Self-management of congestive heart failure among elderly men in Japan

Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review

OBJECTIVE

Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness.

DESIGN

Review of qualitative research studies.

DATA SOURCES

CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020.

ELIGIBILITY CRITERIA

Journal articles in English, reporting qualitative studies on lived experience of CHF.

RESULTS

35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives.

CONCLUSIONS

Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population.

PROSPERO REGISTRATION NUMBER

CRD42017077487.

Development of a Home-Based Nursing Intervention Model for Patients With Heart Failure: A Qualitative Feasibility Study

AIM

To develop and verify the feasibility of a personalized home-based heart failure (HF) nursing intervention model to support HF patients, promote self-management, and avoid HF exacerbation and re-hospitalization.

METHODS

Based on processes established in previous studies, literature reviews, and evidence-based guidelines and theories, we developed the nursing intervention model for patients with HF. The goal of this model is to harmonize symptom deterioration prevention behavior and individual lifestyle. After intervention, we conducted semi-structured interviews with participants, and data were transcribed verbatim, after which qualitative content analysis was employed. The contents of visiting nursing practice, opinions on this nursing model, and self-management in patients with HF were analyzed qualitatively and inductively from the viewpoint of practicality and acceptability.

RESULTS

Five nurses who provided interventions, as well as five patients with HF, participated in this study. Accordingly, our findings showed that the framework, assessment, and nursing intervention contents of this model can be practical for everyday home nursing visitations.

CONCLUSIONS

The content has been revised so that more visiting nurses can use them, including those who have less cardiovascular nursing experience.

Symptom perception in heart failure: a scoping review on definition, factors and instruments

Background:

Symptom perception in heart failure has been identified as crucial for effective self-care that is a modifiable factor related to decreased hospital readmission and improved survival.

Aims:

To review systematically the heart failure symptom perception literature and synthesise knowledge on definition, description, factors and instruments.

Methods:

We conducted a scoping review including studies reporting patient-reported symptom perception in adults with heart failure. Structured searches were conducted in Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, JBI and grey literature. Two authors independently reviewed references for eligibility. Data were charted in tables and results narratively summarised.

Results:

The search yielded 3057 references, of which 106 were included. The definition of heart failure symptom perception comprised body listening, monitoring signs, recognising, interpreting and labelling symptoms, and furthermore awareness of and assigning meaning to the change. Symptom monitoring, recognition and interpretation were identified as challenging. Symptom perception facilitators include prior heart failure hospitalisation, heart failure self-care maintenance, symptom perception confidence, illness uncertainty and social support. Barriers include knowledge deficits, symptom clusters and lack of tools/materials. Factors with inconsistent impact on symptom perception include age, sex, education, experiences of living with heart failure, comorbidities, cognitive impairment, depression and symptom progression. One instrument measuring all dimensions of heart failure symptom perception was identified.

Conclusion:

Heart failure symptom perception definition and description have been elucidated. Several factors facilitating or hampering symptom perception are known. Further research is needed to determine a risk profile for poor symptom perception – which can then be taken into consideration when supporting heart failure self-care.