Older patients with heart failure and their caregivers face significant cognitive, emotional, and systemic challenges during the hospital-to-home transition, underscoring the need for structured transitional care models.
YongQuan Wang,1 ChunYing Wang,2 YunFeng Meng,1 Na Zhu,1 Bo Yue3 1School of Nursing, Qiqihar Medical University, Qiqihar, Heilongjiang, 161003, People’s Republic of China; 2Department of Cardiology, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, People’s Republic of China; 3Department of Standardized Residency Training Management Office, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, People’s Republic of ChinaCorrespondence: Bo Yue, Department of Standardized Residency Training Management Office, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang, 161006, People’s Republic of China, Tel +86 13845200798, Email 1981871726@qq.comObjective: To explore the lived experiences of discharge readiness among older patients with chronic heart failure and their family caregivers during the hospital-to-home transition.Patients and Methods: Guided by Husserlian descriptive phenomenology, we conducted in-depth, semi-structured interviews with 16 patient–caregiver dyads purposively sampled from three cardiology departments at a tertiary hospital in Heilongjiang Province, China, between July and September 2025. Data were analyzed using Colaizzi’s seven-step method to uncover essential structures of the lived experience.Results: Analysis revealed three core themes: (1) Cognitive ambiguity in illness understanding, characterized by reliance on symptom intuition and gaps in knowledge about disease mechanisms; (2) Emotional and relational struggles during psychological adjustment, including fear, role disruption, and efforts to preserve dignity; and (3) Perceived fragmentation of post-discharge support, marked by discontinuous care guidance, caregiver burden, and systemic barriers to healthcare access.Conclusion: This study illuminates how older patients with heart failure and their caregivers navigate the transition home amid persistent uncertainty, emotional strain, and fragmented support. Findings underscore the need for transitional care models that provide structured illness education, integrate dyadic psychological support, and establish nurse-coordinated follow-up to enhance self-management and reduce readmission risk.Keywords: chronic heart failure, discharge preparedness, patient and caregiver experiences, transitional care, phenomenological study
Y et al. (2026) studied this question.