Patients' and their families' coping resources at six weeks following back surgery

www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 Published by Sciedu P ess 105 ORIGINAL ARTICLE Pa ien s’ and hei amilies’ coping esou ces a six weeks ollowing back su ge y Päi i K. Leikkola1,2, Mika T. Helminen1, 3, Eija E-M. Paa ilainen1,2, Päi i M. Ås ed -Ku ki1, 3 1. Uni e si y o Tampe e, School o Heal h Sciences, Tampe e, Finland. 2. Hospi al Dis ic o Sou h Os obo hnia, Seinäjoki, Finland. 3. Hospi al Dis ic o Pi kanmaa, Depa men o Resea ch Adminis a ion, Tampe e, Finland. Co espondence: Päi i K. Leikkola. Add ess: The Hospi al Dis ic o Sou h Os obo hnia, FIN-60220 Seinäjoki, Finland. Email: pai i.leikkola@epshp. i Recei ed: Oc obe 13, 2013 Accep ed: Feb ua y 6, 2014 Online Published: Ma ch 17, 2014 DOI: 10.5430/cns. 2n2p105 URL: h p://dx.doi.o g/10.5430/cns. 2n2p105 Abs ac Backg ound: New esea ch knowledge o adul back su ge y pa ien s’ and amily membe s’ coping esou ces can help p omo e he de elopmen o hei amily nu sing. Pu pose: The pu pose o he s udy was o assess pa ien s’ and hei amily membe s’ coping esou ces and ela ed ac o s six weeks a e back su ge y. Me hods: Quan i a i e da a we e collec ed om 61 pa ien s and 50 amily membe s by s uc u ed, sel -adminis e ed ins umen s designed o measu e hei coping. Resul s: Impo an coping esou ces o pa ien s and hei amilies we e ound o in ol e pa ien ’s mo i a ion o eco e , no malcy o daily li e and he whole amily’s us in nu sing s a . Pa ien s’ o e all coping was ound o be nega i ely associa ed wi h de e io a ed heal h and mood, insecu i y ega ding u u e, social isola ion and inc eased p oblems in amily li e, whe eas amily membe s’ o e all coping was nega i ely associa ed wi h he pa ien ’s poo heal h s a us and he amily membe s’ social isola ion. Conclusion: Pa ien s’ and hei amilies’ coping esou ces a e in luenced by he pa ien ’s heal h s a us and mo i a ion o eco e , by home ci cums ances, amily ela ionships and amily’s us in nu sing s a . Key wo ds Su gical Pa ien , Family, Coping, Resou ces 1 In oduc ion A spinal condi ion may a ec he pa ien ’s abili y o unc ion and wo k no mally [1-7]. In Finland, up o 40% o he days spen on sickness allowance a e due o a ious musculoskele al condi ions [8]; in 2006, hese condi ions accoun ed o 30% o he o al unemploymen pension expendi u e [4]. App oxima ely 15% o back pain pa ien s a e unable o wo k and one in en pa ien s is in need o su gical ea men [9]. The numbe o back su gical p ocedu es inc eased by 40% in Finland in he yea s 1996-2005. E en hough ea men imes a e sho e nowadays, he numbe o hospi aliza ion pe iods has g own [4] and he o al heal h se ice expendi u e o back su gical ea men has inc eased [5]. Os eoa h osis, which is no only con ined o he spinal a ea, is he mos cos ly musculoskele al disease o socie y in Finland [4]. In 2004, he e we e 7335 www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 ISSN 2324-7940 E-ISSN 2324-7959 106 hospi aliza ion pe iods o spinal su ge y in Finland. No na ional s a is ics a e a ailable on he sha e o men and women [10]. Pa ien pa icipan s in his esea ch we e adul s, who had unde gone su ge y o disc he nia ion o spinal s enosis. While he numbe o su ge ies o disc he nia ion has dec eased, spondylosyndesis and su ge y o spinal s enosis ha e con inued o become mo e common [11]. The exis ing esea ch on back su gical pa ien s has ocused on examining he clinical esul s o su gical ea men [12 -16]. The ew s udies ha ha e been conduc ed om he pe spec i e o back su gical pa ien s deal wi h pa ien s’ expe ience o pain [2, 3, 6], hei ea o becoming ill again [1], hei imp o ed physical unc ion [2, 3, 6, 7], hei abili y o wo k [1, 2, 6] and hei pos ope a i e quali y o li e [5, 7]. The e a e ew s udies on he coping o his speci ic g oup o pa ien s and hei amilies, and he knowledge emains agmen ed [9, 17, 18]. Pu pose and heo e ical backg ound o he s udy The pu pose o his s udy is o desc ibe back su gical pa ien s’ and hei amilies’ coping esou ces and ela ed ac o s a six weeks ollowing he su ge y. The esul ing knowledge can by use ul as a con ibu ion o he de elopmen o amily nu sing. In he p esen s udy, amily consis s o wo pe sons; he pa ien and one close amily membe selec ed by he pa ien . These pe sons iden i y hemsel es as amily membe s and hey a e joined oge he by sha ing o emo ional closeness [19, 20]. Coping is de ined as an indi idual’s a emp s o deal wi h a ac o ha is pe cei ed as s ess ul. Coping is seen as a p ocess which changes o e ime and si ua ion [21]. Coping esou ces a e in e nal cha ac e is ics [22] and each pe son’s coping p ocess is indi idually cons uc ed [23]. This s udy desc ibes pa ien s’ and amily membe s’ ac ions in a si ua ion ha calls o a g ea deal o esou ces. These include hei pe cei ed heal h, a i udes and sel -es eem [22]. O e all coping in his esea ch e e s o pa ien s’ and amily memb s’ own es ima e o hei o e all coping. Spinal su ge y pa ien s a e usually p esc ibed a sick lea e o 5-6 weeks, a e which hey a e expec ed o ha e eco e ed. This s udy ocuses on his e y pe iod o ime. Ea lie esea ch has shown ha being hospi alized and unde going su ge y a e majo li e e en s ha cause ea and psychological s ess and inc ease he isk o dep ession and anxie y [21, 24]. Su ge y is o en ollowed by changes in pa ien s’ coping a home and in hei ela ions wi h amily membe s and ela i es. Su gical pa ien s’ daily coping is comp omised by pain, di icul y o mo e, inabili y o wo k and limi a ions o ee- ime ac i i ies, all o which may in u n a ec hei mood and quali y o li e [9]. Family membe s a e also a ec ed. They o en expe ience he pos ope a i e ime as s ess ul and bu densome [25]. They, oo, ha e o deal wi h changes in daily li ing and social ela ionships. Ti edness, anxie y and dis ess ha e been ound o be common among amily membe s. They su e om being sepa a ed om he pa ien and unde go pe iods o ea , helplessness and hopelessness. Inc eased inancial di icul y is also equen ly epo ed [26, 27]. The si ua ion is especially demanding in case o aged pa ien s wi h impai ed cogni i e unc ion, whose amily membe s epo inc eased dissa is ac ion and s ess du ing pa ien ’s eco e y [28]. The eco e y o pa ien s depends on hei age, leng h o sick lea e and on psychosocial ac o s [29]. Fo example, i has been con i med ha pa ien s’ expec a ions on wo k e u n ha e an in luence on pain, sick lea e and disabili y and ha hei ea -a oidance belie s con ibu e o a low quali y o li e [17]. Pa ien s’ highe le els o op imism and expec a ions ha e been ound o esul in be e pe cei ed quali y o li e and in wo k e u n wi hin a yea ollowing su ge y [17, 30]. An associa ion has been demons a ed be ween ac i e coping and physical eco e y om su ge y [31]. I has also been shown ha pa ien s may, despi e ela i ely poo physical eco e y, eel ha he quali y o hei li e has imp o ed, much he same way as pa ien s wi h be e physical eco e y epo [31]. In he ace o s ess and anxie y, bo h pa ien s and amily membe s engage in hei indi idual coping beha iou s [32-34]. Success ul pos ope a i e coping, assessed in e ms o pe cei ed ou come and heal h- ela ed quali y o li e, has been associa ed wi h he indi idual’s ac i e e o s o deal wi h he si ua ion. Adap i e coping, social suppo as well as a combina ion o se e al coping beha io s ha e been ound o be e ec