantly better prepared for the recovery period, reported higher self-efficacy for using the incentive spirometer and for speeding their recovery, performed more repetitions with their incentive spirometer each time they used it postoperatively, had shorter intensive care unit stays, and were released from the hospital more quickly than patients in the control condition. There was also evidence that patients' self-efficacy beliefs for speeding recovery directly mediated the effects of the videotapes on length of stay both in the intensive care unit and in the hospital.

The social construction of cardiovascular reactivity.

One can view the "reactivity hypothesis" as having two basic forms: the individual difference or personality approach, which suggests that people who show exaggerated cardiovascular responses to stress are at increased risk of developing cardiovascular disease, and the situational or social psychological approach, which suggests that circumstances which give rise to unusually large responses are those that put people at risk of disease. Both versions rely on the generality of cardiovascular responses across situations. Evidence is presented from two studies which indicate that such generality may, however, be hard to come by. In the first study, examining the personality approach, we show that a simple change in setting dramatically attenuates the consistency of reactivity. In the second study, from the social psychological perspective, we show that subtle alterations in the situation have profound effects on group mean responses. In both cases, reactivity proved extremely sensitive to the context, suggesting that testing in arbitrary and artificial settings cannot be expected to generalize well to the real world. Instead, we argue, careful attention to psychological naturalism is essential, with the testing carefully matched to specific real-world phenomena of interest.

Stress, affiliation, and emotional contagion.

Female participants were exposed to high or low threat in the presence of another person believed to be facing either the same or a different situation. In Study 1, each dyad consisted of 2 actual participants, whereas in Study 2, each dyad consisted of 1 participant and 1 confederate, trained to convey either a calm or a nervous reaction to the situation. Affiliation patterns in both studies, defined in terms of the amount of time spent looking at the affiliate, were consistent with S. Schachter's (1959) "emotional similarity hypothesis"; threat increased affiliation and did so particularly with affiliates believed to be facing the same situation. The authors also found evidence of behavioral mimicry, in terms of facial expressions, and emotional contagion, in terms of self-reported anxiety. The behavioral mimicry and emotional contagion results are considered from both primitive emotional contagion and social comparison theory perspectives.

Social comparison and affiliation under threat: effects on recovery from major surgery.

This study extends stress and affiliation research by examining the effects of preoperative roommate assignments on the affiliation patterns, preoperative anxiety, and postoperative recovery of 84 male coronary-bypass patients. Patients were assigned preoperatively to a room alone or to a semiprivate room with a roommate who was either cardiac or noncardiac and either preoperative or postoperative. Patients assigned to a roommate who was postoperative rather than preoperative were less anxious, were more ambulatory postoperatively, and had shorter postoperative stays. Independently, patients were more ambulatory postoperatively and were discharged sooner if assigned to a roommate who was cardiac rather than noncardiac. No-roommate patients generally had the slowest recoveries. Affiliations reflecting cognitive clarity concerns, emotional comparison, and emotional support were examined. Theoretical implications for research involving social comparison and affiliation under threat are considered.

Burnout, self- and supervisor-rated job performance, and absenteeism among nurses.

This study examined how job stress and work support predict the experience of burnout and how burnout is related to absenteeism and job performance in a sample of 73 registered nurses. The current study expanded on previous findings by including supervisor ratings of performance and employee records of absenteeism in addition to self-report measures. It also examined the extent to which burnout may mediate the relationships of job stress and social support with these performance indicators. Analyses indicated that levels of work support and job stress were both significant predictors of burnout. Additionally, higher burnout levels were significantly associated with poorer self-rated and supervisor-rated job performance, more sick leave, and more reported absences for mental health reasons. Finally, further analyses suggest that level of burnout served as a mediator of the relationships between social support and self-rated job performance, absences for mental health reasons, and intentions to quit. The findings suggest that burnout not only may negatively impact healthcare providers, but also may influence objective absenteeism and supervisor perceptions of employee performance.

The development and validation of three videos designed to psychologically prepare patients for coronary bypass surgery.

The purpose of this study was to demonstrate the validation of videotape interventions that were designed to prepare patients for coronary artery bypass graft (CABG) surgery. First, three videotapes were developed. Two of the tapes featured the experiences of three actual CABG patients and were constructed to present either an optimistic portrayal of the recovery period (mastery tape) or a portrayal designed to inoculate patients against potential problems (coping tape). The third videotape contained the more general nurse scenes and narration used in the other two tapes, but did not include the experiences of particular patients. We then conducted a study to establish the convergent and discriminant validity of the three tapes. That is, we sought to demonstrate both that the tapes did differ along the mastery-coping dimension, and that they did not differ in other respects (such as in the degree of information provided or the perceived credibility of the narrator). The validation study, conducted with 42 males who had previously undergone CABG, demonstrated that the intended equivalences and differences between the tapes were achieved. The importance of establishing the validity of health-related interventions is discussed.

