Redefining a 'new normality': A hermeneutic phenomenological study of the experiences of patients with chronic heart failure

Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale

BACKGROUND

To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose.

METHODS

The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale.

RESULTS

The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items.

CONCLUSIONS

This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.

The significance of exploring conceptual equivalence within the process of the cross-cultural adaptation of tools: The case of the Patient's Perception of Feeling Known by their Nurses Scale

INTRODUCTION

The exploration of conceptual equivalence within the process of the cross-cultural adaptation of tools is usually neglected as it generally assumed that the theoretical construct of a tool is conceptualized in the same way in both the original and target culture. This article attempts to throw light on the contribution of the evaluation of conceptual equivalence to the process of adaptation, and for tool development. To illustrate this premise, the example of the cross-cultural adaptation of the Patients' Perception of Feeling Known by their Nurses (PPFKN) Scale is presented.

DESIGN

An adapted version of the Sousa and Rojjanasrirat (Journal of Evaluation in Clinical Practice, 2011, 17(2), 268-274) guidelines was used to translate and culturally adapt the PPFKN Scale to Spanish language and culture. A qualitative descriptive study was added to the traditional process of translation and pilot study to explore the concept in the target culture and recognize conceptual equivalence.

METHODS

Experts in the tool concept, bilingual translators and the author of the tool participated in the translation of the original tool into Spanish. A pilot study of the Spanish version with a sample of 44 patients and a panel of six experts from different fields evaluated its clarity and relevance. In addition, seven patients participated in a descriptive qualitative study using semi-structured individual interviews to explore the phenomenon in the new culture. A content analysis following the Miles, Huberman & Saldaña (Qualitative data analysis, a methods sourcebook, 2014) approach was used to analyze qualitative data.

RESULTS

The cross-cultural translation and adaptation of the PPFKN scale into Spanish required a thorough revision. More than half of the items needed discussions to reach consensus regarding the most appropriate Spanish term. In addition, the study confirmed the four attributes of the concept identified in the American context and allowed for new insights within those attributes to appear. Those aspects reflected characteristics of the phenomenon of being known in the Spanish context and were added to the tool in the format of 10 new items.

CONCLUSIONS

A comprehensive cross-cultural adaptation of tools should incorporate, together with the study of linguistic and semantic equivalence, the analysis of the conceptual equivalence of the phenomenon in both contexts. The identification, acknowledgment and study of the conceptual differences between two cultures in relation to a phenomenon becomes an opportunity for deeper study of the phenomenon in both cultures, for understanding of their richness and depth, and for the proposal of changes that may enhance the content validity of the tool.

CLINICAL RELEVANCE

The evaluation of conceptual equivalence of tools within the process of cross-cultural adaptation will make it possible for target cultures to rely on tools both theoretically sound and significant. Specifically, the cross-cultural adaptation of the PPFKN scale has facilitated the design of a Spanish version of the tool that is linguistically, semantically and theoretically congruent with Spanish culture. The PPFKN Scale is a powerful indicator that evidences nursing care contribution to the patient's experience.

Interventions on the social dimension of people with chronic heart failure: a systematic review of randomized controlled trials

AIMS

The symptom burden of patients with chronic heart failure (CHF), together with social determinants and psychosocial factors, results in limitations to maintain adequate social life and roles, participate in social events and maintain relationships. This situation's impact on health outcomes makes it of utmost importance to develop meaningful social networks for these patients. The primary objective aimed to identify randomized controlled trials that impact the social dimension of people with CHF. The secondary objectives were to analyze the methodological quality of these interventions, establish their components, and synthesize their results.

METHODS AND RESULTS

A systematic review following PRISMA guidelines was conducted in Pubmed, Scopus, Cochrane CENTRAL, PsychINFO, and CINAHL databases between 2010 and February 2022. The Revised Cochrane risk-of-bias tool for randomized trials was used. The protocol was registered in PROSPERO. Eight randomized controlled trials were identified, among which two were at 'high risk of bias.' Interventions were synthesized according to the following categories: delivery format, providers and recipients, and the intervention content domains. Half of the studies showed statistical superiority in improving the intervention group's social support in people with CHF.

CONCLUSION

This review has highlighted the scarcity of interventions targeting the social dimension of people with CHF. Interventions have been heterogeneous, which limits the statistical combination of studies. Based on narrative review and vote counting, such interventions could potentially improve social support and self-care, which are important patient reported outcomes, thus warrant further research. Future studies should be co-created with patients and families to be adequately targeted.

REGISTRATION

PROSPERO CRD42021256199.

The relationship competencies guiding tool: A development, content validation and implementation study

AIM

The aims of this paper are (1) to present the results of the development, content validation and implementation study of the Relationship Competencies Guiding Tool; (2) to provide examples of how each item in the tool is reflected in clinical narratives written by nurses and justify the corresponding scores after the evaluation; (3) to present how the language and content of the narratives are interpreted with the tool and to describe an exemplar; and (4) to present barriers to and facilitators of the application of the tool.

BACKGROUND

From a person-centered care approach, the fostering of authentic relationships with patients is key to achieving therapeutic benefits. Therefore, it is essential to help nurses establish meaningful relationships with patients and help them acquire these abilities. Clinical narratives can be used as a way to promote reflective practice and professional competency development among nurses. A tool to evaluate the knowledge, skills, attitudes and values necessary for developing authentic encounters with patients through clinical narratives was developed, validated and implemented.

DESIGN

An instrument-development study comprised of three steps: (1) conceptualization; (2) item generation and content validity; and (3) implementation of the tool and linguistic evaluation.

METHODS

This study was conducted in three major steps. Step one entailed conceptualization. Step two included the generation of items and content validation. In step three, the tool was used to independently evaluate 25 narratives. One of these narratives was also linguistically analysed to provide a comprehensive view of the interpretative strategies deployed by evaluators.

RESULTS

The Relationship Competencies Guiding Tool was developed, validated and implemented. It could help nurses work on nursing relationship-based professional competencies, guided the evaluators in the process of assigning scores to the corresponding items and helped the researchers identify certain barriers and facilitators before and during the narrative evaluation process.

CONCLUSIONS

The tool has been shown to be clear, relevant and conceptually and linguistically suitable for evaluating clinical narratives. The Relationship Competencies Guiding Tool could be applied to interpret how nurses reflect professional competencies in a clinical narrative as a preliminary step in the construction of a measurement tool.

TWEETABLE ABSTRACT

From a person-centered relationship-based care approach, clinical narratives can be used to promote professional competencies between nurses. The Relationship Competencies Guiding Tool may help evaluate the knowledge, skills, attitudes and values necessary for developing authentic encounters with persons/families, as reflected by nurses' clinical narratives.

Causes, experiences and consequences of the impact of chronic heart failure on the person´s social dimension: A scoping review

Chronic heart failure (CHF) is a progressive and disabling condition that significantly impacts patients' daily lives. One of its effects is decreased opportunities to participate in social life, leading to reduced social interaction, loneliness, social isolation and lack of social support to continue with their daily life activities. This study aimed to explore the causes, experiences, and consequences of the impact of CHF on the social dimension of the person. According to the Arksey & O'Malley method, a scoping review of the literature was conducted to examine existing knowledge in the area, summarise existing evidence and identify gaps in the literature. The search was conducted in the PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. Twenty-six articles were identified. The reasons why CHF influences the social dimension of the person were multifactorial and related to physical aspects, sociodemographics, lifestyle changes and the feelings experienced by these patients. Social relationships play a key role, and the benefits of good social relationships and the impact of poor or inadequate social support were identified. Furthermore, the influence of alterations in the social dimension on the CHF patient's clinical outcomes was described. This approach will help to detect and better understand the bidirectional influence that exists in each person between social isolation, relationships, and support life experiences, self-care activities, and morbi-mortality rates. These findings have shown the importance of detecting higher-risk groups and systematically assessing factors related to the social dimension in all patients with CHF.

Family Narratives About Providing End-of-Life Care at Home

Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.

Experiencing the possibility of near death on a daily basis: A phenomenological study of patients with chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is a syndrome that greatly impacts people's lives. Due to the poor prognosis of CHF, together with the frequent exacerbations of symptoms, death is a topic that is very present in the lives of patients with CHF.

OBJECTIVE

To explore thoughts about death experienced by patients with chronic heart failure in their daily lives.

METHODS

A hermeneutic phenomenological study was carried out. Conversational interviews were conducted with 20 outpatients with chronic heart failure. Analysis of the responses was based on the method proposed by van Manen.

RESULTS

From the analysis, four main themes emerged: (1) Feeling afraid of the possibility of dying; (2) Acceptance of the possibility of death; (3) Desiring death for relief from suffering; and (4) Striving to continue living to enjoy family.

CONCLUSIONS

This study presents, as a novel finding, that people with CHF experience the possibility of near death on a daily basis. This experience, which they must encounter on their own, makes them afraid. In addition, some of them, in view of the discomfort they are living, wish to die, with some even considering committing suicide.

The Determinants of Living with Long-Term Conditions: An International Cross-Sectional Study

It is essential that healthcare and social professionals understand the daily lives of people with chronic diseases, and the variables that influence them. The aim of this study was to identify the determinants influencing the process of living with long-term conditions. To investigate this, an observational, international, cross-sectional study was carried out. A consecutive sample of 1788 Spanish-speaking population living with chronic obstructive pulmonary disease, chronic heart failure and type 2 diabetes mellitus were included. Descriptive statistics and multiple linear regression models were performed. The linear regression models identified that social support (β = 0.39, p < 0.001) and the satisfaction with life (β = 0.37, p < 0.001) were the main determinants in the process of living with a long-term condition (49% of the variance). Age (β = -0.08, p = 0.01) and disease duration (β = 0.07, p = 0.01) were determinants only in the chronic heart failure subgroup, and country was significant in the chronic obstructive pulmonary disease subgroup (β = -0.15, p = 0.002). Satisfaction with life and social support were key determinants influencing the process of living with long-term conditions. As such, those aspects should be included in the design of interventions focused on the achievement of a positive living in people with long-term conditions.

Psychometric Validation of the Living with Chronic Illness Scale in Patients with Chronic Heart Failure

It is necessary to develop self-reported instruments that evaluate the process of living with chronic heart failure (HF) holistically. The Living with Chronic Illness Scale—HF (LW-CI-HF) is the only available tool to evaluate how patients are living with HF. The aim is to analyse the psychometric properties of the LW-CI scale in the HF population. An international, cross-sectional validation study was carried out in 603 patients living with HF from Spain and Colombia. The variables measured were living with HF, perceived social support, satisfaction with life, quality of life and global impression of severity. The LW-CI-HF scale presented good data quality and acceptability. All domains showed high internal consistency with Cronbach’s alpha coefficient ≥ 0.7. The intraclass correlation coefficient for the total score was satisfactory (0.9) in test–retest reliability. The LW-CI-HF correlated 0.7 with social support and quality of life measures. Standard error of measurement was 6.5 for total scale. The LW-CI-HF scale is feasible, reliable and valid. However, results should be taken with caution in order to be used in clinical practice to evaluate the complex process of living with HF. Further research is proposed.