This dissertation aims to examine factors associated with telehealth initiation among heart failure patients in home care settings using a mixed methods study design. Chapter One identifies the current gap in the literature on telehealth adoption and the significance of this study in filling this gap. Chapter Two provides an integrative review of the literature on factors affecting heart failure patients’ decision making to accept telehealth services in a home setting. Chapter Three presents a quantitative analysis of data from the Outcome and Assessment Information Set (OASIS) on 2,832 heart failure patients referred to telehealth services using a modified Unified Theory of Acceptance Use of Technology (UTAUT) framework, to identify patient-related factors or characteristics associated with telehealth initiation. Chapter Four describes the findings of a qualitative study using individual telephone interviews with heart failure patients at home to explore reasons for telehealth initiation. Finally, in Chapter Five, the findings of all three studies are summarized and overarching conclusions are reported with a discussion of their relationship to previous research. This chapter concludes with a consideration of the strengths and limitations of the study, and implications for practice, policy, and research.

ABSTRACT The Benefits of Yoga Therapy for Heart Failure Patients by Paula R. Pullen STATEMENT OF THE PROBLEM The number of patients living with heart failure (HF) is on the rise. Yoga has been found to improve physical and psychological parameters amongst healthy individuals. The effects of yoga on HF patients are unknown. The purpose of this study was to examine the effects of yoga on cardio-vascular endurance [functional capacity (FC)], flexibility, inflammatory markers, and quality of life (QoL) on medically stable HF patients. METHOD Forty HF patients with compensated systolic or diastolic HF participated in the study. A randomized control design created two groups, yoga (N=21). and control (N=19).The treatment intervention consisted of 16-yoga sessions conducted bi-weekly (YG) vs. standard medical care (control- CG) for two months. All participants were asked to follow a home walk program. Pre- and post-study measurements included a treadmill stress test to peak exertion, flexibility (FLEX), girth, interleukin-6 (IL-6), c- reactive protein (CRP), and extra-cellular dismutase (EC-SOD). Quality of life was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ). RESULTS Forty patients were randomized to YG (N=21) or CG (N=19). The results were significant for favorable changes in the YG as compared to the CG for flexibility (P=0.012), treadmill time (P=0.002), ~VO2peak (P=0.003), and all biomarkers (IL-6, CRP, and EC-SOD) of inflammation. Within the YG, pre- to post- test scores for the total and physical sub- scale of the MLwHFQ were significant (P=0.02 and P<0.001). CONCLUSIONS Yoga therapy offered additional benefits to the standard medical care of HF patients by improving QoL, exercise capacity, FLEX, and biomarkers of inflammation

Bakgrund: Hjärtsvikt förekommer hos ungefär 2 % av Sveriges befolkning och har hög dödlighet bland äldre. Hjärtsviktspatienter har ett försämrat hälsotillstånd samt sämre livskvalitet relaterat till symtombilden. Egenvård är en betydelsefull del av behandlingen vid hjärtsvikt. Genom ökad kunskap och förståelse för patienters upplevelser kan sjuksköterskan ur ett salutogent förhållningssätt främja egenvårdsförmågan och öka livskvaliteten.Syfte: Syftet med litteraturöversikten är att beskriva patienters upplevelser av att leva med hjärtsvikt.Metod: En litteraturöversikt baserat på 14 vetenskapliga artiklar med kvalitativ ansats som är inhämtade från databaserna CINAHL och PubMed.Resultat: Tre huvudkategorier presenteras i resultatet som beskriver patienters upplevelser av att leva med hjärtsvikt vilka är: Upplevelser av ett fysiskt och socialt begränsat liv, Emotionella reaktioner av ett förändrat liv samt Upplevelser av bristande egenvård, information och kunskap.Slutsats: Att leva med hjärtsvikt innebär fysiska, psykiska och sociala begränsningar i vardagen. Hjärtsviktspatienternas egenvårdsförmåga har betydelse för hantering av begränsningarna. Genom att tillämpa ett salutogent förhållningssätt kan sjuksköterskor få kunskap och förståelse för begränsningar samt vilka resurser som behövs hos varje enskild patient och därmed erbjuda stöd som främjar egenvårdsförmåga och livskvaliteten. / Background: Heart failure occurs in approximately 2% of Sweden's population and has a high mortality rate among the elderly. Heart failure patients have a deteriorating health condition and poorer quality of life related to the symptom picture. Self-care is an important part of the treatment for heart failure. Through increased knowledge and understanding of patients' experiences, the nurse can, from a salutogenic approach, promote self-care ability and increase the quality of life.Aim: The aim of this literature review is to describe patients' experiences of living with heart failure.Method: A literature review based on 14 scientific articles with a qualitative approach obtained from the databases CINAHL and PubMed.Results: Three main categories are presented in the results that describe patients' experiences of living with heart failure which are: Experiences of a physically and socially limited life, Emotional reactions of a changed life and Experiences of lack of self-care, information, and knowledge.Conclusions: Living with heart failure means physical, mental and social limitations in everyday life. The heart failure patients' self-care ability is important for managing the limitations. By applying a salutogenic approach, nurses can gain knowledge and understanding of limitations as well as what resources are needed in each individual patient and thus offer support that promotes self-care ability and quality of life.

