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.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study

BACKGROUND

Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care.

PURPOSE

To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care.

METHOD

Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test.

RESULTS

The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)].

CONCLUSIONS

The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

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

AIM

To explore the perception of normality in life experienced by patients with chronic heart failure.

DESIGN

A hermeneutic phenomenological study was conducted.

METHODS

Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis.

RESULTS

From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others.

CONCLUSIONS

The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process.

IMPACT

Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.