Patients’ experiences of physical limitations in daily life activities when suffering from chronic

EMPIRICAL STUDIES doi: 10.1111/j.1471-6712.2010.00780.x

Patients’ experiences of physical limitations in daily life

activities when suffering from chronic heart failure;

a phenomenographic analysis

Emma Pihl MNSc, RN (Doctoral Student)1,2

, Bengt Fridlund PhD, RNT (Professor)2

and Jan Ma˚rtensson PhD, RN

(Associate Professor)2,3

1

School of Social and Health Sciences, Halmstad University, Halmstad, 2

School of Health Sciences, Jo¨nko¨ping University and 3Unit of Research

and Development in Primary Care, Jo¨nko¨ping, Sweden

Scand J Caring Sci; 2011; 25; 3–11

Patients’ experiences of physical limitations in daily life

activities when suffering from chronic heart failure;

a phenomenographic analysis

The aim of the study was to describe how patients suffering

from chronic heart failure conceived their physical limita￾tions in daily life activities. An explorative and qualitative

design with a phenomenographic approach was chosen, a

total of 15 patients were interviewed. The findings indicate

that participants perceived a variety of structural aspects

pertaining to physical limitations in activities of daily life

which resulted in four referential aspects. Need of finding

practical solutions in daily life focused on how life had to be

changed and other ways of performing activities of daily life

had to be invented. Having realistic expectations about the

future was characterised by belief that the future itself

would be marked by change in physical functioning, but an

incentive to maintain functions and activities ensured good

quality of or even increased capacity in daily life. Not

believing in one’s own ability included the perception of

having no opportunity to improve ability to perform

activities of daily life. There were perceptions of undesired

passivity, undefined fear of straining themselves or

performing activities that could endanger their health in

addition to uncertainty about the future. In Losing one’s

social role in daily life, participants described losing their

social network and their position in society and family

because of limited physical capacity. A lack of important

issues, mental and physical, occurred when physical

capacity was lost. In conclusion, patients suffering from

chronic heart failure found new solutions to manage activ￾ities in daily life, including willingness to change focus and

identify other ways of doing important things. Patients had

an incentive to maintain functions and activities to ensure a

good quality of and strengthen their physical capacity in

daily life. Inability to trust in their physical capacity in

combination with experienced limitations in daily life

prevented patients from attempting to increase activities.

Keywords: activities of daily life, chronic heart failure,

elderly, nursing care, phenomenography, physical

limitations.

Submitted 13 March 2009, Accepted 12 January 2010

Background

Chronic heart failure is a common condition among

Europe’s ageing population. The syndrome occurs at a

median age of around 75 (1) and affects 1–3% of the

general population and approximately 10% of elderly

people (2). The number of people suffering as well as dying

from chronic heart failure will increase as a result of

improved treatment and survival rates for other cardio￾vascular diseases (3). Another contributory factor is

heightened awareness of heart failure syndrome resulting

in more people receiving the diagnosis in combination

with the rapidly growing proportion of elderly individuals

in the population (4). Chronic heart failure is commonly

defined as a pathological state in which an abnormality in

cardiac functioning is responsible for failure of the heart to

pump blood at a rate commensurate with the requirements

of the metabolising tissues (1). The severity of heart failure

ranges from no physical limitations whatsoever to major

restrictions in daily life, see Fig. 1. Chronic heart failure is a

difficult disease to live with and places a great burden on

the patient, his/her family and society (2). In a review on

the subject of life situation, Yu et al. (5) described chronic

Correspondence to:

Mrs. Emma Pihl, Halmstad Central Hospital, Area 3, 301 85

Halmstad, Sweden.

E-mail: [email protected]

2010 The Authors

Scandinavian Journal of Caring Sciences 2010 Nordic College of Caring Science 3