1
|
Xu M, Ruan T, Huang X, Han B, Li Y, Ding Y, Zhu L. Care-seeking delay of patients with heart failure in China: a mixed-method study. ESC Heart Fail 2024; 11:2086-2099. [PMID: 38567397 PMCID: PMC11287340 DOI: 10.1002/ehf2.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
AIM This study aims to explore the duration and influencing factors of care-seeking delay among patients with heart failure (HF) in China. METHODS AND RESULTS A convergent mixed method containing a cross-sectional study and two parts of qualitative studies was designed, following the STROBE and COREQ guidelines. Convenience sampling was applied to recruit patients with HF from two general hospitals from December 2021 to December 2022. Purposive sampling was used to enrol healthcare professionals from two general hospitals and two community hospitals from June to November 2022. Among the 258 patients with HF in the cross-sectional study, the median duration of care-seeking delay was 7.5 days. The result integration indicated that the delay duration was influenced by the dyspnoea symptom burden, the oedema symptom burden, and the depression status. The lower dyspnoea symptom burden, the higher oedema symptom burden, and the higher depression score were related to the prolonged care-seeking delay duration. The duration was also affected by the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers. The COVID-19 pandemic, low level of support from medical system, and limited symptom management abilities of caregivers were related to the prolonged care-seeking delay duration. CONCLUSIONS Care-seeking delay among patients with HF needs attention in China. The duration of care-seeking delay of patients with HF was influenced by the dyspnoea symptom burden, the oedema symptom burden, and depression status, as well as the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers.
Collapse
Affiliation(s)
- Mengqi Xu
- Department of NursingShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Tiantian Ruan
- School of NursingShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaoli Huang
- Department of CardiologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Beibei Han
- Department of CardiologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yingqi Li
- Department of CardiologyShanghai Eighth People's HospitalShanghaiChina
| | - Yuan Ding
- School of NursingShanghai Jiao Tong UniversityShanghaiChina
| | - Lingyan Zhu
- Department of NursingShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| |
Collapse
|
2
|
Lee S, Nolan A, Guerin J, Koons B, Matura LA, Jurgens CY, Dickson VV, Riegel B. The symptom perception processes of monitoring, awareness, and evaluation in patients with heart failure: a qualitative descriptive study. Eur J Cardiovasc Nurs 2024; 23:521-531. [PMID: 38168812 DOI: 10.1093/eurjcn/zvad116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
AIMS Patients with heart failure (HF) experience various signs and symptoms and have difficulties in perceiving them. Integrating insights from patients who have engaged in the process of symptom perception is crucial for enhancing our understanding of the theoretical concept of symptom perception. This study aimed to describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation and what influences the process. METHODS AND RESULTS Using a qualitative descriptive design, we conducted in-person semi-structured interviews with a purposeful sample of 40 adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analysed using directed qualitative content analysis. One overarching theme and three major themes emerged. Patients demonstrated Body listening, which involved active and individualized symptom monitoring tactics to observe bodily changes outside one's usual range. Trajectory of bodily change involved the patterns or characteristics of bodily changes that became apparent to patients. Three subthemes-sudden and alarming change, gradual change, and fluctuating change emerged. Patients evaluated symptoms through an Exclusionary process, sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained. Facilitators and barriers to symptom monitoring, awareness, and evaluation were identified. CONCLUSION This study elaborates the comprehensive symptom perception process used by adults with HF. Tailored nursing interventions should be developed based on the factors identified in each phase of the process to improve symptom perception in HF.
Collapse
Affiliation(s)
- Solim Lee
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, 269 E College Avenue, State College, PA 16801, USA
| | - Amy Nolan
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Julie Guerin
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Brittany Koons
- M. Lousie Fitzpatrick College of Nursing, Villanova University, 800 E. Lancaster Avenue, Villanova, PA 19085, USA
| | - Lea Ann Matura
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Corrine Y Jurgens
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA
- Center for Home Care Policy & Research at VNS Health, 220 East 42nd Street, New York, NY 10017, USA
| |
Collapse
|
3
|
Ivynian SE, Ferguson C, Newton PJ, DiGiacomo M. The role of illness perceptions in delayed care-seeking in heart failure: A mixed-methods study. Int J Nurs Stud 2024; 150:104644. [PMID: 38016267 DOI: 10.1016/j.ijnurstu.2023.104644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management. OBJECTIVE Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms. DESIGN Mixed-methods phenomenological study. SETTING(S) Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation. PARTICIPANTS Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews. METHODS Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts. RESULTS Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial. CONCLUSIONS This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.
Collapse
Affiliation(s)
- Serra E Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia.
| | - Caleb Ferguson
- School of Nursing, University of Wollongong and Centre for Chronic & Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, University of Newcastle, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
| |
Collapse
|
4
|
Stevenson LW, Ross HJ, Rathman LD, Boehmer JP. Remote Monitoring for Heart Failure Management at Home. J Am Coll Cardiol 2023; 81:2272-2291. [PMID: 37286258 DOI: 10.1016/j.jacc.2023.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
Early telemonitoring of weights and symptoms did not decrease heart failure hospitalizations but helped identify steps toward effective monitoring programs. A signal that is accurate and actionable with response kinetics for early re-assessment is required for the treatment of patients at high risk, while signal specifications differ for surveillance of low-risk patients. Tracking of congestion with cardiac filling pressures or lung water content has shown most impact to decrease hospitalizations, while multiparameter scores from implanted rhythm devices have identified patients at increased risk. Algorithms require better personalization of signal thresholds and interventions. The COVID-19 epidemic accelerated transition to remote care away from clinics, preparing for new digital health care platforms to accommodate multiple technologies and empower patients. Addressing inequities will require bridging the digital divide and the deep gap in access to HF care teams, who will not be replaced by technology but by care teams who can embrace it.
Collapse
Affiliation(s)
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Centre, Toronto, Ontario, Canada
| | - Lisa D Rathman
- PENN Medicine Lancaster General Health, Lancaster, Pennsylvania, USA
| | - John P Boehmer
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
5
|
Liu X, Liu L, Li Y, Cao X. The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:205. [PMID: 37087429 PMCID: PMC10122378 DOI: 10.1186/s12872-023-03247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/18/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Patients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients' ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours. METHODS This analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours. RESULTS A total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097). CONCLUSIONS Based on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients' engagement in self-care behaviour in this subpopulation.
Collapse
Affiliation(s)
- Xu Liu
- Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Li Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Xi Cao
- School of Nursing, Sun Yat-Sen University, NO. 74, Zhongshan 2nd Rd., Guangzhou, 510080, China.
| |
Collapse
|
6
|
Reeder KM, Peek GM, Nazir N. Prehospitalization Symptom Perceptions, Lay Consultations, and Treatment-Seeking for Acute Decompensating Heart Failure: Implications for Nursing Practice. Crit Care Nurs Clin North Am 2022; 34:129-140. [DOI: 10.1016/j.cnc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Caggianelli G, Iovino P, Rebora P, Occhino G, Zeffiro V, Locatelli G, Ausili D, Alvaro R, Riegel B, Vellone E. A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial. J Pain Symptom Manage 2022; 63:221-229.e1. [PMID: 34571194 DOI: 10.1016/j.jpainsymman.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022]
Abstract
CONTEXT Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory. OBJECTIVE To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients. METHODS We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02). CONCLUSION MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.
Collapse
Affiliation(s)
- Gabriele Caggianelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia.
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Giulia Locatelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia
| | - Davide Ausili
- Department of Medicine and Surgery (D.A.), University of Milan-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- School of Nursing (B.R.), University of Pennsylvania, Philadelphia, PA, USA; Mary McKillop Institute of Health Research (B.R.), Australian Catholic University, Melbourne, Australia
| | - Ercole Vellone
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
8
|
Lin CY, Hammash M, Miller JL, Schrader M, Mudd-Martin G, Biddle MJ, Moser DK. Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events. Eur J Cardiovasc Nurs 2021; 20:454-463. [PMID: 33580784 DOI: 10.1093/eurjcn/zvaa032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023]
Abstract
AIMS The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death. METHODS AND RESULTS We studied 153 patients hospitalized with an exacerbation of HF. Potential predictors of delay including demographic, clinical, psychosocial, cognitive, and behavioural variables were collected. Patients were followed for 3 months after discharge to determine time to the first cardiac rehospitalization or death. The median delay time was 134 h (25th and 75th percentiles 49 and 364 h). Non-linear regression showed that New York Heart Association functional class III/IV (P = 0.001), worse depressive symptoms (P = 0.004), better HF knowledge (P = 0.003), and lower perceived somatic awareness (P = 0.033) were predictors of delay time from patient perception of worsening HF to subsequent hospital admission. Cox regression revealed that patients who delayed longer (more than 134 h) had a 1.93-fold higher risk of experiencing cardiac events (P = 0.044) compared to non-delayers. CONCLUSIONS Care-seeking delay in patients with worsening HF symptoms was significantly associated with an increased risk of rehospitalization and mortality after discharge. Intervention strategies addressing functional status, psychological state, cognitive and behavioural factors are essential to reduce delay and thereby improve outcomes.
Collapse
Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Jennifer L Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Melanie Schrader
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| |
Collapse
|
9
|
Abstract
BACKGROUND Accurate symptom perception is a fundamentally essential component of self-care for patients with heart failure (HF) so they can make appropriate decisions about their symptoms. OBJECTIVE The purpose of this integrative review was to describe the pathways of the symptom perception process and its contributing factors in patients with HF. METHODS A comprehensive literature search was conducted using PubMed, EMBASE, and PsycINFO databases to identify studies describing the symptom perception process (symptom detection, comprehension, and response) in adult patients with HF. RESULTS Two pathways of the symptom perception process were identified from 42 articles: ideal and undesirable pathways. Patients in the ideal symptom perception pathway had a comprehensive understanding of HF and a firm belief in the importance of self-care, were vigilant, and possessed good decision-making skills. They also were able to successfully use their experiences for future care. However, patients in the undesirable symptom perception pathway had a limited understanding of HF with poor symptom monitoring skills and inaccurate judgments about symptoms. Diverse factors contributing to the symptom perception process were identified (eg, levels of understandings of HF and social support). CONCLUSION Our review indicated that symptom perception was likely to diversify the pathway of HF management. A variety of contributing factors to the symptom perception process were found to be intertwined. The findings of our review can inform the development of best patient education practice, although further research needs to be conducted to understand why and how patients can follow the most appropriate path from their past experiences.
Collapse
|
10
|
Factors influencing care-seeking delay or avoidance of heart failure management: A mixed-methods study. Int J Nurs Stud 2020; 108:103603. [DOI: 10.1016/j.ijnurstu.2020.103603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
|
11
|
Luo H, Lindell DF, Jurgens CY, Fan Y, Yu L. Symptom Perception and Influencing Factors in Chinese Patients with Heart Failure: A Preliminary Exploration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082692. [PMID: 32295183 PMCID: PMC7215728 DOI: 10.3390/ijerph17082692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
A growing body of evidence supports the fact that optimal health-related quality of life is largely dependent on patient competence in symptom perception. However, many studies have reported poor symptom perception in patients with heart failure. In China, there has been no previous research on assessing the symptom perception ability of patients with heart failure. This study aimed to describe how Chinese patients with heart failure perceive their symptoms, as well as to explore their influencing factors. A theory-based, descriptive, correlational cross-sectional design was used in this study. Data on symptom perception and factors related to symptom perception were collected via structured interviews and medical records. A convenience sample of 208 hospitalized patients was enrolled. The degree of symptom perception in this study was at a high level. The results showed that the level of depression, the New York Heart Association functional class, the left ventricular ejection fraction, and educational background were identified as independent factors of symptom perception in Chinese patients with heart failure. The degree of symptom perception of patients with heart failure was affected by personal, psychological, and physiological factors. Health policy and healthcare providers should pay more attention and deepen the understanding to Chinese patients with heart failure to provide better healthcare.
Collapse
Affiliation(s)
- Hong Luo
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan 430071, China; (H.L.)
| | - Deborah F. Lindell
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
| | - Corrine Y. Jurgens
- William F. Connell School of Nursing, Boston College, Boston, MA 02647, USA
| | - Yongsheng Fan
- Department of Public Health and Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Liping Yu
- Department of Nursing, School of Health Sciences, Wuhan University, Wuhan 430071, China; (H.L.)
