Patient-centered Needs Assessment

Trajectories and Predictors of the Care Needs of Patients With Chronic Heart Failure: Growth Mixture Modeling

BACKGROUND

Research on the care needs of patients with heart failure (HF) has predominantly relied on cross-sectional studies. Consequently, there is limited understanding of how care needs evolve over time within this population.

OBJECTIVES

The aims of this study were to explore the trajectories of care needs in patients with HF 1 year after discharge and analyze the potential factors that can predict these trajectories.

METHODS

A total of 197 patients with HF were recruited and followed at 1, 3, 6, and 12 months postdischarge. Care needs were assessed using the care needs survey questionnaire, and potential factors were selected based on the Andersen Behavioral Model. A growth mixture model was used to identify the trajectories of care needs, whereas logistic regression analyses were used for statistical comparisons.

RESULTS

Three trajectories in the care needs of patients with HF were identified: (1) a mild increase trajectory, (2) a decline trajectory, and (3) a persistently high trajectory. Need factors were the most significant determinants of care needs trajectories, with higher New York Heart Association functional classification, left ventricular ejection fraction less than 40%, and lower self-reported health serving as key predictors of persistently high trajectory. In contrast, only lower self-efficacy and the absence of a spouse as predisposing factors were associated with an increased risk of maintaining persistently high levels of care needs.

CONCLUSION

Care needs after discharge in patients with HF can be characterized by 3 trajectories. Need factors will help clinicians with early identification of patients with persistently high level of care needs.

Development and Validation of the Coronary Heart Disease Scale Among the System of Quality of Life Instruments for Chronic Diseases QLICD-CHD (V2.0) Based on Classical Test Theory and Generalizability Theory

Objective

Coronary heart disease (CHD) is a common and frequent disease with a long and incurable course, and the quality of life of patients is severely reduced. This study was to develop and validate a quality of life scale for patients with CHD based on the Chinese context.

Methods

The scale QLICD-CHD (V2.0) was developed based on the QLICD-CHD (V1.0), using a programmed decision procedures. Based on the data measuring QoL 3 times before and after treatments from 189 patients with CHD, the psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation analysis, multi-trait scaling analysis, structural equation modeling, t-test and also G-study and D-study of generalizability theory analysis. The SF-36 scale was used as the criterion to evaluate the criterion-related validity. Paired t tests were conducted to evaluate the responsiveness on each domain/facet as well as the total of the scale, with Standardized Response Mean (SRM) being calculated.

Results

The QLICD-CHD (V2.0) has been developed with 42 items in 4 domains. The Cronbach's α of the general module, the specific module and the total scale were 0.91, 0.92 and 0.91 respectively. The overall score and the test-retest reliability coefficients in all domains are higher than 0.60, except for the specific module. Correlation and factor analysis confirmed good construct validity and criterion-related validity. After treatments, the overall score and score of all domains have statistically significant changes (P<0.01). The SRM of domain-level score ranges from 0.27 to 0.50. Generalizability Theory further confirm the reliability of the scale through more accurate variance component studies.

Conclusion

The QLICD-CHD (V2.0) could be used as a useful instrument in assessing QoL for patients with CHD, with good psychometric properties.

The Mediator Role of Meaning in Life in the Life Quality of Patients With Chronic Heart Failure

PURPOSE

Heart failure (HF) is a highly recurrent disease with a high sudden death rate and a substantial influence on disease-related quality of life (QOL). Social support, symptom distress, care needs, and meaning in life all have significant impacts on QOL. We hypothesized that meaning in life plays a mediating role in the relationship of social support, symptom distress, and care needs with QOL among patients with chronic HF.

METHODS

Based on cross-sectional analysis, we recruited 186 HF outpatients who completed structured questionnaires for social support, symptom distress, care needs, meaning in life, and QOL. Structural equation modeling was used to analyze the mediating role of meaning in life in the relationship of social support, symptom distress, and care needs with QOL.

RESULTS

The final model showed good model fit. Meaning in life was associated with global QOL (β = 0.18, p = .032). Although symptom distress (β = -0.26, p = .005) and care needs (β = -0.36, p = .021) were negatively associated with global QOL, meaning in life played a partial mediating role between symptom distress and global QOL (β = -0.02, p = .023) and between care needs and global QOL (β = -0.07, p = .030). However, meaning in life played a complete mediating role between social support and global QOL (β = 0.08, p = .047). The model showed that meaning in life, symptom distress, and care needs explained 50% of global QOL.

CONCLUSIONS

In patients with chronic HF, meaning in life played a mediating role in the relationship of social support, symptom distress, and care needs with QOL. Implementing an intervention to enrich meaning in life may help patients manage the issues caused by symptoms and alleviate their unmet needs.

Nurse-coordinated home-based cardiac rehabilitation for patients with heart failure: A scoping review

Objectives

This study aimed to review and summarize the studies of nurse-coordinated home-based cardiac rehabilitation for patients with heart failure.

Methods

The review was performed using Arksey and O'Malley's scoping review framework. A systematic search was conducted across eight databases, including PubMed, Embase, Web of Science, EBSCO, China Biomedical Literature Service System (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journals (CSTJ) Database, and Chinese Clinical Trial Registry, from inception to 30 April 2023. Articles relevant to the nurse-coordinated home-based cardiac rehabilitation for patients with heart failure were included.

Results

Eighteen studies were included in this review. These studies showed that nurses primarily focused on patient assessment, home-based cardiac rehabilitation planning and guidance, and follow-up. The studies also reported positive outcomes in patient safety, feasibility, and efficacy of the programs coordinated by nurses.

Conclusions

Home-based cardiac rehabilitation coordinated by nurses is beneficial to patients with heart failure. Future research will explore the potential of nurses in home-based cardiac rehabilitation for patients with heart failure, determine optimal evaluation criteria, and formulate safe, effective, and economical rehabilitation programs suitable for the patients.

Palliative Care Needs of Physically Frail Community-Dwelling Older Adults With Heart Failure

CONTEXT

Physical frailty is emerging as a potential "trigger" for palliative care (PC) consultation, but the PC needs of physically frail persons with heart failure (HF) in the outpatient setting have not been well described.

OBJECTIVES

This study describes the PC needs of community dwelling, physically frail persons with HF.

METHODS

We included persons with HF ≥50 years old who experienced ≥1 hospitalization in the prior year and excluded those with moderate/severe cognitive impairment, hospice patients, or non-English speaking persons. Measures included the FRAIL scale (0-5: 0 = robust, 1-2 = prefrail, 3-5 = frail) and the Integrated Palliative Outcome Scale (IPOS) (17 items, score 0-68; higher score = higher PC needs). Multiple linear regression tested the association between frailty group and palliative care needs.

RESULTS

Participants (N = 286) had a mean age of 68 (range 50-92) were majority male (63%) and White (68%) and averaged two hospitalizations annually. Most were physically frail (44%) or prefrail (41%). Mean PC needs (IPOS) score was 19.7 (range 0-58). On average, participants reported 5.86 (SD 4.28) PC needs affecting them moderately, severely, or overwhelmingly in the last week. Patient-perceived family/friend anxiety (58%) weakness/lack of energy (58%), and shortness of breath (47%) were the most prevalent needs. Frail participants had higher mean PC needs score (26) than prefrail (16, P < 0.001) or robust participants (11, P < 0.001). Frail participants experienced an average of 8.32 (SD 3.72) moderate/severe/overwhelming needs compared to prefrail (4.56, SD 3.77) and robust (2.39, SD 2.91) participants (P < 0.001). Frail participants reported higher prevalence of weakness/lack of energy (83%), shortness of breath (66%), and family/friend anxiety (69%) than prefrail (48%, 39%, 54%) or robust (13%, 14%, 35%) participants (P < 0.001).

CONCLUSION

Physically frail people with HF have higher unmet PC needs than those who are nonfrail. Implementing PC needs and frailty assessments may help identify vulnerable patients with unmet needs requiring further assessment and follow-up.

Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study

Background

Patients with heart failure (HF) experience continuous changes in symptom distress, care needs, social support, and meaning in life from acute decompensation to chronic phases. The longitudinal relationship between these four factors and quality of life (QOL) was not fully explored.

Aims

To simultaneously investigate the relationship between all factors and QOL from hospitalization to 6 months after discharge, and the impact of the changes in these factors on QOL at different time points.

Methods

A longitudinal design with panel research (4 time points) was used. From January 2017 to December 2019, patients hospitalized due to acute decompensated HF were consecutively enrolled and followed up for 6 months. Patients were interviewed with questionnaires assessing symptom distress, care needs, social support, meaning in life and QOL at hospitalization and 1, 3 and 6 months after discharge.

