This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ) scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses. 1. Introduction The leading cause of noncommunicable death (NCD) world-wide in 2008 was cardiovascular disease, accounting for 17 million, or 48%, of all NCD deaths [1]. Heart disease may lead to patients’ physical and emotional distress, job loss, disability, and reduced quality of life [2–4]. While much empirical research suggests that coronary artery bypass graft (CABG) surgery is stressful for the patient [5], the patient’s spouse may be under more stress than the patient [6, 7]. The spouse may demonstrate poorer psychological adjustment and higher levels of anxiety and depression than the patient [6], both immediately and following acute cardiac events, such as acute myocardial infarction (AMI), heart failure [8], CABG surgery [2], as well as during the first 3 months after hospital discharge [9, 10]. During and after acute cardiac interventions, spouses may well be “forgotten” in an environment devoted to the patient [11–13]. Spouses may also be more immediately concerned about the changing marital roles, as the burden of care giving and other responsibilities falls on their shoulders [6, 7]. While the impact of partners’ CABG surgery upon spouses is well documented in general, there is a dearth of research concerning how the older female spouse copes with her partner’s acute surgical event. Artinian’s research [11, 12, 14], along with Dracup et al.’s work [8], has addressed multiple factors that may affect the spouse’s coping with a
References
[1]
World Health Organization (WHO), “Fact sheet: the top 10 causes of death,” http://www.who.int/mediacentre/factsheets/fs310/en/index.html.
[2]
H. Ben-Zur, B. Rappaport, R. Ammar, and G. Uretzky, “Coping strategies, life style changes, and pessimism after open-heart surgery,” Health and Social Work, vol. 25, no. 3, pp. 201–209, 2000.
[3]
A. Ballan and G. Lee, “A comparative study of patient perceived quality of life pre and post coronary artery bypass graft surgery,” Australian Journal of Advanced Nursing, vol. 24, no. 4, pp. 24–28, 2007.
[4]
M. L. Luttik, A. Blaauwbroek, A. Dijker, and T. Jaarsma, “Living with heart failure: partner perspectives,” Journal of Cardiovascular Nursing, vol. 22, no. 2, pp. 131–137, 2007.
[5]
D. K. Moser, ““The rust of life”: impact of anxiety on cardiac patients,” American Journal of Critical Care, vol. 16, no. 4, pp. 361–369, 2007.
[6]
D. K. Moser and K. Dracup, “Role of spousal anxiety and depression in patients' psychosocial recovery after a cardiac event,” Psychosomatic Medicine, vol. 66, no. 4, pp. 527–532, 2004.
[7]
D. L. Baird and M. Eliasziw, “Disparity in perceived illness intrusiveness and illness severity between cardiac patients and their spouses,” Journal of Cardiovascular Nursing, vol. 26, no. 6, pp. 481–486, 2011.
[8]
K. Dracup, L. S. Evangelista, L. Doering, D. Tullman, D. K. Moser, and M. Hamilton, “Emotional well-being in spouses of patients with advanced heart failure,” Heart and Lung, vol. 33, no. 6, pp. 354–361, 2004.
[9]
D. K. Moser and K. Dracup, “Psychosocial recovery from a cardiac event: the influence of perceived control,” Heart and Lung, vol. 24, no. 4, pp. 273–280, 1995.
[10]
R. M. McLain and C. Dashiff, “Family stress, family adaptation, and psychological well-being of elderly coronary artery bypass grafting patients,” Dimensions of Critical Care Nursing, vol. 27, no. 3, pp. 125–131, 2008.
[11]
N. T. Artinian, The Stress Process within the Roy Adaptation Framework: Sources, Mediators and Manifestations of Coronary Artery Bypass Patients During Hospitalization and Six Weeks Post Discharge, University Microfilms International University Microfilms No. 8903215, Wayne State University, 1988.
[12]
N. T. Artinian, “Family member perceptions of a cardiac surgery event,” Focus on Critical Care, vol. 16, no. 4, pp. 301–308, 1989.
[13]
Y. Lai, S. Hsieh, W. Ho, and A. Chiou, “Factors associated with sexual quality of life in patients before and after coronary artery bypass grafting surgery,” Journal of Cardiovascular Nursing, vol. 26, no. 6, pp. 487–496, 2011.
[14]
N. T. Artinian, “Stress experience of spouses of patients having coronary artery bypass during hospitalization and 6 weeks after discharge,” Heart and Lung, vol. 20, no. 1, pp. 52–59, 1991.
[15]
R. S. Lazarus and S. Folkman, Stress, Appraisal and Coping, Springer, New York, NY, USA, 1984.
[16]
S. Folkman and R. Lazarus, Ways of Coping Questionnaire Permissions Set, Manual, Test Booklet, Scoring Key, Mind Garden, Redwood City, Calif, USA, 1988.
