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Heart Failure Care Dyadic Typology

Initial Conceptualization, Advances in Thinking, and Future Directions of a Clinically Relevant Classification System

Buck, Harleah G., PhD, RN, FPCN, FAAN; Hupcey, Judith, EdD, CRNP, FAAN; Juárez-Vela, Raul, PhD, MSc, RN; Vellone, Ercole, PhD, RN, FESC; Riegel, Barbara, PhD, RN, FAAN, FAHA

Journal of Cardiovascular Nursing: March/April 2019 - Volume 34 - Issue 2 - p 159–165
doi: 10.1097/JCN.0000000000000548
ARTICLES: Heart Failure

Background Heart failure (HF) dyadic self-care science is advancing rapidly, as evidenced by recent theoretical work, literature reviews, and multiple empiric studies. Typologies, once considered archaic, are now viewed as person-oriented classification systems that allow a whole-system view of information patterns. This whole-system view is particularly needed to understand complex tasks like dyadic HF self-care.

Purpose The purpose of this article is to review the initial conceptualization of an HF care dyadic typology and the present advances in our thinking and suggest future directions for this clinically relevant classification system.

Conclusions Development and testing of the typology across 5 studies resulted in a well-characterized, pragmatic and parsimonious, person-oriented classification system for understanding how patients and informal caregivers conduct patients' HF self-care at home. The 4 types are characterized as 2 individually oriented types—type I, patient oriented; type II, caregiver oriented; and 2 relationally oriented types—type III, collaboratively oriented; and type IV, incongruently oriented. We have devised a single-item measure of typology group that can be assessed in the clinical setting. Once this information is ascertained, the clinician can personalize the plan of care to the realities of the dyad.

Implications Dyads that disagree on who is responsible for self-care may forego or delay action, resulting in self-care failures with subsequent HF advancement, hospitalization, and mortality. As the HF dyadic self-care science has advanced, we have come to appreciate the complexity that arises when 2 individuals work together on 1 complex task—HF self-care.

Harleah G. Buck, PhD, RN, FPCN, FAAN Associate Professor, College of Nursing, University of South Florida, Tampa.

Judith Hupcey, EdD, CRNP, FAAN Professor and Associate Dean for Graduate Education and Research, College of Nursing, The Pennsylvania State University, University Park.

Raul Juárez-Vela, PhD, MSc, RN Associate Professor, Faculty of Health Sciences, University San Jorge, and Researcher, IIS-Aragón, Hospital Clinico Lozano Blesa, Zaragoza, Spain.

Ercole Vellone, PhD, RN, FESC Assistant Professor, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Italy.

Barbara Riegel, PhD, RN, FAAN, FAHA Edith Clemmer Steinbright Professor of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia

The research reported in this article was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR013419-02 (Hupcey, principal investigator) and R03NR014524 (Buck, principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence Harleah G. Buck, PhD, RN, FPCN, FAAN, College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd MDC22, Tampa, FL 33612-4766 (

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