The ‘work’ of self-care for people with cardiovascular disease and prediabetes: An interpretive description

Background: Cardiovascular disease and sustained high blood glucose (prediabetes) are established concurrent diagnoses. People with these concomitant conditions carry out self-care which is overt (e.g., daily weighing or taking a specific diet), plus there are also concealed facets of self-care (e.g., accessing information about diet or medications). Also of note is the need to 'work' to achieve a self-determined level of self-care. The 'work' put into self-care is currently under-reported when people discuss their progress with health professionals. Objective: Our research aimed to demonstrate that aspects of self-care are typically concealed. A further objective was to reveal the extent of 'work' dedicated to self-care. Design: Interviews were conducted with 23 participants to reveal their experiences of long-term conditions, cardiovascular disease and prediabetes. Interpretive description underpinned the development of a thematic representation of the data. Setting and participants: Recruitment was from a tertiary hospital coronary care unit in New Zealand. Included participants were those with an acute coronary event, also found to have a high blood glucose. Those people known to have diabetes prior to admission were not included. Method: Participants were interviewed once, for approximately 60 min, nine months after discharge home. The data is analysed using thematic analysis, organising an interpretation into themes. Results: Self-care requires 'work', the work itself was frequently understated by participants, they trivialised their important role in their self-care. Participants often required prompting to discuss the responsibilities, choices and behaviours they participated in to support self-care to improve their health and well-being. Participant data showed how the 'work' of self-care aligned to three work themes: solo self-care, teamwork, and constant companion self-care. Conclusion: Nurses can improve the outcomes for people with long-term conditions by acknowledging and incorporating the often concealed 'work' of self-care when assessing, planning and implementing health care in any clinical setting. A important recommendation for nurses is to support people-as-patients, by encouraging self-determination and working with the preferences patients have for self-care, in order to enhance their quality of life while living with ill-health.