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Caring for patients with chronic heart failure
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-4259-3671
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe and evaluate patient education and nurse-led follow up for patients with heart failure. Descriptive designs were used to map out the nurse-led heart failure care in Sweden (I) and to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure.(II) An interactive computer-based multimedia program for the education of patients with heart failure was developed and tested (III) and the effects on knowledge, compliance and quality of life evaluated in a randomised study. (IV) The effects of nurse-led heart failure clinics on mortality, morbidity, health-related quality of life and self-care behaviour in patients hospitalised due to heart failure were also evaluated in a randomised study.(V) Heart failure nurses and nurse-led heart failure clinics were introduced in Sweden in 1990. After 8 years the model has  spread to two thirds of the Swedish hospitals. In total 148 heart failure nurses were involved in education and follow up of patients with heart failure. (I) The compliance with therapeutic regimens was influenced by inward factors; the personality of the patient, the disease and the treatment and outward factors; social activities and relationships to family, friends and health care professionals.(II) The patients with heart failure were satisfied with computer-based education and positive in their attitude towards the computer. There was no need for computer experience in order to run an interactive computer-based program and high age was not a problem for using the program independently.(III) Computer-based education gave increased and more lasting knowledge about heart failure compared to traditional teaching, but compliance was not improved by single-session education. Quality of life was improved after 6 months by both traditional and computer-based education, but only for the men. (IV) Follow up after hospitalisation at a nurse-led heart failure clinic improved survival and selfcare behaviour in patients with heart failure as well as reduced the number of events, readmissions and days in hospital. (V)

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 708
Keyword [en]
caring, compliance, computer-based education, follow up, heart failure, intervention, nurse-led heart failure clinics, morbidity, mortality, patient education, quality of life, self-care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27544Local ID: 12204ISBN: 91-7373-144-7 (print)OAI: oai:DiVA.org:liu-27544DiVA: diva2:248096
Public defence
2001-12-10, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-03Bibliographically approved
List of papers
1. Nurse-led heart failure clinics in Sweden
Open this publication in new window or tab >>Nurse-led heart failure clinics in Sweden
2001 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 3, no 1, 139-144 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to describe the nurse-led heart failure care in Sweden.

Methods: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes.

Results: Sixty-nine percent of all hospitals (n = 86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare.

Conclusion: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26848 (URN)10.1016/S1388-9842(00)00099-4 (DOI)11466 (Local ID)11466 (Archive number)11466 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis
Open this publication in new window or tab >>Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis
1999 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 28, no 5, 334-341 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure.

Methods: A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic.

Results: Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals.

Conclusions: By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26828 (URN)10.1053/hl.1999.v28.a99538 (DOI)11443 (Local ID)11443 (Archive number)11443 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Interactive education on CD-ROM: a new tool in the education of heart failure patients
Open this publication in new window or tab >>Interactive education on CD-ROM: a new tool in the education of heart failure patients
2002 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 46, no 1, 75-81 p.Article in journal (Refereed) Published
Abstract [en]

The study aimed to develop and evaluate whether a computer-based program for patients with heart failure was user-friendly, could be operated by elderly patients and gave sufficient information about heart failure. The program was developed by a multidisciplinary group and designed with large, clear illustrations and buttons. A total of 42 patients aged 51-92 years tested the program and completed afterwards a questionnaire. Three heart failure nurses evaluated how the patients used the program and their attitudes towards the computer. All patients could use the program, despite the fact that only six had used a computer before. The patients were satisfied with the computer-based information and appreciated that the program was interactive, flexible and contained a self-test. They thought it was a better way of receiving information than reading a booklet or watching a video about heart failure. The nurses reported that the patients were positive towards the computer and seemed to understand the information and that the patient education was less time-consuming, when the patients could seek knowledge on their own.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26851 (URN)10.1016/S0738-3991(01)00151-3 (DOI)11469 (Local ID)11469 (Archive number)11469 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life
Open this publication in new window or tab >>Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life
2006 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 64, no 1-3, 128-135 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.

Methods

One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n = 72) or standard education and additional computer-based education (n = 82).

Results

Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P = 0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P = 0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P = 0.0001).

Conclusion

Computer-based education gave increased knowledge about heart failure.

Practice implications

Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-36815 (URN)10.1016/j.pec.2005.12.007 (DOI)32678 (Local ID)32678 (Archive number)32678 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
5. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: Results from a prospective, randomised trial
Open this publication in new window or tab >>Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: Results from a prospective, randomised trial
Show others...
2003 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 24, no 11, 1014-1023 p.Article in journal (Refereed) Published
Abstract [en]

Aim The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge.

Methods A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2–3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family.

Results There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01).

Conclusions Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.

Keyword
Heart failure, Heart failure clinics, Mortality, Nursing, Patient education, Self-care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46609 (URN)10.1016/S0195-668X(03)00112-X (DOI)
Note

On the day of the defence day the status of this article was a manuscript

Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved

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