| |
Collapse
|
12
|
Alghalayini KW. Using Atlanta Heart Failure Questionnaire in ambulatory heart failure patients with preserved ejection fraction HFPEF. JRSM Cardiovasc Dis 2020; 9:2048004020927642. [PMID: 32528670 PMCID: PMC7265075 DOI: 10.1177/2048004020927642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/15/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The present study uses the Atlanta Heart Failure Questionnaire as a tool to evaluate and design a tailored education material for ambulatory heart failure patients with preserved ejection fraction, highlighting the strengths and weakness toward the planning of education programs. METHODS A total of 450 patients were screened; 112 patients were recruited, and 27-item was used to evaluate the usefulness of this questionnaire. All patients received education by a dedicated medical education about the nature of the disease, risk factors and management including prevention of complications. Descriptive statistics were used for assessing the sample characteristics. RESULTS In the assessment of patient disease knowledge, in a 7-item questionnaire, the most well-understood item was correctly identified in 95% patients, whereas the least-understood item was identified in 1.8% of patients. In the assessment of patient management knowledge, in a 6-item questionnaire, the most well-understood item was correctly identified in 50% of patients and the least-understood item was identified in 10% of patients. In the assessment of patient medication intake knowledge, in a 3-item questionnaire, the most well-understood item was correctly identified in 97.3% of patients and the least-understood item was identified in 26.6% of patients. CONCLUSION For a disease not fully understood, the study has concluded the usefulness of Atlanta Heart Failure Questionnaire for filling the gaps, setting a base line and follow-up in the process of educating ambulatory heart failure patients with preserved ejection fraction HFPF.
Collapse
|
13
|
Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure. J Cardiovasc Nurs 2019; 34:36-43. [DOI: 10.1097/jcn.0000000000000526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Born MC, Azzolin KDO, Souza END. How long before hospital admission do the symptoms of heart failure decompensation arise? Rev Lat Am Enfermagem 2019. [PMCID: PMC6396952 DOI: 10.1590/1518-8345.2735.3119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the signs and symptoms of decompensation of heart failure (HF) and the duration of time to hospital admission. Method: this is a cross-sectional study with adult patients hospitalized for decompensated HF in a teaching hospital located in southern Brazil from July to October 2017. Data collection was performed through a structured questionnaire that included sociodemographic, clinical signs and symptoms of HF. In the data analysis, the following tests were applied: t-Student, Mann Whitney U-Test, Chi-Square Tests. Results: 94 patients, aged between 42 and 98 years old (mean of 71.2 years old) were included. The most prevalent signs and symptoms before emergency admission were dyspnea (79.8%), cough (29.8%), orthopnea (27.7%), edema (23.4%), and fatigue (22.3%). The median time from onset of signs and symptoms to arrival in the emergency room is fatigue and edema 7 days, orthopnea 5 days, cough 4 days and dyspnea 3 days. Conclusion: the set of classic signs and symptoms of decompensation of HF occurs around seven days before the emergency search and dyspnea is the worsening that leads the patient to a hospital emergency.
Collapse
|
15
|
A Mobile Application for Patients With Heart Failure: Theory- and Evidence-Based Design and Testing. Comput Inform Nurs 2018; 36:540-549. [PMID: 30045131 DOI: 10.1097/cin.0000000000000465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-care is vital for the successful management of heart failure. Mobile health can enable patients with heart failure to perform effective self-care. This article describes the theory-guided development and beta testing of a mobile application intervention to support self-care and increase symptom awareness in community-dwelling patients with heart failure. Ten participants entered physiologic data, answered qualitative questions about symptoms, and reviewed heart failure education within the HF App daily. Two validated instruments, the Self-care of Heart Failure Index and Heart Failure Somatic Awareness Scale, were administered both before and after the intervention, and results were compared using t tests. Results indicated that there were clinically significant changes from preintervention to postintervention in self-care scores in each subscale, with a statistically significant difference in the confidence subscale scores (P = .037). However, there were no statistically significant differences between preintervention and postintervention symptom awareness scores. These results indicate that incorporating mobile applications that comprise symptom monitoring, reminders, education, and the ability to track trends in physiologic data is most useful to assist individuals with heart failure to perform effective self-care.
Collapse
|
16
|
Daley CN, Bolchini D, Varrier A, Rao K, Joshi P, Blackburn J, Toscos T, Mirro MJ, Wagner S, Martin E, Miller A, Holden RJ. Naturalistic Decision Making by Older Adults with Chronic Heart Failure: An Exploratory Study Using the Critical Incident Technique. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1541931218621130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults with chronic heart failure (CHF) make daily decisions to manage their disease, with some of these decisions resulting in major health outcomes such as acute decompensation, hospitalization, and death. To understand how older adults with CHF make these decisions in their natural sociotechnical system context, we analyzed data from critical incident technique interviews with 12 older adults with CHF and 6 (family or friend) support persons. We identified key decision-making barriers, strategies, and distributed activity in stages of monitoring information or data, interpreting the information, and acting as a result. Our findings contribute to the broader research literature on CHF self-care as a naturalistic phenomenon and can aid in the exploration of design requirements for the development of technologies and interventions to assist in heart failure self-management.
Collapse
Affiliation(s)
- Carly N. Daley
- Health Innovation Laboratory, Indianapolis, IN, USA
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA
| | - Davide Bolchini
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Anagha Varrier
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Kartik Rao
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Pushkar Joshi
- Department of Human Centered Computing, IUPUI, Indianapolis, IN, USA
| | | | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Michael J. Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Shauna Wagner
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Elizabeth Martin
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Amy Miller
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J. Holden
- Health Innovation Laboratory, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis IN, USA
| |
Collapse
|
17
|
Xu J, Arruda S, Gallo JJ, Wenzel J, Nolan MT, Flowers D, Szanton SL, Dennison Himmelfarb C, Han HR. Using vignettes to understand heart failure self-care. J Clin Nurs 2018; 27:3554-3560. [PMID: 29943481 DOI: 10.1111/jocn.14581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore hospitalised heart failure (HF) patients' self-care decisions. BACKGROUND Heart failure self-care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self-care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self-care decision-making. DESIGN This qualitative descriptive analysis was conducted as part of a mixed methods study. METHODS We conducted semi-structured interviews (N = 20) to elicit patient decisions about self-care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses. RESULTS Participants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling. CONCLUSIONS Symptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult. RELEVANCE TO CLINICAL PRACTICE Vignettes may be a helpful tool to prompt patient-healthcare provider communication about self-care management and prompt discussions about appropriate self-care decisions in response to varying levels of symptom severity.
Collapse
Affiliation(s)
- Jiayun Xu
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Joseph J Gallo
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| |
Collapse
|
18
|
Abstract
BACKGROUND Rehospitalization soon after discharge can be distressing for persons with heart failure (HF) and places a heavy burden on the healthcare system. OBJECTIVE We investigated and explored the association of self-care decision making variables with (1) rehospitalization within 30 days of discharge and (2) delay in seeking medical assistance (delayed decision making). METHODS A cross-sectional, explanatory sequential mixed methods design (quan > qual) was used to survey 127 hospitalized HF patients and interview 15 of these participants to explain their survey responses. The survey assessed rehospitalization within 30 days of discharge, delayed decision making, HF self-care, and psychosocial factors influencing self-care. RESULTS The likelihood of delaying the decision to be hospitalized was more than 5 times higher among those with high depressive symptoms (odds ratio, 5.33; 95% confidence interval, 2.14-13.28). Those who delayed going to the hospital were uncertain about their prognosis and did not feel their symptoms were urgent. The likelihood of being rehospitalized within 30 days was more than doubled among those with high depressive symptoms (OR, 2.31; 95% confidence interval, 1.01-5.31). Those who were rehospitalized within 30 days were less likely to consult healthcare professionals in their decision making and wanted immediate relief from their symptoms. CONCLUSIONS We recommend a patient-centered approach to help HF patients identify and adequately self-manage symptoms. The strong association between high depressive symptoms and rehospitalization within 30 days as well as delayed decision making highlights the critical need for clinicians to carefully assess and address depression among HF patients.
Collapse
|
19
|
|
20
|
Riegel B, Dickson VV, Lee CS, Daus M, Hill J, Irani E, Lee S, Wald JW, Moelter ST, Rathman L, Streur M, Baah FO, Ruppert L, Schwartz DR, Bove A. A mixed methods study of symptom perception in patients with chronic heart failure. Heart Lung 2018; 47:107-114. [PMID: 29304990 PMCID: PMC5857218 DOI: 10.1016/j.hrtlng.2017.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. METHODS We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. RESULTS In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. CONCLUSION Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.