Results

A total of 184 patients completed 6 months of follow-up. From baseline to 6 months, QOL continuously improved along with decreases in symptoms and care needs, but increases in social support and meaning in life. Better QOL was associated with younger age, higher education level, economic independence, less symptom distress and care needs, and stronger meaning in life (p < 0.05). Compared with hospitalization, decreases in care needs and increases in meaning in life at 1, 3 and 6 months were associated with an increase in physical QOL (p < 0.01). The decrease in care needs and increase in meaning in life at 3 months were associated with an increase in mental QOL (p < 0.05). The increase in social support at 6 months was associated with increases in both physical and mental QOL (p < 0.01). Changes in symptom distress were not correlated with changes in QOL from baseline to all time points. In the multivariable analysis, these findings were independent of age, educational level and economic status.

Conclusions

Although symptom distress is associated with QOL after acute decompensated HF, QOL cannot be improved only by improvement in symptoms. With differential duration of improvement in each factor, the integration of alleviation in care needs and strengthening in social support and meaning in life might provide additional benefits in QOL.

Care needs, social support and meaning in life in patients after acute heart failure hospitalisation: a longitudinal study

BACKGROUND

Meaning in life serves as a protective mechanism for coping with persistent, often distressful symptoms in patients with heart failure. However, meaning in life and its associated factors are not adequately explored in patients after acute hospitalisation for heart failure.

AIMS

To explore the associated factors of meaning in life in patients with heart failure from acute hospitalisation to 3 months post-discharge.

METHODS

A total of 103 hospitalised patients with heart failure in Northern Taiwan were recruited using a longitudinal study design and interviewed with structured questionnaires including meaning in life, symptom distress, care needs, and social support at hospitalisation, 1 month and 3 months post-discharge.

RESULTS

A total of 83 patients completed the 3 months follow-up. The presence of meaning in life significantly increased from hospitalisation to 3 months post-discharge. Decreases in care needs (B=-0.10, P=0.020) and social support (B=-0.18, P=0.016) from hospitalisation to 3 months post-discharge were significantly associated with an increase in the presence of meaning in life, while a decrease in social support was associated with an increase in the search for meaning in life (B=-0.17, P=0.034).

CONCLUSION

Care needs and social support were pivotal factors for developing meaning in life for patients with heart failure. Assessments of care needs and social support might help strengthen their meaning in life.

Tools to help healthcare professionals recognize palliative care needs in patients with advanced heart failure: A systematic review

BACKGROUND

The delivery of palliative care interventions is not widely integrated in chronic heart failure care as the recognition of palliative care needs is perceived as difficult. Tools may facilitate healthcare professionals to identify patients with palliative care needs in advanced chronic heart failure.

AIM

To identify tools to help healthcare professionals recognize palliative care needs in patients with advanced chronic heart failure.

DESIGN

This systematic review was registered in the PROSPERO database (CRD42019131896). Evidence of tools' development, evaluation, feasibility, and implementation was sought and described.

DATA SOURCES

Electronic searches to identify references of tools published until June 2019 were conducted in MEDLINE, CINAHL, and EMBASE. Hand-searching of references and citations was undertaken. Based on the identified tools, a second electronic search until September 2019 was performed to check whether all evidence about these tools in the context of chronic heart failure was included.

RESULTS

Nineteen studies described a total of seven tools. The tools varied in purpose, intended user and properties. The tools have been validated to a limited extent in the context of chronic heart failure and palliative care. Different health care professionals applied the tools in various settings at different moments of the care process. Guidance and instruction about how to apply the tool revealed to be relevant but may be not enough for uptake. Spiritual care needs were perceived as difficult to assess.

CONCLUSION

Seven tools were identified which showed different and limited levels of validity in the context of palliative care and chronic heart failure.

Tinnitus Questionnaires for Research and Clinical Use

The lack of an objective measure of tinnitus has led to self-report questionnaires as the best option to evaluate tinnitus symptoms and quantify the degree to which quality of life is negatively impacted. There are many tinnitus questionnaires to choose from and it can be difficult to decide which one is best. From an evidence-based perspective, knowing how the questionnaire is designed, including its intended purpose, can help determine if it is appropriate or not to use. For example, a questionnaire designed to screen for the presence or absence of tinnitus should not be used as an outcome measure to answer questions about treatment effectiveness. Often, using more than one questionnaire is preferable to relying on just one. This chapter will review important factors to consider when selecting a questionnaire for research purposes and/or routine clinical care.

