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A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.

Riegel-B; Dickson-VV; Hoke-L; McMahon-JP; Reis-BF; Sayers-S
J Cardiovasc Nurs 2006 May-Jun; 21(3):232-241
Background: Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. Methods: Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 T 1.5 home visits (median 3, mode 3, range 1Y6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. Results: Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). Conclusion: An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.
Humans; Men; Women; Attitude; Behavior; Education; Cardiovascular-system; Cardiovascular-function; Cardiovascular-disease; Cardiopulmonary-function; Cardiac-function; Cardiovascular-system-disorders; Age-groups; Nurses; Racial-factors; Demographic-characteristics; Sex-factors; Author Keywords: heart failure; mixed methods; motivational interviewing; naturalistic decision-making; patient education; self-care
Dr. Barbara Riegel, School of Nursing, Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA 19104-6096
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The Journal of Cardiovascular Nursing
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University of Pennsylvania