Study On Uncertainty In Illness Status And Its Affecting Factors In Cardiac Valvular Surgery Patients With Cardiopulmonary Bypass

Cardiac valvular disease is a common heart disease in China, due to the blood circulation dysfunction, resulting in impaired heart function, and then damage the liver, kidney, and respiratory, digestive and other organs function, even cause organ infarction lesions. Cardiac valvular surgery has become the best treatment for heart valve thickening, deformity and limited mobility. Application of cardiac valvular surgery is a major development in the field of cardiovascular surgery, although it is a obvious advantage, but its complex procedures, prone to cardiopulmonary complications, there is a large risk. And the operation is a kind of stress for patients, not only there is a traumatic stimulation on body, but also it will produce certain psychological change, the serious negative psychological reaction can affect the postoperative effects and complications directly. The operation patients cannot predict disease progression and prognosis because of these factors, so that uncertainty in illness is produced. Uncertainty in illness refers to a lack of ability of determination about disease, the patients have threatening disease often accompanied by uncertainty in illness. There are many influencing factors about uncertainty in illness, understanding the status of uncertainty in illness, influencing factors and the interaction mechanism is the important premise to carry out targeted interventions. Domestic and foreign scholars gave a positive attention to the influencing factors of uncertainty in illness, but their research objects were cancer or chronic disease patients, less of operation patients research, at present cardiac valvular surgery patients with cardiopulmonary bypass are not researched. Uncertainty in illness status and its affecting factors in cardiac valvular surgery patients with cardiopulmonary bypass are unclear, leading to the difficulty in making clinical interventions.Objectives:The purpose of this study was to explore the uncertainty in illness status in cardiac valvular surgery patients with cardiopulmonary bypass and to analysis on factors affecting uncertainty in illness. It established the theoretical foundation for the implementation of effective intervention measures.To explore the general condition, uncertainty in illness, resilience and copping style in cardiac valvular surgery patients with cardiopulmonary bypass, to understand the status of uncertainty in illness and characteristics of resilience and copping style, and to analysis influencing factors of demographic factors, resilience and coping style on uncertainty in illness. According to the patients with different level of uncertainty in illness, resilience and coping style in order to provide scientific basis for the implementation of psychological nursing.Methods:This cross-sectional survey was performed from January2013to July2013in four thoracic and cardiovascular surgery hospitals in Guangdong. By using convenience sampling, patients were investigated with the self-designed questionnaire, Mishel Uncertainty in Illness Scale (MUIS),Connor-Davidson Resilience Scale (CD-RISC) and Medical Coping Modes Questionnaire (MCMQ) to explore patients’social demography, uncertainty in illness status, resilience and coping style. Time point survey for the preoperative day and the day before discharge. The uncertainty in illness status of cardiac valvular surgery patients with cardiopulmonary bypass was described and the uncertainty in illness levels in different patients were compared. The resilience status and the resilience levels in different patients were described.In addition, the situation of patients’coping style and the popular coping style in patients were described and the difference between patients’coping style and the Chinese norm was also analyzed. Furthermore, correlation analysis was used to analyze the relationship among uncertainty in illness, resilience and coping style and multiple stepwise regression analysis was used to analyze the factors affecting uncertainty in illness.The statistical package for the social sciences (SPSS) software13.0was used for all data entry and analysis. Cronbach’s a and Content validity statistical analyses were employed to evaluate the content validity and reliability of the questionnaire. Descriptive and basic statistical analysis of the data were performed and the Pearson correlation analysis was used to analyze the relationship between uncertainty in illness level resilience and coping style. One way ANOVA was used to compare the uncertainty in illness level and resilience in different patients. One-sample T test was used to compare the difference of coping style between cardiac valvular surgery patients with cardiopulmonary bypass and Chinese norm. Paired-Samples T test was used to compare the difference of uncertainty in illness, resilience and coping style between the preoperative day and the day before discharge. Multiple linear regression was employed to analyze the factors affecting uncertainty in illness.ResultsAnalysis of results of uncertainty in illness status, residence status, coping style status and the factors affecting uncertainty in illness level in cardiac valvular surgery patients with cardiopulmonary bypass.1. Of the220questionnaires distributed, there were208valid surveys, and the return rate was94.55%. The208patients were aged between24and76years, with the average age of52.45±13.62years. Males accounted for102, and females accounted for106.2. Uncertainty in illness status in cardiac valvular surgery patients with cardiopulmonary bypass. The preoperative day,the average total score of uncertainty in illness in208patients is99.09±11.41, with the minimum of72and the maximum of125. Of all the patients,4patients (1.9%) had low level of uncertainty in illness,192patients (92.3%) had moderate level of uncertainty in illness, and12patients (5.8%) had high level of uncertainty in illness. The day before discharge, the average total score of uncertainty in illness in208patients is90.33±10.32, with the minimum of61and the maximum of116. Of all the patients,17patients (8.2%) had low level of uncertainty in illness and191patients (91.8%) had moderate level of uncertainty in illness. The score of uncertainty in illness of patients in the preoperative day was significant higher than patients in the day before discharge (P=0.000). The difference of the total score of the uncertainty in illness of different gender, age, marital status, education level, work status, place of residence, monthly income, medical payment (the day before discharge),types of cardiac valvular disease, operation frequency (the preoperative day), operation modes and time of stay in ICU of patients was statistically significant(P<0.05).3. Residence status in cardiac valvular surgery patients with cardiopulmonary bypass. The preoperative day, the average total score of residence in208patients is53.45±11.79, with the minimum of24and the maximum of89. The score of "tenacity" was27.28±6.60, the score of "strength" was17.46±4.61, and the score of "optimism" was8.71±1.88. The day before discharge, the average total score of residence in208patients is55.38±10.63, with the minimum of20and the maximum of84. The score of "tenacity" was28.21±5.87, the score of "strength" was18.21±4.02, and the score of "optimism" was8.96±1.85.The score of tenacity, strength and residence of patients in the preoperative day was significant lower than patients in the day before discharge (P<0.05). The difference of the total score of the residence of different gender, nationality (the day before discharge), marital status (the day before discharge), education level, work status, monthly income (the day before discharge), place of residence(the preoperative day), religious belief, types of cardiac valvular disease(the preoperative day), operation frequency (the preoperative day), and operation modes was statistically significant(P<0.05).4. Coping style status in cardiac valvular surgery patients with cardiopulmonary bypass. The preoperative day, the total score of coping style in208patients is44.15±4.76. The score of "confrontation" was17.34±3.58, the score of "avoidance" was17.06±2.10, and the score of "acceptance-resignation" was9.75±2.93. The day before discharge, the total score of coping style in208patients is44.32±4.25. The score of "confrontation" was18.13±3.38, the score of "avoidance" was16.95±1.75, and the score of "acceptance-resignation" was9.24±2.47. The score of "confrontation" in cardiac valvular surgery patients with cardiopulmonary bypass was significantly lower than Chinese norm the preoperative day and the day before discharge (P=0.000), the score of "avoidance" was significantly higher than Chinese norm (P=0.000), the score of "acceptance-resignation" was significantly higher than Chinese norm (P<0.05)5. The factors affecting uncertainty in illness level in cardiac valvular surgery patients with cardiopulmonary bypass are:age (the preoperative day, P=0.008; the day before discharge, P=0.019), monthly income (the preoperative day, P=0.004; the day before discharge, P=0.000), types of cardiac valvular disease (the preoperative day, P=0.027), operation frequency (the preoperative day, P=0.003), strength (the preoperative day,P=0.000), optimism (the preoperative day, P=0.002).residence (the day before discharge, P=0.000), confrontation (the preoperative day, P=0.000; the day before discharge, P=0.001) and acceptance-resignation coping style (the preoperative day, P=0.000; the day before discharge, P=0.000)Conclusion:Analysis of status of uncertainty in illness, residence and coping style in cardiac valvular surgery patients with cardiopulmonary bypass, and to investigate influencing factors of demographic factors, resilience and coping style on uncertainty in illness.1. Uncertainty in illness level in cardiac valvular surgery patients with cardiopulmonary bypass is moderate. We should pay attention to patients with higher level of uncertainty in illness, such as female, age60to69years old, divorced or widowed, the education level of junior middle school or below, the unemployed, lower monthly income, rural residents, the new payment method (the day before discharge), two kinds of valve lesions or more, the second cardiac valve operation (the preoperative day), replacement and angioplasty operation of cardiac valve and long time in ICU. The score of uncertainty in illness of patients in the day before discharge was significant lower than patients in the preoperative day, but uncertainty in illness level in patients is moderate in the day before discharge. Indicating that routine medical work still exists defects in a certain extent.2. Residence level in cardiac valvular surgery patients with cardiopulmonary bypass is lower. The residence level of the patients is lower, such as female, nationality (the day before discharge), divorced or widowed (the day before discharge), the education level of junior middle school or below, the unemployed, lower monthly income (the day before discharge), rural residents (the preoperative day), no religious belief, two kinds of valve lesions or more(the preoperative day), the second cardiac valve operation (the preoperative day), replacement and angioplasty operation of cardiac valve. The residence level of the patients in the day before discharge was significant higher than patients in the preoperative day, Indicating that routine psychological nursing work can improve the residence level of the patients; The residence level of the patients in the day before discharge was significant lower than domestic and foreign young people, community groups and cancer patients. Because the total level of residence in cardiac valvular surgery patients with cardiopulmonary bypass is lower, we should pay close attention to the patients and imply appropriate measures, so that we can enhance the resilience level of the patients comprehensively.3. The score of "confrontation" of coping style in cardiac valvular surgery patients with cardiopulmonary bypass was significantly lower than Chinese norm, the score of "avoidance" and "acceptance-resignation" was significantly higher than Chinese norm. More patients consider themselves incapable of disease, only resign themselves to their fate, the patients are prone to take negative measures of avoidance and acceptance-resignation to deal with problems. Less patients pay attention to information of operation treatment actively and seek to relatives and friends to support and help, less patients are prone to take active measures of confrontation to deal with problems.4. The factors influencing uncertainty in illness level for cardiac valvular surgery patients with cardiopulmonary bypass are age, monthly income, types of cardiac valvular disease, operation frequency, resilience and confrontation and acceptance-resignation of coping style. Resilience and confrontation of coping style have an passive effect on patients’uncertainty in illness level. Avoidance and acceptance-resignation of coping style have an positive effect on patients’uncertainty in illness level. We should focus on direct effects of resilience and confrontation of coping style on patients’uncertainty in illness level and avoid the passive effects of avoidance and acceptance-resignation of coping style when we make intervention measures, so we can guide the patients actively, reduce the level of uncertainty in illness.In addition, we should not neglect the mediating effect of resilience on patients’uncertainty in illness level, we can reduce the level of uncertainty in illness indirectly through strengthening the methods of resilience.