{'fraction_non_alphanumeric': 0.027627162406403304, 'fraction_numerical': 0.005680351148980119, 'mean_word_length': 5.015527950310559, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Foreword: Self-care of Heart Failure: What Is the State of the Science?

This issue of the Journal of Cardiovascular Nursing focuses on the self-care required of adults with heart failure (HF). Self-care refers to the behaviors that individuals engage in and the decisions they make about activities that promote health and limit illness. In HF, self-care is the cornerstone of therapy. Although much of the general HF literature focuses on the care that persons with HF receive from healthcare providers, in reality, most HF care occurs at home and is done by patients and their families. That is, most of the care that patients receive for HF is self-care. As shown in Figure 1, research into HF self-care has grown exponentially since Medline first began indexing this literature. As of January 2008, there were 204 articles on HF self-care indexed in Medline. Clearly, interest in this topic is growing. Also, the science related to this topic has burgeoned. The purpose of this issue of the Journal of Cardiovascular Nursing is to review what is known about the science of HF self-care. The issue begins with a situation-specific theory of HF self-care. In this article, Riegel and Dickson define self-care as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Confidence in self-care is proposed as moderating and/or mediating the effect of self-care on various outcomes. This article begins with a discussion of related terms (eg, treatment adherence and self-monitoring). Then, the authors test 4 propositions derived from the self-care of HF conceptual model of Riegel and colleagues and test these propositions using data obtained in previous research, lending early support to their situation-specific theory of HF self-care. The self-care behaviors that clinicians routinely counsel HF patients to engage in are weighing themselves daily, monitoring for swelling, taking their prescribed medications, following a low-sodium diet, staying physically active, avoiding illness with routine immunizations, and consulting regularly with providers. Many of us are in a quandary about whether to encourage HF patients to attain and maintain a normal body weight. Of these behaviors, the one that seems to challenge patients the most is following a lowsodium diet. In this issue, Lennie reviews the state of the science in sodium restriction recommendations, nutrition recommendations, body weight recommendations, and strategies to improve nutrition self-care. He concludes that the current state of knowledge is insufficient for clinicians to provide evidence-based interventions to improve nutrition self-care. Hence, at this point, we must continue to base our recommendations on physiology, tradition, and common sense. Research is greatly needed in this area. Experts in self-care recognize that knowledge is necessary but not sufficient in attaining the goal of HF self-care. A wide variety of factors have been determined to impair patients’ abilities to engage in self-care. Moser and Watkins propose a life course model of patient characteristics that influence HF self-care, including aging, psychosocial issues, health literacy, current symptom status, and previous experiences. Wingate comments on the importance of this model for clinical practice and research. Macabasco-O’Connell and colleagues calls our attention to the challenges that indigent HF patients face in performing self-care. Another issue that impairs self-care is poor sleep. Redeker discusses the high prevalence of sleep FIGURE 1. The number of publications on heart failure selfcare between 1902 and 2008. A Medline search done in January 2008 revealed that the number of articles published in the biomedical literature has risen exponentially over time.