Purpose:
Although it is well-known that self-care (SC) reduces the frequency of hospital admissions and exacerbations, and enhances quality of life (QOL) in heart failure patients, little is known about SC in this population. The study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, co-morbidities, and social support), SC strategies, and QOL using Reigel’s Model of Self Care in Patients with Heart Failure as the guiding framework.
Method:
114 subjects were recruited to participate in this descriptive correlational study. SC was measured using the
Self-Care of Heart Failure Index
, which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence (SC-Sc). QOL was measured using a disease-specific instrument, the
Minnesota Living with Heart Failure Questionnaire
, and a generic instrument, the
Short-Form Health Survey
characterizing physical and mental-emotional functioning. Multiple regression analysis was used to identify predictors of QOL.
Findings:
98 subjects (age = 56.7 years; 53.8% male; 49.5% Caucasian) completed and returned mailed questionnaires. Multiple regression analyses demonstrated that better disease-specific QOL was predicted by being less likely to try SC-Mn strategies (β = .325;
p
= 0.003), better SC-Sc (β = −.251;
p
= 0.012), better NYHA functional class (β = .246;
p
= 0.008), and less co-morbidity (β = .236;
p
= 0.014) (R
2
= .334; F = 7.269,
p
= 0.000). Better generic QOL (physical functioning) was predicted by better NYHA functional class (β = −.309; p = 0.001), better SC-Mt (β = .205; p = 0.037), better SC-Sc (β = .296;
p
= 0.003), and being less likely to try SC-Mn strategies (β = −.165;
p
= 0.000) (R
2
= .361; F = 9.602,
p
= 0.000). Better generic QOL (mental-emotional functioning) was predicted by better NYHA functional class (β = −.229; p = 0.024), and being men (β = −.204; p = .047) (R
2
= .277; F = 4.548,
p
= 0.000).
Discussion:
Findings suggest that better QOL is influenced by gender (male), better NYHA functional class, less co-morbidity, and better use of SC strategies. Exploring patient decision-making can assist nurses in identifying how to improve decision-making performance and enhance QOL.
Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure