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Garland R, Gagnon M, Lewis KB. Time to Revisit Heart Failure Self-Care: A Concept Analysis. ANS Adv Nurs Sci 2022; 45:371-386. [PMID: 35704424 DOI: 10.1097/ans.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self .
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Affiliation(s)
- Rachel Garland
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada (Ms Garland and Dr Gagnon); School of Nursing, University of Ottawa, Ottawa, Ontario, Canada (Dr Lewis); and University of Ottawa Heart Institute, Ottawa, Ontario, Canada (Dr Lewis)
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Allana S, Ski CF, Thompson DR, Clark AM. Bringing Intersectionality to Cardiovascular Health Research in Canada. CJC Open 2022; 3:S4-S8. [PMID: 34993427 PMCID: PMC8712551 DOI: 10.1016/j.cjco.2021.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Saleema Allana
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, United Kingdom
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Alexander M Clark
- Faculty of Health Disciplines, Athabasca University. Edmonton, Alberta, Canada
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Hammell KW. Occupation in Natural Environments; Health Equity and Environmental Justice : L'occupation dans les environnements naturels ; équité en matière de santé et justice environnementale. The Canadian Journal of Occupational Therapy 2021; 88:319-328. [PMID: 34486421 DOI: 10.1177/00084174211040000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Occupations undertaken in natural environments can positively impact physical and mental health, improve cognitive functioning, contribute spiritual and cultural benefits, and increase belonging, self-worth, and the meaningfulness of occupations. However, occupational opportunities in healthy natural spaces are inequitably distributed; and the deleterious effects of climate change and environmental degradation are borne disproportionately by socioeconomically disadvantaged people. Purposes. To highlight evidence that occupational engagement in nature is a determinant of health, foreground environmental injustices and identify some implications for occupational therapy. Key issues. Cross-disciplinary, cross-cultural research and critical environmental justice scholarship indicate that healthy nature is an inequitably distributed determinant of occupation, wellbeing, and human health. This merits critical attention from occupational therapy. Implications. By researching, identifying, and addressing occupational and health inequities arising from environmental degradation, climate change and inequitable access to health-promoting natural environments occupational therapists could contribute valuable, occupational perspectives to initiatives addressing human rights and environmental justice.
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Intersectionality and heart failure: what clinicians and researchers should know and do. Curr Opin Support Palliat Care 2021; 15:141-146. [PMID: 33905386 DOI: 10.1097/spc.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes. RECENT FINDINGS Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields - there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life. SUMMARY Approaches to heart failure clinical care should recognize more fully the nature and impact of patients' intersectionality- and how multiple factors interact and compound to influence patients and their caregivers' behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.
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Wiese LK, Williams CL, Tappen RM, Newman D. An updated measure for investigating basic knowledge of Alzheimer's disease in underserved rural settings. Aging Ment Health 2020; 24:1348-1355. [PMID: 30869990 PMCID: PMC8474126 DOI: 10.1080/13607863.2019.1584880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
Objective: Older rural adults face a higher burden of Alzheimer's disease (AD) and delayed detection. This risk is heightened in rural populations that are ethnically diverse. Patients and providers are often hesitant to participate in screening, partially due to gaps in knowledge of the current science. The purpose of this paper is to describe the results of administering the revised version of the Basic Knowledge of Alzheimer's Disease (BKAD) measure in small rural communities in five different states.Methods: The BKAD measure was revised after first being tested in rural Appalachia. Revisions including eliminating non-discriminating items and adding questions regarding early detection, sleep, head injury, and vision changes. Reliability and validity testing included Cronbach's alpha and Rasch item analysis, test-retest, and predictive validity. Descriptive measures and independent sample t-tests were used to analyze knowledge gaps and sociodemographics.Results: Tests for reliability and validity were highly favorable, including Cronbach's alpha = .85 and overall Rasch item analysis of .94. Three-fourths of participants knew that annual cognitive screening was recommended for older adults, but only one-fourth had been previously screened. Sociodemographic findings revealed that a majority of participants (86%) would participate in annual memory screening if offered, regardless of education or health literacy level.Conclusion: The BKAD measure is a good fit for use in rural and underserved populations. BKAD results can inform the design of culturally relevant programs for raising awareness of the importance of early AD detection and treatment.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Ruth M Tappen
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Surikova J, Payne A, Miller KL, Ravaei A, Nolan RP. A cultural and gender-based approach to understanding patient adjustment to chronic heart failure. Health Qual Life Outcomes 2020; 18:238. [PMID: 32682424 PMCID: PMC7368735 DOI: 10.1186/s12955-020-01482-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Persons identifying as Black, Chinese, or South Asian make up the largest minority groups in Canada. Individuals with chronic heart failure (CHF) from these groups experience a greater rate of re-hospitalization and poorer quality of life. Although experts agree that culture can shape the experience of CHF, little is known about how patients from these minority populations define a good quality of life with CHF and what barriers they experience when carrying out self-care behaviours. The aim of this qualitative study was to examine cultural and gender-based influences on quality of life in patients with CHF. Methods Purposive sampling included 30 patients (67% male), 18 to 75 years of age, who self-identified as Black (n = 8), Chinese (n = 9), or South Asian (n = 6). Caucasians (n = 7) were included as a comparison group. Semi-structured interviews (see the online appendix), lasting approximately 60 min, were conducted, which focused on personal understanding of CHF and living with the disease, including impact on lifestyle and quality of life. An inductive qualitative approach with thematic content analysis was used to develop key insights into individual experience of CHF, as well as cultural and gender-based influences on self-care and quality of life. Descriptive statistics were generated from questionnaire responses. Results Five key themes emerged from the narrative analysis of participant interviews: (i) CHF as an emergent reality, (ii) quality of life and disruption of lifecourse milestones, (iii) the challenge to accept CHF and re-evaluation of quality of life; (iv) impact on social activities essential to quality of life, and (v) life with CHF as a commitment to culturally tailored self-care. Participants described the unique impact of CHF on their quality of life, including life trajectory milestones such as dating, parenting, and retirement planning, as well as the importance of accepting their diagnosis, and the reframing goals for living well with heart failure. Positive and negative impacts on social relationships were noted, including sexual intimacy and interactions with spouses, other family members, and co-workers. Conclusions Study findings highlight important lifespan, cultural, and gender considerations that can inform the improvement of patient care and quality of life for patients and their families.
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Affiliation(s)
- Jelena Surikova
- Peter Munk Cardiac Centre, Behavioural Cardiology Research Unit, University Health Network, 585 University Avenue, 6N-618 NU, Toronto, Ontario, M5G 2N2, Canada
| | - Ada Payne
- Cancer Care Ontario, 620 University Ave, Toronto, Ontario, M5G 2L7, Canada
| | - Karen-Lee Miller
- Peter Munk Cardiac Centre, Behavioural Cardiology Research Unit, University Health Network, 585 University Avenue, 6N-618 NU, Toronto, Ontario, M5G 2N2, Canada
| | - Arian Ravaei
- Peter Munk Cardiac Centre, Behavioural Cardiology Research Unit, University Health Network, 585 University Avenue, 6N-618 NU, Toronto, Ontario, M5G 2N2, Canada
| | - Robert P Nolan
- Peter Munk Cardiac Centre, Behavioural Cardiology Research Unit, University Health Network, 585 University Avenue, 6N-618 NU, Toronto, Ontario, M5G 2N2, Canada. .,Department of Psychiatry and Institute of Medical Sciences, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 3H7, Canada.
