The process of self-care in patients with heart failure after nurse-assisted remote patient monitoring: A qualitative longitudinal approach.

Background: Effective self-care, including symptom monitoring and treatment adherence, is essential for individuals with heart failure. It can enhance quality of life, improve survival, and reduce hospital admissions. The home is the primary setting where individuals with heart failure perform self-care. However, many struggle to recognize symptoms that indicate worsening of their condition. Remote patient monitoring allows nurses to track symptoms, weight, and blood pressure while supporting self-care behaviours that help prevent exacerbations. A clearer understanding of these interventions is needed, particularly regarding how they influence patients' views on self-care over time. Objective: This study explored short- and long-term experiences of self-care among individuals with heart failure after a six-week, nurse-assisted remote patient monitoring intervention. Setting: Twelve participants were recruited from the intervention group in a randomised controlled trial. Clinical trial ID 301472. Methods: This study employed a qualitative longitudinal approach. Eleven semi-structured interviews were conducted at two time points: at time one, immediately after participants had completed the nurse-assisted remote patient monitoring intervention; and at time two, six months post-discharge. One participant did not respond to the second interview, resulting in 23 interviews in total. A qualitative content analysis was undertaken to explore the evolving self-care process over time. Results: 'Transition from digital dependence to independent self-care management' emerged as the overarching theme describing participants' experiences at both time points. This theme was illustrated by four subthemes identified at time one: (1) guidance to interpret symptoms and bodily signs; (2) establishing a daily routine in monitoring vital signs; (3) support for changes in lifestyle and medication adherence; and (4) sense of security. At time two, three subthemes were identified: (1) increased confidence in bodily awareness and symptom monitoring; (2) recognition of self-care routines; and (3) feeling in control due to prior feedback from a previous nurse navigator. Conclusions: Individuals with heart failure experienced self-care as an evolving process. This was demonstrated by their transition from reliance on digital support from nurses and the remote patient monitoring intervention to increased independence and proactivity in managing their self-care. There is an urgent need to respond to the pressures facing overburdened health-care systems. These findings highlight the importance of developing a digital environment that supports sustainable transitional care from hospital to home for individuals with heart failure. Registration: The main randomised controlled trial project, "eHealth@hospital-2-home," is registered under ClinicalTrials.gov ID: 301472. It was registered on 27.02.2023, with the first recruitment commencing on 03.05.2023.