1203NRS: how family involvement and self-care management program with post-discharge education: Understanding Research in Practice Assignment, GU, Singapore

Subject: How to prevent readmission for heart failure

Research Poster-

The aim of this poster is to find out how family involvement and self-care management program with post-discharge education can help to reduce heart failure patient hospital readmission. Globally, heart failure (HF) is rising
in aging populations and hence has become one of the commonest reasons for hospitalization. The research shows that the self-management program was found beneficial in supporting patient participation by enhancing their understanding of their disease and encouragement given to create an active working relationship to increase their quality of life.

Interestingly, the research found that the involvement of family also plays an important part in reducing readmission, besides patients’ self-management. In order to highlight the issue, nine articles had been reviewed related to the topic. Education is beneficial for heart failure patients post-discharge.

The use of pamphlets and follow-up calls by nursing staff are helpful in promoting self-care among HF patients. In conclusion, family involvement and self-care management program with post-discharge education are important as they act as guidelines for heart failure patients to smoothen their path of self-care. This could help to improve physical condition and enhance patients’ quality of life so as to reduce their hospital readmission rate.

Part 1- Annotated Bibliography

This study was conducted on 256 heart failure patients in three tertiary medical centers for 13 months. In the study, adult patients were selected for an exacerbation of heart failure. Certain patients were excluded, such as those under 18 years of age, patients living alone or in nursing homes, or those planning to undergo an open-heart surgery or a bypass surgery.

The study aimed at evaluating the effect of family members or caregivers in self-care that would reduce readmission to the hospital; a multi-site block randomized controlled trial design was followed. Patients were divided into interventions group and control group.

In the interventions group, family members were educated on culturally appropriate sessions that would enhance the self-care of the patients. There were only self-care resources used in the control group. Phone calls were conducted till 30 days after the sessions to keep a follow-up.

There was a reduction in hospital readmission. Self-care management was improved, and confidence. Educating the family members also improved self-care management among the patients who were suffering from heart failure issues. The interventions also increased the motivations, and the improved knowledge increased the effectiveness along with the quality of life.

Though certain limitations had been observed in the study, such as cultural generalisability, arose since the survey focused on collectivism and familial connections. Despite the limitation, the collectivist approach could have been used in other cultures, such as western and non-Western countries, which follow the collectivist sense of culture.

Article 2

Dolan, J., Mandras, S., Mehta, J. P., Navas, V., Tarver, J., Chakinala, M., &Rahaghi, F. (2020). Reducing rates of readmission and development of an outpatient management plan in pulmonary hypertension: Lessons from congestive heart failure management. Pulmonary Circulation, 10(4), 2045894020968471-2045894020968471.

https://doi.org/10.1177/2045894020968471

The study population size was greater than or equal to 150 persons suffering from Congestive Heart Failures (CHF) and Pulmonary Hypertension (PH). A total of 76 trials, including initial analysis, meta-analysis, and reviews, were identified. A systematic review was conducted by taking the articles from 1993 to 2019.

This article aimed to apply similar disease management strategies in patients suffering from PH that could help to improve their condition. The interventions that were identified in the Cochrane review were examined. The interventions given to the outpatients suffering from heart disease were also identified, and the causes of their admission and readmission were assessed.

Four primary categories of intervention consisting of Cochrane review were identified. The methods used were to assess the difference between case management and multidisciplinary intervention and the main difference viewed as care coordination. Multidisciplinary intervention (MI) expanded its services that included social workers, dieticians, and pharmacists.

The providers of MI had direct communication with each other to track the progress and cater to the urgent needs. Implantable hemodynamic monitors were used and initially noticed to have elicited mixed results. Reductions were seen in patients in the hospitalized patients after monitoring.  A structured telephone strategy was used as a strategy which consisted of nurse-led education, counseling, and monitoring of patients by keeping a follow-up.

Once the patients were discharged, telephonic strategies were initiated after seven days and checked every three months. Through this, the doses of diuretics could be adjusted and determine whether they needed emergency medical care. The limitation of the study is that there is an identified gap in the current outpatient care and management in PH management. All the patients were not familiar with the technology, extrapolation of data was noticed.

Article 3

Jiang, Y., Shorey, S., Nguyen, H. D., Wu, V. X., Lee, C. Y., Yang, L. F., Koh, K. W. L., & Wang, W. (2020). The development and pilot study of a nurse-led HOMe-based HEart failure self-management program (the HOM-HEMP) for patients with chronic heart failure, following medical research council guidelines. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 19(3), 212-222.

https://doi.org/10.1177/1474515119872853

The aim of this study is to develop a multi-component nursing intervention that could improve self-care behavior among heart failure patients. Consecutive sampling was used, and 10 participants were selected. Everyone received a full intervention package with mobile applications.

Data were collected after six weeks from the baseline. Some of the tools that were used in the study included: Self-Care Heart Failure Index and Cardiac Self Efficacy Scale; apart from this, the Minnesota Living with Heart Failure Questionnaire and Hospital Anxiety and Depression scale were also used.

A short form of the Social Support Questionnaire was also used.  A pilot test was conducted. Nine participants could complete the pilot study. During the intervention, nobody reported any complications or was admitted to the hospital. It was observed that the cardiac self-efficacy control in patients improved.

The UK MRC guidelines provided a structured framework for the development of the nursing intervention. By increasing, self-care management and treatment plans, heart failure can be self-managed. Psychosocial education can also play a great role in educating people.

The nursing management techniques did prove to be important for managing the self-care of CHF patients. No limitations were mentioned in the study. This article concluded that training centers would also improve life quality since CHF is a chronic disease.