**5. Processes of self-management and restructuring own lifestyles**

To promote self-management for patients with HF and support their lives, nurses need to understand patients' perspectives. Sano et al. described the process of selfmanagement among elderly patients with HF who had avoided re-hospitalization for over 2 years [13]. They identified three sub-concepts and one core-concept. **Table 3** shows core-concept and three sub-concepts of self-management of patients with HF [13].


#### **Table 3.** *Core-concept and sub-concepts.*

*A Home-Based Heart Failure Nursing Intervention Supporting Self-Management and Lives DOI: http://dx.doi.org/10.5772/intechopen.102509*

The sub-concepts were perception of heart failure, encountering a new situation, and life coordination for heart failure. The sub-concepts yielded a single core-concept—balance between preventing decompensation and preferences. Patients with HF experience each sub-concept in no particular order and acquire a lifestyle tailored to the condition of HF. Then, when the state of HF becomes stable, not only actions for preventing the worsening of HF but also their own values and preferences are taken in, and the balance between them is maintained. A conceptual model was developed to illustrate the interactive relationships among the sub-concepts and the core-concept (**Figure 1**). **Figure 1** shows a conceptual framework of self-management among patients with HF [13].

### **5.1 Perception of HF**

This sub-concept means that patients with HF experienced the onset of HF by sudden dyspnea and abnormal changes in their bodies. As a result of seeking medical care, they subsequently learned that their abnormal changes were symptoms of HF. Sources of HF information included inpatient and outpatient settings, from medical staff and laypeople, they encountered in daily life. After hospitalization, patients with HF understand that the onset of HF and deterioration of symptoms was related to several factors, such as living habits, work and overwork, fluid retention, excessive salt intake, and untreated high blood pressure.

#### **5.2 Encountering a new situation**

This sub-concept means that once the patients with HF understood how HF was related to their lifestyle, they noticed how the hospital environment was different from their own life at home in terms of activity, reducing salt intake, and management of blood pressure. They began confronting the reality that simple acts, like putting on their socks or cutting their nails, would become more difficult after hospitalization.

**Figure 1.** *Conceptual framework.*

#### **5.3 Life coordination**

This sub-concept means that patients with HF reported that they did not want to experience that painful experience again. They believed that it had been a bad decision to just endure the pain and accept the abnormal physical changes as their condition became more severe. At the same time, they began to look back on their lifestyle selections; these led to behavioral modifications to avoid both painful experience and re-hospitalization. They understand that they could not continue living as they had before hospitalization; they could not avoid re-hospitalization if they did not change their lifestyle.

They also reported limiting their work. They began to adapt their lifestyle to one compatible with HF by limiting activities they had previously engaged in. Meanwhile, they were determined to continue living a worthwhile and energetic life.

#### **5.4 Balance between preventing decompensation and preferences**

This core-concept means that patients with HF try to maintain their agelong preferences to give their life a purpose, such as by maintaining long-term friendships and continuing to engage in interests. Instead of limiting all their activities, they stop engaging in activities that they learn would be bad for their heart and choose to continue those activities not be harmful.

They seek medical guidance to determine which activities were considered good for the heart or feasible within the scope of their limited lifestyle. They begin to reassemble their life into ones that do not put a strain on the heart while making up for lost parts of their life as a result of HF. They describe taking walks, singing a song, and engaging in new physical activities or hobbies within their realm of possibility. They determine which activities caused symptoms to appear and how far they could push themselves even if these were vacation activities or when invited by acquaintances. They make an effort to exercise at their own pace and master how to regulate their amount of exercise so as to avoid placing strain on the heart and causing symptoms.

They also utilize the knowledge they have acquired on limiting alcohol consumption and on excessive fluid and salt intake, which are related to water retention and edema. In doing so, they can prevent exacerbating their HF by modifying their diet. Nonetheless, they are faced with many situations that are difficult to avoid, such as opportunities to go drinking or eating out with others. In these situations, they make an effort to mitigate factors that would exacerbate their HF by avoiding overeating and overexertion, and by informing the people around them of their limits in advance. This allows patients to maintain their work and harmonious social lives while avoiding a diet that might lead to the exacerbation of HF.

Although they are aware of the need to modify their lifestyle, they believe that stress is worse and that it would be better to reduce stress by eating what they liked. Thus, they believe in prioritizing values over exacerbating their condition and giving priority to their preferences to avoid stress instead of respecting their limitations. They acknowledge having chosen to avoid stress over causing HF symptoms and pain. These thoughts, actions, and lifestyle choices demonstrate the complexly of symptom management in HF even when patients want to avoid exacerbating their condition. Apparently, they accept some deterioration because they want to act on their preferences and avoid the stress of compliance.

In summary, nurses need to recognize and value patients' views and experiences to support their self-care management.

*A Home-Based Heart Failure Nursing Intervention Supporting Self-Management and Lives DOI: http://dx.doi.org/10.5772/intechopen.102509*
