The relationship of physiological status, coping, and hardiness to patient outcomes in chronic illness

Abstract

Nurses caring for the chronically ill are confronted with the enigma of disparate outcomes among patients having the same clinical diagnosis and similar physiological status. The purpose of this study was to examine the relationships of physiological status, coping, and hardiness to patient outcomes in chronic illness. Hardiness and coping strategies were viewed as mediating variables between physiological status and patient outcomes. Chronic Obstructive Pulmonary Disease (COPD) was the prototypic chronic illness under study because of its insidious onset, slow progression, advanced stage symptoms, and associated high mortality. The Institute of Medicine (IOM) model for stress research, consistent with Lazarus\u27 theory of stress and coping, provided a framework for the study. The physiological status of 104 adults (85 men, 19 women) with COPD was measured using standardized Pulmonary Function Testing (PFT). Subjects completed the Health Related Hardiness Scale (HRHS), the Ways of Coping (WCQ) Questionnaire with three additional open-ended questions, a Pulmonary Impact Profile Scale (PIPS), and a 12-minute measured walk (12MD). After psychometric evaluation of the PIPS, data were analyzed by descriptive statistics, Analysis of Variance (ANOVA), and Pearson Correlation coefficients. Predictor variables for patient outcomes were examined using Multiple Regression Analysis. Coping strategies did not relate to outcomes (12MD: F =.509, p =.603; PIPS: F =.019, p =.982). Patients with COPD incorporated both problem-focused and emotion-focused strategies. Open-end responses identified coping in terms of problem solving and positive reappraisal strategies; the problems most frequently identified were adjustment to limitations and shortness of breath . Commitment (r =.18) and challenge (r =.21) components of hardiness had significant correlations (p $\u3c$.05) with 12MD, whereas control did not. High hardy individuals used Planful Problem Solving strategies significantly more often (F = 7.772, p =.006) than low hardy subjects. Physiological status and hardiness explained a greater amount of variance in distance walked (R\sp2 =.187, p $\u3c$.0001) than in the PIPS score (R\sp2 =.090, p =.008). Coping strategies did not contribute significantly to either PIPS or 12MD outcomes. Face validity of the PIPS was supported by qualitative data depicting perceived problem areas of dyspnea, activity limitations, and emotional adjustment