Character strengths and the role thereof in the recovery of cardiac surgery patients

Abstract

In this qualitative study the role that character strengths played in the recovery process of cardiac artery bypass grafting (CABG) surgery patients was explored. Semi-structured interviews were the main means of collecting data from ten patients four to eight months post-operatively, with the aim of accurately describing the participants’ experiences during and their perspectives of the CABG recovery process and to identify personal strengths and other restorative and adaptive participant characteristics that could have played an enabling role in the process. Increasing research suggests that a protective relationship exists between positive psychological functioning and physical health (Diener & Chan, 2011) and that subjective well-being strongly contributes to health and well-being over the life span. Research has also found that increases in positive virtues/strengths are associated with better bio-psychosocial functioning. In line with Baer’s (2015) remark that different health situations call for different positive abilities or combinations of such characteristics, Boehm and Kubzansky (2012) suggested that research should investigate whether some unique positive psychological well-being constructs are specifically associated with restorative functions in the context of cardio vascular health. In the study participants were introduced to character strengths and after their signature strengths were identified by means of the VIA-IS, they were invited to talk about their experiences during the CABG recovery period, about the role played by their strengths in the process, and how strengths influenced their post-surgical recovery and adjustment. The GRID method was used initially to illicit first thoughts and to produce data that follow the pathways of the respondents’ thoughts and feelings. Data obtained from interviews were analysed by means of qualitative thematic analysis (Braun & Clarke, 2006) and by making use of the ATLAS.ti computer assisted software program (Lewins & Silver, 2007), a method for identifying, analysing and reporting patterns within data. From the analyses, a hierarchy or constellation of strengths emerged that were context specific to CABG recovery for the participants involved. Participants did however, not primarily use their VIA-IS identified signature strengths to enable them during their recovery processes, but rather used other VIA-IS related strengths and even strengths not included in the VIA-IS. Strengths relating to the recovery process that were identified from analyses of the interviews clustered mainly around the four virtues of Transcendence, Courage, Humanity and Temperance. Transcendence strengths (spirituality, hope, gratitude, appreciation of beauty) were mostly used, followed by Courage strengths (i.e. perseverance, vitality, iii bravery) and Humanity strengths (love, kindness, social intelligence). Thereafter Temperance strengths and particularly the strength of self-regulation seemed to be prominent, with Wisdom and Knowledge strengths (creativity and open mindedness) and Justice strengths (leadership), least of all. These findings seem to be in line with those in various other studies which reported that strengths apparently function optimally in context specific applications (Park & Peterson, 2006; Shryack, Steger, Krueger & Kallie, 2010). The view of Biswas-Diener, Kashdan and Minhas (2011) that strengths are highly contextual phenomena that emerge in distinctive patterns relating to particular goals, interests, values and situational factors, is of important relevance to the findings of this study. Based on the context relevant functioning of strengths, it is understandable that after such a life-changing experience as being diagnosed with cardiac illness and having CABG surgery afterwards (context), transcendence strengths would emerge in order to cope with the anxiety of facing one’s vulnerability and mortality and particularly to find meaning and purpose for one’s life as a whole (Peterson, 2006). Closely related would be the use of courage strengths of persistence, bravery and vitality (especially psychological energy), to restore a sense of personal control, self-efficacy and coping abilities to deal with the recovery challenges after CABG and to regain a sense of self-competence and of resilience that Masten (Masten, 2001; Masten & Reed, 2002) referred to as ordinary magic. Humanity strengths manifested mainly as social intelligence and love, but through the experience of perceived social support and the appropriate response thereto. Research abound about the salutory effects of perceived social support on health related matters, including greater resistance to disease, faster recovery from surgery and heart disease, lower mortality, compliance with medical treatment, reduced levels of medication and the adoption of health-promoting behaviour after illness experiences, all very relevant to CABG patients in recovery (see Compton & Hoffman, 2013). Taylor (2011) found that perceived social support reduces negative affect during times of illness or stress and promotes psychological coping and adjustment, which in turn enhance further coping behaviour and other strengths to promote adjustment behaviour (Salovey, Rothman, Detweiler & Steward, 2000). Although the temperance strengths other than self-regulation did not feature strongly in this study, self-regulation seemed to be prominent as both an enabling strength for other strengths to emerge and as the strength that underpinned the ability to accept the realities of CABG recovery and to adapt to a new health-oriented lifestyle. A sense of self-efficacy and self-regulation seemed to work hand-in-hand in these participants (Bandura, 2005; Hevey, Smith & McGee, 1998; Kubzansky, Park, Peterson, Vokonas & Sparrow, 2011). An interesting finding of the study was that certain strengths apparently did not play a role in promoting the recovery of these CABG patients, but rather emerged as outcomes of their struggling with the challenges of cardiac illness and recovery from surgery. These strengths were seen as post-traumatic growth strengths and seemed to serve a purpose in fostering the participants’ post-recovery well-being and in their ongoing adaptation to a healthy lifestyle. In the study, it was therefore clear that character strengths that were context specific, were mostly used by participants to facilitate their recovery processes after CABG surgery rather than their signature strengths, although the latter were not completely absent and were most likely intricately woven into the strengths pattern of each individual participant and perhaps had an enabling or catalytic role to engage other strengths required by the recovery challenges. * The references in this summary will be found in the reference list of Chapter 1.