Factors associated with the development of expertise in heart failure self-care

Nurs Res. Jul-Aug 2007;56(4):235-43. doi: 10.1097/01.NNR.0000280615.75447.f7.


Background: Self-care is vital for successful heart failure (HF) management. Mastering self-care is challenging; few patients develop sufficient expertise to avoid repeated hospitalization.

Objective: To describe and understand how expertise in HF self-care develops.

Methods: Extreme case sampling was used to identify 29 chronic HF patients predominately poor or particularly good in self-care. Using a mixed-methods (qualitative and quantitative) design, participants were interviewed about HF self-care, surveyed to measure factors anticipated to influence self-care, and tested for cognitive functioning. Audiotaped interviews were analyzed using content analysis. Qualitative and quantitative data were combined to produce a multidimensional typology of patients poor, good, or expert in HF self-care.

Results: Only 10.3% of the sample was expert in HF self-care. Patients poor in HF self-care had worse cognition, more sleepiness, higher depression, and poorer family functioning. The primary factors distinguishing those good versus expert in self-care were sleepiness and family engagement. Experts had less daytime sleepiness and more support from engaged loved ones who fostered self-care skill development.

Conclusion: Engaged supporters can help persons with chronic HF to overcome seemingly insurmountable barriers to self-care. Research is needed to understand the effects of excessive daytime sleepiness on HF self-care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cognition / classification*
  • Decision Making
  • Family
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Myocardial Infarction / classification
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / therapy*
  • Nursing Research / methods*
  • Quality of Health Care*
  • Self Care / methods*
  • Self Care / statistics & numerical data
  • Severity of Illness Index
  • Sleep


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors