Using a longitudinal design, the effect of social support on recovery from coronary bypass surgery was examined in 155 patients and 103 of their spouses. Perception of the availability of 5 types of social support was relatively stable from preoperation to 1 year after surgery and was significantly related to emotional and functional outcomes. Of the 5 types of support measured, only esteem support was significantly and consistently related to outcomes for patients and spouses. This relationship was strongest within-time, and across-time relationships effects were weaker. Spouse's perception of support was related to patient outcomes, controlling for patient perceptions of support. Results suggest that perception of esteem support may be the most salient type of support related to feelings of well-being during and after an acute health-care event. In addition, perception of social support may be characterized by stable individual differences.

BACKGROUND: The acute care nurse practitioner role is relatively new and not yet clearly defined. Our institution is in the first phase of a role delineation study that includes model development, validity testing, model revision, and dissemination. OBJECTIVES: To identify domains of practice, activities within each domain of practice, and common conceptual strands that cut across each domain, and to synthesize this information into a usable format to guide practice and role development. METHODS: A nonexperimental study design was used, including review of literature, expert consultation, brainstorming, and review of practice. RESULTS: The patient is central to the model. The identified domains of practice include direct comprehensive care, support of systems, education, research, and publication, and professional leadership. The conceptual strands include empowerment, collaboration, and scholarship. A continuum of experience from novice to expert was also identified within each domain. CONCLUSIONS: The development of the model is the first and most important phase in the role-delineation process. We believe that the model is accurate but still in need of testing. Nevertheless, our model can be used to guide institutions and individual practitioners.

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Quality of life and perceptions of the consequences of surgery were examined in 155 individuals having coronary bypass surgery. One year after surgery, subjects believing surgery was worth it because of functional improvement (n = 64) had more positive scores on subjective indicators of life satisfaction and mood than those believing surgery was worth it because it saved them from death (n = 62) or those who were not sure surgery was worth it (n = 23). Differences in perceptions of quality of life between the two groups who believed surgery was worth it are discussed in terms of focus of attention. Individuals who perceive improved functional ability may focus on concrete outcomes of surgery, whereas those who interpret the benefit of surgery in light of the alternative of death may focus their attention on affective aspects of recovery. Findings emphasize the need for using a multidimensional approach to studying quality of life.