Sunday, November 4, 2007

This presentation is part of : Strategies for Vulnerable Populations
The Relationship among Social Support, Spiritual Well-Being, Uncertainty and Self-Care in Class I and II Heart Failure Patients
Kerry C. Thompson, Nursing, Lenoir-Rhyne College, Hickory, NC, USA
Learning Objective #1: Identify the variables in a Conceptual Model for Self-Care in a vulnerable popultaion of Heart Failure clients.
Learning Objective #2: Explore the nursing and educational implications of spiritual well-being as a critical piece of psychosocial support for the vulnerable population of heart failure clients.

               The incidence and prevalence of heart failure continues to increase creating a major health problem for our aging society in the United States today.  The disease process often leads to disability, with incapacitating symptoms that can result in frequent hospital admissions and an increased risk of early death.  Management for this vulnerable population involves the ability for individuals to conduct self-care activities such as monitoring symptoms, following a treatment regimen and adjusting to frequent changes in their disease state.  

               Based on the findings from a preliminary qualitative study, Mishel’s (1988; 1990) Uncertainty in Illness theory and Braden’s Self-Help Model of Learned Response in Chronic Illness (1990), a conceptual model of self-care in heart failure was tested on 100 men and women with Class I and II heart failure.  Path analysis was used to explore the path relationships among social support, spiritual well-being, uncertainty and self-care.

The exogenous variables of social support and spiritual well-being were moderately correlated and when social support was alone in the model, there was a statistical significant effect on self-care.  However, when spiritual well-being was included with social support the effects of social support were dampened.  Whereas spirituality explained 22% of the variance in uncertainty, uncertainty was not a significant predictor of self-care.  The total model explained 36% of the variance in self-care for this heart failure population. Additionally, uncertainty was found to partially mediate the effect between social support and self-care as the relationship between social support and self-care was weakened by uncertainty.

Thus, spiritual well-being became the major variable within the model that served as a predictor of self-care.  The strong bivariate relationships between spiritual well-being and self-care and spiritual well-being and uncertainty add to our body of knowledge that spiritual well-being serves as a resource for this chronic disease population.