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Huang Z, Liu T, Gao R, Chair SY. Effects of nurse-led self-care interventions on health outcomes among people with heart failure: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1282-1294. [PMID: 38041606 DOI: 10.1111/jocn.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Abstract
AIM To estimate the effects of nurse-led self-care interventions on people with heart failure (HF). BACKGROUND Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies. METHODS RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA. RESULTS Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50-1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49-2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24-1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear. CONCLUSIONS Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review. RELEVANCE TO CLINICAL PRACTICE The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.
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Affiliation(s)
- Zehao Huang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ruitong Gao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhao X, Wu S, Luo N, Lin Q, Zhao X, Li K. Care models for patients with heart failure at home: A systematic review. J Clin Nurs 2024; 33:1295-1305. [PMID: 38178563 DOI: 10.1111/jocn.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
AIMS The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes. DESIGN Systematic review. DATA SOURCES Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022. REVIEW METHODS This review used the Cochrane Collaboration's 'Risk of Bias' tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators. RESULTS Twenty articles (19 studies) were included. Seven examined nurse-led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self-management, and one examined nurse and physiotherapist co-led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self-care, and anxiety and depression for heart failure patients. The model of patient self-management showed more beneficial results than nurse-led care, multidisciplinary specialist care, and nurse and physiotherapist co-led care in reducing hospital days, improving symptoms, promoting self-care behaviours of HF patients, enhancing the quality of life, and strengthening self-care ability. CONCLUSIONS This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self-management model demonstrated better outcomes. IMPACT The self-management model is more effective in increasing self-management behaviours and self-management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
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Affiliation(s)
- Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Nan Luo
- Medical Records Library, The Second Hospital of Jilin University, Changchun, China
| | - Qiuxia Lin
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Xinyi Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Yang W, Sun L, Hao L, Zhang X, Lv Q, Xu X, Wang Y, Li Y, Zhou L, Zhao Y, Zang X, Wang Y. Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial. EClinicalMedicine 2024; 69:102481. [PMID: 38370538 PMCID: PMC10874718 DOI: 10.1016/j.eclinm.2024.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme. Methods This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168. Findings Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (β: 8.5, 95% CI: 0.7, 16.4) and management (β: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (β: 9.7, 95% CI: 1.5, 17.9) and T2 (β: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints. Interpretation Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions. Funding The National Natural Science Foundation of China.
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Affiliation(s)
- Weiling Yang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lili Hao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Santero M, Song Y, Beltran J, Medina-Aedo M, Canelo-Aybar C, Valli C, Rocha C, León-García M, Salas-Gama K, Kaloteraki C, Niño de Guzmán E, Ballester M, González-González AI, Poortvliet R, van der Gaag M, Spoiala C, Gurung P, Willemen F, Cools I, Bleeker J, Kancheva A, Ertl J, Laure T, Kancheva I, Pacheco-Barrios K, Zafra-Tanaka JH, Tsokani S, Veroniki AA, Seitidis G, Christogiannis C, Kontouli KM, Groene O, Sunol R, Orrego C, Heijmans M, Alonso-Coello P. Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials. Healthcare (Basel) 2024; 12:302. [PMID: 38338187 PMCID: PMC10855227 DOI: 10.3390/healthcare12030302] [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: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF.
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Affiliation(s)
- Marilina Santero
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Jessica Beltran
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Melixa Medina-Aedo
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Montserrat León-García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Karla Salas-Gama
- Quality, Process and Innovation Direction, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Chrysoula Kaloteraki
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | | | - Rune Poortvliet
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Marieke van der Gaag
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Cristina Spoiala
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Pema Gurung
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Fabienne Willemen
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Iza Cools
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Julia Bleeker
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Angelina Kancheva
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Julia Ertl
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Tajda Laure
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Ivana Kancheva
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Kevin Pacheco-Barrios
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Jessica Hanae Zafra-Tanaka
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5S 3G8, Canada
| | - Georgios Seitidis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Katerina Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Oliver Groene
- OptiMedis, 20095 Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten/Herdecke, 58455 Witten, Germany
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain (R.S.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands; (R.P.); (A.K.); (I.K.); (M.H.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain; (M.S.); (M.M.-A.); (C.C.-A.); (C.V.); (M.L.-G.)
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Baker C, Coats H, Jankowski CM, Baik D. Heart Failure Family Caregivers' Perspectives of Physical Activity Engagement: A Qualitative Study. West J Nurs Res 2023; 45:807-814. [PMID: 37403774 PMCID: PMC10990472 DOI: 10.1177/01939459231186339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Research on caregiver burden and related psychological distress has been widely studied. However, little research has focused on perspectives and experiences of older family caregivers of persons with heart failure on engaging in physical exercise to improve their health and wellness. We investigated barriers and facilitators influencing physical activity engagement for older family caregivers of persons with heart failure through a qualitative descriptive study design utilizing participant interviews. The social cognitive theory framework guided the thematic analysis. Identified themes and subthemes that emerged were centered around the framework's interrelated personal, environmental, and behavioral factors. Self-efficacy emerged as a central construct facilitating engagement in physical activity. The older family caregivers embraced technology for physical activity interventions more readily since the COVID-19 pandemic encouraged increased technology use. The age-related and caregiving barriers to physical activity found in this study highlight considerations for an older family caregiver and guide interventions for future family caregivers' engagement.
