Lucinda J. Graven

Social support and self-care behaviors in individuals with heart failure: An integrative review

OBJECTIVES The purpose of this review is to examine and synthesize recent literature regarding the relationship between social support and self-care behaviors in individuals with heart failure (HF). BACKGROUND Self-care is an important factor in maintaining health and well-being for individuals with heart failure. Self-care behaviors are an integral component of self-care, and may be impacted by the disease process of heart failure. However, social support may positively influence an individuals self-care behaviors by assisting with activities associated with symptom management and evaluation, as well as activities associated with maintaining heart failure-related treatment regimens. This review will synthesize the current knowledge related to the influence of social support on heart failure self-care behaviors. DESIGN AND DATA SOURCES Using an integrative review method, a review of current empirical literature was conducted utilizing CINAHL, PsycARTICLES, and PubMed computerized databases for a period of January 2000 to December 2012. Thirteen studies were identified that met the inclusion criteria for review and investigated aspects of social support and heart failure self-care behaviors. RESULTS Social support appears to have a positive relationship on heart failure self-care behaviors, with an individuals family playing an important role in assisting individuals to maintain positive self-care behaviors. Social support appears to influence both heart failure self-care maintenance and management related behaviors by assisting with maintaining treatment regimens and by participating in the decision-making process related to the management of symptoms, as well as seeking treatment for symptoms of heart failure. CONCLUSIONS All four types of social support (i.e., emotional support, instrumental/tangible support, informational support, and appraisal support) are involved in the interactive process between an individuals social network (i.e., family and peers) and the individual with heart failure to maintain self-care behaviors that enhance health and well-being. However, more research is needed, specifically longitudinal and experimental designs, to determine the effectiveness of social support on self-care behaviors in individuals with heart failure, since this review revealed mostly cross-sectional, correlational studies which limits the ability to infer causality.

The impact of social support on depressive symptoms in individuals with heart failure: update and review.

Background:Approximately 50% of individuals living with heart failure (HF) experience depressive symptoms. Social support has been found to have a positive influence on depressive symptoms in individuals with HF. Objective:The purposes of this review were to (1) examine recent literature regarding the impact of social support on depressive symptoms in individuals with HF, (2) synthesize findings across those studies, (3) assess potential areas of future research regarding social support, and (4) identify implications for nursing practice. Methods:An integrative review of current empirical literature was conducted through a search of the CINAHL and PsycARTICLES computerized databases for the period of January 2000 to December 2010. The key words used for the search were heart failure, social support, coping, depressive symptoms, and depression. Results:Fifteen studies matched inclusion criteria. Eleven of these studies found social support to prevent or reduce depressive symptoms. Emotional and tangible support as coping resources or strategies, the perceived availability of or satisfaction with support, and assistance with problem solving positively influenced depressive symptoms. Perceived emotional and tangible support and the presence and availability of social networks lessened depression in patients with HF. Findings from 4 studies on the impact of social support were not statistically significant. Different definitions of social support and a variety of measurement instruments used made it difficult to generalize study findings. Conclusions:Social support seems to positively impact and influence the psychological well-being of those with HF. Additional research is needed to identify specific characteristics of support that is effective in influencing depressive symptoms in this population. Furthermore, more research is needed regarding how factors such as ethnicity influence depressive symptoms and depression.

Predicting depressive symptoms and self-care in patients with heart failure.

OBJECTIVE To examine relationships among heart failure (HF) physical symptoms, social support, social problem-solving, depressive symptoms, and self-care behaviors in outpatients with HF. METHODS Cross-sectional data were collected from 201 outpatients. Structural equation modeling was used in this preliminary analysis to examine the relationships among the study variables. RESULTS HF physical symptoms and social support were predictors of depressive symptoms and self-care behaviors. Social problem-solving also predicted self-care behaviors. Social support mediated the relationship between HF physical symptoms and depressive symptoms. CONCLUSIONS Social support may influence depressive symptoms and self-care behaviors, whereas social problem-solving may impact self-care behaviors. Future research should examine causality and sub-components of social problem-solving on these outcome variables.

Factors associated with depressive symptoms in patients with heart failure.

Home healthcare clinicians commonly provide care for individuals with heart failure (HF). Certain factors may influence the development of depressive symptoms in those with HF. This cross-sectional, descriptive, correlational pilot study (N = 50) examined interrelationships among HF symptoms, social support (actual and perceived), social problem-solving, and depressive symptoms. Findings indicated that increased HF symptoms were related to more depressive symptoms, whereas higher levels of social support were related to fewer depressive symptoms. The use of more maladaptive problem-solving strategies was also associated with more depressive symptoms. Study results have implications for home healthcare clinicians providing care for individuals with HF, indicating a need for programs that strengthen coping skills and resources (i.e., social support and problem solving) in an effort to decrease the risk of developing depressive symptomatology.

Problems experienced by informal caregivers of individuals with heart failure: An integrative review

