Qualitative analysis of the male experience of heart failure

Lived Experience of Adult With Heart Failure at Tibebe Ghion Specialized Teaching Hospital Northwest Ethiopia, Qualitative Phenomenological Study

Background

Heart failure is major public health problem that affects many people worldwide. It affects all aspects of patients' lives, leading to extreme physical, social, and functional restriction and increasing psychological distress. The purpose of this study was to explore the lived experience of adult patient with heart failure at Tibebe Ghion Specialize Hospital, Ethiopia, 2022.

Method

Qualitative Phenomenological study design was conducted at Tibebe Ghion Specialized Referral Hospital, from November 10 to December 15, 2022. Heterogenous purposive sampling technique was used to select 11 study participants. Data were collected through in-depth interviews guides and observational checklist. The rigor and trustworthiness of the study were maintained by transferability, dependability, credibility, and conformability. Thematic analysis method was used for the development of codes and themes using ATLAS. ti.7 software for analysis.

Result

Five main themes and eleven subthemes were developed that explore the lived experience of adults with heart failure. Impact of heart failure on daily life, psychological and spiritual experiences, financial experiences, experiences related to hospital service, and challenges to getting treatment are major themes. Unavailability of medicine, lab investigations, and the inaccessibility of cardiac centers were the main challenges during their treatment.

Conclusion

This study explored that lived experience of adult HF patients were addressed in in terms of Physical, Psychological and Spiritual, financial, hospital service and challenges to get treatment. Therefore, we recommended providing psychological and economical support for HF patients and in addition to accessing medication and medical care centers.

Consequences of Psychological Aspects: From Jordanian Heart Failure Patients' Beliefs

Introduction

Psychological aspects are common in patients with heart failure (HF). Psychological aspects have negative consequences in patients with HF.

Objective

This study was conducted to gain a deeper understanding of the consequences of psychological aspects in Jordanian patients with HF.

Methods

This study is a qualitative study conducted with the participation of 24 patients with HF. Data were collected using semi-structured interviews.

Results

The main theme of the findings can be expressed as "Consequences of psychological aspects of HF." The following four sub-themes emerged from the data: social isolation, disturbance of feelings, being non-compliant, and growing burden on the health care system.

Conclusion

The findings revealed the need for informing healthcare providers about the negative consequences of psychological aspects and develop clinical guidelines to evaluate psychological aspects to support these patients.

Women's experiences of male nursing and midwifery care: An inductive content analysis of blog posts from an open-access parenting site

BACKGROUND

There still remains a gender divide between men and women when it comes to the provision of nursing care. To date, there is a plethora of literature that describes the barriers men face in the profession. However, there is very little with regard to the patients' qualitative experience of male nursing/midwife care.

AIM

The aim of this study was to describe the experiences of women being cared for by a male nurse/midwife.

METHOD

Inductive content analysis was undertaken on blog posts from an online parenting site as they related to the care provided by male nurses and midwives.

RESULTS

A total of 128 blog posts were identified. There were two themes identified-feeling comfortable and feeling cared for. There was a polarized view to the care provided by male nurses and male midwives with respondents either flatly refusing, or wanting a preference as to which gender provided care, to others expressing it was the best care they ever experienced. The provision of care was where the blog posts differed significantly. There were mixed emotions from angered embarrassment at the thought of a male nurse/midwife providing intimate care to being Ok with nonintimate care such as the taking of vital signs.

CONCLUSION

It would appear from the blog posts analyzed that the assimilation of men into clinical areas generally seen as the purview of female nurses is slowly becoming accepted although further research as to the patient perspective of male nursing/midwifery care in these areas is needed.

Illness perceptions in patients with peripheral arterial disease: A systematic review of qualitative studies

BACKGROUND

Patients with chronic diseases create their own subjective beliefs about their conditions based on their illness perceptions. In the common-sense model, illness perceptions constitute personal beliefs about illness with regard to five components: identity, timeline, cause, control/cure, and consequences. Patients' illness perceptions affect both their management of their disease and their adherence to treatment. Since patients with peripheral arterial disease need life-long treatment for secondary prevention, generating knowledge about illness perceptions in patients with peripheral arterial disease is essential.

