"I Should Have Come Sooner": A Qualitative Study Describing Care Preferences of Elders with HF

2.50
Hdl Handle:
http://hdl.handle.net/10755/622024
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
"I Should Have Come Sooner": A Qualitative Study Describing Care Preferences of Elders with HF
Other Titles:
Culturally Diverse Geriatric Health Practices
Author(s):
Dickson, Victoria Vaughan; Blecker, Saul; Grudzen, Corita; Katz, Stuart; Caceres, Billy A.; Martelly, Melissa; Sadarangani, Tina; Blaum, Caroline
Lead Author STTI Affiliation:
Xi
Author Details:
Victoria Vaughan Dickson, PhD, MSN, BSN, RN, CRNP, Professional Experience: Dr. Dickson is an Associate Professor in the Rory Meyers College of Nursing with extensive clinical and research experience in cardiovascular nursing. Her research program focuses on investigating the bio-behavioral influences on self-care in patients with cardiovascular disease including heart failure and multiple comorbidity; and evaluating the effectiveness of self-care interventions on health outcomes. Her work has led to an improved understanding of the sociocultural influences of self-care among vulnerable populations including elders with heart failure, older workers, women, and ethnic minority groups; and the development of innovative theory-based interventions. Dr. Dickson is recognized as an international expert in qualitative research techniques and mixed methods research and has conducted training to interdisciplinary teams locally, nationally and internationally. Dr. Dickson holds a clinical appointment as an advanced practice nurse in the division of cardiology at the NYU Langone Medical Center and the Bellevue Hospital. Author Summary: Dr. Dickson is an Associate Professor at NYU College of Nursing. She has extensive clinical and research experience in cardiovascular nursing. Her research focuses on investigating the bio-behavioral influences on self-care in patients with cardiovascular disease. Her work has led to an improved understanding of the sociocultural influences of self-care among vulnerable populations. She is recognized as an international expert in qualitative and mixed methods research and has conducted training to interdisciplinary teams internationally.
Abstract:

Purpose:  Heart failure (HF) remains the leading cause of hospitalization among adults over the age of 65. The majority of these hospitalizations originate in the emergency department (ED). Hospitalized HF patients are more likely to experience negative health outcomes than outpatients with HF. Experts have suggested that many patients with HF may be safely given treatment in the ED with discharge home and close follow up. Therefore, the purpose of this study was to describe the reasons that elder HF patients present to the ED and explore care preferences including barriers and facilitators to home discharge.

Methods: In this qualitative descriptive study, 13 clinically-stable elders with HF (≥65 years) were enrolled during an ED visit and participated in in-depth interviews about their reason for ED visit, including symptom experience and self-care at home, and HF care preferences. Qualitative data were analyzed using content thematic analysis.

Results:  In this sample (70% male, 77% White, Mean age 81±8; range 67-93 years), the most common reasons for ED visits were dyspnea and leg swelling. All reported ≥1 ED visits for similar symptoms in prior 6 months. Most (n=12) described symptoms that had been present or worsening for ≥2 days; all were admitted. Poor symptom awareness, inadequate resources and fragmented care contributed to delays in seeking treatment. In general, self-care at home was poor including medication nonadherence “I stopped that pill because it gave me  and failed symptom monitoring “they used to monitor me and I did okbut that stopped.” Some (n=4) preferred home discharge from the ED “just get the fluid out…let me go home”; but most believed hospitalization was necessary for symptom management “they have to fix it…change the medication or something” and to improve functional status “…help get strength back.” Barriers to home discharge centered around lack of tangible support “I need help with everything” and general physical deconditioning.

Conclusion:  Many elders with HF struggle with recognizing HF symptom and inadequate support that may delay treatment and lead to emergency situations. Interventions to address recurrent ED admissions in elders should focus on addressing their unique social support and care-coordination needs as well as deficits in self-care.

