Experiences of patients and nurses with thirst in advanced chronic heart failure: a mixed methods study

Abstract

Background Many patients with chronic heart failure (CHF) express thirst. Perceptions of thirst and strategies for reducing this symptom can differ between patients and nurses. Purpose As part of a study to develop and evaluate a nurse-based counselling intervention on thirst in patients with advanced CHF waiting for heart transplantation, we aimed to assess patients' and nurses' perceptions on thirst, possible strategies, as well as information needs and information transfer. Methods Mixed methods study consisting of semi-structured interviews with hospitalized patients waiting for a heart transplantation in Germany. Interviews focussed on experiences with thirst, needs and requirements, and experiences with the information provided by healthcare professionals. We also conducted focus groups and an online survey with German nurses with experiences in the care of cardiac patients. Topics of the focus groups were the perceptions and handling of the symptom in nursing practice as well as the provision of information and counselling. The survey was based on the results of the focus groups and current research findings. In addition to work-related data, we asked questions about the relevance of thirst, the causes of this symptom, recommended interventions and the need for counselling. We analysed quantitative data descriptively and qualitative data using content analysis. Results We conducted 10 interviews with patients (mean age: 43.5 years; 30% female; duration of CHF: 25 days to 21 years; length of stay: 7 to 116 days). All participants had a prescribed fluid restriction. Perceived thirst markedly differed between patients, with some reporting thirst to be very distressing. Most patients described that the feeling of thirst increased especially at mealtimes. Individual strategies for reducing thirst also differed between patients depended on disease durations and their therapeutic regiment. Some patients rated the information provision by healthcare professionals concerning thirst as insufficient. In addition, we conducted two focus groups with respectively 5 nurses from two university hospitals in Germany. 59 nurses participated in the survey. Nurses (81.4% working in a hospital; 54.2% already have at least 5 years of experience in care of cardiac patients) stated that the feeling of thirst in patients with CHF is of great importance in nursing practice, but only 44.1% specified to regularly assess thirst. The perceived most common cause of thirst was a prescribed fluid restriction (93.2%) and diuretics (79.7%). Among others, most nurses recommended ice cubes as intervention to reduce thirst and considered counselling interventions as important. Conclusion(s) The occurrence of thirst is an important issue for patients with advanced CHF. The perception of the symptom varies greatly. Individualised, evidence-based strategies for symptom management are required.