The Psychosocial Aspects of Heart Failure

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

OBJECTIVES

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparing patient and nurse specialist reports of causative factors of depression related to heart failure

PURPOSE

The purpose of this study was to compare participants' and a psychiatric nurse specialist's reports on factors precipitating depression and to validate a depression screening instrument.

DESIGN AND METHODS

Participants were screened for and asked to self-report causative factors of their depression. Participants with moderately severe and severe depressive symptoms received a psychiatric nurse specialist assessment.

FINDINGS

Participants self-reported several causative factors of depression. The psychiatric nurse specialist discovered these plus additional factors. The screening instrument was found to be reliable and valid for the measurement of depressive symptoms.

PRACTICE IMPLICATIONS

Participant self-report identifies many causative factors of depression. The psychiatric nurse specialist identifies additional factors, allowing individualized diagnoses and treatments.

An exploration of the lived experiences of individuals with relapsed multiple myeloma

The experience of living with relapsed Multiple Myeloma (myeloma) for eight patients accessing treatment within a haematology unit in a large London hospital is explored in this study. Myeloma is recognised as incurable and is sometimes described as an 'incurable chronic disease' with a main treatment option of chemotherapy. Hermeneutic phenomenology was the methodology used in conducting the study and data were collected through open-ended, unstructured interviews. Findings suggest that living with relapsed myeloma in the context of a chronic illness causes an ever-shifting perspective between illness and wellness consequently maintaining a state of uncertainty. The patients in this study placed importance on the emotional aspect of their experience. Hope, intuitive knowing and a fighting spirit were expressed as required positive elements that enabled living with relapsed myeloma. These assisted in maintaining normality, coping with bad news and adjusting to the illness. Pervading through the themes was the need to control uncertainty. Having strong support from significant others provided something to live for and the necessary social support required to promote a new orientation to life.

Self-Care Behaviour and Factors Associated with Patient Outcomes Following Same-Day Discharge Percutaneous Coronary Intervention

Background: The demand for percutaneous coronary intervention (PCI) exerts constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and improve access to care.

Aim: The purpose of this study was to describe elective same-day discharge PCI patients' self-care behaviour in the two to five days following their procedure, and the factors associated with cardiac self-efficacy (CSE) and self-care agency (SCA).

Methods: Using a cross-sectional correlational design, 98 consecutive patients were contacted by telephone, following PCI, and asked about their CSE, SCA, and adherence to discharge recommendations. Associations between selected variables were explored through multiple regression analysis.

Results: The findings revealed a high degree of adherence to discharge recommendations, although participants' appreciation of the long term management of their chronic disease was limited. Factors associated with lower levels of CSE and SCA included the burden of having additional chronic co-morbidities, living alone and lacking social support, and a positive screening for psychosocial distress.

Conclusion: Same-day discharge PCI presents a sustainable option for delivery of care for most patients. Some clients may require additional support to manage the transition between acute intervention and chronic disease management.

Caring for special populations: total pain theory in advanced heart failure: applications to research and practice

TOPIC

Total pain theory.

PURPOSE

Describe total pain theory and apply it to research and practice in advanced heart failure (HF).

SOURCE OF INFORMATION

Total pain theory provides a holistic perspective for improving care, especially at the end of life. In advanced HF, multiple domains of well-being known to influence pain perception are adversely affected by declining health and increasing frailty. A conceptual framework is suggested which addresses domains of well-being identified by total pain theory.

CONCLUSION

By applying total pain theory, providers may be more effective in mitigating the suffering of individuals with progressive, life-limiting diseases.

Factors associated with caregiver burden in heart failure family caregivers

Fifty caregivers and 41 heart failure patients participated in a study examining the association of caregiver characteristics and the caregiving environment on caregiver burden. Using a cross-sectional design, caregivers were interviewed face-to-face using a caregiver characteristic/demographic tool designed for this study, the Centers for Epidemiological Studies Short Depression Scale, the Caregiver Reaction Assessment questionnaire, and the New York Heart Association Functional Classification Guide to obtain the caregiver's perception of patient disease severity. Patient medical records were assessed following caregiver interviews for patient demographics, comorbidities, and ejection fraction percentages. Significantly higher levels of burden were found among Caucasian caregivers, those caring for other relatives besides the patient, unemployed caregivers, and single- versus two-family caregivers (respite caregiving). Fifty-one percent of the variance in caregiver burden was accounted for by the variables caregiver advanced age, higher caregiver hours, more caregiver physical health problems, higher levels of caregiver depressive symptoms, and more patient comorbidities. This article concludes with implications for nursing practice and future research.

Identifying and Treating Depression in Patients With Heart Failure

Depression is a common comorbid condition in patients with heart failure (HF) that often goes undiagnosed and untreated. Unless symptoms of depression are specifically looked for, they can be easily missed or mistaken for HF. Clinical depression is a syndromal diagnosis based on patient history, the report of signs and symptoms, and the exclusion of competing diagnoses. This article describes the recommended strategies for recognizing and diagnosing depression. General, psychotherapeutic, and pharmacological approaches to treatment of depression in HF are also discussed. General treatment measures include optimization of medical therapy, patient education, exercise, social support, and family care. Although there are many types of psychotherapy, cognitive-behavioral therapy is particularly appropriate for patients with HF and is described in this article. Categories of antidepressant drugs, including serotonin reuptake inhibitors, tricyclic antidepressants, and miscellaneous antidepressants, are reviewed relative to treating depression in patients with HF. Given the high prevalence and adverse impact of untreated depression in patients with HF, it is essential for advanced practice nurses to develop the requisite knowledge and skills for the identification and treatment of depression.