Heart failure with preserved systolic function: giving well-deserved attention to the "other" heart failure

Heart failure with preserved systolic function is common in patients hospitalized with decompensated heart failure and is associated with postdischarge morbidity and costs similar to patients with heart failure and systolic dysfunction. It is common in the older people, and hypertension and cardiac ischemia are often etiological factors. Nurses must be able to recognize left ventricular diastolic abnormalities and understand treatment priorities and treatment options on the basis of structural cardiovascular disease; etiology and risk factors; and signs, symptoms, and hemodynamic parameters. Currently, clinical treatments are on the basis of individual randomized clinical trials; however, there are general principles that should be followed during hospitalization and as part of general practice. As in the treatment of systolic heart failure, nurses have active roles in ensuring accurate assessment; optimal care planning; implementation of clinical, psychosocial; and education interventions; and timely and accurate evaluation so that patients have the best chance for successful hospital and postdischarge outcomes.     

Educating nurses and patients to manage heart failure.

Patient education is an important component in the management of patients with heart failure and nurses are increasingly involved in this area. This paper reviews the literature on education to patients with heart failure and the education and training for heart failure nurses. Patients with heart failure need education in order to adapt to their chronic syndrome and perform self-care. The education process often starts during the hospital admission, but must continue in the outpatient setting. Nurses need to be skilled in assessing the requirements and level of the education given to the individual. Computer-based education has been found to be a preferred and effective compliment to the education provided by health care professionals. The effect of new materials and methods needs to be evaluated in order to improve the overall effectiveness of the education provided. The patient with heart failure should have an active role in this development and evaluation. The heart failure nurse needs to be experienced in cardiac care, have an ability to work independently in order to be delegated responsibilities such as drug titration and patient assessment. This requires optimal experience, training and education for advanced practice. In order to develop and evaluate the education of patients with heart failure and the overall effectiveness of heart failure nurses in this regard, national and international collaborations are needed.     

The impact of self-care practices on treatment of interstitial cystitis

Self-care, as a theoretical base of practice in caring for patients with interstitial cystitis (IC), has been suggested as a model of holistic health. Those living with IC look to the nurse/health care practitioner for intervention and care. Nurses operating from the self-care nursing framework may find this model useful in caring for patients with IC. These patients are educated by the nurse regarding preventative measures, interventions, and advanced treatments and therefore may be in a better position to participate in achieving the goal of optimal health. Self-care nursing helps the client to care for themselves through education, resource acquisition, and role-modeling positive behavioral outcomes.     

Impact of patient education on self-care behaviour in patients with heart failure: a review of the literature

Heart failure is a highly prevalent chronic condition. Nurse-led patient education has been described in the literature as a key component of disease management programs. This literature review investigates the impact of patient education on self-care behaviour in patients with heart failure. Seven randomised controlled trials could be included in the review. Medication taking, daily weighing, salt and fluid restriction and taking action in case of worsening symptoms are cornerstones in patient education programs. All seven studies revealed that interventions comprising patient education were associated with improved self-care behaviour in patients with heart failure. The education has to be individualized and family members should be included. Nurses play an important role in patient education interventions and must be well trained and skilled for example in clinical assessment. To date, the dose and the length of the patient education interventions necessary to improve self-care behaviour and sustain these behaviours remain unclear and need more research.     

对慢性心力衰竭患者实施基于自我效能健康教育成效的探讨

目的比较基于自我效能健康教育对慢性心力衰竭患者的效果。方法选择2009年1月至5月来我院心力衰竭门诊就诊患者82例,依据患者入院奇偶周数将患者分别纳入传统组和自我效能组,进行相应健康教育,分别在患者入组时、健康教育结束后3个月和6个月采用心力衰竭自理行为量表和心力衰竭知识问卷进行测评。结果自我效能组患者在自理行为和心力衰竭知识方面测评优于传统组患者,且该干预效果在时间、干预和交互作用方面差异具有统计学意义(P0.01或P0.05)。结论自我效能指导下的健康教育有助于心力衰竭患者形成较好自我行为和增加心力衰竭知识。     

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I,NIC, and NOC

ObjectiveThe objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care.MethodIn this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented.ResultsOf the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation.ConclusionNIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care.     

