Date of Conferral







Leslie C. Hussey


Heart failure patients are responsible for managing fluctuations in symptoms between exacerbations by employing treatment adherence, active monitoring, and management strategies based on expert guidelines. Despite education, delayed help seeking persists among those in the need of acute medical intervention, as evidenced by high hospital admission and readmission rates. The purpose of this qualitative grounded theory study was to explore the decision making processes undertaken by heart failure, community-dwelling individuals as they experience symptom changes. Eighteen face-to-face interviews were conducted with participants who had heart failure and received self-management education from a home care agency in Southern Ontario, Canada. Data were analyzed using iterative steps of open, axial, selective coding, and qualitative software text queries. Three process themes were identified: perceiving symptoms, normalizing symptoms, and adapting to symptoms, with an overarching theme of control and absence of consultative behaviors. The central concept revealed in this study was normalizing symptoms in heart failure which included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and a loss of functional capacity. These findings can be used to inform system changes needed to strengthen consultative patient-health professional relationships required for effective self-management problem-solving. This study leads to positive social change by explaining how self-management is practiced from the patient's perspective, which can inform practice recommendations and future research.