1 Nur sing under graduat e st udent ; 2 Advisor, PhD Pr ofessor, e- m ail: r sdant as@eer p.usp.br. Univer sit y of São Paulo at Ribeir ão Pr et o College of Nur sing, WHO Collabor at ing Cent er for Nur sing Resear ch Developm ent
EVALUATI ON OF SOCI AL SUPPORT AMONG SURGI CAL CARDI AC
PATI ENTS: SUPPORT FOR NURSI NG CARE PLANNI NG
Talit a Polian a Rov er on i Mor aes1 Rosana Apar ecida Spadot i Dant as2
Mor aes TPR, Dan t as RAS. Ev alu at ion of social su ppor t am on g su r gical car diac pat ien t s: su ppor t f or n u r sin g
car e planning. Rev Lat ino- am Enfer m agem 2 0 0 7 m ar ço- abr il; 1 5 ( 2 ) : 3 2 3 - 9 .
This descr ipt ive and cr oss- sect ional st udy aim ed t o m easur e social suppor t am ong subj ect s hospit alized for sur gical t r eat m ent of car diac diseases and t o ver ify t he r elat ions bet w een social suppor t and socio- dem ogr aphic var iables. Dat a w er e collect ed bet w een May, 2004 and June, 2005. A t ot al of 86 pat ient s w er e st udied, 47 m en, 58 m ar r ied and t he av er age age w as 53 y ear s old. Regar ding social suppor t , in an int er v al fr om 1 t o 5, w e found an aver age of 4.2+ 0.74 ( int er val of 1.92 t o 5) for t he em ot ional suppor t and 4.2+ 0.6 ( int er val of 2.3 t o 5) for t he inst r um ent al suppor t , w hich indicat e high sat isfact ion and availabilit y of r eceived suppor t s. We found w eak but st at ist ically significant cor r elat ions bet w een inst r um ent al and em ot ional suppor t s and t he par t icipant s’ age and bet w een inst r um ent al suppor t and year s of educat ion. We did not find any differ ences in t he per cept ion of social suppor t in t er m s of par t icipant s’ gender and m ar it al st at us.
DESCRI PTORS: social suppor t ; t hor acic sur ger y ; r ehabilit at ion
EVALUACI ÓN DEL APOYO SOCI AL ENTRE PACI ENTES CARDÍ ACOS QUI RÚRGI COS:
SUBSI DI O PARA LA PLANI FI CACI ÓN EN LA ATENCI ÓN DE ENFERMERÍ A
Las f in alidades de est e est u dio descr ipt iv o y t r an sv er sal f u er on m edir el apoy o social de in div idu os hospit alizados par a t r at am ient o quir úr gico de car diopat ías y v er ificar las r elaciones ex ist ent es ent r e el apoy o social y las var iables sociodem ogr áficas. La r ecopilación de dat os ocur r ió ent r e m ayo de 2004 y j unio de 2005. Par t icipar on del est udio 86 indiv iduos, 47 de los cuales er an hom br es, 58 casados, con edad pr om edio de 53 años. Con r espect o al apoyo social, en un int er valo de 1 a 5, se obser vó una m edia de 4,2+ 0,74 ( int er valo de 1,92 a 5) par a el apoyo em ocional, y de 4,2+ 0,6 ( int er valo de 2,3 a 5) par a el apoyo inst r um ent al, lo que indica al t a sat i sf acci ó n y d i sp o n i b i l i d ad co n r el aci ó n a l o s ap o y o s r eci b i d o s. Se co n st at ó co r r el aci o n es b aj as y est adíst icam ent e significat ivas ent r e los apoyos inst r um ent al - em ocional y la edad; y ent r e el apoyo inst r um ent al y la escolar id ad . No f u er on en con t r ad as d if er en cias en t r e el ap oy o social con r elación al sex o y sit u ación cony ugal de los par t icipant es.
DESCRI PTORES: apoy o social; cir u gía t or ácica; r eh abilit ación
AVALI AÇÃO DO SUPORTE SOCI AL ENTRE PACI ENTES CARDÍ ACOS CI RÚRGI COS:
SUBSÍ DI O PARA O PLANEJAMENTO DA ASSI STÊNCI A DE ENFERMAGEM
Est udo descr it iv o e t r ansv er sal com obj et iv o de m edir o supor t e social de indiv íduos int er nados par a t r a t a m en t o ci r ú r g i co d e ca r d i o p a t i a s e v er i f i ca r a s r el a çõ es ex i st en t es en t r e su p o r t e so ci a l e v a r i á v ei s sociodem ogr áficas. Os dados for am colet ados no per íodo de m aio de 2004 a j unho de 2005. Par t icipar am do est udo 86 suj eit os, sendo 47 hom ens, 58 casados, com idade m édia de 53 anos. Quant o ao supor t e social, em u m in t er v alo p ossív el d e 1 a 5 , con st at ou - se m éd ia d e 4 , 2 + 0 , 7 4 ( in t er v alo d e 1 , 9 2 a 5 ) p ar a o su p or t e em ocion al e de 4 , 2 + 0 , 6 ( in t er v alo de 2 , 3 a 5 ) par a o su por t e in st r u m en t al, in dican do elev ada sat isf ação e disponibilidade quant o aos supor t es r ecebidos. Houv e cor r elações fr acas e est at ist icam ent e significant es ent r e os supor t es inst r um ent al e em ocional e a idade dos par t icipant es e ent r e supor t e inst r um ent al e escolar idade. Não for am encont r adas difer enças na per cepção do supor t e social quant o ao sex o e a sit uação conj ugal dos suj eit os do est udo.