Assessment of health needs, satisfaction with care, and quality of life in compulsorily admitted patients with severe mental disorders

This cross-sectional study compared the levels of needs, care satisfaction, quality of life, and social support of compulsory admitted patients with severe mental disorders to a comparable group of voluntary admitted patients. One hundred and twenty-five patients with schizophrenia and schizoaffective disorder were admitted to a hospital by district psychiatrist order (DPO), court observation order (COO), or voluntary (VA). Participants were assessed before discharge using questionnaires, and psychiatric rating scales. A linear discriminant analysis revealed eight variables that best differentiated the three groups. COO patients were significantly discriminated from the two other groups (DPO and VA) by severe negative symptoms, better satisfaction with both nursing staff and family support. COO subjects had more non-illness unmet needs, while reported better hedonic capacity for social and interpersonal pleasure - compared to VA patients. DPO patients were significantly indicated by poorer awareness to illness, but better satisfaction with subjective feelings. VA subjects were significantly discriminated from compulsory admitted patients by higher illness severity scores. Assessment of unmet needs, satisfaction with care, quality of life, hedonic capacity, and social support constitute the factors that differentiate compulsory admitted patients and could be targets for interventions aimed to reduce the negative effects of compulsory admissions.

A review of records from follow-up visits for immigrant and Swedish patients at a heart failure clinic

Today, nearly 20% of the Swedish population originates from multiethnic backgrounds. Patients’ symptom expressions, adherence to health regimens, and communication with health-care professionals have been shown to be related to their ethnic and cultural backgrounds.

Purpose

To describe documented care of immigrant patients and matched Swedish patients at a heart failure clinic.

Method

Journal audit of records of 25 immigrant and 25 matched Swedish patients with HF included from the patient registration database at the hospital where they were cared for.

Results

In the immigrant group, significantly fewer clinical parameters were assessed during their visits and fewer patients were scheduled for follow-up visits. Analyses revealed that some of the items recommended in the European Society of Cardiology guidelines for non-pharmacological HF care were overlooked for both of the groups.

Conclusions

We found that medication adjustments and information about the condition and treatment were fairly similarly documented between Swedish and immigrant patients while significantly fewer clinical measurements and follow-up visits were documented for the immigrant group.

The Adaptation, Face, and Content Validation of a Needs Assessment Tool: Progressive Disease for People with Interstitial Lung Disease

BACKGROUND

Irrreversible interstitial lung disease (ILD) is associated with high morbidity and mortality. Palliative care needs of patients and caregivers are not routinely assessed; there is no tool to identify needs and triage support in clinical practice.

OBJECTIVE

The study objective was to adapt and face/content validate a palliative needs assessment tool for people with ILD.

METHODS

The Needs Assessment Tool: Progressive Disease-Cancer (NAT:PD-C) was adapted to reflect the palliative care needs identified from the ILD literature and patient/caregiver interviews. Face and content validity of the NAT:PD-ILD was tested using patient/caregiver focus groups and an expert consensus group. Participants in the study were two English tertiary health care trusts' outpatients clinics. There were four focus groups: two patient (n = 7; n = 4); one caregiver (n = 3); and one clinician (n = 8). There was a single caregiver interview, and an expert consensus group-academics (n = 3), clinicians (n = 9), patients (n = 4), and caregivers (n = 2). Each item in the tool was revised as agreed by the groups. Expert consensus was reached.

RESULTS

Overall, the tool reflected participants' experience of ILD. Each domain was considered relevant. Adaptations were needed to represent the burden of ILD: respiratory symptoms (especially cough) and concerns about sexual activity were highlighted. All emphasized assessment of caregiver need as critical, and the role of caregivers in clinical consultations.

CONCLUSIONS

The NAT:PD-ILD appears to have face and content validity. The inclusion of the family caregiver in the consultation as someone with their own needs as well as a source of information was welcomed. Reliability testing and construct validation of the tool are ongoing.

Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument

OBJECTIVE

Although assessment of palliative patients' needs is a key issue in palliative care, a suitable instrument for identification of such needs is not available in Central European countries. Our objectives were to produce an adequate tool for identifying the importance and satisfaction of palliative patients' needs and to verify its psychometric properties.

METHOD

The patient needs assessment in palliative care (PNAP) instrument was constructed based on a literature review and qualitative research (focus groups, n = 5). The psychometric properties of the questionnaire were verified by a cross-sectional study. The convergent validity of the questionnaire was determined by confirmatory factor analysis. Furthermore, internal consistency, test-retest reliability, and construct validity were also tested. The qualitative research group comprised 30 participants (27 experts in palliative care, 1 patient, and 2 family members). Psychometric properties were evaluated in a group of 349 hospital inpatients terminally ill with chronic disease or cancer and receiving palliative care.

RESULTS

Based on the qualitative data analysis, a questionnaire was constructed that contained 42 items grouped into 5 domains. When testing the psychometric properties of the questionnaire, a new model containing 40 items in 7 domains was produced. Cronbach's α for the entire PNAP questionnaire was 0.89 on the importance scale and 0.80 on the satisfaction scale. Test-retest reliability was higher than 0.7 for all domains in both scales.

SIGNIFICANCE OF RESULTS

The results of tests on the psychometric properties of the PNAP questionnaire showed at least satisfactory validity and reliability, and it can be employed to assess the needs of palliative care patients in Central European countries.

Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease

OBJECTIVE

People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients.

DESIGN

Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data.

RESULTS

The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness).

CONCLUSIONS

While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs--namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.

Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment

Chronic heart failure (CHF) is a multi-dimensional and complex syndrome. Outcome measures are important for determining both the efficacy and quality of care and capturing the patient's perspective in evaluating the outcomes of health care delivery. Capturing the patient's perspective via patient-reported outcomes is increasingly important; however, including objective measures such as mortality would provide more complete account of outcomes important to patients. Currently, no single measure for CHF outcomes captures all dimensions of the quality of care from the patient's perspective. To describe the role of outcome measures in CHF from the perspective of patients, a structured literature review was undertaken. This review discusses the concepts and methodological issues related to measurement of CHF outcomes. Outcome assessment at the level of the patient, provider and health care system were identified as being important. The perspectives of all stakeholders should be considered when developing an outcomes measurement suite to inform CHF health care. This paper recommends that choice of outcome measures should depend on their ability to provide a comprehensive, comparable, meaningful and accurate assessment that are important to patient.

Needs in health care: what beast is that?

Need is a pivotal concept within health systems internationally given its driving force in health care policy, development, and delivery at population and individual levels. Needs assessments are critical activities undertaken to ensure that health services continue to be needed and to identify new target populations that demonstrate unmet need. The concept of need is underpinned by varied theoretical definitions originating from various disciplines. However, when needs are assessed, or health interventions developed based on need, little, if any, detail of the theoretical or conceptual basis of what is being measured is ever articulated. This is potentially problematic and may lead to measurement being invalid and planned health services being ineffective in meeting needs. Seldom are theoretical definitions of need ever compared and contrasted. This critical review is intended to fill this gap in the literature. Interpretations of the concept of need drawing from areas such as psychology, social policy, and health are introduced. The concept and relevance of unmet need for health services are discussed. It is intended that these definitions can be used to operationalize the term "need" in practice, theoretically drive needs assessment, and help guide health care decisions that are based upon need.

Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability, and validity of a needs assessment tool

CONTEXT

Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF).

OBJECTIVES

To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF.

METHODS

A convenience sample of multidisciplinary health professionals working in heart failure care was invited to comment, via an online survey and consultation, on suitability and required modifications to a validated cancer care needs assessment measure to inform the support and palliative care needs of patients with CHF and their caregivers. Psychometric testing was then undertaken with 52 patients with CHF recruited from a multidisciplinary heart failure service to explore inter-rater reliability and concurrent validity of the newly adapted Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF).

RESULTS

Health professionals (n=21) rated the tool as easy to administer, comprehensive, and relevant for the CHF population. Prevalence- and bias-adjusted kappa values indicated good agreement between pairs of raters for each item in the NAT: PD-HF (range 0.54-0.90). Participants indicating a higher severity of concern in the NAT: PD-HF physical, daily living, and spiritual items reported significantly higher Heart Failure Needs Assessment Questionnaire physical and existential scores.

CONCLUSION

This study provides preliminary evidence for the NAT: PD-HF as a potential strategy for identifying and informing the management of physical and psychosocial issues experienced by people with CHF. Further work is needed to examine additional psychometrics, benefits relating to unnecessary symptom burden, futile treatments, and admissions to hospital.

Social support among African Americans with heart failure: is there a role for community health advisors?

OBJECTIVE

The study had 2 objectives: (1) to gather the observations of community health advisors (CHAs) on the role of social support in the lives of African Americans; and (2) to develop a lay support intervention framework, on the basis of the existing literature and observations of CHAs, depicting how social support may address the needs of African American patients with heart failure.

METHODS

Qualitative data were collected in semistructured interviews among 15 CHAs working in African American communities in Birmingham, Alabama.

RESULTS

Prominent themes included the challenge of meeting clients' overlapping health care and general life needs, the variation in social support received from family and friends, and the opportunities for CHAs to provide multiple types of social support to clients. CHAs also believed that their support activities could be implemented among populations with heart failure.

CONCLUSION

The experience of CHAs with social support can inform a potential framework of a lay support intervention among African Americans with heart failure.

Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?

BACKGROUND

Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes.

AIM

To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure.

METHOD

In a randomized control trial, a total of 105 patients were recruited to the study. Patients in the intervention group received an individualized, multidisciplinary 12-week cardiac rehabilitation program, including an individualized exercise component tailored to functional ability and social circumstances. The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner. This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs.

RESULTS

During the study period, patients in the intervention group were less likely to have been admitted to hospital for any cause (44 vs. 69%, P = 0.01) or after a major acute coronary event (24 vs. 55%, P = 0.001). Participants in the intervention group were more likely to be alive at 12 months, (93 vs. 79%; P = 0.03) (odds ratio = 3.85; 95% confidence interval=1.03-14.42; P = 0.0042). Quality of life scores improved at 3 months compared with baseline (intervention t = o/-4.37, P<0.0001; control t = /-3.52, P<0.01). Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group (t = 3.40; P = 0.01).

CONCLUSION

This study shows that a multidisciplinary heart failure cardiac rehabilitation program, including an individualized exercise component, coordinated by a specialist heart failure nurse can substantially reduce both all-cause and cardiovascular readmission rates, improve functional status at 3 months and exercise tolerance.

The evaluation of nurses and nursing activities through the perceptions of inpatients

AIM

To examine the relationship of inpatients' perceptions and satisfaction statements with nurses and the nursing activities presented and to determine nursing activities that were implemented mostly from the view of inpatients.

BACKGROUND

Nursing care is one of the fundamental components of health care, and studies have shown that it has a considerable influence on how patients experience hospitalization. However, nursing care is usually listed as one category in surveys. In fact, nursing care is an integrated combination of specific nursing activities, and to improve nursing practice we need to clarify how each nursing activity affects the perceptions of patients.

METHODS

This descriptive study uses cross-sectional survey design. The sample consists of 454 inpatients from a large-scale teaching hospital in Ankara, Turkey. A questionnaire survey including demographics and perceptions of the patients, along with a list of the activities that nurses were required to carry out, were administered to the patients.

FINDINGS

Age, gender and marital status were the variables influencing patients' perceptions. Technical nursing activities were recognized more by patients than activities related to care. All nursing activities were relevant to patient satisfaction statements. Most of the patients were satisfied with the nursing care despite the task-oriented environment.

CONCLUSIONS

The results of this study show that nurses tend to do technical activities. All nursing activities were related to patient satisfaction statements. Nurses should be aware of the effect of each activity they are required to carry out on patients and the importance of good communication with patients.

A dimensional analysis of patient-centered care

BACKGROUND

Patient-centered care (PCC) is a poorly conceptualized phenomenon and can indicate anything from soothing room design, emotional support of patients, customization of meals, to support of patient decision making. This inconsistency across the clinical and research literature makes the application of PCC difficult.

OBJECTIVES

The objective of this study was to identify dimensions of PCC as found in the literature.

METHODS

A dimensional analysis of PCC was conducted from 69 clinical and research articles published from 2000 to 2006. Coding of the literature for the perspective, context, conditions, process, and consequences of PCC was completed. These codes were used to determine literature selected for inclusion, organize article content, and frame the delineation of PCC.

RESULTS

Alleviating vulnerabilities, consisting of both compromised physiological states and threats to individual identity, was constant throughout the literature. Therapeutic engagement was the process sustaining the patient during an illness episode that necessitated service use and involved allocating time, carrying out information practices, knowing the patient, and developing a relationship. This process occurs during nurse-patient interaction, sustained during successive interactions, and reinforced by the information practices of a particular setting.

DISCUSSION

The interaction between nurse and patient is central to the effective study and application of PCC. Appropriate use of PCC can improve study outcomes and measurements by clarifying the variables involved, and PCC holds great promise to frame patient outcome and satisfaction research by analyzing how and with what effect nurses alleviate patient vulnerability. Moreover, consideration of information practices as a critical supporting structure of nurse-patient interaction can be explored.

Preparing for the worst while hoping for the best: the relevance of hope in the heart failure illness trajectory

BACKGROUND

Patients with heart failure have higher mortality rates than those with most malignant diseases. The heart failure illness trajectory is one of gradual decline characterized by unpredictable events such as acute decompensation of heart failure or a sudden cardiac death. Health professionals have an obligation to give patients and their families concise and honest information concerning their prognosis. The challenge exists to give what ostensibly may seem a bleak prognosis within a context of hope and optimism.

AIM

To explore the role of hope in heart disease and the potential utility of this construct in the development of nursing interventions.

METHODS

The electronic databases CINAHL, MEDLINE, EmBASE, and PSYCHlit were searched from 1982 to August 2004 using the key words "hope," "hopelessness," "heart disease," and "heart failure." Articles were subsequently sorted to meet the inclusion criteria of (1) a philosophical discussion of the construct of hope and/or (2) investigation of hope in heart disease.

RESULTS

This search retrieved 768 articles, and 24 met the inclusion criteria. Key findings from the review indicate that "hope" and "hopelessness" are underdeveloped, yet important constructs and conceptually linked with depression and spirituality. Intriguing findings from descriptive, observational studies have demonstrated the positive impact of expression of hope on cardiovascular outcomes. These findings need to be validated in randomized controlled trials.

CONCLUSIONS

This critical literature review has determined that "hope" is strongly associated with the individual's future orientation. Increased understanding of this concept may assist in refining patient-focused interventions and developing therapeutic strategies to enhance hope.

Development and psychometric analysis of the systemic lupus erythematosus needs questionnaire (SLENQ)

This study aims to develop a self-administered needs assessment questionnaire for people with systemic lupus erythematosus (SLE), assess its face, content and construct validity and test the reliability of the instrument. Eighty-four people with SLE, registered with a Lupus Resource Centre in New South Wales, Australia participated in a series of focus groups and pre and pilot testing phases in the development of a needs instrument and 594 people from a SLE support association were sent the SLE needs questionnaire (SLENQ) and the MOS-SF-36 and asked to complete both. Face and content validity were found to be high following pre and pilot testing. Principal components analysis identified seven factors with eigenvalues greater than 1, which together accounted for 53% of the total variance (psychological/spiritual/existential, health services, health information, physical, social, daily living and employment/financial needs). Internal reliability coefficients (Cronbach's alpha) of all seven factor-based scales were found to be substantial, ranging from 0.77 to 0.96. Moderately significant correlation between the domains of the SLENQ and the MOS SF-36 were supportive in ascertaining concurrent validity. These findings suggest that the SLENQ provides a reliable and valid index of the global needs of people with SLE.

A review of environmental hazards associated with in-patient falls

Slips, trips and falls present the greatest risk to in-patients in terms of exposure (frequency of occurrence) but only present a low severity risk in terms of mortality. The risk factors have been categorized as intrinsic (individual to the patient, e.g. visual impairment, balance problems and medicine use) or extrinsic (environmental). Many recommendations have been made concerning the management of environmental hazards but, of these, only beds rails have supporting research evidence. Other recommendations include patient assessment, footwear, flooring, lighting, staffing levels and bed alarms. However, three systematic reviews and the current narrative review have all failed to find research evaluating the benefits of these recommendations. The most robust evidence relates to the use of bed rails. This research suggests that bed rails not only fail to reduce the frequency of falls, but may also exacerbate the severity of injury. As Maslow's Hierarchy of Needs model has been used as a framework for nursing models of care, it was chosen as the basis for the development of an environmental hazard assessment model. The environmental hazards are revisited using this model in order to take an ergonomic or patient-centred approach for risk assessment.