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Affiliation(s)
- Christina Baker
- PhD, College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Heather Coats
- Assistant Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine M Jankowski
- Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Dawon Baik
- Assistant Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
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Seid SS, Amendoeira J, Ferreira MR. Self-Care and Quality of Life Among Adult Patients With Heart Failure: Scoping Review. SAGE Open Nurs 2023; 9:23779608231193719. [PMID: 37576941 PMCID: PMC10413905 DOI: 10.1177/23779608231193719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/10/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF. Methods Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included. Results Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF. Conclusion Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.
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Affiliation(s)
- Sheka Shemsi Seid
- School of Nursing, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - José Amendoeira
- School of Nursing, Polytechnic Institute of Santarem, Quality of Life Research Center, Santarem, Portugal
| | - Maria Regina Ferreira
- School of Nursing, Polytechnic Institute of Santarem, Quality of Life Research Center, Santarem, Portugal
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Huang Z, Liu T, Chair SY. Effectiveness of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression and illness perceptions in people with heart failure: A systematic review and meta-analysis. Int J Nurs Stud 2022; 132:104255. [DOI: 10.1016/j.ijnurstu.2022.104255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/17/2022]
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Choi EY, Park JS, Min D, Lee HS, Ahn JA. Association between self-management behaviour and quality of life in people with heart failure: a retrospective study. BMC Cardiovasc Disord 2022; 22:90. [PMID: 35260090 PMCID: PMC8903718 DOI: 10.1186/s12872-022-02535-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to investigate the variables that significantly associated with the quality of life in people with heart failure, and particularly, to identify the association between self-management behaviour and the quality of life. Methods This retrospective study used data from heart failure outpatient clinics at two large tertiary medical centres in Seoul and Suwon, South Korea. We enrolled 119 participants who completed echocardiography and stress tests and responded to questionnaires on self-management behaviour and quality of life. We collected more data on sociodemographic and clinical characteristics and anthropometric and serum blood test results through electronic medical record review. We analysed data using multiple linear regression and the classification and regression tree (CART) method to explore the associated factors with the quality of life in participants with heart failure. Results Participants’ mean age was 74.61 years, and women represented 52.1% of the sample. It showed that cardiac systolic function (β = 0.26, p = .013) and self-management behaviour (β = 0.20, p = .048) were two major associated factors with the quality of life in participants with heart failure in the multiple linear regression analysis. Also, cardiac systolic function and self-management behaviour were shown to be the primary determinants for the quality of life in those with heart failure in the CART analysis. Therefore, self-management behaviour of the participants with heart failure was a significant modifiable factor that can improve their quality of life. Conclusions Healthcare providers should be aware of the importance of self-management in people with heart failure and help promote their quality of life by enhancing their self-management behaviour as own efforts to properly maintain and monitor the health status and prevent further worsening of heart failure.
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Affiliation(s)
- Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ah Ahn
- College of Nursing and Research Institute of Nursing Science, Ajou University, Worldcup-ro 164, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Madanat L, Saleh M, Maraskine M, Halalau A, Bukovec F. Congestive Heart Failure 30-Day Readmission: Descriptive Study of Demographics, Co-morbidities, Heart Failure Knowledge, and Self-Care. Cureus 2021; 13:e18661. [PMID: 34786247 PMCID: PMC8579470 DOI: 10.7759/cureus.18661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Congestive heart failure (CHF) readmissions are associated with substantial financial and medical implications. We performed a descriptive study to determine demographic, clinical, and behavioral factors associated with 30-day readmission. Materials and methods Patients hospitalized with CHF at William Beaumont Hospital in Royal Oak, MI, from March 2019-May 2019 were studied. Response to heart failure knowledge and self-care questionnaires along with the patients' demographic and clinical factors were collected. Thirty-day readmission to any of the eight hospitals in the Beaumont Health System was documented. Results One-hundred ninety-six (196) patients were included. The all-cause 30-day readmission rate was 23%. A numerical higher rate of readmissions was observed among males (23.7% vs 22.2%), current smokers (27.3% vs 22.9%), and patients with peripheral vascular disease (PVD; 28.9% vs 21.2%), diabetes mellitus (DM; 26.4% vs 18.9%), hypertension (HTN; 26.4% vs 10%), coronary artery disease (CAD; 24.6% vs 19%), and prior history of cerebrovascular accident (CVA; 28.9% vs 21.2%) (p>0.05). Reduced left ventricular ejection fraction (LVEF) was associated with higher readmissions (24.4% vs 20.5%, p=0.801). Patients with the highest reported questionnaire scores corresponding to better heart failure knowledge and self-care behaviors at home were readmitted at a similar rate compared to those scoring in the lowest interval (25%, p=0.681). Conclusion Though statistically insignificant due to the limitations of sample size, a higher percentage of readmissions was observed in male patients, current smokers, reduced LVEF, and higher comorbidity burden. Better reported patient self-care behavior, medication compliance, and heart failure knowledge did not correlate with reduced readmission rates. While the impact of medical comorbidities on 30-day readmissions is better established, the role of socioeconomic factors remains unclear and might suggest a focus for future work.
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Affiliation(s)
- Luai Madanat
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | - Monique Saleh
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
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10
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da Cunha DCPT, Rossi LA, Dessote CAM, Bolela F, Dantas RAS. Evolution of self-care in patients with heart failure at the first outpatient return and three months after hospital discharge. Rev Lat Am Enfermagem 2021; 29:e3440. [PMID: 34287539 PMCID: PMC8294791 DOI: 10.1590/1518-8345.4364.3440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/24/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1). METHOD an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student's t test and paired distribution (McNemar) with a significance level of 0.05. RESULTS we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales. CONCLUSION self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.
