Journal of Cardiovascular Nursing Vol. 34, No. 2, pp. E28–E35 x Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Caregiver Contribution to Self-care in Patients With Heart Failure A Qualitative Descriptive Study Angela Durante, MSN, RN; Marco Paturzo, PhD, RN; Antonella Mottola, PhD, RN; Rosaria Alvaro, MSN, RN, FESC; Victoria Vaughan Dickson, PhD, CRNP, FAHA, FAAN; Ercole Vellone, PhD, RN, FESC Background: Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe. Objective: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur). Methods: Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis. Results: Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic). Conclusions: Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices. KEY WORDS: Self-care, Caregivers, Heart failure, symptom assessment, treatment adherence and compliance, health behavior H eart failure (HF) is a chronic syndrome that has an important impact on the world population. In Europe and the United States, HF affects approximately 15 million and 6.5 million people, respectively, 1,2 with an increasing prevalence due to the aging of the population. Heart failure has an important impact on patients' quality of life because of recurrent hospitalizations and the bur- den caused by its symptoms (eg, fatigue). 3,4 To cope with the burden caused by this disease, self- care performed by patients with HF is a cornerstone of Angela Durante, MSN, RN PhD Student, Department of Biomedicine and Prevention University of Rome Tor Vergata, Italy. Marco Paturzo, PhD, RN Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy; Military Nurse (current), CELIO Military Hospital of Rome, Italy. Antonella Mottola, PhD, RN Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy; Nurse Manager (current), San Pio Hospital, Benevento, Italy. Rosaria Alvaro, MSN, RN, FESC Professor, Department of Biomedicine and Prevention University of Rome Tor Vergata, Italy. Victoria Vaughan Dickson, PhD, CRNP, FAHA, FAAN Associate Professor, New York University Rory Meyers College of Nursing. Ercole Vellone, PhD, RN, FESC Assistant Professor, Department of Biomedicine and Prevention University of Rome Tor Vergata, Italy. The authors have no conflicts of interest to disclose. The Centre of Excellence for Nursing Scholarship, Rome, Italy, funded this study. Correspondence Angela Durante RN, MSN, Department of Biomedicine and Prevention University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy (angela.durante@uniroma2.eu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jcnjournal.com). DOI: 10.1097/JCN.0000000000000560 E28 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.