The physical symptom experience and the cognitive and emotional response to HF symptoms were inadequate for timely care seeking for most of this older aged sample.

Symptom monitoring is difficult for heart failure (HF) patients. Difficulties physically sensing and determining symptom meaning may lead to uncertainty and delay treatment. Somatic awareness may provide insight into symptom monitoring ability. A model combining physical and cognitive aspects of the symptom experience was developed to examine factors affecting care-seeking among HF patients. Adults hospitalized with acute HF were interviewed and completed questionnaires measuring somatic awareness and uncertainty. HF symptom duration prior to admission measured delay. HF specific somatic awareness and symptom pattern predicted delay. Uncertainty correlated with somatic awareness, but did not predict delay. Few responded to early HF symptoms delaying until acutely ill. Development of interventions to improve symptom monitoring is needed.

This article has been copublished in Circulation: Cardiovascular Quality and Outcomes.

Objective The purpose of this study was to test the efficacy of a tailored motivational interviewing (MI) intervention versus usual care for improving HF self-care behaviors, physical HF symptoms and quality of life. Methods This is a single-center, randomized controlled trial. Participants were enrolled in the hospital. Immediately after discharge, those in the intervention group received a single home visit and 3–4 follow-up phone calls by a nurse over 90 days. Results A total of 67 participants completed the study (mean age 62 ± 12.8 years), of which 54% were African American, 30% were female, 84% had class III/IV symptoms, and 63% were educated at a high school level or less. There were no differences between the groups in self-care maintenance, self-care confidence, physical HF symptoms, or quality of life at 90 days. Conclusion Patients who received the MI intervention had significant and clinically meaningful improvements in HF self-care maintenance over 90 days that exceeded that of usual care. Practice Implications These data support the use of a nurse-led MI intervention for improving HF self-care. Identifying methods to improve HF self-care may lead to improved clinical outcomes.

Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N=687) was conducted. The sample was 51.7% female, mean age 71±12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of 9 items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact.

The purpose of this study was to identify barriers in providing spiritual care to hospitalized patients. A convenience sample (N = 271) was recruited at an academic medical center in New York City for an exploratory, descriptive questionnaire. The Spiritual Care Practice (SCP) questionnaire assesses spiritual care practices and perceived barriers to spiritual care. The SCP determines the percentage that provides spiritual support and perceived barriers inhibiting spiritual care. The participation rate was 44.3% (N = 120). Most (61%) scored less than the ideal mean on the SCP. Although 96% (N = 114) believe addressing patients spiritual needs are within their role, nearly half (48%) report rarely participating in spiritual practices. The greatest perceived barriers were belief that patient's spirituality is private, insufficient time, difficulty distinguishing proselytizing from spiritual care, and difficulty meeting needs when spiritual beliefs were different from their own. Although nurses identify themselves as spiritual, results indicate spirituality assessments are inadequate. Addressing barriers will provide nurses opportunities to address spirituality. Education is warranted to improve nurses' awareness of the diversity of our society to better meet the spiritual needs of patients. Understanding these needs provide the nurse with opportunities to address spirituality and connect desires with actions to strengthen communication and the nurse-patient relationship.

Background Symptoms are known to predict survival among patients with heart failure (HF) but discrepancies exist between patients’ and health providers’ perceptions of HF symptom burden. Objective The purpose of this study was to quantify the internal consistency, validity and prognostic value of patient perception of a broad range of HF symptoms using a HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v.3. Methods Factor analysis of the HFSPS was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Divergent validity was examined using the Self-Care of HF index self-care management score. One-year survival based on HFSPS scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics and lab values. Results The sample was 63% male, 85% Caucasian, 67% functionally compromised (NYHA class III-IV) with a mean age of 63, SD12.8 years. Internal consistency of the HFSPS was α =.90. Convergent (r=−0.54, p=<0.0001) and divergent (r=0.18, p>0.05) validity were supported. Controlling for Seattle HF scores, HFSPS was a significant predictor of one-year survival with those most symptomatic having worse survival (HR=1.012 (95%CI=1.001–1.024), p=0.038). Conclusions Perception of HF symptom burden as measured by the HFSPS is a significant predictor of survival contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms may be useful in evaluating therapeutic outcomes and predicting event-free survival.

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