What Determines Expertise In Heart Failure Self-Care?

6 June 2016

Since heart failure is common among people living in developed nations, the researchers attempted to explore self-care by patients diagnosed with such a condition. Specifically, they studied the self-care behaviors of patients with chronic heart failure and identified the factors or variables that were associated with expertise in self-care.

How It Was Studied

What Determines Expertise In Heart Failure Self-Care? Essay Example

The researchers used a study design that combined both qualitative and quantitative methods. They recruited 29 patients diagnosed with chronic heart failure, supported by an abnormal left ventricular ejection fraction on echocardiography. The physicians and nurses who were in charge of these patients were then asked to classify them as being either good or poor in self-care in terms of their heart failure.

Interviews were conducted with the patients, and their loved ones were encouraged to participate in the discussion. With the use of open-ended questions and probes, the patients were prompted to talk about their methods of self-care. Transcripts of the interviews were then analyzed with the Atlas software. Using the data thus acquired, one of the investigators  — who was blinded to the results of the other parts of the investigation — then classified each of the participants as “poor,” “good” or “expert” in heart failure self-care.

The patients were also asked to complete a sociodemographic survey and questionnaires measuring the following variables: symptoms and physical limitations; heart failure self-care; excessive daytime sleepiness; family functioning; and depression. Finally, two neurobehavioral tests were administered to the participants. The Probed Memory Recall Test measured their short-term memory and learning ability. The Digit Symbol Substitution Test measured their attention and cognitive processing.

Qualitative categorization of self-care expertise was done with descriptive statistics. For comparison of the quantitative data obtained between groups of different expertise, analysis of variance and chi-square analyses were performed using SPSS 13.0.

What Was Found / Discovered

Out of the 29 participants, only three (10.3%) were rated by the blinded investigator as expert in heart failure self care. They were all female homemakers who did not live by themselves. They were older than the other 26 and surprisingly had less years of formal education (mean = 12.7 years).

Their average body mass index was lower (mean of 26.6) but they had more comorbid illnesses (mean Charlson Comorbidity Score of 4.7). Although 33.3% of them rated their overall quality of life as poor, 66.7% rated their health as good while only 33.3% rated their health as fair. (It must be remembered, however, that there are only three “experts.” Thus, 33.3% refers to just one participant, and 66.7% refers to just two.)

The factors that further distinguished the patients who were “expert” in heart failure self-care from those who were merely “good” at it were excessive daytime sleepiness (the experts tended to be less sleepy), ability to describe specific heart failure symptoms, understanding of their treatment, and supporters who were actively involved in their heart failure self-care. The small sample size of the study, however, limited its statistical power.

The Relevance of the Research for Nursing Practice

The findings of the study indicate that nurses can do more for their patients than merely administering medicines or taking their vital signs. Since nurses interact with heart failure patients at length, they have a great opportunity to contribute to their development of self-care. Taking some time to educate them about the symptoms of heart failure and the rationale behind its treatment can go a long way. Encouraging the patients’ loved ones to actively participate in their care can also help the patients take better care of themselves.


Riegel, B., Dickson, V. V., Goldberg, L. R., & Deatrick, J. A. (2007). Factors associated with the development of expertise in heart failure self-care. Nursing Research, 56(4), 235– 243.

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