The importance of self-efficacy expectations in elderly patients recovering from coronary artery bypass surgery

Abstract

Objective: To describe and test a model of recovery in the elderly after coronary artery bypass surgery derived from Self-Care and Self-Efficacy Theory.

Design: Prospective, longitudinal, repeated measures.

Setting: Two large urban teaching hospitals on the East Coast.

Patients: One hundred thirty-three adults over the age of 65 years who had coronary artery bypass surgery on hospital admission. There were 32 women and 101 men with an age range of 65 to 87 years (M = 71.8 years +/- 4.8 years) in whom 77.5% were in a New York Heart Association class of 3 or 4, indicating significant functional limitations.

Outcome measures: Self-care agency, self-efficacy expectations, and the performance of self-care/recovery behaviors at discharge, 6, and 12 weeks after coronary artery bypass surgery.

Instruments: The exercise of self-care agency was measured with the Exercise of Self-Care Agency Scale, self-efficacy expectation, and the performance of self-care/recovery behavior by the Jenkins Self-Efficacy Expectation Scales and Activity Checklists. Data were collected at discharge, 6 weeks, and 12 weeks after surgery for the specific behaviors of walking, climbing stairs, resuming general activities, and the performance of roles.

Results: Repeated measures analysis of variance revealed significant changes in self-care agency, the self-efficacy expectations for all behaviors, and the performance of the behaviors for walking, resuming general activities, and performance of roles over the recovery period (p < 0.01).

Conclusions: In support of the model, self-efficacy expectations mediated between self-care agency and all self-care/recovery behaviors at selected times. Comparison of the performance of self-care/recovery behaviors with other samples from the literature found recovery in the elderly to be protracted. Nurses can be pivotal in providing the elderly with accurate projections of recovery and an environment to support the initial mastery of self-care/recovery behaviors to promote optimal health in this vulnerable population.