Patient-nurse contracts in critical care: a controlled trial

An experimental trial was conducted to measure the effects of a patient-nurse contract on patients' emotional state during hospitalization in the Coronary Care Unit (CCU). The contractual agreement focused on areas of environmental restrictions and nursing care in the CCU that might decrease patients' sense of control. Forty-one patients with documented coronary heart disease, never previously hospitalized, were randomly assigned to either a control or an experimental group upon admission to the CCU. The control group was oriented to the routines of the unit by one of the nursing staff, while the experimental group made individualized contracts with a nurse regarding family visitation, schedules for daily hygiene, patient teaching, activity and the room environment. A significant difference existed between the two groups over time for the three dependent measures of anxiety, depression and hostility (p less than .001). Twenty-four hours after completing baseline measures, the control group was significantly more anxious (p less than .01) and hostile (p less than .05) than the experimental group. At 48 hours, the experimental group reported significantly lower anxiety (p less than .01), depression (less than .05), and hostility (p less than .05) compared to the control group. These findings suggest that a strategy designed to enhance cardiac patients' sense of personal control may facilitate emotional adaptation to hospitalization.