Investigation On The Self-care Behavior And Study On Nursing Intervention Effect Among Elderly Patients With Chronic Heart Failure

BackgroundChronic heart failure is a poor prognosis disease,it is the main health care expenditure of the developed and developing countries.A recent survey of Canada found that chronic heart failure affected the survival of 1-2%of the population, cardiac function in patients with classⅢ-Ⅳmedical expenses each year was up to 1.4-2.3 billion.The medical costs of CHF are even higher in the United States.At present,heart failure currently affects approximately five million people in the United States,with more than 550,000 new cases diagnosed annually.2030 may be expected to rise to 1000 million patients.The main factors of CHF growth are the aging and a variety of risk factors increasing,about 80%of CHF patients are over the age of 65.Epidemiological survey showed that Chinese CHF prevalence was 0.9%,CHF hospitalization rates accounted for 20%of cardiovascular disease,the mortality rate accounted for 40%.A high incidence of CHF has become a major public health problem.Due to symptoms,it caused frequent hospital admission.55% of patients readmission after 3 - 6 months discharged from hospital.However,Most of the time patients live in the community.So strengthening of community nursing intervention in patients with CHF,lower hospitalization rates in patients with readmission,improving quality of life of patients have become a hot research at home and abroad.Many developed countries pay great attention to community-based nursing intervention because of the low-input and high out-output of preventive health care measures.Some countries have formed a more perfect and advanced community health service system,which can supply continuous care for discharged CHF patients. A large number of foreign research and practice have proved that management of CHF patients after discharge from hospital can significantly reduce the relapse rate, re-admission rate,the number of re-admission,mortality and other resource consumption.China's community care is still in its infancy stage,many areas of the country have community health service organization,but it is far from perfect and doesn't provide an effective extended care services for discharged patients, community groups(especially the elderly) are poor awareness of hygiene.High risk groups with chronic diseases such as high blood pressure,coronary heart disease, CHF et al.are lack of necessary understanding of the risk factors on their own,lack of the danger of chronic disease and sufficient awareness of complications,particularly poorly understand CHF.If it does not be prevented actively and are simply taken by the disease after treatment,it is vulnerable to form the society,family and personal burden.Therefore,the functions of nursing must continue to expand,its services must be gradually shifted from hospital to the community.China is meeting in an unprecedented wave of giant aging population.Predicte to 2040,the total number of Chinese elderly will reach 397 million people,more than the sum of the current population of France,Germany,Italy,Japan and the United Kingdom.How to develop community-based chronic disease care to deal with the wave of aging has become a major task for the community care workers. The subject planned to use advanced experience from abrod,tried to investigate on status quo of self-care in patients with CHF,then provided community care intervention and continuity care for CHF patients who discharged from hospital,we registered for discharged elderly CHF patient to provide convenient,timely, effective and continuous care services.The purpose is to reduce the re-admission rate,the number of re-admission,mortality,and improve self-care ability,hoping to explore community care model which is suitable for Chinese national conditions.ObjectiveTo know the status quo of self-care in patients with CHF,and compare the effects of nurse-led community intervention focused on self-care management problems versus usual care among elderly patients with CHF.MethodsThe first step,select 97 cases at Aug.- Oct.2007 in the top three hospital in Guangzhou,selected criteria:adults 18 years of age or older;according with the clinic evaluation standard of the cardiovascular Branch of Chinese medical association,agree to take this study.Exclusion criteria were cognitive impairment that prevented interaction with the nurse and terminal illness of brain,liver,lung et al.We translate the English version of European Heart Failure Self-Care Behavior Scale(EHFScBS) into Chinese,and test the reliability and validity of the Chinese version of EHFScBS.The second step,a total of 87 patents with CHF were investigated on self-care behavior on Oct.