Heart failure self-management and normalizing symptoms: an exploration of decision making in the community. 
To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.  Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations.  Despite education, some patients fail to seek timely medical intervention when symptoms change.  Semi-structured interviews were conducted with homecare patients after receiving self-management education.  Grounded theory methods and qualitative software were used to collect and analyze the data.  Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity.  Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations.  Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.  Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration.