title: Managing heart failure in the long-term care setting: nurses' experiences in Ontario, Canada.
abstract: BACKGROUND
  Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure.
  
  
  OBJECTIVE
  The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure.
  
  
  METHODS
  This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010.
  
  
  RESULTS
  Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress.
  
  
  CONCLUSIONS
  Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.
authors.affiliation: Patricia H. Strachan, PhD, RN, is Associate Professor; and Sharon Kaasalainen, PhD, RN, is Associate Professor, School of Nursing, McMaster University, Hamilton, Ontario, Canada. Amy Horton, MN, RN(EC), is Nurse Practitioner-Primary Health Care, Tutor-Ontario Primary Health Care Nurse Practitioner Program, School of Nursing, McMaster University, Hamilton, Ontario, Canada. Hellen Jarman, RN(EC), BScN, MN, GNC(C), is Nurse Practitioner-Primary Health Care, Geriatric Medicine Consultation Service, ED/Community Outreach Program, St. Mary's General Hospital, Ontario, Canada. Teresa D'Elia, MA, is Project Coordinator, Institute for Work and Health, Toronto, Ontario, Canada. Mary-Lou Van Der Horst, RN, MScN, MBA, is Assistant Clinical Professor, School of Nursing, McMaster University, Project Consultant Seniors' Health, Conestoga College and University of Waterloo-Research Institute for Aging-Schlegel Villages, Kitchener, Ontario, Canada. Ian Newhouse, PhD, is Professor, School of Kinesiology, Director of the Centre for Education and Research in Aging and Health, Lakehead University, Thunder Bay, Ontario, Canada. Mary Lou Kelley, MSW, PhD, is Lakehead University Research Chair in Palliative Care Professor, School of Social Work and Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada. Carrie McAiney, PhD, is Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. Robert McKelvie, MD, PhD, FRCPC, is Professor, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. George A. Heckman, MD, MSc, FRCPC, is Schlegel Research Chair for Geriatric Medicine, Associate Professor, Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Ontario, Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.forename: Amy
authors.initials: A
authors.lastname: Horton
authors.forename: Hellen
authors.initials: H
authors.lastname: Jarman
authors.forename: Teresa
authors.initials: T
authors.lastname: D'Elia
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: Van Der Horst
authors.forename: Ian
authors.initials: I
authors.lastname: Newhouse
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Kelley
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.forename: Robert
authors.initials: R
authors.lastname: McKelvie
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003657:Decision Making; D017144:Focus Groups; D017408:Guidelines as Topic; D006333:Heart Failure / Q000451:nursing*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008875:Middle Aged; D009735:Nursing Homes; D009864:Ontario; D036301:Qualitative Research