Issues in cardiovascular nursingA telephone-delivered empowerment intervention with patients diagnosed with heart failure
Section snippets
Background
Heart disease continues to be the leading cause of death in the United States.10 HF, a manifestation of heart disease, is the first-listed diagnosis in more than 800,000 hospitalizations per year and is the most common diagnosis in hospital patients aged 65 years and older. By using the Framingham Heart Study, Levy and colleagues11 assessed trends and survival in men and women after the onset of HF. They found that rates of HF were higher among men than women, and that mortality rates for both
Telephone Interventions
Telephone calls from nurses to chronically ill patients on a weekly or monthly basis has gained support as a strategy to manage patient care needs and promote positive health outcomes.22, 23 Laramee et al24 compared the effects of nursing case management, coupled with follow-up telephone calls, with usual care (education for HF management and all referrals requested by the attending physician). They found no significant difference in hospital readmission rates between the groups; the
Theoretic Perspective
This research was designed to foster empowerment from a theoretic perspective guided by Rogers’ Science of Unitary Human Beings person-environment process.27 From a Rogerian perspective, empowerment entails purposeful participation in change,9, 27 leading to patient outcomes including goal attainment, self-management, and enhanced perception of functional health. From this perspective, patients purposefully participate with nurses to optimize personal health consistent with their own
Methods
A randomized, controlled trial was conducted with preintervention and postintervention data collection. The study was approved by the appropriate hospital and university institutional review boards. All participating patients signed a consent form before beginning the study.
Procedure
Patients eligible for the study were identified from the daily census by one of the study nurse clinicians who reviewed the patient’s medical record. Before patient recruitment, primary physicians were contacted by one of the three nurse clinicians to seek their commitment to the project and receive verbal approval to recruit their patients for the study. After physician approval was received, the study was explained to the patient. If the patient agreed to participate and met the inclusion
Statistical Methods
Two-sample group, repeated-measures analyses of variance (ANOVAs) were used to examine the effects of the telephone-delivered EI on outcomes of purposeful participation in attaining health goals, functional health, and self-management. The assumption of homogeneity of variance was met using Levene’s test for each of the dependent measures. All the dependent measures were consistent with a normal distribution, as evaluated with the Lilliefors test of normality, with the exception of the SF-36
Results
There were no significant differences in demographic (Table I) and physiologic measures of cardiac function, ejection fraction, NYHA classification for HF (Table II), or measures of purposeful participation in attaining health goals, functional health, and self-management at baseline between the EI group and control group (Table III).
At 12 weeks, the two groups did not differ significantly in reported PKPCT (Table IV). The mean score for both groups averaged 257.9 on the pretest and 262.2 on
Discussion
The findings of this study suggest that the telephone-delivered EI facilitated self-management of HF. This finding is consistent with the findings of Laramee and colleagues24 in a randomized, controlled trial of adherence to a self-management treatment plan in patients with HF. The authors found a statistically significant improvement in adherence to the treatment plan with regard to daily weights, checks for edema, and low-salt diet in the intervention group compared with the usual care group.
Limitations
This study had several limitations. First, the sample was recruited from one metropolitan hospital and included a high percentage of white, well-educated men, a characteristic that may not represent the general population of patients diagnosed with HF. Second, the SF-36 instrument was used to measure functional health and may not have been sensitive enough to capture subtle changes in the level of physical function or to detect small but meaningful improvements in function consistent with
Conclusion
The knowledge gained from this study may enhance health care providers’ ability to facilitate self-management among patients diagnosed with HF. In this study, the nurses assisted patients to freely choose ways to purposefully participate in their health care decisions and care management. Nurses whose practice is guided by theory-based interventions and other sources of knowing are better able to facilitate awareness that patients can purposefully participate in attaining their health goals,
References (37)
- et al.
Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm
Patient Educ Couns
(2005) - et al.
Predictors of successful heart failure self-care maintenance in the first three months after hospitalization
Heart Lung
(2004) - American Heart Association. Heart disease and stroke statistics—2006 update. Available at:...
- et al.
Disease management in congestive heart failure
Contin Care
(2000) Outcomes measure
J Cardiovasc Nurs
(2000)- et al.
Identification of factors predictive of hospital readmissions for patients with heart failure
Heart Lung
(2003) - et al.
Longitudinal nursing case management for elderly heart failure patients: notes from the field
Nurs Case Manage
(2000) - et al.
The effectiveness of heart failure disease management: initial findings from a comprehensive program
Dis Manage
(2002) Inside case management and telehealth
Lippincotts Case Manag
(2004)- et al.
Empowerment: reformulation of a non-Rogerian concept
Nurs Sci Q
(2004)
Healthy People 2010
Long-term trends in the incidence of and survival with heart failure
N Engl J Med
Prevention of readmission in elderly patients with congestive heart failure: results of a prospective, randomized pilot study
J Gen Intern Med
National trends in the initial hospitalization for heart failure
J Am Geriatr Soc
Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities
N Engl J Med
Quality of life in women with heart failure, normative groups, and patients with other chronic conditions
Am J Crit Care
Health-related quality of life and sense of coherence among elderly patients with severe chronic heart failure in comparison with healthy controls
Heart Lung
Development and testing of a clinical tool measuring self-management of heart failure
Heart Lung
Cited by (66)
Impact of nurse scientist-led digital health interventions on management of chronic conditions
2020, Nursing OutlookCitation Excerpt :These approaches were utilized to increase the accessibility of services for patients living in the community to improve self-management and patient outcomes (Badger et al., 2007; Evangelista et al., 2015; Hintistan et al., 2017). The interventions implemented were mostly those that involved less sophisticated technology, such as telephone (n = 15) (Aytekin Kanadli et al., 2016; Badger et al., 2007; Barnason et al., 2009; Beaver et al., 2009; Brandon et al., 2009; Budin et al., 2008; Chambers et al., 2014; Chunta, 2016; Fang & Li, 2016; Graziano & Gross, 2009; Hintistan et al., 2017; Hsiao et al., 2007; Kim et al., 2009; Shearer et al., 2007; Yu et al., 2015); and instant messaging (n = 4) (Bond et al., 2010; Celik et al., 2015; Fang & Li, 2016; Kim & Jeong, 2007). Four of the studies involved automated responses or feedback, such as educational initiatives (Graziano & Gross, 2009; Pressler et al., 2013; Ruland et al., 2013; Sherifali et al., 2011); three involved tracking or logging of behavior or activity (Bond et al., 2010; Kim & Jeong, 2007; Kooiman et al., 2018); two involved video-visits or remote monitoring (Evangelista et al., 2015; Hawkins, 2010); and two included some sort of game (Li et al., 2011; McPherson et al., 2006) to promote behavior change or increase well-being.
What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials
2018, Patient Education and CounselingEmpowerment in Dermatology
2018, Actas Dermo-SifiliograficasThe effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure—A systematic review and meta-analysis
2018, International Journal of Nursing Studies
Research funded in part by the Mayo Clinic—Arizona State University Nursing Research Grant.