Personal growth, symptoms, and uncertainty in community-residing adults with heart failure

Perceived posttraumatic growth in cardiac patients: A systematic scoping review

Despite the life-threatening nature of many cardiac conditions, patients often report perceived posttraumatic growth (PPTG) in their recovery. To date, this research remains scattered across the literature, and no systematic review across cardiac patient populations is available. To understand the state of the literature on PPTG in cardiac patients, we conducted a systematic scoping review, aiming to (a) describe patient populations included, (b) characterize associations between PPTG and mental and physical health indices, (c) identify potential psychosocial resources that moderate or mediate the effects of a cardiac condition on PPTG, and (d) describe and critique study methodologies. A systematic search was conducted on June 21, 2021, using the PubMed and PsycInfo databases. Two authors independently screened the results for eligibility and resolved discrepancies before extracting study data. We identified 21 studies that met the search and eligibility criteria (i.e., original, peer-reviewed, English language). Most studies focused on a single cardiac condition (61.9%), with myocardial infarction the most common. PPTG was studied in relation to myriad mental health and physical health indices. The findings suggested that appraisal and coping may mediate and psychosocial resources (e.g., social support) may moderate the effects of a cardiac condition on PPTG. The generalizability of results is limited, as most studies employed a cross-sectional design with mostly male and majority White samples. Future research would benefit from studying PPTG in more diverse cardiac populations, assessing appraisals of the cardiac condition as traumatic, measuring posttraumatic depreciation in tandem with PPTG, and conducting prospective studies.

Uncertainty levels differ by physical heart failure symptom cluster

BACKGROUND

The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF.

AIMS

Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster.

METHODS

Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group.

RESULTS

One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033).

CONCLUSIONS

Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.

Personal Growth and Associated Factors Among Patients with Chronic Obstructive Pulmonary Disease in China: A Cross-Sectional Study

Purpose

This cross-sectional study aimed to describe personal growth and to analyze its associated factors among patients with chronic obstructive pulmonary disease (COPD) in China.

Patients and Methods

A total of 364 Chinese COPD hospitalized patients were included in the study between November 2016 and April 2018. Participants provided demographic information and completed the Growth Through Uncertainty Scale (GTUS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the modified Medical Research Council dyspnoea scale (mMRC).

Results

The mean total score on the GTUS was 142.34 (SD = 7.61). The multiple linear regression analysis showed that factors including educational level, average monthly income, social support, and breathlessness can influence personal growth (R² = 0.427, F = 44.420, p < 0.001), explaining 42.7% of the variance.

Conclusion

COPD patients tend to report a moderate level of personal growth in China. Educational level, average monthly income, social support, and breathlessness were significant factors associated with personal growth. Medical workers should be aware of the level of personal growth among COPD patients and make tailored interventions to facilitate COPD patients’ personal growth, such as increasing social support and decrease breathlessness.

[Using lived experiences and theoretical insights to gain a better understanding of the adaptation difficulties encountered by elderly patients with chronic heart failure during the hospital-to-home transition]

Heart failure is one of the most common reasons for hospitalization in older people, and the hospital-to-home transition can be unsuccessful for these patients. Existing care programs focus primarily on the physiological aspects of the disease and are rarely based on theory. Using Roy's adaptation model (1), the aim of this study was to develop a thorough understanding of the adaptation difficulties and factors that influence how well elderly patients with chronic heart failure cope with the hospital-to-home transition, in order to develop a nursing interventions program. Based on the process proposed by Sidani and Braden (2011), this qualitative descriptive study adopted a deductive approach, with the use of intermediary theories and empirical data, as well as an inductive approach, where older people with chronic heart failure (n=7), caregivers (n=6), and healthcare professionals (n=14) participated in semi-structured individual interviews. The triangulation of data highlights the difficulties and factors influencing adaptation at the physical, psychological, and social levels. Gaining a better understanding of the experience of older people with heart failure when it comes to their transition from hospital to home, and doing so with a holistic vision, provides information for interventions that can contribute to better management of chronic disease and a better quality of life for these elderly patients.

Perceived benefits of the disease: A qualitative study of patients' experiences of heart failure

Heart failure may bring about positive outcomes, which have not been adequately addressed in the literature. Therefore, this qualitative study sought to scrutinize the experiences of patients and the perceived positive effects of heart failure. The opinions of 19 patients with heart failure in Mashhad city (Iran) were collected via semistructured interviews from December 2017 to November 2018. After analyzing the data, six themes were identified by framework analysis: healthy lifestyle, effective interactions, appreciation of life, spirituality, reappraisal of life and priorities, and endurance. Such positive effects may lead to empowerment and better coping of patients with the disease. Therefore, nurses should consider the patients' perception of illness in addition to the disease manifestations and offer training focusing on the possibilities instead of limitations.