title: Dyadic heart failure care types: qualitative evidence for a novel typology.
abstract: BACKGROUND
  Compared with other chronic illness populations, relatively little is known about heart failure (HF) patient and caregiver spousal/partner dyads and what effect dyadic interactions have on self-care.
  
  
  OBJECTIVE
  The aim of this study was to present a new typology of patient and caregiver dyadic interdependence in HF care, presenting exemplar cases of each type: patient oriented, caregiver oriented, collaboratively oriented, complementarily oriented.
  
  
  METHODS
  Stake's instrumental case study methodology was used. Interviews were unstructured, consisting of open-ended questions exploring dyad's experiences with HF, audiorecorded, and transcribed. Cases were selected because they exhibited the necessary characteristics and also highlighted a unique, little understood variation in self-care practice. Each case represents a dyad's discussion of caring for HF in their normal environment.
  
  
  RESULTS
  From 19 dyads, 5 exemplar case studies illustrate the 4 dyadic types. A fifth, incongruent case, defined as a case where the patient and caregiver indicated incongruent dyadic types, was included to highlight that not all dyads agree on their type. A major theme of Sharing Life infused all of the dyad's narratives. This typology advances the science of dyadic interdependence in HF self-care, explains possible impact on outcomes, and is an early theoretical conceptualization of these complex and dynamic phenomena.
  
  
  CONCLUSIONS
  The cases illustrate how long-term dyads attempt to share the patient's HF care according to established patterns developed over the trajectory of their relationship. In keeping with the interdependence theory, these couples react to the patient's declining ability to contribute to his/her own care by maintaining their habitual pattern until forced to shift. This original pattern may or may not have involved the dyad working together. As the patient's dependence on the caregiver increases, the caregiver must decide whether to react out of self-interest or the patient's interest. Continued study of the typology is needed in nonspousal/partner dyads.
authors: Harleah G. Buck, PhD, RN, CHPN Assistant Professor, School of Nursing, The Pennsylvania State University, University Park. Lisa Kitko, PhD, RN, CCRN Assistant Professor, School of Nursing, The Pennsylvania State University, University Park. Judith E. Hupcey, EdD, CRNP, FAAN Associate Dean for Graduate Education, School of Nursing, The Pennsylvania State University, University Park.
authors: Harleah G
authors: HG
authors: Buck
authors: Lisa
authors: L
authors: Kitko
authors: Judith E
authors: JE
authors: Hupcey
mesh_terms: D000368:Aged; D017028:Caregivers; D005195:Family Relations; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D012648:Self Care; D013812:Therapeutics / Q000145:classification
references: Eur J Heart Fail. 2011 Apr;13(4):377-83
references: 21216785
references: West J Nurs Res. 2012 Apr;34(3):289-316
references: 21383082
references: Heart Lung. 2007 Jan-Feb;36(1):16-24
references: 17234473
references: Heart Lung. 2001 Jan-Feb;30(1):18-25
references: 11174364
references: Res Nurs Health. 1996 Jun;19(3):183-92
references: 8628907
references: Qual Life Res. 2009 Feb;18(1):71-85
references: 19052916
references: Annu Rev Psychol. 2003;54:351-75
references: 12415073
references: J Adv Nurs. 2005 Oct;52(2):170-9
references: 16164478
references: Circulation. 2009 Sep 22;120(12):1141-63
references: 19720935
references: J Psychosom Res. 2009 Jul;67(1):29-35
references: 19539816
references: J Cardiovasc Nurs. 2007 Mar-Apr;22(2):131-7
references: 17318039
references: Eur J Cardiovasc Nurs. 2009 Jun;8(2):97-104
references: 18706865
references: Nurs Outlook. 2006 Sep-Oct;54(5):278-86
references: 17027605
references: J Cardiovasc Nurs. 2013 Mar-Apr;28(2):129-36
references: 22343213
references: Psychol Bull. 2007 Nov;133(6):920-54
references: 17967089
references: Qual Health Res. 2003 Jul;13(6):871-83
references: 12891720
references: J Cardiovasc Nurs. 2012 Jan-Feb;27(1):8-15
references: 21558868
references: J Cardiovasc Nurs. 2008 May-Jun;23(3):258-65
references: 18437068
references: Circulation. 2012 Jan 3;125(1):e2-e220
references: 22179539
references: J Am Geriatr Soc. 2002 Jun;50(6):1108-12
references: 12110073
references: Am J Hosp Palliat Care. 2009 Oct-Nov;26(5):399-404
references: 19357374
references: Gerontology. 2009;55(4):449-59
references: 19346740
references: J Cardiovasc Nurs. 2010 Mar-Apr;25(2):142-8
references: 20168194
references: Arch Intern Med. 2011 Feb 14;171(3):196-203
references: 20937916
references: Am J Cardiol. 2011 Apr 15;107(8):1203-7
references: 21310371
references: Nurs Res. 2005 May-Jun;54(3):158-66
references: 15897791
references: Nat Rev Cardiol. 2011 Jul 19;8(11):644-54
references: 21769111
references: Arch Intern Med. 2011 Feb 14;171(3):211-7
references: 20937918
references: J Cardiovasc Nurs. 2008 May-Jun;23(3):190-6
references: 18437059