NEW YORK NURSE: November 2009
by Connie Randolph, RN, MS, Clinial Nurse Specialist, Saint Joseph's Hospital Health Center, Syracuse, NY and NYSNA Research Fellow, Foundation of New York State Nurses
Heart failure is a growing public health concern, affecting more than five million Americans at an estimated cost of $33.2 billion annually. Heart failure is the most costly cardiovascular illness in the United States and the leading cause of hospitalizations among Medicare recipients (American Heart Association, 2007).
The results of a qualitative, descriptive meta-analysis recently published in Heart & Lung: Journal of Acute & Critical Care indicated that traditional patient education does not support self-care skill development in patients with heart failure (HF).
Dickson and Riegel (2009) reported the findings of their study from a sample of 85 adults with chronic HF enrolled in three prior studies. The themes were re-examined (tactical and situational) to create a broader and more complete understanding of skills needed in HF patients to build self-care techniques.
The research objective was to “assess what self-care skills patients with HF perceive that they need and how they developed the skills needed to perform self care.” In the three descriptive studies, patients were eligible for participation if they had documented evidence of symptomatic HF for at least three months.
Patients who could not speak or read English or who had a history of a neurological event were excluded. More than 3,000 pages of transcripts from the three previous studies were reviewed. Cases were identified that illustrated reports of skill in HF care. The comments on self-care maintenance and self-care management were reexamined to identify repeating distinct self-care skills.
The results indicated that self-care skill deficits described by the HF patients included both tactical and situational skills. They identified specific skills related to diet, diuretic titration, and exercise. Interestingly, the skill of medication taking was not identified by the HF patients as a need. The patients were able to describe their medications and their usage, and had routines utilizing printed material and pill boxes.
Nurses instruct their patients about low-salt diets and provide educational tools. This study demonstrated, however, that patients would like “how to” guidance about reading food labels and preparing low-salt meals. They also needed “how to” information about obtaining a reliable body weight measurement and assessing their own bodies. Patients are encouraged to develop an exercise plan, but they need to know how to exercise safely, utilizing resources that are available.
The study also revealed that patients utilized family members, friends, and neighbors to help them manage and maintain their self care.
Situational skills are another concern. HF patients’ daily routines can be challenged by planned or unplanned situations. Patients need to know what to do when their routines are altered. For example, if they are invited out for dinner, how can they maintain a low-salt diet?
The authors concluded that traditional patient education falls short in building skills that HF patients need to perform self care, and that patient education strategies should be developed to meet the needs of HF patients.
The implications of this study suggest a transformation of HF patient education to identify the patient’s skill level and build education around the patient’s individual tactical and situational needs.
In their role as patient educators, nurses are instrumental in imparting knowledge. This study challenges nurses to evaluate their patient education strategies and to be aware of the skills patients need to maintain and manage the chronic illness of HF.
American Heart Association (2007). Heart Disease and Stroke Statistics: 2007 Update. Dallas, Tex.
Dickson,V., & Riegel, B. (2009). Are we teaching what patients need to know? Heart & Lung: Journal of Acute & Critical Care, 31(3), 253-261.