Nurse educator guidelines for the management of heart failure

Heart failure is a chronic illness that poses a significant societal burden in the United States. Health care facilities are challenged to provide the most current treatment options available for patients with heart failure. Patient education focusing on self-management is recognized as essential. Nurses play a key role in the delivery of patient education. This article reviews the limited available evidence regarding nurses' knowledge of heart failure self-management principles. The key topics of symptom and weight management, dietary recommendations, medications, and activity are discussed.     

Learning for heart failure patients (The L‐HF patient study)

Aim and objective. To investigate the learning style and preferences for information delivery of heart failure patients for the purpose of informing the design of educational resources. Background. Patient education is a vital component of heart failure management programmes however the content and delivery of education varies in each programme. Traditionally education programmes for patients have focussed on educational needs as identified by health care providers however research has shown there are discrepancies between patients’ and nurses’ perceptions of the learning needs of heart failure patients. There is no evidence that educational programmes for heart failure patients are based on identification of patients learning needs or their preferred learning style. Design. Qualitative. Method. A purposive sample of 12 participants, diagnosed with heart failure and enrolled in a heart failure management programme, participated in semi‐structured interviews. Results. Four themes emerged: knowledge quest (L‐loading), barriers to learning (L‐inhibitors), facilitators for learning (L‐agonists), and meeting educational needs (L‐titration). Integral to these themes was the participant’s relationship with health care professionals. Conclusion. This study provides unique information regarding the preferred learning modality of heart failure patients and, as such, serves to inform the development of appropriate education resources specifically tailored for this population. Relevance to clinical practice. The development of effective modes of education is likely to further enhance heart failure management programmes service organisation and delivery and improve health outcomes for heart failure patients.     

早期运动干预对重度心力衰竭患者生活质量的影响

目的探讨早期运动干预对重度心力衰竭（心功能Ⅳ级）患者生活质量的影响。方法选择200例重度心力衰竭患者随机分为观察组和对照组（各100例）,在常规药物治疗的基础上分别采用早期运动护理方案（包括心理、行为、运动强度和时间）和常规护理方案。于入院时、3周、6个月后观察患者的血压和静息心率、6min步行距离、生活质量、左心室射血分数等变化情况。结果观察组患者静息心率明显下降,6min步行距离延长,生活质量明显提高,左心室射血分数增加,心功能明显改善,随访期间再次因心衰住院次数和总住院次数等与对照组对比较,P〈0.01,差异有显著意义,而且死亡率并不增加;观察组2例（2%）死于心源性猝死,对照组9例（9%）因肺部感染、心血管事件而心衰,导致死亡。结论早期运动干预对提高重度心力衰竭患者的生活质量和促进心脏功能康复是有效并安全的。     

Providing palliative care in end-stage heart failure

Little attention has been given to the palliative care needs of heart failure patients. Patients dying from heart disease experience a wide range of symptoms that are frequently distressing, including breathlessness, nausea and vomiting and anxiety. Nurses can draw on the literature relating to the care of cancer patients when devising strategies to care for patients with heart failure.     

Opportunities for an improved role for nurses in psychoactive substance use: review of the literature

Nurses form a core component of many health care systems so their role in responding to problems related to psychoactive substance use is crucial. They are often under-utilized, mainly because of anxieties concerning role adequacy, legitimacy, lack of support and failure to implement interventions in a variety of settings. Nurses have unique opportunities through interactions they have with young people, families and significant others. Training and career preparation should encompass development of innovative strategies, taking a leading role in management of substance use patients, involvement in the treatment of the homeless mentally ill, HIV-infected individuals and persons with dual disorders of mental health and substance use. Future directions should focus on developing skills for critical thinking, preventive and therapeutic interventions, clinical judgement, effective organizational capacity and team work. Barriers such as scope of practice, authority, ethical and legal issues surrounding health care for substance use need to be addressed.     

