Self-care behaviors among patients with heart failure.
ABSTRACT One way to prevent frequent hospitalizations and promote positive health outcomes among patients with heart failure (HF) is to ensure that the amount and quality of self-care used is appropriate to the patient's situation.
The following are the purposes of this study: (a) examine the frequency of performance of self-care behaviors, (b) describe personal and environmental factors (basic conditioning factors [BCFs]) that affect self-care behaviors, and (c) describe the relationship between the level of knowledge patients have to empower their performance of self-care and the actual performance of self-care behaviors.
This descriptive correlational study was guided by Orem's theory of self-care. One hundred ten participants, predominantly African Americans, who were outpatients or inpatients ready for hospital discharge, 18 years or older, and diagnosed with HF that was confirmed by an ejection fraction of 40% or less were conveniently selected from 1 of 2 sites. Data were collected with 2 investigator-developed instruments: the Revised Heart Failure Self-Care Behavior Scale and the Heart Failure Knowledge Test. Descriptive statistics, correlational analyses, and t tests for independent samples were used to analyze the data.
Three of the top 5 most frequently performed self-care behaviors were related to taking prescribed medications, and the 5 least frequently performed self-care behaviors were concerned with symptom monitoring or management. There were no significant relationships between the total self-care behavior score and any of the BCFs; however, a number of significant relationships between BCFs and individual self-care behaviors were observed. There was a significant relationship between the mean total knowledge score and the total mean self-care score (r = 0.21, P =.026).
Detailed information about the influence of BCFs on the performance of specific HF self-care behaviors can help nurses tailor interventions to the patient's situation.
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ABSTRACT: Today's complex healthcare system relies heavily on sophisticated self-care regimens. To navigate the system and follow self-care protocols, patients must be able to understand and use health information, which requires health literacy. However, nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Understanding how to effectively care for one's self is thought to improve heart failure symptoms and patient outcomes, but little is actually known about how health literacy influences self-care in patients with heart failure. The purpose of this pilot study was to examine the relationship between health literacy and self-care of patients with heart failure. Patients with a diagnosis of heart failure were recruited from a variety of community settings. Participants completed the Short-Form Test of Functional Health Literacy (measured health literacy), the Self-care Index of Heart Failure (measured self-care maintenance, management, and confidence), and a demographic questionnaire. Spearman ρ correlations were used to assess the strength of the relationship between health literacy level and self-care scores. Among the 49 participants recruited, health literacy was positively related to self-care maintenance (Rs = 0.357, P = .006). Health literacy had a negative relationship with self-care management (Rs = -0.573, P = .001). There was no association between health literacy and self-care confidence (Rs = 0.201, P = .083). This project provides preliminary data regarding the association between health literacy and self-care in heart failure, showing support for higher health-literate patients performing more self-care maintenance, which has been shown to improve patient outcomes in heart failure. Patients with higher health literacy trended toward having greater self-care confidence, which can increase the likelihood of performing self-care, but this finding was not statistically significant. It was unexpected to find that lower health-literate patients performed more self-care management.The Journal of cardiovascular nursing 01/2011; 26(6):446-51. · 1.43 Impact Factor
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ABSTRACT: Nancy Jean Gardetto*Division of Cardiology, Department of Veterans Affairs, San Diego, CA, USA *Ms Gardetto is also a doctoral student at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USAAbstract: Chronic conditions such as heart failure (HF) place a tremendous strain on patients, their families, the community, and the health care system because there are no real “cures”. Adding to the burden are longer life expectancies and increased numbers of people living with multiple chronic conditions. Today, whether engaging in a health-promoting activity, such as exercise, or living with a chronic disease such as HF, the individual is responsible for actively managing day-to-day activities, a concept referred to as self-management. Self-management emerged as the cornerstone for chronic care models and multidisciplinary disease-management strategies in chronic illness care. Moreover, self-management has been prioritized as a central pathway for improving the quality and effectiveness of most chronic HF care. Adherence to self-management is vital to optimize the treatment outcomes in HF patients, but implementing chronic disease self-management (CDSM) strategies and identifying the difficulties in self-management has proved to be a challenge. Understanding both where we have been and the future direction of self-management in HF care is not only timely, but a crucial aspect of improving long-term outcomes for people with HF and other chronic diseases.Keywords: self-management, heart failure, chronic disease, self-care, disease managementJournal of Multidisciplinary Healthcare. 01/2011;
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ABSTRACT: Self-care is an important aspect of heart failure (HF) management. Information on the determinants of self-care is necessary for the development of self-care promotion interventions. HF self-care includes self-care management, self-care maintenance, sodium, fluid and alcohol intake restriction, physical activity, smoking cessation, monitoring signs and symptoms and keeping follow-up appointments. To assess the evidence regarding presumed determinants of HF self-care and make recommendations for interventions to promote self-care behavior among HF patients, a systematic literature review was conducted. Based on inclusion and exclusion criteria and a quality assessment, twenty-six articles were included. A best evidence synthesis was used. Results showed that the length of time since patients' diagnosis with HF is positively related to their performance of self-care maintenance. Moreover, it was found that HF patients' perceived benefits and barriers are related to their restriction of sodium intake, and that patients with type-D personality are less likely to consult medical professionals. There was also evidence for a few non-significant relationships. All other evidence was inconsistent, mainly due to insufficient evidence. Interventions that aim to increase the performance of self-care maintenance can teach newly diagnosed patients the skills that are usually attained with experience acquired as a result of living with HF for a longer time. Perceived benefits and barriers of restricting sodium intake could be targeted in interventions for sodium intake reduction among HF patients. Finally, interventions for the promotion of adequate consulting of medical professionals can specifically target HF patients with a type-D personality.Heart Failure Reviews 12/2011; 17(3):367-85. · 3.20 Impact Factor