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A Situation-Specific Theory of Heart Failure Self-care

Riegel, Barbara DNSc, RN, CS, FAAN, FAHA; Dickson, Victoria Vaughan PhD, CRNP

The Journal of Cardiovascular Nursing: May-June 2008 - Volume 23 - Issue 3 - p 190-196
doi: 10.1097/01.JCN.0000305091.35259.85
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Heart failure, a common syndrome in developed countries worldwide, is associated with poor quality of life, frequent rehospitalizations, and early death. Self-care is essential to improving outcomes in this patient population. The purpose of this article is to describe a situation-specific theory of heart failure self-care in which self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Self-care maintenance is further defined to encompass routine symptom monitoring and treatment adherence. Self-care management is characterized as a process initiated by symptom recognition and evaluation, which stimulates the use of self-care treatments and treatment evaluation. Confidence in self-care is thought to moderate and/or mediate the effect of self-care on various outcomes. Four propositions were derived from the self-care of heart failure conceptual model: (1) symptom recognition is the key to successful self-care management; (2) self-care is better in patients with more knowledge, skill, experience, and compatible values; (3) confidence moderates the relationship between self-care and outcomes; and (4) confidence mediates the relationship between self-care and outcomes. These propositions were tested and supported using data obtained in previous research. Support of these propositions provides early evidence for this situation-specific theory of heart failure self-care.

Barbara Riegel, DNSc, RN, CS, FAAN, FAHA Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia.

Victoria Vaughan Dickson, PhD, CRNP Lecturer, School of Nursing, University of Pennsylvania, Philadelphia.

This work was funded partially by a grant from the National Institutes of Health (NHLBI RO1 HL084394-01A1).

Corresponding author Barbara Riegel, DNSc, RN, CS, FAAN, FAHA, School of Nursing, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104-6096 (briegel@nursing.upenn.edu).

© 2008 Lippincott Williams & Wilkins, Inc.