Symptom perceptions and self-care behaviors in patients who self-manage heart failure.
Symptom perceptions and self-care behaviors in patients who self-manage heart failure.
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DOI：
10.1097/jcn.0000000000000117
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Smith CE
中科院分区：
文献类型：
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作者：
Reeder KM;Ercole PM;Peek GM;Smith CE
心力衰竭(HF)患者急性加重的风险增加，需要住院治疗。虽然及时报告症状可以加快门诊治疗并避免住院的需要，但很少有患者在病情危重之前认识到症状并对其做出反应。这项研究的目的是探讨患者对症状的认知和缓解症状的自我护理行为，从而导致心力衰竭住院。为了检查院前症状情景，对60名因急性失代偿性心衰住院的患者进行了半结构访谈。37名患者(61.7%)表示，在症状开始之前，他们有一种“有些事情就是不太对劲”的感觉，但无法进一步说明。患者最常识别的体征和症状与呼吸困难(85%)、乏力(53.3%)和浮肿(41.7%)有关。很少有患者将他们的症状解释为与心力衰竭恶化有关，最常见的是将症状归因于饮食(18.3%)和药物(13.3%)的变化。26名患者(43.3%)在入院前使用自我护理策略来缓解症状。超过40%的患者在入院前至少2周就有症状。尽管广泛传播了心衰循证指南，症状自我管理的重要组成部分仍然不是最理想的。由于大多数心力衰竭自我管理发生在出院后环境中，因此需要研究确定患者如何在患者自我管理心力衰竭的特定环境中解释心力衰竭症状。这些发现表明，需要采取干预措施，帮助患者迅速识别、准确解释并使用适当和安全的自我护理策略来应对症状。
Patients with heart failure (HF) are at heightened risk for acute exacerbation requiring hospitalization. Although timely reporting of symptoms can expedite outpatient treatment and avoid the need for hospitalization, few patients recognize and respond to symptoms until acutely ill. The purpose of this study was to explore patients’ perceptions of symptoms and self-care behaviors for symptom relief, leading up to a HF hospitalization. To examine prehospitalization symptom scenarios, semistructured interviews were conducted with 60 patients hospitalized for acute decompensated HF. Thirty-seven patients (61.7%) said that they had a sense that “something just wasn’t quite right” before their symptoms began but were unable to specify further. Signs and symptoms most often recognized by the patients were related to dyspnea (85%), fatigue (53.3%), and edema (41.7%). Few patients interpreted their symptoms as being related to worsening HF and most often attributed symptoms to changes in diet (18.3%) and medications (13.3%). Twenty-six patients (43.3%) used self-care strategies to relieve symptoms before hospital admission. More than 40% of the patients had symptoms at least 2 weeks before hospitalization. Despite the wide dissemination of HF evidence-based guidelines, important components of symptom self-management remain suboptimal. Because most of HF self-management occurs in the postdischarge environment, research is needed that identifies how patients interpret symptoms of HF in the specific contexts in which patients self-manage their HF. These findings suggest the need for interventions that will help patients expeditiously recognize, accurately interpret, and use appropriate and safe self-care strategies for symptoms.