Many patients experience psychological distress following a myocardial infarction (MI). Emotional problems can interfere with a return to family, social and work-related activities, and are associated with poor cardiac prognosis. Although many psychosocial intervention programs designed for this population have been evaluated, little is known about which components of the interventions are effective. The major aim of the present secondary analysis was to identify the types of patient-nurse interactions associated with a reduction in psychological distress in post-MI patients who participated in the Montreal Heart Attack Readjustment Trial (M-HART) randomized controlled study of home-based psychosocial nursing interventions. / The sample for the present study included 431 patients (36.2% female) in the treatment group who received at least two home nursing visits over a two-month period. The types of concerns experienced by patients (those related to symptoms, treatment, uncertainty, interpersonal roles, and work/finance) and the types of nursing approaches undertaken during the first two home visits (cognitive, educational, emotionally supportive including reassurance/encouragement, listening and providing advice, and managerial) were examined in relationship to short-term changes in distress. These relationships were examined in the sample as a whole and also in subgroup analyses where gender and baseline level of depressive symptoms were taken into account. / In the sample as a whole, reassurance/encouragement and listening were related to a reduction in distress, but mainly for patients who had physical symptoms and treatment-related concerns. The provision of advice for psychologically-related concerns such as fears was not associated with better outcomes. However, nursing approaches that were more directive (educational, cognitive and advice) appeared to have been linked to better outcomes in men, but less so in women, while listening was associated with reductions in distress in women, but not in men. Reductions in distress after the two visits was less common in patients with higher baseline levels of depressive symptoms, and those who presented psychologically-related concerns. Finally, patients who showed short-term reductions in distress had lower death rates, lower readmission rates, and a lower risk of reporting depressive symptoms at one year. / These results highlight the importance of determining the types of intervention approaches that may be most effective in men and in women, and identifying patients who are more and less likely to benefit from psychosocial interventions such as those provided in M-HART. It is also particularly notable that post-MI patients whose short-term psychological distress is reduced by individualized psychosocial interventions appear to have improved cardiac prognosis and reduced depressive symptoms in the longer term.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.36569 |
| Date | January 2000 |
| Creators | Cossette, Sylvie. |
| Contributors | Frasure-Smith, Nancy (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (School of Nursing.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001754349, proquestno: NQ64541, Theses scanned by UMI/ProQuest. |
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