Davis Karen K, Himmelfarb Cheryl R Dennison, Szanton Sarah L, Hayat Matthew J, Allen Jerilyn K
Karen K. Davis, PhD, RN Director of Nursing/Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland. Cheryl R. Dennison Himmelfarb, PhD, ANP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Sarah L. Szanton, PhD, CRNP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Matthew J. Hayat, PhD Assistant Professor, College of Nursing, Rutgers University, Newark, New Jersey. Jerilyn K. Allen, ScD, RN, FAAN M. Adelaide Nutting Professor and Associate Dean for Research, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
J Cardiovasc Nurs. 2015 Mar-Apr;30(2):152-60. doi: 10.1097/JCN.0000000000000130.
Heart failure (HF) is associated with cognitive impairment, which could negatively affect a patient's abilities to carry out self-care, potentially resulting in higher hospital readmission rates. Factors associated with self-care in patients experiencing mild cognitive impairment (MCI) are not known.
This descriptive correlation study aimed to assess levels of HF self-care and knowledge and to determine the predictors of self-care in HF patients who screen positive for MCI.
The Montreal Cognitive Assessment was used to screen for MCI. In 125 patients with MCI hospitalized with HF, self-care (Self-care of Heart Failure Index) and HF knowledge (Dutch Heart Failure Knowledge Scale) were assessed. We used multiple regression analysis to test a model of variables hypothesized to predict self-care maintenance, management, and confidence.
Mean (SD) HF knowledge scores (11.24 [1.84]) were above the level considered to be adequate (defined as >10). Mean (SD) scores for self-care maintenance (63.57 [19.12]), management (68.35 [20.24]), and confidence (64.99 [16.06]) were consistent with inadequate self-care (defined as scores <70). In multivariate analysis, HF knowledge, race, greater disease severity, and social support explained 22% of the variance in self-care maintenance (P < .001); age, education level, and greater disease severity explained 19% of the variance in self-care management (P < .001); and younger age and higher social support explained 20% of the variance in self-care confidence scores (P < .001). Blacks, on average, scored significantly lower in self-care maintenance (P = .03).
In this sample, patients who screened positive for MCI, on average, had adequate HF knowledge yet inadequate self-care scores. These models show the influence of modifiable and nonmodifiable predictors for patients who screened positive for MCI across the domains of self-care. Health professionals should consider screening for MCI and identifying interventions that address HF knowledge and social support. Further research is needed to explain the racial differences in self-care.
心力衰竭（HF）与认知障碍相关，这可能会对患者的自我护理能力产生负面影响，进而可能导致更高的住院再入院率。目前尚不清楚与轻度认知障碍（MCI）患者自我护理相关的因素。
这项描述性相关性研究旨在评估HF自我护理和知识水平，并确定MCI筛查呈阳性的HF患者自我护理的预测因素。
使用蒙特利尔认知评估量表筛查MCI。对125例因HF住院的MCI患者的自我护理（心力衰竭自我护理指数）和HF知识（荷兰心力衰竭知识量表）进行评估。我们使用多元回归分析来检验一个假设模型，该模型包含假设可预测自我护理维持、管理和信心的变量。
HF知识平均（标准差）得分（11.24 [1.84]）高于被认为足够的水平（定义为>10）。自我护理维持（63.57 [19.12]）、管理（68.35 [20.24]）和信心（64.99 [16.06]）的平均（标准差）得分与自我护理不足（定义为得分<70）一致。在多变量分析中，HF知识、种族、疾病严重程度增加和社会支持解释了自我护理维持中变异的22%（P <.001）；年龄、教育水平和疾病严重程度增加解释了自我护理管理中变异的19%（P <.001）；年龄较小和社会支持较高解释了自我护理信心得分中变异的20%（P <.001）。平均而言，黑人在自我护理维持方面的得分显著较低（P =.03）。
在这个样本中，MCI筛查呈阳性的患者平均有足够的HF知识，但自我护理得分不足。这些模型显示了可改变和不可改变的预测因素对MCI筛查呈阳性的患者在自我护理各领域的影响。卫生专业人员应考虑筛查MCI并确定针对HF知识和社会支持的干预措施。需要进一步研究来解释自我护理方面的种族差异。
