Faculty

BACKGROUND: Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe. OBJECTIVE: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur). METHODS: Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis. RESULTS: Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic). CONCLUSIONS: Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.

Background: Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care - especially among patients with heart failure (HF). Objective: We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. Methods: In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Results: Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Conclusions: Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.

Objectives: To understand how patients make decisions regarding a left ventricular assist device (LVAD). Design: A qualitative multiple case study design was used to explore the context and influence of individuals regarding patients’ decision-making processes through: 1) detailed, in-depth interviews of those mostly involved in the patient's decision and 2) pertinent data including observations, medical records, educational information and physical artifacts. Data clusters and patterns of co-occurring codes were examined using thematic analysis. Main outcome measures: Themes were extrapolated from individual case summaries to provide an in-depth analysis of each case and a cross-case analysis across the multiple cases. The predominant theme, consistent with other studies, was the salience of survival. Findings: This case study approach revealed new themes beyond those of prior studies. Patients considered: 1) self-care management for patients without a caregiver, 2) acceptability and future expectations of the LVAD and 3) the role of nurses in eliciting patients’ fears, values and preferences. Conclusion: The patients’ decision-making processes regarding an LVAD involve a cost-benefit analysis of the anticipated needs and consequences of the LVAD. Acceptability of the device is relevant to clinical practice and public policy. Nurses have a unique role in seeking patients’ concerns, an essential component of shared decision-making.

Background Despite the strong literature on the influence of self-care on hypertension (HTN) diagnosis, there is a notable lack of studies that explore self-care among Filipino immigrants in the United States (US) who have HTN. Aim To determine the levels of and relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care among first generation Filipino immigrants in the US who have HTN. Design A cross-sectional correlational design was used to determine the relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care using the Transactional Model of Stress and Coping. One hundred and sixty-three community-dwelling first-generation Filipino immigrants participated in the study. Methods Data on HTN self-care, acculturation, acculturative stress, HTN self-efficacy, and patient activation were collected. Results The study results revealed that HTN self-efficacy and patient activation significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further analysis revealed that patient activation had a mediating role between HTN self-efficacy and HTN self-care. Conclusions Findings from this study revealed that HTN self-efficacy and patient activation were associated with self-care behaviors associated with HTN management for this sample. Clinical relevance Findings from this study highlight the importance of addressing HTN self-efficacy and patient activation in improving HTN self-care for this population.

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and allcause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

Background: Individuals with cancer are surviving long term, categorizing cancer asa a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. Objective: Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. Methods: PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. Results: Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. Conclusions: Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. Implications for Practice: Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.