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Nicholas Dionne-Odom J, Hooker SA, Bekelman D, Ejem D, McGhan G, Kitko L, Strömberg A, Wells R, Astin M, Metin ZG, Mancarella G, Pamboukian SV, Evangelista L, Buck HG, Bakitas MA. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review. Heart Fail Rev 2017; 22:543-557. [PMID: 28160116 PMCID: PMC5544594 DOI: 10.1007/s10741-017-9597-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms "heart failure" AND "caregiver." Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients' unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | - Stephanie A Hooker
- Department of Psychology, University of Colorado, Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - David Bekelman
- Veterans Affairs Eastern Colorado Health Care System, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, 1055 Clermont Street, Research 151, Denver, CO, 80220, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gwen McGhan
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Lisa Kitko
- College of Nursing, Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Campus University Hospital, Linköping University, Building 511-001, 581 85, Linköping, Sweden
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Meka Astin
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zehra Gok Metin
- Department of Internal Medicine Nursing, Hacettepe University, 06100, Ankara, Turkey
| | - Gisella Mancarella
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL, 35294, USA
| | - Lorraine Evangelista
- Program in Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
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Namukwaya E, Grant L, Downing J, Leng M, Murray SA. Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals. BMC Res Notes 2017; 10:184. [PMID: 28545502 PMCID: PMC5445313 DOI: 10.1186/s13104-017-2505-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients' and health care professionals'(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients' and HPs' views of HF patients' needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. METHODS Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. RESULTS Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO health systems strengthening approach. CONCLUSION Management of HF in Uganda requires an approach that targets multidimensional needs, embraces multidisciplinary care and strengthens health systems which are all important tenets of palliative care.
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Affiliation(s)
- Elizabeth Namukwaya
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Liz Grant
- Global Health Academy, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Julia Downing
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Mhoira Leng
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Scott A. Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Herber OR, Bücker B, Metzendorf MI, Barroso J. A qualitative meta-summary using Sandelowski and Barroso’s method for integrating qualitative research to explore barriers and facilitators to self-care in heart failure patients. Eur J Cardiovasc Nurs 2017; 16:662-677. [DOI: 10.1177/1474515117711007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Individual qualitative studies provide varied reasons for why heart failure patients do not engage in self-care, yet articles that aggregated primary studies on the subject have methodological weaknesses that justified the execution of a qualitative meta-summary. Aim: The aim of this study is to integrate the findings of qualitative studies pertaining to barriers and facilitators to self-care using meta-summary techniques. Methods: Qualitative meta-summary techniques by Sandelowski and Barroso were used to combine the findings of qualitative studies. Meta-summary techniques include: (1) extraction of relevant statements of findings from each report; (2) reduction of these statements into abstracted findings and (3) calculation of effect sizes. Databases were searched systematically for qualitative studies published between January 2010 and July 2015. Out of 2264 papers identified, 31 reports based on the accounts of 814 patients were included in the meta-summary. Results: A total of 37 statements of findings provided a comprehensive inventory of findings across all reports. Out of these statements of findings, 21 were classified as barriers, 13 as facilitators and three were classed as both barriers and facilitators. The main themes relating to barriers and facilitators to self-care were: beliefs, benefits of self-care, comorbidities, financial constraints, symptom recognition, ethnic background, inconsistent self-care, insufficient information, positive and negative emotions, organizational context, past experiences, physical environment, self-initiative, self-care adverse effects, social context and personal preferences. Conclusion: Based on the meta-findings identified in this study, future intervention development could address these barriers and facilitators in order to further enhance self-care abilities in heart failure patients.
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Affiliation(s)
- Oliver Rudolf Herber
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- School of Health and Population Sciences, University of Birmingham, Edgbaston, England
| | - Bettina Bücker
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Cochrane Metabolic and Endocrine Disorders Group, Düsseldorf, Germany
| | - Julie Barroso
- Medical University of South Carolina, College of Nursing, Charleston, USA
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Myers NAL, Ziv T. "No One Ever Even Asked Me that Before": Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis. Med Anthropol Q 2016; 30:395-413. [PMID: 26990015 DOI: 10.1111/maq.12288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 11/27/2022]
Abstract
Our article draws on ethnographic research with African American males diagnosed with a psychotic disorder in a high-poverty urban area of the northeastern United States. Our participants frequently described the ways public mental health services led them to experience a paralyzing erosion of autobiographical power, which we define as the ability to tell one's own story and be the editor of one's own life. We identified three important points when the loss of autobiographical power seemed to perpetuate social defeat or a sense of social powerlessness (Luhrmann 2007) for our participants during their interactions with public mental health care. We invite further inquiry into the loss of autobiographical power in settings of public mental health care, the sense of social defeat it seems to perpetuate, and the impact of these on mental health recovery, especially for people living in contexts of persistent social adversity.
