In order to correctly manage heart failure and prevent the exacerbation of their condition, patients need to monitor their own health and pay attention to things such as weight gain, aggravated shortness of breath or a lack of physical activity. However, for various reasons, many patients are uncertain about the necessary methods for managing their own health, which often leads to repeated hospitalisations. To address the problems associated with heart failure patients being readmitted to hospital over and over again, Dr Yoko Hattori, a researcher formerly based at Konan Women's University and now at Otemae University in Japan, has developed an evaluation scale for self-monitoring by patients with heart failure (ESSMHF). Hattori worked as a nurse and met many heart failure patients who were stuck in a loop of being admitted to hospital, discharged, then readmitted. Over time, she came to believe that something had to be done to aid patients in those circumstances and decided upon a self-monitoring system. 'Self-monitoring is a useful concept for breaking through the vicious cycle of repeatedly being in and out of hospital. One of the aims of nursing for chronic heart failure patients is to enhance the self-care behaviour of patients,' explains Hattori. 'While self-care is a large-scale concept, the details of self-monitoring are part of the processes affecting self-care behaviour and, since the appropriateness of patients' self-monitoring directly affects self-care behaviour, self-monitoring is considered to be key for the improvement of self-care behaviour.'