Mastering self-care: a qualitative exploration of the psychological and behavioral experiences of older heart failure patients living alone during hospital discharge preparation

Abstract Background The transition from hospital to home presents significant psychological and practical challenges for older heart failure patients living alone (OHELP), who must navigate complex self-care needs within a socially isolated context. Although discharge preparation is a critical period for adapting to solitary living, the psychological and behavioral coping mechanisms of this vulnerable population remain underexplored. Objective This study aimed to explore the psychological experiences during the pre-discharge period regarding self-care readiness, and to describe the behavioral strategies preferred by the OHELP. Methods This descriptive qualitative study employed purposive sampling to recruit 26 participants from a geriatric hospital in Zhengzhou, China, between January and June 2025. Interview data were systematically organized and coded using NVivo 12, and reflexive thematic analysis was conducted through the research. Results Four themes and twelve sub-themes emerged from the analysis: (a) anticipated psychological burden of living alone, (b) perceived deficits: needs vs. resources, (c) coping strategies for self-care and the defense of autonomy, (d) reconstructing one’s self-worth and meaning. Conclusions The OHELP addressed anticipatory psychological burden during discharge preparation through adaptive strategies such as reestablishing daily routines and enhancing technological literacy, thereby reconstructing self-worth and maintaining autonomy. Clinical trial number Not applicable.