In reviewing The Beneficial Effects on Physical and Psychological
Well-Being (1989) Scheier, Magovern, Abbott, Matthews, Owens, Lefebvre, and
Carver put into perspective the measurable effects stress has on individuals
recovering from coronary artery bypass surgery (CABS). A highly stressful procedure for most people;
but an environment beneficial for determining the effects optimism has on the physical
and psychological well-being of patients.
Scheier et. al. (1989), specifically wanted to measure the coping
strategies used and the “beneficial effects on the patient’s mood, rate of
recovery, and quality of life” through medical staff projections and a series
of three patient surveys; one pre and two post-surgery (p. 1026).
The
effects of optimism are different from person to person. According to Scheier et. al. (1989) “One
possibility is that the differences in well-being between optimists and
pessimists derive from differences between them in the kinds of strategies they
use to deal with stressful encounters” (p. 1025). That is, problem-focused coping or
emotion-focused coping; problem-focused coping is associated with optimistic
outlooks and emotion-focused coping with pessimistic. This required a pre-surgical assessment to
determine the current style of coping for each participant. Using the Life Orientation Test (LOT), this
evaluation based information measures the patients pre-existing style of
coping. Patients were asked, before
surgery, to identify what expectations they had about their recovery progress. After surgery, patients were asked to
indicate when they believed he or she would “return to normal,” they were also physically
assessed to measure recovery markers (e.g., sitting, standing, walking, etc--) (p.
1027). In both cases, patients with an
optimistic outlook tended to predict a better outcome than did pessimists. Six to eight days post-surgery medical personnel
examining patients also provided their assessment on where the patient’s
physical and psychological recovery might be at month four. Although further details will be discussed
later, results were marginal. At six
weeks, post-op surgeons identified how patients were recovering (e.g., normal
progress or suffering complications). Thus,
reflecting significant evidence that optimists were progressing more rapidly
than pessimists. At six months, patients
were again surveyed, via mail with a follow-up call on their psychological
well-being and quality of life. Results
from the six-month survey, dubbed the Rose Questionnaire, had patients assess
how satisfied they were with their health status at that time; if the surgery
had improved their quality of life and if they had resumed normal activities,
how long it took. In all respondents,
reports Scheier et. al. (1989), optimists “normalized their lives” faster and
“reported a higher quality of life than did pessimists” (p. 1030-1031).
The
use of medical evaluation assessments to remove deviations to the comprehensive
survey results also needed to be made. The
first medical assessment used to obtain the patient’s medical factors, was to evaluate
his or her pre-operative medical status as it related to the extent of the
surgery needed, the severity of the underlying CADS, and the patient’s standing
on major coronary heart disease (p. 1029).
These factors were identified by the number of medical graphs the
patient had done, the amount of blockage in the coronary artery, and finally
the extent to which the patient understood the risk factors of the procedure. As related to LOT scores, optimist or
pessimist, additional factors were also assessed during surgery: the
development or lack of new Q-waves on the EKGs as a result of surgery and the
release of AST and CPK; both related to general muscle damage. The surgical results reflect, those patients
with optimistic outlooks developed fewer Q-waves than those with a pessimistic
outlook. Post-surgical physical markers
reflect optimists achieving faster recovery that did pessimists; taking fewer
days to begin walking. As indicated
earlier, physical and psychological assessments by medical staff indicated optimists
were in better post-surgical condition and they anticipated them to recover
more rapidly. As for patient morale,
medical staff indicated patient lifestyle would return to normal more quickly;
however, their discoveries in all areas were only marginally more significant
for optimists than for pessimists. Of
further interest the majority of optimists showed fewer probable myocardial
infarction issues; accelerated medical problems.
In
post-operative results the effects of patient anticipations was reviewed. Only the anticipation of nervousness produced
consistent effects. Scheier et. al.
(1989) indicates only negative effects were the result of anticipated
nervousness: “The rate at which certain recovery
milestones were
achieved, such as number of days to walk for 5-10 min., and length of
hospitalization, amount of time spent in intensive care, ratings made by
Division of Cardiac Rehabilitation members regarding patient morale, and
anticipated rate of normalization of life-style, whether the patient had
returned to work as well as how quickly the return to work took place, how
quickly the patient began socializing again with friends, overall rate of
normalization of life function 6 months post-operatively, [and] life quality 6
months postoperatively” [calculations removed] (p. 1033). The study further notes that when anticipated
nervousness and the three medical factors listed earlier are controlled, all
elements are positively affected. Hostility
and depression is rare for optimists than for pessimists; better able to cope
with the unexpected. The relation
between optimism and quality of life after surgery rather than the extension of
life benefits was also notable. Specific predictions about recovery and total
health resulted in better outcomes than did generalizations. It may be that pessimists require more care
because they are less active and knowledgeable in their recovery; they may, in
fact, by their outlook prevent the care and attention needed to adequately
recover.
It
is my opinion that the studies in this program were adequately administered and
the resulting analyses are feasible and appropriate. Pre-analyzing the patient for his or her existing
outlook permits an accurate hypothesis to classification optimistic or
pessimistic behaviors. Furthermore, the study eliminated medical condition
variances. Through the additional
surveys, this study showed that optimism clearly affects physical and
psychological health both going into and recovering from CABS.
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