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Affiliation(s)
| | - Lidia Aparecida Rossi
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Carina Aparecida Marosti Dessote
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Fabiana Bolela
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Rosana Aparecida Spadoti Dantas
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Meng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: A meta-analysis. Diabetes Metab Syndr 2021; 15:102176. [PMID: 34186372 DOI: 10.1016/j.dsx.2021.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. METHODS The research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. RESULTS Eight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. CONCLUSION Self-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).
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Affiliation(s)
- Xianghong Meng
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yuping Wang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Xiaowen Tang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Jianfang Gu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yonghua Fu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China.
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Effects of Predischarge Patient Education Combined With Postdischarge Follow-Ups on Self-Care, Readmission, Sleep, and Depression in Patients With Heart Failure. J Nurs Res 2021; 28:e112. [PMID: 32694457 DOI: 10.1097/jnr.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with heart failure rarely engage in adequate self-care. Greater emphasis on self-care discharge readiness is needed. PURPOSE This study examined the effects of a predischarge educational program combined with 1 year of postdischarge follow-up on self-care behaviors, readmission, sleep quality, and depression in patients with heart failure. METHODS A longitudinal, nonequivalent two-group pretest-posttest design was used. The intervention group received tailored education and follow-ups, whereas the control group received routine predischarge heart-failure education from direct care nurses only. Measurements included the self-care maintenance and self-care management subscales of the Self-Care of Heart Failure Index, Pittsburg Sleep Quality Index, Patient Health Questionnaire-9, and readmission rate. Data obtained at baseline and at 1, 3, 6, and 12 months postdischarge were analyzed using linear mixed models with both intention-to-treat and per-protocol approaches. The propensity score was used to adjust for the confounding effects of the New York Heart Association functional class and left ventricular ejection fraction. RESULTS Of the 62 patients with heart failure (28 in the intervention group and 34 in the control group) who were sampled at baseline, 47 (n = 25 vs. n = 22) provided data over the entire course of this 1-year study (76% retention rate). The per-protocol analysis did not find significant differences for any variables. However, the intention-to-treat analysis showed that the intervention group significantly improved in self-care maintenance at 6 months and self-care management at 12 months after hospital discharge, with fewer, albeit not significantly fewer, first and subsequent hospital readmissions than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The effect of this intervention was not found to be substantial, indicating a need to design more efficacious and powerful interventions. Hospitalized patients must receive patient education before discharge to foster their self-care knowledge and skills regarding self-care at home. Strategies are needed to help nurses provide patient education in a time-efficient manner.
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Sanson G, Vellone E, Takao-Lopes C, Barrientos-Trigo S, Porcel-Gálvez AM, Riegel B, D'Agostino F. Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care. Int J Nurs Knowl 2021; 33:18-28. [PMID: 33760361 DOI: 10.1111/2047-3095.12324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. DATA SOURCES A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. DATA SYNTHESIS Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. CONCLUSIONS This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. IMPLICATIONS FOR NURSING PRACTICE This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.
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Affiliation(s)
- Gianfranco Sanson
- Assistant Professor, School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34100, Italy
| | - Ercole Vellone
- Associate Professor, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy
| | - Camila Takao-Lopes
- Adjunct Professor, Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), R. Napoleão de Barros, 754, São Paulo, 04024-002, Brazil
| | - Sergio Barrientos-Trigo
- Associate Professor, Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, C/ Avenzoar, 6, Seville, 41009, Spain
| | - Ana María Porcel-Gálvez
- Associate Professor, Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, C/ Avenzoar, 6, Seville, 41009, Spain
| | - Barbara Riegel
- Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217, USA
| | - Fabio D'Agostino
- Assistant Professor, Saint Camillus International University of Health Sciences, Rome, 00131, Italy
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Behaviour change techniques in personalised care planning for older people: a systematic review. Br J Gen Pract 2021; 71:e121-e127. [PMID: 33495201 PMCID: PMC7846352 DOI: 10.3399/bjgp20x714017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/06/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Personalised care planning (PCP) interventions have the potential to provide better outcomes for older people and are a key focus in primary care practice. Behaviour change techniques (BCTs) can maximise effectiveness of such interventions, but it is uncertain which BCTs are most appropriate in PCP for older adults. AIM To identify BCTs used in successful PCP interventions for older people aged ≥65 years. DESIGN AND SETTING Systematic review. METHOD The authors searched 12 databases from date of inception to 30 September 2017. They identified randomised controlled trials (RCTs) of interventions involving participants aged ≥65 years, and contextually related to PCP. Five areas of risk of bias were assessed. The Michie et al, BCT taxonomy was used for coding. RESULTS Twenty-three RCTs involving 6489 participants (average age 74 years) described PCP interventions targeting the general older adult population and older people with specific long-term conditions (for example, heart disease, diabetes, stroke). Just over half of the studies were deemed to be at a low risk of bias. Eleven 'promising' BCTs were identified in five trials reporting significant improvements in quality of life (QoL). Six BCTs were reported in all five of these trials: 'goal setting', 'action planning', 'problem solving', 'social support', 'instructions on how to perform a behaviour', and 'information on health consequences'. Modes of delivery varied. CONCLUSION Future PCP interventions to improve QoL for people aged ≥65 years may benefit from focusing on six specific BCTs. Better reporting of BCTs would enhance future design and implementation of such interventions.