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Thesis (MPhil (Rehabilitation))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: In South Africa, rapid urbanisation and epidemiological transition have left the black urban population vulnerable to diseases of lifestyle such as chronic heart failure. This is in part due to the fact that changes in dietary patterns during urbanization play an important role in the increase of risk factors of these diseases. However, there is a lack of information on dietary choices of black urban populations. Therefore the current study evolved to describe the food choices and macro-and micronutrient intake of black, urban Sowetans, newly diagnosed with chronic heart failure, who attended the outpatient cardiac clinic at Chris Hani Baragwanath Hospital. A descriptive study methodology that made use of quantitative methods of data collection was used. Study participants comprised Sowetans with chronic heart failure who attended the Chris Hani Baragwanath Hospital outpatient cardiac clinic for the first time. Consecutive sampling followed by stratified random sampling was used to identify study participants. Participants were stratified for gender. Hundred persons participated in the study. Data was collected through the Food Frequency Questionnaire, a demographic questionnaire and measuring of height and weight. Data from the FFQ's was analysed for macro- and micronutrient intake by using the MRC "Food Finder 3‟ programme. Data were analysed by a statistician using StatSoft, Inc. (2009) STATISTICA, version 9.0. A p value of 0.05 was seen as statistically significant. The most significant clinical finding is an inadequate intake of certain micro nutrients and excessive salt consumption. Study participants continued to eat the more traditional carbohydrate foods. These staples were supplemented by highly refined carbohydrate sources, such as added sugar, sweets and chocolates, cakes, biscuits and cold drinks. Women ate significantly more maltabella (p=0.04), sweets and chocolates (p=0.01) than men, while men consumed significantly more, meat (p=0.01), milk and milk products (p=0.04), additional salt (p=0.02) and take away foods (p=0.05). Both genders had inadequate intake of Vitamin D [men 4 mcg/day (p=0.00), and women, 4 mcg/day (p=0.01)], selenium, [46 mcg/day (p=0.03) and 32 mcg/day (p=0.00)], folate [215 mcg/day (p=0.00) and 179 mcg/day (p=0.00)] and Vitamin C [71 mg/day (p=0.05) and 66 mg/day (p=0.07)]. Women had an inadequate intake of iron of 9 mg/day (P=0.00). It is recommended that dietary health promotion packages are developed and targeted specifically at this high risk community. Key words: Chronic heart failure, black, urban, food choices, macro-and micronutrients. / AFRIKAANSE OPSOMMING: Die swart stedelike bevolking in Suid Afrika gaan gebuk onder 'n al groter wordende risiko vir leefstyl siektes soos kroniese hartversaking. Dit kan gedeeltelik toegeskryf word aan veranderinge in dieet patrone as gevolg van verstedeliking en die epidemiologiese oorgang. Daar is egter nie genoeg inligting oor die voedselkeuses van swart stedelike bevolkingsgroepe nie. Die huidige studie het dus ontwikkel uit die behoefte om die voedselkeuses en mikro- en makronutrient inname van swart, stedelike Soweto inwoners wat nuut gediagnoseer is met hartversaking en die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal bygewoon het, te bepaal. Daar was gebruik gemaak van 'n beskrywende studie metodologie wat gebruik gemaak het van kwantitatiewe metodes van data insameling. Deelnemers aan die studie het bestaan uit swart inwoners van Soweto met kroniese hartversaking wat die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal vir die eerste keer bygewoon het. 'n Opeenvolgende steekproef, gevolg deur gestratifiseerde steekproefneming was gebruik om die studie deelnemers te identifiseer. Deelnemers was gestratifiseer volgens geslag. Eenhonderd pesone het aan die studie deelgeneem. Data is ingesamel deur gebruik te maak van die Voedsel Frekwensie Vraelys, a demografiese vraelys en die meet van lengte en gewig. Data van die Voedsel Frekwensie Vraelyste was ge-analiseer vir mikro-en makronutrient inname met die MRC ”Food Finder 3” program. Data is ge-analiseer deur 'n statistikus met die „StatSoft, Inc. (2009) STATISTICA, version 9.0‟. 