Despite extensive patient education, many heart failure (HF) patients are unable to master self-care. Purpose: The purpose of this study was to identify 1) patients who improved in HF self-care or knowledge after receipt of an intervention by an APN trained in motivational interviewing and couples counseling, and 2) specific strategies that were effective. Methods: The intervention was provided during home visits (M=3 1.5,range1-6) following a HF hospitalization. Patients (N=15) were followed for 3-months. Using a comparative mixed method design, one investigator categorized patients according to whether they improved in HF self-care (Self- Care of HFI ndex (SCHFI) .73 this sample) or HF knowledge (Representations,.75). A second in vestigator, blinded to the quantitative results, analyzed qualitative data obtained from audiotaped intervention sessions augmented with field notes and personal stories using Atlas software. Improvement was judged by consensus based on quantitative and qualitative results. Effective strategies were coded from the qualitative data. Results: Of the15 patients who completed the study, sufficient data were available on 12 (66.7% female, 50% African American, age M=57.75 (13.4) years, 66.7% functional class II, 75% systolic HF). Eleven of 12 (92%) improved in self-care, defined as >8 point improvement in SCHFI maintenance, management, or confidence scores or >5 points in knowledge plus qualitative evidence of behavioral change. Techniques used by the APN to improve self-care included motivational enhancement strategies such as linking self-care behaviors to symptoms, skill building, therapeutic listening, correcting misconceptions, activating resources and support, negotiating an action plan, and bridging the transition from hospital to home. Conclusions: A multifaceted counseling intervention that considers the unique needs of individual patients and actively targets ambivalence and motivation may be essential in promoting HF self-care.
Humans; Men; Women; Behavior; Cardiac-function; Cardiovascular-function; Cardiovascular-system; Cardiopulmonary-function; Cardiovascular-system-disease; Cardiovascular-system-disorders; Health-care; Education; Heart; Psychology; Physical-exercise; Physical-fitness; Physical-reactions; Statistical-analysis; Qualitative-analysis; Demographic-characteristics; Age-factors; Racial-factors; Sex-factors