Keywords:
heart failure; qualitative research; self-care
Repository Posting Date:
21-Jul-2017
Date of Publication:
21-Jul-2017
Other Identifiers:
INRC17I03
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.title"I Should Have Come Sooner": A Qualitative Study Describing Care Preferences of Elders with HFen_US
dc.title.alternativeCulturally Diverse Geriatric Health Practicesen
dc.contributor.authorDickson, Victoria Vaughanen
dc.contributor.authorBlecker, Saulen
dc.contributor.authorGrudzen, Coritaen
dc.contributor.authorKatz, Stuarten
dc.contributor.authorCaceres, Billy A.en
dc.contributor.authorMartelly, Melissaen
dc.contributor.authorSadarangani, Tinaen
dc.contributor.authorBlaum, Carolineen
dc.contributor.departmentXien
dc.author.detailsVictoria Vaughan Dickson, PhD, MSN, BSN, RN, CRNP, Professional Experience: Dr. Dickson is an Associate Professor in the Rory Meyers College of Nursing with extensive clinical and research experience in cardiovascular nursing. Her research program focuses on investigating the bio-behavioral influences on self-care in patients with cardiovascular disease including heart failure and multiple comorbidity; and evaluating the effectiveness of self-care interventions on health outcomes. Her work has led to an improved understanding of the sociocultural influences of self-care among vulnerable populations including elders with heart failure, older workers, women, and ethnic minority groups; and the development of innovative theory-based interventions. Dr. Dickson is recognized as an international expert in qualitative research techniques and mixed methods research and has conducted training to interdisciplinary teams locally, nationally and internationally. Dr. Dickson holds a clinical appointment as an advanced practice nurse in the division of cardiology at the NYU Langone Medical Center and the Bellevue Hospital. Author Summary: Dr. Dickson is an Associate Professor at NYU College of Nursing. She has extensive clinical and research experience in cardiovascular nursing. Her research focuses on investigating the bio-behavioral influences on self-care in patients with cardiovascular disease. Her work has led to an improved understanding of the sociocultural influences of self-care among vulnerable populations. She is recognized as an international expert in qualitative and mixed methods research and has conducted training to interdisciplinary teams internationally.en
dc.identifier.urihttp://hdl.handle.net/10755/622024-
dc.description.abstract<p><strong>Purpose: </strong><span> Heart failure (HF) remains the leading cause of hospitalization among adults over the age of 65. The majority of these hospitalizations originate in the emergency department (ED). Hospitalized HF patients are more likely to experience negative health outcomes than outpatients with HF. Experts have suggested that many patients with HF may be safely given treatment in the ED with discharge home and close follow up. Therefore, the purpose of this study was to describe the reasons that elder HF patients present to the ED and explore care preferences including barriers and facilitators to home discharge.</span></p> <p><strong>Methods: </strong>In this qualitative descriptive study, 13 clinically-stable elders with HF (≥65 years) were enrolled during an ED visit and participated in in-depth interviews about their reason for ED visit, including symptom experience and self-care at home, and HF care preferences. Qualitative data were analyzed using content thematic analysis.</p> <p><strong>Results: </strong> In this sample (70% male, 77% White, Mean age 81±8; range 67-93 years), the most common reasons for ED visits were dyspnea and leg swelling. All reported ≥1 ED visits for similar symptoms in prior 6 months. Most (n=12) described symptoms that had been present or worsening for ≥2 days; all were admitted. Poor symptom awareness, inadequate resources and fragmented care contributed to delays in seeking treatment. In general, self-care at home was poor including medication nonadherence “<em>I stopped that pill because it gave me <pain>”</em> and failed symptom monitoring <em>“they used to monitor me <at home> and I did ok</em>…<em>but that stopped.” </em>Some (n=4) preferred home discharge from the ED “<em>just get the fluid out…let me go home</em>”; but most believed hospitalization was necessary for symptom management “<em>they have to fix it…change the medication or something</em>” and to improve functional status <em>“…help get strength back</em>.” Barriers to home discharge centered around lack of tangible support “<em>I</em> <em>need help with everything</em>” and general physical deconditioning.</p> <p><strong>Conclusion: </strong> Many elders with HF struggle with recognizing HF symptom and inadequate support that may delay treatment and lead to emergency situations. Interventions to address recurrent ED admissions in elders should focus on addressing their unique social support and care-coordination needs as well as deficits in self-care.</p>en
dc.subjectheart failureen
dc.subjectqualitative researchen
dc.subjectself-careen
dc.date.available2017-07-21T18:21:57Z-
dc.date.issued2017-07-21-
dc.date.accessioned2017-07-21T18:21:57Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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