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There is no simple answer to the complex problem of job related stress, which is inherent in the practice of nursing. However, some solution to the problem has to be found otherwise young people will not enter the profession and older, experienced nurses will continue to leave the profession, resulting in a continuation of the current shortage and generating more critical future shortages. Teaching nurses to become self-dependent and to assume the role of avatar offers one possible solution to cope with the problem, a solution which requires active participation by the persons involved.

The victims of myocardial infarction pose a real challenge to nursing. Effective nursing intervention is based on an understanding of human responses to the stress of heart disease and the series of behavioral changes individuals undergo in an attempt to cope with the stress. Cardiac teaching is an essential aspect of this intervention. After a myocardial infarction, patients first go through two stages on the way to recovery--independency and dependency--before they are receptive to teaching. It is during the next two stages--interdependency and self-dependency--that nurses can use specific behavioral changes of the patients to plan health teaching and to negotiate contracts with them to effect learning and permanent behavioral change.