Issues in Cardiovascular NursingQualitative analysis of living with heart failure*,**
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).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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Cited by (58)
How do patients' values influence heart failure self-care decision-making?: A mixed-methods systematic review
2016, International Journal of Nursing StudiesCitation Excerpt :In the context of HF, the extent of this perceived incapability is broad as HF constrains a wide range of activities, including the ability to wake up (Bennett et al., 2000, 2005), to maintain a household (Boren, 2001; Pattenden et al., 2007), and practice spiritual traditions such as service to God (Mahoney, 2000), which is itself a traditional value. These further limit patients’ independence, which is one form of the value of self-direction (Boren, 2001; Ryan and Farrelly, 2009; Zambroski, 2003). A desire to terminate one's own life could also result from patients’ inability to fulfill key values such as achievement (Selman et al., 2007; Small et al., 2009).
Context matters in heart failure self-care: A qualitative systematic review
2014, Journal of Cardiac FailureUnderstanding help-seeking decisions in people with heart failure: A qualitative systematic review
2012, International Journal of Nursing StudiesCitation Excerpt :Caregivers provided intensive support when symptoms worsened (Box 2C). Patients valued and could rely on caregivers to determine if help was needed (Brannstrom et al., 2007; Edmonds et al., 2005; Patel et al., 2007; Sanford et al., 2011; Zambroski, 2003). At times, caregivers could contribute to increased delays by providing inaccurate advice (Zambroski, 2003).
Coping resources of heart failure patients – a comparison with cancer patients and individuals having no chronic condition results from the esther study
2020, Heart and LungCitation Excerpt :Thus, psychosocial interventions addressing and strengthening patients’ resources can be regarded as a promising holistic approach aiming for better health outcomes and overall well-being in HF patients.19,20 To date, studies on coping resources in HF patients are either limited to a qualitative study design22,24-26 or merely focus on how single resources (i.e. social support) affect health outcomes.17-19 Therefore, our first objective was to investigate a wide range of resources in a large population-based sample of HF patients.
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Reprint requests: Cheryl Hoyt Zambroski PhD, RN, Assistant Professor, University of Louisville, School of Nursing, Louisville, KY 40292.
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