Search

Individuals with chronic obstructive pulmonary disease experience suffering that affects their families and community relationships. However, no studies provide an explicit account of social suffering among these individuals. This secondary analysis was conducted to understand the lived experiences of social suffering in individuals with chronic obstructive pulmonary disease. The theory of social suffering guided the analysis of an interpretative phenomenological study. Thirteen individuals were recruited using purposive sampling. Data were analyzed using reflexive thematic analysis. Three themes were generated: a) prevailing hopelessness and burden, b) progressing relational adversities, and c) struggling with co-dependency. Social suffering is a complex entity experienced by the patients and the family caregivers. For enhanced caregiving, health professionals could prepare patients to tackle the suffering through collective actions.

In recent years, the increase in textual data production has meant that researchers require faster text analysis techniques and software to reliably produce knowledge for the scientific–nursing community. Automatic text data analysis opens the frontiers to a new research area combining the depth of analysis typical of qualitative research and the stability of measurements required for quantitative studies. Thanks to the statistical–computational approach, it proposes to study more or less extensive written texts produced in natural language to reveal lexical and linguistic worlds and extract useful and meaningful information for researchers. This article aims to provide an overview of this methodology, which has been rarely used in the nursing community to date.

BackgroundNutritional status is related to the prognosis and length of hospital stay (LOHS) of patients with atrial fibrillation (AF). This study aimed to assess how nutritional status affects LOHS for patients with AF.MethodsWe performed retrospective analysis of the medical records of 1,813 patients admitted urgently with a diagnosis of AF to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland.ResultsIn total, 1,813 patients were included in the analysis. The average LOHS in the entire group was 3.53 ± 3.41 days. The mean BMI was 28.7 kg/m2 (SD: 5.02). Patients who were hospitalized longer were statistically more likely to have a Nutritional Risk Score (NRS) ≥3 (p = 0.028). A higher percentage of longer hospitalized patients with LDL levels below 70 mg/dl (p < 0.001) and those with HDL ≥40 mg/dl (p < 0.001) were observed. Study participants with NRS ≥3 were an older group (M = 76.3 years), with longer mean LOHS (M = 4.44 days). The predictors of LOHS in the univariate model were age (OR = 1.04), LDL (OR = 0.99), HDL (OR = 0.98), TC (OR = 0.996), CRP (OR = 1, 02, p < 0.001), lymphocytes (OR = 0.97, p = 0.008) and in the multivariate model were age, LDL (mg/dl), HDL (mg/dl), Na, and K.ConclusionFor nutritional status, factors indicating the risk of prolonged hospitalization in patients with AF are malnutrition, lower serum LDL, HDL, potassium, and sodium levels identified at the time of admission to the cardiology department. Assessment of nutritional status in patients with AF is important both in the context of evaluating obesity and malnutrition status, as both conditions can alter the prognosis of patients. Further studies are needed to determine the exact impact of the above on the risk of prolonged hospitalization.

Aim To develop a comprehensive understanding of resilience and its associated factors among informal caregivers of people with heart failure. Design Transnational multicentre convergent mixed methods approach. Methods This study was conducted in three European countries: Italy, Spain and the Netherlands; during February 2017 and December 2018. In total, 195 caregivers completed the Connor-Davidson Resilience Scale, Caregiver Burden Inventory and Hospital Anxiety and Depression Scale. From a nested sample 50 caregivers participated in semi-structured face-to-face interviews. Data were analysed using qualitative content analysis, multiple regression and joint displays. Results The caregivers' mean age was over 60 years. The quantitative results showed that caregivers experienced anxiety and depression regardless of a good score of resilience and moderate level of burden. Regression analysis showed that the resilience was associated with caregiver depression. From qualitative findings three resilience inhibiting (psychological outlook, physical weariness and affective state) and two promoting factors (community interconnectedness and self-comforting activities) were generated. Mixed analysis confirmed that depression decreased caregivers' resilience. Conclusions Caregivers of people with heart failure experience continuous stress and anxiety resulting in reduced resilience. Collaborative efforts are needed to build multifaceted interventions and programs to enhance caregivers' resilience by targeting the factors identified in this study. Impact The quality of informal caregiving is affected by the resilience of caregivers. No research has explored the resilience levels and its factors in this population. Depression, psychological outlook, physical weariness and affective state are negative factors of caregivers' resilience. Personal strategies combined with social and community support and belongingness enhance caregivers' resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers' resilience.

