Harkness Karen, Spaling Melisa A, Currie Kay, Strachan Patricia H, Clark Alexander M
Karen Harkness, PhD, RN, CCN(C) Clinician Scientist, School of Nursing, Heart Function Clinic, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada. Melisa A. Spaling, MEd Research Assistant, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Kay Currie, PhD, RN Reader, School of Health & Life Sciences, Glasgow Caledonian University, Scotland, United Kingdom. Patricia H. Strachan, PhD, RN Associate Professor, School of Nursing, McMaster University, Hamilton, Ontario, Canada. Alexander M. Clark, PhD, RN Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
J Cardiovasc Nurs. 2015 Mar-Apr;30(2):121-35. doi: 10.1097/JCN.0000000000000118.
Self-care is at the foundation for living with a chronic condition such as heart failure (HF). Patients with HF express difficulty with translating self-care knowledge into understanding "how" to engage in these activities and behaviors. Understanding the strategies that patients develop to engage in self-care will help healthcare providers (HCPs) improve support for unmet self-care needs of HF patients. The purpose of this systematic review was to highlight strategies that HF patients use to accommodate self-care recommendations into the reality of their daily lives.
A systematic review using qualitative meta-synthesis was carried out. Included studies had to contain a qualitative component and data pertaining to self-care of HF from adults older than 18 years and be published as full papers/theses beginning 1995. Ten databases were searched until March 19, 2012.
Of 1421 papers identified by the search, 47 were included. Studies involved the following: 1377 patients, 45% women, mean age of 67 years (range, 25-98 years), 145 caregivers, and 15 HCPs. Approaches to self-care reflected both perception- and action-based strategies and were a means to effectively manage HF. Although HF patients often expressed difficulty on how to integrate self-care recommendations into their daily lives, they developed intentional, planned strategies that harnessed previous experiences.
Healthcare providers must appreciate that patients view self-care as an "adaptation" that they undertake to maintain their independence and quality of life. In addition, HCPs must recognize that because self-care is a process of learning over time from experience, an individualized approach that emphasizes how to self-care must be adopted for patients to develop the necessary HF self-care skills.
自我护理是心力衰竭（HF）等慢性病患者生活的基础。心力衰竭患者在将自我护理知识转化为理解“如何”参与这些活动和行为方面存在困难。了解患者为参与自我护理而制定的策略，将有助于医疗服务提供者（HCPs）更好地满足心力衰竭患者未得到满足的自我护理需求。本系统评价的目的是突出心力衰竭患者将自我护理建议融入日常生活现实所采用的策略。
采用定性元分析进行系统评价。纳入的研究必须包含定性成分以及与18岁以上成年人心力衰竭自我护理相关的数据，并自1995年起以全文/论文形式发表。检索了10个数据库，检索截至2012年3月19日。
在检索到的1421篇论文中，47篇被纳入。研究涉及以下对象：1377名患者，45%为女性，平均年龄67岁（范围25 - 98岁），145名护理人员，以及15名医疗服务提供者。自我护理方法既反映了基于认知的策略，也反映了基于行动的策略，是有效管理心力衰竭的一种方式。尽管心力衰竭患者在如何将自我护理建议融入日常生活方面常常表示困难，但他们制定了基于以往经验的有意、有计划的策略。
医疗服务提供者必须认识到，患者将自我护理视为他们为维持独立和生活质量而进行的“适应”。此外，医疗服务提供者必须认识到，由于自我护理是一个随着时间从经验中学习的过程，必须采用强调如何进行自我护理的个体化方法，以便患者培养必要的心力衰竭自我护理技能。
