Semester

Spring

Date of Graduation

2008

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Not Listed

Committee Chair

Susan McCrone.

Abstract

Background. Studies that have explored the experiences of open-heart surgery patients have reported that incongruent or unrealistic expectations have lead to negative feelings of anger, disappointment, and frustration. Physical Health Status (PHS) limitations after open-heart surgery have resulted in negative emotions such as anxiety and depression. Depressive symptoms have been correlated with lower improvement in PHS and decreased physical and emotional recovery after surgery.;Purpose. The purpose of this research was to examine the relationship among expectations, anxiety, depression, and PHS and to determine predictors of postoperative PHS in open-heart surgery patients.;Methods. A convenience sample (N = 54) was recruited from two hospitals, one in Pennsylvania, and one in West Virginia. The sample included participants who were undergoing coronary artery bypass graft (CABG) or valve replacement surgery for the first time. The study used a longitudinal design and data was collected preoperatively in the hospital or surgeons' offices and four weeks postoperatively by phone interviews. Participants were asked to complete three questionnaires: The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), The Future Expectations Regarding Life with Heart Disease Scale, and The Hospital Anxiety and Depression (HAD) Scale. The questionnaires measured expectations, anxiety, depression, and PHS. Subjects were also asked three open-ended questions postoperatively regarding their expectations of surgery and recovery.;Findings. Repeated Measures ANOVA indicated that expectations improved after surgery (p = .246), while PHS decreased slightly after surgery (p = .323), but the findings were not significant. Anxiety and depression scores decreased postoperatively and the findings were significant (p = .002 anxiety, p = .026 depression). Pearson Product Moment Correlations revealed positive preoperative expectations were associated with better preoperative PHS (p = .008). In contrast, preoperative expectations were negatively correlated with anxiety (p = .000) and depression (p = .000). Preoperative depression was also negatively correlated with preoperative PHS (p = .006). Postoperative expectations were associated with better postoperative PHS (p = .047). In contrast, postoperative expectations were negatively correlated with postoperative anxiety ( p = .000) and postoperative depression (p = .000). Postoperative depression was also negatively correlated with postoperative PHS (p = .017). Multiple regression analyses indicated that preoperative expectations, anxiety, depression, and PHS contributed to 38% of the variance of postoperative PHS, and the findings were statistically significant (p = .000). Postoperative expectations, anxiety and depression only contributed to 8% of the variance of postoperative PHS and the findings were not significant (p = .075).;Conclusions. The findings support the need for interventions to assist patients in developing realistic expectations. The findings also support the need for clinicians to screen patients before and after surgery for anxiety and depression. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.

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