They will eventually go home and will have many years after the procedure. It is important for the nursing staff to make a positive impact on how they feel about the procedure. The procedure will represent a lasting memory to the patient. If the patient perceives this to be a time of strength and care from nurturing individuals then it will help them to be able to develop the coping mechanisms necessary to learn to live with the after-effects of the procedure. If the patient sees this as a negative experience, then it could produce unwanted effects such as depression, post-traumatic stress disorder, or other emotional problems that could have an effect on their ability to cope with the life changes. Those that develop appropriate coping mechanisms will be more likely to have a successful recovery than those that have a negative experience. Fear is often the result of the unknown. We fear what we do not understand or hoave not experienced. The goal of this research is to develop a program that will provide the patient with a greater understanding of their disease and the procedure that they will undergo. It is hoped that this will relieve some anxiety on their part and that this will result in a more positive outlook on the procedure. This research will help the patient to develop effective coping strategies in dealing with their disease and the invasive procedure.

Chapter 2: Literature Review

Research into how the emotional state of the patient and personality traits effect stress an the willingness to adhere to advice after discharge has only begun to appear in mass over the past two years. This research is built on concepts borrowed from other disciplines of psychology that relate to the influence of one's emotional state on their physiological ability to heal and cope with trauma. This represents a paradigm shift in the field from focusing primarily on the physical body to recognizing the role that a person's emotional state plays on their general health.

Currently, literature has been produced by an only a handful of researchers. However, they are beginning to develop the groundwork for clinical application of their theories. This new branch of mental health research will become more specific as the theories are developed. The current state of research in this new field is largely theoretical at this time, with a few instruments under development that may become useful in the future. This research study will take the current body of research one step further and will attempt to apply it in the patient setting.

In areas of research that are better developed, one often finds large groups of literature that address a certain facet of the topic. However, in areas that are just beginning to be recognized as a separate entity, such as this one, it is sometimes more necessary to provide more explanation as to how the new theories apply to the field than in a traditional literature review. This literature review will not only examine the literature in composite, but will provide a detailed discussion of how the research applies to this developing union between mental health and physiological health.

There are several factors that are borrowed from other areas of psychology that are useful in determining the likelihood that a patient will have a positive emotional outcome after the procedure. Early research indicates that identification of certain personality traits and attitudes might predispose certain patients to be at-risk for developing psychological disorders after a traumatic procedure. If clinicians can identify these risk factors, they may be able to take precautions to help the patient adjust to life after surgery. This concept forms the theoretical basis for this research study.

The purpose of nurse training is two fold. It is to inform the patient about the physical sensations, risks, and other factors that will effect them before, during, and after surgery. However, the goal is to reduce the amount of stress associated with the procedure and their disease. Several areas of literature will be useful in the development of the training program, patient assessment, and measurement of the training program. Many of these are borrowed from psychology and applied to the specific population addressed in this study. Literature into factors that influence the emotional states of patients and their relationships to achieving treatment objectives can be divided into several subtopics. The following will address the major categories of literature that exist within this newly emerging discipline.

Factors that Influence the Ability to Maintain Physical Activity

Goal intentions and implementation intentions play an important role in the exercise that rehabilitation patients performed independently (Ziegelmann et al., 2006)....

This study found that goal intentions were not predictive in whether the patient would follow the prescribe regime of exercise. However, implementation intentions were found to be associated with exercise 12 months after the rehabilitation program was complete. Implementation intentions, rather than goal intentions predicted behavior. Planning was found to be a significant factor in implementation intentions (Sniehotta, Scholz, & Schwarzer, 2006). This study provides an important factor in the recovery process and is easily extrapolated to the sample population of the current study.
Heart patients must make many changes in their lives in order to improve their health and maintain the benefits of the surgery. The study by Ziegelman and associates demonstrates that although the patient has goals, this alone does not predict whether they will be able to elicit permanent changes in their exercise level after discharge. This is an area where nurse training of patients could prove to be an important factor in creating permanent change in the patient that will lead to long-term exercise regimes. It is important for the patient to have a goal, but we now know that the plan and intention to stick with the plan are a key factor in the ability to cope with changes.

Intention is one of the most important predictors of behavior (Sniehotta, et al., 2006). In heart patients, it is important that patients develop a sense of proper intentions regarding their willingness to stick to necessary exercise and diet recommendations. This is perhaps the most important area where the nurse training program will be beneficial to patients. Training will enhance the need to stick to the routine in order to prevent the need for future surgery.

Ziegelmann, Lippke, and Schwarzer, (2006a) explored socio-cognitive predictors of physical exercise in patients released from rehabilitation. This study measured the effect of perceived remaining life expectancy and the willingness to exercise. The study examined those who felt their lifetime was expansive, versus those who felt their lifetime was limited. Individuals who felt their lifetime was limited were less likely to achieve their exercise goals than those who felt that they had many years remaining.

How a person perceives their life expectancy has a significant impact on self-regulation of activities that will help to improve the quality of their life (Ziegelmann, Lippke, and Schwarzer, 2006a). If is expected that the educational process developed as a part of this research will have a positive impact on the patient's perception of their life expectancy. The most important factor in this equation is that education could make the patient realize that exercise and adherence to suggestions could help to improve their life expectancy. This factor will be an important element in the educational training program of the nurses.

Age is a factor in the type of intervention that will be most likely to result in prolonged maintenance of exercise programs after physical therapy (Ziegelmann, Lippke, and Schwarzer, 2006b). According to this study, middle aged and older patients benefited from a program where the interviewer assisted in planning. Whereas younger persons benefited from a plan that they developed independently. This study demonstrates that age will have to be considered in the type of training that the patient receives. Certain training styles may be more beneficial than others to certain age groups.

In some patients critical life events, such as cancer surgery were beneficial in improving the patient's sense of well-bring (Schwarzer et al., 2006). This study demonstrates the connection between mental state and one's overall health. The most marked improvement in attitude was in those that started out with a relatively low sense of well-being, as opposed to those that had a relatively high level before their surgery. Self-efficacy and social support also predicted benefit finding in patients who had undergone cancer surgery (Luszczynska, Mohamed, and Schwarzer, 2005). Benefit finding can be distinguished by personal growth, acceptance of life's imperfections, sensitivity to others, and improved family relationships.

Support Systems

Support is a critical factor in the success of heart patients in coping with their illness after discharge (Schulz & Schwarzer, 2004). Gender and age differences, as well as associations with mental health were considered in an assessment of support systems available. Support can be divided into four types, advice giving, assistance, reassurance, and empathic listening (Schwarzer & Gutierrez-Dona, 2005). Support came from four primary sources, friends, family, spouses and groups/organizations (Schwarzer & Gutierrez-Dona, 2005). It is not only the quantity of…