Home > RNJ > 2006 > March/April > Commentary: Access to the World After Myocardial Infarction: Experience the Recovery Process

Commentary: Access to the World After Myocardial Infarction: Experience the Recovery Process
Barbara Zimmerman, DNSc RN

Hildingh et al. have shown the process of recovery from the perspective of the client who suffered a Myocardial Infarction (MI). This rich data may be utilized in the rehabilitation setting to assist clients to reach a level of healthy adaptation and optimum level of functioning—a goal for all patients in rehabilitation.

This qualitative research design was utilized to describe the recovery experiences for clients who have suffered a MI. The sample of 16 informants, who had suffered a MI 8 or 9 months earlier, was interviewed using a partially structured format. Data were analyzed using the content analysis process and revealed three themes to the recovery process.

  • Ability describes the informants’ ability to work through the recovery process.
  • Restraint refers to the majority of the informants dealing with fear and vigilance.
  • Reorientation is a change of values and motivation to make lifestyle changes, particularly focused on a balance of work and family or diet and exercise. A new body image was incorporated into defining this balance.

According to Lazarus (1999), coping begins with a primary and secondary appraisal of the meaning of the event at that time. Factors that influence the appraisal include the clients’ beliefs and commitments, past experiences, values and unique personality traits (temperament, self esteem, body image, age, and resiliency). The appraisal of this life-threatening experience will differ with each client, validating that for some the response may not be in accordance to the severity of the illness.

As post-MI acute care time shortens, it is crucial that nurses provide the client with information about both the physical and emotional changes that may occur. Taking time to listen to the client for subtle clues of difficulty in coping is a critical part of a nurse’s care. Cardiac rehab nurses, in particular, need to provide information but also assess each client’s coping and recovery progress. “Reorientation” signals that clients have reestablished a new body image and integrated these changes into their lifestyle. The client re-enters the world after finding a balance, a new meaning in life. Some authors speak to this resocialization as the goal of rehabilitation.

Three points for practice in rehabilitation

  • Awareness of the fear and vigilance that surfaced in this study necessitates that nurses address these topics with clients. Clients need to know that there will be times when the fear of reoccurrence may strike. Nurses can help clients recognize the signs of this fear and how to deal with it. In the cardiac rehab setting, encouraging the clients to discuss their fears and learn what they can do empowers them. The energy that is wasted on vigilance can be utilized for healing and bringing a better balance to their lifestyle.
  • Utilize the rich contextual data gained from the informant’s perspective of the recovery process when caring for the post-MI client in the acute or rehab setting. Share these perspectives and describe what some clients have experienced as a way to open a dialogue with the client. Speak to the process and timeframe that it takes to become reoriented, and reinforce the need for lifelong changes to be made.
  • The process described in this qualitative study is similar to others that have examined adaptation following a chronic illness or disabling event. Appraisal of an event and options for coping are unique to each individual’s perspective. The process by which the client gains meaning of the event and assigns value to oneself must occur before strength (ability) to venture back into society. The restraints of that process can impact recovery. Nurses must assist clients to gain control and empower them to deal with uncertainty. These two interventions may promote the client’s progress in adapting and reorientating their lifestyle.