Department of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
J Clin Nurs. 2023 Jul;32(13-14):4103-4115. doi: 10.1111/jocn.16575. Epub 2022 Nov 12.
To enhance knowledge of how older people with heart failure, living at home, manage their illness with the support of their family caregivers and home care nursing services.
Heart failure monitoring and self-care have been important means of reducing the serious impact of heart failure. Drawing on theories of practice as enacted and conceptualising service users and their family caregivers as active, the idea of attunement was used to explore how home care nurses work in supporting them.
Ethnographic case study.
Data collection involved home visits and interviews (10 home care users, 10 caregivers, five home care team leaders). Data were field-notes and transcribed interviews. Themes were deductively developed from the findings, informed by the theoretical background, using content analysis. The COREQ checklist was used.
Three themes were developed from the data: (1) Practices of attunement in relations, (2) Becoming among difficulties and (3) Off track-difficult to attune around self-care.
The findings reflect the complexity of heart failure monitoring at home, showing how, in addition to self-care measures, users are supported by an array of informal and formal care. The caregiving situation is shaped by relations among participants and involves making oneself available to the situation. We suggest a stance of attunement for home care nurses, which demands tact and calls for interest, engagement and openness.
Study findings caution against limiting heart failure monitoring to circumscribed tasks, instead calling for a holistic understanding of what may be helpful for users. Home care nurses need time to attune with users living with heart failure and their caregivers to prevent exacerbations and promote well-being.
Although patients were not formally involved in study design ethnography favours their voice.
提高对心力衰竭老年人在家中如何在家庭护理人员和家庭护理服务的支持下管理疾病的认识。
心力衰竭监测和自我护理一直是减轻心力衰竭严重影响的重要手段。借鉴实践理论，并将服务使用者及其家庭护理人员视为积极的参与者，调谐的概念被用来探索家庭护理护士如何在支持他们方面发挥作用。
民族志案例研究。
数据收集包括家访和访谈（10 名家庭护理使用者、10 名护理人员、5 名家庭护理团队负责人）。数据是现场笔记和访谈转录。主题是从理论背景出发，从研究结果中推断出来的，并使用内容分析进行了分析。使用了 COREQ 清单。
从数据中得出了三个主题：（1）关系中的调谐实践，（2）在困难中成长，（3）偏离轨道——难以围绕自我护理进行调谐。
研究结果反映了家庭心力衰竭监测的复杂性，表明除了自我护理措施外，使用者还得到了一系列非正式和正式护理的支持。护理情况是由参与者之间的关系塑造的，涉及到对情况的投入。我们建议家庭护理护士采取调谐的立场，这需要机智，并需要兴趣、参与和开放。
研究结果告诫不要将心力衰竭监测限制在特定的任务上，而是需要全面了解对使用者有帮助的方法。家庭护理护士需要时间与患有心力衰竭的使用者及其护理人员调谐，以防止病情恶化并促进健康。
尽管患者没有正式参与研究设计，但民族志方法支持他们的声音。
