Heart failure, self care, social support, cognition


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.


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Graduation Date





Sole, Mary Lou


Doctor of Philosophy (Ph.D.)


College of Nursing



Degree Program









Release Date

December 2015

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)


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

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Nursing Commons