Abstract

An important nursing objective is to assist patients through stressful experiences. It has been assumed that cardiac surgery constitutes such a stress situation. For this reason, twenty-two patients undergoing cardiac surgery at Loma Linda University Hospital studied for the purpose of exploring the degree and time-course of were psychological stress.

The methodology consisted of administration of psychological tests before and after surgery; determination of urine catecholamines (UCA) before, during and after surgery; administration of a coping assessment tool before surgery, and a recall interview on the fifth day after surgery. The Multiple Affect Adjective Check List (MAACL)-Today form, and the State-Trait Anxiety Inventory (STAI)-State and Trait forms were the standardized tests of emotional stress. A predictive assessment of coping was formulated and done preoperatively. Rate of urinary excretion of catecholamines was the biological index used. All urine specimens were analyzed by fluorometric quantitation for catecholamines, using Bio-Rad Laboratories' modified trihydroxyindole method.

A significant difference was found between most of the pre- and postoperative physiological and psychological measures of stress. Increased rates of UCA output occurred during the first six hours post-surgery. The increase in measured postoperative psychological stress may be related to the nature of the surgery and ensuing procedures, the use of the recall interview, and the threat of impending surgery.

The lower index of preoperative stress in all measures may relate to differences in personality traits, the time lapse between knowledge of the need for surgery and the event, the preoperative teaching and supportive interactions, and the life-giving connotation of this kind of surgery.

A relationship significant at the 5% level of confidence existed between the events described by patients as most stressful during the post operative recall interview and the peak elevations of UCA excretion during the six hours following surgery.

The Pearson r correlation coefficient revealed some significant relationships among our measures of psychological stress. Preoperative standardized tests correlated significantly with each other, as did the same tests given postoperatively. However, few correlations were found among our measures pre- and postoperatively. Significant correlations at the 1% level existed between the MAACL and STAI-State form pre- and postoperatively. At the 5% level there were a number of correlations. The preoperative MAACL was related to the STAI-Trait form before surgery and the STAI-State form after surgery. The coping assessment tool correlated with both the UCA peak output and the output during the immediate postoperative period. Comparisons of pre- and post-surgery STAI-State forms correlated with comparisons of the UCA before surgery, the peak UCA output after surgery, and that of the total first three days after surgery.

Three relationships were found at the 10% level. The STAI-Trait and State forms given prior to surgery correlated with each other. The coping assessment tool was related to the preoperative UCA value. Also, the UCA value during the surgical procedure was related to the length of time the patient was on cardiopulmonary bypass.

We conclude that in our group the preoperative levels of psychological stress were lower than the postoperative levels of emotional as measured by the MAACL, STAI and UCA response. stress We also conclude that, because of few correlations between these measures and the coping assessment, the validity of the assessment tool was not established. However, with further development, the coping assessment tool may have predictive potential.

LLU Discipline

Nursing

Department

Nursing

School

Graduate School

First Advisor

Dorothy M. Martin

Second Advisor

Ruth A. Wang

Third Advisor

Lavaun W. Sutton

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1971

Date (Title Page)

8-1971

Language

English

Library of Congress/MESH Subject Headings

Heart Surgery; Stress

Type

Thesis

Page Count

viii; 69

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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