title: Factors associated with the development of expertise in heart failure self-care.
abstract: BACKGROUND
  Self-care is vital for successful heart failure (HF) management. Mastering self-care is challenging; few patients develop sufficient expertise to avoid repeated hospitalization.
  
  
  OBJECTIVE
  To describe and understand how expertise in HF self-care develops.
  
  
  METHODS
  Extreme case sampling was used to identify 29 chronic HF patients predominately poor or particularly good in self-care. Using a mixed-methods (qualitative and quantitative) design, participants were interviewed about HF self-care, surveyed to measure factors anticipated to influence self-care, and tested for cognitive functioning. Audiotaped interviews were analyzed using content analysis. Qualitative and quantitative data were combined to produce a multidimensional typology of patients poor, good, or expert in HF self-care.
  
  
  RESULTS
  Only 10.3% of the sample was expert in HF self-care. Patients poor in HF self-care had worse cognition, more sleepiness, higher depression, and poorer family functioning. The primary factors distinguishing those good versus expert in self-care were sleepiness and family engagement. Experts had less daytime sleepiness and more support from engaged loved ones who fostered self-care skill development.
  
  
  CONCLUSIONS
  Engaged supporters can help persons with chronic HF to overcome seemingly insurmountable barriers to self-care. Research is needed to understand the effects of excessive daytime sleepiness on HF self-care.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6096, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Victoria
authors.initials: V
authors.lastname: Vaughan Dickson
authors.forename: Lee R
authors.initials: LR
authors.lastname: Goldberg
authors.forename: Janet A
authors.initials: JA
authors.lastname: Deatrick
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003071:Cognition / Q000145:classification*; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000188:drug therapy / Q000628:therapy*; D015399:Nursing Research / Q000379:methods*; D011787:Quality of Health Care; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012890:Sleep
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors