Anne Jalowiec

Psychometric assessment of the Jalowiec Coping Scale.

The Jalowiec Coping Scale consists of 40 coping behaviors culled from a comprehensive literature review, which are rated on a 1− to 5-point scale to indicate degree of use. Twenty judges classified the items to permit analysis of the coping behaviors according to a problem-oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. Overall agreement by the judges was 85%, with greater consensus on problem items. Evaluation of stability using a two-week retest interval (N=28) yielded significant rhos of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month interval (N=30) coefficients were .78, .84, and .83, respectively. Alpha reliability coefficients of .86 (N= 141) and .85 (N= 150) supported instrument homogeneity. Content validity is substantiated by the systematic manner of tool development, by the large number of items used, and by the inclusion of diverse coping behaviors. Factor analysis (N=141) was used to investigate construct validity. A two-factor solution to evaluate the validity of the dichotomous classification showed that 80 % of the problem items loaded on Factor I, but only 56% of the affective items loaded on Factor II. To examine this multidimensional aspect, several other factor solutions were explored. Ultimately, the four-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition of these factors is discussed, and several tentative labels for each factor are suggested.

Stress and coping in hypertensive and emergency room patients.

Stressful life events (SLEs) and coping behavior were compared in 25 emergency room patients with nonserious acute illness and 25 newly diagnosed hypertensive patients. Stress was evaluated with a modified Rahes SLE questionnaire and coping with a rating scale developed by the primary investigator. Results showed that: ER patients reported significantly more (p<.05) SLEs for the one year preceding illness onset, although more hypertensives subjectively rated their stress level as high; ER patients experienced significantly more SLEs in personal and social, home and family, and financial categories; hypertensives experienced significantly more health-related SLEs; age was seen as influencing SLEs; hypertensive patients used significantly more problem-oriented coping methods than did ER patients; hypertensives relied more on religion and physical activity in coping than did the ER group; ER patients more often day-dreamed or used their past experience as a guide for coping with stress; each group rated use of drugs as least important in coping; and educational level proved to be a salient variable affecting coping.

Predictors of quality of life in patients at one year after heart transplantation

BACKGROUND A multivariate approach to the study of relationships between quality of life and demographic, physical, and psychosocial variables after heart transplantation has not been examined in a large, multi-site sample. The purpose of this study was to describe quality of life, examine relationships between quality of life and demographic, physical, and psychosocial variables, and identify predictors of quality of life in patients who were 1 year post heart transplantation. METHODS Data were collected from a nonrandom sample of adult patients (n = 232) who were 1 year post heart transplantation at a Midwestern or Southern medical center. Nine self-administered instruments and chart review were used to gather data from patients. All tools had adequate psychometric support. Descriptive statistics, Pearson correlations, and step-wise multiple regression were used to analyze data. Level of significance was set at 0.05. RESULTS Patients were most satisfied with the areas of quality of life regarding social interaction and least satisfied with their psychological state. Patients experienced an average amount of stress, were coping fairly well, reported overall good quality of life, and were very satisfied with the outcome of their transplant surgery. Nine out of 16 variables were significant predictors of quality of life and explained 66% of the variance in quality of life: less stress, more helpfulness of information from health care providers, better health perception, better compliance with the transplant regimen, more effective coping, less functional disability, less symptom distress, older age, and fewer complications. CONCLUSIONS Predictors of quality of life at 1 year after heart transplantation were primarily psychological. Additional variance in quality of life was explained by physical, somatic sensation, demographic, and health status variables. Knowledge of these factors provides (1) information to identify patients who are at risk for poor quality of life at 1 year after heart transplantation and (2) direction for the development of interventions to improve quality of life.

Stressors in Patients Awaiting a Heart Transplant

The authors identify 39 common preoperative stressors found in 175 heart transplant candidates from two medical centers. Relevance of the 10 worst and 10 least stressors during the preop wait is discussed. The 10 worst stressors were finding out about the need for a transplant, having end-stage heart disease, family worrying, illness symptoms, waiting for a donor, uncertainty about the future, no energy for leisure activities, constantly feeling worn out, less control over life, and dependency on others. The impact of transplant waiting time on the perceived stressfulness of illness factors is also examined. One factor was more stressful for those waiting longer than the median time of 1 month; 16 factors were more stressful for those waiting less than 1 month. The novelty or familiarity of the factor seemed to influence the stressfulness ratings of many variables during the period of waiting for the transplant.

Nurse practitioner and physician care compared for nonurgent emergency room patients.

This experimental field study compared knowledge, satisfaction and compliance in 62 nonurgent emergency room (ER) patients based on whether they were cared for by a nurse practitioner (experimental group) or a physician (control). Data were collected via structured interviews in the ER, two weeks later by phone and three months later by phone, mail and chart review. No significant differences were found between groups in overall short- and long-term compliance scores, appointment-keeping scores for the three-month study period, number of health recommendations recalled, resolution of health problem or satisfaction ratings of ER care. It was also found that: referrals were the recommendation least complied with; 60 percent of appointments were kept; frequent reasons for non-compliance were inconvenience and lack of perceived need; experimental subjects showed greater comprehension of diagnostic recommendations and therapeutic applications, while controls had better knowledge of medications; 77 percent of experimentals were completely satisfied with NP care, as compared to only 48 percent of the controls with MD care; and reasons for satisfaction centered on the quality of care, while reasons for dissatisfaction focused on unresolved problems and slow care.

Issues in using multiple measures of quality of life

Assessment of quality of life requires a multifaceted approach in order to evaluate the impact of an illness, treatment, or intervention on quality of life. The use of several measures offers notable advantages over unidimensional and global assessment techniques. Disadvantages of multiple measures also exist, but these problems can be circumvented with adequate knowledge and careful planning.

Functional status one year after heart transplant.

PURPOSE: Although heart transplantation (HT) increases survival of heart failure patients, many patients still experience problems afterward that affect functioning. Purposes: (1) to compare the functional status of HT patients before transplant versus 1 year after transplant, (2) to identify functional problems 1 year post-transplant, and (3) to identify which variables predicted worse functional status 1 year later. METHODS: The sample was 237 adult HT recipients who completed the 1-year post-transplant study booklet. Functional ability was assessed by the Sickness Impact Profile. Paired t tests compared Sickness Impact Profile scores before and after transplant. Medical and demographic data plus patient questionnaire data on Sickness Impact Profile, symptoms, stressors, and compliance were used in the regression. RESULTS: Sickness Impact Profile functional scores improved significantly from pre-transplant (23.0%) to post-transplant (13.4%); however, many HT recipients still reported problems in 12 functional areas 1 year after surgery. Major problem areas were the following: work (90% of patients), eating (due to dietary restrictions, 87%), social interaction (70%), recreation (63%), home management (62%), and ambulation (54%). Only 26% were working 1 year after transplant; 59% of those working reported health-related problems performing their job. Predictors of worse functional status were greater symptom distress, more stressors, more neurologic problems, depression, female sex, older age, and lower left ventricular ejection fraction (worse cardiac function). CONCLUSIONS: Many HT recipients were still having functional problems and had not reached their full rehabilitation potential by the 1-year anniversary after transplant.

Preoperative psychosocial predictors of hospital length of stay after heart transplantation.

The effect of psychosocial factors on hospital length of stay (LOS) after heart transplantation has not been reported. This study examines relationships between preoperative psychosocial variables and LOS and identifies preoperative psychosocial predictors of LOS after transplant. A nonrandom sample of 307 patients at two medical centers completed a self-administered booklet of psychosocial measures. A chart review was also conducted. Psychosocial problems included anxiety, stress, and inadequate coping; questionable understanding of heart failure and treatment; substance abuse; and noncompliance. Self-care disability, a history of noncompliance, and more emotional disability predicted 8% of LOS. This supports the inclusion of psychosocial issues and functional disability in post-heart transplant clinical pathways.

Predictors of compliance with diet 6 months after heart transplantation

OBJECTIVE To examine and predict patient compliance with diet 6 months after heart transplantation. DESIGN Prospective, correlational design, with nonrandom sample. SETTING Midwestern and southern medical centers. PATIENTS Ninety-four adult patients who had undergone heart transplantation 6 months previously (mean age 55 years; primarily married men). VARIABLES Sixteen independent variables measured by nine instruments (with acceptable preliminary reliability and validity data) and chart review were used to predict compliance with diet 6 months after heart transplantation. STATISTICS Descriptive statistics, correlations, and multiple regression were used to analyze the data. RESULTS More than 85% of patients were compliant with their diet most or all of the time, and more than 70% of patients experienced little or no difficulty complying with their diet. Difficulty with dietary compliance, gastrointestinal symptoms, and health perception predicted dietary compliance (accounting for 38% of variance). CONCLUSIONS This study will contribute to enhanced patient care and may decrease morbidity and deaths after transplantation.

Psychometric evaluation of the hemodialysis stressor scale.

This report updates the psychometric information available on the Hemodialysis Stressor Scale. The tool is a 29-item scale that rates the incidence and severity of stressors associated with hemodialysis treatment of end-stage renal disease. Six items are classified as physiologic stressors and 23 as psychosocial stressors. Alpha homogeneity coefficients achieved acceptable standards for reliability. Content validity is demonstrated by the varied sources used to ascertain pertinent items for the scale. Construct validity of the scale was investigated by factor analysis (N = 174). A two-factor solution to evaluate the validity of the physiological-psychosocial dichotomy showed insufficient support for this simplistic dichotomous classification of hemodialysis stressors. A subsequent unrestricted factor solution to explore the multidimensionality of the scale yielded eight factors, but only three were significant, so a three-factor solution was subjected to rotation. The content of the 6 physiological and 9 psychosocial items loading significantly on Factor I characterized this factor as psychobiological; Factor II consisted of 12 psychological and social stressors; Factor III pertained to 8 dependency and restriction stressors. The three-factor solution was seen as the best-fitting solution with this particular data set because it was conceptually clear, informative, and parsimonious.