Chronic Heart Failure and Self-Care
Heart failure is a complex and manageable chronic illness with an increase in prevalence due to the aging population, multiple self-care barriers, and lack of patient knowledge and adherence to treatment regimen. Recommended heart failure regimens, and a variety of studies will be discussed in order to support and better understand the connection to the nursing diagnosis self-care deficit. A comprehensive evaluation of research and summary of supporting evidence was conducted to assess the importance, application, challenges, interventions, and outcomes of self-care in chronic heart failure patients. On the contrary, with multiple factors to take into consideration that influence the outcomes, the results are becoming closer to conclusive, but more informational data studies are required.
Chronic Heart Failure and Self-Care
According to the Centers for Disease Control and Prevention (CDC) (2019), about 6.5 million adults in the United States have heart failure. Heart failure, sometimes called congestive heart failure, is a condition in which the heart muscle does not pump as effectively as it should. As a result, fluid can build up in the lungs and cause difficulty breathing or it may collect in other parts of the body and cause swelling (typically in the ankles, legs, and abdomen). Certain underlying conditions can cause or worsen heart failure which include high blood pressure, obesity, excessive alcohol use, uncontrolled diabetes, chronic lung disease, coronary artery disease, abnormal heart rhythms like atrial fibrillation, heart valve and autoimmune diseases, or infection in the heart (CDC, 2019). Reducing the risk of heart failure can be done by changing unhealthy behaviors. This can be done by decreasing the amount of foods high in fat, cholesterol, and sodium. Other lifestyle changes can decrease the risk of heart disease such as increasing regular physical activity, tobacco cessation, and decreasing excessive alcohol intake (CDC, 2019). Chronic heart failure can be treated and controlled by simply taking medicines, reducing the amount of sodium in the diet, drinking less fluids, and specific surgeries for the heart (CDC, 2019).
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According to Ryan, Bierle, & Vuckovic (2019), “each year, more than 1 million people are hospitalized with heart failure.” Regardless of continuing improvements in therapies, hospital admissions and readmissions for heart failure continue to increase. Studies have shown that a single intervention may not provide enough sufficiency to focus on the multiple needs of patients with heart failure (Ryan et al., 2019). Nurses’ should provide individualized care based on each specific patient and family needs in order to maintain successful interventions and outcomes. Demonstrated by research, every patient requires an individualized plan for facilitating a successful transition from the hospital to home and preventing readmissions (Ryan et al., 2019). Therefore, it is crucial to understand the perspectives of patients experiencing heart failure and the families caring for that patient.
Nursing Diagnosis: Self-Care Deficit
Heart failure affects a persons’ normal activities of daily living. One common symptom is shortness of breath, which can be a major contribution to self-care barriers. A long with other barriers like weakness and fatigue; shortness of breath may cause difficulty walking to the bathroom or getting dressed for a patient experiencing heart failure. The inability to complete everyday life tasks can lead to multiple barriers that contribute to the individual self-care of a patient trying to manage. As a result of these barriers, family may step in to help with daily tasks. These obstacles create burdens on caregivers and adherence to therapy difficult.
Recommended self-care behaviors include adherence to medications, therapies, restricted sodium and fluid diet, daily weights, smoking cessation, and securing appointments (Holden, Schubert, & Mickelson, 2015). In patients with chronic heart failure, rehospitalization is one of the strongest predictors for increased mortality (Lay, Moody, Johnsen, Petersen, & Radovich, 2019). It is not just the responsibility of clinical professionals to aid in controlling and managing this chronic illness; it depends significantly on the patient or caregivers’ performance of recommended self-care behaviors (Holden et al., 2015).
Challenges and outcomes
As heart failure worsens, management of the condition becomes more challenging and a decrease in adherence to self-care behaviors occurs (Gary, Dunbar, Higgins, Butts, Corwin, Hepburn, Butler, & Miller, 2020). Based off several studies, many of the challenges that patients encounter with heart failure are related to patient factors such as age, lack of knowledge, and low self-efficacy (Holden et al., 2015). Despite challenges, higher self-efficacy can reflect the degree of confidence that the patient has in order to perform self-care-related task and to continue with the actions or behaviors needed to follow heart failure regimen (Pancani, Ausili, Greco, Vellone, & Riegel, 2018). The Pacani et al. (2018) study resulted in heart failure patients with inadequate self-care confidence to be at risk for poor adherence to self-maintenance and at a higher risk for inadequate outcomes. Patients with inadequate outcomes tend to be readmitted into the hospital, which may be the result of deficient knowledge on the disease and regimen. Knowledge and skills are important for patients and caregivers to maintain self-management of heart failure (Ryan et al., 2019). Readmission into the hospital poses as a challenge to the patient, signifying that the patient is experiencing barriers since the condition is not controlled. Multiple studies suggest that consistent education improved knowledge, self-monitoring, and medication adherence (Ryan et al., 2019).
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Deterioration in the quality of life of the patient can result in the family assuming the responsibilities of managing the heart failure self-care regimen. When the family member assumes the role as caregiver, focus tends to solely remain on the self-care of the patient; therefore, proceeding to place the family caregiver at risk for a decline in function of well-being and poor health (Gary et al., 2020). There are nearly 44 million caregivers providing care for the chronically ill adult, and approximately one third experience burden that has shown to have a negative impact on outcomes (Gary et al., 2020). Evidence has revealed through decades that it is stressful for family caregivers to care for other family members with a chronic illness resulting in depressive symptoms and emotional hardship (Gary et al., 2020). Although, recent studies have shown positive experiences from family caregivers with an increase in physical and psychological health benefits (Gary et al., 2020).
Programs and interventions
The development of interventions that not only target the patient, but both the patient and caregiver together can help incorporate self-care tasks into existing clinical and personal task (Holden et al., 2015). A cost-effective way to connect with the patient and check on the overall well-being is via telephone calls. A telephone call gives the clinical professional a chance to reinforce interventions and address any issues that could be leading to adverse outcomes (Ryan et al., 2019). One study on telephone intervention presented that calling closer to the date of discharge proved the greatest impact for preventing readmission (Ryan et al., 2019).
Despite patients receiving education on medication, diet, and self-care interventions; repeat hospital admissions persist (Lay et al., 2019). Unnecessary hospital readmissions can be prevented within the home environment by understanding the illness, learning to manage symptoms, and detecting early signs of worsening heart failure (Lay et al., 2019). The clinical data collected by Lay et al. (2019), involved a specialized plan of care created with goals and interventions that involved the teach back method and a visit-by-visit approach. This studied program of home health care has proven to show an increase in patient engagement, knowledge, confidence, and ability to successfully manage heart failure symptoms (Lay et al., 2019). Based off the results of the Lay et al. (2019) study, it shows that home health care significantly reduced hospital readmissions and is becoming a critical link in the heart failure process by improving patient knowledge, self-confidence, and understanding of the management of the disease.
The impacts of education, interventions, and outcomes is important for the compliance of the patient to adhere to heart failure regimens. Efforts made by clinical professionals to provide proper understanding of the disease to the patient and caregiver can impact the outcomes of self-care. Research evidence has proven that patients have a decrease in hospital readmission and a better adherence to the heart failure regimen from increased self-efficacy, knowledge, specific interventions, targeted barriers, and home health programs. However, with mindfulness of nurses and clinical professionals in recognizing the reasons for self-care deficit and implementing individual specific interventions can result in more successful outcomes for the patient.
- Gary, R., Dunbar, S. B., Higgins, M., Butts, B., Corwin, E., Hepburn, K., … Miller, A. H. (2020). An Intervention to Improve Physical Function and Caregiver Perceptions in Family Caregivers of Persons With Heart Failure. Journal of Applied Gerontology, 39(2), 181–191. https://doi-org.dax.lib.unf.edu/10.1177/0733464817746757
- Heart Failure. (2019, December 9). Retrieved from https://www.cdc.gov/heartdisease/heart_failure.htm
- Holden, R. J., Schubert, C. C., & Mickelson, R. S. (2015). The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. Applied Ergonomics, 47, 133–150. https://doi-org.dax.lib.unf.edu/10.1016/j.apergo.2014.09.009
- Lay, S., Moody, N., Johnsen, S., Petersen, D., & Radovich, P. (2019). Home Care Program Increases the Engagement in Patients With Heart Failure. Home Health Care Management & Practice, 31(2), 99–106. https://doi-org.dax.lib.unf.edu/10.1177/1084822318815439
- Pancani, L., Ausili, D., Greco, A., Vellone, E., & Riegel, B. (2018). Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis. International Journal of Behavioral Medicine, 25(4), 399–409. https://doi-org.dax.lib.unf.edu/10.1007/s12529-018-9731-2
- Ryan, C. J., Bierle, R. (Schuetz), & Vuckovic, K. M. (2019). The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate. Critical Care Nurse, 39(2), 85–93. https://doi-org.dax.lib.unf.edu/10.4037/ccn2019345
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