Date of Award

Spring 1995

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Nursing

First Advisor

Fehring, Richard J.

Second Advisor

Simandl, Gladys

Third Advisor

Frenn, Marilyn

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) is a commonly accepted treatment for coronary artery disease (CAD). Over 400,000 have been performed in 1993 (Crawford & Holland, 1993). Much is known about the medical outcome of a PTCA. Yet, little is known or published about the health behavior changes patients go through after a PTCA. This study explored two questions through interviews from patients who had a one vessel PTCA. The dual purposes of this study were to examine what variables clients identified as enablers or disablers for healthier lifestyle behavior changes after a PTCA and to examine how, if at all, do the variables change from one day after a PTCA to approximately 30 days after the PTCA. A combination of phenomenology and an emergent fit of grounded theory were used to refine the framework proposed by Frenn, Borgeson, Lee, and Simandl (1989). A qualitative study was conducted with a sample of three adult men and two adult women who had a PTCA at a large, midwestern hospital. The first interview took place the day after the PTCA in the hospital. Demographic information and five open-ended questions were asked and audiotaped. The second interview was conducted around 30 days later. It took place at the subjects' places of convenience: three at their home, one at a clinic, and one at the hospital. The same five questions from the first interview were asked and audiotaped in the second interview so the answers could be compared. Data were analyzed and several conclusions were drawn from the analysis. First, precipitants to change contained health protection and health promotion behaviors. Those behavior changes were: have to, fear, enjoyment for life, and future goals. Secondly, the subjects then identified enabling and disabling forces which influenced their behavior changes. Those forces were: Family/friends, information, control, and other existing health problems. Lastly, the subjects identified the same precipitants to change and the same forces influencing change during both interviews. The only difference was a clearer articulation of the precipitants and forces during the second interview. These findings suggest an expansion of an extant model of health behavior changes in individuals with CAD. Findings also suggest that nurses need to attend to what the individuals say while convalescing in the hospital since those findings didn't change when they return home. Finally, the findings suggest areas that nurses should address while the individuals are in the hospital and to bridge the gap to the clinic or outside the hospital. The areas to address are the precipitants to change and forces influencing change. Health promotive behavior has received widespread multidisciplinary attention in research and program development. The recent trend toward public awareness of lifestyles, the emphasis on health behavior, and behavior change techniques for wellness enhancement are issues for all nurses. There is little dispute that significant improvements in health status are achievable with medical intervention and changes in personal patterns of self-directed action. Nurses need to be aware of these behaviors and what enables or disables those behaviors from occurring. This study has provided some evidence and information to enhance and better refine a framework which can be utilized in nursing practice to guide nursing interventions.

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