Résilience familiale en tant que processus au sein de couples dont la femme est atteinte d'insuffisance cardiaque

The purpose of this study is to propose a conceptualization of family resilience as a process undertaken by couples where the woman is suffering from chronic heart failure (CHF). Year after year, this chronic disease afflicts not only a growing number of women, but also, and just as much, their life partner. There is increasing recognition that the experience of these women differs from that of their male counterparts. The experience of the male partner as well as the experience of the couple are not often discussed in the literature. The couple consisting of a woman with CHF faces many difficulties inherent in the CHF, difficulties that may require the couple to show family resilience. To achieve our goal, a grounded theory approach was chosen. Data collection used joint semi-structured interviews with 12 couples. As well, a sociodemographic questionnaire and field notes were used. Rigorous analysis of the data permits the proposal of a conceptualization of family resilience as a process undertaken by these couples. In fact, the CHF of the woman is a difficult experience for the couple. Each one faces a shock incurred by the many upheavals associated with CHF that disrupt forever all the plans of their life together. In such an unfavorable life situation, they are called to engage in a process of family resilience. According to two perspectives of family resilience, their commitment to such a process is actualized by the implementation of many strategies, most of which are marital, though a few of them are carried out separately by each member of the couple. Indeed, according to the first perspective, couples bounce back in facing the shock of the diagnosis both individually and as a couple. Individually, each member of the couple tends to take charge while retaining his or her autonomy. To do this, women with CHF take control of the illness and its symptoms, and take care of themselves both physically and psychologically. To do so requires managing their energy, discovering inventiveness and taking responsibility for the CHF. Meanwhile, their male partner prefer the single individual strategy of becoming open to other ways of doing things. As for couple strategies, couples tend to maintain both their independence and their complicity in the experience related to the CHF. To this end, they use their reciprocity of care and work to strengthen and reaffirm their conjugal autonomy by being more open to extended family and community and by carefully measuring how much place the CHF will have in their relationship. According to the second perspective, couples bounce back, this time in growing as a couple by discovering new ways of behaving and finding meaning in their experience of living with CHF. To discover new ways, they revisit together all previous activities. To find meaning, they relativize the upheavals of the CHF by such strategies as a life review of their experience as couple and family, the adoption of suitable leitmotifs and, finally, the discovery and appreciation of grandchildren.  In our opinion, the findings of this study make an important contribution to nursing knowledge. This should help nurses to better understand the process of family resilience as a process and contribute to the improvement of nursing practice with couples struggling with CHF in women.

Keyphrases: Couple, Genre, Family resilience, Heart failure, Women, Couple, Grounded theory, Gender