title: The sliding context of health: the challenges faced by patients with heart failure from the perspective of patients, healthcare providers and family members.
abstract: OBJECTIVE
  To understand the challenges faced by patients with heart failure.
  
  
  BACKGROUND
  Heart failure is a clinical syndrome that is increasing across the globe. People affected with it encounter various problems that reduce their quality of life and well-being. Therefore, identifying the challenges faced by patients with heart failure is necessary for health care and treatment plans.
  
  
  METHODS
  This study was performed using the qualitative research approach and content analysis method.
  
  
  METHODS
  Data were collected using semistructured interviews and notes in the field of 21 Iranian participants, namely 12 patients with heart failure, three cardiologists, three nurses and three members of patient family. The data were analysed using Lundman and Graneheim qualitative content analysis.
  
  
  RESULTS
  The results of this study were revealed in the form of a theme: 'sliding context of health' in which the following three categories 'perceived threat of health and life', 'the struggle between doubt and certainty' and 'in the downward slope of quality of life' reflect the experiences of patients faced with heart failure.
  
  
  CONCLUSIONS
  The findings of this study showed that it is necessary to identify the challenges of facing heart failure, in order to support and educate patients with heart failure. Patients do not take care of themselves based on the fact that these challenges affect them psychologically and physically, and as such, the new situations are often misunderstood, thereby resulting in frequent recurrence of symptoms, mandatory hospitalisations and reduced quality of life.
  
  
  CONCLUSIONS
  Nurses, as the first line of health care, play an important role in identifying problems and supporting patients with heart failure. By acquiring knowledge and listening to the complaints of patients, interventions can be developed to improve their situation.
authors.affiliation: Department of Medical Surgical, School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Parvin
authors.initials: P
authors.lastname: Mangolian Shahrbabaki
authors.affiliation: Department of Medical Surgical, School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Esmat
authors.initials: E
authors.lastname: Nouhi
authors.affiliation: Department of Medical Surgical, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Kazemi
authors.affiliation: Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Fazlollah
authors.initials: F
authors.lastname: Ahmadi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005190:Family / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006333:Heart Failure / Q000451:nursing / Q000523:psychology*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D036301:Qualitative Research; D011788:Quality of Life; D035501:Uncertainty
keywords: heart failure; nurse; nursing; patient experience; qualitative content analysis