Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Degree Program

Nursing, PhD

Committee Chair

Hall, Lynne

Committee Co-Chair (if applicable)

Crawford, Timothy

Committee Member

Crawford, Timothy

Committee Member

Staten, Ruth

Committee Member

Moser, Debra

Author's Keywords

Heart Failure; Impulsivity; Hot/Cool Systems Model; Self-care; Moderated mediation; Perceived control; Perceived stress


Introduction: Heart failure is a serious illness that mostly affects the elderly. It is characterized by progressive deterioration of the heart muscle and affects the quality of life of those living with it. The progression of the illness has been shown to be slower with appropriate self-care. Several studies examined predictors of self-care extensively. The results were inconsistent and usually explained a small fraction of the variance in self-care in persons with heart failure, and they usually overlooked some potential predictors that could be related to self-care in person with heart failure. Purpose: The purpose of this study was to explore impulsivity, perceived control, and perceived stress as predictors of self-care behavior in person with heart failure using the Hot/Cool System Model. This study examined the mechanism by which these variables interact to affect self-care behavior. Methods: A cross-sectional exploratory study was conducted with 100 persons with heart failure from a heart failure clinic affiliated with Norton Healthcare using self-report questionnaires. Inclusion criteria were: a diagnosis of heart failure with no terminal illness or memory problems, at least 18 years of age, and able to read and speak English. Participants received a $10 gift card as compensation for their participation. SPSS macros were used to investigate the proposed relationships among study variables. Results: Perceived control mediated the effect of impulsivity on self-care maintenance only at low levels of stress. Backward regression showed that the best fit model for predicting self-care maintenance included impulsivity, perceived control, and functional status. A follow up mediation analysis showed that perceived control partially mediated the relationship between impulsivity and self-care maintenance. However, the results did not show any significant effect of those potential predictors on self-care management. Conclusion: The current study added new insights and filled a gap in the literature. Further research is needed since this study is the first to introduce impulsivity and Hot Cool System Model to the nursing literature, and it is the first to study this combination of variables in persons with heart failure Keyword: Heart failure, self-care, impulsivity, perceived control, perceived stress, Hot/Cool System Model, moderated mediation

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