i e [21, 24]. Pa ien s’ in e es in coping is ansla ed in o ac i e pa icipa ion in ca e, which is likely o ha e a posi i e ou come on he inal eco e y ou come [35]. Pa ien s ha e www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 Published by Sciedu P ess 107 been ound o cope, o example, by con inuing li e as no mally as possible, s ep by s ep. I has also been con i med ha inc eased sel -ca e ega ding physical heal h educes pa ien s’ anxie y on pos -ope a i e days [36, 37]. In con as , pa ien s’ eco e y may be complica ed by hei educed li e sa is ac ion and lowe si ua ion-speci ic sel -con ol expec a ions [18]. Family membe s, on he o he hand, ha e been shown o equi e suppo and in o ma ion on how he pa ien should ac o ensu e coping a home [38]. Wi h inc easingly sho hospi al s ays, amily membe s’ end o expec mo e om he hospi al s a [39]. These backg ound ideas, oge he wi h u he li e a u e on pa ien s’ and hei amilies’ coping needs and expe iences, o med a ounda ion o he c ea ion o an ins umen , whose pu pose was o measu e coping and help seek answe s o he ollowing esea ch ques ions. Resea ch ques ions 1) Wha kind o coping esou ces did pa ien s and hei amily membe s ha e a six weeks ollowing su ge y? 2) Which backg ound ac o s we e associa ed wi h pa ien s’ and hei amilies’ coping esou ces a six weeks ollowing su ge y? 3) In wha way we e pa ien s’ and hei amilies’ coping esou ces associa ed wi h hei o e all coping a six weeks ollowing su ge y? 2 Me hod 2.1 Resea ch design This is a c oss-sec ional obse a ional s udy. Da a we e collec ed om 61 adul back su gical pa ien s and 50 amily membe s in one cen al hospi al in Finland. A new li e a u e-based, sel -adminis e ed ins umen was de eloped o his pu pose. In he esul s, pa ien s’ and amily membe s’ esponses o backg ound ques ions and o wel e g oups o ques ions on coping esou ces as well as hei assessmen o hei o e all coping a e combined o analysis. 2.2 Ins umen As no sui able ins umen o pa o ins umen was ound, a new ins umen was de eloped o measu e he coping o pa ien s and amily membe s. This s udy uses wo o he h ee majo pa s o he ins umen s: backg ound ac o s and pa ien s’ and amily membe s’ coping esou ces [40]. In addi ion, pa ien s and amily membe s we e p esen ed wi h a Visual Analogue Scale (VAS), a 10 cen ime e long scale wi h a alue ange o 0-100. The VAS has been used in ea lie esea ch o assess subjec i e expe iences, o example pain, mood, a en ion, sleep quali y, a i ude and abili y o unc ion. In his s udy, he pa ien s and amily membe s we e asked o ma k hei assessmen o hei o e all coping a e su ge y on he scale [41, 42]. In he i s sec ion o he ins umen , backg ound da a we e collec ed by ques ions on he pa ien ’s and amily membe ’s age, sex, ma i al s a us, amily, employmen , social li e and he pa ien ’s illness ha equi ed su gical ea men . These backg ound ac o s we e la e s udied o hei associa ion wi h esponden s’ coping esou ces. The coping esou ces sec ion o he ins umen is based on ea lie esea ch on pa ien s and amilies expe iencing su ge y [18, 26, 37, 43] accessed wi h help o a lib a ian om he da abases Cinahl (102), Cinahlcumula i eindex (174), B i ish Nu sing Index– (14), O idMedline (143), Linda (29) and Medic (15). The li e a u e was sea ched o esul s on pa ien s’ and hei amilies’ coping needs and expe iences. This sec ion o he ins umen is also based on an ea lie pilo s udy conduc ed by he au ho [44]. The ins umen o pa ien s was o mula ed i s and hen modi ied o p oduce an ins umen o amily membe s. www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 ISSN 2324-7940 E-ISSN 2324-7959 108 The ollowing li e a u e-based cons uc s we e o mula ed o