OBJECTIVES

To systematically review and synthesise the literature on illness perceptions in patients with peripheral arterial disease.

DESIGN

A systematic review DATA SOURCES: PubMed, CINAHL, and PsycINFO.

REVIEW METHODS

A systematic search strategy was conducted in December 2017, with an update in July 2019. Two team members independently screened all titles and abstracts. A relevance and quality appraisal of the studies was performed. The references from the included studies were evaluated for additional studies. The data from 14 studies were extracted and synthesised using a "best-fit" approach to framework analysis. A deductive analysis was conducted using the common-sense model. The data not suitable for the framework were analysed separately using inductive conventional content analysis, yielding an additional component representing the retrospective consequences of peripheral arterial disease.

FINDINGS

The findings showed diversity in illness perceptions in each of the five components of the framework as well as in the additional component. The findings showed participants' lack of understanding of the chronic nature of the disease, i.e., about the timeline, the identity of the symptoms and the cause of the disease. The patients' beliefs about control and cures varied from having high motivation to engage in physical activity to thinking that walking could make their situations worse. There was fear about the future, as patients perceived disease progression and decreasing control to be consequences of their illness. Living with the disease, the emphasis in the additional component, was a process for regaining control and adapting to their situations.

CONCLUSIONS

Patients with peripheral arterial disease shape their own understandings of their conditions. These beliefs may influence their management of their disease and adherence to treatment. Therefore, the current study suggests that illness perceptions should be addressed when planning secondary prevention for patients with peripheral arterial disease.

Unexplored Aspects of the Meaning of Living with Chronic Heart Failure: A Phenomenological Study within the Framework of the Model of Interpersonal Relationship between the Nurse and the Person/Family Cared for

The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient's perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.

Redefining a 'new normality': A hermeneutic phenomenological study of the experiences of patients with chronic heart failure

AIM

To explore the perception of normality in life experienced by patients with chronic heart failure.

DESIGN

A hermeneutic phenomenological study was conducted.

METHODS

Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis.

RESULTS

From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others.

CONCLUSIONS

The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process.

IMPACT

Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.

Living with Severe Chronic Heart Failure in Palliative Advanced Home Care

BACKGROUND

Living with severe chronic heart failure (CHF) in palliative care has been little studied.

AIM

The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives.

METHODS

Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text.

RESULTS

Meaning of living with severe CHF in palliative advanced home care emerged as 'knocking on death's door' although surviving. The course of the illness forces one to live a 'roller coaster life,' with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the 'roller coaster' by the palliative advanced home care team evokes feelings of security.

CONCLUSIONS

Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.

Alcohol consumption after health deterioration in older adults: a mixed-methods study

OBJECTIVE

To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behaviour.

STUDY DESIGN

Explanatory follow-up mixed-methods research.

METHODS

The association between health deterioration and changes in alcohol consumption was examined using secondary data from the English Longitudinal Study of Ageing, a biennial prospective cohort study of a random sample of adults aged 50 years and older living in England. Data were collected through a personal interview and self-completion questionnaire across three waves between 2004 and 2009. The sample size (response rate) across the three waves was 8781 (49.9%), 7168 (40.3%) and 6623 (37.3%). The Chi-squared test was used to examine associations between diagnosis with a long-term condition or a worsening of self-rated health (e.g. from good to fair or fair to poor) and changes in drinking frequency (e.g. everyday, 5-6 days per week, etc.) and volume (ethanol consumed on a drinking day) between successive waves. In-depth interviews with 19 older adults recently diagnosed with a long-term condition were used to explore the factors that influenced change or maintenance in alcohol consumption over time. A purposive sampling strategy was used to recruit a diverse sample of current and former drinkers from voluntary and community organizations in the north of England. An inductive approach was used to analyze the data, facilitating the development of an a posteriori framework for understanding drinking change.

