Symptom clusters of heart failure

Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N = 687) was conducted. The sample was 51.7% female, mean age 71 ± 12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of nine items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:551–560, 2009     

Development of self-care educational material for patients with heart failure in Japan: a pilot study

This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P < 0.05). In conclusion, heart failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension.     

协同护理模式对慢性心力衰竭病人自我护理能力的影响

[目的]探讨协同护理模式对慢性心力衰竭病人自我护理能力的影响。[方法]采用随机数字表法将96例慢性心力衰竭病人分为观察组和对照组各48例,对照组予常规的护理模式,包括饮食、休息与运动、用药指导和预防感染等措施,观察组在常规护理的基础上运用协同护理模式,采用自我护理能力测定量表(ESCA)对两组病人干预前后的自我护理能力进行评价并比较。[结果]干预后3个月观察组病人的自我护理技能、自我责任感、自我概念及健康知识水平得分显著高于对照组(P0.01)。[结论]协同护理模式以其独特的理念促进病人及家属共同参与护理,提供优质、高效护理,帮助解决病人的各种健康问题,以达到提高病人自我护理能力的目的。     

Lessons learned from the implementation of a video health coaching technology intervention to improve self‐care of family caregivers of adults with heart failure

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients (“Virtual Caregiver Coach for You”—ViCCY). A randomized controlled trial is currently in progress to test the efficacy of the intervention to improve self‐care. In this trial, 250 caregivers will be randomly assigned to receive health information via a tablet computer (hereafter, tablet) plus 10 live health coaching sessions delivered virtually (intervention group; n = 125) or health information via a tablet only (control group; n = 125). Each tablet has specific health information websites preloaded. To inform others embarking on similar technology projects, here we highlight the technology challenges encountered with the first 15 caregivers who received the ViCCY intervention and the solutions used to overcome those challenges. Several adaptations to the implementation of ViCCY were needed to address hardware, software, and network connectivity challenges. Even with a well‐designed research implementation plan, it is important to re‐examine strategies at every step to solve implementation barriers and maximize fidelity to the intervention. Researcher and interventionist flexibility in adapting to new strategies is essential when implementing a technology‐based virtual health coaching intervention.     

慢性心力衰竭患者灵性照护的研究进展

慢性心力衰竭(chronic heart failure,CHF),它能够在几年甚至几十年内逐渐恶化[1]。随着人们生活质量的提高以及人口老龄化趋势的上升,CHF的人数逐年上升。目前,全球被诊断为CHF的患者2300万人,且每年增加200万人[2]。研究显示[3],CHF的发病率高,给国家带来巨大的医疗负担。随着生物-心理-社会医学模式的盛行,不仅要求护理人员对患者进行症状管理,更要注重其身体、心理、社会、灵性层面的整体照护。目前,我国护理人员更多的是关注患者的躯体疾病,然而却忽视了患者的灵性照护。灵性照护措施能够将心与心相连,避免被遗弃,有助于维护CHF患者的尊严,减轻其负性情绪,提高幸福感,提升生命质量[4]。     

慢性心力衰竭病人自我护理行为及影响因素的研究

[目的]描述慢性心力衰竭病人自我护理行为的现状,探讨自我护理行为的影响因素。[方法]采用描述性研究设计,采取便利抽样的方法,选取广州市某三级甲等医院心血管内科30例确诊为慢性心力衰竭的住院病人,调查病人的一般资料及自我护理行为状况。[结果]慢性心力衰竭病人的自我护理行为分值为76.83分±13.97分,年龄、文化程度对慢性心力衰竭病人的自我护理行为的影响有统计学意义(P<0.05)。[结论]慢性心力衰竭病人的自我护理行为总体处于中等水平,医务工作人员应该针对不同年龄及文化程度的病人,采取不同的教育方式及教育内容,以提高其自我护理能力。     

Pharmacists' role in the post-discharge management of patients with heart failure: a literature review

BACKGROUND AND OBJECTIVE: The incidence of heart failure is increasing in developed countries. In the aged population, heart failure is a common cause of hospitalization and hospital readmission, which in conjunction with post-discharge care, impose a significant cost burden. Inappropriate medication management and drug-related problems have been identified as major contributors to hospital readmissions. In order to enhance the care and clinical outcomes, and reduce treatment costs, heart failure disease management programmes (DMPs) have been developed. It is recommended that these programmes adopt a multi-disciplinary approach, and pharmacists, with their understanding and knowledge of medication management, can play a vital role in the post-discharge care of heart failure patients. The aim of this literature review was to assess the role of pharmacists in the provision of post-charge services for heart failure patients. METHOD: An extensive literature search was undertaken to identify published studies and review articles evaluating the benefits of an enhanced medication management service for patients with heart failure post-discharge. RESULTS: Seven studies were identified evaluating 'outpatient' or 'post-discharge' pharmacy services for patients with heart failure. In three studies, services were delivered prior to discharge with either subsequent telephone or home visit follow-up. Three studies involved the role of a pharmacist in a specialist heart failure outpatient clinic. One study focused on a home-based intervention. In six of these studies, positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated. One study did not show any difference in the number of hospitalizations between intervention and control groups. The quality of evidence of the randomized controlled trials was assessed using the Jadad scoring method. None of the studies achieved a score of more than 2, out of a maximum of 5, indicating the potential for bias. DISCUSSION: The DMPs carried out by pharmacists have contributed to positive patient outcomes, which has highlighted the value of extending the traditional roles of pharmacists from the provision of professional guidance to the delivery of continuity of care through a more holistic and direct approach. CONCLUSION: This review has demonstrated the effectiveness of pharmacists' interventions to reduce the morbidity and mortality associated with heart failure. However, there is an on-going need for the development and evaluation of pharmacy services for these patients.     

慢性心力衰竭患者自我护理行为影响因素的研究

目的探讨慢性心力衰竭患者在出院后1个月及3个月时自我护理行为的影响因素。方法采用目的抽样法,选取北京市某心血管病专科医院住院治疗的160例慢性心力衰竭患者为研究对象,调查其护理行为及其影响因素。结果①在出院后1个月时职业状况、收入水平、社会支持、自我概念、抑郁和心力衰竭知识与自我护理行为之间存在相关关系;在出院后3个月时职业状况、收入水平、社会支持、自我概念和心力衰竭知识与自我护理行为之间存在相关关系;②在出院后1个月时影响慢性心力衰竭患者自我护理行为的因素按照影响作用由大到小依次是:社会支持、自我概念、抑郁,对自我护理行为变异的解释度为23.70%;在出院后3个月时,其影响因素按照影响作用由大到小依次是:社会支持、自我概念,对自我护理行为变异的解释度为20.50%。结论对慢性心力衰竭患者应实施针对性的健康教育以提高其自我护理行为。社会支持等影响因素对自我护理行为总变异的解释度较低,建议在此基础上再扩大影响因素的范围,进一步广泛深入开展可干预因素的探讨和研究。     

改善慢性心力衰竭患者健康素养相关研究进展

通过回顾国内外相关文献,综述慢性心力衰竭患者健康素养的临床意义和提升策略,为今后开展相关临床护理干预提供参考依据。