Background The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses’ Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments. Objective The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors. Methods The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool’s internal structure. The tool’s reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is Results Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023. Conclusions We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management. International Registered Report Identifier (IRRID) PRR1-10.2196/39482

Aims To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design A qualitative focused mixed methods design was used. Methods In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made., The "Heart failure specialists of Tomorrow" (HoT) group gathers young researchers, physicians, basic scientists, nurses and many other professions under the auspices of the Heart Failure Association of the European Society of Cardiology. After its foundation in 2014, it has quickly grown to a large group of currently 925 members. Membership in this growing community offers many advantages during, before, and after the 'Heart Failure and World Congress on Acute Heart Failure'. These include: eligibility to receive travel grants, participation in moderated poster sessions and young researcher and clinical case sessions, the HoT walk, the career café, access to the networking opportunities, and interaction with a large and cohesive international community that constantly seeks multinational collaborations.

Background: Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. Objectives: We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. Methods: This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients’ informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. Results: Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. Conclusions: Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Background: The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers’ contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients’ self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. Purpose: To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. Method: CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. Results: Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale (“treatment adherence behaviors” and “symptom control and maintenance behaviors”), two in the self-care monitoring subscale (“illness behaviors” and “prevention behaviors”) and one factor for the self-efficacy subscale. The Pearson’s rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension.

Understanding participants’ perspectives in qualitative research is contingent on unravelling the essential meaning of their speech. When data are collected in native language and translated into English language, the underlying sociocultural meaning of participants’ speech can be missed. This paper discusses a new contextual coding approach and illustrates its application in research. The technique was used in a phenomenological study in Pakistan and a mixed methods study in Europe. Contextual coding entails a preliminary coding stage involving data reading in native language, choosing socially and culturally relevant words and phrases, and developing preliminary codes. The concluding coding stage focuses on creating a sociocultural query list, seeking answers through discussions among multilingual individuals, and finding a common language for code description. Contextual coding can enable researchers to understand sociocultural meaning of their data at an early stage, rather than waiting at the later stage of theme development to contextualize the findings.

In this study, we analysed the lived experiences of frontline nurses and physicians who were affected by COVID-19 through a phenomenological study, using a Cohen's phenomenological methodology. The participants were enrolled in the study in May 2020 during the COVID-19 pandemic in Italy. The inclusion criteria were as follows: (1) was a nurse or physician employed full time caring for COVID-19 patients before falling ill; (2) contracting SARS-CoV-2 during the period from February 2020 to May 2020; and (3) had recovered before enrolment in the study. Sixteen participants (60% nurses) with an average age of 45 years were included in this study. The following main themes were extrapolated from our data analysis: "fear of diagnosis", "loneliness (as isolation)", "touch of nurses" and "feeling guilty of abandonment". From our study several aspects emerge that highlight how strong the emotional impact of COVID was on nurses and physicians infected during their activities, such as, on the one hand, feelings of fear, loneliness, and, on the other hand, the impotence of not being able to help.

Minimizing the biological sewage sludge (BSS) produced by wastewater treatment plants (WWTPs) represents an increasingly difficult challenge. With this goal, tests on a semi-full scale Thermophilic Alternate Membrane Biological Reactor (ThAlMBR) were carried out for 12 months. ThAlMBR was applied both on thickened (TBSS) and digested biological sewage sludge (DBSS) with alternating aeration conditions, and emerged: (i) high COD removal yields (up to 90%), (ii) a low specific sludge production (0.02–0.05 kgVS produced/kgCODremoved), (iii) the possibility of recovery the aqueous carbon residue (permeate) in denitrification processes, replacing purchased external carbon sources. Based on the respirometric tests, an excellent biological treatability of the permeate by the mesophilic biomass was observed and the denitrification kinetics reached with the diluted permeate ((4.0 mgN-NO3−/(gVSS h)) were found comparable to those of methanol (4.4 mgN-NO3−/(gVSS h)). Moreover, thanks to the similar results obtained on TBSS and DBSS, ThAlMBR proved to be compatible with diverse sludge line points, ensuring in both cases an important sludge minimization.

Background Heart failure (HF) patient-caregiver dyads experience severe psychological problems, such as anxiety and depression. A variable that has been found to be associated with anxiety and depression in patients and caregivers in severe chronic conditions is mutuality. However, this association has not been explored in HF patient-caregiver dyads to date. Objective The aim of this study was to evaluate the associations among mutuality, anxiety, and depression in HF patient-caregiver dyads. Methods This was a cross-sectional study. Mutuality, anxiety, and depression in HF patient-caregiver dyads were assessed using the Mutuality Scale (MS) total and 4 dimension scores and the Hospital Anxiety and Depression Scale, respectively. Data were analyzed using the actor-partner interdependence model to examine how mutuality of patients and caregivers was associated with both the patients' own (actor effect) and their partners' anxiety and depression (partner effect). Results A sample of 366 dyads of patients with HF (mean age, 72 years; 56% male) and caregivers (mean age, 54 years; 73.3% female) was enrolled. Regarding patient anxiety, we observed only an actor effect between the MS dimension scores of "love and affection" and "reciprocity" and anxiety in patients (B = -1.108, P = .004 and B = -0.826, P = .029, respectively). No actor and partner effects were observed concerning caregiver anxiety. Regarding depression, we observed that only the MS dimension of "love and affection" in patients had both an actor (patient: B = -0.717, P = .032) and a partner (caregiver: B = 0.710, P = .040) effect on depression. Conclusions The assessment of MS in HF patient-caregiver dyads is important to formulate interventions aimed at improving anxiety and depression in patients and caregivers.

Background Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe. Objective The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur). Methods Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis. Results Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic). Conclusions Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): HFA Nurse training Fellowship Award Center for Excellence for Culture and Nursing Research (CECRI)Nursing Scholarship OPI Rome Italy Introduction Resilience is a dynamic process of utilising abilities to harness personal, social, and spiritual resources and coping characteristics and developing regulatory flexibility to manage challenges and bounce back from emotional and physical distress. Caregivers of patients with heart failure are prone to increased stress and reduced resilience while assisting their family members in meeting self-care needs, activities of daily living, and complex medical and dietary regimens. To date, limited research exists on resilience and its predictors among caregivers of people with heart failure. Purpose To develop a comprehensive understanding of resilience and its predictors among caregivers of patients with heart failure. Methods A convergent mixed methods design was used. In total, 50 caregivers completed the Connor-Davidson Resilience Scale (CDRS) (score range: 0–100, with higher scores indicating higher resilience), the Caregiver Burden Inventory (CBI) (higher scores indicate greater caregiver burden; there are no cut-off points for classifying burden), and the Hospital Anxiety and Depression Scale (HADS) (two subscales, range score 0 and 21 per each subscale; higher scores mean worse anxiety and depression) and participated in semi-structured face-to-face interviews. Data were analysed using multiple regression, qualitative content analysis, and joint displays. Results The caregivers’ mean age was 62.8 ± 12.83 years. The CDRS mean score was 62.37 ± 24.2, and the mean HADS scores for anxiety and depression were 12.38 ± 2.74 and 8.54 ± 2.49, respectively. The mean CBI score was 16.82 ± 17.12. Regression analysis showed that the resilience score was only predicted by depression (B = -1.491, p = 0.031). Qualitative analysis generated three resilience-inhibiting factors (psychological outlook, physical weariness, and affective state) and two promoting factors (community interconnectedness and self-comforting activities). Mixed analysis confirmed that depression decreased caregivers’ resilience. Conclusions Caregivers of people with heart failure are likely to experience extreme stress and anxiety that affect their resilience to provide better care for their family members. This study identified that depression, hopelessness, pessimism, powerlessness, physical fatigue, and fluctuating emotional states affected negatively caregivers’ resilience. However, self-comforting activities and community interconnectedness improved caregivers’ resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers’ resilience.

Background: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist. Objective: To develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients. Methods: The EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands. Results: Exploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers contributions to HF self-care related to medical issues, and caregivers contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbachs alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale. Conclusion and Practice Implications: The EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient selfcare. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies. (C) 2021 Elsevier B.V. All rights reserved. Funding Agencies|Heart Failure Association of European Society of Cardiology ESC within the Heart Failure Nurse Research Training Fellowship; Center of Excellence for Nursing Scholarship, Rome, Italy

Background: Heart failure (HF) is a major and growing public health problem worldwide. Across the world, heart failure is associated with high mortality, high hospitalization rates, and poor quality of life. Self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability, the response to symptoms when they occur, and the ability to follow the treatment regimen and control symptoms. One instrument used to measure self-care is the Self Care of Heart Failure Index. Aim: The purpose of this study was to test the psychometric properties of the Spanish version of the Self Care of Heart Failure Index v.6.2 (SCHFI v.6.2). Methodology: Before testing its psychometric properties, the SCHFI v.6.2 was translated and adapted from its original English version into Spanish. Subsequently, we tested the instrument&rsquo, s psychometric properties on a sample of 203 participants with HF. Descriptive statistics were used to analyze the sociodemographic and clinical variables, and to describe item responses. We tested the factorial validity of the SCHFI v.6.2 using confirmatory and exploratory factor analysis. Results: Confirmatory factor analysis (CFA) was performed using the our pre-existing models which resulted with poor fit indices. Thus, we performed exploratory factor analysis (EFA) on each of the SCHFI v.6.2 scales. Conclusion: The Spanish version of the SCHFI v.6.2. has good characteristics of factorial validity and can be used in clinical practice and research to measure self-care in patients with HF.

Background: Heart failure is a major problem in western societies. Sleep Disorders maintain a bidirectional relationship with heart failure, as shown by studies conducted in other countries. This study aims to describe the quality of sleep in Spanish patients with heart failure. Materials and methods: We carried out a cross-sectional study to analyze the quality of sleep in a sample of 203 patients with a diagnosis of heart failure admitted to an Internal Medicine Service. The Pittsburg Sleep Quality Index (PSQI) was used to evaluate sleep quality in our sample over a one-month period. Results: 75% of the sample presented sleep disorders. The most common problems included the interruption of sleep (73.5% nocturia and 30% breathing difficulties); 35% had poor sleep efficiency; 33% showed a decrease in daytime performance; 84% had used hypnotics at some point to induce sleep and 35% used them regularly. Conclusions: This is the first study to report on the perceived sleep quality of patients with heart failure in Spain. Self-perception of sleep quality differed from that estimated by the PSQI. The prevalence of the use of sleep-inducing medication was very high. The diurnal dysfunction generated by sleep disorders in a heart failure environment can contribute to the development of self-care and cognitive deterioration problems.

Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients’ physical deterioration.

This paper describes involving patients and the public in nursing research and discusses the challenges and opportunities in adopting this approach during a doctoral training programme. The paper summarises patient engagement initiatives across a number of European countries, draws on some key literature and critically reflects on the perspectives of doctoral students undertaking gerontological nursing research in Europe. It concludes with a number of recommendations on how to include older people as active partners in doctoral nursing research.

Background: The burden is high in caregivers of heart failure patients, but the literature on patient and caregiver predictors of caregiver burden is inconsistent. Also, it is unknown if caregiver contribution to heart failure self-care maintenance (i.e. helping patients to maintain heart failure stable) and self-care management (i.e. helping patients to act in case of heart failure worsening) increases caregiver burden. Aims: To identify caregiver and patient predictors of caregiver burden in heart failure; and to evaluate if caregiver contribution to heart failure self-care maintenance and management increases caregiver burden. Methods: A cross-sectional study with the enrolment of 505 caregivers of heart failure patients. We used the caregiver burden inventory and the caregiver contribution to self-care of heart failure index. We analysed the data using hierarchical regression. Results: Heart failure caregivers, mostly women (52.5%), with a mean age 56.5 (±14.9) years, cared for heart failure patients, mostly men (55.2%), with a mean age of 75.9 (±10.4) years. Caregiver predictors of higher caregiver burden were older age, female gender, fewer caregiving hours and poor social support. Patient predictors of higher caregiver burden were older age, better education, taking fewer medications and higher quality of life. Caregiver contribution to self-care maintenance and management were not significant predictors of caregiver burden. Conclusions: Our results could help providers to identify heart failure caregivers who are more exposed to burden. As caregiver contribution to heart failure self-care improves patient outcomes and seems not burdensome for caregivers, providers may consider educating caregivers about self-care as a viable option for improving patient outcomes without increasing caregiver burden.

Informal Caregivers (CG) for heart failure patients are very important for preserving health status, preventing symptoms exacerbation and improving self-care. However, being a caregiver can be very burdensome, emotionally stressful and, often, associated with social interaction problems. Despite this, literature lacks in interventions aimed to reduce burden and improve wellbeing. The aim of this project is to reduce burden, improve mutuality and increase resilience with the use of immersive virtual reality. A concurrent mixed method design will be used to test the intervention with two experiments on volunteer CG. Open-ended questions will be used, meanwhile, to explore the impact of the experience. Caregiver Burden Inventory (CBI), Mutuality Scale (MS) and Connor Davidson Resilience Scale (CDRISC-25) will be administered both pre and post experiments. On psychophysiological indexes, an analysis of variance will be performed (ANOVA). Data about burden, mutuality and resilience will be presented through data integration with the content analysis of the open-ended questions in a joint display.

Antecedentes: La información sobre el autocuidado en la insuficiencia cardiaca (IC) en España es escasa. En concreto, existe la necesidad de fijar el nivel de comprensión de los pacientes sobre la IC, así como su capacidad para reconocer los signos y los síntomas de la descompensación. Pacientes y métodos: Estudio transversal para determinar el nivel de autocuidado en una población de pacientes españoles ingresados en el hospital con un diagnóstico primario de IC descompensada. Para el estudio, se reclutó una muestra de conveniencia integrada por 108 pacientes (50 mujeres y 58 hombres) con una edad de 83 ± 8 años. Resultados: Para cuantificar el autocuidado en nuestra muestra se empleó el Índice de Autocuidado en Insuficiencia Cardiaca versión 6.2. La media y la desviación estándar de la subescala de mantenimiento de autocuidado del Índice de Autocuidado en Insuficiencia Cardiaca fueron: a) «ejercicio durante 30 minutos», 1 ± 1; b) «olvida tomar una de sus medicinas», 2 ± 2; c) «pedir productos bajos en sal cuando sale a comer o de visita», 2 ± 1. En el mes previo, el 67, 6% experimentó dificultad para respirar o inflamación del tobillo. Sin embargo, era improbable que la gran mayoría de nuestros pacientes implementaran de forma independiente un remedio: a) reducir sal, 2 ± 1; b) reducir la ingesta de líquidos, 1 ± 1; c) tomar un diurético extra, 1 ± 1. Más del 50% de los pacientes de nuestra muestra se sintieron confiados o muy confiados siguiendo los consejos profesionales (3 ± 1), manteniéndose libres de síntomas (3 ± 1), reconociendo los cambios en su enfermedad (3 ± 1) y valorando la importancia de dichos cambios (3 ± 1). Conclusiones: Al comparar a nuestros pacientes con IC con los de otros países el nivel de autocuidado es significativamente bajo, especialmente en lo que se refiere a la gestión de su enfermedad. La promoción del autocuidado debería ser una prioridad para todos los profesionales de la salud involucrados en la gestión de los pacientes con IC. Background: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients’ level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. Patients and methods: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83 ± 8 were recruited to participate in this study. Results: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) “exercise for 30 minutes”, 1 ± 1; b) “forget to take one of your medicines”, 2 ± 2; c) “ask for low-salt items when eating out or visiting others”, 2 ± 1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2 ± 1; b) reduce fluid intake, 1 ± 1; c) take an extra diuretic, 1 ± 1. Over 50% of our sample felt confident or very confident at following professional advice (3 ± 1), keeping themselves free of symptoms (3 ± 1), recognizing changes in their condition (3 ± 1) and evaluating the significance of such changes (3 ± 1). Conclusions: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.

