Annotated Bibliography and Recommendations for CHF Patient Care

This assignment is an annotated bibliography focusing on the nursing care of patients with Congestive Heart Failure (CHF). It includes an analysis of three journal articles, each critically reviewed and summarized. The first article examines the effectiveness of psychological interventions on CHF patients, emphasizing the benefits of improving self-care and quality of life. The second article discusses strategies to prevent heart failure readmission, highlighting the importance of review, reassessment, and re-education. The third article reviews educational interventions for improving self-care behaviors. The assignment then justifies the selection of these articles based on their relevance to a case study involving a patient experiencing worsening CHF symptoms, and it offers recommendations for patient care and clinical practice. The analysis emphasizes the importance of psychological support, patient education, and continuous care to improve patient outcomes and prevent symptom remission. The assignment concludes with a strong emphasis on the need for nurses to maintain continuity of care, incorporating self-management steps and educational interventions into routine care. This assignment highlights the critical role of nurses in managing CHF, focusing on a holistic approach that encompasses physical, psychological, and educational aspects of patient care.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Part 1: Annotated bibliography
Jiang, Y., Shorey, S., Seah, B., Chan, W. X., San Tam, W. W., & Wang, W. (2018). The
effectiveness of psychological interventions on self-care, psychological and health outcomes in
patients with chronic heart failure—A systematic review and meta-analysis. International
journal of nursing studies, 78, 16-25.
https://doi.org/https://doi.org/10.1016/j.ijnurstu.2017.08.006
The main purpose of this systematic review was to evaluate evidence to determine the
impact of psychological interventions on self-care and psychological and health outcomes of
patients with chronic heart failure (CHF). The study included all those papers that used
psychological methods or theory on self-care behaviour, anxiety, depression and physical
function. By the search for articles in electronic databases like Cochrane library, CINAHL,
PubMed, Scopus, Web of Science, ProQuest Dissertations and Theses and PsycINFO and
searching for articles published from January 2006 to December 2016, total 29 articles were
finally selected for the review. The findings of the review revealed that psychological
interventions were successful in improving self-care in CHF patients. Moreover, positive
outcome in the area of HRQoL was found. However, no statistically significant result was
obtained for the impact of psychological intervention on physical outcome and anxiety levels.
The main conclusion made by the study was that psychological interventions can enhance health
outcomes and quality of life of CHF patient. Despite the above outcome, one limitation is that
this study included papers with multi-component interventions, which may not give true estimate
regarding the efficacy of the psychological intervention. Despite this limitation, this study can be
useful for the case study as it shows that psychological intervention can be used for John so that
he can improve his self-care behaviour.

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Ryan, C. J., Bierle, R., & 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/10.4037/ccn2019345
The main purpose of this study was to discuss about three Rs that could prevent heart
failure readmission. These three Rs include review, reassess and re-educate. The main rationale
for discussing about these three Rs was the issue of high hospital readmission rates despite
improvement in heart failure therapies. The article focused on giving evidence for decreasing
readmission within 30 days by analysing clinical, psychosocial, and systems-based factors in the
acute setting. The clinical factors that were discussed in the study included self-management
factors, patient education, biomarkers and co-morbidities. The psychosocial factors included
focusing on HRQoL and treating depression in patients using multidisciplinary approach and
social support. The system based factors included using telephone calls to connect with patient,
transitioning between inpatient and outpatient settings, palliative care and low socioeconomic
status. To resolve transition issue, the study suggested employing steps like proper discharge
planning, medical reconciliation, advanced care planning and delivering patient education. For
issues related to lack of resource due to poor SES, the study recommended initiating immediate
cardiology consultation for this group of patients. The limitation of this study is that it was not
any experimental study that confirmed the findings; instead it was a synthesis of many research
evidence. However, the utility of the paper is that it can provide guidance regarding the strategies
that can be taken by the nurse to prevent readmission of John post discharge.
Salahodinkolah, M. K., Ganji, J., Moghadam, S. H., Shafipour, V., Jafari, H., & Salari, S. (2020).
Educational intervention for improving self-care behaviors in patients with heart failure: A

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narrative review. Journal of Nursing and Midwifery Sciences, 7(1), 60.
DOI: 10.4103/JNMS.JNMS_19_19
The main purpose of this systematic review was to review educational interventions for
improving self-care behaviors in patient with heart disease. The main rationale for investigating
on this topic is that heart failure is a chronic disorder that adversely affects interpersonal and
social relationships of patients. Most of the patients reduce their physical activity levels and
engage in poor self-care. Thus, educational interventions have the potential to promote self-care
behaviors. To validate the same hypothesis, the searches for articles were done in various
databases like ProQuest, Springer and many others. Only articles published from 2000 to 2018
were included in the review and total seventy one articles were included. These studies mainly
covered four types of educational interventions such as face-to-face teach back method, group
training, e-learning and home visit with follow-up. The main conclusion from the evaluation of
these education interventions was that educational intervention is effective in management of
self-care. This study also gave the implication for nurses to consider the different educational
needs of patients according to their culture and level of literacy. The strength of the study is that
it revealed the benefits of various teaching methods. However, one limitation of the narrative
review is that it did not conduct quality assessment of papers, which would have given better
idea about validity and credibility of the findings.
Part 2:
The first article chosen for this review was the study by Jiang et al. (2018) which is
relevant to the case study as John was suffering from distressing shortness of breath and his
deteriorating symptoms may affect his psychological health too. Thus, meeting mental health

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need of John is crucial because it may double the risk of adverse events; impair his self-care
ability and quality of life (Tully et al., 2014). His current symptoms of breathlessness suggest
that he is showing signs of relapse and worsening heart failure. As currently he is suffering from
worsening symptoms, he is in need psychological interventions too apart from core treatments.
The strength of the study in relation to the case study is that it shows how interventions like
cognitive behavioural therapy, motivation interviewing, stress management and supportive
counselling could enhance his coping skills and help him to confidently deal with worsening
symptoms. Coping skills can enhance quality of life and improve disease biomarkers (Sherwood
et al., 2017). The systematic review revealed that psychological intervention can improve self-
care behaviour of CHF patients. Thus, the key benefit of this article is that it signifies why self-
care should be prioritised for John too. Promoting self-care behaviour would help to maintain
healthy functioning and well-being for John (Sedlar et al., 2017). Another rationale for including
this study is that it used systematic review design to confirm the clinical benefit of psychological
intervention on patient with CHF. As systematic review comes under top level in evidence
hierarchy, it is an indication of the quality of the study. By supporting similar results with
numerous studies, the paper confirms the validity of the findings (Murad et al., 2016).
The article chosen to manage the condition of John was the study by Ryan, Bierle and
Vuckovic (2019) which reported about factors that should be considered to prevent readmission
of heart failure patients. John was experiencing worsening of heart failure symptoms and the
article contributed to the case study by differential between discharge teachings for expected
symptoms vs worsening symptoms. The study emphasized on the need for continous discharge
education for heart failure patient by discussing and educating on topics like disease progression,
self-monitoring measures like daily weight tracking, dietary education, activity and exercise and

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medication. The study suggested maintaining the self-management cycle by reviewing current
treatment plan with patient, reassessing if plan of care will meet patient needs and reeducate
patient regarding any changes. The study covered other important clinical, psychosocial and
system based factors for preventing heart failure readmissions. These suggestion are
comprehensive to give detailed information on ways to clinically manage the condition of John
This is relevant with the case study because John’s relapse of symptoms occurred due to poor
self-management and disease education. His weight is a proof for the same. Carbone et al. (2019)
supports that obesity or overweight is a condition that increases risk of heart failure and coronary
heart disease. Moreover, the significance of weight monitoring is that it can help in timely
detection of weight gain issues and implementing adequate treatment at the right time (Wang et
al., 2014). With the use of this resource, John’s is likely to have better confidence in engaging in
self-care behaviors.
The third article by Salahodinkolah et al. (2020) was chosen as it discussed about the role
of educational intervention for improving self-care behaviours. John was in need of self-care
education because he had history of hypertension, weight gain issues and ischaemic
cardiomyopathy, which may further aggravate his condition. Moreover, his worsening symptoms
of breathlessness can lead to poor blood pressure control and poor compliance with foods (Oh &
Cho, 2020). Thus, the article contributes to the case study by showing how self-care education
can decrease symptoms and complaints of patient. Another rationale for choosing this article in
the context of the case study was that it was a narrative review and the findings of narrative
review are likely to be reliable as they represent findings from various research studies reporting
on similar problems (Greenhalgh et al., 2016).The study will help in the clinical management of
John because it discussed about benefits of various educational interventions like face-to-face

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training, educational writing and home visits. By exploring cultural and health literacy needs of
John, this study can guide nurse regarding what types of educational intervention can be most
successful in improving their self-care behaviours. For example, teach back method is the best
strategy as it can improve physical, social and emotional aspects of CHF management. Barnason
et al. (2017) supports that face-to-face education is a form of therapeutic educational
interventions that is likely to provide maximum benefits and prevent avoidable complications for
patient. The strength of the selected paper is that it suggests the need to consider the cultural
factor of patient while developing educational intervention. A culturally appropriate intervention
can reduce barrier to interpretation of message in patient coming from minority or non-English
speaking backgrounds (Howie-Esquivel et al., 2014).
Part 3:
Based on the analysis of the three papers in the context of management of John, it can be
concluded that psychological intervention, educational intervention for self-care and
reassessment of patient care needs even post discharge are the best strategies to minimize
worsening symptoms of patients like John and prevent remission of symptoms. These
combination of the interventions suggested in the three studies are likely to improve both
physical health as well as mental and emotional health of patients with CHF. The final lesson
that is learnt from these paper is that when dealing with CHF patient in the future, it will be
crucial for nurse to maintain continuity of care even after discharge. To prevent remission of
symptoms, it is recommended that all nurses and health professionals adhere to cyclical self-
management step of review, reassess and reeducate. This step will provide nurse guidance
regarding facilitating successful transition of CHF patient from home to hospital (Ryan et al.,
2019). Moreover, taking cues from the findings of Salahodinkolah et al. (2020), it is

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recommended that educational intervention along with long-term follow should be incorporate in
routine care of CHF patient so that continuity of care is maintained and unavoidable
complications are prevented. Furthermore, based on the review of psychological intervention, it
is recommended that health care professionals take training on psychological interventions like
motivational counselling too so that they focus on mental well-being of patients with CHF too
(Jiang et al., 2020; Liguori et al., 2018).

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References:
Barnason, S., White-Williams, C., Rossi, L. P., Centeno, M., Crabbe, D. L., Lee, K. S., ... & Wood, K.
(2017). Evidence for therapeutic patient education interventions to promote cardiovascular
patient self-management: A scientific statement for healthcare professionals from the American
Heart Association. Circulation: Cardiovascular Quality and Outcomes, 10(6), e000025.
Carbone, S., Canada, J. M., Billingsley, H. E., Siddiqui, M. S., Elagizi, A., & Lavie, C. J. (2019).
Obesity paradox in cardiovascular disease: where do we stand?. Vascular health and risk
management, 15, 89–100. https://doi.org/10.2147/VHRM.S168946
Greenhalgh, T., Raftery, J., Hanney, S., & Glover, M. (2016). Research impact: a narrative review. BMC
medicine, 14(1), 78.
Howie-Esquivel, J., Bibbins-Domingo, K., Clark, R., Evangelista, L., & Dracup, K. (2014). A Culturally
Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart
Failure: A Pilot Randomized Controlled Trial. Cardiology research, 5(3-4), 91–100.
https://doi.org/10.14740/cr346w
Jiang, Y., Shorey, S., Seah, B., Chan, W. X., San Tam, W. W., & Wang, W. (2018). The effectiveness of
psychological interventions on self-care, psychological and health outcomes in patients with
chronic heart failure—A systematic review and meta-analysis. International journal of nursing
studies, 78, 16-25. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2017.08.006
Liguori, I., Russo, G., Curcio, F., Sasso, G., Della-Morte, D., Gargiulo, G., Pirozzi, F., Cacciatore, F.,
Bonaduce, D., Abete, P., & Testa, G. (2018). Depression and chronic heart failure in the elderly:

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an intriguing relationship. Journal of geriatric cardiology : JGC, 15(6), 451–459.
https://doi.org/10.11909/j.issn.1671-5411.2018.06.014
Murad, M. H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid. BMJ Evidence-
Based Medicine, 21(4), 125-127.
Oh, G. C., & Cho, H. J. (2020). Blood pressure and heart failure. Clinical Hypertension, 26(1), 1.
Ryan, C. J., Bierle, R., & 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/10.4037/ccn2019345
Salahodinkolah, M. K., Ganji, J., Moghadam, S. H., Shafipour, V., Jafari, H., & Salari, S. (2020).
Educational intervention for improving self-care behaviors in patients with heart failure: A
narrative review. Journal of Nursing and Midwifery Sciences, 7(1), 60.
DOI: 10.4103/JNMS.JNMS_19_19
Sedlar, N., Lainscak, M., Mårtensson, J., Strömberg, A., Jaarsma, T., & Farkas, J. (2017). Factors
related to self-care behaviours in heart failure: A systematic review of European Heart Failure
Self-Care Behaviour Scale studies. European Journal of Cardiovascular Nursing, 16(4), 272-
282.
Sherwood, A., Blumenthal, J. A., Koch, G. G., Hoffman, B. M., Watkins, L. L., Smith, P. J., ... &
Chang, P. P. (2017). Effects of coping skills training on quality of life, disease biomarkers, and
clinical outcomes in patients with heart failure: a randomized clinical trial. Circulation: Heart
Failure, 10(1), e003410.

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Tully, P. J., Wittert, G., Selkow, T., & Baumeister, H. (2014). The real world mental health needs of
heart failure patients are not reflected by the depression randomized controlled trial
evidence. PloS one, 9(1), e85928. https://doi.org/10.1371/journal.pone.0085928
Wang, X. H., Qiu, J. B., Pang, J., Ju, Y., Xu, Y., Zhao, X., Wei, W., & Miao, J. (2014). Establishment of
a Weight Management Scale for Patients with Congestive Heart Failure. Acta Cardiologica
Sinica, 30(1), 74–81.