Karimi-Dehkordi Mehri, Clark Alexander M
Mehri Karimi-Dehkordi, PhD, MScN, BScN Postdoctoral Fellow, University of Alberta, Department of Medicine, Division of Geriatric Medicine, Alberta, Canada. Alexander M. Clark, RN, PhD, FCAHS Professor, Associate Vice-President (Research), Vice-President Research Innovation, University of Alberta, Canada.
J Cardiovasc Nurs. 2020 Nov/Dec;35(6):E89-E98. doi: 10.1097/JCN.0000000000000733.
Self-care adherence remains low in patients with heart failure (HF); little is known about the influence of patients' values on self-care decisions and behaviors.
The aim of this study was to explore how participants living with HF perceive their values and how those values are reportedly expressed in self-care decision making.
The Interpretative Phenomenological Analysis approach was used. Semistructured interviews were conducted with 12 patients 60 years or older; with New York Heart Association class II and III HF; and able to speak, read, and understand English. Participants recruited via convenience sampling (January-December 2016) from 2 urban sites in Western Canada.
Values were reported to pivotally influence HF self-care decisions and behaviors. Overarching themes addressed aspects of values and decision making: notably, directness and complexity. Two main types of values, functional and emotional values, were involved in both adherent and nonadherent decisions. Values were often in flux, with the pursuit of these values being frequently in conflict with physical ability and changing over time.
Two types of values serve influence self-care decisions and adherence. As HF and its self-care prevent patients from pursuing their prioritized values, patients are often nonadherent. Thus, patients with HF should be supported to find alternative ways to enact their values.
心力衰竭（HF）患者的自我护理依从性仍然很低；关于患者价值观对自我护理决策和行为的影响知之甚少。
本研究的目的是探讨心力衰竭患者如何看待自己的价值观，以及这些价值观在自我护理决策中是如何体现的。
采用解释现象学分析方法。对12名60岁及以上、纽约心脏协会II级和III级心力衰竭、能够说、读和理解英语的患者进行了半结构化访谈。通过便利抽样（2016年1月至12月）从加拿大西部的2个城市地点招募参与者。
据报道，价值观对心力衰竭自我护理决策和行为具有关键影响。总体主题涉及价值观和决策的各个方面：特别是直接性和复杂性。功能性和情感性这两种主要类型的价值观在依从性和非依从性决策中都有涉及。价值观常常处于变化之中，对这些价值观的追求往往与身体能力相冲突，并随时间而变化。
两种类型的价值观会影响自我护理决策和依从性。由于心力衰竭及其自我护理阻碍患者追求其优先考虑的价值观，患者往往不依从。因此，应该支持心力衰竭患者找到实现其价值观的替代方法。