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Clement C, Ridd MJ, Roberts K, Santer M, Boyle R, Muller I, Gilbertson A, Angier E, Selman L, Shaw ARG. Parents and GPs' understandings and beliefs about food allergy testing in children with eczema: qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial. BMJ Open 2020; 10:e041229. [PMID: 33208335 PMCID: PMC7677338 DOI: 10.1136/bmjopen-2020-041229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM To explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema. DESIGN AND SETTING Qualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial. PARTICIPANTS Semi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study. RESULTS 21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making. CONCLUSIONS Parents' motivations for allergy testing are driven by the desire to improve their child's condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making. TRIAL REGISTRATION NUMBER ISRCTN15397185.
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Affiliation(s)
- Clare Clement
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kirsty Roberts
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam Santer
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Robert Boyle
- Inflammation, Repair, and Development Section, National Heart & Lung Institute, Imperial College London, London, UK
- Centre of Evidence-based Dermatology, University of Nottingham, Nottingham, UK
| | - Ingrid Muller
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna Gilbertson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Angier
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lucy Selman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison R G Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Abstract
Heart failure is a chronic disease with a multitude of different clinical manifestations. Empowering people living with heart failure requires education, support structure, understanding the needs of patients, and reimaging the care delivery systems currently offered to patients. In this article, the authors discuss practical approaches to activate and empower people with heart failure and enable patient-provider dialogue and shared decision making.
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Affiliation(s)
- Peter Wohlfahrt
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA; Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Irene Z Pan
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA; College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
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18
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Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness of an electronic pain management programme for the working population with chronic pain: study protocol for a randomized controlled trial. Trials 2020; 21:421. [PMID: 32448387 PMCID: PMC7245757 DOI: 10.1186/s13063-020-04348-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background Chronic pain is highly prevalent in the working population. People tend to attempt self-initiated treatments to manage their pain. The self-efficacy of behavioural change is a suitable model for guiding the development of an electronic pain management programme (ePain). The aim in this study is to develop ePain and to evaluate its effectiveness at improving pain self-efficacy, reducing pain intensity and negative emotions, and increasing quality of life. Methods This study will be a randomized controlled trial. ePain will take the form of a 6-week online pain management programme. Participants will be aged 15 years or above, have chronic pain, and be employed. They must complete the baseline questionnaire and will be randomized into intervention and control groups. They will receive notifications to encourage their participation in ePain and complete the evaluation questionnaires. They will complete the process evaluation at week 3, the post assessment at week 6, and the follow-up assessment at week 12. The study will focus on pain self-efficacy; pain situations; negative emotions including levels of depression, anxiety, and stress; and quality of life. The participants’ opinions of ePain will be collected as feedback. Data will be analysed on an intention-to-treat basis and generalized estimating equations will be used to investigate the time-averaged difference and differences at each follow-up time. Discussion The study will provide information about the pain situations of online users in the working population. The participants will benefit from improvements in pain self-efficacy, pain situations, emotional status, and quality of life. The study will illustrate whether online learning is an effective intervention for improving the pain self-efficacy of the working population. Trial registration ClinicalTrials.gov, NCT03718702. Registered on 23 October 2018.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, BN1 9PH, UK
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Kalogirou F, Forsyth F, Kyriakou M, Mantle R, Deaton C. Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:194-212. [PMID: 31978280 PMCID: PMC7083420 DOI: 10.1002/ehf2.12559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) poses a substantial challenge for clinicians, but there is little guidance for effective management. The aim of this systematic review was to determine if there was evidence that disease management programmes (DMPs) improved outcomes for patients with HFpEF. METHODS AND RESULTS A systematic review of controlled studies in English or Greek of DMPs including patients with HFpEF from 2008 to 2018 was conducted using CINAHL, Cochrane, MEDLINE, and Embase. Interventions were assessed using a DMP taxonomy and scored for complexity and intensity. Bias was assessed using the Cochrane Collaboration tool. Initial and updated searches found 6089 titles once duplicates were removed. The final analysis included 18 studies with 5435 HF patients: 1866 patients (34%, study ranges 18-100%) had potential HFpEF (limited by variable definitions). Significant heterogeneity in terms of the population, intervention, comparisons, and outcomes prohibited meta-analysis. Statistically significant or positive trends were found in mortality, hospitalization rates, self-care ability, quality of life, anxiety, depression, and sleep, but findings were not robust or consistent. Four studies reported results separately for study-defined HFpEF, with two finding less positive effect on outcomes. CONCLUSIONS Varying definitions of HFpEF used in studies are a substantial limitation in interpretation of findings. The reduced efficacy noted in contemporary HF DMP studies may not only be due to improvements in usual care but may also reflect inclusion of heterogeneous patients with HFpEF or HF with mid-range EF who may not respond in the same way as HFrEF to individual components. Given that patients with HFpEF are older and multi-morbid, DMPs targeting HFpEF should not rely on a single-disease focus but provide care that addresses predisposing and presentation phenotypes and draws on the principles of comprehensive geriatric assessment. Other components could also be more targeted to HFpEF such as modification of lifestyle factors for which there is emerging evidence, rather than simply continuing the model of care used in HFrEF. Based on current evidence, HF DMPs may improve mortality, hospitalization rates, self-care, and quality of life in patients with HFpEF; however, further research specifically tailored to appropriately defined HFpEF is required.
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Affiliation(s)
| | - Faye Forsyth
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of Public Health and Primary Care, Forvie SiteUniversity of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUK
| | - Martha Kyriakou
- Cyprus University of TechnologyLimassolCyprus
- American Medical CenterNicosiaCyprus
| | - Rhys Mantle
- University of Cambridge School of Clinical MedicineCambridgeUK
| | - Christi Deaton
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of Public Health and Primary Care, Forvie SiteUniversity of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUK
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20
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Saluja S, Rudolfson N, Massenburg BB, Meara JG, Shrime MG. The impact of physician migration on mortality in low and middle-income countries: an economic modelling study. BMJ Glob Health 2020; 5:e001535. [PMID: 32133161 PMCID: PMC7042584 DOI: 10.1136/bmjgh-2019-001535] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.
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Affiliation(s)
- Saurabh Saluja
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Niclas Rudolfson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Sciences, World Health Organization Collaborating Center for Surgery and Public Health, Lund University, Lund, Sweden
| | - Benjamin Ballard Massenburg
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Singh Curry R, Evans E, Raftery AM, Hiscock J, Poolman M. Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study. BMJ Support Palliat Care 2019; 9:381-388. [PMID: 31597626 DOI: 10.1136/bmjspcare-2019-001866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/05/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Malignant bowel obstruction (MBO) is a complication of advanced malignancy and is associated with a short prognosis. MBO can infrequently be reversed by surgery or stenting. The focus of treatment is usually symptomatic management, of which percutaneous venting gastrostomy/gastrojejunostomy (PVG) is one consideration. There is little data considering the impact of PVG on quality of life; we therefore aimed to explore this. METHODS We identified patients with a PVG inserted for MBO and those who consented to participate were interviewed. The interviews were audio recorded, transcribed and analysed using Framework. Alongside patient interviews, a data collection tool was designed and used to record patient demographics and medical information, enabling us to contextualise individual patients' experiences. RESULTS 11 patients were interviewed and 10 patients' data were analysed (1 patient withdrew). No patients regretted having a PVG and many benefitted symptomatically and psychosocially. Challenges encountered included practical issues, pain and PVG tube complications. CONCLUSIONS The analysis provided a detailed insight into the impact of PVG insertion and demonstrated that each patient's experience is shaped by a complex interplay of individual factors, thereby highlighting the need to improve referral criteria and individualise patient selection. Other service improvements include enhancing information provision for patients and training for healthcare professionals, thus aiming to mitigate the challenges experienced. Our study is the first in-depth exploration of patients' experiences of PVG at a tertiary cancer centre. Ensuring that the insights from this study are fed back to guide future service provision is critical in enhancing future patient experiences.
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Affiliation(s)
| | - Elizabeth Evans
- Palliative Care Department, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Anne-Marie Raftery
- The Supportive Care Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Julia Hiscock
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
| | - Marlise Poolman
- Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
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22
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Yu DSF, Li PWC, Yue SCS, Wong J, Yan B, Tsang KK, Choi KC. The effects and cost‐effectiveness of an empowerment‐based self‐care programme in patients with chronic heart failure: A study protocol. J Adv Nurs 2019; 75:3740-3748. [DOI: 10.1111/jan.14162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Doris S. F. Yu
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Polly W. C. Li
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
| | - Sunny C. S. Yue
- Department of Medicine and Geriatrics United Christian Hospital Kwun Tong Hong Kong
| | - John Wong
- Division of Cardiology, Department of Medicine and Geriatrics Tseung Kwan O Hospital Tseung Kwan O Hong Kong
| | - Bryan Yan
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin Hong Kong
| | | | - Kai Chow Choi
- The Nethersole School of Nursing The Chinese University of Hong Kong Shatin Hong Kong
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Randomized control trial of a self-management intervention for heart failure older adults in Northern Taiwan. Collegian 2019. [DOI: 10.1016/j.colegn.2018.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Liljeroos M, Strömberg A. Introducing nurse-led heart failure clinics in Swedish primary care settings. Eur J Heart Fail 2018; 21:103-109. [PMID: 30338881 DOI: 10.1002/ejhf.1329] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
AIM According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC. METHODS AND RESULTS The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. CONCLUSION Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.
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Affiliation(s)
- Maria Liljeroos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden.,Sue & Bill Gross School of Nursing, University of California Irvine, CA, USA
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Smink GM, Jeffe DB, Hayashi RJ, Al-Hammadi N, Fehr JJ. Pediatric-Oncology Simulation Training for Resident Education. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:155-160. [PMID: 31485338 DOI: 10.1136/bmjstel-2018-000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. Method In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Results Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. Conclusions It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.
