Journal
JOURNAL OF CARDIOVASCULAR NURSING
Volume 21, Issue 3, Pages 232-241Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00005082-200605000-00012
Keywords
heart failure; mixed methods; motivational interviewing; naturalistic decision-making; patient education; self-care
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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 +/- 1.5 home visits (median 3, mode 3, range 1-6) 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.
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