[17]
S. Folkman and J. T. Moskowitz, “Coping: pitfalls and promise,” Annual Review of Psychology, vol. 55, pp. 745–774, 2004.
[18]
C. S. Carver and J. Connor-Smith, “Personality and coping,” Annual Review of Psychology, vol. 61, pp. 679–704, 2010.
[19]
E. A. Skinner, K. Edge, J. Altman, and H. Sherwood, “Searching for the structure of coping: a review and critique of category systems for classifying ways of coping,” Psychological Bulletin, vol. 129, no. 2, pp. 216–269, 2003.
[20]
T. S?rlie and H. C. Sexton, “The factor structure of “The Ways of Coping Questionnaire” and the process of coping in surgical patients,” Personality and Individual Differences, vol. 30, no. 6, pp. 961–975, 2001.
[21]
G. Wagnild and H. M. Young, “Resilience among older women,” Image, vol. 22, no. 4, pp. 252–255, 1990.
[22]
G. Wagnild, “A review of the resilience Scale,” Journal of Nursing Measurement, vol. 17, no. 2, pp. 105–113, 2009.
[23]
G. M. Wagnild and H. M. Young, “Development and psychometric evaluation of the Resilience Scale,” Journal of Nursing Measurement, vol. 1, no. 2, pp. 165–178, 1993.
[24]
N. T. Artinian and C. H. Duggan, “Patterns of concerns and demands experienced by spouses following coronary artery bypass surgery,” Clinical Nursing Research, vol. 2, no. 3, pp. 278–295, 1993.
[25]
H. I. McCubbin, J. Patterson, and L. Wilson, “Family inventory of life events and changes,” in Family Assessment: Resiliency, Coping, and Adaptation—Inventories for Research and Practice, H. I. McCubbin, A. I. Thompson, and M. A. McCubbin, Eds., pp. 103–178, University of Wisconsin Publishers, Madison, Wis, USA, 1996.
[26]
I. S. Palmer, “The development of a measuring device: measuring patients' perceptions toward impending surgery,” Nursing Research, vol. 14, no. 2, pp. 100–105, 1965.
[27]
M. E. Silva, The effect of orientation information on spouse’s anxiety and attitude toward hospitalization and major general surgery [Ph.D. dissertation], University of Maryland, 1976.
[28]
E. K. Beach, B. H. Maloney, A. R. Plocica et al., “The spouse: a factor in recovery after acute myocardial infarction,” Heart and Lung, vol. 21, no. 1, pp. 30–38, 1992.
[29]
H. I. McCubbin, J. Patterson, and T. Glynn, “Social support index,” in Family Assessment: Resiliency, Coping and Adaptation—Inventories for Research and Practice, H. I. McCubbin, A. I. Thompson, and M. A. McCubbin, Eds., pp. 357–390, University of Wisconsin Publishers, Madison, Wis, USA, 1996.
[30]
R. Azar and C. R. Solomon, “Coping strategies of parents facing child diabetes mellitus,” Journal of Pediatric Nursing, vol. 16, no. 6, pp. 418–428, 2001.
[31]
S. Folkman, R. S. Lazarus, S. Pimley, and J. Novacek, “Age differences in stress and coping processes,” Psychology and Aging, vol. 2, no. 2, pp. 171–184, 1987.
[32]
R. B. King, C. E. Carlson, Y. Shade-Zeldow, K. K. Bares, E. J. Roth, and A. W. Heinemann, “Transition to home care after stroke: depression, physical health, and adaptive processes in support persons,” Research in Nursing and Health, vol. 24, no. 4, pp. 307–323, 2001.
[33]
N. Santavirta, S. Kettunen, and S. Solovieva, “Coping in spouses of patients with acute myocardial infarction in the early phase of recovery,” The Journal of Cardiovascular Nursing, vol. 16, no. 1, pp. 34–46, 2001.
[34]
J. D. A. Parker, N. S. Endler, and R. M. Bagby, “If it changes, it might be unstable: examining the factor structure of the ways of coping questionnaire,” Psychological Assessment, vol. 5, no. 3, pp. 361–368, 1993.
[35]
J. Houser, Nursing Research: Reading, Using and Creating Evidence, Jones & Bartlett, Sudbury, Mass, USA, 2008.
[36]
D. F. Polit and C. T. Beck, Generating and Assessing Evidence for Nursing Practice, Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2004.
[37]
D. G. Uitenbroek, SISA Correlation, Southampton, 1997.
[38]
K. Pargament, The Psychology of Religion and Coping, Guilford, New York, NY, USA, 1997.
[39]
World Health Organization (WHO), Women, Ageing & Health: A Framework for Action, World Health Organization (WHO), 2007.
[40]
J. R. Linnarsson, J. Bubini, and K. I. Perseius, “Review: a meta-synthesis of qualitative research into needs and experiences of significant others to critically ill or injured patients,” Journal of Clinical Nursing, vol. 19, no. 21-22, pp. 3102–3111, 2010.