Date of Award

2001-08-01

Degree Name

PhD Nursing

Dissertation Committee

Jane Georges, PhD, RN, Chair; Diane Hatton, DNSc, RN; Sandra Bibb, DNSc,RN

Keywords

Chronic Heart Failure, nursing, postmodern feminism, women

Abstract

Nationwide, approximately 4.1 million Americans suffer from chronic heart failure accounting for estimated direct and indirect costs of over $21 billion spent annually for health care. The incidence of heart failure has doubled each decade since the 1940's and slightly more men were inflicted with the illness. This trend changed three years ago, with a decline in the overall incidence of heart failure and a slight predominance of the illness in women rather than men. The incidence of this condition was reduced in males nearly three times that of females. Women survive longer after diagnosis, however they are hospitalized more, and they have more symptoms and a poorer quality of life. There is a significant gender gap in scientific and therapeutic progress made with heart failure. Most research and clinical trials were conducted using primarily male subjects, and then findings applied to women. The heightening trends in women with heart failure question whether findings from this research are beneficial for women. Until new scientific and therapeutic advances are developed using research with female participants, women with heart failure are destined to living with their illness and current therapies. In light of these issues, a grounded theory study was completed that explored women's experiences with chronic heart failure. A postmodern feminist lens informed a critical analysis of the literature, research procedures, methods to achieve rigor, and the discussion of findings. Data collection using participant observation and interviewing occurred in two major Naval Medical Centers. Dimensional analysis was used as a method of data analysis to generate a theoretical model exploring the phenomenon under study. Two parsimonious dimensions, network and health care emerged as the most salient. A social network was instrumental for women in their journey of finding out they had heart failure, through a process of psychosocial remodeling to living with chronic heart failure. This network was significant in helping women overcome challenges of lifestyle changes, health care and illness management. The heart failure management approach, provider-client relationships and communication influenced women's physical and psychosocial health and satisfaction with their health care. Experiences with health care inspired women to send messages to other women and health care providers as recommendations for improved health care practices and illness management for women with chronic heart failure. Historical and social perspectives, and gender issues in pathophysiology, therapies and provider-client relationships must inform nursing practice for women with chronic heart failure. Partnerships and multidisciplinary health care approaches, such as a heart failure clinic were popular among this sample and are recommended for women with chronic heart failure. Possibilities for research that stem from this study are vast.

Document Type

Dissertation: Open Access

Department

Nursing

Included in

Nursing Commons

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