Living with Heart Failure

1
Living with Heart Failure

• Fergal Searson

2
Heart Failure Management

• Readmission rates
• Accessing services
• Polypharmacy
• Diet restrictions/Fluid restrictions
• Self monitoring
• Co-morbidities
• Compliance

3
Research Rationale

• Multiple brief professional interventions
• Most work of illness management done at home
• How is this done?

4
Framework

• Most illness is chronic
• Trajectory Framework Model
• Corbin and Strauss (1988)
• There are three kinds of illness work
• Biographical work
• Illness Work
• Every Day Life work
• Most illness work is done in the home

5
Trajectory Phases

• Pre trajectory
• onset
• 
  crisis
• stable
• 
  
• 
  acute
• unstable
• 
  
  downward
• 
  
  dying
• 
  

6
Discovery interviews

• Thinking something was wrong
• Seeing someone in the NHS
• Having tests to find out what was wrong
• Being told what was wrong
• Receiving treatment
• Getting better
• Living with your condition
• Being followed up

7
My Research

• Secondary qualitative analysis
• Explore the
• - patient and carer experience of illness
• - tasks involved in managing the illness
  - every day work of living with the illness

8
Findings

• Mostly newly diagnosed
• CHD v HF
• Biographical work
• Illness work
• every day life work

9
Everyday life work

• Changing roles
• Limitations
• Dependency
• Organising self
• Relationships

10
Changing roles

• Domestic roles
• I feel guilty about my husband having to do all
  that when I should be doing it and then I feel
  guilty about asking him to do jobs, like change
  beds and different things

11
Limitations

• Social activity
• I was going to the gym before my interest and
  I had a lot of friends there
• I knew a lot of people, a lot of people that I
  came into contact with through work, with going
  to jobs, it all stopped

12
Dependency

• Shopping
• I have to take my son because I cant go
  shopping on my own because I cant push the
  trolley when Ive got the food in it.

13
Organising self

• Medicine management
• So the tablets you take at night you keep
  upstairs?
• Yes, and the tablets I take in the morning, I
  keep downstairs then I know to take them before
  my breakfast and I know to take them last thing
  at night.

14
Relationships

• Changes to living arrangements
• He was getting so bad, dementia I think they
  called it.
• So, hes been in a nursing home now for about
  14 15 months and I feel awful saying it but Ive
  been better since he was away from me. Weve
  been married 57 years and thats a long time to
  be married and that was the first time wed been
  apart

15
Every day life work

• Hinted
• Expertise
• Stability and NYHA classification

16
Discussion

• What is known
• What this research added
• What is needed

17
The Future

• Develop an explanatory model of expertise in
  stable HF patients
• What constitutes stability and instability?
• What are characteristics of every day life work
  in stable HF patients?