Recovery from coronary artery bypass surgery: age-related outcomes

As people age, their incidence of coronary heart disease increases. The majority of persons undergoing invasive procedures such as coronary artery bypass surgery are 65 and older. Because of population trends related to aging, it is projected that there will be exponential increases in the numbers of people requiring treatment for this health problem in the future. Changes in health care reimbursement have significantly decreased hospital length of stay, resulting in many patients completing their recovery either in a rehabilitation facility or at home. Patients with multiple preoperative comorbidities are at risk for postoperative complications. Older patients usually have more health problems after coronary artery bypass surgery because they have more risk factors prior to the procedure. It is not known whether there are differences in outcomes between comparatively older and younger patients when they are matched by risk classification. Information on the recovery of patients at home will enable nurses to meet their care needs prior to surgery and after discharge from the hospital

Illness Representations, Emotional Distress, Coping Strategies, and Coping Efficacy as Predictors of Patient Outcomes in Type 2 Diabetes

Aim.  To examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of self-care behaviour and A1c levels in individuals with type 2 diabetes. Background.  Diabetes mellitus affects 23·6 million Americans and is the seventh leading cause of death in the United States. Reduction in complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control. Understanding the degree of influence that psychosocial factors have on individuals’ decisions to perform self-regulation activities will give insight on strategies to encourage better decision-making to prevent acute and chronic complications. Methods.  A descriptive, correlational design examined the psychosocial factors to determine the predictive relationships with self-care behaviour and A1c levels. Participants were 119 men and women recruited from physician offices, medical clinics, and diabetes education centers. The research was conducted from March–December 2007. Results.  Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analyses revealed that a) coping efficacy uniquely accounted for 9% of the variance in self-care behaviour and b) illness representations, particularly timeline-cyclical, uniquely accounted for 12% of the variance in A1c levels. Conclusions.  The findings confirm how illness representations, emotional distress, coping strategies, and coping efficacy influence self-care behaviour and health outcomes. Psychosocial factors can influence lifestyle behaviour changes and outcomes of individuals with diabetes mellitus. Relevance to clinical practice.  Findings from the study have implications for nurses in the areas of assessment, diabetes management, coping skills training, and cognitive behavioural therapy. Nurses should incorporate these strategies into their daily practice to help individuals identify successful coping strategies, enhance coping efficacy, and change misconceptions about diabetes mellitus to improve self-care behaviour and health outcomes