Elsevier

Heart & Lung

Volume 36, Issue 3, May–June 2007, Pages 159-169
Heart & Lung

Issues in cardiovascular nursing
A telephone-delivered empowerment intervention with patients diagnosed with heart failure

https://doi.org/10.1016/j.hrtlng.2006.08.006Get rights and content

Background

Heart failure (HF) is a major public health problem. Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF. Similarly, a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness.

Objective

The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention (EI) on clinically and theoretically relevant outcomes in patients with HF, including purposeful participation in goal attainment, self-management of HF, and perception of functional health. The EI was guided by Rogers’ Science of Unitary Human Beings person-environment process.

Methods

A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States. The participants were randomly assigned to the control group (n = 45) or EI group (n = 45). All participants received standardized HF patient education; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse. Repeated-measures analysis of variance was used to evaluate intervention effects.

Results

The telephone-delivered EI facilitated self-management of HF through self-care activities in EI group members.

Conclusion

The knowledge gained from this study provides a beginning understanding of strategies to enhance health care providers’ ability to facilitate self-management of HF among patients diagnosed with HF.

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,

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    Research funded in part by the Mayo Clinic—Arizona State University Nursing Research Grant.

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