Introduction
Heart failure is regarded as the common ultimate path for all cardiac disorders [1]. Prevalence of heart failure is increasing in the world [2]. According to reports for American Heart Association in 2016, it is estimated that currently 5.7 million individuals in USA live with heart failure and annually 5500000 ones are caught by this disease [3]. Heart failure is also regarded as a major mortality factor in Iran, and by changing the age pyramid of society and population aging, in the near future, the current outbreak will be 3,500 patients per one hundred thousand people [4]. It is estimated that between 30-56.6 percent of patients with heart failure are re-admitted to the hospital at the first trimester after admission[5].
Heart failure, in addition to imposing heavy costs on the individual and the community, has many complications and side effects for the patient. Often, these patients experience symptoms such as dyspnea, fatigue, sleep disturbances, depression, and chest pain, which limit the patient’s daily social and physical activity and reduce the quality of life [6]. Fatigue often neglected because the relatives and the treatment team treat it as an ambiguous and indeterminate complaint. In the physical dimension, fatigue is experienced as the absence of energy and need for rest, in the cognitive dimension, there is a defect in the concentration of the senses and in the emotional dimension, it is experienced in the form of a decrease in motivation or interest [3]. Prevalence of fatigue in heart failure varies between 50 - 96 percent, and it is associated with increased mortality risk in patients with heart failure by 2-3 times [1].
Fatigue and non-tolerance of activity in these patients causes loss of independence in performing common life activities, and makes them dependent on others in self-care. Thus, it influences quality of their life. Therefore, paying attention to fatigue in patients in highly important in heart failure management programs[7]. Meanwhile, nurses often are in the best situation for identifying symptoms of fatigue and investigating effect of these symptoms on daily performance, interpersonal relationships, and quality of life of patients [3]. One of the solutions for clinical readiness of nurses is scientific care based on standard care models [8]. On the other hand, using nursing theories in studies is regarded as an attempt for validating nursing theories, organizing nursing measures, and generating knowledge[9]. Thus, diagnosis and training self-care methods and adaptation with current status, which eliminate or reduce fatigue in these patients, would be highly effective[10]. Overall, various models and theories have been proposed in relation with adaptation with chronic diseases[11].
Roy model is one of the nursing models that were designed for better understanding of adaptation concept [12]. Based on Roy model, the human being is a biologic, psychological, social, and spiritual creature, which is in relation with his surrounding environment and uses adaptation mechanisms for preserving balance[13]. “Roy” introduces this model as follows: in order to achieve this goal, the patient requires to achieve physical adaptation (physiologic dimension) and psychological adaptation in different dimensions (self-concept, role function, interdependence)[14]. A nurse according to this model, systematically and carefully survey the patient through observation and interview. Then, she specifies the maladaptive behavior, which is in fact the patient’s problems, in four dimensions, along with the stimulus of behavior (causes), and subsequently, designs the precise educational and care plans to address the patient’s problems (maladaptive behaviors)[11]. study of Bakan and Akyol reported that using Roy model caused increased adaptation in patients with heart failure[15]. researchers used Roy’s Adaptation Theory in cardiac patients as a suitable tool for patient care and performing nursing measures [16].
Considering above-mentioned material, fatigue and reduced or inability of patients with heart failure in performing daily activities are raised as maladaptive behaviors, which require nursing attention. Thus, diagnosis and training effective adaptation methods in this regard would be valuable. In Iran less studied the application of this model on fatigue and daily activities of patients with heart failure. Therefore, due to the importance of this issue the present research was designed and carried out to investigate effect of care plan based on Roy adaptation model on fatigue and daily activities of patients with heart failure.