RESULTS

There was no significant relationship between health deterioration and changes in drinking volume over time. There was however a significant association between health deterioration and changes in drinking frequency between successive waves (χ² = 15.24, P < 0.001 and χ² = 17.28, P < 0.001). For example, of participants reporting health deterioration between the first two waves, 47.6% had stable drinking frequency, 23.4% increased their drinking frequency and 29% reported decreased drinking frequency. In comparison, of participants reporting no health deterioration, 52.7% reported stable frequency, 20.8% increased frequency and 26.4% decreased frequency. In qualitative interviews, older adults described a wide range of factors that influence changes in drinking behaviour: knowledge gained from talking to healthcare professionals, online and in the media; tangible negative experiences that were attributed to drinking; mood and emotions (e.g. joy); the cost of alcohol; pub closures; and changes in social roles and activities. Health was just one part of a complex mix of factors that influenced drinking among older adults.

CONCLUSION

Patterns of drinking change after health deterioration in older adults are diverse, including stable, increasing and decreasing alcohol consumption over time. Although health motivations to change drinking influence behaviour in some older adults, social and financial motivations to drink are also important in later life and thus a holistic approach is required to influence behaviour.

A Narrative Literature Review of the Experiences of Patients Living With Heart Failure

This article reviews the literature on the experiences of patients with heart failure and their coping strategies and learning needs. Previous studies have consistently demonstrated that heart failure had negative impacts on the individuals who experienced it. Studies have also focused on the learning needs and the various coping strategies that patients with heart failure have adopted. However, there are limited studies that have investigated the experience of heart failure from the Asian patient's perspective. By incorporating the perspectives of patients with heart failure from the Asian context into clinical practices, research will promote patient-centered holistic care and improve patients' quality of life and satisfaction.

'Engage me in taking care of my heart': a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure

OBJECTIVE

In approaching the study and practice of heart failure (HF) management, authors recognise that the patient-doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters.

DESIGN

Using a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles.

SETTINGS

All interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy.

PARTICIPANTS

The data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist.

RESULTS

The HF patient engagement process develops in four main phases that are characterised by different patients' emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients' ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients' engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience.

CONCLUSIONS

This study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh way about encounters with patients and their role in fostering their patients' health engagement.

Androgen receptor in human endothelial cells

Androgen receptor (AR) is a ligand-inducible transcription factor, and a member of the steroid-thyroid-retinoid receptor superfamily, that mediates the biological effects of androgens in a wide range of physiological and pathological processes. AR expression was identified in vascular cells nearly 20 years ago, and recent research has shown that AR mediates a variety of actions of androgens in endothelial and vascular smooth muscle cells. In this mini-review, we review evidence indicating the importance of AR in human endothelial cell (HUVEC) homeostatic and pathogenic processes. Although a role for AR in the modulation of HUVEC biology is evident, the molecular mechanisms by which AR regulates HUVEC homeostasis and disease processes are not fully understood. Understanding these mechanisms could provide critical insights into the processes of pathogenesis of diseases ranging from cardiovascular disease to cancer that are major causes of human morbidity and mortality.

Experiences of Patients Living With Heart Failure

The purpose of this study was to explore the experiences, needs, and coping strategies of patients living with heart failure in Singapore. A descriptive qualitative design was used. A purposive sample of 15 informants was recruited from two cardiology wards of a tertiary public hospital in Singapore. Individual face-to-face interviews were conducted with a semistructured interview guideline that was developed based on a review of the literature and a pilot study. Content analysis was adopted to analyze the data, and four main categories were identified: perceived causes, manifestations, and prognosis; enduring emotions; managing the condition; and needs from health care professionals. The informants were overwhelmed with the experience of living with heart failure due to the disruptive and uncertain nature of the condition. This study offers health care professionals practical and useful suggestions when providing holistic care for patients with heart failure.

