1203NRS, Trimester 2, 2019: Impact of Self-Care in Heart Failure

This report examines the impact of self-care and family support on the management of heart failure (HF). It begins by outlining the dysfunction in the cardiovascular system caused by insufficient oxygen supply, highlighting that adequate patient education on self-care significantly reduces HF symptoms and readmission rates. The report emphasizes the importance of clinical practices that incorporate family support to address issues like social isolation and depression, ultimately improving self-care behaviors and medication adherence. The report then critically appraises several studies, noting limitations such as uneven group distributions, small sample sizes, and challenges in program implementation. It concludes with recommendations for practice, education, research, and policy, emphasizing the need for comprehensive approaches that consider both individual patient needs and the crucial role of family involvement in HF management. The report references several research articles, including those by Deek et al. (2017), Moon, Yim & Jeon (2018), and Odom et al. (2017), to support its findings and recommendations.

The Impact of Self-Care and Family Support in Managing
Heart Failure
Name
Institution
Outline
1. HF Management
2. Findings from Evidence
3. Critical Appraisal
4. Limitation of Findings
5. Recommendations
Heart Failure Management
Recommendations
HF is a dysfunction in cardiovascular system created by insufficiency in oxygen
supply (Deek et al., 2017)
Patients who receive adequate education on self-care experience reduced HF
symptoms and readmission rates. Clinical practice that emphasize on family
support can address issues such as social isolation & depression. Support
further improves self-care behavior and medication adherence (Moon, Yim &
Jeon, 2018).
• practice needs to incorporate family
educational sessions with telephone self-
management program.
Clinical
practice
• HF patients require additional support
from family and nurses to mitigate
readmission.
Education
• There is need to expand research to cover
wider patient population groups.Research
Critical Appraisal:
Level 1LOE
Study by Lim et al., (2018) is a
secondary analysis of a
randomized control and the
highest level of evidence.
Systematic review of 120 RCT
studies and hence, a level I
LOE.
Meta analysis of 20 RCT studies
(Jonkman et al., 2016) and
hence, a first level of evidence.
Toukhsati et al., (2019) conduct
a meta-analysis of RCT studies
on self-care interventions with a
first level of evidence.
Critical Appraisal:
Level II LOE
Deek et al., conducted the first
RCT that involved family in HF
management.
Moon, Yim & Jeon (2018) have a
RCT involving self-management
education program is a second
level of evidence.
RCT study and level II in LOE
(Odom et al., 2017).
Draacup et al., study is a Level II
RCT to guide nursing care.Education of self-care management among families reduce the risk of
readmission to the hospital (Deek et al., 2017).
Multidisciplinary disease management including personalized
education and regular assessment is effective HF intervention in both
exercise and non-exercise based treatments (Lim et al., 2018).
Telephone based self-management program produces better
treatment outcomes for HF patients (Moon, Yim & Jeon, 2018).
Self-management education program that includes self-care behavior
improves quality of life in HF patients (Abbasi, Ghezeljeh & Farahani,
2018).
Self-management interventions has beneficial effect on HF
hospitalization. According to these findings it also reduces mortality
and increase QOL (Jonkman et al., 2016).
Self-care interventions improve patient-self care and reduce hospital
readmissions although with variable efficacy according to findings by
Toukhsati et al., (2019)
Evidence by Odom et al., (2017) reveals that family focused
intervention reduces social isolation and vulnerability to poor self-
care.
Family focused supportive intervention is an effective method to
improve self-care behaviors in HF patients as indicated from study
by Shariari et al., (2014).
Face to face education sessions for family and patients reduces
cardiac mortality and hospitalization according to Drascup et al.,
(2014).
Limitations of Findings
Distribution of groups was unevenly distributed in the first RCT by Deek et
al., (2017).
Study by Lim et al., (2018) was performed in a small population while
patients with limited mobility were not included.
Difficult to implement programs proposed by Moon, Yim & Jeon (2018) in
areas with limited communication channels.
Fourth study failed to investigate the impact of depression and social
support in the education program.
Odom et al., (2017) fails to integrate the varying caregiving situations
such as distress and burden.
Evidence limited to studies indexed in PubMed and CINAHL.

References
• Abbasi, A., Ghezeljeh, T. N., & Farahani, M. A. (2018). Effect of the Self-Management Education Program on the Quality of Life
in People with Chronic Heart Failure: A Randomized Control Trial. Electronic Physician, 10(7), 7028-7037. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092147/
• Deek, H., Chang, S., Newton, P. J., Noureddine, S., Inglis, S. C., Arab, G. A., . . . Davidson, P. M. (2017). An Evaluation of
Involving Family Caregivers in the Self-Care of Heart Failure Patients on Hospital Readmission: Randomised Controlled Trial
(the FAMILY study). International Journal of Nursing Studies, 75, 101-111. doi:10.1016/j.ijnurstu.2017.07.015
• Dracup, K., Moser, D. K., Pelter, M. M., Nesbitt, T. S., Southard, J., Paul, M. S., & Cooper, L. S. (2014). Randomized Controlled
Trial to Improve Self-Care in Patients with Heart Failure Living in Rural Areas. Circulation, 130(3), 256-264. Retrieved from
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.003542
• Jonkman, N. H., Westland, H., Groenwold, R. H., Agren, S., Atienza, F., Blue, P., & Kimm, F. K. (2016). Do Self-Management
Interventions Work in Patients with Heart Failure? Circulation, 133(12), 1189-1198. Retrieved from https
://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.018006
• Liu, M., Wang, C., Tung, T., Kuo, L., & Chiou, A. (2018). Effects of a Multidisciplinary Disease Management Programme with or
without Exercise Training for Heart Failure Patients: Secondary Analysis of a Randomized Controlled Trial. International
Journal of Nursing Studies, 87, 94-102. doi:10.1016/j.ijnurstu.2018.06.010
• Moon, M. K., Yim, J., & Jeon, M. Y. (2018). The Effect of a Telephone-Based Self-Management Program led by Nurses on Self-
Care Behaviour, Biological Index for Cardiac Function, and Depression in Ambulatory Heart Failure Patients. Asian Nursing
Research, 12(4), 251-257. doi:10.1016/j.anr.2018.10.001
• Odom, J. N., Hooker, S. A., Bekelman, D., Ejem, D., McGhan, G., Kitko, L., … Bakitas, M. A. (2017). Family Caregiving for
Persons with Heart Failure at the Intersection of Heart Failure and Palliative Care: A State-of-the-Science Review. Heart
Failure Review, 22(5), 543-557. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544594/
• Shahriari, M., Ahmadi, M., Babaee, S., Mehrabi, T., & Sadeghi, M. (2014). Effects of a Family Support Program on Self-Care
Behaviors in Patients with Congestive Heart Failure. Iranian Journal of Nursing and Midwifery Research, 18(2), 152-157.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748572/
• Toukhsati, S. R., Jaarsma, T., Babu, A. S., Driscoll, A., & Hare, D. L. (2019). Self-Care Interventions that Reduce Hospital
Readmissions in Patients with Heart Failure: Towards the Identification of Change Agents. Clinical Medicine Insights
Cardiology, 13(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563392/