'n P waarde van 0.05 is gesien as statisties beduidend. Mees beduidendste kliniese bevinding was die ontoereikende inname van sekere mikro-nutriënte en die verhoogde inname van sout. Studie deelnemers het nog steeds die meer tradisionele koolhidraat voedsels geëet. Hierdie stapel voedsels was aangevul deur hoogs verfynde bronne van koolhidrate, soos ekstra suiker, lekkergoed en sjokolade, koek, koekies en koeldrank. Die vrouens het beduidend meer maltabella (p=0.01), lekkergoed en sjokolade (p=0.01) geëet as mans, terwyl mans beduidend meer vleis (p=0.01), melk en melkprodukte (p=0.04), bygevoegde sout (p=0.02) en wegneem kosse (p=0.05) ingeneem het. Beide geslagte het ontoereikende innames van vitamiene D [mans 4 mcg/dag (p=0.00), en vrouens, 4 mcg/dag (p=0.01)], selenium [46 mcg/dag (p=0.03) en 32 mcg/dag (p=0.00)], foliensuur [215 mcg/dag (p=0.00) en 179 mcg/dag (p=0.00)] en vitamiene C [71 mg/dag (p=0.05) en 66 mg/dag (p=0.07)]. Vrouens het 'n ontoereikende inname van yster van 9 mg/dag (p=0.00) gehad. Daar word aanbeveel dat gesonde voedingsprogramme ontwikkel word, spesifiek gemik op hierdie bevolkingsgroep. Sleutelwoorde: Kroniese hartversaking, swart, verstedeliking, voedselkeuses, makro- en mikronutriënte.

Bakgrund: Antalet personer med hjärtsvikt beräknas till 23 miljoner i världen och ungefär 250 000 i Sverige. Hjärtsvikt är en av de vanligaste orsakerna till sjukhusinläggningar hos personer över 65 år. I framtiden kommer antalet äldre i samhället öka och det finns tendenser att även antalet yngre med hjärtsvikt ökar. Symtom som följer med hjärtsvikt påverkar den drabbade så det kan bli svårt att få vardagen att fungera. Genom egenvård kan personen lindra symtom, få en enklare vardag och minska sjukhusvården. Med rätt kunskap kan sjuksköterskor främja egenvårdsförmågan hos personer med hjärtsvikt.   Syfte: Syftet var att beskriva effekter av omvårdnadsåtgärder för att främja egenvårdsförmågan hos personer med hjärtsvikt.   Metod: En litteraturöversikt där 11 kvantitativa artiklar har analyserats.   Resultat: Olika inriktningar identifierades för hur egenvårdsförmågan kunde främjas: Utbildning med individuell inriktning- hjälpmedel, individuell inriktning- kognitivt beteende och inriktning individuell och anhörig. Alla inriktningar, utom individuell inriktning- kognitivt beteende visade sig leda till förbättrad egenvård.     Slutsats: Genom personcentrerad utbildning kan sjuksköterskan motivera personer med hjärtsvikt och deras anhöriga utifrån de resurser och familjefunktioner som är aktuella hos just den personen. Att kontakten med sjuksköterska är kontinuerlig och att personen lätt kan följa symtom med något slags hjälpmedel ökar följsamheten av egenvård och ger personen empowerment. / Background: In the world 23 million people, of which 250 000 live in Sweden, suffer with heart failure. It is one of the most common causes of hospitalization in the population 65 years and older. In the future the number of elderly people will increase and there are signs of an increasing number of younger people suffering with heart failure as well. The symptoms of heart failure affect the person’s ability to perform the chores of daily living. By performing self-care the person diagnosed with heart failure can alleviate symptoms so the chores of daily living can be performed easier. With the right knowledge can nurses promote self-care in persons diagnosed with heart failure.   Aim: Effects of nursing actions to promote self-care in persons diagnosed with heart failure.   Method: Eleven quantitative studies have been analyzed and presented in a result.   Result: The result is presented in four different categories; Individual education with aid to follow up symptoms, individual education with cognitive behavior programs, education for the person diagnosed with heart failure and his/her relatives. The result was positive in all categories except from the category individual education with cognitive behavior programs.   Conclusion: The nurse can through personcentered care motivate people diagnosed with heart failure to perform self-care. The motivation can be based on resources and family functions that are relevant to that particular person. It strengthens the adherence to self-care and empowers the patient if the contact with the nurse is continuous and if the person diagnosed with heart failure has some kind of aid to follow up symptoms.

Indiana University-Purdue University Indianapolis (IUPUI) / The number of patients with chronic heart failure (HF) is at an all-time high and the incidence is expected to increase as our population ages. HF patients experience impaired cognition, exertional shortness of breath, and persistent fatigue; therefore, family members are needed to assist with their care at home. Although existing literature suggests that HF caregivers experience negative physical, mental, and social outcomes, there is a lack of studies guided by a conceptual model to determine factors associated with these outcomes. The purpose of this study was to determine factors associated with HF caregiver depressive symptoms, life changes, and quality of life guided by a conceptual model derived from Lazarus and colleagues’ transactional approach to stress. Psychometric properties of a new HF caregiver-specific quality of life (HFCQL) scale were also determined. Using a descriptive design, a convenience sample of 100 HF caregivers was interviewed by telephone using established measures along with the new HFCQL scale. The 16-item HFCQL scale, which measures physical, psychological, social, and spiritual well-being demonstrated evidence of internal consistency reliability (alpha = .89); 2-week test-retest reliability (ICC = .83); construct validity, as evaluated with factor analysis (loadings > .32) and hierarchical multiple regression (59% variance, p < .001); and criterion validity, as shown with significant (p < .001) correlations with the Bakas Caregiving Outcomes Scale (r = .73), SF-36 general and mental health (r = .45; .59), and a single overall QOL item (r = .71). Using hierarchical multiple regression, the model constructs accounted for 35% variance of depressive symptoms, 46% variance of life changes, and 59% variance of HFCQL (p < .001). Factors significantly associated with these outcomes included caregiving task difficulty, uncertainty, social support, and threat appraisal. Support for the conceptual model was provided, and potential areas for intervention development were identified. The new HFCQL scale showed potential as a quality outcome measure in HF caregivers, and might be used to screen HF caregivers for poor quality of life. Further research using the proposed conceptual model and the HFCQL scale is warranted. Tamilyn Bakas, DNS, RN, Chair

L’insuffisance cardiaque chronique est une maladie systémique où des dysfonctions périphériques viennent s’ajouter à l’incapacité du cœur à assurer un débit cardiaque adéquat aux tissus métabolisants. Parmi des dysfonctions périphériques, l’atrophie ainsi que la perte de force et d’endurance musculaire jouent un rôle primordial et contribuent largement à la genèse des symptômes majeurs de l’insuffisance cardiaque chronique, c’est à dire la fatigue, la dyspnée et l’intolérance à l’effort.<p>Ce n’est que depuis le début des années 1990 que des études ont montré que le réentraînement à l’effort pouvait être bénéfique pour le patient insuffisant cardiaque chronique; auparavant, il était considéré comme contre-indiqué.<p>La méthodologie d’entraînement proposée à cette époque aux patients était un entraînement de l’endurance cardio-vasculaire, le renforcement musculaire n’y avait pas sa place car on craignait que l’impact hémodynamique de ce type d’entraînement risquerait de détériorer la fonction cardiaque encore plus. Des études menées sur des contractions musculaires de type isométrique montraient en effet une diminution de la fonction cardiaque pendant l’entraînement. Cependant, les contraintes imposées pendant les exercices de renforcement musculaire dynamique (encore appelés « résistifs ») ne correspondent nullement à celles du renforcement isométrique. Des études sur des personnes saines ont montré que le renforcement musculaire est plus adapté à induire des améliorations du volume et de la force musculaire que l’entraînement de l’endurance cardio-vasculaire.<p>Le but de nos travaux a donc été de vérifier si l’introduction du renforcement musculaire, en complément de l’entraînement cardio-vasculaire ou bien comme entraînement à part entière, pouvait apporter un bénéfice supplémentaire chez l’insuffisant cardiaque chronique par son aptitude, du moins théorique, à mieux corriger certains aspects des dysfonctions musculaires.<p><p><p>Il s’agissait, dans les différentes études que nous avons menées, de vérifier qu’un entraînement composé de renforcement musculaire (au moins partiellement) chez le patient insuffisant cardiaque chronique:<p>-\ / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished