2.50
Hdl Handle:
http://hdl.handle.net/10755/163680
Category:
Abstract
Type:
Presentation
Title:
Response shift in aged survivors of cardiac surgery
Author(s):
Mick, Diane; Ackerman, Michael H.; Ryan, Jean
Author Details:
Diane Mick, Assistant Professor, University of Rochester, School of Nursing, Rochester, New York, USA, email: Diane_Mick@urmc.rochester.edu; Michael H. Ackerman; Jean Ryan
Abstract:
Purpose: To test an adapted model of response shift. Specific Aim: To enhance understanding of aged patients' recovery experiences following cardiac surgery. Framework: Response shift is an emerging construct that is regarded as a cognitive/behavioral mediator of the subjective adaptation process to chronic illness. In the aftermath of hospitalization, aged persons may experience response shift, a transformation in their idea of what constitutes acceptable physical health and functioning. This shift may involve true behavioral change (alpha change); it may reflect a recalibration of internal standards (beta change), or it may represent a reconceptualization of health (gamma change). Methods: In this prospective descriptive feasibility pilot study, thirty very old subjects (> 75 years), who have been hospitalized at a major Northeastern academic medical center for cardiac surgery, including coronary artery bypass grafting and/or valve replacement, will be evaluated cognitively during hospitalization, and at one-month and three-month intervals during home visits following discharge, using the Brief MMSE. Perceptions of functional status will be evaluated during hospitalization, and at the same post-discharge time intervals, using the Physical Functioning sub-scale of the MOS SF-36 Standard Version Questionnaire. Chronic illnesses will be quantified via the Charlson Comorbidity Index at the time of study entrance. Comparisons of retrospective pre-tests (reevaluations of prior health) and prospective then tests (projected expectations of health), via the 10-item Physical Functioning sub-scale of the SF-36, as well as narrative analysis of tape-recorded subject discussion at each time interval, following an investigator developed interview form, will be utilized to determine whether response shift has taken place. A 3 x 3 repeated measures ANOVA will be constructed to examine the relationships among baseline assessments of physical health and functioning. Retrospective pre-tests at 1 month and 3 months post-discharge, and prospective then tests focused toward perceptions of future physical health and functioning at 1 month and 3 months post-discharge will be carried out. Growth curve analysis, focusing on individual growth trajectories of each subject, will be utilized as a first step in determining whether response shift has occurred. Implications: Examination of subjective appraisals of post-illness physical health and function among aged survivors of cardiac surgery holds potential for understanding the recovery experience, as well as for evaluating such indicators as latent markers of successive decline. Model testing may demonstrate that, in the presence of response shift, objective measurements of health do not reveal sufficient substantive information on which to base treatment decisions for the very old. Ultimately, the clinical significance of this study will extend to development of a psychometrically sound demonstration measure that will combine objective clinical indicators and patients' subjective reports of health and function. Concurrent with this effort, design of home-based restorative interventions, grounded in enhanced understanding of aged persons' subjective self-appraisals, will help to ensure the health and autonomy that is central to a fulfilling and productive old age.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleResponse shift in aged survivors of cardiac surgeryen_GB
dc.contributor.authorMick, Dianeen_US
dc.contributor.authorAckerman, Michael H.en_US
dc.contributor.authorRyan, Jeanen_US
dc.author.detailsDiane Mick, Assistant Professor, University of Rochester, School of Nursing, Rochester, New York, USA, email: Diane_Mick@urmc.rochester.edu; Michael H. Ackerman; Jean Ryanen_US
dc.identifier.urihttp://hdl.handle.net/10755/163680-
dc.description.abstractPurpose: To test an adapted model of response shift. Specific Aim: To enhance understanding of aged patients' recovery experiences following cardiac surgery. Framework: Response shift is an emerging construct that is regarded as a cognitive/behavioral mediator of the subjective adaptation process to chronic illness. In the aftermath of hospitalization, aged persons may experience response shift, a transformation in their idea of what constitutes acceptable physical health and functioning. This shift may involve true behavioral change (alpha change); it may reflect a recalibration of internal standards (beta change), or it may represent a reconceptualization of health (gamma change). Methods: In this prospective descriptive feasibility pilot study, thirty very old subjects (> 75 years), who have been hospitalized at a major Northeastern academic medical center for cardiac surgery, including coronary artery bypass grafting and/or valve replacement, will be evaluated cognitively during hospitalization, and at one-month and three-month intervals during home visits following discharge, using the Brief MMSE. Perceptions of functional status will be evaluated during hospitalization, and at the same post-discharge time intervals, using the Physical Functioning sub-scale of the MOS SF-36 Standard Version Questionnaire. Chronic illnesses will be quantified via the Charlson Comorbidity Index at the time of study entrance. Comparisons of retrospective pre-tests (reevaluations of prior health) and prospective then tests (projected expectations of health), via the 10-item Physical Functioning sub-scale of the SF-36, as well as narrative analysis of tape-recorded subject discussion at each time interval, following an investigator developed interview form, will be utilized to determine whether response shift has taken place. A 3 x 3 repeated measures ANOVA will be constructed to examine the relationships among baseline assessments of physical health and functioning. Retrospective pre-tests at 1 month and 3 months post-discharge, and prospective then tests focused toward perceptions of future physical health and functioning at 1 month and 3 months post-discharge will be carried out. Growth curve analysis, focusing on individual growth trajectories of each subject, will be utilized as a first step in determining whether response shift has occurred. Implications: Examination of subjective appraisals of post-illness physical health and function among aged survivors of cardiac surgery holds potential for understanding the recovery experience, as well as for evaluating such indicators as latent markers of successive decline. Model testing may demonstrate that, in the presence of response shift, objective measurements of health do not reveal sufficient substantive information on which to base treatment decisions for the very old. Ultimately, the clinical significance of this study will extend to development of a psychometrically sound demonstration measure that will combine objective clinical indicators and patients' subjective reports of health and function. Concurrent with this effort, design of home-based restorative interventions, grounded in enhanced understanding of aged persons' subjective self-appraisals, will help to ensure the health and autonomy that is central to a fulfilling and productive old age.en_GB
dc.date.available2011-10-27T11:11:54Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:11:54Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.