| Summary: | This thesis is focused on the experience of people suffering a particular enduring illness, heart failure. In the heart failure literature exploring self-care, there is an assumption that patients have come to terms with their new condition and are in a position to care for this new self. Consequently, this study explored ways patients come to terms with their new situation, and if this affects self-care behaviours. As a heart failure nurse, I wanted to better understand patients' experiences. Gadamer proposed a methodology about how a better understanding might be reached if sought mutually. This study was therefore conceived as a conversation between researcher and researched. A longitudinal research study was designed to engage participants over a period of time. Three separate groups of patients, including those newly diagnosed and those living with the condition for longer were interviewed on 3-occasions over a 1-year period. Findings from this study revealed new knowledge about an adaptive process concerning individuals' ability to integrate illness with their sense of themselves. How the patients succeed or fail to transition through this not only has significance for their ability to participate in self-care but also highlighted that many experienced a considerable degree of suffering. These findings were then organised within a conceptual framework for clinical practice, providing practitioners with an opportunity to match care around individuals' needs. Whilst the methodology used within the study developed a new framework about self-care grounded from within nursing, it also challenges practice. Gadamer's method, conversation, allowed the patients' the opportunity to discuss whatever they wished, which was not only emancipatory for them, but provided the practitioner with the chance to critically self-evaluate. This iterative method can be used in both clinical practice and research to empower all participants and lead to the development of nursing as a reflective profession.
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