I Learned to Say No to Anyone......Understanding Heart Failure Patients’ Learning Process and Behaviour: A Qualitative Study

Öz

Becoming a patient with chronic HF involves a process of taking on a new identity. The behaviours of the patients have been based on their experience of the disease. The aim of this study was to explore HF patients health behaviours, beliefs, experiences, adaptation, coping strategies and learning process. The design is qualitative descriptive. Semi-structured in-depth interviews were conducted with 21 HF patients. Content analysis was used to analyse. Patient learning process and behaviours in chronic heart failure were determined by using basic principles of SLT. Four main themes that emerged from the the qualitative data: restrictions, fellowship, learn to cope, roles. Heart failure patients explain their restriction about daily activity and sexuality. Also, they state about spouse's support, coping with chronic disease, changing of their roles, fear particularly when experiencing severe shortness of breath. SLT indicate that an individual’s representation of illness affects how they cope and view their quality of life. This is the first study that SLT being used to study patients with HF in Turkey. The results of the study will be helpful in developing new strategies and interventions to improve patient coping behaviours.

Anahtar Kelimeler

• Heart Failure
• Learning Process
• Social Learning Theory
• Patients’ Experiences
• Qualitative Study

References

1. Abshire, M., et al., (2015). Symptoms and fear in heart failure patients approaching end of life: a mixed methods study. Journal of Clinical Nursing, 24(21–22):3215–3223. doi:10.1111/jocn.12973.
2. Andermann, A., (2016). Taking action on the social determinants of health at a local health department. Canadian Medical Association Journal, 188:1–10. doi:10.1503/cmaj.160177/-/DC1.
3. Bandura, A., (1977). Social learning theory. New Jersey: Prentice-Hall Englewood Cliffs.
4. Bandura, A., (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2):143–164. doi:10.1177/1090198104263660.
5. Boerner, K., Carr, D., and Moorman, S., (2013). Family relationships and advance care planning: Do supportive and critical relations encourage or hinder planning?. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 68(2):246–256. doi:10.1093/geronb/gbs161.
6. Bower, G.H. and Hilgard, E.R., (1981). Theories of learning. 5th ed. Englewood Cliffs, N.J. Prentice-Hall. Available at: https://trove.nla.gov.au/version/11495554.
7. Clark, A.M., et al., (2012). Understanding help-seeking decisions in people with heart failure: A qualitative systematic review. International Journal of Nursing Studies, 49(12):1582–1597. doi:10.1016/j.ijnurstu.2012.05.010.
8. Conley, S., Feder, S., and Redeker, N.S., (2015). The relationship between pain, fatigue, depression and functional performance in stable heart failure. Heart and Lung: Journal of Acute and Critical Care. Elsevier Inc. 44(2):107–112. doi:10.1016/j.hrtlng.2014.07.008.

