慢性心力衰竭患者接受教育支持干预后的健康状况和自我护理结果
Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure.
作者信息
Clark Angela P, McDougall Graham, Riegel Barbara, Joiner-Rogers Glenda, Innerarity Sheri, Meraviglia Martha, Delville Carol, Davila Ashley
机构信息
Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin.
出版信息
J Cardiovasc Nurs. 2015 Jul-Aug;30(4 Suppl 1):S3-13. doi: 10.1097/JCN.0000000000000169.
BACKGROUND
The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination.
OBJECTIVE
The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention.
METHODS
This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study.
RESULTS
The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale).
CONCLUSIONS
An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
背景
心力衰竭（HF）护理住院费用的不断上涨要求采用干预模式来促进自我护理成功的教育。记忆增强策略对改善自我护理和学习的有效性需要进一步研究。
目的
本研究的目的是检验在家庭环境中实施的教育支持干预的效果，该干预采用了改善Ⅰ至Ⅲ级HF成人/老年人健康状况和自我护理的策略。我们的次要目的是探讨参与者对该干预的主观感受。
方法
本研究采用随机两组设计。50人参与研究9个月，并在4个时间点进行测试——基线；经过3个月的教育支持干预后；6个月时，经过3个月的电话/电子邮件支持后；以及9个月时，经过3个月无接触期后。由高级实践注册护士实施干预。记忆增强方法被纳入干预的教材和实施过程中。我们测量了干预对健康状况结果（功能状态、自我效能感、生活质量、情绪状态/抑郁症状和元记忆）和自我护理结果（知识/知识保留、自我护理能力）的有效性。在研究结束时，受试者对干预的有用性进行了评估。
结果
样本的平均年龄为62.4岁，女性参与者略占多数。参与者受教育程度较高，患有其他合并症，包括糖尿病（48%）和意外程度的肥胖。干预组在功能状态、自我效能感和生活质量（堪萨斯城心肌病问卷）；元记忆变化和能力子量表（成人元记忆问卷）；自我护理知识（HF知识测试）；以及自我护理（心力衰竭自我护理指数）方面有显著改善。两组参与者的抑郁评分（老年抑郁量表）均有所改善。
结论
由高级实践注册护士实施的家庭干预在多个健康状况和自我护理结果方面取得了成功，包括功能状态、自我效能感、生活质量、元记忆、自我护理状态和HF知识。
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