The multidimensional nature of fibromyalgia syndrome (FMS) requires heath care practitioners to adopt a biopsychosocial approach to care in order to select appropriate individualized interventions for patients. The philosophical perspective of the practitioner and the level of frustration held by the practitioner towards patients with FMS are believed to contribute to the adoption of a biopsychosocial approach to care. The purpose of this study was to explore these specific practitioner characteristics and their relationship to the adoption of a psychosocial approach to care for patients with FMS. Specifically, the philosophical perspective of the practitioner and the frustration level of practitioners towards patients with FMS were explored as predictors to attitudes and beliefs about psychosocial care for patients with FMS. The sample for this descriptive correlational study consisted of 134 health care practitioners who care for patients with FMS. The Organicism-Mechanism Paradigm Inventory (OMPI) used to measure practitioner philosophical perspective and the Difficult Doctor Patient Relationship Scale (DDPRQ) used to measure frustration level in relation to attitudes and beliefs about psychosocial care for patients with fibromyalgia, measured by the Physician Belief Scale (PBS). Nurse practitioners and physicians differed significantly on philosophical perspective, frustration levels, and attitudes and beliefs about psychosocial care for patients with FMS. Philosophical perspective was a predictor of attitudes and beliefs towards psychosocial care for patients with FMS in a single predictor model. The same was true for frustration levels towards patients with FMS. However, only frustration level was predictive of attitudes and beliefs about psychosocial care when both variables of interest were entered in to a regression model. These findings have implications for care of patients with FMS. Practitioners who participate in educational interventions aimed at understanding and enhancing communication skills with patients seen as frustrating to the patient-practitioner relationship may improve care by utilization of a biopsychosocial approach.

Cardiovascular disease is the leading cause of death in America today. The potential onset of cardiovascular disease in the fourth decade for men and fifth decade for women, underscores the scope of the health problem, as the population grows older. Twenty-three percent of men and thirty percent of women who survive a myocardial infarction will have a recurrence within six months. Patients with coronary artery bypass grafts are more susceptible to progressive stenosis from atherosclerosis than native vessels. Secondary prevention through physical activity is recommended by the AHA to reduce the occurrence of these events, requiring expensive re-intervention. However, less than one half of those eligible for cardiac rehabilitation enroll. The purpose of this study is to examine whether cardiac rehabilitation or home-walking with or without nurse telephone support will affect cardiac recovery. A convenience sample of sixty-three cardiac patients self-selected a cardiac rehabilitation (comparison) program in this quasi-experimental research design. One hundred twenty-six surgical cardiac patients were randomized to a home-walking or control group. MANCOVA tests on health status, self-efficacy, and diastolic blood pressure revealed significant differences for the main effect of group on health status, self-efficacy, and diastolic blood pressure (F = 3.980, 16,647, 6.562, p = .020, .000, .011), while controlling for pre-self-efficacy, medical diagnosis, and age. Post hoc tests showed no significant difference between the cardiac rehabilitation and home-walking groups on health status (p = .485) and self-efficacy scales (p = .285). No significant difference was found between the home-walking and control groups on health status ( p = .241). A significant difference was found between the cardiac rehabilitation and control groups on all three dependent variables, respectively (p = .016, .000, .000). The home-walking group revealed a significant difference on self-efficacy from the control group (p = .000). Additional findings include significant differences between home-walking and control groups on physical function (F = 7.3354, p = .0009) and mental health (F = 4.3659, p = .0140). The findings indicate that a home-walking program could be a comparable alternative to a cardiac rehabilitation group by improving self-efficacy and health status and lowering blood pressure.