9. Dougherty, C.M., et al., (2017). Development and testing of a goals of care intervention in advanced heart failure. Applied Nursing Research, 38(September):99–106. doi:10.1016/j.apnr.2017.09.017.
10. Edwardson, S.R., (2007). Patient education in heart failure**This article was completed when the author was the Senior Nurse Scholar in Residence at the Agency for Healthcare Research and Quality. The views expressed in this article are those of the author and do not necessarily. Heart and Lung: Journal of Acute and Critical Care, 36(4):244–252. doi:10.1016/j.hrtlng.2006.08.011.
11. Ehrenberg, A., Ehnfors, M., and Ekman, I., (2004). Older patients with chronic heart failure within Swedish community health care: A record review of nursing assessments and interventions’, Journal of Clinical Nursing, 13:90–96. doi:10.1046/j.1365-2702.2003.00837.x.
12. Europe, E. and Tyni-Lenné, R., (2004). Qualitative analysis of the male experience of heart failure. Heart and Lung: Journal of Acute and Critical Care, 33(4):227–234. doi:10.1016/j.hrtlng.2004.03.003.
13. Everett, B., Salamonson, Y., and Davidson, P., (2009). Bandura’s Exercise Self-Efficacy Scale: validation in an Australian cardiac rehabilitation setting. International Journal of Nursing Studies, 46:824–829. doi:10.1016/j.ijnurstu.2009.01.016.
14. Falk, S., Wahn, A.K. and Lidell, E., (2007). Keeping the maintenance of daily life in spite of Chronic Heart Failure. A qualitative study. European Journal of Cardiovascular Nursing, 6(3):192–199. doi:10.1016/j.ejcnurse.2006.09.002.
15. Harnegie, M.P., (2015). Generating Middle Range Theory: From Evidence to Practice by Sister Callista Roy with the Roy Adaptation Association. Journal of Hospital Librarianship, 15(3):342–343. doi:10.1080/15323269.2015.1049073.
16. Holst, M., et al., (2007). Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. European Journal of Cardiovascular Nursing : Journal of The Working Group on Cardiovascular Nursing of The European Society of Cardiology, 6:153–159. doi:10.1016/j.ejcnurse.2006.06.006.
17. Kraai, I.H., et al., (2018). “Not getting worse” a qualitative study of patients perceptions of treatment goals in patients with heart failure. Applied Nursing Research, 39(October):41–45. doi:10.1016/j.apnr.2017.10.010.
18. Mansoreye, N., et al., (2017). The Correlation between Social Support and Self-care in Patients with heart failure: the mediating role of ıllness perception. Journal of Health Promotion Managment, 7(3):43–50. doi:10.21859/jhpm-07036.
19. McEwen, M. and Wills, E.M., (2014). Theories from the sociologic sciences. 4th ed., Theoretical basis for nursing. 4th ed. China: Wolters Kluwer Health lippincott Williams. Available at: http://zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_171030_28.pdf.
20. Van der Meer, P., Gaggin, H.K., and Dec, G.W., (2019). ACC/AHA versus ESC guidelines on heart failure, Journal of the American College of Cardiology, 73(21):2756 LP–2768. doi:10.1016/j.jacc.2019.03.478.
21. Mozaffarian, D., et al., (2015). Heart disease and stroke statistics-2015 update : A report from the American Heart Association. Circulation, 131(4):e29–e39. doi:10.1161/CIR.0000000000000152.
22. Olano-Lizarraga, M., et al., (2016). The personal experience of living with chronic heart failure: a qualitative meta-synthesis of the literatüre. Journal of Clinical Nursing, 25(17–18):2413–2429. doi:10.1111/jocn.13285.
23. Pihl, E., Fridlund, B., and Mårtensson, J., (2011). ‘Patients’ experiences of physical limitations in daily life activities when suffering from chronic heart failure; a phenomenographic analysis. Scandinavian Journal of Caring Sciences, 25(1):3–11. doi:10.1111/j.1471-6712.2010.00780.x.
24. Reblin, M. and Uchino, B.N., (2008). Social and emotional support and its ımplication for health. International Journal of Behavioural and Healthcare Research, 21(2):201–205. doi:10.1097/YCO.0b013e3282f3ad89.Social.
25. Rong, X., et al., (2017). Cultural factors influencing dietary and fluid restriction behaviour: perceptions of older Chinese patients with heart failure. Journal of Clinical Nursing, 26(5–6):717–726. doi:10.1111/jocn.13515.
26. Ryan, M. and Farrelly, M., (2009). Living with an unfixable heart: A qualitative study exploring the experience of living with advanced heart failure. European Journal of Cardiovascular Nursing. European Society of Cardiology, 8(3):223–231. doi:10.1016/j.ejcnurse.2009.02.005.
27. Savarese, G. and Lund, L., (2017). Global public health burden of heart failure. Cardiac Failure Review. 3(1):56–61. doi:10.15420/cfr.2016.
28. Schunk, D., (2012). Learning theories an educational perspective. 6. edition. Edited by P. Smith. Boston: Pearson Education. doi:10.1007/BF00751323.
29. Tavallaei, M. and Abu Talib, M., (2010). A general perspective on role of theory in qualitative research. The Journal of International Social Research, 3(11):570–577. Available at: http://www.sosyalarastirmalar.com/cilt3/sayi11pdf/tavallaei_abutalib.pdf.
30. Thomas, P.A., Liu, H., and Umberson, D., (2017). Family relationships and well-being. Innovation in Aging, 1(3):1–11. doi:10.1093/geroni/igx025.
31. Van der Wal, M.H.L., et al., (2010). Qualitative examination of compliance in heart failure patients in The Netherlands. Heart and Lung: Journal of Acute and Critical Care. Elsevier Inc. 39(2):121–130. doi:10.1016/j.hrtlng.2009.07.008.
32. Walthall, H., Jenkinson, C., and Boulton, M., (2017). Living with breathlessness in chronic heart failure: a qualitative study. Journal of Clinical Nursing, 26(13–14):2036–2044. doi:10.1111/jocn.13615.
33. Welstand, J., et al., (2011). 2011 Update to National Heart Foundation of Australian and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006. European Journal of Cardiovascular Nursing. European Society of Cardiology, 8(4):888–895. doi:10.1016/j.ijnurstu.2009.12.011.
34. Wingham, J., et al., (2014). Heart failure patients’ attitudes, beliefs, expectations and experiences of self-management strategies: a qualitative synthesis. Chronic Illness, 10(2):135–154. doi:10.1177/1742395313502993.
35. Yildirim, A. and Simsek, H., (2013). Qualitative research methods in the social sciences. 9th ed. Seckin Publishing. doi:10.17244/eku.46826.
36. Zambroski, C., et al., (2005). Impact of Symptom Prevalence and Symptom Burden on Quality of Life in Patients with Heart Failure. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 4:198–206. doi:10.1016/j.ejcnurse.2005.03.010.