A motivational counseling approach to improving heart failure self-care: Mechanisms of effectiveness

TitleA motivational counseling approach to improving heart failure self-care: Mechanisms of effectiveness
Publication TypeJournal Article
Year of Publication2006
AuthorsRiegel, B, Dickson, VV, Hoke, L, McMahon, JP, Reis, BF, Sayers, S
JournalJournal of Cardiovascular Nursing
Date PublishedMay-Jun
Publication Languageeng
ISBN Number1550-5049 (Electronic)0889-4655 (Linking)
Accession Number16699364
Keywords*Motivation, Communication, Female, Health Knowledge, Attitudes, Practice, Heart Failure/*nursing, Humans, Male, Middle Aged, Nurse-Patient Relations, Patient Education as Topic/*methods, Philadelphia, Qualitative Research, Self Care/*methods, Social Support, Teaching/methods, Treatment Outcome

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.

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