he ins umen : pa ien s’ and amily membe s’ a i udes owa ds u u e, pa ien ’s eco e y mo i a ion and ac i i y in sel -ca e, no malcy o daily li e, pa ien ’s and amily membe ’s wellbeing, pa ien ’s mood changes, insecu i y ega ding u u e, de e io a ion o heal h, social isola ion, ea (o losing he pa ien ) and he inc eased complica ions o li e oge he . In his s udy, hese cons uc s a e e e ed o as componen s o coping esou ces. Responden s we e asked o use he Like scale o assess he impo ance o he abo e componen s as cons i uen s o hei coping esou ces, wi h he op ion 1 indica ing he leas and 4 he highes le el o impo ance. The e we e 2-11 ques ions pe componen on he ques ionnai es. Means we e calcula ed pe esponden and pe componen , bu only o componen s in which a minimum o 80% o he i ems had been esponded o. In he assessmen o o e all coping (VAS), sco es abo e 50 we e conside ed o indica e be e o e all coping. 2.3 Validi y and eliabili y Bo h p e- es ing and expe panel consul a ion we e used o ensu e con en alidi y o he ins umen s. The expe panel, which consis ed o h ee membe s wi h expe ise in esea ch, assessed he ace alidi y o each ins umen espec i ely. The expe s we e consul ed o ensu e ha he ins umen con en s and ques ions we e clea and comp ehensible and ha he ime gi en o p ospec i e pa icipan s was adequa e. Following his, bo h ins umen s we e es ed and commen ed on by en heal h ca e p o essionals. The con en alidi y index was 0.88 o he pa ien ins umen and 0.87 o he amily membe ins umen . Bo h alues a e good [45]. A eliabili y assessmen was also conduc ed o de e mine he ex en o which he ins umen measu ed wha i was in ended o measu e and o assess ins umen eliabili y, s abili y and in e nal consis ency [46]. The C onbach alpha sco es anged om 0.43 o 0.90 o pa ien s and om 0.13 o 0.89 o amily membe s. In bo h ins umen s, he ollowing componen s showed poo e consis ency han he o he s: ac i i y in sel ca e (pa ien α = 0.56, amily membe α = 0.13); no malcy o daily li e (pa ien α = 0.67, amily membe α = 0.21) and social isola ion (pa ien α = 0.43, amily membe α = 0.22). Fu he mo e, wo componen s in he amily membe ins umen p o ed o ha e poo in e nal consis ency: a i ude owa ds u u e (α = 0.57) and pa ien ’s and amily membe ’s wellbeing (α = 0.65). The p oblem may be due o he small numbe o ques ions (2-7) wi hin hese componen s. Second, he ime passed since su ge y may ha e esul ed in he pa ly poo in e nal consis ency o he amily membe s’ ins umen , because he pa ien ’s heal h may al eady ha e imp o ed conside ably. The esponden s may ha e el ha he ques ions conce ned amily membe s o pa ien s who a e in a poo e condi ion. The pa allel- o ms me hod could no be used in es ing eliabili y, as no sui able al e na i e ins umen was a ailable. A es - e es analysis was uled ou because he phenomena o be examined we e no expec ed o emain s able o e ime [47]. Finally, he ins umen was p e es ed in a pilo s udy conduc ed by he au ho [40] p io o he p esen s udy wi h pa ien s (N=30) and amily membe s (N=30) selec ed by pa ien s. Fo he pilo s udy, ques ionnai es and co e ing le e s we e handed o pa ien s and amily membe s in one hospi al du ing wo mon hs in 2008 and e u ned, oge he wi h consen o ms, o he in es iga o by pos . The analysis in ol ed a s udy o equencies, dis ibu ions, means, s anda d de ia ions and co ela ion. The e was no need o make amendmen s in he ques ionnai es. Da a om he pilo s udy we e no included in he ma e ial o he p esen s udy. 2.4 Sample The inclusion c i e ia o pa icipan s, bo h pa ien s and amily membe s, included: age 18 o olde , Finnish speaking, awa e o he s udy objec i es and capable o esponding o he ques ionnai e. The pa ien s had ecei ed su gical ea men o disc he nia ion o spinal s enosis and hey had been ca ed o on neu osu gical o o hopaedic wa ds in a cen al hospi al in Finland. The amily membe s we e selec ed and ec ui ed by pa ien s. Na ional s a is ics we e i s s udied o lea n he o al numbe o a ge g oup pa ien s in Finland and a s a is ician was consul ed o help assess how much ime ( wo yea s) would be equi ed o ob ain an adequa e sample. Da a collec ion was ended a e wo yea s. No powe analysis was conduc ed. The da a we e collec ed be ween May 2008 and Augus 2010. The ques ionnai es, along wi h he Visual Analog Scales, we e mailed o p ospec i e pa icipan s. The ini ial a ge g oup consis ed o 126 pa ien s and 126 amily www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 Published by Sciedu P ess 109 membe s, o whom 61 pa ien s ( esponse a e 48%) and 50 amily membe s ( esponse a e 40%) e u ned he ques ionnai e. Table 1. Pa ien and amily membe backg ound da a Backg ound ac o s Pa ien (N=61) Family membe (N=50) N % N % Sex emale 31 51 27 54 male 30 49 23 46 Ma i al s a us single 5 8 3 6 ma ied/cohabi ing 47 77 43 86 di o ced 7 11 3 6 widowed 1 2 1 2 missing da a 1 2 -- -- On ea nings- ela ed/disabili y pension no 43 70 40 80 yes 15 25 6 12 applica ion pending 1 2 1 2 missing da a 2 3 3 6 Unemployed no 49 80 44 88 yes 5 8 3 6 missing da a 7 12 3 6 Family membe s no child en 11 18 9 18 one o mo e child en 24 39 22 44 child en no li ing in he same home 23 38 14 28 missing da a 3 5 5 10 Leng h o sick lea e be o e su ge y ( esponse op ions gi en) 0-3 mon hs 22 36 -- -- >3 mon hs 21 34 -- -- missing da a 18 30 -- -- O he pe sis en disease no 40 66 -- -- yes 20 33 -- -- missing da a 1 1 -- -- Fi s - ime ope a ion no 15 25 -- -- yes 46 75 -- -- (Table 1 con inued on page 110) www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 ISSN 2324-7940 E-ISSN 2324-7959 110 Table 1. (Con inued.) Backg ound ac o s Pa ien (N=61) Family membe (N=50) N % N % Fi s ime as a amily membe o pa ien unde going su ge y no -- -- 28 56 yes -- -- 21 42 missing da a -- -- 1 2 P e ious ope a ions ( esponse op ions gi en) none 13 21 19 38 one o mo e 48 79 29 58 missing da a -- -- 2 4 F ee- ime ac i i ies no ee- ime ac i i ies be o e o a e illness 7 11 -- -- no ee- ime ac i i ies be o e o a e pa ien ’s illness -- -- 7 14 had o s op he ee- ime ac i i ies 21 34 -- -- i egula pu sui o ee- ime ac i i ies a e illness 24 39 -- -- i egula pu sui o ee- ime ac i i ies a e pa ien ’s illness -- -- 21 42 egula ee- ime ac i i ies 6 10 20 40 missing da a 3 5 2 4 One o se e al con idan s no 1 2 5 10 yes 60 98 43 86 Con ac wi h he mos signi ican pe son daily 48 79 31 62 weekly 9 15 16 32 once a mon h 1 1 1 2 missing da a 3 5 2 4 The pa ien s’ mean age was 47.7 yea s ( ange 18-71) and he amily membe s’ 47 yea s ( ange 18-77). As shown in Table 1, a sligh majo i y o esponden s we e women. Mos pa ien s and amily membe s we e ei he ma ied o cohabi ing and had one o mo e child en. In bo h g oups, a small mino i y o esponden s we e unemployed. All he pa ien s had been on sick lea e du ing he pas yea , wi h li le a ia ion in he du a ion o sick lea e. Nea ly one hi d o he pa ien s had been diagnosed wi h ano he ch onic disease. Fo mos pa ien s, his had been hei i s spinal su ge y. A sligh majo i y o amily membe s had p e ious expe ience o being a su gical pa ien ’s amily membe , and in bo h g oups, he majo i y o he esponden s had a his o y o ea lie su gical p ocedu es. One hi d o he pa ien s had been compelled o gi e up hei ee- ime ac i i ies due o hei illness, whe eas amily membe s had con inued o pu sue hei in e es s. Bo h pa ien s and amily membe s had one o se e al con idan s o pe sons o alk o. Mos o hem s ayed in con ac wi h such close pe sons on a daily basis. 2.5 E hical conside a ions The Na ional Ad iso y Boa d on Heal h Ca e E hics p inciples we e obse ed [48]. Pa icipa ion was olun a y and based on in o med consen . The ques ionnai es we e mailed, gi ing each p ospec i e pa icipan ull eedom o decide whe he o no o en e he s udy. All pa icipan s we e legally compe en adul s. Tampe e Uni e si y Hospi al E hical Commi ee www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 Published by Sciedu P ess 111 pe mission (R07165H) and hospi al pe mission o conduc esea ch we e ob ained and he anonymi y o he esponden s ensu ed. 2.6 Da a analysis The S a is ical Packages o Social Sciences (SPSS) 18.0 o Windows was used o s a is ical analysis. Whe e needed, i em sco es we e e e sed o make he alues di ec ionally consis en [49]. To help desc ibe da a and o u he analysis, bo h pa ien s and amily membe s we e g ouped in o wo ca ego ies o almos equal size: he unde 45-yea -olds and hose 45 o olde . The esponses o i ems on esponden s’ coping esou ces we e sco ed as ollows: s ongly disag ee =1 poin , disag ee =2 poin s, ag ee =3 poin s and s ongly ag ee = 4 poin s. The esul s a e p esen ed using equencies, pe cen ages, ange, means and medians. Since he da a we e no no mally dis ibu ed, non-pa ame ic s a is ical me hods (Mann-Whi ney and K uskal-Wallis Tes s) we e used o assess ela ionships be ween a iables [49]. Spea man’s co ela ion was also conduc ed o analyse he associa ion be ween he g oups o ques ions and assessmen o o e all coping. A co ela ion was de e mined o be signi ican i he P- alue was below .05. Because o he limi ed sample size, missing da a has no been complemen ed o eplaced o example by means du ing he analysis. Table 2. Pa ien s’ and amily membe s’ expe iences o he componen s o coping esou ces Componen s o coping esou ces Pa ien Numbe Median Q= Q1-Q3 Family membe numbe Median Q= Q1-Q3 A i ude owa ds u u e 60 3.50 3.00-3.80 50 3.33 3.00-3.53 Pa ien ’s eco e y mo i a ion 60 3.75 3.06-4.00 48 4.00 3.50-4.00 Ac i i y in sel -ca e 56 3.25 2.81-3.75 46 2.88 2.50-3.00 No malcy o daily li e 58 3.50 2.50-4.00 50 4.00 3.50-4.00 Pa ien ’s and amily membe ’s well-being 59 3.00 2.71-3.57 50 3.21 2.82-3.71 Sha ed us in nu sing s a 57 3.67 3.33-4.00 48 4.00 3.42-4.00 Pa ien ’s mood changes 59 1.82 1.27-2.27 50 1.67 1.22-2.14 Insecu i y ega ding u u e * 52 1.83 1.00-3.00 44 2.17 1.00-3.00 De e io a ion o heal h * 59 2.40 1.70-2.90 50 1.94 1.50-2.72 Social isola ion * 58 2.25 1.50-3.00 49 1.50 1.00-2.50 Fea (o losing he pa ien ) 58 3.50 3.38-4.00 49 3.50 3.50-4.00 Inc eased complica ions o li e oge he 59 1.63 1.25-2.13 49 1.71 1.14-2.14 (Scale 1-4, 4= s ongly ag ee, 3= ag ee, 2=disag ee, 1= s ongly disag ee). * Re e se o de ing wi h low alues indica ing posi i e meaning 3 Resul s 3.1 Pa ien s’ and amily membe s’ coping esou ces As shown in Table 2, i was ound ha acco ding o pa ien s, he mos posi i e componen s o hei coping esou ces we e eco e y mo i a ion, no malcy o daily li e and esponden s’ sha ed us in nu sing s a . Fea was ound o deple e coping esou ces. Inc eased complica ions o li e oge he and changes in he pa ien ’s mood, howe e , we e no conside ed o ha e any majo con ibu ion. Simila ly, amily membe s also ega ded pa ien ’s eco e y mo i a ion, no malcy o daily li e and sha ed us in nu sing s a as hei mos posi i e coping esou ces. They ound ha hei ea o losing he pa ien dec eased hei coping esou ces, whe eas social isola ion due o he pa ien ’s illness, he pa ien ’s mood changes, www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 ISSN 2324-7940 E-ISSN 2324-7959 112 inc eased complica ions o li e oge he and he de e io a ion o he pa ien ’s heal h did no a ec hei coping esou ces signi ican ly. 3.2 Backg ound ac o s ela ed o pa ien s’ and amily membe s’ coping esou ces Compa ison by ma i al s a us e ealed ha pa ien s who we e sepa a ed o di o ced expe ienced mo e o en ha inc eased complica ions o li e oge he had a ec ed hei coping nega i ely (p- alue o he di e ence .028). In compa ison, he median o unma ied pa ien s was 2.50, o ma ied o cohabi ing pa ien s 1.50 and o widowed pe sons 2.86, so he e was a signi ican di e ence be ween he g oups. Rega dless o hei educa ional backg ound, amily membe s expe ienced ha hei a i ude owa ds u u e had been a posi i e con ibu ion o hei coping esou ces. The di e ences be ween educa ional g oups we e p ac ically a he small; he median o amily membe s wi hou any oca ional quali ica ion was 3.00, whe eas i was 3.25 o hose wi h uppe seconda y le el educa ion, 3.60 o hose wi h a deg ee o diploma om a uni e si y o applied sciences o college and 3.33 o uni e si y g adua es (p=.039). In o he wo ds, hose wi h a ela i ely high educa ion had he highes sco e. No majo di e ences we e ound be ween educa ional g oups in amily membe s conce ning hei a ing o he pa ien ’s sel -ca e ac i i y as a coping esou ce. The median was 2.50 o amily membe s wi hou a oca ional quali ica ion, 2.75 o hose wi h uppe seconda y le el educa ion, 3.00 o uni e si y o applied sciences o college g adua es and 2.50 o amily membe s wi h a uni e si y deg ee (p= .049). Again, hose wi h mo e educa ion, excep ing he mos highly educa ed g oup, ound his componen sligh ly mo e impo an o hei coping han o he esponden s. I was ound ha in pa ien s wi h an applica ion pending o ea nings- ela ed o disabili y pension, insecu i y ega ding u u e had a s onge nega i e con ibu ion o hei coping esou ces han in o he g oups. Responden s wi h an applica ion pending had a median o 4.00, whe eas hose in wo king li e had a median o 1.33 (p=.023) and hose al eady pensioned a median o 3.00. In amily membe s, esponden s on ea nings- ela ed o disabili y pension el mo e s ongly (median 3.33) ha hei insecu i y o u u e had con ibu ed o hei coping esou ces nega i ely han o he g oups. Wo king amily membe s had a median o 1.67 (p= .019) and amily membe s wi h an applica ion pending a median o 2.68. A signi ican associa ion was ound be ween pa ien s’ employmen s a us and insecu i y ega ding u u e as a componen a ec ing coping esou ces. The median o employed people was 1.33, whe eas i was 3.00 o unemployed pa ien s (p= .027). Wo king pa ien s expe ienced u u e as mo e secu e han unemployed pa ien s. Fu he mo e, he unemployed esponden s el sligh ly mo e s ongly ha hei social isola ion had had a nega i e con ibu ion o hei coping esou ces. This associa ion be ween pa ien s’ employmen s a us and social isola ion was s a is ically almos signi ican , wi h he median o 2.00 o wo king and 3.00 o unemployed pa ien s (p= .045). I espec i e o he numbe o ea lie ope a ions, pa ien s ega ded hei eco e y mo i a ion as a posi i e componen o hei coping esou ces. The eco e y mo i a ion was mo e p onounced in he esponses o hose pa ien s, who had had i s - ime su ge y o hei condi ion compa ed o pa ien s, who had ea lie expe ience o su ge y. The median o he i s - ime su ge y g oup was 4.00 and o he la e g oup 3.13 (p=.012). As ega ds pa ien s’ a i ude owa ds u u e, hose who had had i s - ime su ge y el mo e s ongly ha hei a i ude had posi i ely a ec ed hei coping esou ces (median 3.50), compa ed o pa ien s wi h ea lie expe ience o su ge y (median 3.00; p= .013). As o pa ien s’ de e io a ion o heal h, i was ound o a ec coping esou ces nega i ely, i espec i e o he amoun o ea lie su gical expe ience. The i s - ime su ge y pa ien s el his less s ongly. Thei median was 2.25, whe eas hose wi h p e ious expe ience o su ge y had a median o 2.89 (p=.020). The eco e y mo i a ion median o pa ien s who we e 45 o olde was 3.50, while i was 4.00 (p= .019) o unde 45-yea -old pa ien s. This is p ac ically no a e y signi ican di e ence, bu i indica es ha he eco e y mo i a ion o www.sciedup ess.com/cns Clinical Nu sing S udies, 2014, Vol. 2, No. 2 Published by Sciedu P ess 113 unde 45-yea -old pa ien s was a sligh ly s onge posi i e componen o hei coping esou ces. Opposi e esul s we e ob ained o sha ed us in nu sing s a ; he olde age g oup a ed hei expe iences mo e posi i ely wi h a median o 4.00, whe eas he unde 45-yea -old pa ien s had a median o 3.33 (p= .020). The unde -45-yea -old amily membe s a ed hei u u e as sligh ly less insecu e (median 1.67) han he olde age g oup, whose median was 2.67 (p=.043). 3.3 Associa ion be ween pa ien s’ and amily membe s’ coping esou ces and o e all coping Pa ien s’ coping a six weeks ollowing su ge y was also assessed by s udying he associa ion be ween he VAS o e all assessmen and he means calcula ed o each componen . Table 3. Co ela ion s udy (Spea man’s co ela ion) on he ela ionship be ween componen means and pa ien s’ and amily membe s’ o e all assessmen o pos ope a i e coping Componen s o coping esou ces N Co ela ion P- alue Pa ien Family membe Pa ien Family membe Pa ien Family membe A i ude owa ds u u e 60 50 .681 .313 .000 .027 Pa ien ’s eco e y mo i a ion 60 48 .716 .309 .000 .032 Ac i i y in sel -ca e 56 46 .292 .000 .029 .999 No malcy o daily li e 58 50 .595 .450 .000 .001 Pa ien ’s and amily membe ’s wellbeing 58 50 .569 .188 .000 .191 Sha ed us in nu sing s a 57 48 .330 .167 .012 .256 Pa ien ’s mood changes 59 50 -.720 -.514 .000 .000 Insecu i y ega ding u u e 52 44 -.536 -.122 .000 .430 De e io a ion o heal h 59 50 -.739 -.413 .000 .003 Social isola ion 58 49 -.677 -.540 .000 .000 Fea (o losing he pa ien ) 58 49 .295 .156 .024 .283 Inc eased complica ions o li e oge he 59 49 -.617 -.350 .000 .014 In Table 3 s a is ically signi ican esul s (p<.05) a e highligh ed in bold. The able shows how Spea man’s co ela ion e ealed some s a is ically signi ican and meaning ul di e ences. The pa ien s who epo ed poo e mood, mo e insecu e u u e, de e io a ed heal h, social isola ion and inc eased complica ions o li e oge he , also a ed hei o e all coping a six weeks ollowing he su ge y as poo e han pa ien s wi h opposi e expe iences. In con as , pa ien s wi h a mo e posi i e a i ude owa ds u u e, highe eco e y mo i a ion, expe ienced no malcy o daily li e and sha ed wellbeing, a ed hei o e all coping as highe a six weeks a e he su ge y. Family membe s’ assessmen o coping was s udied by he same me hod as ha o pa ien s. The analysis yielded s a is ically pa ly signi ican and meaning ul di e ences. Mos no ably, hose amily membe s, who epo ed pa ien ’s changeable moods and hei own social isola ion, a ed hei o e all coping as poo e a six weeks ollowing he pa ien ’s su ge y. 4 Discussion Changes in amily ela ions o in pa ien s’ abili y o cope a home a e e lec ed on he whole amily’s coping esou ces [9]. In he p esen s udy, his associa ion was de e mined in bo h pa ien s and amily membe s; bo h el ha he pa ien ’s eco e y mo i a ion, no malcy o daily li e and hei sha ed us in nu sing s a cons i u ed s eng hening and posi i e coping esou ces. Acco ding o Salmenpe ä e al. [9] pa ien s’ mood a ec s hei coping in daily li e. The p esen s udy had di e en esul s; bo h pa ien s and amily membe s a ed he ole o pa ien ’s mood changes as insigni ican a six weeks