A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness

J Cardiovasc Nurs. May-Jun 2006;21(3):232-41. doi: 10.1097/00005082-200605000-00012.

Abstract

Background: Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging.

Methods: Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 +/- 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness.

Results: Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources).

Conclusion: An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Communication
  • Female
  • Health Knowledge, Attitudes, Practice
  • Heart Failure / nursing*
  • Humans
  • Male
  • Middle Aged
  • Motivation*
  • Nurse-Patient Relations
  • Patient Education as Topic / methods*
  • Philadelphia
  • Qualitative Research
  • Self Care / methods*
  • Social Support
  • Teaching / methods
  • Treatment Outcome