Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

Ineffective health management: A systematic review and meta-analysis of related factors

PURPOSE

A standardized language system can support the elaboration of clinical guidelines by matching information from similar patterns of response to people. To identify the factors that are related to a higher likelihood of an ineffective health management nursing diagnosis.

METHODS

We conduct a systematic review and meta-analysis. An electronic search was conducted in MEDLINE databases via PubMed, Web of Science, SciELO, CINAHL, SCOPUS, and Embase between October and November 2020. Descriptive data were extracted from each article. The odds ratios for each etiological factor related to ineffective health management were directly extracted from the articles or calculated from the data described in the articles. The analysis of the measurements of exposure and the magnitude of the effect was performed using the statistical software R, and a forest plot was constructed for each etiological factor.

FINDINGS

Ten studies were included, and 15 related factors were recovered from the primary studies. The factors that significantly increased the likelihood of an ineffective health management nursing diagnosis were insufficient knowledge of the therapeutic regimen, perceived barriers, powerlessness, economic disadvantage, and difficulty managing complex treatment regimens. No effect was verified with the following factors: decision conflict, family pattern of healthcare, and inadequate number of cues to action.

CONCLUSION

Factors related to a higher likelihood of ineffective health management may be the focus of early and targeted nursing interventions, contributing to an improved quality of care.

CLINICAL RELEVANCE

Understanding exposure to these factors can improve diagnostic reasoning at different population levels.

Literacy critical to heart failure management: a scoping review

Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.

Health education: the effectiveness of interventions in patients with heart failure

OBJECTIVES

To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control".

METHODS

Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%.

RESULTS

The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001).

CONCLUSIONS

The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

Nursing taxonomies in hospital discharge planning: a quasi-experimental study

ABSTRACT Objective: to evaluate the effect of implementation of hospital discharge planning based on the taxonomies of NANDA-International, nursing interventions classification (NIC) and nursing outcomes classification (NOC) for patients with heart failure (HF) or diabetes mellitus (DM). Methods: quasi-experimental quantitative study conducted in a public university hospital located in the state of Rio Grande do Sul, Brazil. Convenience sampling included 28 adult patients hospitalized for HF or DM with the nursing diagnosis Ineffective Health Management (00078), who received the following nursing interventions: Teaching: Disease Process, Teaching: Prescribed Medication and Teaching: Prescribed Diet. Before and after the intervention, the following nursing outcomes were evaluated : Knowledge: Diabetes Management and Knowledge: Heart Failure Management. Results: the score of the nursing outcome Knowledge: Heart Failure Management went from 2.05±0.28 to 2.54±0.30 (P=0.002), and of the nursing outcome Knowledge: Diabetes Management went from 2.61±0.55 to 3.21±0.57 (P=0.000). Conclusion: discharge planning based on the NIC improves the NOC score and may interfere in the health outcomes.

Use of the Nursing Outcomes Classification - NOC to assess the knowledge of patients with venous ulcer

OBJECTIVE

To evaluate the knowledge of patients with venous ulcers (VU) on their chronic disease, treatment, and prevention of complications, according to the Nursing Outcomes Classification-NOC.

METHODS

This is a cross-sectional study conducted between 2017 and 2018 in a Brazilian hospital. The sample consisted of 38 patients with VU attended in outpatient nursing consultations. The study analyzed sociodemographic, clinical and nine indexes from the Knowledge: Chronic Disease Management (1847) of the NOC, assessed using a five-point Likert scale, analyzed using descriptive statistics.

RESULTS

The mean of the result Knowledge: Chronic Disease Management (1847) was 3.56±1.42. The clinical index Procedures involved in treatment regimen had the highest mean 4.18±0.21, followed by Pain management strategies with 3.92±0.27. In the association between knowledge and healing, the best scores were in patients with at least one healed VU.

CONCLUSION

The knowledge of the patients was moderate and it was necessary to promote educational actions according to individual demands.

Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial

OBJECTIVE

to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure.

METHOD

randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%).

RESULTS

One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days.

CONCLUSION

discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859.

