An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients

A Pilot Study on Standardized In-hospital Education About Heart Failure Conducted During the First Days After Decompensation

INTRODUCTION

Education addressed to heart failure (HF) patients constitutes an important element of modern comprehensive treatment programs. The present article demonstrates a novel method of standardized in-hospital education addressed to patients admitted due to decompensation in HF.

METHODS

This pilot study was conducted among 20 patients [19 men, age 63 ± 16 years, NYHA (Classification according to New York Heart Association) on admission (II/III/IV): 5/25/70%]. Five-day education was based on individual sessions conducted using colorful boards demonstrating selected, highly practical elements of the knowledge about HF management, prepared by experts in HF management (medical doctors, a psychologist, and a dietician). The level of knowledge about HF was measured before and after education, based on a questionnaire prepared by the authors of the boards.

RESULTS

All patients experienced an improvement of their clinical status (confirmed by reduced New York Heart Association class and body mass, both P < 0.05). Mini Mental State Exam (MMSE) confirmed that no one demonstrated cognitive impairment. The score reflecting the level of knowledge about HF improved significantly after 5 days of in-hospital treatment accompanied by education (P = 0.0001).

CONCLUSIONS

We showed that the proposed model of education addressed to patients with decompensated HF, conducted using colorful boards demonstrating selected, highly practical elements of the knowledge about HF management, prepared by experts in HF management lead to significant increase of HF-related knowledge.

Time to Revisit Heart Failure Self-Care: A Concept Analysis

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self .

The Learning Incubator: an innovative teaching and learning technology in nursing

OBJECTIVE

To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area.

METHOD

Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students.

RESULTS

The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator.

CONCLUSION

The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from January 2000 to December 2019, and 25 articles were included.

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.

Cluster randomized controlled trial testing the effectiveness of a self-management intervention using the teach-back method for people with heart failure

In this study, we examined the effectiveness of a self-management intervention delivered to people with heart failure in Vietnam. It used teach-back, a cyclical method of teaching content, checking comprehension, and re-teaching to improve understanding. A single-site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach-back heart failure self-management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self-care, with understanding reinforced using teach-back, a heart failure booklet, weighing scales, diary, and a follow-up phone call 2 weeks post-discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self-care (maintenance, management and confidence), and all-cause hospitalizations assessed at 1 and 3 months (end-point). Upon completion of the study, the intervention group had significantly greater knowledge and self-care maintenance than the control group. Other outcomes did not differ between the two groups. The teach-back self-management intervention demonstrated promising benefits in promoting self-care for heart failure patients.

Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

Influence of socio-demographic characteristics in the self-care of people with heart failure

OBJECTIVE

To determine the influence of socio-demographic characteristics in the self-care of people with heart failure (HF).

METHOD

Cross-sectional, analytical study, held in three private hospitals in Fortaleza, Ceará, Brasil, with 57 hospitalized patients. The data were collected through a demographic characterization form and a self-care assessment scale and were analyzed with inferential statistics, using mean comparison tests.

RESULTS

Self-care was best assessed in people with higher education level, higher household income and in a relationship.

CONCLUSION

The socio-demographic characteristics influenced seven self-care practices: dietary control; monitoring of body weight; effort in labor activities; knowledge about HF; up-to-date vaccination record; leisure activities; and family and social support network with strong bonds. The higher prevalence of answers indicating satisfactory self-care practices among the patients occurred in the areas of health promotion and tolerance to stress.

Symptom Management and Hospital Readmission in Heart Failure Patients: A Qualitative Study From Portugal

This article reports a study aimed at identifying the factors that result in hospital readmissions for patients with heart failure. The high rates of readmission are often due to a lack of knowledge about symptoms and signs of disease progression, and these Portuguese nurses believed that readmissions could be decreased through disease management programs in which patients assumed a more active role in self-care. A study was designed to identify broad categories of problems that lead Portuguese patients with heart failure to be readmitted to hospital. Semistructured interviews were conducted, recorded, and submitted for content analysis, revealing 3 main categories for targeting: health management, behavioral management, and psychological support. This study revealed that patients with heart failure seem to struggle with management of multiple treatment regimens during the long course of their chronic illness. Based on these interviews, authors conclude that a disease management program be tailored expressly for the Portuguese culture and their lifestyle.

Quality of life related to health for heart failure patients

ABSTRACT Objective: To assess the quality of life related to health for heart failure patients and to relate sociodemographic and clinical data. Method: It is an observational and transversal study, with quantitative approach, carried out in a heart failure ambulatory in the state of Pernambuco. Results: In the sample (n=101), there was prevalence of men older than 60 years old, married and professionally inactive. The quality of life related to health, based on the Minnesota Living With Heart Failure Questionnaire, was considered moderate (34.3±21.6), being significantly related to age (p=0.004), functional class (p<0.001), and patients with chagasic cardiopathy (p=0.02). Conclusion: The quality of life in the HF group of chagasic etiology was more compromised, specially in the emotional dimension. It is suggested that studies on the hypothesis that longer ambulatory follow-up improves quality of life and that having Chagas disease interferes negatively with the quality of life of heart failure patients.

ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature

BACKGROUND AND AIMS

Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation.

METHODS

This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study.

RESULTS

Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated.

CONCLUSION

This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

How long before hospital admission do the symptoms of heart failure decompensation arise?

ABSTRACT Objective: to identify the signs and symptoms of decompensation of heart failure (HF) and the duration of time to hospital admission. Method: this is a cross-sectional study with adult patients hospitalized for decompensated HF in a teaching hospital located in southern Brazil from July to October 2017. Data collection was performed through a structured questionnaire that included sociodemographic, clinical signs and symptoms of HF. In the data analysis, the following tests were applied: t-Student, Mann Whitney U-Test, Chi-Square Tests. Results: 94 patients, aged between 42 and 98 years old (mean of 71.2 years old) were included. The most prevalent signs and symptoms before emergency admission were dyspnea (79.8%), cough (29.8%), orthopnea (27.7%), edema (23.4%), and fatigue (22.3%). The median time from onset of signs and symptoms to arrival in the emergency room is fatigue and edema 7 days, orthopnea 5 days, cough 4 days and dyspnea 3 days. Conclusion: the set of classic signs and symptoms of decompensation of HF occurs around seven days before the emergency search and dyspnea is the worsening that leads the patient to a hospital emergency.

Intervención educativa de enfermería para el autocuidado de los pies en personas que viven con diabetes tipo 2

Objetivo: probar una intervención educativa con fundamento en la teoría de autocuidado, con aplicación pedagógica de la educación dialógica para el autocuidado de los pies. Materiales y métodos: estudio cuantitativo de diseño cuasiexperimental de preprueba y posprueba. El grupo experimental estuvo conformado por 40 personas y el grupo de comparación por 32. La variable de autocuidado de los pies se midió a través de dos instrumentos, “Autocuidados para prevenir el pie diabético” y “Autocuidados del pie diabético”, este último elaborado por investigadores de la Universidad de Málaga. Resultados: en la preprueba, el 35 % de las personas del grupo experimental presentó un nivel bajo de autocuidado, el 28 % medio y el 37 % alto. Después de la intervención se observó un incremento estadísticamente significativo (p = 0,000) en el autocuidado; en cambio, el grupo de comparación mantuvo casi los mismos porcentajes, sin encontrarse diferencias significativas. Conclusiones: los resultados sugieren que una intervención educativa con fundamento teórico influye en la mejora del autocuidado de los pies de las personas que viven con diabetes, donde enfermería cumple un papel fundamental para su desarrollo.

Possible Solutions as a Concept in Behavior Change Interventions

PROBLEM

Nurses are uniquely positioned to implement behavior change interventions. Yet, nursing interventions have traditionally resulted from nurses problem-solving rather than allowing the patient to self-generate possible solutions for attaining specific health outcomes.

PURPOSE

The purpose of this review is to clarify the meaning of possible solutions in behavior change interventions.

METHODS

Walker and Avant's method on concept analysis serves as the framework for examination of the possible solutions.

CONCLUSION

Possible solutions can be defined as continuous strategies initiated by patients and families to overcome existing health problems.

IMPLICATIONS FOR NURSING PRACTICE

As nurses engage in behavior change interventions, supporting patients and families in problem-solving will optimize health outcomes and transform clinical practice.

Efficacy of a social support and problem-solving intervention on heart failure self-care: A pilot study

OBJECTIVE

The purpose of this study was to examine the preliminary effects of a coping partnership intervention comprised of social support and problem-solving on HF self-care maintenance, management, and confidence.

METHODS

A 3-group randomized controlled pilot study was conducted. The intervention group received 1 home visit, weekly (month 1), and biweekly (months 2 and 3) telephone calls. The attention group received telephone calls starting at week 2, following a similar pattern. The control group received usual care only. The Self-care of Heart Failure Index, was administered at baseline, 5, 9, and 13 weeks. Linear mixed modeling examined intervention effect on study outcomes.

RESULTS

A total of 66 participants completed the study. The participants were mean age 61 years; 54.2% male; 56% Non-Caucasian; and 43.9% New York Heart Association HF Class II. Significant treatment-by-time interaction effects were noted for self-care maintenance (F=4.813; p=0.010) and self-care confidence (F=4.469; p=0.014). There was no significant treatment-by-time interaction effect on self-care management.

CONCLUSIONS

Coping partnership interventions that strengthen support and social problem- solving may improve self-care maintenance and confidence in individuals with HF.

PRACTICE IMPLICATIONS

Clinicians should consider including these components in HF patient education and clinical follow-up.

Effect of an orientation group for patients with chronic heart failure: randomized controlled trial

OBJECTIVE

To evaluate the effect of the orientation group on therapeutic adherence and self-care among patients with chronic heart failure.

METHOD

Randomized controlled trial with 27 patients with chronic heart failure. The intervention group received nursing consultations and participated in group meetings with the multi-professional team. The control group only received nursing consultations in a period of four months. Questionnaires validated for use in Brazil were applied in the beginning and in the end of the study to assess self-care outcomes and adherence to treatment. Categorical variables were expressed through frequency and percentage distributions and the continuous variables through mean and standard deviation. The comparison between the initial and final scores of the intervention and control groups was done through the Student's t-test.

RESULTS

The mean adherence in the intervention group was 13.9 ± 3.6 before the study and 4.8 ± 2.3 after the study. In the control group it was 14.2 ± 3.4 before the study and 14.7 ± 3.5 after the study. The self-care confidence score was lower after the intervention (p=0.01).

CONCLUSION

The orientation group does not improve adherence to treatment and self-care management and maintenance and it may reduce confidence in self-care. Registry REBEC RBR-7r9f2m.

Associação das condições sociais e clínicas à qualidade de vida de pacientes com insuficiência cardíaca

RESUMO Objetivo Analisar a associação entre as condições sociodemográficas e clínicas com a qualidade de vida relacionada à saúde de pacientes com insuficiência cardíaca. Método Estudo transversal, com amostra não probabilística de 84 pacientes com insuficiência cardíaca, em seguimento ambulatorial, realizado no município de João Pessoa, PB, Brasil, no período de janeiro a julho de 2015. Utilizou-se o questionário Minnesota Living with Heart Failure Questionnaire. Na análise dos dados, foram aplicados os testes: t-Student, ANOVA e Correlação de Pearson, com nível de significância de 5%. Resultados Os escores médios do Minnesota Living with Heart Failure Questionnaire revelaram boa qualidade de vida do grupo pesquisado. Houve associação negativa significante entre qualidade de vida e idade: portanto, quanto menor a idade, pior a qualidade de vida. Conclusão Fazem-se necessárias ações de promoção à saúde para melhorar a capacidade de enfretamento dessa doença, em especial, para os pacientes mais jovens.