Effects of nurse-led self-care interventions on health outcomes among people with heart failure: A systematic review and meta-analysis

The Effectiveness of Nursing Interventions in Hospital: An Umbrella Review

AIM

The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals.

DESIGN

Existing systematic reviews were synthesised.

DATA SOURCES

The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit.

METHODS

A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full-text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively.

RESULTS

The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence.

CONCLUSIONS

There is limited high-quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high-quality systematic reviews and meta-analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost-effectiveness of nursing interventions.

NO PATIENT OR PUBLIC CONTRIBUTIONS

This umbrella review did not include any patient or public involvement.

REPORTING METHOD

This umbrella review of systematic reviews adheres to the PRISMA statement.

Home-based telemonitoring care and executive function in patients with heart failure

Enhancement of self-care ability is essential for patients with heart failure (HF), and executive function plays a critical role. We investigated the clinical influence of a home-based remote care program using telemonitoring and telecoaching on executive function in patients with HF and assessed the relationship between executive functional status and clinical outcomes. This prospective study enrolled outpatients with HF, and they received home-based remote care program with telemonitoring and telecoaching using self-measured physical data. Executive function was assessed using the Trail Making Test Part B (TMT-B). The incidences of HF hospitalization and all-cause death were also compared according to baseline executive function status based on TMT-B test performance. Forty-one participants were enrolled in this study (mean age: 64.8 ± 13.8 years; male 68.3%; New York Heart Association [NYHA] class II/III: 78.0/22.0%). Twelve months after the initiation of the program, TMT-B significantly improved (p = 0.039), accompanied by an obvious amelioration of HF symptoms as assessed by the NYHA class (p = 0.027). During a median follow-up of 20.5 months, the incidence of HF hospitalization was significantly higher in patients with executive dysfunction than in those without (hazard ratio: 4.97, 95% confidence interval: 1.15-21.4, p = 0.031). This was unchanged even in a subcohort without cognitive dysfunction, as assessed using the Mini-Mental State Examination. Telemonitoring and telecoaching at home may be effective in improving executive function in patients with HF. Further studies are needed to assess whether supportive care assisting executive functioning improves clinical outcomes in patients with HF.

Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review

Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539.

Validity and Reliability of the Self-Care of Chronic Illness Inventory and Self-Care Self-Efficacy Scale in Patients Living With Cancer

AIM

This study aimed to test the psychometric properties of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale in patients with cancer.

DESIGN

A multisite cross-sectional validation study was conducted.

METHODS

Between November 2022 and July 2023, a convenience sample of 318 patients with cancer were enrolled in five Italian inpatient and outpatient facilities. Confirmatory factor analysis was performed on the three scales of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale. Internal consistency was tested using Cronbach's alpha for unidimensional scales and McDonald's Omega for multidimensional scales. Construct validity was assessed with the global health status by Pearson's correlation. The COnsensus-based Standards for the selection of health Measurement INstruments reporting guidelines were followed for the reporting process.

RESULTS

Three hundred fourteen patients were included (median age: 55.5 years; male: 53.82%). Confirmatory factor analysis showed supportive fit indices for the three Self-Care of Chronic Illness Inventory scales (CFI: 0.977-1.000; SRMR: 0.004-0.78) and the Self-Care Self-Efficacy scale (CFI: 1.000; SRMR: 0.014). All scales demonstrated adequate internal consistency (0.89-0.99) and test-retest reliability (0.85-0.95). Construct validity was confirmed through correlations between Self-Care Self-Efficacy, each Self-Care of Chronic Illness Inventory scale, and global health status.

CONCLUSION

The Self-Care of Chronic Illness Inventory and Self-Care Self-Efficacy scales demonstrated excellent psychometric qualities and construct validity when administered to patients with cancer. Future research should explore self-care behaviours across different diseases and cultural contexts.

IMPLICATIONS FOR THE PROFESSION

These tools can help develop targeted educational programs, improving patient outcomes.

IMPACT

Currently, there is a lack of knowledge regarding self-care behaviours in patients with cancer. These tools enable healthcare professionals to identify patient needs, design personalised interventions, and monitor their effectiveness over time.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nursing approaches to self-care, self-management, and adaptation to illness

Nursing approaches to self-care, self-management, and adaptation to illness encompass diverse strategies aimed at enhancing patient well-being and empowering chronic condition management. The BMC Nursing collection "Nursing Approaches to Self-Care, Self-Management, and Adaptation to Illness" invites research advancing knowledge and care quality in these areas.

Effectiveness of nurse-led self-care interventions on quality of life, social support, depression and anxiety among people living with HIV: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

People living with HIV often face challenges related to quality of life, mental health, and social support. Nurse-led self-care interventions have been proposed as a means to address these issues, but their overall effectiveness needs systematic evaluation.

OBJECTIVES

To systematically review and meta-analyze the effectiveness of nurse-led self-care interventions on quality of life, social support, depression, and anxiety among people living with HIV.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic search of PubMed, EMBASE, Web of Science (Core Collection), Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO (Ovid) was conducted for articles from inception to May 2024. Two authors independently screened studies and extracted data. Randomized controlled trials that investigated the effects of nurse-led self-care interventions on the quality of life, social support, depression, and anxiety in people living with HIV, published in English, were included. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.3 and Stata17, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Nineteen randomized controlled trials published between 2003 and 2024 were included. The meta-analysis showed that compared to the control group, nurse-led self-care interventions significantly improved quality of life (SMD = 0.45, 95 % CI: 0.07 to 0.84, P < 0.05) and reduced depression (SMD = -0.46, 95 % CI: -0.75 to -0.17, P < 0.001; RR = 0.80, 95 % CI: 0.68 to 0.94, P < 0.05). The impact on social support was not statistically significant (SMD = -0.02, 95 % CI: -0.25 to 0.22, P = 0.89). Only two studies reported beneficial effects on anxiety, indicating a need for further high-quality research.

CONCLUSION

Nurse-led self-care interventions effectively improve the quality of life and reduce depression in people living with HIV, but current evidence shows these interventions have little impact on social support. The evidence regarding anxiety is limited, indicating a need for more rigorous research to explore the potential benefits of these interventions for anxiety in people living with HIV. These findings support the inclusion of nurse-led self-care interventions in routine HIV care to enhance the well-being of people living with HIV.

REGISTRATION NUMBER

(PROSPERO): CRD42024548592.