1
|
Khanipour-Kencha A, Ghiyasvandian S, Mohammadi S, Khabazkhoob M, Mirshahi A, Wells R, Zakerimoghadam M. Effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission of patients with heart failure: protocol for a randomised controlled trial. BMJ Open 2023; 13:e074256. [PMID: 37558436 PMCID: PMC10414091 DOI: 10.1136/bmjopen-2023-074256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF. METHODS AND ANALYSIS The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients' hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ2, analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome. ETHICS AND DISSEMINATION The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Iranian Registry of Clinical Trials (IRCT20100725004443N30).
Collapse
Affiliation(s)
- Ali Khanipour-Kencha
- Department of Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
- USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Somaye Mohammadi
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arvin Mirshahi
- Department of Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
- USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Rachel Wells
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | |
Collapse
|
2
|
Cuzco C, Castro P, Marín Pérez R, Ruiz García S, Núñez Delgado AI, Romero García M, Martínez Momblan MA, Benito Aracil L, Carmona Delgado I, Canalias Reverter M, Nicolás JM, Martínez Estalella G, Delgado-Hito P. Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial. Crit Care Med 2022; 50:1757-1767. [PMID: 36178294 DOI: 10.1097/ccm.0000000000005676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN A prospective, multicenter, randomized clinical trial. SETTING Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials. TRIAL REGISTRATION NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).
Collapse
Affiliation(s)
- Cecilia Cuzco
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Raquel Marín Pérez
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samuel Ruiz García
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana I Núñez Delgado
- Department of lntensive Care Unit, Hospital Valle d'Hebron, Barcelona, Spain
| | - Marta Romero García
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martínez Momblan
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llucia Benito Aracil
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - José M Nicolás
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Head, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
3
|
Nursing Interventions for Patient Empowerment during Intensive Care Unit Discharge: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111049. [PMID: 34769569 PMCID: PMC8582948 DOI: 10.3390/ijerph182111049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.
Collapse
|