Discussion
It is clear that adaptation of patients with long-term complications of chronic diseases had important role in controlling of disease and improve and promote of their quality of life[14, 19].Research findings indicated that care plan based on Roy adaptation model can influence maladaptive behaviors of patients with heart failure in all physiologic, self-concept, role function and interdependence modes, so that significant reduction was observed in the number of maladaptive behaviors after intervention compared to before intervention. This finding is in line with studies conducted by studies of [20-22].They have revealed that mean score of all adaptation dimension of Roy adaptation model significantly increased after intervention. But this finding is not line with studies conducted by [14, 18].that cause can be difference in research tools and cultural components. Patients with heart failure are required to perform some activities, pursue care recommendations, and change life style in order to control and avoid consequences of the disease. Thus, involving patients in implementation of these adaptation behaviors as well as change and manipulation of stimulus of maladaptive behaviors is an important factor in adaptation with heart failure disease. Therefor can be say Roy model of adaptation is one of the most widespread nursing models in coming to terms with diverse illnesses and problems.
Findings of this research showed effectiveness of the proposed care plan in improvement of patient’s ability in performing daily activities in intervention group, so that significant statistical difference was observed in intervention group before and after intervention. While no significant statistical difference was observed in control group before and after intervention. This finding is in line with study conducted by[19]with titled using Roy model on daily activities of hemodialysis patients, study of [23]conducted a on daily activities of patients with MS using self-care program based on Orem’s model and study of [24]with title effects of antenatal education on maternal prenatal and postpartum adaptation. They found that using nursing theories has positive effect on increasing ability to perform daily activities of patient’s life. The patient’s ability to perform life daily activities is one of the important indicators in order to assess the role performance compatibility that the results of this study indicate the effectiveness of the provided care plan in improving the patient’s ability to perform life daily activities in the intervention group.
In the present study, results showed the mean Piper fatigue score in the pre and post intervention stage was significantly different in the intervention group in behavioral, emotional, sensory, and cognitive aspects of Piper’s fatigue scale ,so that mean score of fatigue in each aspect was decreased in intervention group. While no difference was observed in control group. This finding is in line with studies conducted by [4, 10, 23, 25, 26]. Various methods have been investigated for reducing fatigue in patients with heart failure. Including music and back massage [7], energy conservation techniques [3]and acupressure[1], although these methods have helped patients with heart failure, the nature of the programs should be taken into account. That is, the more they are derived from their needs; motivation and empathy are increased in patient and family and empowers them. The present study also indicated that the implementation of a care program based on Roy adaptation model, adapted from their educational and tangible needs, is significantly effective on the fatigue of patients.
The results of this study showed that there was a significant relationship between the duration of time heart failure disease and frequency of hospitalization with fatigue in both intervention and control groups so that, the mean score of fatigue was less than other participants in patients hospitalized twice a month because of the nature of the disease and their duration of heart failure was 5 years or less. This result was consistent with similar studies performed in other chronic patients such as the studies of[18, 27].They also reported in their studies that the more the frequency of hospitalization, the more the fatigue of individuals. According to the high prevalence of fatigue in heart failure patients because of the nature of disease, it is needed to provide necessary measures and facilities by health authorities in order to provide community-based therapeutic care, especially at home, to prevent multiple hospitalizations and increase well-being in these people.
The results of this study showed that there was a significant relationship between the duration of time heart failure disease and frequency of hospitalization with daily activities level so that, the mean score of daily activities level in the participants both control and intervention groups was more than other participants in the first 5 years of heart failure and hospitalization twice per month. This result was consistent with the results of studies by[28, 29]. Therefore, the nurses and patient’s family must perform necessary interventions in order to increase life daily activities level and appropriate lifestyle patterns by increasing the disease duration through education. There was no significant relationship between other demographic features of the participants with daily activities level and fatigue in both control and intervention groups. In general, the absence of a significant relationship between some demographic information and fatigue does not mean that there is no real relationship, but the sample size of this study was not estimated to investigate these relationships. More specific studies with appropriate sample size and focus on these variables are needed to investigate these relationships.