Heart failure has long been recognized as a major health problem in the United States. Nevertheless, it has been proposed that heart failure is now occurring in epidemic proportions. Five-year mortality rates are as high as 50% (AHA, 2001). Although literature abounds regarding epidemiology, pathophysiology, and treatment strategies, little is known about how heart failure affects adults’ daily lives. Objectives: The purpose of this study was to describe and analyze the lived experience of adults who have heart failure. The aims were to: a) describe the problems, challenges, and processes of living with heart failure; b) identify strategies and tactics used to live with heart failure; and c) provide a model that articulated what the participants described. Design: Principles of naturalistic inquiry and a grounded theory approach were used to explore and describe problems, challenges, and processes of living with heart failure. Sample: Five men and six women participated in the study. Age of participants ranged from 50 to 81 with a mean age of 67. All of the men and two women were Euro-American. Four women were African-American. Estimated time since the diagnosis of heart failure varied from approximately one to six years (M=3 years). Numbers of medications prescribed for these adults ranged from four to fourteen (M=7.8) each day. Method: Principles of purposive and theoretical sampling were used throughout the study. Interviews were conducted in participants’ homes and ranged from 40 minutes to 1 hour and 40 minutes in length. Two participants were re-interviewed for clarification and verification of themes. Codes, categories, and themes emerged and a model was created to depict the findings. Codes such as “huffing and puffing,” “gallons of water,” and “feel like I was drowning” and emerging categories of “problems of water” and “problems of wind” led to the use of several non-traditional literature sources that provided the springboard for comparison of non-traditional concepts to the data. This strategy proved to be vital in the discovery of the analogy to, and, ultimately, identification of, the concept of navigating and the use of concepts traditionally associated with navigating to describe the experiences of living with heart failure. Findings: The three main categories of the resulting model were called Experiencing Turbulence, Navigating, and Finding Safe Harbor. Experiencing Turbulence represents the problems and challenges of living with heart failure: physical, emotional, or social. Navigating is the core category and represents strategies and tactics used to manage the problems and challenges of heart failure. Navigating includes four sub-categories. These are 1) determining position, 2) charting the course, 3) operating, and 4) being piloted. The final category is Finding Safe Harbor. Safe Harbor represents a feeling of safe and calm, the freedom from distressing symptoms. Whether the individual reaches safe harbor is contingent on the availability and use of navigational aids that may be either human or technical resources. Conclusion: Concepts that emerged in this study are not traditionally associated with nursing. Yet, the metaphor of Navigating to Safe Harbor arose through the interaction of the investigator with data that included interviews, fieldnotes, and resources from non-traditional literature. Experiencing Turbulence (physical, emotional, and social) was discovered as a consequence of living with heart failure. Navigating includes issues of self-assessment, planning, and acting that can be examined as self-management strategies. The concept of safe harbor recognizes the need for the feeling of safe and calm for persons with heart failure and the crucial nature of providers as human resources. Implications: For the participants in this study, symptoms related to heart failure were most often associated with problems of wind and water. These fundamental concepts can be used in educating those with heart failure about their illness. Framing patient education and self-management in a model rooted in adult experiences and familiar metaphor may be an effective mechanism of enhancing abilities to learn. Several questions for additional study emerged during the course of the study. How do beliefs about death relate to the concept of Finding Safe Harbor? How do specific human and technical resources foster the ability of the individual to maintain a sense of safety and well-being rather than experiencing exacerbations of physical, emotional, or social turbulence? In the current study, no married women or African-American men volunteered to participate and so were not represented. Further study would be necessary to determine if themes applied to these groups.
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