DESCRI TORES: apoio social; cir u r gia t or ácica; r eabilit ação
I NTRODUCTI ON
S
o ci a l su p p o r t h a s b e e n p r e se n t e d a s a cont r ibut ive fact or t o decr ease st r ess and t o im pr ov ecopin g m ech an ism s in people w it h dif f er en t ch r on ic
h ealt h con dit ion s, in clu din g h ear t diseases( 1 ). Social su p p o r t p e r ce p t i o n s ca n v a r y a cco r d i n g t o t h e se
persons’ gender, age, educat ion level and civil st at us( 2).
When people get ill, t he support of fam ily and
friends is im port ant during hospit alizat ion. However, it
is aft er t hey ar e dischar ged t hat t hey w ill need t his
support even m ore. I n t he case of heart disease, t he
r elat iv es’ su ppor t in car diac r eh abilit at ion pr ogr am s
has been ext rem ely im port ant . Aft er t he cardiac event
o r t h er ap eu t i c i n t er v en t i o n s, t h e su p p o r t p at i en t s
per ceiv e, m ain ly w h en com in g f r om t h eir h u sban d/
w ife, has been r elat ed w it h favor able effect s on t heir
rehabilit at ion, m aking it possible for t hem t o reassum e
t heir professional act ivit ies( 3) and decreasing depression
lev els( 1). I ndiv iduals w it h gr eat er social suppor t hav e
displayed bet t er physical and m ent al perform ance aft er
t h e y w e r e s u b m i t t e d t o c o r o n a r y a r t e r y b y p a s s
gr aft ing( 4) and hear t t r ansplant at ion( 5). On t he ot her
h an d, t h e lack of social su ppor t an d social isolat ion
have been associat ed wit h high m ort alit y rat es am ong
people w it h hear t failur e( 6) and pat ient s subm it t ed t o
cor onar y ar t er y by pass gr aft ing( 7).
Anot her aspect t hat j ust ifies looking at social
suppor t am ong hear t pat ient s is t he obser vat ion of a
posit iv e associat ion am ong social suppor t , t r eat m ent
adher ence and qualit y of life. St udies hav e det ect ed
t h a t m a r r i e d p e r so n s p r e se n t g r e a t e r e m o t i o n a l
support , which is posit ively relat ed wit h t heir em ot ional
s t a t e ( d e c r e a s i n g a n x i e t y a n d d e p r e s s i o n ) a n d
im pr ov ed qualit y of life( 8). On t he ot her hand, liv ing
alone can be r elat ed w it h incr eased r ehospit alizat ion
rat es am ong pat ient s wit h chronic diseases( 9). A higher
risk of rehospit alizat ion was found am ong single heart
pat ient s, supposedly j ust ified by t he fact of living alone,
social isolat ion or lack of a social support syst em( 9).
A st u d y ca r r i ed o u t t o v er i f y t h e r el a t i o n
bet w een social suppor t , self- est eem and coping in t he
qualit y of life of pat ient s subm it t ed t o cor onar y ar t er y
b y p a s s g r a f t i n g f o u n d p o s i t i v e o r c o n v e r g i n g
correlat ions bet w een t hese variables( 10). I n t his st udy,
t h e in clu sion of t h e social su p p or t m easu r e in t h e
m ult iv ar iat e r egr ession m odel cont r ibut ed t o ex plain
a 1 5 % v ar iat ion in t h e qu alit y of life m easu r e aft er
cont rolling for sociodem ographic and clinical variables.
Accor din g t o t h e au t h or s, t h ese r esu lt s con f ir m t h e
im por t ance of t his v ar iable t o det er m ine t he qualit y
of life of pat ient s aft er surgical t reat m ent of coronary
hear t disease( 10).
This st udy aim ed t o assess t he social support
o f h ear t d i sease p at i en t s h o sp i t al i zed f o r su r g i cal
t reat m ent of t heir cardiac disease. To develop t he st udy,
social suppor t w as consider ed as assist ance r eceiv ed
from ot her people, which cont ribut es t o t he individuals’
p er cep t i o n t h a t t h ey a r e b ei n g ca r ed f o r, v a l u ed ,
est eem ed, loved and secure t hat t hey can count on t his
support( 11). The assessm ent of support is based on t he
su bj ect s’ per cept ion of t h e f r equ en cy at w h ich t h ey
r e ce i v e su p p o r t a n d t h e i r sa t i sf a ct i o n w i t h t h e
inst rum ent al and em ot ional dom ains of social support( 11).
The inst r um ent al dom ain r efer s t o t he av ailabilit y of
help t hat helps t he person in handling or solving pract ical
or operat ional everyday sit uat ions t hrough m at erial or
f i n a n ci a l su p p o r t o r f o r d i f f e r e n t d a i l y a ct i v i t i e s.
Em ot ional or est eem support , on t he ot her hand, consist s
in behaviors like list ening, giving at t ent ion or keeping
com pany. These behav ior s or at t it udes cont r ibut e t o
t he person’s feeling cared for and/ or est im at ed( 12).
We b el i ev e t h a t t h e a ssessm en t o f so ci a l
suppor t am ong car diac pat ient s subm it t ed t o sur gical
t r eat m en t can su p p or t h ealt h p r of ession als, m ain ly
n u r s e s a n d s o c i a l w o r k e r s , t o b e t t e r p l a n t h e
pr epar at ion of hear t pat ient s’ dischar ge and out pat ient
follow - up, w it h a view t o a bet t er r ehabilit at ion.
OBJECTI VES
Th i s s t u d y a i m e d t o m e a s u r e t h e s o c i a l
su ppor t of car diac pat ien t s h ospit alized f or su r gical
t r eat m en t an d t o ch eck ex ist in g r elat ion s b et w een
s o c i a l s u p p o r t a n d t h e v a r i a b l e s g e n d e r, a g e ,
educat ion lev el and m ar it al st at us.
METHODOLOGY
Design an d sam ple
Th e s t u d y w a s a p p r o v e d b y t h e Et h i c s
Com m it t ee at t he Univer sit y of São Paulo at Ribeir ão
Pret o Medical School Hospit al das Clínicas and is part
of a b r oad er r esear ch on q u alit y of lif e an d social
support am ong individuals wit h different heart diseases.
The pot ent ial part icipant s were invit ed t o part icipat e in
t he research and inform ed about t he st udy obj ect ives.
I f t h e su b j e ct s a g r ee d , t h e y si g n ed t h e f r e e a n d
We c a r r i e d o u t a n o b s e r v a t i o n a l , c r o s s
-sect ional st udy. The pot ent ial populat ion consist ed of
m ale and fem ale individuals w ho w ere hospit alized at
t h e h ea r t su r g er y w a r d s o f t h e st u d y h o sp i t a l . A
con v en ien ce sam ple w as com posed of su bj ect s w h o
at t en d ed t o t h e f o l l o w i n g i n cl u si o n cr i t er i a: b ei n g
h osp it alized f or su r g ical t r eat m en t of con g en it al or
acq u ir ed car d iac d iseases, b et w een May 2 0 0 4 an d
June 2005; older t han 18; in appr opr iat e physical and
em ot ional condit ions t o be int er v iew ed and agr eeing
t o par t icipat e in t he st udy.
Dat a collect ion an d m easu r es
S o c i o d e m o g r a p h i c d a t a w e r e c o l l e c t e d
t hr ough indiv idual int er v iew s w it h t he subj ect s, w hile
t he part icipant s’ files w ere exam ined for clinical dat a.
To assess social suppor t , w e used an inst r um ent t hat
w as adapt ed for applicat ion in car diac pat ien t s: t h e
v er sion adapt ed t o Por t uguese( 12) of t he scale called
So ci a l Su p p o r t I n v en t o r y f o r Peo p l e w h o a r e HI V Posit iv e or Hav e Aid s( 1 1 ). Th e Br azilian au t h or w h o adapt ed t his inst r um ent t o Por t uguese consent ed w it h
t he use of t he t r anslat ed inst r um ent( 12).
The adapted scale consists of two social support
cat egor ies or dim en sion s, t h e in st r u m en t al an d t h e
em ot ional. The inst rum ent al dim ension, assessed in t en
it em s, addresses individuals’ percept ion and sat isfact ion
with the availability of support to: solve operational issues
relat ed t o t heir healt h t reat m ent , pract ical act ivit ies of
daily living, m aterial and/ or financial help. The em otional
dim ension includes 12 it em s and assesses per cept ion
and satisfaction with the availability of listening, attention,
infor m at ion, est eem , com pany and em ot ional suppor t
wit h respect t o t heir healt h condit ion and t reat m ent( 12).
Th is f iv e- p oin t Lik er t scale assesses t h e p er ceiv ed
su p p o r t f r e q u e n cy ( 1 = n e v e r t o 5 = a l w a y s) a n d
sat isf act ion w it h it ( 1 = v er y d issat isf ied t o 5 = v er y
sat isfied) . I n t he inst rum ent al support com ponent , t he
support score is calculated by adding up the scores of its
ten item s and dividing this result by ten. I n the em otional
support com ponent , on t he ot her hand, t he scores of
the 12 item s are added up and the result divided by the
sam e figure. Thus, the m ean values of the com ponents
in dicat e t h at , t h e h igh er t h e scor e, t h e gr eat er t h e
perceived availabilit y and sat isfact ion wit h t he assessed
supports, that is, the higher the score obtained by adding
up the item s, the greater the social support(12).
I n or der t o gu ar an t ee t h e u n der st an dabilit y
of t he inst rum ent , w e decided t o sem ant ically analyze
t he social support scale first( 13). We int er view ed t hr ee
subj ect s, ask ed t hem about t he under st andabilit y of
t h e scale it em s an d r eq u est ed t h eir su g g est ion s t o
m ak e each it em as under st andable as possible. This
st ep result ed in t he reform ulat ion of som e it em s, w hich
favor ed t he under st anding of t he final inst r um ent but
w i t h o u t ch an g i n g t h ese i t em s’ m ean i n g . Nex t , w e
car r ied out a pilot t est w it h fiv e ot her subj ect s t hat
at t ended t o t he sam ple inclusion crit eria, w it h a view
t o checking t he adequacy of t he collect ion inst rum ent ,
including t he social support scale. Aft er t he pilot t est ,
w e found t hat t her e w as no need for alt erat ions in t he
inst r um ent , w hich w as consider ed adequat e for dat a
collect ion. Hence, w e decided t o include t hese subj ect s
in t he final st udy sam ple.
Dat a analy sis and st at ist ical m et hods
Af t er p r o cessi n g t h e co l l ect ed d at a i n t h e
soft w ar e pr ogr am St at ist ical Package for Social Science
( SPSS) v er si o n 1 3 . 0 , t h ey w er e an al y zed t h r o u g h
d escr ip t iv e st at ist ics, in clu d in g p osit ion ( m ean an d
m e d i a n ) a n d v a r i a b i l i t y ( s t a n d a r d d e v i a t i o n )
m easur es. Cr onbach’s alpha w as used t o analy ze t he
r eliabilit y of t h e social su ppor t m easu r e in t er m s of
t he adapt ed scale it em s’ int er nal consist ency.
To ach iev e t h e secon d st u d y ob j ect iv e, w e
decided t o select t he sociodem ogr aphic var iables t hat
h a d b e e n i n d i c a t e d i n t h e l i t e r a t u r e r e v i e w a s
associat ed w it h social su ppor t . Hen ce, w e an aly zed
t he r elat ions bet w een t he ( inst r um ent al and em ot ional)
social suppor t m easur es and t he v ar iables of gender,
age, educat ion and m ar it al st at us.
The r elat ions bet w een t he ( inst r um ent al and
e m o t i o n a l ) s o c i a l s u p p o r t m e a s u r e s a n d t h e
con t in u ou s v ar iab les ( ag e an d y ear s of ed u cat ion )
w e r e a n a l y z e d t h r o u g h S p e a r m a n ’ s c o r r e l a t i o n
co e f f i ci e n t . Th e co r r e l a t i o n st r e n g t h w a s v e r i f i e d
accor din g t o t h e f ollow in g classif icat ion : w eak ( r <
0 . 0 3 ) , m o d er a t e ( 0 . 0 3 < r < 0 . 5 ) a n d st r o n g ( r >
0 . 0 5 )( 1 4 ). Fo r t h e ca t eg o r y v a r i a b l es ( g en d er a n d m ar it al st at us) , Mann- Whit ney ’s t est w as car r ied out
t o com par e t h e social su ppor t m easu r es am on g t h e
gr oups, at a significance lev el of 0.05.
Concerning t he m issing dat a for t he scale used
in t his st udy, we adopt ed t he crit erion t hat est ablishes
t hat part icipant s who did not answer 20% or m ore of
t he scale it em s w ill be ex cluded fr om t he sam ple( 15).
I n t he case of t he scale we used, t his crit erion im plied
t he loss of four or m ore it em s. Two part icipant s reached
t his crit erion and were excluded from t he sam ple. For
it em , r elat ed t o t h eir sat isf act ion w it h on e r eceiv ed
suppor t aspect , w e adopt ed t he cr it er ion of r eplacing
t h e lost d at a b y t h e m ean scor e of t h e scor es t h e
individuals at t ribut ed t o t he ot her scale it em s( 10).
RESULTS
I n t h e s t u d y p e r i o d , 1 9 2 p a t i e n t s w e r e
hospit alized at t he hear t sur ger y w ar ds. Eight y - eight
( 4 5 . 8 % ) of t h em at t en ded t o t h e abov e m en t ion ed
inclusion crit eria. This percent age can be explained by
t he pat ient s’ hospit al discharge before t hey had cont act
w it h t he researchers, non- agreem ent t o part icipat e in
t h e st u dy an d u n fav or able clin ical sit u at ion s. Hov er,
t wo of t he 88 pat ient s init ially included in t he sam ple
were excluded because t hey did not m anage t o answer
m ore t han 80% of t he social support assessm ent it em s.
Hence, t he final sam ple consist ed of 86 par t icipant s,
equivalent t o 44.8% of t he pot ent ial st udy populat ion.
Ta b l e 1 s h o w s t h e p a r t i c i p a n t s ’
sociodem ogr aph ic an d clin ical ch ar act er izat ion .
Table 1 - Sociodem ographic and clinical charact erizat ion
of t he st udy sam ple. Ribeirão Pret o, SP. 2004/ 2005
T h e s a m p l e ’ s s o c i o d e m o g r a p h i c
ch a r a ct e r i st i cs sh o w e d t h a t , i n t h e g r o u p o f 8 6
par t icipant s, 47 ( 54. 7% ) w er e m en; 58 ( 67. 4% ) w er e
m a r r i e d o r l i v e d w i t h a si g n i f i ca n t p e r so n ; a g e s
r an ged fr om 1 6 t o 7 7 y ear s ( m ean 5 3 . 3 ) . I n t er m s
of incom e and educat ion, t he st udy gr oup display ed
pr ecar iou s econ om ic an d edu cat ion con dit ion s, w it h
a m ean fam ily incom e of 710 r eais and four y ear s of
ed u cat i o n .
Wh at t h e su bj ect s’ clin ical ch ar act er ist ics is
con cer n ed, 5 6 ( 6 5 . 1 % ) w er e aw ait in g su r ger y ( pr
e-oper at iv e per iod) . Cor onar y hear t disease and v alv e
d iseases w er e t h e m ost f r eq u en t d iag n oses, w h ich
j ust ify t he sur gical indicat ion of cor onar y ar t er y bypass
g r af t i n g ( 4 7 . 7 % ) an d v al v e r ep l acem en t or r ep ai r
( 3 7 . 2 % ) .
Resu lt s f or t h e in st r u m en t al an d em ot ion al
dim ensions of social suppor t ar e show n in Table 2.
Table 2 - Assessm ent of inst r um ent al and em ot ional
d im en sion s of social su p p or t scale. Rib eir ão Pr et o,
SP, 2004/ 2005
) 6 8 = N ( s e l b a i r a
V Mean(SD)*or
) % ( r e b m u n n a i d e M ) l a v r e t n i ( ) s r a e y ( e g
A 53,3(15,35) 53,2(16-77)
r e d n e G e l a m e
f 39(45,3%)
e l a
m 47(54,7%)
) s r a e y n i ( n o i t a c u d
E 4(3,97) 4(0-16)
) s i a e r n i ( e m o c n i y l i m a
F 710(605,3) 710(65-3000)
s u t a t s l i v i C n o s r e p t n a c if i n g i s a h t i w g n i v il / d e i r r a
m 58(67,4%)
e l g n i s / d e t a r a p e s / d e w o d i
w 28(32,6%)
h t i w s e v il t n e i t a p e h t s n o s r e p f o r e b m u N s n o s r e p 3 o t 0 m o r
f 68(79%)
s n o s r e p e r o m r o
4 18(20%)
n o i t a u t i s l a n o i s s e f o r P e v i t c
A 20(23,3%)
s e i t i v i t c a d i a p h t i w d e r i t e
R 08(9,3%)
d e r i t e
R 30(34,9%)
d i a p n u , e m o h t a k r o
W 17(19,8%)
s r e h t
O 11(12,8%)
) s y a d n i ( e m i t n o i t a z il a t i p s o
H 6(6,75) 6(0-33)
s e s a e s i d d e t a i c o s s a f o r e b m u
N 2(1,43) 2(0-6)
d o i r e p n o i t a z il a t i p s o H e v i t a r e p o -e r
P 56(65,1%)
e v i t a r e p o -t s o
P 30(34,9%)
e s a e s i d t r a e H e s a e s i D t r a e H y r a n o r o
C 38(44,2%)
e s a e s i D e v l a
V 32(37,2%)
h t o
B 05(5,8%)
s r e h t
O 11(12,8%)
n o i t a c i d n i l a c i g r u S g n i t f a r g s s a p y b y r e t r a y r a n o r o
C 41(47,7%)
r i a p e r / t n e m e c a l p e r e v l a
V 32(37,2%)
h t o
B 02(2,3%)
n o i t a c i d n i r e h t
O 11(12,8%)
* SD: St andar d deviat ion
* Social Suppor t Scale * * S.D.: St andar d deviat ion
I n a possible in t er v al fr om 1 t o 5 , w e fou n d
a m ean scor e of 4 . 2 ( in t er v al r an gin g fr om 1 . 9 2 t o
5 ) for t h e em ot ion al dim en sion an d a m ean scor e of
4 . 2 ( i n t er v a l f r o m 2 . 3 t o 5 ) f o r t h e i n st r u m en t a l
d im en sion . As t o t h e r eliab ilit y of t h e scales ( t ot al
a n d d i m e n si o n s) , t h e i t e m s’ i n t e r n a l co n si st e n cy
r ev ealed t o be ad equ at e in t h e st u dy sam ple, w it h
Cr on bach ’s alph a cor r espon din g t o 0 . 8 8 ( t ot al) , 0 . 7 4
( i n s t r u m e n t a l s u p p o r t ) a n d 0 . 8 6 ( e m o t i o n a l
su p p or t ) .
Wit h r espect t o t he social suppor t sour ces t he
par t icipant s m ent ioned, w e obser v ed t hat t hese w er e
r elat ively equal in t he t w o suppor t cat egor ies ( Table
3) . I n t he t w o suppor t t y pes w e analy zed, t he t hr ee
so u r ces t h e p ar t i ci p an t s m o st m en t i o n ed w er e, i n
d ecr easi n g or d er : “ r el at i v e n ot l i v i n g i n t h e sam e
house”, “ husband/ w ife/ par t ner ” and “ r elat iv e liv ing in
t he sam e house”. s n o i s n e m i
D InstrumentalSSC* EmotionalSSC*
s m e t I f o r e b m u
N 10 12
l a v r e t n I e l b i s s o
P 1-5 1-5
l a v r e t n I d e n i a t b
O 2,3-5 1,92-5
* * ) . D . S ( n a e
M 4,2(0,6) 4,2(0,74)
a h p l A s ´ h c a b n o r
Tab le 3 - Fr eq u en cy of in st r u m en t al an d em ot ion al
suppor t sour ces m ent ioned by t he par t icipant s ( N= 84) .
Ribeir ão Pr et o, SP. 2 0 0 4 / 2 0 0 5
su b j ect s w h o w er e m ar r ied or liv ed w it h som eon e
w as 4 . 1 ( SD= 0 . 7 ) , ag ai n st 3 . 9 ( SD= 0 . 8 2 ) am o n g
sin g le/ sep ar at ed / w id ow ed p ar t icip an t s.
DI SCUSSI ON
Aft er concluding dat a analy sis, w e obser v ed
t h at t h e p ar t icip an t s r eceiv ed h ig h lev els of social
s u p p o r t f o r t h e e m o t i o n a l a s w e l l a s f o r t h e
in st r u m en t al d im en sion . Th ese r esu lt s w er e sim ilar
t o t h ose obt ain ed f or HI V/ AI DS pat ien t s in a st u dy
t hat used t he sam e assessm ent scale in Br azil( 12).
The r esult s found for t he cor r elat ions bet w een
social suppor t and t he par t icipant s’ age indicat ed dir ect
o r co n v er g i n g st at i st i cal l y si g n i f i can t co r r el at i o n s,
alt hough t hese w er e w eak. These r esult s suggest t hat
older par t icipant s assessed t he suppor t t hey r eceiv ed
as being m or e available and sat isfact or y t han younger
subj ect s. Ot her aut hor s had alr eady highlight ed t hat ,
am ong older pat ient s, gr eat er t oler ance is per ceiv ed
a b o u t t h e s u p p o r t r e c e i v e d f r o m r e l a t i v e s a n d
friends( 2). They em phasize t hat , as opposed t o younger
adult s, elder ly do not r eceiv e t hat m uch pr essur e as
r esponsible for m aint aining t heir fam ily and for daily
h ou seh old an d ch ild car e t ask s. On t h e ot h er h an d,
t he ex per iences t hey hav e accum ulat ed dur ing t heir
liv es allow t he elder ly t o bet t er cope w it h t he losses
caused by t heir chr onic healt h condit ions( 2).
Th e a n a l y si s o f t h e r e l a t i o n b e t w e e n t h e
p e r c e i v e d s u p p o r t m e a s u r e a n d t h e s u b j e c t s ’
ed u cat ion lev el sh ow ed w eak an d st at ist ically n on
-si g n i f i ca n t co r r e l a t i o n s f o r t h e e m o t i o n a l su p p o r t
d i m e n s i o n . H o w e v e r, t h e d i r e c t i o n b e t w e e n t h e
m easur es confir m s t he inv er se r elat ion bet w een t he
v ar iables, indicat ing t hat , t he longer t he par t icipant s
hav e st udied, t he low er t he per ceiv ed social suppor t
seem s t o be( 2). These r esult s ar e differ ent fr om t hose
obt ained am ong HI V/ AI DS pat ient s, w her e individuals
w it h higher educat ion levels assessed t he suppor t t hey
r eceiv ed m or e posit iv ely( 1 2 ).
Wit h r espect t o t h e r elat ion bet w een social
su ppor t an d m ar it al st at u s, w e f ou n d n o dif f er en ce
bet w een t he gr oups ( m ar r ied/ liv ing w it h a significant
p er son an d sin g le/ sep ar at ed / w id ow ed ) f or t h e t w o
per ceiv ed social suppor t dim ensions. A differ ent r esult
w as found in anot her st udy, in w hich people w ho w er e
m ar r ied or liv ed w it h som eone obt ained higher m ean
s c o r e s , m a i n l y o n t h e e m o t i o n a l s u p p o r t
dim en sion( 1 2 ). e
c r u o S t r o p p u
S InstrumentalSSC* EmotionalSSC*
e h t n i g n i v il t o n e v i t a l e R
e s u o h e m a
s 70(81,4%) 69(80,2%)
r e n t r a p / e f i w / d n a b s u
H 61(70,9%) 61(70,9%)
e m a s e h t n i g n i v il e v i t a l e R
e s u o
h 49(57,0%) 50(50,8%)
) s ( r o b h g i e
N 30(34,9%) 29(33,7%)
) s ( d n e i r
F 28(32,6%) 41(47,7%)
s l a n o i s s e f o r p h t l a e
H 04(4,7%) 16(18,6%)
e u g a e ll o c / s s o
B 03(3,5%) 07(8,1%)
s r e h t
O 02(2,3%) 06(7,0%)
*Social Suppor t scale
To ach iev e t h e secon d st u dy obj ect iv e, t h at
i s, t o ch eck t h e ex i st i n g r el a t i o n s b et w een so ci a l
su p p o r t an d so ci o d em o g r ap h i c v ar i ab l es, w e u sed
n o n - p a r a m e t r i c a l l i n e a r c o r r e l a t i o n t e s t s a n d
com par isons bet w een t he gr oups’ m ean social suppor t
sco r es.
To t est t h e co r r el at i o n b et w een t h e so ci al
suppor t m easur es and t he cont inuous v ar iables ( age
and y ear s of st udy ) , w e used Spear m an’s cor r elat ion
co e f f i ci e n t . Th e o b t a i n e d r e su l t s w e r e : w e a k b u t
st at ist ically significant cor r elat ions bet w een age and
t h e em o t i o n al ( r = 0 . 2 6 ; p < 0 . 0 5 ) an d i n st r u m en t al
dim en sion s ( r = 0 . 2 6 ; p< 0 . 0 5 ) . Wh at t h e cor r elat ion
b et w een su p p o r t a n d ed u ca t i o n i s co n cer n ed , w e
f o u n d w eak co r r el at i o n s f o r b o t h d i m en si o n s, b u t
st at ist ically significant for t he inst r um ent al dim ension
( r = - 0.21; p< 0.05) and not significant for t he em ot ional
d i m e n si o n ( r = - 0 . 1 3 ; p > 0 . 0 5 ) . Bo t h co r r e l a t i o n s
revealed t o be inverse, confirm ing t he relat ions found
in t h e lit er at u r e r ev iew , w h ich in d icat ed d ecr eased
per cept ion of social suppor t as t he subj ect ’s educat ion
lev el in cr eased .
