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Koontalay A, Botti M, Hutchinson A. Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study. J Adv Nurs 2024. [PMID: 39014994 DOI: 10.1111/jan.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
AIMS To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). DESIGN The study design was based on a three-round e-Delphi survey. METHODS A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. RESULTS There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. CONCLUSION Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. IMPACT This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.
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Affiliation(s)
- Apinya Koontalay
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Institute of Health Transformation, Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
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Suwanno J, Phonphet C, Mayurapak C, Ninla-Aesong P, Thaimwong L. Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors. Int J Nurs Pract 2023:e13208. [PMID: 37797953 DOI: 10.1111/ijn.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/12/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
AIM To explore the association between nurse education levels and patient-related factors with hypertension self-care. BACKGROUND Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed. DESIGN A cross-sectional study. METHODS Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty). RESULTS A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities. CONCLUSIONS Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.
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Affiliation(s)
- Jom Suwanno
- School of Nursing, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Chennet Phonphet
- School of Nursing, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | | | - Putrada Ninla-Aesong
- School of Medicine, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Ladda Thaimwong
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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Davies P, Smith S, Wilcox R, Stewart JD, Davis TJ, McKenna K, Hanson J. Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia. PLoS Negl Trop Dis 2022; 16:e0010604. [PMID: 35849581 PMCID: PMC9292120 DOI: 10.1371/journal.pntd.0010604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. PRINCIPAL FINDINGS Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93-10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22-7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. CONCLUSIONS In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility.
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Affiliation(s)
- Phoebe Davies
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Rob Wilcox
- Tropical Public Health Service, Cairns, Queensland, Australia
| | - James D. Stewart
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tania J. Davis
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Kylie McKenna
- Tropical Public Health Service, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
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Jeamjitvibool T, Tankumpuan T, Lukkahatai N, Davidson PM. Noncommunicable diseases and social determinants of health in Buddhist monks: An integrative review. Res Nurs Health 2022; 45:249-260. [DOI: 10.1002/nur.22215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/01/2022] [Accepted: 01/22/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Thanakrit Jeamjitvibool
- Department of Adult and Geriatric Nursing, Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science Chulabhorn Royal Academy Bangkok Thailand
| | - Thitipong Tankumpuan
- Department of Surgical Nursing, Faculty of Nursing Mahidol University Bangkok Thailand
| | - Nada Lukkahatai
- The Johns Hopkins University School of Nursing Baltimore Maryland USA
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Tankumpuan T, Sindhu S, Perrin N, Commodore-Mensah Y, Budhathoki C, Padula W, Himmelfarb CD, Davidson PM. A Multi-Site Thailand Heart Failure Snapshot Study. Heart Lung Circ 2021; 31:85-94. [PMID: 34364801 DOI: 10.1016/j.hlc.2021.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/19/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence of heart failure (HF) is increasing in many low-income and middle-income countries, but the limited availability of data on patient profiles and clinical outcomes, particularly at a community level, challenges health service planning. METHODS The Thai HF Snapshot Study was a multi-site, observational study conducted in Thailand between June 2017 to June 2019. It aimed to document demographic, clinical and sociodemographic characteristics, and to compare clinical outcomes by the level of the hospital. RESULTS A total of 512 participants were recruited across Thailand: mean age was 64.9±15.3 years and 286 were female (55.9%). The most frequently identified admitting diagnosis was ischaemic heart disease (45.1%). Most patients (70.3%) were classified as New York Heart Association class II at discharge. Patients in university hospitals were frailer (3.2 vs 2.9; p=0.015), had more depressive symptoms (8.1 vs 5.7; p<0.001), and had lower functional status (66.2 vs 73.3; p<0.001) than those in tertiary care. CONCLUSION Although HF patients admitted to university hospitals had access to advanced technology and health care specialists, clinical outcomes likely affected patient acuity. Interventions are urgently needed to ensure improved HF management considering the social determinants of health in Thailand.
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Affiliation(s)
| | - Siriorn Sindhu
- Mahidol University, Faculty of Nursing, Bangkok, Thailand
| | - Nancy Perrin
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | - William Padula
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
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Srisuk N, Wichit N, Thompson DR, Ski CF. A psychometric evaluation of the Caregiver Contribution to Self-Care of Heart Failure Index in a Thai population. Health Qual Life Outcomes 2021; 19:177. [PMID: 34246255 PMCID: PMC8272368 DOI: 10.1186/s12955-021-01814-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregivers are major contributor to the self-care of patients with heart failure. The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions across three scales: self-care maintenance (symptom monitoring and treatment adherence); self-care management (dealing with symptoms); and confidence in contributing to the self-care (self-efficacy in managing self-care) of patients with heart failure. Informal caregivers play a vital role in supporting family members with heart failure in Thailand, yet no validated tool exists to measure their contribution. We examined the psychometric properties of the CC-SCHFI in a Thai population. METHODS The CC-SCHFI was translated into Thai using a standard forward and backward translation procedure. A cross-sectional design was used to examine the psychometric properties of the Thai version of the CC-SCHFI in 100 family caregivers of heart failure patients in Southern Thailand. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability. RESULTS The Thai version of the CC-SCHFI demonstrated acceptable internal consistency (composite reliability of each scale ranged from 0.76 to 0.99). Reliability estimates were adequate for each scale (McDonald's omega ranged from 0.75 to 0.96). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.98-1.00; root-mean-square error of approximation = 0.00-0.07). CONCLUSIONS The Thai version of the CC-SCHFI appears to be a valid and reliable instrument for measuring caregiver contributions to self-care maintenance and self-care management as well as contributing to caregiver confidence in the self-care of Thai heart failure patients.
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Affiliation(s)
- Nittaya Srisuk
- Faculty of Nursing, Surat Thani Rajabhat University, Surat Thani, Thailand
| | - Nutchanath Wichit
- Faculty of Nursing, Surat Thani Rajabhat University, Surat Thani, Thailand
| | - David R Thompson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
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Suksatan W, Tankumpuan T. Depression and Rehospitalization in Patients With Heart Failure After Discharge From Hospital to Home: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320986965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with heart failure are known to be particularly vulnerable to depression resulting in adverse health outcomes. However, there has been no literature review on current evidence regarding the relationship between depression and rehospitalization. This review aims to explore the relationship between depression and rehospitalization in patients with heart failure. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included articles published between 2001 and 2019 taken from Scopus, PubMed, CINAHL, and PsycINFO databases. We identified 12 relevant studies with participants ranging from 115 to 160,169 patients. Heart failure patients with depression were more likely to be rehospitalized than those without. To explain this, few reasons have been proposed. First, depression could disrupt the regulation of autonomic nervous system, neurohormonal activation, and body’s natural rhythm. Second, depressed patients tend to have poor adherence to medication. Healthcare providers should not only focus on drug and dietary management but also on implementing effective interventions to manage depression, in order to reduce the risk of rehospitalization. Moreover, palliative care should start at the stage of heart failure diagnosis to improve quality of life, better outcomes, and lower cost of care for the patients.
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Affiliation(s)
- Wanich Suksatan
- HRH Princess Chulabhorn College of Medical Science Faculty of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
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Somsiri V, Asdornwised U, O’Connor M, Suwanugsorn S, Chansatitporn N. Effects of a Transitional Telehealth Program on Functional Status, Rehospitalization, and Satisfaction With Care in Thai Patients with Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2020. [DOI: 10.1177/1084822320969400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Limited functional status is a common health problem in patients living with heart failure (HF), which often requires rehospitalization.Home-based transitional telehealth programs (TTPs) focused on health monitoring, education, promotion of self-management, and multidisciplinary team consultation have been shown to improve functional status and satisfaction with care while reducing rehospitalization rates in this population. Nonetheless, these variables and outcomes have yet to be assessed in a Thai patient with HF. Thus, the aim of this study was to investigate the effectiveness of a TTP on functional status, rehospitalization, and satisfaction with care in Thai patients with HF. Eligible participants (N = 146) were randomly assigned to either the control or TTP group. The TTP included in-hospital discharge planning and 6-week telemonitoring via a mobile phone application to provide follow-up home care. Data on the outcome variables were collected at 6 and 8 weeks post-enrollment and analyzed by descriptive statistics, independent t-tests, repeated measures ANOVA, and Z-tests. Functional status and satisfaction with care scores in the TTP group were significantly higher than those of the control group, and rehospitalization rates in the TTP group were significantly lower than those of the control group at 6 and 8 weeks post-enrollment. Thus, the TTP effectively improved functional status, increased satisfaction with care, and reduced rehospitalization rates in Thai patients with HF. TTP implementation could be considered to improve the quality of transitional care in Thailand.
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Affiliation(s)
- Vasinee Somsiri
- Doctor of Philosophy Program in Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Melissa O’Connor
- Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, PA, USA
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Abstract
Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.
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Koirala B, Budhathoki C, Dennison-Himmelfarb CR, Bhattarai P, Davidson PM. The Self-Care of Heart Failure Index: A psychometric study. J Clin Nurs 2019; 29:645-652. [PMID: 31770472 DOI: 10.1111/jocn.15119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/17/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Self-Care of Heart Failure Index is an empirically tested instrument to measure self-care of heart failure patients across different populations and cultures. AIMS To develop and evaluate the psychometric properties of the Nepali Self-Care of Heart Failure Index. DESIGN This psychometric study used a cross-sectional, observational, study design to collect data. The study was guided and reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. METHODS To develop and culturally validate Nepali Self-Care of Heart Failure Index, a combination of the recommended methods for cross-cultural validation studies were applied such as translation, back translation, expert committee review of the translated version and validity/reliability testing. Face and content validity were ensured using expert review. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis. Composite reliability scores were calculated for each sub-scale of the Nepali Self-Care of Heart Failure Index. RESULTS A total of 221 heart failure patients in Nepal were enrolled in the study. Adequate face and content validity were ensured through expert review. Exploratory factor analysis and confirmatory factor analysis supported the original three-factor model. Although the three factors explained only 41% of the variance, confirmatory factor analysis fit indexes and error measures were found reasonable. The composite reliability coefficients for self-care maintenance, management and confidence scale were 0.6, 0.7 and 0.8, respectively. CONCLUSIONS The Nepali Self-Care of Heart Failure Index is a theoretically based, culturally acceptable and appropriate instrument for use among Nepali heart failure patients. However, further studies are needed to refine its psychometric properties. RELEVANCE TO CLINICAL PRACTICE Access to reliable, valid and culturally appropriate instruments is crucial in describing the state of the problem as well as for developing and evaluating tailored and targeted self-care practice interventions for Nepali patients living with heart failure.
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Affiliation(s)
- Binu Koirala
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Center for Innovative Care in Aging, Baltimore, MD, USA
| | | | - Cheryl R Dennison-Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Priyanka Bhattarai
- School of Nursing, The University of Notre Dame, Fremantle, WA, Australia
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Koirala B, Dennison Himmelfarb CR, Koirala B, Budhathoki C, Davidson PM. Epidemiology and Management of Heart Failure in Nepal. J Card Fail 2019; 25:846-848. [PMID: 31476372 DOI: 10.1016/j.cardfail.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/17/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Binu Koirala
- School of Nursing, Johns Hopkins University, Baltimore, Maryland.
| | - Cheryl R Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, Maryland; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bibhu Koirala
- Internal Medicine, University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, Pennsylvania
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