Uncertainty, symptom distress, anxiety, and functional status in patients awaiting coronary artery bypass surgery.

OBJECTIVE: The study's objective was to (1) describe uncertainty, anxiety, the symptom distress experience, and functional status of patients on a coronary artery bypass graft (CABG) waiting list and express the relationship between these concepts; (2) explore whether length of time waited has an influence on the psychosomatic condition of patients; and (3) explore the use of semistructured interviews within the context of a theoretic framework and compare open-ended responses to quantitative results. DESIGN: A descriptive, correlational, cross-sectional design was used with supplementary telephone interviews using semistructured questions. Quantitative data were collected with a mailed questionnaire. Study instruments included the Mishel Uncertainty in Illness Scale (Community), Symptom Frequency and Symptom Distress Scale, Graphical Anxiety Rating Scale, and Kansas City Cardiomyopathy Questionnaire (Physical and Social Limitation). The Mishel Uncertainty in Illness Theory was used as the guiding theoretic framework. SETTING: The study took place in one large tertiary care hospital in Winnipeg, Manitoba, Canada. SAMPLE: The study included a convenience sample of 42 patients undergoing first-time elective CABG only, 25 of whom participated in the telephone interview. RESULTS: Average uncertainty and anxiety were present at moderate levels and were associated with moderate deterioration of functional status. Reported symptom distress was low; however, presence of symptoms showed a strong relationship with anxiety (P=.0002), and this relationship was confirmed through semistructured interviews. Although the relationship between uncertainty and anxiety was nonsignificant, the interviews suggest positive views of uncertainty as an opportunity may have muted the relationship between uncertainty and anxiety, and that it is possible to experience uncertainty as a danger and an opportunity simultaneously. No statistically significant relationship was found between the study variables and waiting time; however, there was a nonsignificant trend toward deterioration of psychologic and physical condition with longer waits, which may be clinically significant. CONCLUSION: Psychosocial distress and physical condition among patients on CABG waiting lists should be continually assessed in all patients regardless of how long they have been waiting. Each patient will have a unique presentation of symptoms and a corresponding unique psychologic response.

A qualitative analysis of the experience of uncertainty while awaiting coronary artery bypass surgery.

The aim of this article is to present a qualitative examination of the phenomenon of uncertainty in patients awaiting CABG surgery. Cardiac symptoms are presented as an antecedent to uncertainty and both positive and negative outcomes of uncertainty are discussed. Semi-structured interview questions, based on Mishel's Uncertainty in Illness Theory, were developed to investigate the experience of waiting for CABG surgery and identify what patients were doing: to make their cardiac symptoms more manageable, to relieve their own anxiety while waiting, and to identify why patients felt having CABG surgery would benefit them. Telephone interviews were conducted with a self-selected sample of 25 participants. The qualitative results presented are part of a larger multimethod study examining the psychosomatic experience of waiting for CABG surgery. Data collected from telephone interviews were analyzed using content analysis and constant comparison techniques. Content analysis identified three conceptual categories: i) taking responsibility; ii) getting my life back; and iii) getting it over with. Strategies associated with each of these categories, the consequences of the strategies, and factors that facilitate or constrain their use were also identified. Participants were actively trying to lessen the impact of their cardiac symptoms and were very aware of their own bodies and what actions would exacerbate symptoms or relieve symptoms if they occurred. Participants envisioned physical and psychological improvements for post-CABG surgery. Participants also identified actions they took to limit their anxiety while waiting. Anxiety levels were influenced by family members as well as stories they had heard from friends, family, or acquaintances who had also experienced CABG. This study concluded that the lengthy waits experienced by some patients can create significant psychological disturbance including anxiety and uncertainty about the future. In addition, patient symptom status requires attentive monitoring.

Application of feminist theory in nursing research: the case of women and cardiovascular disease.

Researchers have provided evidence that women recover from and live with heart disease in very distinct ways from men. The challenge for researchers has been to discuss women in a manner that allows their differences to emerge but does not depict them as inferior to men. Our goal is to review current cardiovascular research on women from a feminist theoretical perspective. We believe that a feminist perspective in cardiovascular research will advance the knowledge and recognition of women's health. We examined nine qualitative research articles in depth and applied a model of feminist research critique to them (Bunting, 1997). Historical androcentric notions in women's health and cardiovascular research are discussed. Also included are recommendations for future research to influence social change in women's cardiac health.

A concept analysis of uncertainty in illness.

PURPOSE: To examine the concept of uncertainty in illness and to propose an alternate model of uncertainty in the illness experience. ORGANIZING CONSTRUCT AND METHODS: Following a review of the literature, Morse's description of concept analysis by critically appraising the literature was used as a guideline in examining the concept of uncertainty. FINDINGS: Characteristics of the illness situation--ambiguity, vagueness, unpredictability, unfamiliarity, inconsistency, and lack of information--underlie the process of uncertainty. Three attributes of the concept of uncertainty were identified as probability, temporality, and perception. Loss of personal control is often erroneously equated with uncertainty. CONCLUSIONS: Uncertainty is a multidimensional concept that in its purest form is a neutral cognitive state and should not be mistaken for its emotional outcomes. To clarify the concept of uncertainty, further research is needed to determine the relationship of uncertainty to loss of control and psychosocial outcomes.

Symptoms and distress in patients awaiting coronary artery bypass surgery.

In this examination of symptom distress in patients awaiting coronary artery bypass graft (CABG) surgery, a convenience sample of 42 patients on a waiting list for first-time CABG-only surgery were contacted via mail as part of a larger study into the experience of waiting for CABG surgery. They were asked to respond to questions about the frequency and distress of their coronary artery disease symptoms. A modified version of the Symptom Frequency and Symptom Distress Scale (SFSDS) was used. The mean symptom distress score was 77.7 out of a possible 386. Strong correlations were established between each individual item on the scale and the total score. The most frequent and distressing symptoms were fatigue, shortness of breath with activity, and chest pain. The most frequent' symptoms were also the most distressing. The findings underscore the significance of symptom experience in patients on a waiting list for CABG surgery and also point to the need for further testing of this version of the SFSDS.