Theoretical Foundations for Research:
Fatigue in Congestive Heart Failure Implications for Chronic
Disease Management
Walden UniversityConstance Schumacher RN BScN MSN
Phenomenon: Fatigue in Congestive Heart FailureFatigue is a
common symptom of Congestive Heart Failure (Heart and Stroke
Foundation of Ontario, 2010).Concept DescriptorsOverwhelming,
sustained sense of exhaustion Persistent tirednessDecreased
capacity for physical and mental workIncreased dependency(North
American Nursing Diagnosis Association, 2004; Trendall, 2000; Yang
& Wu, 2005)
Fatigue Mental Work (Cognition) Decision Making
2
The Middle-Range Theory of Unpleasant Symptoms Lenz, Pugh,
Milligan, Gift, & Suppe (1997)
Performance
Functional Status: Role
Cognitive Functioning: Problem Solving
Physical Performance: Activity Level
Fatigue from three dimensions Physiological, Psychological, and
SituationalImpacting performance Relational statements mirrored in
the tasks of self-care stages.3
Self-Care in Congestive Heart FailureSelf-Care is comprised of
self-care maintenance, self-care monitoring, and self-care
management (Riegel, Jaarsma, & Stromberg, 2012).
Self-Care Management DescriptorsRecognition of alteration in
health status, reflection, insight, decision making, and deliberate
actions to promote a healthy state (Harkness et al., 2014; Orem,
2001; Riegel et al., 2012).
Recognition Reflect/Insight Decision Making Action
Relational statements : Reflection/Insight related to relational
statements in the theory of unpleasant symptoms (Cognition/ Problem
Solving)4
A Middle-Range Theory of Self-Care of Chronic Illness:
Congestive Heart Failure
Adapted from A Middle-Range Theory of Self-Care of Chronic
Illness. Riegel, Jaarsma, & Stromberg (2012)
Self-care as a complex cyclic process of tasks.5
Self-Care Management in the Presence of Unpleasant
SymptomsAdapted from Middle-Range Theory of Self-Care of Chronic
Illness and Middle-Range Theory of Unpleasant Symptoms. Riegel,
Jaarsma, & Stromberg (2012); Lenz, Pugh, Milligan, Gift, &
Suppe (1997)Constance Schumacher
Implications : Practice; The model breaks down the process of
self-care when influenced by unpleasant symptoms, this helps to
identify areas that are critical for successful management skills.
If the cognitive component of recognition, decision making is not
optimized the patient will not initiate the help seeking behaviors
required to halt/minimize an impending exacerbation. Are recall and
teach-back methods of evaluating health literacy accurate
reflections of whether the patient has acquired insight and adopted
the behavior skill of help seeking? Do patients that experience
fatigue require decision making support measures to decrease
exacerbations (telemedicine, nurse monitoring).Theory: Towards a
theory of adherence in chronic illness.6
ReferencesHarkness, K., Heckman, G. A., Akhtar-Danesh, N.,
Demers, C., Gunn, E., & McKelvie, R. S. (2014). Cognitive
function and self-care management in older patients with heart
failure. European Journal of Cardiovascular Nursing, 13(3),
277-284.Heart and Stroke Foundation of Ontario. (2010). End of Life
Planning and Care for Heart Failure Patients. Retrieved from
www.heartandstroke.on.ca/.../END%20OF%20LIFE%20PLANNING%2...Lenz,
E., Pugh, L., Milligan, R., Gift, A., & Suppe, F. (1997). The
middle-range theory of unpleasant symptoms: An update. Advances in
Nursing Science, 19(3), 14-27. North American Nursing Diagnosis
Association. (2004). Nursing diagnosis: Definitions and
classification, 2003-2004. Philadelphia, PA: NANDA.Orem, D. (2001).
Nursing concepts of practice (6th Ed.). St. Louis: Mosby.Riegel,
B., Jaarsma, T., & Stromberg, A. (2012). A middle-range theory
of self-care of chronic illness. Advances in Nursing Science,
35(3), 194-204.Trendall, J. (2000). Concept analysis: Chronic
fatigue. Journal of Advanced Nursing, 32(5), 1126-1131.Yang, C.,
& Wu, C. (2005). The situational fatigue scale: A different
approach to measuring fatigue. Quality of Life Research, 14,
1357-1362. doi: 10.1007/s11136-004-5680-0
