Development of nursing practice model supporting activity adjustments in patients with heart failure undergoing outpatient cardiac rehabilitation (SAAHF-NPM)

Abstract Background/Introduction Japanese patients with heart failure (HF) attend outpatient cardiac rehabilitation (OCR) less frequently than clinical guideline recommendations, which also require supplementation with home-based cardiac rehabilitation 1. Managing and adjusting physical activity independently is challenging for patients with HF due to various barriers 2. Structured support during OCR visits that facilitate exercise and daily activity adjustments may yield benefits similar to supervised exercise therapy. However, specific nursing support strategies remain underexplored. Purpose The purpose of this study was to describe the development and refinement process of a nursing practice model (SAAHF-NPM) supporting activity adjustment in patients with HF undergoing OCR. Methods The SAAHF-NPM was developed using a comprehensive iterative approach 3. In phase 1, a qualitative synthesis and grounded theory study explored physical activity experiences in patients with HF and noted how patients undergoing OCR integrated rehabilitation into daily activity adjustment. Next, the Capability, Opportunity, Motivation and Behaviour (COM-B) model 4 was used as a theoretical basis to understand patient behaviours related to activity adjustment, and a comprehensive literature review on interventions and guidelines was conducted. Based on obtained results, we examined and modelled the goals, structure, process and outcomes of nursing support for activity adjustment in patients with HF, and the SAAHF-NPM and a practice guidebook for clinical implementation were developed. In phase 2, a survey and focus group interviews were conducted with 10 expert HF and CR nurses to discuss the clarity, feasibility and practical appropriateness of the SAAHF-NPM and the practice guidebook; refinements were made based on obtained. Results The SAAHF-NPM provides a framework for nursing practice that "motivates patients to adjust their activities, enhance their capabilities, and utilize available opportunities aligned with their cardiac conditions and living situations." The SAAHF-NPM identifies elements requiring support through assessment of three elements that trigger activity adjustment behaviour in patients with HF: "motivation", "opportunity" and "capability". The model outlines a series of processes for planning, implementing and evaluating the support required for identified patient needs. The practical guide contains detailed information on how to use the SAAHF-NPM (e.g. explanations of activity adjustment assessments and specific support content). Conclusion The SAAHF-NPM offers a patient-centred framework for assessing and addressing activity adjustment in patients with HF. The model is expected to enhance development, execution and evaluation of individualized intervention plans while promoting effective activity management for patients with HF. Future research will focus on clinical application and evaluation of model feasibility, acceptability, and effectiveness.