Elsevier

Heart & Lung

Volume 32, Issue 1, January–February 2003, Pages 32-40
Heart & Lung

Issues in Cardiovascular Nursing
Qualitative analysis of living with heart failure*,**

https://doi.org/10.1067/mhl.2003.10Get rights and content

Abstract

Background: The incidence of heart failure has been described as epidemic in proportion. Although literature abounds surrounding issues of epidemiology, pathophysiology, and treatment issues for those with heart failure, little is known about the day-to-day experiences of adults living with this chronic illness. Objectives: The purpose of this study was to describe and analyze the experience of adults who are living with heart failure. The specific aims were to describe the problems, challenges, and processes of living with heart failure, to identify strategies and tactics adults use to live with heart failure, and to provide a model that articulates what the participants described. Methods: Principles of naturalistic inquiry were used to describe problems, challenges, and processes of living with heart failure. Six women and 5 men participated in in-depth interviews that lasted from 40 minutes to 100 minutes. Data were collected and analyzed with the constant, comparative method. Results: Participants' use of language referring to wind and water in describing their heart failure symptoms led to discovery of navigating and aspects of navigational science as metaphors for living with heart failure. The 3 main categories of the resulting model were called experiencing turbulence, navigating, and finding safe harbor. Conclusions: Use of the model for living with heart failure may provide for creation of interventions for adults to improve their ability to manage their own care in the face of this potentially devastating illness. (Heart Lung® 2003;32:32-40.)

Section snippets

Symptoms and self-management

Researchers have reported decreased quality of life resulting from a range of physical, psychologic, and social symptoms in adults with heart failure.8, 9, 10 Friedman11 reported the physical symptoms most commonly associated with heart failure include dyspnea, paroxysmal nocturnal dyspnea, edema, palpitations, chest pain, orthopnea, and cough. Nurse researchers also have documented the symptom of fatigue as it relates to heart failure.12, 13 Beyond the physical symptoms of heart failure, its

Purpose

The purpose of this naturalistic study was to explore the experience of living each day with heart failure. The specific aims were to describe the problems, challenges, and processes of living with heart failure, to identify strategies and tactics adults use to live with heart failure, and to provide a model that articulates what the participants described.

Participants

Inclusion criteria included the following: patients were (1) diagnosed with heart failure, (2) undergoing medical treatment for heart failure, (3) English speaking, and (4) 40 years of age or older. Participants were recruited from a local hospital, a visiting nurse association, a mall health center, and professional referral. Human subject approval was obtained through the appropriate institutional review boards.

In this study, fieldwork involved the cyclic process of data collection and

Data collection

All interviews were conducted in participants' private residences. Interviews varied in length from 40 minutes to 100 minutes. Data were collected primarily with the use of audiotaped interviews and fieldnotes. Transcriptions of tapes were verified to determine accuracy of transcription.

Interviewing strategies included the use of a semi-structured interview guide on the basis of a review of literature, preliminary study activity, and guidance from professional colleagues. Questions addressed

Data analysis

The technique of constant, comparative analysis was used to generate the major conceptual categories. The first phase of analysis involved open coding.30 As the coding process proceeded, categories were developed. For example, participants' terms and phrases referring particularly to water and to lack of wind (eg, “choppy breathing,” “huffing and puffing,” “blowing,” or “gallons of water come off me”) emerged from the data. Symptoms that participants were most clearly able to associate with

Findings

Three key categories emerged as a result of data analysis representing the experience of living with heart failure: experiencing turbulence, navigating, and finding safe harbor (Table I).

. Categories and subcategories

Experiencing turbulence
Experiencing physical turbulence: “Where you feel like you are drowning.…”
Experiencing emotional turbulence: “I get excited easily.…”
Experiencing social turbulence: “I miss the playing of life.…”
Navigating
Determining position
 Use of “dead reckoning” to determine

Discussion

Concepts that emerged in this study are not traditionally associated with nursing. However, the metaphor of navigating to safe harbor clearly arose through the interaction of the investigator with data that included interviews, fieldnotes, and resources from nontraditional sources.

Lorig26 defined self-management as “learning and practicing skills necessary to carry on an active and emotionally satisfying life in face of a chronic condition.” The key element of Lorig's model is its focus on the

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    *

    Reprint requests: Cheryl Hoyt Zambroski PhD, RN, Assistant Professor, University of Louisville, School of Nursing, Louisville, KY 40292.

    **

    0147-9563/2003/$30.00 + 0

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