Home care nursing practice for older persons with heart failure living at home

Abstract

Aims and objectives: 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.

Background: 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.

Design: Ethnographic case study.

Method: 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.

Findings: 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.

Conclusions: 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.

Relevance to clinical practice: 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.

No patient or public contribution: Although patients were not formally involved in study design ethnography favours their voice.

Keywords: capacity; family caregiver; home care nurse; home care nursing; living with heart failure; older person; person-centred care; self-care.