To analyze t he relat ion bet w een social suppor t
and cat egor ical var iables ( gender and m ar it al st at us) ,
w e u sed Man n - Wh it n ey ’s t est . We f ou n d t h at t h er e
w as n o d if f er en ce b et w een t h e t w o social su p p or t
dim ensions’ scores in t erm s of t he par t icipant s’ gender
a n d m a r i t a l s t a t u s ( p > 0 . 0 5 ) . W i t h r e s p e c t t o
inst r um ent al suppor t , w e found no differ ences bet w een
m en ( M= 4.2; SD= 0.51) and w om en ( M= 4.0; SD= 0.69)
and bet w een par t icipant s w ho w er e m ar r ied or liv ed
w i t h s o m e o n e ( M = 4 . 2 ; S D = 0 . 5 2 ) a n d s i n g l e /
separ at ed/ w idow ed pat ient s ( M= 3 . 9 ; SD= 0 . 7 2 ) . The
sam e w as t r u e f or em ot ion al su p p or t an d w om en ,
w it h a m ean scor e of 3.9 ( SD= 0.85) and m en, w it h a
Anot her r esult t hat at t r act ed our at t ent ion w as
r e l a t e d t o t h e s u p p o r t s o u r c e s t h e p a r t i c i p a n t s
m e n t i o n e d . We f o u n d t h a t , f o r t h e t w o s u p p o r t
d im en sion s, t h e h u sb an d s/ w iv es/ p ar t n er s w er e n ot
t h e m ost m en t ion ed sou r ces, bu t r elat iv es w h o did
n ot liv e in t h e sam e h ou se as t h e pat ien t s. I n t h is
r esp ect , ou r st u d y d if f er s f r om ot h er r esear ch t h at
pr esent s higher per ceiv ed av ailabilit y and sat isfact ion
w it h support , especially in t he inst rum ent al dim ension,
by people living w it h t heir husband/ w ife/ par t ner( 16- 17).
Som e aut hors believe t hat individuals w ho ar e m ar r ied
o r l i v e w i t h a si g n i f i ca n t p e r so n r e ce i v e g r e a t e r
su p p o r t i n co m p a r i so n w i t h si n g l e , se p a r a t e d o r
w i d o w e d i n d i v i d u a l s . Th e p e r c e p t i o n o f g r e a t e r
av ailabilit y and sat isfact ion w it h inst r um ent al suppor t
seem s t o der ive fr om t he fact t hat t his m odalit y im plies
m at er ial and oper at ional suppor t in healt h t r eat m ent ,
w hich is facilit at ed by t he shar ing of expenses and by
t h e spat ial pr ox im it y bet w een t h e per son pr ov idin g
and r eceiv ing t he suppor t( 16- 17).
How ev er, w e f ou n d div er gin g opin ion s, w it h
r esear cher s w ho hav e quest ioned t he ex t ent t o w hich
t h e in d iv id u als’ b ein g m ar r ied or h av in g a p ar t n er
gu ar an t ees t h e su ppor t t h ey n eed. Th ey ar gu e t h at
som e f act or s lik e g en d er, ag e an d t h e p r esen ce of
d i s e a s e s c a n j u s t i f y e x i s t i n g d i f f e r e n c e s i n t h e
su p p or t ob t ain ed f r om h u sb an d s/ w iv es/ p ar t n er s( 2 ). Mor eov er, t h ey em p h asize t h at t h is p r em ise ab ou t
h u sb a n d s/ w i v es b ei n g t h e m o st a v a i l ab l e su p p o r t
so u r ce ca n cr e a t e p r o b l e m s a m o n g a d u l t s i n t h e
pr odu ct iv e ph ase. Th ese gen er ally do n ot ex pect t o
assu m e t h e r ole of car eg iv er s f or t h eir p ar t n er in
t his phase of t heir liv es( 18).
CON CLUSI ON AN D I M PLI CATI ON S FOR
NURSI NG PRACTI CE
We f o u n d h i g h l ev el s o f i n st r u m en t al an d
em ot ional social suppor t am ong t he par t icipant s. Weak
but st at ist ically significant cor r elat ions w er e obser v ed
b et w een t h e t w o d im en sion s of social su p p or t an d
t he st udy subj ect s’ age. What educat ion is concer ned,
w e f ou n d a w eak an d in v er se bu t st at ist ically n on
-sig n if ican t cor r elat ion b et w een y ear s of st u d y an d
inst r um ent al suppor t . No differ ences in em ot ional and
inst r um ent al suppor t w er e pr ov ed w hen w e analy zed
t he par t icipant s’ gender and m ar it al st at us.
As social support has been a facilit at ing fact or
for hear t disease pat ient s’ coping and r ecov er y, and
as t he presence of high social support levels has been
associat ed w it h low st ress and depression levels aft er
hear t sur ger y, w e suggest t hat nur ses include social
suppor t assessm ent in t heir car e planning.
We b eliev e t h at social su p p or t assessm en t
c a n c o n t r i b u t e t o d e t e c t p e r s o n s w i t h g r e a t e r
rehabilit at ion difficult ies. To give one exam ple, people
w h o p e r ce i v e so ci a l su p p o r t a s u n sa t i sf a ct o r y o r
u n a v a i l a b l e m a y f e e l i n ca p a b l e o f ch a n g i n g a n d
behavior s t hat benefit cardiovascular healt h, such as:
p h y sical ex er cise, an ad eq u at e d iet an d g iv in g u p
sm ok i n g .
REFERENCES
1 . Pen n in x BWJH, Tilb u r g TV, Kr ieg sm an DMW, Boek e AJP, Deeg DJH, Eij k JTHM. Social n et w or k , social su p p or t , an d loneliness in older per sons w it h differ ent chr onic diseases. J Ag in g Healt h 1 9 9 9 ; 1 1 ( 2 ) : 1 5 1 - 6 8 .
2. Allen SM, Ciam br one D, Welch LC. St age of life cour se and social suppor t as a m ediat or of m ood st at e am ong per sons w it h disabilit y. J Agin g Healt h 2 0 0 0 ; 1 2 ( 3 ) : 3 3 8 - 4 1 . 3 . D a n t a s RAS, Ag u i l l a r OM, Ba r b e i r a CBS. Re t o r n o à s a t i v i d a d e s o c u p a c i o n a i s e s e x u a i s a p ó s c i r u r g i a d e r ev ascu lar ização do m iocár dio. Rev Lat in o- am En f er m agem 2 0 0 1 j u lh o; 9 ( 4 ) : 2 6 - 3 1 .
4. Lindsay GM, Sm it h LN, Hanlon P, Wheat ley DJ. The influence of gener al healt h st at us and social suppor t on sy m pt om at ic ou t com e f ollow in g cor on ar y ar t er y b y p ass g r af t in g . Hear t 2 0 0 1 ; 8 5 : 8 0 - 6 .
5. Bohachick P, Taylor MV, Sereika S, Reeder S, Anton BB. Social support , personal cont rol, and psychosocial recovery following heart t ransplant at ion. Clin Nurs Res 2002; 11( 1) : 34- 51.
6 . Mu r ber g TA, Br u E. Social r elat ion sh ips an d m or t alit y in pat ient s w it h congest ive hear t failur e. J Psychosom Res 2001; 5 1 ( 3 ) : 5 2 1 - 7 .
7. Brum m et t BH, Barefoot JC, Siegler I C, Clapp- Channing NE, Lyt le BL, Boswort h HB et al. Charact erist ics of socially isolat ed pat ient s wit h coronary art ery disease who are at elevat ed risk f or m or t alit y. Psy ch osom Med 2 0 0 1 ; 6 3 ( 2 ) : 2 6 7 - 7 2 . 8. Bennet t SJ, Perkins SM, Lane KA, Deer M, Brat er DC, Murray MD. Social support and healt h- relat ed qualit y of life in chronic hear t failur e pat ient s. Qual Life Res 2001; 10: 671- 82. 9 . Ber k m an B, Millar S, Holm es W, Bon an der E. Pr edict in g car d iac p at ien t s at r isk f or r ead m ission . Soc Wor k Healt h Car e 1 9 9 1 ; 1 6 ( 1 ) : 2 1 - 3 8 .
10. Dant as RAS, Mot zer SA, Ciol MA. The r elat ionship bet w een qualit y of life, sense of coher ence and self- est eem in per sons aft er cor on ar y ar t er y by pass graft su r ger y. I n t J Nu r s St u d 2 0 0 2 ; 3 9 ( 7 ) : 7 4 5 - 5 5 .
12. Seidl EMF. Pessoas v iv endo com HI V/ Aids: configur ando r elações ent r e enfr ent am ent o, supor t e social e qualidade de v i d a. [ t ese] . Br asíl ia ( DF) : Un iv er si d ad e d e Br asília/ Un B; 2 0 0 1 .
1 3 . Pasq u ali L. I n st r u m en t os p sicológ icos: m an u al p r át ico d e elab or ação. Br asília ( DP) : Lab PAM/ I BAPP; 1 9 9 9 . 1 4 . A j z e n I , Fi s h b e i n M. Un d e r s t a n d i n g a t t i t u d e s a n d pr edict ing social behavior. Upper Saddle River ( NJ) : Pr ent ice-Hal l ; 1 9 8 0 .
15. Cohen J, Cohen P. Applied m ult iple r egr ession/ cor r elat ion an aly sis f or t h e beh av ior al scien ces. 2 ª ed. Hillsdale ( NJ) : Law r en ce Er bau m ; 1 9 8 3 .
1 6 . D a n t a s RA S . Re a b i l i t a ç ã o a p ó s c i r u r g i a d e r ev ascu lar ização do m iocár dio. [ t ese] . Ribeir ão Pr et o ( SP) : Escola de En f er m agem de Ribeir ão Pr et o/ USP; 1 9 9 9 . 1 7 . Bou t in - Fost er C, Ch ar lson ME. Get t in g t o t h e h ear t of social su p p or t . A q u alit at iv e st u d y on t h e m ech an ism s of act ion of social suppor t am ong pat ient s w it h cor onar y ar t er y disease. J Clin Epidem iol 2 0 0 2 ; 5 5 ( 6 ) : 6 2 9 .
1 8 . Al l en S, Go l d sch ei d er F, Ci a m b i o n e D. Gen d er r o l es, m ar it al int im acy and nom inat ion of spouse a pr im ar y car egiver. Ger o n t o l o g i st 1 9 9 9 ; 3 9 : 1 5 0 - 8 .
