Discussion
It is clear that adaptation of patients with long-term complications of
chronic diseases had important role in controlling of disease and
improve and promote of their quality of life[14,
19].Research findings indicated that care plan based on Roy
adaptation model can influence maladaptive behaviors of patients with
heart failure in all physiologic, self-concept, role function and
interdependence modes, so that significant reduction was observed in the
number of maladaptive behaviors after intervention compared to before
intervention. This finding is in line with studies conducted by studies
of [20-22].They have revealed that mean score of
all adaptation dimension of Roy adaptation model significantly increased
after intervention. But this finding is not line with studies conducted
by [14, 18].that cause can be difference in
research tools and cultural components. Patients with heart failure are
required to perform some activities, pursue care recommendations, and
change life style in order to control and avoid consequences of the
disease. Thus, involving patients in implementation of these adaptation
behaviors as well as change and manipulation of stimulus of maladaptive
behaviors is an important factor in adaptation with heart failure
disease. Therefor can be say Roy model of adaptation is one of the most
widespread nursing models in coming to terms with diverse illnesses and
problems.
Findings of this research showed effectiveness of the proposed care plan
in improvement of patient’s ability in performing daily activities in
intervention group, so that significant statistical difference was
observed in intervention group before and after intervention. While no
significant statistical difference was observed in control group before
and after intervention. This finding is in line with study conducted by[19]with titled using Roy model on daily
activities of hemodialysis patients, study of [23]conducted a on daily activities of patients with MS using self-care
program based on Orem’s model and study of [24]with title effects of antenatal education on maternal prenatal and
postpartum adaptation. They found that using nursing theories has
positive effect on increasing ability to perform daily activities of
patient’s life. The patient’s ability to perform life daily activities
is one of the important indicators in order to assess the role
performance compatibility that the results of this study indicate the
effectiveness of the provided care plan in improving the patient’s
ability to perform life daily activities in the intervention group.
In the present study, results showed the mean Piper fatigue score in the
pre and post intervention stage was significantly different in the
intervention group in behavioral, emotional, sensory, and cognitive
aspects of Piper’s fatigue scale ,so that mean score of fatigue in each
aspect was decreased in intervention group. While no difference was
observed in control group. This finding is in line with studies
conducted by [4, 10, 23, 25, 26]. Various methods
have been investigated for reducing fatigue in patients with heart
failure. Including music and back massage [7],
energy conservation techniques [3]and acupressure[1], although these methods have helped patients
with heart failure, the nature of the programs should be taken into
account. That is, the more they are derived from their needs; motivation
and empathy are increased in patient and family and empowers them. The
present study also indicated that the implementation of a care program
based on Roy adaptation model, adapted from their educational and
tangible needs, is significantly effective on the fatigue of patients.
The results of this study showed that there was a significant
relationship between the duration of time heart failure disease and
frequency of hospitalization with fatigue in both intervention and
control groups so that, the mean score of fatigue was less than other
participants in patients hospitalized twice a month because of the
nature of the disease and their duration of heart failure was 5 years or
less. This result was consistent with similar studies performed in other
chronic patients such as the studies of[18,
27].They also reported in their studies that the more the frequency
of hospitalization, the more the fatigue of individuals. According to
the high prevalence of fatigue in heart failure patients because of the
nature of disease, it is needed to provide necessary measures and
facilities by health authorities in order to provide community-based
therapeutic care, especially at home, to prevent multiple
hospitalizations and increase well-being in these people.
The results of this study showed that there was a significant
relationship between the duration of time heart failure disease and
frequency of hospitalization with daily activities level so that, the
mean score of daily activities level in the participants both control
and intervention groups was more than other participants in the first 5
years of heart failure and hospitalization twice per month. This result
was consistent with the results of studies by[28,
29]. Therefore, the nurses and patient’s family must perform
necessary interventions in order to increase life daily activities level
and appropriate lifestyle patterns by increasing the disease duration
through education. There was no significant relationship between other
demographic features of the participants with daily activities level and
fatigue in both control and intervention groups. In general, the absence
of a significant relationship between some demographic information and
fatigue does not mean that there is no real relationship, but the sample
size of this study was not estimated to investigate these relationships.
More specific studies with appropriate sample size and focus on these
variables are needed to investigate these relationships.