慢性心力衰竭病人自我护理状况的调查

[目的 ]了解慢性心力衰竭病人自我护理状况。 [方法 ]应用慢性心力衰竭自我护理量表 ,对 90例慢性心力衰竭病人的自我护理维持、自我护理决策及自我护理评估状况进行调查。[结果 ]慢性心力衰竭病人自我护理维持较好的为遵医嘱服药 (70 .0 % ) ,但对症状识别率较差。 [结论 ]慢性心力衰竭病人自我护理状况在中等水平以上 ,健康教育时要教会病人识别心力衰竭症状 ,并采取综合措施。     

Education for genetics and nursing practice

Genetic factors influence the risk for disease, selection of treatments, and overall health of persons throughout the life span. Nurses in critical care practice participate in assessing genetic risks for disease, implementing treatments, educating people about genetic aspects of health and disease, supporting the client's abilities to cope with the information, and assisting the individual and family to make health-related decisions involving genetic information. Opportunities for critical care nurses to become knowledgeable about genetic aspects of critical care nursing exist through academic courses, continuing education, and summer institutes. Recently, new guidelines for the genetic education of nurses have been developed. However, genetic education opportunities are not available to all nurses throughout the United States. Genetic nursing education programs based on guidelines for integration of genetic knowledge into professional nursing practice are needed.     

Nurse-led heart failure clinics: Swedish experiences of Advanced Nursing Practice during 10 years

This paper aims at describing the development of nurse-led heart failure clinics in Sweden and discusses what effects and possibilities this type of advanced nursing practice gives the patients, the health care system and the nurses. Follow-up at nurse-led heart failure clinics involve patient education, optimised treatment and social support and has been shown to improve survival and self-care behaviour in patients with heart failure and reduce the need for hospital care. This model of care has spread from Sweden to many European countries, but still only a minority of the patients hospitalised due to heart failure receive this type of follow-up. It should be considered for several more patients in Europe. The organisation of the nurse-led follow-up needs to be adapted to the different needs of patients within the heart failure population and to the health care system of each country. Formal competence among heart failure nurses needs to be continuously improved in order to provide high-quality care to heart failure patients. This can be achieved through improved education and increased national and international collaboration among heart failure nurses. Networking among heart failure nurses on a regional, national and international level is crucial. Joint activities such as study visits, national and international working groups, conferences, workshops and research collaboration can be important tools in this development.     

Family caregivers need support with heart failure patients

Millions of family members are serving as caregivers for patients with heart failure and the numbers will continue to rise. It appears that caregivers desire to be involved in the patient's care even when the caregiving tasks average 8 hours per day. Burden, stress, and depression have been found to be significantly associated with the caregiving role in this population. Decreasing any negative aspects of caregiving should be a priority. Alarmingly, caregivers have reported being ignored or made to feel like an outsider by health care providers. Nurses are in a pivotal position to improve patient and caregiver outcomes by including the family caregivers of heart failure patients in all aspects of care and in promoting the well being of the caregiver. This article will highlight the importance of social support on patient and caregiver outcomes, and second, review studies on family caregiving among heart failure patients. Recommendations for nursing practice and further research will be discussed.     

Psychiatric mental health evidence-based practice

This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.     

Combining propensity score‐based stratification and weighting to improve causal inference in the evaluation of health care interventions

When a randomized controlled trial is not feasible, a key strategy in observational studies is to ensure that intervention and control groups are comparable on observed characteristics and assume that the remaining unmeasured characteristics will not bias the results. In the past few years, propensity score‐based techniques such as matching, stratification and weighting have become increasingly popular for evaluating health care interventions. Recently, marginal mean weighting through stratification (MMWS) has been introduced as a flexible pre‐processing approach that combines the salient features of propensity score stratification and weighting to remove imbalances of pre‐intervention characteristics between two or more groups under study. The weight is then used within the appropriate outcome model to provide unbiased estimates of treatment effects. In this paper, the MMWS technique is introduced by illustrating its implementation in three typical experimental conditions: a binary treatment (treatment versus control), an ordinal level treatment (varying doses) and nominal treatments (multiple independent arms). These methods are demonstrated in the context of health care evaluations by examining the pre‐post difference in hospitalizations following the implementation of a disease management program for patients with congestive heart failure. Because of the flexibility and wide application of MMWS, it should be considered as an alternative procedure for use with observational data to evaluate the effectiveness of health care interventions.     

Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure

A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: discuss the current status of palliative care for patients with advanced heart failure; explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure; describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure.