Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Dr. Gretchen Wells

Committee Member

Dr. Paula Halcomb


Introduction:  Prevalence of heart failure (HF) in the US is projected to rise 46% by 2030, resulting in more than 8 million people with HF.  Negative psychologic states including depression and pessimism (negative future expectations) have been linked with poor cardiovascular outcomes, including HF.  Despite the fact that optimism (positive future expectations) and other positive affective states have been associated with superior outcomes, there has been little focus on interventions designed to increase positive psychological states in patients with HF.

Objective: To test the acceptability and feasibility of a nurse-led positive psychology intervention, Best Possible Self (BPS).

Methods: A convenience sample of patients with HF were enrolled at an academic medical center in Kentucky. Baseline data including demographics, clinical information and optimism score was measured using the Life Orientation Test-Revised (LOT-R). The LOT-R is a validated and reliable measure of dispositional optimism, and scores range between 6-30, with higher scores indicating higher levels of optimism. The BPS intervention is relatively simple and does not require a psychologist to administer.  The intervention requires participants to write/verbalize their imagined self in the future in terms of physical health or social relationships.  The participants were asked to repeat the activity at home to prompt positive emotions and thoughts about oneself. Participants were contacted by telephone at 1 and 4 weeks to verify practice of the intervention.

Results: We approached 87 patients (inpatients and outpatients) to enroll 60 participants, with a yield rate of 69%.  Our sample was 62 + 13 years of age, 46.7% male and 76% Caucasian. The mean LOT-R score from our sample was 22.3 + 5.1 (range 6-30); the mean optimism subscale score was 12.0 + 2.6 (range 3-15). The nurse-led intervention was determined to be feasible as 62% practiced the intervention at home, and acceptable with an attrition rate of 20% at 4 weeks.

Conclusion: Our data indicate that patients with heart failure are willing to participate and accept a nurse-led positive psychology intervention. These data will inform the development of a larger scale study to test positive psychology interventions on optimism scores and health-related outcomes.