Collapse
Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Christopher S Lee
- School of Nursing, Oregon Health & Sciences University, Portland, OR, USA
| | - Marguerite Daus
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Hill
- Community Healthcare Network, New York, NY, USA
| | - Elliane Irani
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Solim Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce W Wald
- Heart Failure - Transplant Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen T Moelter
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
| | - Lisa Rathman
- The Heart Group of Lancaster General Health/PENN Medicine, Philadelphia, PA, USA
| | - Megan Streur
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Foster Osei Baah
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Ruppert
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Daniel R Schwartz
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Alfred Bove
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| |
Collapse
|
21
|
Validation of the Symptom Status Questionnaire-Heart Failure in Korean patients. Appl Nurs Res 2017; 38:141-146. [DOI: 10.1016/j.apnr.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 01/06/2023]
|
22
|
Abstract
OBJECTIVES This study aimed to assess patients' healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients' healthcare-seeking preference. DESIGN A retrospective study. SETTING The study was conducted in 14 tertiary hospitals in Shanghai, China. PARTICIPANTS Questionnaires were distributed to 1519 patients, and 1114 were completed and returned. All patients participated in the study voluntarily, provided written informed consent, and possessed the ability to complete the questionnaire. MAIN OUTCOME MEASURES We measured and compared preferences and choice of healthcare providers in patients if they had experienced mild, chronic, or serious illness. RESULTS More than 50% of participants, including those who were >60 years of age, had consulted a doctor more than three times during the preceding year, were single, and were most likely to decide not to seek medical treatment. Community health facilities were the most frequently selected healthcare provider in mild illness. In addition, patients who had no personal preference, did not express a preference for a good environment or first-class medical technology, were concerned about close proximity and short waiting times, and pursued low medical costs were most likely to choose a community health facility. General hospitals were the most frequently selected healthcare provider in chronic and serious illness. In addition, patients who earned higher monthly incomes, did not pursue low medical costs, were not concerned about short waiting times or close proximity, and expressed a preference for first-class medical technology, were most likely to choose general hospitals. CONCLUSION Patients' healthcare-seeking preference was influenced mainly by healthcare providers' characteristics, illness severity, and sociodemographic characteristics. These findings indicate that patients' current healthcare-seeking preference was not ideal and requires optimisation.
Collapse
Affiliation(s)
- Wenya Yu
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Meina Li
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Feng Ye
- Department of Medical Affairs, No. 187th hospital of PLA, Haikou, China
| | - Chen Xue
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China
| |
Collapse
|
23
|
Abstract
BACKGROUND Persons with heart failure (HF) are required to make decisions on a daily basis related to their declining health and make urgent decisions during acute illness exacerbations. However, little is known about the types of decisions patients make. OBJECTIVE The aims of this study were to critically evaluate the current quantitative literature related to decision making among persons with HF and identify research gaps in HF decision-making research. METHODS A systematic search of literature about decisions persons with HF make was conducted using PubMed, CINAHL, and PsychINFO databases. The following inclusion criteria were used: sample composed of at least 50% HF participants, concrete decisions were made, and a quantitative study design was used. Two authors performed title, abstract, and full-text reviews independently to identify eligible articles. RESULTS Twelve quantitative articles were included. Study samples were predominately older, white, male, and married. Two-thirds of the articles focused on decisions related to the end-of-life topics (ie, resuscitation decisions, advanced care planning). The other one-third focused on decisions about care seeking, participant's involvement in treatment decisions during their last clinic visit, and self-care behaviors. CONCLUSIONS Within the HF literature, the term decision is often ill-defined or not defined. Limitations in methodological rigor limit definitive conclusions about HF decision making. Future studies should consider strengthening study rigor and examining other decision topics such as inclusion of family in making decisions as HF progresses. Research rigorously examining HF decision making is needed to develop interventions to support persons with HF.
Collapse
|
24
|
Abstract
Persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment. Delay can result in worse symptoms and potentially impact outcomes. The purpose of this review was to describe predictors and outcomes of delay in HF patients. Demographic factors, increased symptom number, social factors, greater HF knowledge, lower anxiety, and depression predicted increased delay. HF patients had difficulty recognizing and interpreting symptoms of HF. Results are conflicting related to symptom pattern, time of care seeking, and history of HF as predictors of delay. The only outcome predicted by delay was length of stay with those delaying longer reporting longer lengths of stay. Future research related to delay should include theoretical frameworks and larger, more ethnically diverse samples from multiple sites and link delay to outcomes. Valid and reliable instruments are needed to measure delay and related factors. HF education should include supportive others.
Collapse
|
25
|
Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Juárez-Vela R, Hiatt SO, Alvaro R, Lee CS. Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis. Res Nurs Health 2015; 38:392-402. [PMID: 26355702 DOI: 10.1002/nur.21675] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
Abstract
Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.
Collapse
Affiliation(s)
- Julie T Bidwell
- PhD Student, School of Nursing, Oregon Health & Science University, Mail code: SN-2N, 3455 SW US Veterans Hospital Road, Portland, OR, 97239-2941, USA
| | - Ercole Vellone
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Karen S Lyons
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Fabio D'Agostino
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- Professor, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Raúl Juárez-Vela
- Research Fellow, Faculty of Health Science, University of San Jorge, Zaragoza, Spain
| | - Shirin O Hiatt
- Research Associate, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Rosaria Alvaro
- Research Associate, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher S Lee
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
26
|
Lee YW, Jeng YJ, Huang LH. Development and testing of a scale to assess fluid overload symptoms. Appl Nurs Res 2015; 28:206-9. [DOI: 10.1016/j.apnr.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/31/2014] [Accepted: 10/04/2014] [Indexed: 01/11/2023]
|
27
|
Heo S, Moser DK, Pressler SJ, Dunbar SB, Mudd-Martin G, Lennie TA. Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardiovasc Nurs 2015; 30:136-44. [PMID: 24598550 PMCID: PMC4391745 DOI: 10.1097/jcn.0000000000000102] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with heart failure (HF) experience physical symptoms, poor health-related quality of life (HRQOL), and high rates of hospitalization. Physical symptoms are associated with HRQOL and are major antecedents of hospitalization. However, reliable and valid physical symptom instruments have not been established. Therefore, this study examined the psychometric properties of the Symptom Status Questionnaire-Heart Failure (SSQ-HF) in patients with HF. METHOD Data on symptoms using the SSQ-HF were collected from 249 patients (aged 61 years, 67% male, 45% in New York Heart Association functional class III/IV). Internal consistency reliability was assessed using Cronbach's α. Item homogeneity was assessed using item-total and interitem correlations. Construct validity was assessed using factor analysis and testing hypotheses on known relationships. Data on depressive symptoms (Beck Depression Inventory II), HRQOL (Minnesota Living With Heart Failure Questionnaire), and event-free survival were collected to test known relationships. RESULTS Internal consistency reliability was supported: Cronbach's α was .80. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Factor analysis supported the construct validity of the instrument. More severe symptoms were associated with more depressive symptoms, poorer HRQOL, and more risk for hospitalization, emergency department visit, or death, controlling for covariates. CONCLUSIONS The findings of this study support the reliability and validity of the SSQ-HF. Clinicians and researchers can use this instrument to assess physical symptoms in patients with HF.
Collapse
Affiliation(s)
- Seongkum Heo
- Seongkum Heo, PhD, RN Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock Debra K. Moser, DNSc, RN, FAAN Professor and Gill Chair of Nursing, College of Nursing, University of Kentucky, Lexington. Susan J. Pressler, PhD, RN Professor, School of Nursing, University of Michigan, Ann Arbor Sandra B. Dunbar, DSN, RN Professor, School of Nursing, Emory University, Atlanta, Georgia Gia Mudd-Martin, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington Terry A. Lennie, PhD, RN Professor, University of Kentucky, College of Nursing, Lexington
| | | | | | | | | | | |
Collapse
|
28
|
|
29
|
A Place to Get Worse: Perspectives on Avoiding Hospitalization from Patients with End-Stage Cardiopulmonary Disease. J Hosp Palliat Nurs 2014; 16:338-345. [PMID: 25328448 DOI: 10.1097/njh.0000000000000081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health 2013; 30:79-88. [PMID: 24383487 DOI: 10.1111/jrh.12032] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. METHODS The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. RESULTS For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR = 1.69), male sex (OR = 1.24), younger age (18-34 years OR = 2.34; 35-49 years OR = 2.10), lack of health insurance (OR = 1.43), lack of confidence in personal health care (OR = 2.24), lack of regular provider (OR = 1.49), little trust in physicians (OR = 1.34), and poor provider rapport (OR = 0.94). CONCLUSION The results of this study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes.
Collapse
Affiliation(s)
- Angela M Spleen
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | | | | | | |
Collapse
|