title: Living with heart failure: an integrative review.
abstract: OBJECTIVE
  To conduct an integrative review that explores the experiences and perceptions of patients who have heart failure to find any commonality that might enhance care giving to this patient group and areas for future research.
  
  
  BACKGROUND
  Patients are expected to take responsibility for much of the day-to-day management of their heart failure and modify their behaviour to maintain and improve their health. The degree of responsibility which patients can take is to a large extent dependant on how they see themselves in the context of their new situation. Limited research has been undertaken about how patients come to terms with their new condition and subsequent 'new self', but this has not been linked to patients' ability to take more responsibility. This review will integrate this notion of self-care, personal responsibility and the implications of this for nursing care, as this is not identified in current guidelines.
  
  
  METHODS
  Using an integrative review method, Ovid MEDLINE, CINAHL, EMBASE, AMED, HMIC, BNI and PsycINFO databases were searched from January 1985 to May 2008. 18 papers were selected that most clearly reflected the concept of understanding the patient's experience of living with heart failure.
  
  
  RESULTS
  Patients appear to undergo a process of taking on a new identity, 'a new self'. From the review five conceptual categories emerge: diagnosis and manifestations of heart failure; perceptions of day-to-day life; coping behaviours; role of others and concept of self which influences all of the other categories. This maps a journey, as the individual experiences heart failure; their success or failure at adapting to this new sense of self, will influence self-care behaviours.
  
  
  CONCLUSIONS
  Literature that explores understanding the patient's experiences of living with heart failure, taking on a new identity and the influence of this on their self-care behaviour, is limited. The integration of the new condition with patient's sense of self is likely to a have a major impact on the effectiveness of treatments offered. An essential and ethical care component for patients with heart failure should be an ongoing assessment of their experience of the situation that they live with.
authors.affiliation: Heart Failure Office, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom. jenny.welstand@ukf.net
authors.forename: Jenny
authors.initials: J
authors.lastname: Welstand
authors.forename: Alex
authors.initials: A
authors.lastname: Carson
authors.forename: Peter
authors.initials: P
authors.lastname: Rutherford
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D005190:Family / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D008019:Life Style; D016294:Models, Nursing; D008960:Models, Psychological; D024802:Nurse's Role; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D012107:Research Design; D012648:Self Care / Q000379:methods / Q000523:psychology; D012649:Self Concept; D012944:Social Support