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Affiliation(s)
| | - Tali Ziv
- University of Pennsylvania, Department of Anthropology
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Karimi M, Clark AM. How do patients' values influence heart failure self-care decision-making?: A mixed-methods systematic review. Int J Nurs Stud 2016; 59:89-104. [PMID: 27222454 DOI: 10.1016/j.ijnurstu.2016.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/14/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Values are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients' values have in influencing self-care is poorly understood. METHODS A mixed methods systematic review was conducted using a critical meta-narrative synthesis approach to synthesizing qualitative and qualitized data. Nine databases were searched (14 March 2014). To be included in the review, studies had to contain data on heart failure patients' values and self-care behaviors, include adults aged ≥18 years with symptomatic heart failure, and be published ≥2000 as full articles or theses. Study quality was assessed using a mixed-methods appraisal tool. FINDINGS Of 6467 citations identified, 54 studies were included (30 qualitative, 8 mixed methods, and 16 quantitative; 6045 patients, 38 lay caregivers, and 96 health care professionals). The synthesis identified multiple bi-directional interactions between heart failure, patients' values, and self-care. Patients are motivated by self-related and other-related values. Self-related values are tied directly to intimate personal feelings (self-direction, pleasure, and being healthy) or related to individuals' life circumstances (maintaining a healthy lifestyle and financial balance). Other-related values, which are fundamentally socially-based, are related to benefits received from society (social recognition and socialization) and social obligations (responsibility, observing traditions, and obedience). For each decision, several values are involved; some are incompatible and some are in conflict. Patients make their self-care decision based on the values they prioritize and those that are blocked. CONCLUSION Values are integral to how patients approach and undertake HF self-care. These values both affect and respond to this self-care and the severity of HF symptoms. Values extend to those relating to the self and others and incorporate a range of personal, life, and social dimensions. Values cannot be assumed to be fixed, normative or similar to those held by nurses and other health professionals. Future interventions to improve HF self-care must address and respond to the complexity of patients' values and how they influence patient behavior in undertaking heart failure self-care.
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Affiliation(s)
- Mehri Karimi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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12
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Zhang KM, Dindoff K, Arnold JMO, Lane J, Swartzman LC. What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management. PATIENT EDUCATION AND COUNSELING 2015; 98:927-934. [PMID: 25979423 DOI: 10.1016/j.pec.2015.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/02/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the life goals of heart failure (HF) patients and to determine whether adherence is influenced by the extent to which these priorities are perceived as compatible with HF self-care regimens. METHOD Forty HF outpatients identified their top-five life goals and indicated the compatibility of HF self-care regimens (diet, exercise, weighing) with these priorities. HF knowledge, self-efficacy and reported adherence were also assessed. RESULTS Patients valued autonomy and social relationships as much as physical health. However, the rated importance of these domains did not predict adherence. Adherence positively correlated with the extent to which the regimen, specifically exercise, was considered compatible with life goals (r=.34, p<.05). Exercise adherence also correlated with illness severity and self-efficacy (rs=-.42 and .36, p<.05, respectively). The perceived compatibility of physical activity with personal goals predicted 11% of the variance in exercise adherence above and beyond that accounted for by illness severity and self-efficacy (FΔ (1, 36)=7.11, p<.05). CONCLUSIONS Patients' goals outside of the illness management context influence self-care practices. PRACTICE IMPLICATIONS Exploring patients' broad life goals may increase opportunities to resolve ambivalence and enhance motivation for self-care adherence.
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Affiliation(s)
- Karen M Zhang
- Department of Psychology, University of Western Ontario, London, ON, Canada.
