Does telemonitoring in heart failure empower patients for self-care? A qualitative study.

J Clin Nurs. 2012 Nov 27. doi: 10.1111/j.1365-2702.2012.04294.x Riley JP, Gabe JP, Cowie MR. Royal Brompton & Harefield NHS Foundation Trust, London, UK. AIMS AND OBJECTIVES: To explore the extent to which telemonitoring in patients with heart failure empowers them to self-care.

BACKGROUND: Telemonitoring is increasingly used to provide structured follow-up. In patients with heart failure it has been shown to reduce mortality. However there is limited knowledge of the extent to which it supports the patient to develop self-care skills.

DESIGN: A qualitative study including interviews with patients at 2 time-points.

METHODS: Fifteen patients mean age 74, 11 (73%) male, 9 (60%) symptomatic on moderate activity, 6 (40%) symptomatic on mild exertion were interviewed at two time points: firstly following three months of telemonitoring and the second interview following six months of telemonitoring. Thematic analysis of the data was undertaken using constant comparison.

RESULTS: Patients undertook a variety of self-care actions. During the three-month interview technological skills featured highly in patients accounts and they used telemonitoring to facilitate professional monitoring. However, during the six-month interview patients described how they used telemonitoring to support their self-care actions. Such actions were based on the understanding of heart failure that patients developed from their personal experience of symptoms, and their interaction with the telemonitoring and the telemonitoring nurse. We found no difference in self-care actions regardless of patients age, severity of their heart failure, time since diagnosis with heart failure or living alone.

CONCLUSION: In summary, the majority of patients used telemonitoring daily and developed self-care skills in monitoring their heart failure. Such skills were developed over the six-month time-period of the study.

RELEVANCE TO CLINICAL PRACTICE: Our findings suggest how the nurse can help patients to use telemonitoring to develop their understanding of their heart failure and empower them for self- care decision making.

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