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In our newly updated theory (the Situation specific theory of heart failure self-care, Riegel, Dickson & Faulker, 2016), self-care is defined as a naturalistic decision-making process that influences actions that maintain physiologic stability, facilitate the perception of symptoms, and direct the management of those symptoms. Specifically, self-care entails 3 separate but linked concepts that reflect processes that often are mastered in sequence. The first self-care process is maintenance, which captures treatment adherence and healthy behaviors (e.g., taking medications, exercising, and following a salt restricted diet). The second self-care process, symptom perception, involves both the detection of physical sensations and the interpretation of meaning. Specifically, symptom perception involves body listening, monitoring signs, as well as recognition, interpretation, and labeling of symptoms. Individual symptoms and the interactions between symptoms influence the meaning attributed to the symptom experience. The third self-care process is management, or the response to symptoms when they occur (Figure). All 3 processes involve both autonomous and consultative elements, discussed in our article (Riegel B, Dickson VV, and Faulkner KM. The situation-specific theory of heart failure self-care: Revised and updated. Journal of Cardiovascular Nursing, 2016).

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The Caregiver versions of the self-care measures were developed by Ercole Vellone, PhD, RN, FESC, Assistant Professor in Nursing Science at the University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy.  Dr. Vellone recognized that caregivers make an important contribution to the self-care of patients with chronic conditions, but few instruments are available to measure this contribution. He began his work with a measure of Caregiver Contribution to Heart Failure Self-Care and then used the same approach to develop complementary measures for other self-care inventories. Use of the patient and the caregiver versions together facilitates dyadic analyses.