| | - Kathleen Dindoff
- School of Language & Liberal Studies, Fanshawe College, London, ON, Canada
| | - J Malcolm O Arnold
- Division of Cardiology, London Health Sciences Centre, London, ON, Canada
| | - Jeanine Lane
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Leora C Swartzman
- Department of Psychology, University of Western Ontario, London, ON, Canada
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Gessert C, Waring S, Bailey-Davis L, Conway P, Roberts M, VanWormer J. Rural definition of health: a systematic literature review. BMC Public Health 2015; 15:378. [PMID: 25879818 PMCID: PMC4406172 DOI: 10.1186/s12889-015-1658-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advent of patient-centered care challenges policy makers, health care administrators, clinicians, and patient advocates to understand the factors that contribute to effective patient activation. Improved understanding of how patients think about and define their health is needed to more effectively "activate" patients, and to nurture and support patients' efforts to improve their health. Researchers have intimated for over 25 years that rural populations approach health in a distinct fashion that may differ from their non-rural counterparts. METHODS We conducted a systematic review of the literature to assess the extent and strength of evidence for rural definition of health. Studies were eligible for inclusion if they were published in English, reported on original research and presented findings or commentary relevant to rural definition of health, were published over the last 40 years, and were based on observations of rural U.S., Canadian, or Australian populations. Two reviewers were assigned to each selected article and blinded to the other reviewer's comments. For discordant reviews, a third blinded review was performed. RESULTS Of the 125 published articles identified from the literature, 34 included commentary or findings relevant to a rural definition of health. Of these studies, 6 included an urban comparison group. Few studies compared rural and urban definitions of health directly. Findings relevant to rural definition of health covered a broad range; however, good health was commonly characterized as being able to work, reciprocate in social relationships, and maintain independence. This review largely confirmed many general characteristics on rural views of health, but also documented the extensive methodological limitations, both in terms of quantity and quality, of studies that empirically compare rural vs. urban samples. Most notably, the evidence base in this area is weakened by the frequent absence of parallel comparison groups and standardized assessment tools. CONCLUSIONS To engage and activate rural patients in their own healthcare, a better understanding of the health beliefs in rural populations is needed. This review suggests that rural residents may indeed hold distinct views on how to define health, but more rigorous studies are needed to confirm these findings.
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Affiliation(s)
- Charles Gessert
- Essentia Institute of Rural Health, 502 E 2nd St, Duluth, MN, 55805, USA.
| | - Stephen Waring
- Essentia Institute of Rural Health, 502 E 2nd St, Duluth, MN, 55805, USA.
| | | | - Pat Conway
- Essentia Institute of Rural Health, 502 E 2nd St, Duluth, MN, 55805, USA.
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Howie-Esquivel J, Carroll M, Brinker E, Kao H, Pantilat S, Rago K, De Marco T. A Strategy to Reduce Heart Failure Readmissions and Inpatient Costs. Cardiol Res 2015; 6:201-208. [PMID: 28197226 PMCID: PMC5295554 DOI: 10.14740/cr384w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 01/19/2023] Open
Abstract
Background The objective of this study was to evaluate the effect of a disease management intervention on rehospitalization rates in hospitalized heart failure (HF) patients. Methods Patients treated with the TEACH-HF intervention that included Teaching and Education, prompt follow-up Appointments, Consultation for support services, and Home follow-up phone calls (TEACH-HF) from January 2010 to January 2012 constituted the intervention group (n = 548). Patients treated from January 2007 to January 2008 constituted the usual care group (n = 485). Results Group baseline characteristics were similar with 30-day readmission rates significantly different (19% usual care vs. 12% for the intervention respectively (P = 0.003)). Patients in the usual care group were 1.5 times more likely to be hospitalized (95% CI: 1.2 - 1.9; P = 0.001) compared to the intervention group. A savings of 641 bed days with potential revenue of $640,000 occurred after TEACH-HF. Conclusions The TEACH-HF intervention was associated with significantly fewer hospital readmissions and savings in bed days.
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Affiliation(s)
- Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Maureen Carroll
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Eileen Brinker
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Helen Kao
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Steven Pantilat
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Karen Rago
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Teresa De Marco
- University of California San Francisco Medical Center, San Francisco, CA, USA
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Hauenstein EJ, Glick DF, Kane C, Kulbok P, Barbero E, Cox K. A Model to Develop Nurse Leaders for Rural Practice. J Prof Nurs 2014; 30:463-73. [DOI: 10.1016/j.profnurs.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 12/29/2022]
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Strachan PH, Currie K, Harkness K, Spaling M, Clark AM. Context Matters in Heart Failure Self-Care: A Qualitative Systematic Review. J Card Fail 2014; 20:448-55. [DOI: 10.1016/j.cardfail.2014.03.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
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Macdonald M, Lang A, Storch J, Stevenson L, Donaldson S, Barber T, Iaboni K. Home care safety markers: a scoping review. Home Health Care Serv Q 2014; 32:126-48. [PMID: 23679662 DOI: 10.1080/01621424.2013.783523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health.
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Buck HG, Harkness K, Wion R, Carroll SL, Cosman T, Kaasalainen S, Kryworuchko J, McGillion M, O'Keefe-McCarthy S, Sherifali D, Strachan PH, Arthur HM. Caregivers' contributions to heart failure self-care: a systematic review. Eur J Cardiovasc Nurs 2014; 14:79-89. [PMID: 24399843 DOI: 10.1177/1474515113518434] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The purpose of this study was to conduct a systematic review answering the following questions: (a) what specific activities do caregivers (CGs) contribute to patients' self-care in heart failure (HF)?; and (b) how mature (or developed) is the science of the CG contribution to self-care? METHODS MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Library and ClinicalTrials.gov were searched using the terms heart failure and caregiv* as well as the keywords 'careers', 'family members' and 'lay persons' for studies published between 1948 and September 2012. Inclusion criteria for studies were: informal CGs of adult HF patients-either as dependent/independent variable in quantitative studies or participant in qualitative studies; English language. Exclusion criteria for studies were: formal CGs; pediatric, adult congenital, or devices or transplant CGs; mixed diagnosis; non-empiric reports or reports publishing duplicate results. Each study was abstracted and confirmed by two authors. After CG activities were identified and theoretically categorized, an analysis across studies was conducted. RESULTS Forty papers were reviewed from a pool of 283 papers. CGs contribute substantively to HF patients' self-care characterized from concrete (weighing the patient) to interpersonal (providing understanding). Only two studies attempted to quantify the impact of CGs' activities on patients' self-care reporting a positive impact. Our analysis provides evidence for a rapidly developing science that is based largely on observational research. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS To our knowledge, this is the first systematic review to examine CGs' contributions in depth. Informal caregivers play a major role in HF self-care. Longitudinal research is needed to examine the impact of CGs' contributions on patient self-care outcomes.
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Affiliation(s)
- Harleah G Buck
- School of Nursing, The Pennsylvania State University, USA
| | - Karen Harkness
- McMaster University, Canada Hamilton Health Sciences, Canada
| | - Rachel Wion
- School of Nursing, The Pennsylvania State University, USA
| | - Sandra L Carroll
- School of Nursing, McMaster University, Canada Population Health Research Institute, Hamilton Health Sciences, Canada
| | | | | | | | - Michael McGillion
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada
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Hand CL, Wilkins S, Letts LJ, Law MC. Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research. The Canadian Journal of Occupational Therapy 2014; 80:251-62. [PMID: 24371933 DOI: 10.1177/0008417413501290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult. PURPOSE This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease. METHODS Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes. FINDINGS For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments. IMPLICATIONS Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.
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Affiliation(s)
| | - Seanne Wilkins
- School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada
| | - Lori J Letts
- School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada
| | - Mary C Law
- School of Rehabilitation Sciences, MsMaster University, Hamilton, ON, Canada
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Abstract
BACKGROUND Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood. METHODS A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995. RESULTS Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients' decisions to attend. The main personal factors affecting attendance after referral included patients' knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influenced patient attendance, including family and, less commonly, health professionals. Regardless of the perceived severity of heart disease, patients could view risk as inherently uncontrollable and any attempts to manage risk as futile. CONCLUSIONS Decisions to attend programs are influenced more by social factors than by health professional advice or clinical information. Interventions to increase patient attendance should involve patients and their families and harness social mechanisms.
