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A motivational counseling approach to improving heart failure self-care : Mechanisms of effectiveness
Riegel, Barbara Dickson, Victoria V. Hoke, Linda McMahon, Janet P. Reis, Brendali F. Sayers, Steven
Riegel, Barbara
Dickson, Victoria V.
Hoke, Linda
McMahon, Janet P.
Reis, Brendali F.
Sayers, Steven
Abstract
Background:
Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging.
Methods:
Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 ± 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness.
Results:
Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources).
Conclusion:
An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.
Keywords
heart failure, mixed methods, motivational interviewing, naturalistic decision-making, patient education, self-care
Date
2006
Type
Journal article
Journal
Journal of Cardiovascular Nursing
Book
Volume
21
Issue
3
Page Range
232-241
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled