8.2.1 What is the home-based self-management experience of heart failure patients and the impact of the specialist nursing service? (93)

Jennifer Wingham, Research Nurse, Research and Development Directorate, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom Jenny.Wingham@rcht.cornwall.nhs.uk

Abstract:

Background:

Many people living with heart failure experience poor quality of life, Murray et al (2002). There is paucity of research relating to patients’ perspective of the heart failure nurses’ role in self-management.

Aim:

To explore the impact (if any) the specialist nurses have on heart failure patients’ overall day-to-day self-management strategies.

Methods:

31 theoretical sampled participants with confirmed heart failure were recruited from a district general hospital between October 2004 and September 2006. All took part in taped, semi-structured interviews prior to the community nurse intervention to determine their experience of heart failure, understanding of self-management and current self-management strategies. The nurses conducted home visits and telephone contact according to individual need independent of the research. 29 participants (3 died and 1 withdrew from the research) were interviewed at 6 months to explore their experience of heart failure and how their strategies have changed if at all. Critically adaptive grounded theory techniques, narrative methods and reflexive accounting informed analysis. A team of researchers confirmed findings.

Results:

Participants managed the consequences of living with heart failure more than the illness itself. Successful management was influenced by construction of or maintenance of an acceptable personal identity while living with a chronic life limiting and uncertain condition. Central to successful management was “intelligent support” meaning careful consideration and understanding of advice and information by the family to support lifestyle change. Participants and their families obtained information from a variety of sources. Self-management includes relationship building within the family, community and health service professionals. The nurses’ role included physical monitoring, educational and psychological support in ‘being there’ for the people with heart failure and their family. Some stable patients discharged from the service felt abandoned and reluctant to contact the nurses for further consultation.

Conclusion:

Community based heart failure nurses can improve self-management of heart failure by enhancing intelligent support.

Biography:

Jenny Wingham is an NHS research nurse based at the Royal Cornwall Hospital. Previous research was in cardiac rehabilitation working with Dr Hayes Dalal on a Randomised Controlled trial with patient preference arms comparing home-based and hospital based cardiac rehabilitation and a health economic review. Nested within this study she comleted a qualitative study of choice in cardiac rehabilitation. Both papers are being used in a British Heart Foundation led campaign for cardiac rehabilitation. She is now in her third year of a part time PhD with the Peninsula Medical School exploring self-management in heart failure.