Children undergoing major orthopedic surgery encounter different stressors over the many months of recovery. How children experience the event, how they cope with it and how coping influences their postoperative outcomes are factors critical to the success of their management and recovery. The purpose of the proposed study is to test the effects of interventions designed to alter children's attention focus and coping. It is proposed that interventions providing concrete-objective information and instruction in coping will direct patients' attention to the problems usually encountered at specific times during recovery, and will emphasize vigilant, problem-solving coping. The proposed study also expands prior research by extending the assessment of coping over the postoperative period, in order to be able to make more definitive statements about the effectiveness of particular strategies over time and situations. The effects of the attention interventions will be assessed using a completely randomized 2 x 2 factorial design with two factors (coping and information), each having two levels (coping instruction vs. No coping instruction, and information vs. No information). The results in four groups to be tested. The intervention effects assessed using 2 x 2 ANOVA yield a coping main effect, an information main effect and a coping by information interaction effect. Planned contrasts among experimental groups will be used to assess specific forms of interactions. IN order to assess the effects of a child's pre and postoperative coping on outcomes over time, coping will be assessed at specific points during hospitalization and over the nine month recovery course. Results will be assessed using correlations and multiple regressions, and differences in coping over time will be explored using a one-factor repeated measures ANOVA. The findings of the proposed research will help explicate the usefulness of particular strategies over time, and in dealing with different stressors of surgery. The knowledge gained of how specific information helps patients to achieve positive outcomes, is important for health care professionals to know as they plan interventions for pediatric surgical patients.
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