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The experience of fatigue as a distressing symptom of heart failure. Heart Lung 2012; 41:484-91. [DOI: 10.1016/j.hrtlng.2012.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 04/08/2012] [Accepted: 04/10/2012] [Indexed: 11/22/2022]
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Clark AM, Savard LA, Spaling MA, Heath S, Duncan AS, Spiers JA. Understanding help-seeking decisions in people with heart failure: a qualitative systematic review. Int J Nurs Stud 2012; 49:1582-97. [PMID: 22721677 DOI: 10.1016/j.ijnurstu.2012.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/23/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals. DESIGN Systematic review using qualitative meta-synthesis. METHODS A systematic search (20th May 2011) was conducted to identify studies published in English as full papers ≥1995 reporting primary qualitative data with extractable heart failure-specific data or themes related to help-seeking in patients, caregivers or health professionals. Databases searched were: CINAHL, Medline, PsycInfo, Social Science Citation Index, Embase, Social policy/Practice, SocIndex, Ageline, Health Source Nursing, Scopus; additionally, we consulted with experts and manually searched references. RESULTS 58 studies (990 patients; 274 female, 527 male, 189 sex not described; 229 caregivers, 79 health professionals) were included. Heart failure help-seeking was embedded in daily experiences of heart failure but ongoing symptoms were confusing, ambiguous and disruptive; little support was available from professionals to interpret the presence and significance of fluctuations in symptoms for help-seeking. Other significant barriers to help-seeking were: avoidance-based coping, fear of hospitals and misplaced reluctance to be burdensome. Help-seeking was facilitated by good involvement and frank communication between patients, caregivers and health professionals and the presence of a sense of elevated personal risk. CONCLUSION Health services should harness primary care providers and support patients and caregivers to prioritize development of objective symptom monitoring skills, recognize and personally assimilate the elevated risks of heart failure and help-seeking delays and discourage avoidance-based coping and unwarranted concerns that downplay the significance of heart failure and urgency to address symptoms.
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Clark AM. What are the components of complex interventions in healthcare? Theorizing approaches to parts, powers and the whole intervention. Soc Sci Med 2012; 93:185-93. [PMID: 22580076 DOI: 10.1016/j.socscimed.2012.03.035] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 11/27/2022]
Abstract
The components of complex interventions are frequently discussed, invoked and examined in theory and research but seldom defined. This leads to theoretical and ontological ambiguities, lack of methodological transparency, and potentially, resistance to the wider movement towards complex intervention. This paper is the first to compare and contrast the different approaches that can be taken to the components of complex interventions. Most basically, complex interventions are defined as being composed of parts that make the whole intervention and, in isolation or combination, can generate the power of the intervention. Examples from the field of cardiac rehabilitation are used to illustrate key points. In relation to complex interventions past approaches variously: downplay complexity, focus on the complicatedness of complex interventions, or emphasize the complexity of complex interventions. Thus, approaches can be categorized as viewing components variously as: (1) Non existent parts and powers; (2) Irrelevant parts and powers; (3) Undifferentiated powerful parts; (4) Higher order parts and non-existent lower parts; (5) Higher order parts with non-powerful lower order parts; (6) Higher and lower order parts with powers; and (7) Components as the parts and the whole with powers. Based on this overview, complex interventions should be defined as being formed of parts, which can be material, human, theoretical, social, or procedural in nature, possibly stratified into higher and lower realms, that exercise power individually, in combination, or as emergent properties.
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Affiliation(s)
- Alexander M Clark
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada T6G 1C9.
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Audulv A, Asplund K, Norbergh KG. The integration of chronic illness self-management. QUALITATIVE HEALTH RESEARCH 2012; 22:332-345. [PMID: 22167155 DOI: 10.1177/1049732311430497] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Self-management is crucial for people living with chronic diseases, but the actual process of integrating self-management has not been explored in depth. In this article, we investigate the integration of self-management into the lives of people with chronic illness. In this longitudinal study, we used an interpretive description approach. Twenty-one individuals were interviewed regularly during the first 3 years after they were diagnosed with a chronic condition. We found self-management integration to be an ongoing process that included four phases: seeking effective self-management strategies, considering costs and benefits, creating routines and plans of action, and negotiating self-management that fits one's life. The participants managed the phases according to their context, e.g., illness experience, life situation, personal beliefs, and social support. Health care providers should therefore facilitate self-management integration by providing support that is adjusted to the person's phase of self-management integration and life context.
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Affiliation(s)
- Asa Audulv
- Mid Sweden University, Sundsvall, Sweden.
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Harwood L, Clark AM. Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease. Nurs Inq 2011; 19:29-38. [DOI: 10.1111/j.1440-1800.2011.00575.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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