Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jeanne Salyer Ph.D. RN F.N.A.P.

Second Advisor

Lauren Goodloe Ph.D RN

Third Advisor

Christine Schubert Kabban Ph.D. MBA

Fourth Advisor

Dolores G. Clement

Fifth Advisor



Abstract HEART FAILURE SYMPTOM CLUSTERS AND FUNCTIONAL STATUS Janet Kay Herr Ph.D A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2012 Major Director: Dr. Jeanne Salyer, Ph.D., R.N., F.N.A.P Associate Professor, Adult Health & Nursing Systems Clinical assessment of heart failure includes symptom identification and the evaluation of the relationship of symptoms to functional status. Symptom clusters are groups of at least 2 or 3 co-occurring symptoms that are related but are independent of other groups of symptoms. The objectives of this study are to: (1) examine relationships among symptoms commonly experienced by individuals with heart failure, (2) identify symptoms that form clusters, and (3) evaluate the impact of heart failure symptom clusters on attributes of functional status: limitations and mobility The Theory of Unpleasant Symptoms guided the conduct of this study. Heart failure symptoms and the outcome variables functional limitations and mobility were evaluated in a convenience sample of individuals (n = 117) with a confirmed diagnosis of heart failure recruited viii from an academic medical center. Principle components analysis was used to extract symptom clusters and regression analysis was used to evaluate the relationship between the symptom clusters, their interaction terms, the demographic variables, age and co-morbidity, and functional status. Three symptom clusters, sickness behavior, discomforts of illness, and GI distress were extracted. Predictors of functional limitations (F = 35.96, p = 0.0005, R2 = 0.578) included sickness behavior (β = -.681, p 0.0005), discomforts of illness (β = - .765, p = 0.0005) and the interaction term between these two symptom clusters (β = .649, p = 0.014). This model predicted 59% of the variance in functional limitations. Predictors of limited mobility (F 20.68, p = 0.0005, R2 = 0.275) included sickness behavior (β = -0.441, p 0.0005) and co-morbidity (β = -.200, p = 0.019). This model predicted 28% of the variance in mobility. Relationship between clusters of heart failure symptoms and functional limitations or mobility was observed. The interaction between discomforts of illness and sickness behaviors implies that not only do functional limitations increase as discomforts of illness increase, but increases at a faster rate when sickness behaviors are increased. Changes in sickness behaviors has the potential to improve mobility from being bed or chair bound everyday or most days to being bed or chair bound only some days.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2012

Included in

Nursing Commons