Social comparison and affiliation under threat: going beyond the affiliate-choice paradigm.

This study examined the emotional similarity hypothesis--a derivation from social comparison theory, which predicts that increasing fear should lead to greater affiliation with someone who is awaiting the same threat (and who therefore is of relatively similar emotional status) relative to someone who has already experienced the threat (and who therefore is of relatively dissimilar emotional status). The results failed to support the emotional similarity hypothesis and in so doing challenged the importance of emotional comparison as a determinant of verbal affiliation under threat. Cognitive clarity concerns instead seemed to account better for the observed effects on verbal affiliation. Supplementary analyses of nonverbal affiliation (facial glances) likewise ran counter to an emotional similarity prediction. Effects of affiliation on anxiety were also examined. Previous conclusions regarding the pattern and causes of affiliation under threat that have relied on the affiliate-choice paradigm are considered.

Stress and affiliation: hospital roommate effects on preoperative anxiety and social interaction.

Fifty-three preoperative men were studied who were assigned to a hospital roommate who varied in terms of the similarity of the roommate's health problem and surgical status. The similarity of a roommate's particular type of health problem to that of the patient exerted little detectable influence. However, patients assigned to a preoperative roommate were more anxious compared with those assigned a postoperative or nonsurgical roommate. Affiliation was also significantly greater with fellow preoperative roommates compared with postoperative roommates. The possibility that the obtained roommate effects on anxiety are mediated directly by affiliation is explored. Additional mechanisms and theoretical implications for basic research involving social comparison, stress, and affiliation relationships are discussed. Practical considerations for hospital policy also are considered.

Emotional support as a moderator of adjustment and compliance after coronary artery bypass surgery: a longitudinal study.

The independent relationships of emotional support and marital status with posthospital adjustments following coronary artery bypass surgery (CABS) were examined longitudinally with an intake sample of 85 male patients. Follow-ups occurred at 1, 4, and 13 months after hospital release. Demographic characteristics (age, education) and cardiac status at the time of surgery (wall motion abnormalities) were controlled statistically. As anticipated, married patients were higher in emotional support throughout the follow-up period than were their unmarried counterparts, and both groups reported decreased support with time. Of more interest, higher support was significantly and independently predictive of better emotional status (lower anxiety, depression), perceived quality of life, and compliance with recommended behaviors (ambulating and not smoking). Support did not predict cardiac health (angina episodes, doctor visits for cardiac problems) during follow-up, however. There was no evidence that marital status, independent of emotional support, was related significantly to outcomes.

Effects of cognitive style and maintenance strategies on breast self-examination (BSE) practice by African American women.

A convenience sample of 159 African American women, 18-45 years old, was trained to perform breast self-examination (BSE) and was categorized according to the participants' cognitive style (monitors/blunters). Participants were then randomly assigned to one of four groups differing in BSE maintenance strategy (self-management, positive reinforcement, both, or neither). Self-reported monthly compliance with BSE was subsequently assessed during a 9-month period. A significant interaction between maintenance strategies and cognitive style was found. For blunters, the highest compliance rates and the highest competency scores occurred in the group with no maintenance strategy, whereas for monitors, the highest compliance rates and competency scores were found in the groups receiving positive reinforcement and/or self-management strategies. Additional results indicate that high levels of BSE competency were achieved across conditions and that competency improved over time.

Respiratory illness in nonsmokers chronically exposed to tobacco smoke in the work place.

We evaluated CO levels as an index of cigarette smoke in the work place and analyzed diary entries on respiratory symptoms, eye irritation, chest colds and lost days from work due to respiratory illness in 40 passive smokers (nonsmokers chronically exposed to tobacco smoke in the work place) and 40 control subjects (nonsmokers not exposed to tobacco smoke in the work place) matched for age and gender. Passive smokers experienced greater CO levels during the workday. Also they reported significantly more cough, greater phlegm production, more shortness of breath, greater eye irritation, more chest colds and more days lost from work due to chest colds than control subjects. Nonsmoking workers and their employers are likely to incur significant financial loss because of missed workdays due to illnesses resulting from exposure to second-hand tobacco smoke.

Health care involvement preferences and social-emotional recovery of male coronary-artery-bypass patients.

Examined how the preferences of male coronary-bypass patients either for information or behavioral involvement, respectively, predicted social and emotional recovery during the year following hospital release. Preferences for health care involvement were assessed prior to surgery. Outcome measures were collected at 1-, 4-, and 13-month follow-ups. Results indicated that patients who preoperatively had a high relative to a low desire for behavioral involvement experienced less ambulation dysfunction, fewer social interaction problems, and less emotional upset during the initial 4 months following hospital release. Also, patients who had a high relative to a low desire for information involvement experienced more social interaction and emotional problems during this period. At the final follow-up, these involvement-group differences for social interaction and emotional status had disappeared, and no differences in cardiac health were found. However, there were systematic differences in use of medical services. Results are discussed with reference to recent considerations about the potential benefits of more active patient involvement in the health care process. Possible mechanisms and clinical implications are also discussed.

Preferences for health care involvement, perceived control and surgical recovery: a prospective study.

In a sample (N = 75) of coronary bypass patients, we examined the manner in which preoperative perceptions of personal control over recovery, desires for behavioral involvement in health care, and desires for information about health care predicted recovery in the hospital. Results indicated that preoperative control beliefs and desires for health care involvement predicted independently several important indices of recovery. Specifically, patients who prior to their surgery expressed a greater desire for information tended to experience less surgical pain and more negative psychological reactions. Greater preferences for behavioral involvement were associated with greater pain behavior, more ambulation, and shorter hospital stays. Finally, greater perceived personal control over recovery was associated with a shorter hospital stay.

Social support and recovery from surgery.

This study examined the relationship of naturally occurring social support from the spouse with the preoperative anxiety and postoperative recovery of 56 male coronary-bypass patients. Patients were divided into groups based on whether the overall quality of their marital relationship was perceived to be relatively good or bad at the time of surgery and on whether they received relatively high or low spouse support in the hospital (defined in terms of frequency of visits). A fifth group (n = 16), consisting of unmarried patients, enabled additional comparisons. The results indicated that, although groups were essentially equivalent in preoperative physical status, married patients who received higher hospital support took less pain medication and recovered more quickly than their low-support counterparts. In contrast, perceived quality of the marital relationship was a relatively insignificant factor. Speed of recovery for unmarried patients was generally slower than for married, high-support patients and faster than for married, low-support patients.

The effect of verbal commitment and treatment choice on medication compliance in a pediatric setting.

This experiment examined the manner in which verbal commitment and treatment choice affect medication compliance in a pediatric setting. Parents (N = 89) of children suffering from an inner ear infection (otitis media) were asked or not asked for a verbal promise to give their child all prescribed antibiotic medication (commitment manipulation) and allowed or not allowed to choose between two equally appropriate antibiotics as the treatment for their child (choice manipulation). Self-reports at follow-up visits, which were supported by urinalysis results, indicated that obtaining a verbal commitment significantly increased medication compliance. Verbal commitment also nonsignificantly increased the likelihood of a resolved infection at follow-up. Providing the parent with a choice of treatments had no effect on compliance or health outcome.

Health status, perceptions of risk, and prevention interest for health and nonhealth problems.

Healthy and acutely ill college students indicated their risk compared to their peers for 10 health and nonhealth problems. Participants as a whole showed clear evidence of optimistic bias. However, whereas healthy participants showed an equal tendency to be biased optimistically for health and nonhealth problems, ill participants felt significantly more vulnerable to future health relative to nonhealth problems. This was the case even though the future health problems were objectively unrelated to their current illnesses. Perceptions of the preventability of the health and nonhealth problems paralleled the comparative risk judgments. Finally, those who were ill expressed relatively little interest in receiving prevention information. Possible mechanisms and implications are discussed.

Effects of preoperative roommate assignment on preoperative anxiety and recovery from coronary-bypass surgery.

This study examined the effect of preoperative roommate assignment on the preoperative anxiety and postoperative recovery of 27 male coronary-bypass patients. Patients were assigned preoperatively to a roommate who was either similar or dissimilar in his surgical status (preoperative vs. postoperative, respectively) and either similar or dissimilar in his type of operation (cardiac vs. noncardiac, respectively). The results indicated that the similarity/dissimilarity of a roommate's surgical status exerted important effects. Specifically, patients who before their operations had a postoperative roommate were less anxious preoperatively, were more ambulatory postoperatively, and were released more quickly from the hospital than patients who before their operations had a preoperative roommate. In contrast, the similarity/dissimilarity of the roommate's type of operation exerted no significant effects either separately or in interaction with the similarity of the roommate's surgical status. Theoretical implications, possible mechanisms, and practical implications for hospital policy are discussed.

College-student abstainers, moderate drinkers, and heavy drinkers: A comparative analysis.

Comparison of college freshman male and female abstainers, moderate drinkers, and heavy drinkers indicated that male and female heavy drinkers were more likely than their abstinent counterparts to engage in social, cultural, and impulsive-deviant activities, to describe themselves as dominant and rebellious, and to experience exuberance, negative affect, and physical complaints. Female and especially male heavy drinkers also performed more poorly academically than did abstainers. College health and academic counseling services may benefit from knowledge of individuals at high risk for poor physical health, academic dropout, and alcohol abuse.