| Objectives1.To understand and analyze the congruence status of self-care behavior between chronic heart failure patients and caregivers,and discuss its relationship with patients’ discharge readiness,caregivers’ readiness,patients’ quality of life,and caregivers’ positive feelings.To explore the underlying reasons for the inconsistencies of self-care behavior between chronic heart failure patients and caregivers.2.To explore the application effect of the dyadic illness management program based on the results of previous studies on the congruence of self-care behavior of chronic heart failure patients and caregivers,the quality of life of patients and the positive feelings of caregivers.Methods1.Interpretive sequence studyThe first stage is quantitative study.Using convenience sampling method,134 pairs of chronic heart failure patients and their caregivers who were hospitalized in the cardiovascular department of a Grade-III hospital in Zhenjiang City from November 2021 to February 2022 were selected as research objects.The general information of patients and caregivers,self-care behavior,patient discharge readiness,caregiver readiness,patient quality of life and caregiver positive feelings were investigated in a cross-sectional manner.The congruence of self-care behavior between chronic heart failure patients and caregivers was analyzed,and the relationship between chronic heart failure patients’ readiness for discharge,caregivers’ readiness,patients’ quality of life,and caregivers’ positive feelings was analyzed.The second stage is describe qualitative research.Objective sampling method was used to select 14 patients with inconsistent self-care behaviors among the quantitative research objects in the first stage from May 2022 to August 2022 based on the principle of maximum difference,and semi-structured interviews were conducted between patients and caregivers to explore the reasons for incongruence of self-care behaviors between patients with chronic heart failure and caregivers.2.Based on the theory of duality disease management,the experimental study developed the guided intervention measures for patients with chronic heart failure and their caregivers’ self-care behavior disease.The program consists of four parts(binary relationship review,assessment consensus,unified management behavior,and promotion of common health).From September 2022 to February 2023,88 pairs of patients with chronic heart failure and their caregivers hospitalized in the cardiovascular department of a third-class A hospital in Zhenjiang City were selected as research objects,with 44 pairs in each group.Both groups received routine treatment and nursing for chronic heart failure inpatients in cardiovascular department.The experimental group also received the intervention program based on the theory of binary disease management.The score changes of self-care behavior congruence,patient discharge readiness,caregiver readiness,patient quality of life,and caregiver positive feelings were compared between the two groups at baseline,1 day before discharge,and 1month after discharge.Results1.(1)The first-stage quantitative study showed that the level of self-care behavior of patients with chronic heart failure and caregivers was generally low,and the congruence of self-care behavior was also generally low,and there was a negative correlation with the quality of life of patients,discharge readiness,caregiver positive feelings and caregiver readiness(P <0.05).(2)In the second stage of qualitative research,the interview data were analyzed to form four themes of the causes of self-care behavior incongruence:(1)Symptom recognition:indulgence and symptom rationalization;(2)Emotional expression and communication:extreme expression and repression;(3)Adherence to disease management: passive and active pulling;(4)Prognostic plan: self-consolation and disregard.2.A total of 88 pairs of patients and their caregivers were included in the category of experimental study,84 pairs of patients and caregivers who completed all the study courses were included,and 4 pairs were lost to follow-up.Finally,42 pairs were included in the experimental group and 42 pairs in the control group.1 day before discharge and 1 month after discharge,the congruence of the self-care behavior and the three dimensions of the experimental group and the control group showed an increasing trend,but the improvement of the experimental group was more significant,and the total score difference between the two groups was statistically significant(P < 0.05).The dimensions of self-care maintenance and self-care confidence were significantly improved over time(P < 0.05),but the dimensions of self-care management were not significantly improved(P > 0.05).The scores of quality of life,discharge readiness and caregiver positive feeling of experimental group were better than those of control group,and the difference was statistically significant(P < 0.05).The caregiver readiness scores of the two groups showed an improvement trend over time,but there was no statistical significance between the two groups(P > 0.05).Conclusion1.The congruence of self-care behavior between chronic heart failure patients and caregivers needs to be improved.The causes of incongruence self-care behaviors were concentrated in four aspects: symptom recognition,communication,disease management compliance and future planning.It is suggested that medical staff can take the binary group of patients and caregivers as a whole to provide professional and dualistic health education and guidance in the aspects of symptom assessment,disease management behavior,communication and decision-making.2.The intervention program of binary disease management can effectively improve the congruence of self-care behavior between patients with chronic heart failure and caregivers,improve patients’ quality of life,hospital discharge readiness and caregivers’ positive feelings,but its effect on improving caregivers’ readiness remains to be further studied. |
PDF Full Text Request