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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Using vignettes to understand heart failure self-care

TitleUsing vignettes to understand heart failure self-care
Publication TypeJournal Article
Year of Publication2018
AuthorsXu, J, Arruda, S, Gallo, JJ, Wenzel, J, Nolan, MT, Flowers, D, Szanton, SL, Dennison Himmelfarb, C, Han, HR
JournalJ Clin Nurs
Volume27
Pagination3554-3560
Date PublishedOct
ISBN Number0962-1067
Accession Number29943481
Keywords*Narrative Medicine, *Self Care, Aged, Decision Making, Decision-making, Female, Heart Failure, Heart Failure/diagnosis/psychology/*therapy, Humans, Male, Middle Aged, Patient Education, self-care, symptom assessment
Abstract

AIMS AND OBJECTIVES: To explore hospitalised heart failure (HF) patients' self-care decisions. BACKGROUND: Heart failure self-care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self-care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self-care decision-making. DESIGN: This qualitative descriptive analysis was conducted as part of a mixed methods study. METHODS: We conducted semi-structured interviews (N = 20) to elicit patient decisions about self-care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses. RESULTS: Participants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling. CONCLUSIONS: Symptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult. RELEVANCE TO CLINICAL PRACTICE: Vignettes may be a helpful tool to prompt patient-healthcare provider communication about self-care management and prompt discussions about appropriate self-care decisions in response to varying levels of symptom severity.