Evaluation of an intervention to individualise patient education at a nurse-led heart failure clinic: a mixed-method study

Patients' perspective and practices of heart failure recurrence prevention in Yancheng City

Effective self-management is essential for patients with heart failure, but many struggle with acquiring the necessary skills. Given the complexity of heart failure management and the importance of patient adherence to prescribed regimens, this study aims to investigate the knowledge, attitudes, and practices (KAP) concerning the prevention of heart failure recurrence among patients. A cross-sectional study was conducted at the Third People's Hospital of Yancheng City from September 1, 2023, to December 31, 2023, employing a self-administered KAP questionnaire. The study included 421 heart failure patients, of whom 230 (54.6%) were male. Median scores for knowledge, attitudes, and practices were 12.00 [10.00, 13.00] (possible range: 1-18), 20.00 [19.00, 21.00] (possible range: 5-25), and 16.00 [15.00, 17.00] (possible range: 5-22), respectively. Pearson's correlation analysis indicated a positive correlation between knowledge and attitude scores (r = 0.183, P < 0.001), as well as between knowledge and practice scores (r = 0.169, P < 0.001). A higher attitude score was significantly associated with a higher practice score (r = 0.245, P < 0.001), as supported by structural equation modelling. Multivariate logistic regression revealed that attitude score (OR = 1.238), suburban residence (OR = 2.524), monthly household income exceeding 5000 RMB (OR = 3.539), BMI less than 20 kg/m2 (OR = 2.155, P = 0.029), BMI between 20 and 24 kg/m2 (OR = 2.387), and BMI between 25 and 29 kg/m2 (OR = 4.063) were independently linked to proactive practices (all P < 0.05). Additionally, Structural Equation Modelling (SEM) elucidated the intricate relationship between sociodemographic factors and KAP dimensions. Despite positive attitudes and proactive prevention efforts, heart failure patients exhibit a knowledge gap. Tailored educational interventions by healthcare providers could effectively bridge this gap, leveraging patients' positive attitudes and proactive behaviours to reinforce preventive measures.

Effectiveness of nurse-led heart failure clinic: A systematic review

Objectives

Heart failure is a stage of various cardiovascular diseases and constitutes a growing major public health problem worldwide. Nurse-led heart failure clinics play an important role in managing heart failure. All nurse-led heart failure clinic services are clinic-based. We conducted a systematic review to describe the contents and impact of nurse-led heart failure clinics.

Methods

A review of nurse-led heart failure clinic research was undertaken in PubMed, Embase, Web of Science, and Cochrane Library. The search was initially conducted on October 23, 2022 and updated on November 21, 2023. Articles were appraised using the Joanna Briggs Institute Appraisal criteria by two independent reviewers. This review was registered on PROSPERO (CRD42022352209).

Results

Twelve articles were included in this systematic review. The nurse-led heart failure clinic contents were: medication uptitration, educational counselling, evidence-based transitional care, psychosocial support, physical examination and mental well-being assessment, therapy monitoring and adjustment, follow-up, and phone consultations. Most studies reported largely positive clinical outcomes in nurse-led heart failure clinics. Four studies examined the quality of life and reported conflicting results; four studies examined medication titration efficacy, and the results were generally positive. Only two studies examined cost-effectiveness.

Conclusions

Nurse-led heart failure clinics have shown a largely positive impact on patient outcomes, quality of life, and medication titration efficacy. More randomised controlled trials and other studies are needed to obtain more robust conclusions.

The Development of a Situation-Specific Nurse-Led Culturally Tailored Self-Management Theory for Chinese Patients With Heart Failure

INTRODUCTION

Self-management is essential for treating heart failure (HF). Culture influences the ability to cope, negotiate, and adopt self-management behaviors. However, current HF self-management interventions for Chinese patients do not take culture into consideration. The aim of this article is to describe the development of a situation-specific nurse-led culturally tailored self-management theory for Chinese patients with HF.

METHODOLOGY

An integrative approach was used as theory development strategy for the situation-specific theory.

RESULTS

Based on theoretical and empirical evidence, and theorists' experiences from research and practice, a nurse-led culturally tailored self-management theory for Chinese patients with HF was developed.

DISCUSSION

Researchers addressing health phenomena often have difficulty defining, conceptualizing, and operationalizing culture. The situation-specific theory developed in this study has the potential to increase specificity (i.e., logical adequacy and usefulness) of existing theories while informing the application to nursing practice. Further critique and testing of the situation-specific theory is warranted.

Self-care status in children with congenital heart disease: A mixed-method study

BACKGROUND

Suffering congenital heart disease leads to physical and mental disabilities in children. Children's self-care can result in appropriate care behaviors for limiting disease-induced problems. Given the ability of children to care for themselves, we investigated self-care statues in children who are suffering from congenital heart disease.

METHOD

This study was conducted using a mixed-method approach and a sequential explanatory design. A cross-sectional study was conducted to assess self-care status in 124 CHD children who were living in Kerman, Iran. In the qualitative phase, the researchers interviewed 13 of these children and three parents using semi-structured in-depth and face-to-face approaches.

RESULTS

The mean of self-care scores in these school-age children was optimal (10/7 ± 2/6). In the qualitative phase, three main themes were extracted: captive to health issues physical and mental sufferings and wishing for peace of mind.

CONCLUSION

The results showed that self-care status in these children was optimal. As the main pillar of patient education, nurses can help enhance self-care behaviors and reduce the complications and problems induced by the disease by implementing educational and support interventions for children with CHD and their families.

Knowledge among patients with heart failure: A narrative synthesis of qualitative research

BACKGROUND

Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience.

OBJECTIVES

We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease.

METHODS

We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria.

RESULTS

Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge.

CONCLUSION

The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.

Heart Failure Patients' Perceptions of Received and Wanted Information: A Cross-Sectional Study

This study aimed to investigate heart failure patients' perceptions of received and wanted information and to identify differences regarding received and wanted information in relation to sociodemographic variables. A cross-sectional descriptive design was used. Patients with heart failure ( n = 192) were recruited from six primary health care centers in Sweden. Data were collected by a postal questionnaire. A majority of the respondents had received information about the condition and the medication. Within primary health care, most respondents had been informed about medication. The respondents wanted more information about continued care and treatment, medication, and the condition. There were significant differences between sociodemographic groups concerning what information they wanted. Clinical nurses can support patients with heart failure by using evidence-based methods that strengthen the patients' self-efficacy and by individualized information that increases patients' knowledge and improves their self-care behaviors. Future studies are needed to identify informational needs of particular fragile groups of patients.

Coping, social support and information in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A 2-year retrospective cohort study

Objectives:

Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension are severe diseases with complicated treatment that need care at specialist clinics. The aim was to investigate changes in the patients’ perceptions on coping, social support and received information when attending a newly started nurse-coordinated pulmonary arterial hypertension-outpatient clinic.

Methods:

The present study was a descriptive, questionnaire-based cohort study including 42 adult patients. To evaluate coping, the Pearlin Mastery Scale was used. Social support, information and health-related quality of life were measured using Social Network and Support Scale, QLQ-INFO25 and the EQ-5D.

Results:

Attending the pulmonary arterial hypertension-outpatient clinic increased coping ability (Mastery Scale) significantly (baseline 16.0 ± 3.3 points vs 2-year follow-up 19.6 ± 5.2 points, p < 0.001) while there was no difference in social network and support or in perception of received information after. Patients who improved their coping ability (67%) were younger, had better exercise capacity, experienced better health-related quality of life and were more satisfied with received information about treatment and medical tests than those who reduced the coping ability. There was no difference in gender, diagnosis, time since diagnose, pulmonary arterial hypertension–specific treatment, education level or civil status between the two groups.

Conclusion:

This study suggests that the pulmonary arterial hypertension-team, in partnership with the patient, can support patients to take control of their disease and increase their health-related quality of life.

Empowered to Self-Care: A Photovoice Study in Patients With Heart Failure

Introduction: Heart failure–related hospitalization is preventable through self-care but remains a common cardiovascular reason for rehospitalization. The purpose of this study was to explore the promotion of self-care in Singaporean patients with heart failure. Method: A descriptive qualitative design was adopted using Photovoice. Sixteen participants with heart failure were recruited from an outpatient cardiology clinic in Singapore. The participants were asked to take photographs that represented their promotion of self-care and used them in the subsequent interviews. Data were transcribed verbatim and analyzed using thematic analysis. Results: Four themes emerged: (1) accepting life; (2) appreciating life; (3) maintaining meaning in life; and (4) establishing a new normal life. The four themes provided insights into how they empowered themselves to self-care. Discussion: Participants were empowered to self-care through active and passive processes. Self-reflection served as an active process internally. Support from health care providers served as a passive process externally.

Person-centred discharge education following coronary artery bypass graft: A critical review

AIMS AND OBJECTIVES

To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery.

BACKGROUND

Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation.

DESIGN

A critical review of published peer-reviewed literature was conducted.

METHODS

Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015.

RESULTS

Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews.

CONCLUSION

A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft.

RELEVANCE TO CLINICAL PRACTICE

Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being.

Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).

SETTING

CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.

PARTICIPANTS

Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.

INTERVENTION

CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.

PRIMARY AND SECONDARY OUTCOMES

Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.

RESULTS

22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference -1.28 days (95% CI -2.04 to -0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.

CONCLUSIONS

Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.