-Des.2007,Researchers distributed a questionnaire to patients,if patients are illiterate or unable to fill it,the researchers completed the questionnaire by verbal report,completed questionnaires were taken back on the spot,Researchers checked whether the questionnaire were all filled,if missing item were found,the patient were asked to add immediately.A total of 87 questionnaires were all taken back. The third step,select 150 cases at Jan-Apr.2008 in the top three hospital in Guangzhou,patients were asked to participate in the study at discharge when the patients should in a stable condition,selected criteria:according with the clinic evaluation standard of cardiovascular Branch of Chinese medical association,adults 60 years of age or older,New York Heart Association classificationⅡorⅢ,without difficulties to understand and speak in Putonghua or Cantonese,can contact with the patient by telephone,informed consent by patients and their family member. Ineligible were patients:with dementia or other significant mental diseases,with communication problems,with malignant or other severe diseases affect morbidity with a life expectancy of less than six months,participating in another clinical trial. Patients were also excluded if they were being discharged from the hospital to another institution or long-term.We enrolled 150 hospitalized patients aged 60 years or over with chronic heart failure who discharged from hospital,they were randomly assigned into intervention group(n=72) and control group(n=78) using random number table for six months follow up.Intervention group were given health education on medication adherence,weight myself everyday,sports and maintenance of a healthy life style et al.through a face to face interview and regularly scheduled follow-up telephone calls by trained nurses,while control group patients were not. Demographic data including age,gender,caregiver,number of medications,New York Heart Association classification et al were gathered before the patient at discharge.Data were obtained through reviewing the hospitalization notes, telephone calls and outpatient visits.Compared patients with re-hospitalization rate, mortality rate,re-hospitalization days,number of re-hospitalization and the Chinese version of EHFScBS score between the two groups.The data were analyzed by SPSS13.0,using descriptive analyses,Cronbach's Alpha coefficient,2 independent samples tests,principal components/factor analysis,Chi-square test,Mann Whitney test et al.There was statistical significance according to the P≤0.05 in all results.ResultsThe Chinese version of EHFScBS was accepted well by the patients.Analysis of reliability the Chinese version showed that Cronbach's Alpha coefficient was 0.72. The principal component analysis produce 5 factors if the eigenvalue was greater than 1,which could account for 65.34 percent of the total variance,and every item was more satisfied with the load factor(≥0.4) in the corresponding factor.The investigation found:as high as 81.6%of patients don't agree weighing themselves every day,the percentage of contacting doctor of nurse because of short of breath,shortness of breath increases,feet/legs become more swollen than usual and experiencing increased fatigue was 62.0%,43.6%,22.9%and 27.5%.65,5%of patients agreed to eat a low salt diet.83.7%of the patients took medication as prescribed 37.9%of the patients got a flu shot every year,and 77.2%of them had exercises regularly.The scores of patients with different history of the disease (F=4.806,P=0.011) and classification of cardiac function(F=3.361,P=0.023) were significantly different,patients with different ages(F=0.389,P=0.697)and qualifications(F=0.627,P=0.645) were had a similar score.At sixth months,the re-admission rates were significantly different(41.2 vs. 58.1%in control subjects,χ~2=4.064,P=0.044,Chi-square test).But the average number of re-admissions tended to lower in the intervention group(0.52±0.74 vs. 0.90±0.891 in control group,t=2.691,P=0.008,Mann Whitney test),Intervention group subjects had less average number of readmission days(5.64±8.64 0 vs. 15.04±20.27 in control subjects,Z=-2.881,P=0.004,Mann Whitney test),Intervention group subjects had lower scores in the Chinese version European Heart Failure Self-Care Behavior Scale(26.15±7.29 vs.32.97±8.45 in control subjects, t=3.357,P=0.001,two-sample t-test),and it was no difference in mortality. ConclusionAn acceptable property of the Chinese version of EHFScBS was indicated. EHFScBS could be used as positive aspects measurement of Chinese heart failure for further clinical study.The Chinese version of EHFScBS was accepted,it had a good reliability and validity,it can be used to evaluate the existent insufficiency in the self caring behavior of the chronic heart failure patients and identify the point which the patients need to help.It also provides evidence for nursing intervention.The level of self-care behavior of elder CHF patients remains low,we need do some intervention such as to help patients learning more about medical knowledge, regular follow-up,to encourage families to participate in et al so that they improve their self-care behavior.Community post-discharge nursing intervention was effective in improving self-care behavior and reducing the number of unplanned readmissions for heart failure patients in community.The study provides a number of the original date on self-care activities for elderly patients with CHF.The limitations of this study are to survey only inpatients, most of the elderly CHF patients recuperate in the community,thus the patients in community also should be paid more attention.The intervention lasted 6 months, although the re-hospitalization rate decreased significantly,we didn't find a decline in mortality.So intervention efforts should be intensified and extended the time to intervene in order to explore the intervention effect.