Paper
Thursday, 20 July 2006
This presentation is part of : Caring for the Chronically Ill
The Relation Between Uncertainty and Psychosocial Adjustment Among Implantable Cardioverter Defibrillator Recipients
Ann Marie P. Mauro, PhD, RN, Department of Adult Health Nursing, Seton Hall University, South Orange, NJ, USA
Learning Objective #1: analyze changes in uncertainty and psychosocial adjustment during the first two months following defibrillator implantation.
Learning Objective #2: identify predictors of uncertainty and psychosocial adjustment among implantable cardioverter defibrillator recipients at one and eight weeks post discharge.
Background/Problem: Mishel’s uncertainty in illness model was the theoretical framework for this study. Uncertainty and psychosocial adjustment (PSA) problems have been documented among implantable cardioverter defibrillator recipients; however, little is known about the relation between uncertainty and PSA in this population. The purpose was to explore the relation between uncertainty and PSA during the first two months following ICD implant. Five research questions were posed. Method: Ninety-four adult, first-time ICD recipients recruited from four New England hospitals were studied using a repeated measures, correlational survey design. At one and eight weeks (S1 and S2) following discharge, the Mishel Uncertainty in Illness Scale, Psychosocial Adjustment to Illness Scale, and a demographic questionnaire were administered. Data were analyzed using descriptive and inferential statistics, including Pearson correlations, repeated measures analysis of variance, multivariate canonical analysis, multiple regression, and one-way analysis of variance. Results: There was no significant change in the nature of uncertainty from S1 to S2. Uncertainty at S1 explained a significant amount (39%) of the variance in overall PSA at S2. PSA domains at S1 explained a very large proportion (62%) of the variance in overall PSA at S2. At S2, recipients with less education had greater ambiguity than those with more education. Education, employment status, and functional status explained a significant proportion (21%) of the variance in uncertainty at S2. Younger participants, people with a lower functional status, and those who were disabled had more PSA problems. Time since discharge was not correlated with uncertainty or PSA. Uncertainty accounted for 21% and 45% of the variance in PSA at S1 and S2, respectively. Conclusions: The results support the relation between uncertainty and PSA during the first two months among first time ICD recipients. Longitudinal studies using larger samples are needed to determine the relation between uncertainty and PSA over time.

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