OBJECTIVES The purpose of this review was to examine and synthesize recent literature regarding problems experienced by informal caregivers when providing care for individuals with heart failure in the home. DESIGN Integrative literature review. DATA SOURCES A review of current empirical literature was conducted utilizing PubMed, CINAHL, Embase, Sociological Abstracts, Social Sciences Full Text, PsycARTICLES, PsycINFO, Health Source: Nursing/Academic Edition, and Cochrane computerized databases. 19 qualitative, 16 quantitative, and 2 mixed methods studies met the inclusion criteria for review. REVIEW METHODS Computerized databases were searched for a combination of subject terms (i.e., MeSH) and keywords related to informal caregivers, problems, and heart failure. The title and abstract of identified articles and reference lists were reviewed. Studies were included if they were published in English between January 2000 and December 2016 and examined problems experienced by informal caregivers in providing care for individuals with heart failure in the home. Studies were excluded if not written in English or if elements of caregiving in heart failure were not present in the title, abstract, or text. Unpublished and duplicate empirical literature as well as articles related to specific end-stage heart failure populations also were excluded. Methodology described by Cooper and others for integrative reviews of quantitative and qualitative research was used. Quality appraisal of the included studies was evaluated using the Joanna Briggs Institute critical appraisal tools for cross-sectional quantitative and qualitative studies. RESULTS Informal caregivers experienced four key problems when providing care for individuals with heart failure in the home, including performing multifaceted activities and roles that evolve around daily heart failure demands; maintaining caregiver physical, emotional, social, spiritual, and financial well-being; having insufficient caregiver support; and performing caregiving with uncertainty and inadequate knowledge. CONCLUSIONS Informal caregivers of individuals with heart failure experience complex problems in the home when providing care which impact all aspects of their lives. Incorporating advice from informal caregivers of individuals with heart failure will assist in the development of interventions to reduce negative caregiver outcomes. Given the complex roles in caring for individuals with heart failure, multicomponent interventions are potentially promising in assisting informal caregivers in performing these roles.

Progressing From Metformin to Sulfonylureas or Meglitinides

The article provides an overview of sulfonylureas and meglitinides as second-line agents for treating type 2 diabetes mellitus (T2DM). Implications for occupational health clinicians who work with these individuals when they take either of these medications to achieve target glycemic indices are emphasized.

Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure.

Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (β = 34.265, R 2 = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with ones social network may be appropriate when assessing self-care.

Problems Experienced in the First Month After Discharge From a Heart Failure-Related Hospitalization

Purpose Heart failure is a global health concern with high morbidity and mortality rates. Individuals with heart failure commonly experience problems that impact daily life. However, little is known regarding which problems are most significant during the immediate posthospitalization period. Thus, the purpose of this study was to identify high-priority problems experienced by individuals the first month after discharge from an acute care facility with a diagnosis of heart failure. Methods This descriptive, exploratory study was part of a 12-week randomized controlled pilot study that examined the efficacy of a coping partnership intervention (COPE-HF Partnership) between a trained research nurse and individuals with heart failure in managing self-care and depressive symptoms. Data from participants randomized to the intervention group (N=19; 58% Caucasian, 58% male) were used in this study. Participants were provided a list of potential heart failure-related problems, from which they identified those of highest priority. Content and quantitative data analysis was conducted. Results Difficulty in managing heart failure symptoms, adhering to treatment plan, completing daily activities, and experiencing negative emotions and moods were the most common problems experienced by individuals with heart failure. Other less common problems for the group were inadequate resources and managing interpersonal issues. Conclusions Individuals with heart failure experience complex problems in the home that impact all aspects of their lives. Incorporating strategies to address these problems could assist in the development of interventions to reduce negative heart failure outcomes.

Predictors of depression in outpatients with heart failure: An observational study

BACKGROUND Depression is a common comorbidity of heart failure. Little is known about the influence of heart failure symptomatology and coping resources, such as social support and social problem-solving, on depression. OBJECTIVE To examine whether individual and clinical characteristics, heart failure symptomatology, and the subcomponents of social support and social problem-solving increase the likelihood of depression in outpatients with heart failure. METHODS A secondary data analysis of a cross sectional study with 201 outpatients with heart failure was conducted. The following self-report questionnaires were used to collect data: the Heart Failure Symptom Survey, the Interpersonal Support Evaluation List-12, the Graven and Grant Social Network Survey, the Social Problem-Solving Inventory Revised-Short, and the Center for Epidemiological Studies - Depression scale. Descriptive statistics examined patient characteristics. Logistic regression explored predictors of depression from among individual and clinical characteristics, heart failure symptomatology, and subcomponents of social support (i.e., belonging, tangible, and appraisal support) and social problem-solving (i.e., positive and negative problem orientation; rational, impulsiveness/carelessness, and avoidance problem-solving styles). RESULTS The sample was primarily Caucasian (86.1%) male (62.6%) with an average age of 72.57 years. Individuals who were unmarried, experienced a higher symptom burden, and those who perceived less belonging support were more likely to be depressed. The subcomponents of social problem-solving did not influence depression. CONCLUSIONS Belonging support was the most beneficial type of social support related to depression. Components of social problem-solving were not related to depression. Assessment of marital status, heart failure symptomatology, and perceived belonging support is needed to identify potential stressors and available social support in order to promote psychological adaptation.

Development and Preliminary Testing of the Graven and Grant Social Network Survey in Patients with Heart Failure

Heart failure (HF) is common form of cardiac dysfunction that affects over five million Americans and is responsible for upwards of 32% of preventable hospital re-admissions each year in adults over the age of 65 [1,2]. Cardiac function progressively worsens, resulting in advanced symptoms (i.e., dyspnea, fluid retention, and activity intolerance) and an increased need for assistance with activities of daily living [3,4]. The decline in physical function that accompanies HF necessitates a need for assistance and support by others to influence disease-related outcomes (i.e., quality of life, event-free survival, depressive symptoms) [5-8]. Consequently, social support plays a critical role in assisting individuals with HF to maintain their physiological and psychological well-being [9,10]. In fact, evidence suggests that social support is vital and aids in influencing self-care behaviours in those with HF, by indirectly affecting self-care management through self-care confidence and influencing treatment adherence [11,12]. Family support, particularly, aids in symptom assessment and management and in the problem-solving process regarding treatment-seeking decisions for symptoms of HF [13,14]. Family support is also instrumental in providing assistance with daily activities (e.g., cooking, cleaning, and home maintenance) as HF progresses and functional ability is impacted [15].