Effective follow-up and management of elderly post-CABG patients is important in the overall recovery process. Specifically, this study will attempt to bridge the gap in current literature related to the impact of follow-up interventions to enhance recovery outcomes in the CABG population. The major purpose of this experimental study is to test the effects of the symptom management home care nursing intervention (SMHCNI) on recovery outcomes of elderly CABG patients using a randomized, two group (N=284) repeated measures design with measurements at discharge, at 3 and 6 weeks, and 3 and 6 months post- operatively. One group will receive the intervention and routine care (RC) and the other group will receive only RC. The major aim will be to determine if the intervention group will demonstrate: better physiological functioning (decreased symptom interference on physical functioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales: physical, role-physical and vitality, and increased activity and exercise energy expenditure); better physiological conditioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales; role-emotional, social, mental, and vitality); and fewer post-operative problems (e.g., infections, fluid in lungs, heart rate rhythm problems). Additional outcomes for secondary aims are: lower levels of health care utilization [HCU] (i.e., fewer number of visits to health care providers, fewer number of emergency department visits, fewer number of home health visits, fewer rehospitalizations); and higher patient satisfaction (with level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received)> In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of symptoms, and perceived self-efficacy, and moderating variables (participation in cardiac rehabilitation) with the intervention on outcomes identified above. The intervention will be delivered using a device called the Health Buddy that is attached to the patient's telephone line, able to download to a free secure Internet site daily, and cannot be used by health care providers for post-hospital follow up care. The 6- week SMHCNI was designed using Bandura's (1986) definition of self- efficacy which is to enhance the beliefs in ones capabilities to organize and execute the sources and actions required to manage prospective situations. Preliminary data have shown that these patients are going home with symptom management problems, but that complications arising from these problems might be prevented with early detection and management. Using a follow-up intervention such as the SMHCNI is expected to result in better functioning, management of symptoms and fewer post-operative problems. Also, a better understanding of HCU, patient satisfaction, and self-efficacy as variables will be described.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR007759-02
Application #
6625587
Study Section
Nursing Research Study Section (NURS)
Program Officer
Huss, Karen
Project Start
2002-05-01
Project End
2007-01-31
Budget Start
2003-02-01
Budget End
2004-01-31
Support Year
2
Fiscal Year
2003
Total Cost
$338,100
Indirect Cost
Name
University of Nebraska Medical Center
Department
Miscellaneous
Type
Schools of Nursing
DUNS #
168559177
City
Omaha
State
NE
Country
United States
Zip Code
68198
Zimmerman, Lani M; Barnason, Susan; Schulz, Paula et al. (2012) Rural Versus Urban Comparison: Physical Activity and Functioning Following Coronary Artery Bypass Surgery. Online J Rural Nurs Health Care 12:16-28
Schulz, Paula S; Zimmerman, Lani; Pozehl, Bunny et al. (2011) Symptom management strategies used by elderly patients after coronary artery bypass surgery. Appl Nurs Res 24:65-73
Zimmerman, Lani; Barnason, Susan; Hertzog, Melody et al. (2011) Gender differences in recovery outcomes after an early recovery symptom management intervention. Heart Lung 40:429-39
Schulz, Paula; Lottman, Donna J; Barkmeier, Travis L et al. (2011) Medications and associated symptoms/problems after coronary artery bypass surgery. Heart Lung 40:130-8
Abbott, Amy A; Barnason, Susan; Zimmerman, Lani (2010) Symptom burden clusters and their impact on psychosocial functioning following coronary artery bypass surgery. J Cardiovasc Nurs 25:301-10
Barnason, Susan; Zimmerman, Lani; Nieveen, Janet et al. (2009) Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung 38:364-76
Barnason, Susan; Zimmerman, Lani; Schulz, Paula et al. (2009) Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. Heart Lung 38:459-68
Barnason, Susan; Zimmerman, Lani; Nieveen, Janet et al. (2008) Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery. Heart Lung 37:245-56
Nieveen, Janet L; Zimmerman, Lani M; Barnason, Susan A et al. (2008) Development and content validity testing of the Cardiac Symptom Survey in patients after coronary artery bypass grafting. Heart Lung 37:17-27
Zimmerman, Lani; Barnason, Susan; Schulz, Paula et al. (2007) The effects of a symptom management intervention on symptom evaluation, physical functioning, and physical activity for women after coronary artery bypass surgery. J Cardiovasc Nurs 22:493-500

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