Patients\u27 expected and actual functional status after coronary artery bypass graft surgery

The purpose of this study was to examine coronary artery disease (CAD) patients\u27 expectations regarding the effect of surgery on their postoperative functional status. Bandura\u27s theory of expectations provided the framework: patients\u27 capacity and outcome expectations would significantly impact their decision to have coronary artery bypass graft (CABG) surgery and contribute to their actual functional status after surgery. The study\u27s goals were to: (1) establish functional status levels for CAD patients prior to CABG surgery, and at six and 12 weeks postoperatively; (2) identify which physical functional activities CABG patients consider most important; and (3) determine the degree of congruence between patients\u27 expected and actual functional status at 12 weeks post-CABG surgery. A prospective, repeated measures design was used. Seventy-eight consenting adults completed the SF-36 health status survey during pre-testing for CABG surgery, and at six and 12 weeks post-CABG surgery. At 12 weeks post-CABG surgery patients identified the functional status they had expected at that time. Additionally, patients rated the importance of eight physical activities on the SF-36 health status survey. Parsonnet Risk score, New York Heart Association classification, and left ventricular ejection fraction were used to describe pre-surgical physiological status. Data analysis included descriptive statistics, rank order of mean importance scores for each activity, ANOVA, Chronbach\u27s alpha, and paired t-test. Results indicated a significant relationship between actual and expected functioning at 12 weeks after surgery. Patients ranked having enough energy to perform normal activities of daily living as most important to them. Patients whose preoperative functional status scores ranged from 59 to 100% of U.S. adult norms had postoperative scores that approached 79 to 100% of U.S. norms at six weeks and 90 to 100% at 12 weeks after surgery. Return of physical functioning, role-physical and role-emotional activities to adult norms did not occur in 12 weeks. This study has contributed to nursing practice by providing empirical data about pre- and post-CABG surgery functional status in elective cases, which expands the information available for pre-CABG patient counseling, coaching patient progress during recovery, setting postoperative goals and predicting CABG patients\u27 resource utilization during the postoperative and post-discharge (12-week) period

Measuring patient-provider trust in a primary care population: refinement of the health care relationship trust scale

Accurately measuring trust between patients and health care providers is important because low patient-provider trust can lead to poor treatment adherence and negative health outcomes. To measure patient-provider trust, we developed the Health Care Relationship (HCR) Trust scale. Findings from our initial use of the scale suggested the need to examine the scale\u27s psychometric performance in a larger sample of adults with various chronic health conditions. We therefore examined the psychometric properties of the HCR Trust Scale in a random sample of adult primary care patients. Thirteen of the original 15 items fit the data best; a single-factor structure explained 67% of the variance in patient-provider trust. The Cronbach\u27s alpha for the 13-item HCR Trust Scale-Revised was .96