INTRODUCTION:

Heart failure is a clinical syndrome in which an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate commensurate with the requirements of the metabolizing tissues.¹Latest statistics shows that heart failure is on the rise which stated that the number of adults living with heart failure increased from about 5.7 million to about 6.5 million, according to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update²

NEED FOR THE STUDY:

Heart failure has been defined as global pandemic, since it affects around 23 million people worldwide.3 The lifetime risk of heart failure increases with age. With the growing age of population in India, the burden of this problem is bound to rise. The number of people above 60yrs of age in India is projected to increase from 105 million in 2011 (8.4% of total population) to 376 million in 2051(21.6%).4Individuals with heart failure have markedly impaired quality of life compared to with other chronic diseases as well as healthy population. Quality of life reflects the multidimensional impact of a clinical condition and its treatment on patients’ daily lives. Patients with heart failure experience various physical and emotional symptoms such as dyspnea, fatigue, edema, sleeping difficulties, depression, and chest pain. These symptoms limit patient’s daily physical and social activities and result in poor quality of life. So the investigator felt the need to conduct a study to assess the relationship between self care and quality of life in patients with heart failure.

PROBLEM STATEMENT:

A study to assess the relationship between self-care and quality of life in patients with heart failure in a selected hospital, Kottayam.

OBJECTIVES:

· Assess the self-care of patients with heart failure.

· Determine the quality of life of patients with heart failure.

· Find the relationship between self-care and quality of life in patients with heart failure.

· Identify the association between self-care and quality of life in patients with heart failure with selected demographic and clinical variables.

OPERATIONAL DEFINITIONS:

SELF-CARE:

In this study, self-care is any activity that a heart failure patient does voluntarily which helps in maintaining physical, mental or emotional health as measured by Modified Self-care of Heart Failure Index Scale (MSCHFIS) which measures the self care maintenance, self-care management, and self-care confidence of heart failure patients.

QUALITY OF LIFE:

In this study, quality of life is a measurement of multidimensional impact of heart failure and its treatment on the physical, emotional, economic and social domains of heart failure patient’s life, as measured by Quality of Life Assessment Scale.

PATIENTS WITH HEART FAILURE:

In this study, patients with heart failure refers to those who are having a clinical condition characterized by the inability of the left heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients along with the ejection fraction less than 40% , which is determined by findings of the echocardiogram by the consultant cardiologist.

HYPOTHESES:

All the hypotheses are tested at 0.05 level of significance.

H1- There is significant correlation between the self-care and quality of life of patients with heart failure.

H2- There is significant association between the self-care and selected demographic variables like age and education among patients with heart failure.

H3- There is significant association between the quality of life and selected demographic and clinical variables like age, gender, education, monthly income and ejection fraction among patients with heart failure.

ASSUMPTIONS:

· Heart failure patients with greater self-care maintenance, self-care management and self-care confidence can have a higher quality of life.

· Quality of life in patients with heart failure can be affected by disease and treatment process.

LIMITATIONS:

· The study was limited to a small representative group of heart failure patients.

· The data was gathered from only one setting, so the generalizability was limited.

· Random sampling technique was not used because of limited time frame and only small numbers of patients were eligible to participate in the study.

· Prescribed medical therapy was not accounted for this study. Thus, the effect of prescribed medical therapy on the participant’s quality of life is unknown.

REVIEW OF LITERATURE:

A descriptive study was conducted to describe the self-care abilities and associated factors in chronic heart failure patients in Nantong University Affiliated Hospital, China between June 2015 and August 2016. Convenience sampling method was used to select 91 patients and data were collected by using Modified Congestive Heart Failure patient comprehensive self care ability evaluation scale questionnaire (MCHFCSQ). The study findings revealed the self care abilities were in the low-medium range. The education level, employment status, monthly income, and level of health education were correlated with the information subscale of the MCHFCSQ (P< 0.05) and sex, employment status, mastery over heart failure information and cardiac function grading were also correlated with patient mobility( P<0.05).The researcher concluded that medical workers need to enhance self-care education for congestive heart failure patients to help them better understand their condition and help them gain the necessary skills for self-care.5

A cohort study was conducted to assess quality of life and survival in 661 patients with heart failure in Netherland. The samples were followed prospectively for three years and collected data using Quality of life questionnaire and Minnesota Living with Heart Failure Questionnaire. The study results showed that non-survivors had a significantly lower quality of life than survivors on the physical functioning (P< 0.001), role limitations physical (P< 0.001), bodily pain (P=0.031) and general health (P=0.001) dimensions. The researcher concluded that quality of life was independently related to survival in a cohort of hospitalized patients with heart failure.6

A descriptive correlational study was conducted to assess self-care and quality of life among 30 patients with heart failure at Midwestern hospital in America. The samples were selected by convenience sampling and the data collected by using Self-care of Heart Failure Index and the Minnesota Living with Heart Failure questionnaires. The study results showed that self care confidence was significantly associated with physical quality of life (r=0.37, p<0.05), emotional quality of life (r=0.45, p<0.05) and total quality of life (r=0.48, p<0.05). The researcher concluded that assisting patients to build enough confidence in their self care abilities can improve their perception of health as well as their quality of life.7

METHODOLOGY:

RESEARCH DESIGN:

The research design selected for the present study was a descriptive research design.

SETTING OF THE STUDY:

The study was conducted in the cardiology wards of Caritas Heart Institute, Kottayam

POPULATION:

Population in the present study are the patients with heart failure admitted in the cardiology wards of Caritas Heart Institute.

SAMPLE SIZE:

The study sample consists of 100 patients diagnosed with heart failure admitted in the cardiac wards of Caritas Heart Institute.

SAMPLING TECHNIQUE:

The sampling technique selected for the present study was convenience sampling.

CRITERIA FOR SAMPLE SELECTION:

Inclusion criteria:

Patients who were diagnosed as heart failure with ejection fraction less than 40%, which is determined by echocardiogram.

· Patients between the age limit of 50-90 yrs, diagnosed as heart failure.

· Patients with heart failure who are willing to participate in the study.

· Patients with heart failure who are able to read and write Malayalam.

· Patients with heart failure who are conscious and oriented.

Exclusion criteria:

Patients with heart failure who have altered level of consciousness and are critically ill.

Patients with heart failure who have cognitive impairments like hearing loss or vision loss.

TOOL:

In this study the data collection instruments used are,

Tool 1: Structured Questionnaire on socio-demographic data and clinical profile.

Tool 2: Modified Self-Care of Heart Failure Index Scale

Tool 3: Quality of Life Assessment Scale.

Tool 1: Structured Questionnaire to collect socio demographic data and clinical profile

It includes the information regarding the client such as age, gender, education, occupation, type of family, monthly income. The clinical profile which includes the information regarding ejection fraction according to recent echocardiography.

Tool 2: Modified Self care of Heart Failure Index Scale

Self care of heart failure patients was assessed by semi-structured interview technique using 4 point rating scale type Modified Self Care Of Heart Failure Index Scale.

Tool 3: Quality of Life Assessment Scale

Quality of life of patients with heart failure was assessed by using Quality of Life Assessment tool.

Score interpretations:

Based on Modified Self care of Heart Failure Index Scale the level of self care was graded as follows:

· Overall self care: Poor (22-40), Average (41-60) Good (61-88)

· Self care maintenance: Poor (10-20), Average (21-30), Good (31-40)

· Self care management: Poor (6-12), Average (13-18), Good (19-24)

· Self care confidence: Poor (6-12), Average (13-18), Good (19-24)

The Quality of Life Assessment Scale was graded as follows:

Good: 0-33,

Average: 34-66,

Poor: 67-100

RESULTS:

· The study findings revealed that more than half (67 %) of samples had average self care, 21 % were having good self care and only 12 % of samples were having poor self care.

· The study findings revealed that more than half (54 %) of samples had average quality of life, 34 % of samples were having good quality of life and only 12 % of samples had poor quality of life.

· The study findings of the present study showed that there is there is no significant correlation(r=0.11) existing between total self care and quality of life scores.

· The study findings revealed that there is significant association between quality of life with gender (χ2= 6.02, p<0.05), education (χ2= 15.62, p<0.05), monthly income (χ2= 12.38, p<0.05), and ejection fraction (χ2= 5.74, p<0.05).

CONCLUSION:

The study results revealed that there is no significant correlation between self care and quality of life (r = 0.11). But, the present study findings showed that among the domains of self care, self care management domain and quality of life have significant correlation (r=0.37,p<0.05) which indicated that self care management can increase the quality of life in patients with heart failure. The present study results showed that there is significant association between self care and socio demographic variables like education (χ2=14.43, p<0.05) and there is no significant association between self care and age. Self care was highest in self care confidence domain (64.75%) and lowest in self care management domain (49.87%) among patients with heart failure. Quality of life was highest in social domain (33.80 %) and lowest in economic domain (64.60 %) among heart failure patients.

NURSING IMPLICATIONS:

The study findings have implications in the field of nursing education, nursing service, nursing administration and nursing research.

Nursing service:

Nurses can assess the self care abilities and help the patient to use self care strategies to improve the quality of life in patients with heart failure.

Nursing Education:

· The study results can be utilized by the nurse educators in preparing class on effectiveness of health education regarding assessment of different domains of self care and its importance in promoting quality of life in patients with heart failure.

· The nursing curriculum of Medical-Surgical Nursing should include learning strategies for the students to assess, plan, implement and evaluate nursing interventions on self care and its domains to improve the quality of life in patients with heart failure.

Nursing Administration:

The nursing administrators can arrange and conduct workshops, conferences, and in service education programs on the importance of self care assessment and management tools and its effectiveness in assessing self care of patients with heart failure.

Nursing Research:

· The nurse researcher can undertake similar studies on assessment of self care and quality of life among larger sample sizes of heart failure patients using different tools in the hospital.

· The nurse researcher can conduct a comparative study using variables like self care and quality of life with other chronic diseases such as, chronic renal failure, cancer, and stroke.

RECOMMENDATIONS:

· A similar study can be replicated on a large sample with different demographic variables.

· An interventional study on predictors for self care and quality of life in patients with heart failure.

· A quantitative study on effect of health education programme on improving self care management and quality of life in heart failure.

REFERENCES:

1. Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al. Harrison’s Textbook of internal medicine.16th ed. New York: Mc Graw publication; 2005,1367.

2. Carrie Thacker. Latest statistics show heart failure on the rise; cardiovascular diseases remain leading killer. .journal of american heart association. 2017 Jan 26;65-70.

3. Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, Jaarsma T, Krum H, Rastogi V, Rohde LE, Samal UC. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014 Sep 1;1(1):4-25.

4. World Population Prospects: The 2010 Revision, CD-ROM Edition [Internet]. United Nations, Department of Economic and Social Affairs, Population Division; 2011 [cited 2013 Apr 18]. Available from: http://esa.un.org/wpp/Excel-Data/population.html

5. Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, Haass M. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002 Mar 1;87(3): 235-41.

6. Hoekstra T, Jaarsma T, Veldhuisen DJ, Hillege HL, Sanderman R, Lesman‐Leegte I. Quality of life and survival in patients with heart failure. European journal of heart failure. 2013 Jan 1;15(1):94-102.

7. Chiaranai C, Salyer J, Best A. Self-care and quality of life in patients with heart failure. Pacific Rim International Journal of Nursing Research. 2009;13(4):3

Received on 19.11.2019 Modified on 30.12.2019

Research J. Science and Tech. 2020; 12(1):52-56.

DOI: 10.5958/2349-2988.2020.00006.6