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.