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Affiliation(s)
- Gayle M Smink
- Assistant Professor of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donna B Jeffe
- Professor of Medicine and director of the Health Behavior, Communication, and Outreach Core, Department of Medicine, and director of the Medical Education Research Unit, Office of Education, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Hayashi
- Professor of Pediatrics, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- statistical data analyst, Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James J Fehr
- Professor of Anesthesiology and Pediatrics, Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, and medical director of the Saigh Pediatric Simulation Center at St. Louis Children's Hospital, St. Louis, Missouri, USA
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Jiang Y, Shorey S, Seah B, Chan WX, Tam WWS, Wang W. The effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure—A systematic review and meta-analysis. Int J Nurs Stud 2018; 78:16-25. [DOI: 10.1016/j.ijnurstu.2017.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/16/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
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Implementing a Protocol to Improve Self-Care Behaviors in Adult Patients With Heart Failure. J Dr Nurs Pract 2018; 11:59-71. [DOI: 10.1891/2380-9418.11.1.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background:Heart failure (HF) is a condition that affects millions of Americans and costs $30 billion to treat annually. HF is the cause for frequent hospitalizations. Self-care practices have been found to improve quality of life, decrease hospitalizations, and reduce treatment costs.Participants:Fifteen adult patients with a HF diagnosis ages 18 to 70 voluntarily participated in the implementation of a protocol aimed at improving self-care behaviors in patients with HF in a private cardiology practice located in a southeastern city.Methods:The project was a quality improvement design. A protocol was implemented using resources from the American Heart Association. Monitoring logs were provided to patients to record daily weights, sodium intake, blood pressure, and symptoms. Educational resources included information about medications and a list of valid HF websites. Participants were provided medication organizers and a two-liter container with which to monitor daily fluid intake. The written information and logs were compiled in red folders.Results:Of the 15 participants, there were no hospital admissions or readmissions for HF during the implementation period. Leg and ankle swelling worsened; dyspnea improved; fewer participants felt like a burden to their family; HF knowledge improved.Discussion:The findings indicate the feasibility of implementing the protocol throughout a private practice organization.
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Effect of educational program on self-care behaviors and health outcome among patients with heart failure. INT J EVID-BASED HEA 2017; 15:178-185. [DOI: 10.1097/xeb.0000000000000108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur J, Gallani MC. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev Lat Am Enfermagem 2017; 23:753-68. [PMID: 26444179 PMCID: PMC4623739 DOI: 10.1590/0104-1169.0370.2612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. METHODS PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). RESULTS this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. CONCLUSIONS these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.
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Affiliation(s)
- Sophie Boisvert
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | | | - Natalia Gonçalves
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
| | - Michel Doré
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | - Julie Francoeur
- Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, CA
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Bryant R, Alonzo A, Schmillen H. Systematic review of provider involvement in heart failure self-care interventions. J Am Assoc Nurse Pract 2017; 29:682-694. [PMID: 28805305 DOI: 10.1002/2327-6924.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Heart failure is a global concern impacting patient outcomes. Self-care interventions improve self-care behaviors in heart failure patients. The impact of direct provider involvement on patient self-care outcomes is unknown in research. The purpose is to review self-care interventions for adults with heart failure and describe direct provider involvement versus no direct provider involvement on patient self-care behaviors. METHODS Review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were independently selected, grounded in the population, intervention, comparison, and outcome (PICO) question, and predetermined inclusion/exclusion criteria, including self-care interventions, adult heart failure patients, self-care behavior measurement, and 10-year publication. Quality assessment of studies was conducted. CONCLUSION There was a lack of data and quality studies to answer the PICO question. Comparison of variables that impact self-care behaviors is problematic because the interventions are heterogeneous, which limits interpretation of results. There were minimal studies with direct provider involvement. None of the studies conceptually addressed direct provider involvement. IMPLICATIONS FOR PRACTICE The involvement of providers, health systems, and patients in pragmatic research can impact the integration of research, policy, and practice. Strategies to decrease threats to internal validity need to be addressed as research is translated into practice.
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Wan TTH, Terry A, Cobb E, McKee B, Tregerman R, Barbaro SDS. Strategies to Modify the Risk of Heart Failure Readmission: A Systematic Review and Meta-Analysis. Health Serv Res Manag Epidemiol 2017; 4:2333392817701050. [PMID: 28462286 PMCID: PMC5406120 DOI: 10.1177/2333392817701050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Human factors play an important role in health-care outcomes of heart failure (HF) patients. A systematic review and meta-analysis of clinical trial studies on HF hospitalization may yield positive proofs of the beneficial effect of specific care management strategies. Purpose: To investigate how the 8 guiding principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition reduce HF readmissions. Basic Procedures: Appropriate keywords were identified related to the (1) independent variable of hospitalization and treatment, (2) the moderating variable of care management principles, (3) the dependent variable of readmission, and (4) the disease of HF to conduct searches in 9 databases. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PubMed, PsycInfo, Science Direct, and Web of Science. Only prospective studies associated with HF hospitalization and readmissions, published in English, Chinese, Spanish, and German journals between January 1, 1990, and August 31, 2015, were included in the systematic review. In the meta-analysis, data were collected from studies that measured HF readmission for individual patients. Main Findings: The results indicate that an intervention involving any human factor principles may nearly double an individual’s probability of not being readmitted. Participants in interventions that incorporated single or combined principles were 1.4 to 6.8 times less likely to be readmitted. Principal Conclusions: Interventions with human factor principles reduce readmissions among HF patients. Overall, this review may help reconfigure the design, implementation, and evaluation of clinical practice for reducing HF readmissions in the future.
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Affiliation(s)
- Thomas T H Wan
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Amanda Terry
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Enesha Cobb
- Florida Hospital Translational Research Institute, Orlando, FL, USA
| | - Bobbie McKee
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Rebecca Tregerman
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Sara D S Barbaro
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
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Shen Q, Zhu H, Jiang G, Liu X. Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res 2017; 40:874-888. [PMID: 28395593 DOI: 10.1177/0193945917701128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate the effects of self-management educational intervention on the symptoms of patients with functional constipation. From January 2014 to April 2015, 66 patients with functional constipation were randomly assigned into intervention group receiving intensive educational interventions and control group receiving routine nursing care. The constipation score of all clinical symptoms (Bristol stool form scale, defecation interval, incomplete evacuation, evacuatory difficulty) at 1 month postdischarge were all significantly lower in the intervention group than in the control group (all, p < .05). At 1 month postdischarge, the intervention group had a significantly higher proportion of patients with good health habits (reasonable diet, regular exercise, good defecation habits, proper use of laxatives) as compared with the control group (all, p < .05). These data suggest educational intervention can effectively improve constipation symptoms and compliance with treatment of patients, and lead to the development of good health habits.
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Affiliation(s)
- Qiong Shen
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hongqin Zhu
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Guixiang Jiang
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xueqin Liu
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Redeker NS, Knies AK, Hollenbeak C, Klar Yaggi H, Cline J, Andrews L, Jacoby D, Sullivan A, O'Connell M, Iennaco J, Finoia L, Jeon S. Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial. Contemp Clin Trials 2017; 55:16-23. [PMID: 28159703 DOI: 10.1016/j.cct.2017.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/24/2017] [Accepted: 01/28/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients. OBJECTIVES The purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS). METHODS Two hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis. DISCUSSION The results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings.
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Affiliation(s)
- Nancy S Redeker
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Andrea K Knies
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Christopher Hollenbeak
- Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States.
| | - H Klar Yaggi
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States; Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States.
| | - John Cline
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States.
| | - Laura Andrews
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Daniel Jacoby
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States.
| | - Anna Sullivan
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Meghan O'Connell
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Joanne Iennaco
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Lisa Finoia
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
| | - Sangchoon Jeon
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06477, United States.
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Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, Battersby M. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice. Curr Cardiol Rev 2016; 12:270-284. [PMID: 27397492 PMCID: PMC5304248 DOI: 10.2174/1573403x12666160703183001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
Abstract
Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
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Chen SH, Huang YP, Shao JH. Effects of a dietary self-management programme for community-dwelling older adults: a quasi-experimental design. Scand J Caring Sci 2016; 31:619-629. [DOI: 10.1111/scs.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Su-Hui Chen
- School of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Yu-Ping Huang
- School of Nursing; National Quemoy University; Taiwan
| | - Jung-Hua Shao
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
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Unverzagt S, Meyer G, Mittmann S, Samos FA, Unverzagt M, Prondzinsky R. Improving Treatment Adherence in Heart Failure. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:423-30. [PMID: 27397013 PMCID: PMC4941608 DOI: 10.3238/arztebl.2016.0423] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite improved treatment options, heart failure remains the third most common cause of death in Germany and the most common reason for hospitalization. The treatment recommendations contained in the relevant guidelines have been incompletely applied in practice. The goal of this systematic review is to study the efficacy of adherence-promoting interventions for patients with heart failure with respect to the taking of medications, the implementation of recommended lifestyle changes, and the improvement in clinical endpoints. METHODS We performed a meta-analysis of pertinent publications retrieved by a systematic literature search. RESULTS 55 randomized controlled trials were identified, in which a wide variety of interventions were carried out on heterogeneous patient groups with varying definitions of adherence. These trials included a total of 15 016 patients with heart failure who were cared for as either inpatients or outpatients. The efficacy of interventions to promote adherence to drug treatment was studied in 24 trials; these trials documented improved adherence in 10% of the patients overall (95% confidence interval [CI]: [5; 15]). The efficacy of interventions to promote adherence to lifestyle recommendations was studied in 42 trials; improved adherence was found in 31 trials. Improved adherence to at least one recommendation yielded a long-term absolute reduction in mortality of 2% (95% CI: [0; 4]) and a 10% reduction in the likelihood of hospitalization within 12 months of the start of the intervention (95% CI: [3; 17]). CONCLUSION Many effective interventions are available that can lead to sustained improvement in patient adherence and in clinical endpoints. Longterm success depends on patients' assuming responsibility for their own health and can be achieved with the aid of coordinated measures such as patient education and regular follow-up contacts.
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Affiliation(s)
- Susanne Unverzagt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Susanne Mittmann
- Institute for Medical Epidemiology, Biostatistics and Informatics, Section for General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
| | - Franziska-Antonia Samos
- Institute for Medical Epidemiology, Biostatistics and Informatics, Section for General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
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Abstract
OBJECTIVE Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. METHODS Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. RESULTS Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44). CONCLUSIONS Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
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Bos-Touwen I, Jonkman N, Westland H, Schuurmans M, Rutten F, de Wit N, Trappenburg J. Tailoring of self-management interventions in patients with heart failure. Curr Heart Fail Rep 2016; 12:223-35. [PMID: 25929690 PMCID: PMC4424272 DOI: 10.1007/s11897-015-0259-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The effectiveness of heart failure (HF) self-management interventions varies within patients suggesting that one size does not fit all. It is expected that effectiveness can be optimized when interventions are tailored to individual patients. The aim of this review was to synthesize the literature on current use of tailoring in self-management interventions and patient characteristics associated with self-management capacity and success of interventions, as building blocks for tailoring. Within available trials, the degree to which interventions are explicitly tailored is marginal and often limited to content. We found that certain patient characteristics that are associated with poor self-management capacity do not influence effectiveness of a given intervention (i.e., age, gender, ethnicity, disease severity, number of comorbidities) and that other characteristics (low: income, literacy, education, baseline self-management capacity) in fact are indicators of patients with a high likelihood for success. Increased scientific efforts are needed to continue unraveling success of self-management interventions and to validate the modifying impact of currently known patient characteristics.