Patient perspectives about depressive symptoms in heart failure: a review of the qualitative literature

BACKGROUND

Scientists have systematically established the prevalence and the consequences of depressive symptoms in patients with heart failure (HF). However, a comprehensive understanding of patient perspectives about depressive symptoms, in combination with HF, has not been published. A patient-centered approach may support the design of interventions that are effective and acceptable to patients with HF and depressive symptoms.

OBJECTIVE

The aim of this study was to review qualitative findings about patient perspectives of contributing factors, associated symptoms, consequences, and self-care strategies used for depressive symptoms in HF.

METHODS

Qualitative studies were included if they were published between 2000 and 2012, if they were in English, and if they described emotional components about living with HF. Three electronic databases were searched using the key words heart failure, qualitative, and depression or psychosocial or stress or emotional.

RESULTS

Thirteen studies met the inclusion criteria. Patients with HF reported that financial stressors, overall poor health, past traumatic life experiences, and negative thinking contributed to depressive symptoms. The patients described cognitive-affective symptoms of depression and anxiety but not somatic symptoms of depression. Perceived consequences of depressive symptoms included hopelessness, despair, impaired social relationships, and a decreased ability to engage in HF self-care. Recommended management strategies consisted of enhanced social support and cognitive strategies.

CONCLUSIONS

Depressive symptoms in patients with HF were associated with a number of contributing factors, including those not specifically related to their disease, and serious consequences that reduced their self-care ability. Nonpharmacological management approaches to depressive symptoms that include improved social support or cognitive interventions may be effective and acceptable strategies.

Living with heart failure: psychosocial resources, meaning, gratitude and well-being

OBJECTIVES

The present study explored the experiences of people living with advanced heart failure (HF) to determine the extent to which (1) psychosocial resources relevant to HF patients were qualitatively reported, and (2) to determine the extent to which psychosocial resources were correlates of subsequent well-being as assessed by validated quantitative measures.

BACKGROUND

HF is a serious life-limiting illness that involves impaired heart functionality. Patients commonly face severe physical fatigue and frequently endure disabling depression. Individuals with HF often report the use of social support and religion/spirituality (R/S) as helpful, but little work has systematically linked their reliance on these resources and well-being.

METHODS

111 participants completed four open-ended questions to assess aspects of living with HF. Open-ended questions were coded to identify psychosocial resources: positive meaning, gratitude, R/S, social support, and medical resources. Data were collected once and then again 3 months later. Participants also completed measures of well-being, including religious meaning, life meaning, satisfaction with life, depressive symptoms, death anxiety, and health-related quality of life. Bivariate correlations were used to relate psychosocial resources and well-being.

RESULTS

Patients reported many psychosocial resources, particularly positive meaning, R/S, social support, and medical resources. Positive meaning and R/S were inversely linked with depressive symptoms. R/S was also related to less death anxiety, while social support was related to higher anxiety about death three months later.

CONCLUSIONS

Findings advance our understanding of the struggles HF patients experience and the roles of psychosocial resources such as meaning and gratitude in alleviating these struggles. Results may help explain how resources like R/S and social support may influence well-being.

Adapting to living with a mechanical aortic heart valve: a phenomenographic study

AIM

To describe how patients adapt to living with a mechanical aortic heart valve.

BACKGROUND

Aortic valve replacement with a mechanical prosthesis is preferred for patients with life expectancy of more than 10 years as they are more durable than bioprosthetic valves. Mechanical valves have some disadvantages, such as higher risk of thrombosis and embolism, increased risk of bleeding related to lifelong oral anticoagulation treatment and noise from the valve.

DESIGN

An explorative design with a phenomenographic approach was employed.

METHODS

An explorative design with a phenomenographic approach was applied. Interviews were conducted over 4 months during 2010-2011 with 20 strategically sampled patients, aged 24-74 years having undergone aortic valve replacement with mechanical prosthesis during the last 10 years.

FINDINGS

Patients adapted to living with a mechanical aortic heart valve in four ways: 'The competent patient' wanted to stay in control of his/her life. 'The adjusted patient' considered the implications of having a mechanical aortic valve as part of his/her daily life. 'The unaware patient' was not aware of warfarin-diet-medication interactions. 'The worried patient' was bothered with the oral anticoagulation and annoyed by the sound of the valve. Patients moved between the different ways of adapting.

CONCLUSIONS

The oral anticoagulation therapy was considered the most troublesome consequence, but also the sound of the valve was difficult to accept. Patient counselling and adequate follow-up can make patients with mechanical aortic heart valves more confident and competent to manage their own health. We recommend that patients should participate in a rehabilitation programme following cardiac surgery.

The experience of living with chronic heart failure: a narrative review of qualitative studies

Background

Chronic heart failure (CHF) is the leading cause of all hospitalisations and readmissions in older people, accounting for a large proportion of developed countries' national health care expenditure. CHF can severely affect people's quality of life by reducing their independence and ability to undertake certain activities of daily living, as well as affecting their psychosocial and economic capacity. This paper reports the findings of a systematic narrative review of qualitative studies concerning people's experience of living with CHF, aiming to develop a wide-ranging understanding of what is known about the patient experience.

Methods

We searched eight relevant electronic databases using the terms based on the diagnosis of 'chronic heart failure', 'heart failure' and 'congestive heart failure' and qualitative methods, with restrictions to the years 1990-May 2008. We also used snowballing, hand searching and the expert knowledge of the research team to ensure all relevant papers were included in the review. Of 65 papers collected less than half (n = 30) were found relevant for this review. These papers were subsequently summarised and entered into QSR NVivo7 for data management and analysis.

Results

The review has identified the most prominent impacts of CHF on a person's everyday life including social isolation, living in fear and losing a sense of control. It has also identified common strategies through which patients with CHF manage their illness such as sharing experiences and burdens with others and being flexible to changing circumstances.

Finally, there are multiple factors that commonly impact on patients' self care and self-management in the disease trajectory including knowledge, understanding and health service encounters. These health service encounters encompass access, continuity and quality of care, co-morbid conditions, and personal relationships.

Conclusions

The core and sub-concepts identified within this study provide health professionals, service providers, policy makers and educators with broad insights into common elements of people's experiences of CHF and potential options for improving their health and wellbeing. Future studies should focus on building a comprehensive picture of CHF through examination of differences between genders, and differences within age groups, socioeconomic groups and cultural groups.

Fatigue in elderly with chronic heart failure: an under-recognized symptom

In this secondary analysis of interviews with people with chronic heart failure, we examine living with fatigue in terms of obstacles and opportunities on personal, systemic and societal levels. On a personal level, people report that their bodies force them to rest, and to give in to and make space in their lives for fatigue. The need for rest is strong, but resting and inactivity are also regarded as dangerous. The healthcare system provides assistance through home care and technical equipment. However, society imposes obstacles, such as a lack of services in the immediate surroundings that prevent living well. In conclusion, people with chronic heart failure can manage their lives on a personal level by means of selection, optimization and compensation, and the healthcare system can provide further support; however, on a societal level there is lack of resources for those suffering from fatigue due to chronic heart failure.

Cognitive deficits in heart failure: Re-cognition of vulnerability as a strange new world

BACKGROUND

Patients with chronic heart failure (HF) have impairment in memory, psychomotor speed, and executive function.

OBJECTIVE

The aim of this study was to describe how individuals with HF and cognitive deficits manage self-care in their daily lives.

METHODS

Using an interpretive phenomenology method, HF patients completed unstructured face-to-face interviews about their ability to manage complex health regimens and maintain their health-related quality of life. Analysis of data was aided by use of Atlas.ti computer software.

RESULTS

The sample consisted of 12 patients (10 men; aged 43-81 years) who had previously undergone neuropsychological testing and were found to have deficits in 3 or more cognitive domains. Patients confirmed that they followed the advice of healthcare providers by adherence to medication regimens, dietary sodium restrictions, and HF self-care. One overarching theme was identified: "Re-cognition of Vulnerability: A Strange New World." This theme was further differentiated into 3 components: (1) not recognizing cognitive deficits; (2) recognizing cognitive deficits, described as (a) never could remember anything, (b) just old age, (c) HF-related change, and (d) making normal accommodations; and (3) recognizing vulnerability, explained by perception of (a) cognitive, (b) physical, and (c) social vulnerabilities, as well as perception of (d) the nearness of death.

DISCUSSION

Although the study was designed to focus on the cognitive changes in HF patients, it was difficult to separate cognitive, physical, and social challenges. These changes are most useful when taken as a constellation. Healthcare professionals can use the knowledge to identify problems and interventions for HF patients.

Clinical research 4: qualitative data collection and analysis

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasise the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process.

The qualitative content analysis process

AIM

This paper is a description of inductive and deductive content analysis.

BACKGROUND

Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method.

DISCUSSION

When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge.

CONCLUSION

Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.

Living with chronic heart failure: a review of qualitative studies of older people

AIM

This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure.

BACKGROUND

Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience.

DATA SOURCES

Eligible studies published in 1997-2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals.

REVIEW METHODS

Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis.

FINDINGS

Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition.

CONCLUSION

Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.

Breaking the vicious circle of fatigue in patients with chronic heart failure

Fatigue is a common symptom in patients with chronic heart failure (CHF). Characteristics of the experience and consequences of fatigue might be unique in these patients. The authors interviewed 15 patients with CHF and analyzed focused online observations of the content discussed in an Internet patient discussion group concerning CHF using grounded theory. The results suggest that fatigue is a circular process in which the consequences of fatigue further exaggerate the experience. However, fatigue could be alleviated by restorative activities. The bodily experience of fatigue was defined as lacking strength and energy and feeling sleepy. Patients reported the mental aspects of fatigue as demoralizing and that they frequently experienced intellectual deficiency. Fatigue leads to sacrificing, which was manifested as refraining, denying oneself, and being isolated. The restoring activities included the categories involuntarily attentive, socially interactive, and mentally absorbed. Interventions aimed to relieve fatigue should focus on restorative activities.

Living with moderate-severe chronic heart failure as a middle-aged person

In this article the authors describe a study focusing on middle-aged persons living with chronic heart failure (CHF), a group with which few studies have been conducted. They used the lifeworld perspective to focus on persons' lived experiences of the phenomenon, that is, living with moderate-severe CHF as a middle-aged person. They interviewed 7 middle-aged persons (4 men, 3 women; aged 38 to 65 years) and analyzed the data obtained using a phenomenological approach. The phenomenon's essence is described as a life situation characterized by a failing body, a life constantly under threat, a rapidly changing health condition, and an altered self-image, which implies that the persons live in a changed life situation. The essence was further illuminated by three meaning constituents: an ambiguity of the body, losing track of life, and balancing life. Knowledge from this study will help caregivers understand and support patients with this debilitating condition.

Clinical research 4: qualitative data collection and analysis

This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process. A couple of points: 1. It is artificial to describe research as qualitative or quantitative. Studies often include both dimensions (for example, Evangelista LS, Doering L, Dracup K. Meaning and life purpose: the perspectives of post-transplant women. Heart Lung 2003;32(4):250-7; Fitzsimmons D, Parahoo K, Richardson SG, Stringer M. Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis. Heart Lung 2003;32(1):23-31). However, for the purposes of this paper/series, this distinction is drawn for clarity of writing. 2. It is common practice for quantitative studies to refer to study 'subjects' and qualitative studies to refer to study 'participants'. For ease of reading, the latter term will be used throughout this series.