Background:The Heart Failure Somatic Perception Scale (HFSPS) is a four-factor instrument used to assess how bothersome are 18 physical signs and symptoms of heart failure. To date, construct validity and reliability of the HFSPS have been evaluated in only one American study and never in a European population.Aim:To evaluate psychometric properties (validity and reliability) of the HFSPS in a European heart failure population.Methods:This was an Italian multicentre study in which the HFSPS factorial structure was assessed using confirmatory factor analysis. Criterion related validity of the HFSPS was evaluated by correlating its factor scores with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using Pearson’s r. The HFSPS internal consistency reliability was evaluated using the factor score determinacy coefficient, Cronbach’s α and model-based internal consistency index.Results:Most of the participants ( n=321) were male (56.6%), with a mean age of 71.48 years (SD, 12.75) and in New York Heart Association class II (61.8%). The confirmatory factor analysis, testing the original HFSPS four-factor structure (dyspnoea, chest discomfort, early and subtle, and oedema), resulted in the following supportive fit indices: χ2(126, N=321)=337.612, pConclusion:The validity and reliability of the HFSPS were supportive in this European sample. The HFSPS can be used to assess how bothersome heart failure signs and symptoms are in order to improve their management.

Introduction Distance learning generally is identified as all types of formal instruction that are conducted when teachers and learners are not located in the same place (Gilbert, 1995). In the mid-1990s, the Internet was hailed as the promising tool for connecting the remote teacher and learner. Indeed the Internet is flourishing in that promise. McNealy (1999) predicted that by 2002 about 84 percent of four-year colleges would be offering on-line courses via the Internet and the American Distance Education Consortium (2002, online) confirms that all forms of technology "are increasingly common components of the instructional experience for American college students." From its incarnations, Web-based distance learning's merits have been touted for their asynchronous benefits. The promise of anywhere, anyplace, anytime education (Rosenkrans, 2001; Downes, 1998; Cooper, 1999; Gubbins, Clay, & Perkins, 1999; Rose, 1999; Seymour, Durante, & Koohang, 1998) has intrigued both instructor and student alike. An increasing number of universities are experimenting with the hybrid instructional model--the newest entrant into the familiar classroom experience (Young, 2002). The hybrid instructional model is a blend of conventional face-to-face instruction and Web-based distance learning. In other words, a hybrid instructional model consists of both classroom face-to-face meetings and distance learning. The hybrid instructional model brings together classroom and technology as essential partners in instructional design. Courses designed in the hybrid instructional model move a significant portion of the learning activities from the classroom to the Web and reduce the amount of seat time. The instructor and the student have the advantages of real-time exchange in scheduled classes but have the benefit of continuing the discussion and assignments in the spaces between meetings (Young, 2002; Garnham & Kaleta, 2002). Adult students were among the first to embrace the asynchronous model for its convenience. Adult students are characteristically independent learners who are self-directed in establishing their learning objectives. They are more likely than other students to be involved in distance education programs (Thompson, 1988). Similarly, adults are particularly suited for the hybrid instructional model because it also relies on students' self-motivation. Adult learners tend to self-select, knowing that their success requires self-discipline and good time management (Koohang & Durante, 1998). The present study took place in a university that has maintained its home campuses in a large U.S. Midwestern urban region--a highly competitive college market for more than 100 years. In the last five years, the university has sought to incorporate Web-based distance learning into its conventional face-to-face programs using the hybrid instructional model. The first program to be dedicated to the hybrid approach was an accelerated undergraduate degree completion program in management designed for working adult learners. In each course, the students are required to meet face-to-face once a week. They are also required to log into a courseware known as WebCT and complete weekly Web-based distance learning activities/assignments portion of the course. These activities/assignments are designed specifically for the Web-based distance learning activities/assignments portion of the course. The hybrid program began in the 2001--2002 academic year. Courses in the program are upper division level and covered the subject areas of organizational behavior, communications, research design, human resources, management, marketing, finance, business ethics, and strategic management. To ensure the quality of the instruction, the Web-based distance learning activities/assignments portion of the hybrid program was designed based on a set of instructional parameters and objectives using appropriate androgogy (pedagogy for adult learners) to meet the specific learning needs of adult learners. …