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Affiliation(s)
- Irene Bos-Touwen
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nini Jonkman
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Heleen Westland
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marieke Schuurmans
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frans Rutten
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Niek de Wit
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jaap Trappenburg
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Morilla-Herrera JC, Garcia-Mayor S, Martín-Santos FJ, Kaknani Uttumchandani S, Leon Campos Á, Caro Bautista J, Morales-Asencio JM. A systematic review of the effectiveness and roles of advanced practice nursing in older people. Int J Nurs Stud 2015; 53:290-307. [PMID: 26542652 DOI: 10.1016/j.ijnurstu.2015.10.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals. BACKGROUND In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact. DESIGN Systematic review. DATA SOURCES Sixteen electronic databases were consulted (1990-2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies. REVIEW METHODS Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease). RESULTS Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients' and caregivers' satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers. CONCLUSION Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.
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Affiliation(s)
- Juan Carlos Morilla-Herrera
- Primary Health Care District of Málaga, Spain; Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Silvia Garcia-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Francisco Javier Martín-Santos
- Primary Health Care District of Málaga, Spain; Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | | | - Álvaro Leon Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Jorge Caro Bautista
- Health Care Centre El Limonar, Primary Health Care District of Málaga, Spain
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Tougas ME, Hayden JA, McGrath PJ, Huguet A, Rozario S. A Systematic Review Exploring the Social Cognitive Theory of Self-Regulation as a Framework for Chronic Health Condition Interventions. PLoS One 2015; 10:e0134977. [PMID: 26252889 PMCID: PMC4529200 DOI: 10.1371/journal.pone.0134977] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/15/2015] [Indexed: 01/18/2023] Open
Abstract
Background Theory is often recommended as a framework for guiding hypothesized mechanisms of treatment effect. However, there is limited guidance about how to use theory in intervention development. Methods We conducted a systematic review to provide an exemplar review evaluating the extent to which use of theory is identified and incorporated within existing interventions. We searched electronic databases PubMed, PsycINFO, CENTRAL, and EMBASE from inception to May 2014. We searched clinicaltrials.gov for registered protocols, reference lists of relevant systematic reviews and included studies, and conducted a citation search in Web of Science. We included peer-reviewed publications of interventions that referenced the social cognitive theory of self-regulation as a framework for interventions to manage chronic health conditions. Two reviewers independently assessed articles for eligibility. We contacted all authors of included studies for information detailing intervention content. We describe how often theory mechanisms were addressed by interventions, and report intervention characteristics used to address theory. Results Of 202 articles that reported using the social cognitive theory of self-regulation, 52% failed to incorporate self-monitoring, a main theory component, and were therefore excluded. We included 35 interventions that adequately used the theory framework. Intervention characteristics were often poorly reported in peer-reviewed publications, 21 of 35 interventions incorporated characteristics that addressed each of the main theory components. Each intervention addressed, on average, six of eight self-monitoring mechanisms, two of five self-judgement mechanisms, and one of three self-evaluation mechanisms. The self-monitoring mechanisms ‘Feedback’ and ‘Consistency’ were addressed by all interventions, whereas the self-evaluation mechanisms ‘Self-incentives’ and ‘External rewards’ were addressed by six and four interventions, respectively. The present review establishes that systematic review is a feasible method of identifying use of theory as a conceptual framework for existing interventions. We identified the social cognitive theory of self-regulation as a feasible framework to guide intervention development for chronic health conditions.
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Affiliation(s)
- Michelle E. Tougas
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Jill A. Hayden
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick J. McGrath
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
- Canada Research Chair, Dalhousie University, Halifax, Nova Scotia, Canada
- Science, Pediatrics, and Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - Anna Huguet
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sharlene Rozario
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
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Toukhsati SR, Driscoll A, Hare DL. Patient Self-management in Chronic Heart Failure - Establishing Concordance Between Guidelines and Practice. Card Fail Rev 2015; 1:128-131. [PMID: 28785446 DOI: 10.15420/cfr.2015.1.2.128] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self-management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.
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Affiliation(s)
- Samia R Toukhsati
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.,Department of Cardiology, Austin Health, Heidelberg, Australia
| | - Andrea Driscoll
- Department of Cardiology, Austin Health, Heidelberg, Australia.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.,Department of Cardiology, Austin Health, Heidelberg, Australia
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Iyngkaran P, Harris M, Ilton M, Kangaharan N, Battersby M, Stewart S, Brown A. Implementing guideline based heart failure care in the Northern Territory: challenges and solutions. Heart Lung Circ 2013; 23:391-406. [PMID: 24548637 DOI: 10.1016/j.hlc.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
Abstract
The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.
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Affiliation(s)
- Pupalan Iyngkaran
- Consultant Cardiologist, Senior Lecturer Flinders University, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Melanie Harris
- Senior Research Fellow, Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100 Adelaide SA 5001.
| | - Marcus Ilton
- Director of Cardiology, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Nadarajan Kangaharan
- Director of Medicine/Consultant Cardiologist, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, South Australia, Australia 5001.
| | - Simon Stewart
- Director NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC, 3004, Australia.
| | - Alex Brown
- Professor of Population Health and Research Chair Aboriginal Health School of Population Health, University of South Australia & South Australian Health & Medical Research Institute, Adelaide.
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