Kristen A Sethares1, Marilyn E Asselin2. 1. Adult Nursing Department, University of Massachusetts Dartmouth, North Dartmouth, MA, USA. Electronic address: ksethares@umassd.edu. 2. Adult Nursing Department, University of Massachusetts Dartmouth, North Dartmouth, MA, USA.
Abstract
OBJECTIVE: Evaluate the effect of structured, guided reflection on patient descriptions of self-care maintenance and management. BACKGROUND: Inadequate HF self-care behaviors are linked to hospitalizations. Symptom monitoring and recognition are precursors to adequate HF self-care. Reflection on actions taken during HF exacerbations may lead to insights and future changes in HF self-care maintenance and management. METHODS: One-group mixed method pre-test/post-test design. Following cognitive screening, self-care maintenance and management was measured prior to the intervention at a home visit one-week after hospital discharge, and one-month post intervention. Qualitative data consisted of audiotaped individual interviews with participants, field notes and reflective diaries kept by patients. RESULTS: The results (N = 10) demonstrate large effect sizes and increases in self-care maintenance (69.9 vs 79.6, d = 1.04) and management (47.2 vs 63.9, d = 2.53) scores after intervention. Eight themes emerged from the data that reflected the HF participant's experience of self-care. Reflection evoked emotions around concerns for family and mortality. Participants linked symptoms experienced with contextual factors which facilitated discussion about changing future actions. CONCLUSIONS: Purposeful reflection may be necessary for the development of self-care. Guided reflection on previous actions that includes contextual considerations may also play a role in enhancing self-care management by allowing the person to more fully understand the illness experience.
OBJECTIVE: Evaluate the effect of structured, guided reflection on patient descriptions of self-care maintenance and management. BACKGROUND: Inadequate HF self-care behaviors are linked to hospitalizations. Symptom monitoring and recognition are precursors to adequate HF self-care. Reflection on actions taken during HF exacerbations may lead to insights and future changes in HF self-care maintenance and management. METHODS: One-group mixed method pre-test/post-test design. Following cognitive screening, self-care maintenance and management was measured prior to the intervention at a home visit one-week after hospital discharge, and one-month post intervention. Qualitative data consisted of audiotaped individual interviews with participants, field notes and reflective diaries kept by patients. RESULTS: The results (N = 10) demonstrate large effect sizes and increases in self-care maintenance (69.9 vs 79.6, d = 1.04) and management (47.2 vs 63.9, d = 2.53) scores after intervention. Eight themes emerged from the data that reflected the HF participant's experience of self-care. Reflection evoked emotions around concerns for family and mortality. Participants linked symptoms experienced with contextual factors which facilitated discussion about changing future actions. CONCLUSIONS: Purposeful reflection may be necessary for the development of self-care. Guided reflection on previous actions that includes contextual considerations may also play a role in enhancing self-care management by allowing the person to more fully understand the illness experience.
Authors: Jill Howie-Esquivel; Kathleen Dracup; Mary A Whooley; Charles McCulloch; Chengshi Jin; Debra K Moser; Robyn A Clark; Michele M Pelter; Martha Biddle; Linda G Park Journal: ESC Heart Fail Date: 2018-10-24