Heart failure has long been recognized as a major health problem in the United States. Nevertheless, it has recently been proposed that heart failure is occurring in epidemic proportions (National Heart, Lung, and Blood Institute [NHLBI] Information Center, 1996). Although literature abounds regarding epidemiology, pathophysiology, and treatment strategies, little is known about how heart failure affects adults' daily lives. The purpose of this study was to describe and analyze the lived experience of adults who have heart failure. Principles of naturalistic inquiry and grounded theory were used to describe problems, challenges, and processes of living with heart failure. Six women and five men participated in in-depth interviews lasting from 40 minutes to one hour and 40 minutes. Data were collected and analyzed using the constant, comparative method. Codes, categories, and themes emerged and a model was created to depict the findings. Participants' use of language referring to wind and water in describing their heart failure symptoms led to discovery of navigating and aspects of navigational science as metaphors for living with heart failure. The three main categories of the resulting model were called Experiencing Turbulence, Navigating, and Finding Safe Harbor. Experiencing Turbulence represents the problems and challenges of living with heart failure: physical, emotional, or social. Navigating is the core category and includes four sub-categories. These are (1) determining position, (2) charting the course, (3) operating, and (4) being piloted. The final category is Finding Safe Harbor. Whether the individual reaches safe harbor is contingent on the availability and use of navigational aids. Findings suggested: (1) adults develop their own strategies for evaluating their health status and planning, often without guidance from health professionals; (2) hospitals are often seen as a last resort unless symptoms are extreme; and (3) quality and availability of navigational aids influence whether the person experiences increased turbulence or finds safe harbor. Implications for nursing practice include the use of the model in identifying nursing interventions particularly directed towards enhancing self-management skills for those who live with heart failure.
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