Keywords

Heart failure, self care, social support, cognition

Abstract

Problem: Heart failure is the most frequent cause for hospital readmissions in Medicare recipients, with an estimated annual cost of $12 billion. Heart failure hospitalizations are also an independent risk factor for increased mortality. Self-care, thought to be enhanced by perceived social support, is key to managing this syndrome, and up to 50% of readmissions are considered the result of inadequate self-care. Purpose: To evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure, and to compare these characteristics with a study of ambulatory patients with heart failure. In addition, to assess the relationship between perceived social support and self-care. Methods: This was a multi-site descriptive comparative study. Following informed consent, participants were screened for sufficient cognition to consent. Patients were then administered the Medical Outcome Study-Social Support emotional/informational subscale, and the three Self-Care of Heart Failure Index subscales. Two-sample t tests and multiple regression were utilized to analyze the data. Results were compared with a sample of community-dwelling heart failure patients in another study. Results: Of 161 consented patients 121 passed the cognition screening and were included in the study. Average age was 71 years; gender and type of heart failure was evenly split. Mean Charlson Comorbidity Score was 7.43, and the mean six month number of hospitalizations was 2.43. Approximately 31% of participants were African American. Both perceived social support (t=-4.007, df=211, p < .001) and self-care maintenance (t=-3.343, df=220, p < .002) scores were lower in the hospitalized participants than the comparison group of community dwellers. Perceived social support was associated with self-care confidence (?=.210, t=-2.210, p < .029), but not self-care maintenance or self-care management. Forty-six percent of participants scored higher than the 70% cut point for adequate self-care confidence, which was 1.4 times higher than in the community participants. Self-care confidence was also related to self-care maintenance (?=.388, t=4.676, p < .001) and self-care management (?=.327, t=3.793, p < .001). Conclusions: Results have implications for facilitating self-care knowledge and skills in heart failure patients. Patient education during hospitalization may not be the ideal timing to promote understanding and retention. Interventions to enhance self-care confidence may assist patients to develop self-care skills more than current teaching techniques. Because cognitive deficiencies were found in 25% of pre-screened participants for this study, further research is recommended to determine if hospitalized patients have transient cognitive issues or if cognitive impairments are more prevalent in all heart failure patients.

Notes

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Graduation Date

2015

Semester

Fall

Advisor

Sole, Mary Lou

Degree

Doctor of Philosophy (Ph.D.)

College

College of Nursing

Department

Nursing

Degree Program

Nursing

Format

application/pdf

Identifier

CFE0005933

URL

http://purl.fcla.edu/fcla/etd/CFE0005933

Language

English

Release Date

December 2015

Length of Campus-only Access

None

Access Status

Doctoral Dissertation (Open Access)

Subjects

Dissertations, Academic -- Nursing; Nursing -- Dissertations, Academic

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Included in

Nursing Commons

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