Acute myocardial infarction is associated with physical and psychosocial distress that have the potential for negatively affecting health outcomes and disease progression. Mortality in individuals following AMI is negatively impacted by the degree of psychological distress the individual experiences. A number of psychosocial factors, including learned helplessness, have been shown to have an impact across clinical populations. Little is known, however, about the nature of the relationship between social support and self-efficacy and the presence of learned helplessness following an AMI. What was once believed to be a learned response in animals has been shown to be relevant to health outcomes in humans. Learned helplessness has the potential of affecting recovery from medical conditions, including AMI. Psychosocial factors are believed to impact learned helplessness across clinical populations. Through the ability to influence both social support and self-efficacy, learned helplessness has the potential of affecting outcomes of patients following acute myocardial infarction (AMI). Currently, little is known about these relationships. The purpose of this research study was to examine the relationship between social support, self-efficacy, learned helplessness, and targeted demographic, clinical, and psychosocial factors following an AMI.
Methods:
Using a descriptive cross-sectional design, a convenience sample (N=75) was recruited from two comprehensive heart institutes located in the southeastern United States. Subjects were individuals who had a diagnosed AMI within the past 12 months. Standardized instruments and measures were used to evaluate learned helplessness, self-efficacy, and social support. Demographic and clinical data were also collected for analysis. Descriptive statistics and bivariate analysis was conducted for the study and clinical variables. Hierarchical multiple linear regression analysis was also conducted to explore the potential unique and combined effect of study variables.
Results:
A statistically significant, inverse relationship was found between social support and self-efficacy with learned helplessness suggesting that individuals who had higher self-reported levels of social support and self-efficacy also reported lower incidences of learned helplessness. Statistically significant correlations with learned helplessness were also noted with demographic factors of years of education, socioeconomic status, and having two previous AMIs. Hierarchical regression analysis suggested, after controlling for the influence of other study variables, self-efficacy alone continued to significantly contribute to the occurrence of learned helplessness in individuals following AMI.
Conclusion:
Based on the findings of this study, a clear benefit exists in ameliorating the presents of learned helplessness in AMI patients. With social support and self-efficacy representing a statistically significant and unique contribution to the occurrence of learned helplessness following an AMI, an area for practice change exists within these concepts. The current plan of care models emphasize lifestyle modifications and adherence to medication regimens while little attention is directed towards a patient’s support structure and perceptions of having an influence on their own outcomes if unable to adhere to the strict guidelines set forth by the medical community.
The findings of this study help to further delineate factors contributing to the concept of learned helplessness, which continues to not be evaluated as a factor associated with clinical outcomes in patients who have experienced an AMI. Social support and self-efficacy are associated with learned helplessness in individuals following an AMI. Given that nursing interventions are able to target a patient’s ability to do for themselves as well as identify means of support upon discharge, this research suggests the importance of these two concepts as impactful methods to improve outcomes for patients following an AMI. With the initial care of many AMI patient occurring in the hospital setting, these interventions are applicable to bedside nurses as well as advanced practice nurses in tertiary care settings, but also in primary care as patients transition into care of chronic illnesses. Attention can then be directed toward hospital discharge to support a patient to identifying an effective social support system along with a strategic and attainable recovery pathway that will help patients develop an empowerment plan to facilitate the needed self-efficacy as patients re-integrate into self-care. Individualizing a plan of care based on an individual’s human experiences, relationships, environmental interactions, and human responses to previous situations carries the potential to be more effective (American Nurses Association, 2000; Condon, 2006). Nurses may be the first to recognize symptoms of poor self-efficacy and a lack of social support, therefore, mitigating the progression through intentional psychological care and possible referral to behavioral health professionals (Plummer, 2000).
Our results also support ongoing efforts to develop post-AMI treatment plans that take into account the psychosocial aspects of an individual’s experience. Learned Optimism (Seligman, 2011) is a contrary concept to learned helplessness. Explored methods to shift the helpless individual towards a more empowered cognitive optimism is part of the concept of cognitive-behavioral therapy (McGuire-Snieckus, 2011). In developing post-AMI treatment plans, healthcare staff need to expand their focus beyond the physiologic and identify psychological points of intervention. Potential interventions that may be useful for pre-discharge implementation include: increasing positive cognition and self-affirmation, and using “as if” statements to envision their lives improved in a desired way (McGuire-Snieckus, 2011). By having a greater understanding of learned helplessness following an AMI, a timeline for interventions may be identified to help improve patient survival.
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