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What our profession needs to look like in the upcoming decade.

Context: Heart failure is a chronic complex syndrome that is common and burdensome. International clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients with heart failure., Objectives: The aim of this study was to conduct an integrative review to evaluate how healthcare providers perceived communication barriers to offering information to individuals in the palliative phase of heart failure., Methods: Four databases and the gray literature were searched from January 1987 to February 2017. Inclusion and exclusion criteria were applied. Studies were graded for strength and quality using a critical appraisal tool, and key themes were extracted and synthesized., Results: Ten articles met the full inclusion criteria. Most studies were qualitative or nonexperimental studies of good quality. Authors of several studies found that healthcare providers lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach., Conclusions: The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Healthcare providers caring for individuals with heart failure need palliative care knowledge, skills, and competencies to ensure that this vulnerable population receives holistic patient-centered care.

Background: Living with a left ventricular assist device has significant psychosocial sequelae that affect health-related quality of life (HRQOL)., Objective: The purpose of this study was to (1) describe psychosocial indicators of stress including perceived stress, depression, fatigue, and coping; (2) examine relationships among stress indicators by level of perceived stress; (3) examine relationships among indicators of stress and clinical outcomes; and (4) test the moderation of social support on the relationship between stress and clinical outcomes., Methods: Participants were recruited from 2 outpatient clinics in a cross-sectional study design. Standardized measures were self-administered via survey. Descriptive statistics, correlation, and multiple linear regression analysis were conducted., Results: The sample (N = 62) was mostly male (78%), black (47%), and married (66%), with a mean age of 56.5 ± 13 years. The overall sample had a moderate stress profile: moderate perceived stress (mean, 11.7 ± 7), few depressive symptoms (mean, 3.2 ± 3.9), and moderate fatigue (mean, 14.3 ± 9.1). Increased perceived stress was associated with fatigue, depressive symptoms, and maladaptive coping (P < .001). Regression analysis demonstrated that perceived stress and fatigue were significant correlates of overall HRQOL (adj. R = 0.41, P < .0001). Social support moderated the relationship between perceived stress and HRQOL, controlling for fatigue (R = 0.49, P < .001)., Conclusions: Individuals living with left ventricular assist device with high perceived stress have worse depressive symptoms, fatigue, and coping. The influence of high social support to improve the relationship between stress and HRQOL underscores the importance of a comprehensive plan to address psychosocial factors.

Background: Chronic heart failure (CHF) is an increasing and costly health problem worldwide. Effective self-care behaviors reduce the cost and improve CHF outcomes. Interventions targeting improvement of self-care need to identify the baseline status of patients and factors associated with self-care to tailor the programs to patients' needs., Aim: The aim of this study was to describe self-care and its predictors in patients with CHF in western Iran., Methods: In a cross-sectional study, 255 patients with CHF in Kermanshah were recruited and 231 (mean [SD] age, 66 [13] years; 51.5% women) completed the interviews. Self-care maintenance, self-care management, and self-care confidence were evaluated using a Persian heart failure self-care index. Each of these 3 measures had a total possible score of 100, with 22 indicators., Results: The mean (SD) self-care scores were low: maintenance, 33.8 (10.7); management, 32.2 (12.0); and confidence, 43.6 (15.6). Self-care maintenance was significantly and positively associated with education, disease duration, and living conditions. Self-care management was significantly and positively associated with education and number of hospital admissions. However, the parameter estimates in all those relationships were small., Conclusion: Self-care in patients with CHF in Iran needs major improvement, and many determinants of self-care identified by other studies were not consistently associated with poor self-care scores in Iran. Further research considering a wide range of factors associated with self-care (eg, socioeconomic and health system-related factors) and application of culturally relevant interventional strategies is recommended.

Background: Chronic heart failure (CHF) is a common burdensome health problem worldwide. Self-care improves outcomes in patients with CHF. The Self-care of Heart Failure Index (SCHFI) is a well-known scale for assessing self-care. A reliable, valid, and culturally acceptable instrument is needed to develop and test self-care interventions in Iran., Objective: We sought to translate and validate the Persian version of SCHFI v 6.2 (pSCHFI)., Methods and Results: We translated the SCHFI into Persian (pSCHFI) using standardized methods. The reliability was evaluated by assessing Cronbach's α coefficient. Expert opinion, discussion with patients, and confirmatory factor analysis were used to assess face validity, content validity, and construct validity, respectively. The analysis, using 184 participants, showed acceptable internal consistency and construct validity for the 3 subscales of pSCHFI-self-care maintenance, self-care management, and self-care self-confidence., Conclusion: The pSCHFI is a valid instrument with an acceptable reliability for evaluating self-care in Persian patients with heart failure.

Background: Coronary heart disease (CHD) is a common and costly condition and is increasing at a higher rate among Asian Indians than among other ethnic groups. An understanding of how Asian Indians perceive their risk is important for health providers to develop culturally appropriate programs to raise awareness of the risk of CHD., Objective: The aim of this survey was to investigate the attribution of risk factors for CHD among the Asian Indian community in Australia., Methods: Asian Indian community leaders were recruited to provide their views of how their community perceived the risk of CHD. An online survey collected demographic data and information from the Illness Perception Questionnaire-Revised, which measures 6 domains of illness perception: timeline acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension., Results: An 84% response rate (n = 49) was achieved from Asian Indian community leaders. Heart disease and cancer were considered to be the illnesses of major concern. Participants indicated that people in their community perceived hereditary factors (90%), hypertension, stress or worry (84%), and aging (86%) as the major cause of their illnesses. Smoking, high blood pressure, and cholesterol were identified as being major risk factors for CHD., Conclusions: These data suggest that as well as strategies to address risk factors such as diet and exercise, stress management is an important issue to consider in developing community-based programs.