Investigating the Relevance of Nursing Caring Interventions Delivered to Patients with Coronary Artery Disease at a Teaching Hospital in China: A Retrospective Study

OBJECTIVE

Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. Previous systematic reviews and meta-analysis of randomized controlled trials concluded that nursing caring interventions (NCIs) are beneficial for coronary artery patients. However, most of those interventions were conducted in outpatient or home-based settings or through the telephone. Due to its multiple benefits, the authors recommended the application of such interventions to hospitalized coronary artery patients. Currently, little is known on the status of application of such evidence-based interventions in the actual clinical setting for hospitalized coronary artery patients. Similar studies conducted in China were also inadequate. Therefore, this study aimed to investigate the kinds of NCIs delivered to hospitalized coronary artery patients and their consistent relationship with risk factors of CAD found in the clinical records of patients. Results of this study were expected to alert nurses to consider such risk factors when caring for coronary artery patients as well as appraising their caring efforts in improving the patient's wellbeing for the reduction of morbidity and mortality from a CAD sequel. This report also disseminates some cardiovascular knowledge and health tips to the readers.

METHODS

A descriptive, cross-sectional, retrospective design using clinical case notes was employed; the study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. A total of 300 coronary artery case notes were randomly selected from 700 eligible cardiovascular patients files by using a simple random technique of simple random numbers through Microsoft office excel sheet. Chi-square (χ2) test and multivariate logistic regression analysis for adjusted odds ratio with 95% confidence interval (CI) within its range were used to compare the relationship among independent (patient's demographic and clinical risk factors of CAD) and dependent variables (NCIs implemented to such patients).

RESULTS

A total of 300 coronary artery patients' case notes were audited with a mean age of 63±11.2 years. Of these 175 (58.3%) were males, 126 (42%) were smokers and 224 (74.7%) were hypertensive. NCIs such as "administer coronary artery medication and their instructions" was mostly delivered to 291 (97%) patients. The delivery of three out of eight gathered NCIs were significantly influenced by three or all of these CAD risk factors (age, smoking, hypertension, and diabetes) (p < 0.05 and/or < 0.01) with an adjusted odds ratio (95% CI) within their significant ranges. Patients with diabetes mellitus were five times more likely to influence the delivery of "administer medication and their instructions" than the rest of patients with coronary artery risk factors (p < 0.01; AOR (95% CI) 5.02(2.059-7.207).

CONCLUSION

This study reveals that nurses delivered beneficial evidence-based interventions to patients with CAD. The interventions were significantly consistent with age as an unmodifiable risk factor and smoking, hypertension, and diabetes as modifiable risk factors of CAD. However, the management of stress in these patients was low; and since stress may trigger CAD, it should be assessed and managed appropriately.

Effects of a multidisciplinary disease management programme with or without exercise training for heart failure patients: Secondary analysis of a randomized controlled trial

BACKGROUND

Heart failure is a complex syndrome that causes substantial functional impairment and poor outcomes. Although multidisciplinary disease management programmes are effective, the role of additional outpatient-based exercise training and the effects of multidisciplinary disease management programmes for patients with contraindications to exercise training are unclear.

OBJECTIVES

To compare the effects of the multidisciplinary disease management programme with and without exercise training on heart failure-related rehospitalization, disease knowledge, and functional capacity.

DESIGN

Secondary analysis of a randomized controlled trial.

PARTICIPANTS AND SETTING

Data for 212 patients hospitalized for heart failure at a local teaching hospital in Taiwan were analysed.

METHODS

Patients' data were assigned to three groups: control (n = 71), multidisciplinary disease management programme without exercise training (n = 70) or multidisciplinary disease management programme with exercise training (n = 71). The multidisciplinary disease management programme included comprehensive assessments, individualized education, optimizing medications, pre-scheduled clinic visits, and encouraging regular physical activity at home. Outpatient-based exercise training was performed only in the multidisciplinary disease management programme with exercise training group. The control and the multidisciplinary disease management programme without exercise training groups were further divided into subgroups with and without contraindications to exercise training. Patients were followed up monthly for heart failure-related rehospitalizations for 1 year. Cox proportional hazard models and Kaplan-Meier analyses were used to identify the significant predictors of heart failure-related rehospitalizations. A generalized estimation equation model was used to analyse the secondary outcomes, including disease knowledge and 6-min walking distance at baseline and 6 and 12 months after discharge.

RESULTS

At 12 months after discharge, the multidisciplinary disease management programme with and without exercise training groups had significantly lower heart failure-related rehospitalization rates and better disease knowledge compared with the control group (p < 0.01). Only the multidisciplinary disease management programme with exercise training group had a significant improvement in 6-min walking distance (p < 0.05). For patients with contraindications to exercise, the multidisciplinary disease management programme significantly reduced heart failure-related rehospitalization rates at 12 months after discharge (p < 0.05). For those without contraindications, the event-lowering effect was only noted for the multidisciplinary disease management programme with exercise training group (p < 0.05).

CONCLUSIONS

Outpatient-based exercise training is recommended to be incorporated into multidisciplinary disease management programmes for patients without exercise contraindications to improve disease outcomes and functional capacity. For patients with contraindications to exercise, a multidisciplinary disease management programme is recommended to improve patient outcomes.

Impacto do monitoramento telefônico em pacientes com insuficiência cardíaca: ensaio clínico randomizado

Resumo Objetivo Analisar o autocuidado e o conhecimento em pacientes com insuficiência cardíaca monitorados por contato telefônico e analisar a correlação do conhecimento com o autocuidado. Métodos Ensaio clínico randomizado, realizado em uma clínica especializada, no período de abril de 2015 a dezembro de 2015. Foram monitorados e randomizados 36 pacientes no Grupo Controle (17) ou no Grupo Intervenção (19). Ambos os grupos participaram do monitoramento convencional, compreendendo três atendimentos (Basal; 2° mês; 4° mês); no Grupo Intervenção houve associação do monitoramento telefônico por meio de um guia padronizado. Foram utilizados os Questionários de Conhecimento e de Autocuidado para avaliação dos desfechos primários e secundários. Resultados Houve diferença no conhecimento (12,7±1,7 vs. 10,8±2,2; p=0,009) e autocuidado (25,4±6,6 vs. 29,5±4,8; p=0,04) no 4° mês; correlação negativa entre os escores do conhecimento e autocuidado no 2° mês (r=-0,48; p=0,03). Conclusão O monitoramento convencional combinado ao monitoramento telefônico mostra-se eficaz no 4° mês com a melhoria do conhecimento e autocuidado de pacientes com insuficiência cardíaca e correlação significativa desses desfechos no 2° mês.

Género y efectividad de la metodología enfermera en pacientes con insuficiencia cardiaca

Estudios recientes demostraron que una intervención enfermera de educación sanitaria en la Insuficiencia Cardiaca (IC) evita descompensaciones. Por otro lado, dado que existen diferencias de género en los patrones de la IC, las intervenciones tendrán también efectos diferentes. Objetivo: determinar la existencia de posibles diferencias según el género de los pacientes, en el efecto de una intervención enfermera respecto al autocuidado. Material y método: Se realizó un estudio cuasi experimental con pacientes atendidos en consulta de IC (129). Seleccionados en dos tiempos, primer trimestre año grupo control (62), y segundo trimestre año grupo intervención (67).Todos se evaluaron tres veces, primera consulta, tres y seis meses. Al grupo intervención se aplicó en cada visita una intervención enfermera que consistía en la educación terapéutica, control y seguimiento de su IC. Resultados: inicio: T.A. sistólica hombres 133.90±0.96(DE 27.77), mujeres 119.64±0.57 (DE18.72). Cuidador 93% hombres, 63% mujeres. Conducta terapéutica 2.07+0.02 (DE0.20) hombres,3.04+0.01 (DE 0.31) mujeres. Final: autocuidado -16.00±2.08 (DE10.99) hombres, -9.68±2.22 (DE12.92) mujeres. Adherencia terapéutica1.32±0.35 (DE1.83) hombres, 2.94±1.87 (DE10.93) mujeres. Mejoría muy similar de los NOC en todos. Conclusiones: en el grupo de estudio, participaron más mujeres que hombres,estos[1] últimos tuvieron mayor co morbilidad, consumo de tabaco y alcohol que lasmujeres y disponían de una cuidadora informal. Con relación al autocuidado y adherencia al tratamiento, en la valoración inicial, no se encontró una diferencia significativa entre ambos géneros, mientras que en la calidad de vida el resultado fue mejor en los hombres. Después de la intervención, se encontró que todos los pacientes mejoraron los resultados en calidad de vida y en el NOC (Nursing outcomesclassification), así como el autocuidado y la adhesión terapéutica en todos los participantes. [2] Es importante destacar que los hombres doblaron la puntuación en autocuidado y las mujeres en adhesión terapéutica.