Social support sources among older women with heart failure: continuity versus loss over time

The extent to which older women with heart failure experienced continuity or loss of their support sources and the relationship between support source loss, perceived enacted support, and psychological well-being were examined in this study. In-home interviews were conducted with 57 older women who completed two interview 18 months apart following a hospital admission for heart failure. Both the emotional and tangible support sources were quite stable, indicating that the predominant pattern is continuity for older women with heart failure. Loss of tangible support sources was related to a perception of receiving less tangible support and less positive affect. Implications for future research and nursing practice are discussed.

Risk management strategies for home transfusion therapy

Transfusion therapy has been performed safely in the home setting for the past 15 years; however, it is not free of risks. Legal liability and risks can be reduced when transfusions are performed according to the accepted standards of care. Strategies to reduce transfusion risks through administrative, patient care, and quality control activities will be discussed. Methods to assure high-quality home care services also are provided.

Older adults' symptoms and their duration before hospitalization for heart failure

OBJECTIVE

To describe the older adult heart failure patients' symptoms and their duration before a hospital admission and to explore related factors.

DESIGN

The study was an archival study of inpatient hospital records at one acute care facility in western New York.

SAMPLE

One hundred eighty-one patients with a mean age of 76 years.

RESULT

Ninety-one percent of the patients reported having dyspnea an average of 3 days before hospital admission, and 37% reported having acute dyspnea an average of 12 hours before admission. Thirty-five percent of the patients reported having edema, and 33% reported a cough for an average of 7 days before their hospital admission. Age, heart failure history, and a symptom pattern of simultaneous development of preadmission symptoms were each related to the length of time patients experienced symptoms before admission.

CONCLUSION

This study, at one acute care institution, showed that older adult patients with heart failure experience symptoms for a relatively long time before hospital admission. Education about symptom monitoring, symptom interpretation, and prompt health care-seeking are warranted for all patients with heart failure.

1997 Joint Commission on Health Care Organizations home care standards: what's new?

Even though there are no new home care standards for 1997, there are some changes in the standards' interpretations and documentation expectations. Not all of the new interpretations are stricter interpretations. In fact, most of the new 1997 standards interpretations are more flexible. New interpretations for other problematic home care standards will be addressed in future columns.

Correlates of fatigue in older women with heart failure

OBJECTIVE

To examine the relative contribution of psychologic factors and physical symptoms to the variance in fatigue in older women with heart failure.

METHODS

Eighty women who had been hospitalized in the previous 12 months for heart failure were interviewed. Fifty-seven women completed second interviews 18 months after the first interview.

RESULTS

Fatigue was the most frequently occurring physical symptom at both measurement times, and it significantly increased with time. Other physical symptoms contributed uniquely to the variance in fatigue at both measurement times, but psychologic factors did not. At time 1, sleep difficulties, chest pain, and weakness each explained unique variance in fatigue. At time 2, dyspnea was the only variable that explained unique variance in fatigue (9%). Dyspnea also explained a significant portion of the variance (7%) in time 2 fatigue, when time 1 fatigue was controlled.

CONCLUSIONS

Fatigue in older women with heart failure is related more to other physical symptoms than psychologic factors.

The relationship of emotional and tangible support to psychological well-being among older women with heart failure

The purpose of this study was to determine the relationship between social support, symptom severity, and psychological well-being in older women with heart failure. In-home interviews were conducted with 80 older women following a hospital admission for heart failure. Subjects were asked their perceptions of emotional and tangible support received, symptom severity, and psychological well-being. Greater emotional support was related to greater positive affect and satisfaction with life. Greater tangible support was related to less negative affect. Neither emotional nor tangible support buffered symptom severity. The results indicate that emotional and tangible support may each affect different aspects of psychological well-being in older women with heart failure.

Social support sources and psychological well-being in older women with heart disease

A test of the compensatory hierarchical model of social support sources was conducted in a sample of 80 older women with heart disease. Relationships of support sources to measures of psychological well-being also were investigated. Emotional and tangible support sources fit the model with the exception that unmarried women without children named friends more often than extended family as emotional support sources. Receipt of emotional support from nonfamily members rather than from sources including family members was related to lower positive affect. Similarly, receipt of tangible support from nonfamily members rather than from sources including family members was related to less satisfaction with life. Factors that disrupt the family relationships of older women with illness are worthy of further exploration.