| Objectives1.To investigate the status of symptom clusters,perceived self-efficacy for symptom management,symptom management behavior and quality of life in patients with chronic stable heart failure,and to analyze their influencing factors.2.From the perspective of "cognitive behavior",to explore the mediating effect of perceived self-efficacy for symptom management and symptom management behavior between the symptom clusters and quality of life in patients with chronic stable heart failure.3.Based on quantitative studies,supplemented by qualitative studies,to construct a model of "The Relationships among Symptom Clusters,Perceived Self-efficacy for Symptom Management,Symptom Management Behavior and Quality of Life in Patients with Chronic Stable Heart Failure".MethodsThis study adopted the method of combining quantitative research and qualitative research,including two parts:1.The mediating effect of perceived self-efficacy for symptom management and symptom management behavior between the symptom clusters and quality of life in patients with chronic stable heart failure.Convenience sampling method was used to select 676 patients with chronic stable heart failure who were hospitalized in the Department of Cardiology in three tertiary A general hospitals in Zhengzhou,Henan Province from November 2018 to August 2019.And to investigate them with the general information questionnaire,Memorial Symptom Assessment Scale-Heart Failure,Self-Efficacy for Symptom Management Scale,symptom management subscale in the Self-management Scale of Heart Failure Patients and Minnesota Living with Heart Failure Questionnaire.IBM SPSS Statistics 21.0 was used for exploratory factor analysis,t-test,one-way analysis of variance,non-parametric test,Pearson correlation analysis and multiple stepwise regression analysis.IBM SPSS AMOS 21.0 was used to analyze the structural equation model.The test level a is 0.05 on both sides.2.Qualitative study on symptom management behavior and its influencing factors in patients with chronic stable heart failure.Objective sampling method was used to conduct semi-structured interviews with chronic stable heart failure patients whose symptom management behavior scores were ?14 or?21 in the questionnaire survey.3.According to the literature review and theoretical research,To construct the prototype of the model of "The Relationships among Symptom Clusters,Perceived Self-efficacy for Symptom Management,Symptom Management Behavior and Quality of Life in Patients with Chronic Stable Heart Failure",and then the model was improved with quantitative research results as the main and qualitative research results as the auxiliary.Results1.Patients with chronic stable heart failure had heart specific symptom cluster,emotion-digestion-sleep symptom cluster and non-specific symptom cluster,and the severity scores of the three symptom clusters were(2.14±0.97),(2.01±1.02)and(1.50±1.01),respectively.Multiple regression analysis showed that age(?=0.105),living condition(?=0.109),heart function classification(?=0.193),left ventricular ejection fraction(?=-0.389),medication compliance(?=-0.113)and regular exercise(?=0.218)were the influencing factors of the severity of heart specific symptom cluster(R2=0.502,F=112.564,P<0.001).Age(?=-0.184),living condition(?=0.086),heart function classification(?=0.316),left ventricular ejection fraction(?=-0.257)and regular exercise(?=0.149)were the influencing factors of the severity of emotion-digestion-sleep symptom cluster(R2=0.351,F=72.395,P<0.001).Living condition(?=0.079),living area(?=0.079),heart function classification(?=0.330),left ventricular ejection fraction(?=-0.177),comorbidity index(?=0.124),medication compliance(?=-0.083)and regular exercise(?=0.221)were the influencing factors of the severity of non-specific symptom cluster(R2=0.444,F=76.173,P<0.001).2.The average score of perceived self-efficacy for symptom management items in patients with chronic stable heart failure was(5.34±1.35),of which 268 patients(39.64%)had low self-efficacy level,311 patients(46.01%)had medium self-efficacy level,and 97 patients(14.35%)had high self-efficacy level.Multiple regression analysis showed that education level(?=0.176),family monthly income per capita(?=0.124),living condition(?=-0.218),living area(?=-0.071),course of heart failure(?=-0.350),heart function classification(?=-0.227),left ventricular ejection fraction(?=0.079),and comorbidity index(?=-0.152)were the influencing factors(R2=0.480,F=77.082,P<0.001).3.The total score of symptom management behavior in patients with chronic stable heart failure was(15.78 ± 3.05),of which 171(25.30%)were at a lower level,463(68.49%)were at a middle level,42(6.21%)were at a higher level.The multiple regression analysis showed that education level(?=0.342),living condition(?=-0.364),living area(?=-0.123),heart function classification(?=-0.231)and left ventricular ejection fraction(?=0.094)were the influencing factors(R2=0.553,F=165.595,P<0.001).Qualitative studies showed that the symptom management behavior of patients with chronic stable heart failure included explicit behavior and implicit behavior,among which explicit behavior included three themes,including treatment-related behavior,health promoting behavior and health hazard behavior,and including eleven subtopics.The implicit behavior includes three themes,such as cognitive processing,emotion management and volitional activity,and including eight subtopics.The influencing factors of symptom management behavior were extracted into two themes:personal factors and external factors,and including seven subtopics.4.The original score of quality of life in patients with chronic stable heart failure was(53.24± 14.19)and the total score of transformation score was(49.29±13.52).344 patients(50.89%)had low quality of life,299 patients(44.23%)had medium quality of life,33 patients(4.88%)had high quality of life.Multiple stepwise regression analysis showed that age(?=-0.159),education level(?=0.103),family monthly income per capita(?=0.075),course of heart failure(?=-0.074),medication compliance(?=0.093),regular exercise(?=-0.124),heart specific symptom cluster(?=-0.227),emotion-digestion-sleep symptom cluster(?=-164),non-specific symptom cluster(?=-0.127),perceived self-efficacy for symptom management(?=0.178)and symtom management behavior(?=0.180)were the influencing factors(R2=0.573,F=80.911,P<0.001).5.The structural equation model showed that the perceived self-efficacy for symptom management and symptom management behavior were the mediate variables(?=-0.526,P<0.01)between symptom clusters and quality of life in patients with chronic stable heart failure,and the mediating effect accounted for 32.04%of the total effect.6.Based on the results of literature review,theoretical research,quantitative research and qualitative research,the model of "The Relationships among Symptom Clusters,Perceived Self-efficacy for Symptom Management,Symptom Management Behavior and Quality of Life in Patients with Chronic Stable Chronic Heart Failure"was preliminarily formed.Conclusions1.The symptom burden of chronic stable heart failure patients was heavy.There were three major symptom clusters:heart specific symptom cluster,emotion-digestion-sleep symptom cluster and non-specific symptom cluster,and there were similarities and differences parts of influencing factors.2.The level of perceived self-efficacy for symptom management,symptom management behavior and quality of life of patients with chronic stable heart failure were low,which needs to be improved.And they were affected by many factors.3.The perceived self-efficacy for symptom management and symptom management behavior played a part of mediating role between symptom clusters and quality of life in patients with chronic stable heart failure.4.The preliminary formed the model of "The Relationships among Symptom Clusters,Perceived Self-efficacy for Symptom Management,Symptom Management Behavior and Quality of Life in Patients with Chronic Stable Heart Failure" showed that it was important to reduce the severity of symptom clusters in the treatment and nursing process of patients with chronic stable heart failure.But the improvement of perceived self-efficacy for symptom management and symptom management behavior can be as the goal of intervention,so as to alleviate some of the negative effects of their symptom clusters on quality of life. |
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