COGNITIVE APPRAISAL OF PSYCHOLOGICAL STRESS, APPRAISAL CONTEXTS AND LIFE DISRUPTION IN PATIENTS HAVING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (ANGIOPLASTY PATIENTS).
Contributors: University of Rochester.
Published: 1992
Number of pages: 213
Subjects: Health Sciences, Nursing.
Description: The purpose of the study was to explicate the process of cognitive appraisal in a sample of patients having percutaneous transluminal coronary angioplasty (PTCA). Two models of different illness-related contexts for cognitive appraisals of PTCA were examined to determine which was the better predictor of coping outcomes following treatment. One model focused on procedural perceptions of PTCA such as whether or not it was painful, a specific appraisal context. The other model focused on illness altering perceptions of how PTCA affected heart disease, a broad appraisal context.

Subjects were studied at three time points: within 24 hours prior to the procedure, at discharge and at two weeks following discharge from the hospital. A convenience sample of 100 subjects was selected from among those patients scheduled to have non-emergent PTCA. Measures of optimism, heart disease threat, and appraisals of threat, harm, challenge and benefit associated with PTCA were obtained. Functional and emotional outcomes of coping were operationalized using the Sickness Impact Profile and the Profile of Mood States. Procedural perceptions and illness altering perceptions were measured using instruments developed by the researcher. Of the 74 subjects who had successful PTCA, 59 subjects comprised the final analytic sample. Subjects' mean age was 62 years (SD 11 years).

Path analyses and goodness of fit tests were used to test the models. Analyses indicated that both procedural perceptions and illness altering perceptions played similar roles in mediating the effects of optimism on coping outcomes. Further hierarchical regressions demonstrated that global threat of heart disease was the best and most consistent predictor of functional and emotional outcomes following PTCA. Increased threat of heart disease was associated with more disruption in usual daily activities and less positive mood two weeks following successful PTCA. Procedural perceptions and illness altering perceptions were noted to change over time, while threat of heart disease remained stable.

Findings were interpreted in light of theoretical formulations about hierarchical processing of illness representations and personal narratives of illness. Cognitive processing of coronary artery disease-related threats may occur at different levels of abstraction. Nursing interventions designed to help persons cope with PTCA should involve careful assessment of the multiple meanings of the experience for patients, particularly patients' perceptions of coronary artery disease.
Notes: Source: Dissertation Abstracts International, Volume: 53-11, Section: B, page: 5648.

Thesis (PH.D.)--THE UNIVERSITY OF ROCHESTER, 1992.

School code: 0188.