People with heart failure frequently experience poor quality of life, often exacerbated by co-morbidities. This demands complex self-management activities, often supported by family members in care roles, and includes input from community Heart Failure Specialist Nurses (HFSNs) that is known to reduce hospital readmissions. There is, however, a paucity of knowledge about the perceptions of people living with heart failure concerning self-management strategies. Aim This thesis is a longitudinal study exploring emergent patterns and styles of self- management of persons with heart failure, the impact of family members and HFSNs. Method Thirty-one theoretically sampled participants with heart failure were recruited from a district general hospital between October 2004 and September 2006. The sample participated in home-based, audio-taped, semi-structured interviews prior to nurse intervention, describing how heart failure affected their lives, focusing on self-management strategies. The HFSNs conducted home visits and telephone contacts according to individual needs independent of the research. At five months, 23 participants completed a diary for 14 days. Twenty- seven participants (three died, and one withdrew) were interviewed at six 3 months to explore how self-management strategies had changed. The HFSNs participated in a focus group. Constructivist grounded theory and reflexive accounting informed data collection and analysis, leading to the inductive development of an explanatory framework for emergent themes, one of which, Informed Support, serves as an original and significant contribution to the literature. Results Successful management is a complex biopsychosocial activity, involving reconstructions of identity, symptom management, and relationship management, while living with a chronic and uncertain condition that severely compromises life activities. Central to successful management is Informed Support, where family members collaboratively develop a range of activities and attributes to augment self-management. This was perceived as most effective when the HFSNs were able to adopt a 'whole family' approach. Conclusion Heart failure self-management is a dynamic, complex and adaptive activity that can be positively and significantly shaped by Informed Support from family members. Community based HFSNs can influence, but need to recognise differing styles of, self-management.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:553683 |
| Date | January 2011 |
| Creators | Wingham, Jennifer |
| Publisher | Exeter and Plymouth Peninsula Medical School |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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