瑞典和荷兰心力衰竭诊所中护士与患者之间预后沟通的相关变量。

Variables Related to Communication About Prognosis Between Nurses and Patients at Heart Failure Clinics in Sweden and the Netherlands.

作者信息

van der Wal Martje H L, Hjelmfors Lisa, Mårtensson Jan, Friedrichsen Maria, Strömberg Anna, Jaarsma Tiny

机构信息

Martje H.L. van der Wal, PhD, RN Senior Researcher, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden; and Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands. Lisa Hjelmfors PhD Student, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden. Jan Mårtensson, PhD, RN Professor, School of Health and Welfare, Jönköping University, Sweden. Maria Friedrichsen, PhD, RN Associate Professor, Faculty of Medical and Health Sciences, Linköping University; and Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden. Anna Strömberg, PhD, RN Professor, Division of Nursing Science Departments of Medical and Health Science and Cardiology, Linköping University, Linköping, Sweden; and UCI Program in Nursing Science, University of California, Irvine. Tiny Jaarsma, PhD, RN Professor, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden; and UCI Program in Nursing Science, University of California, Irvine; and Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.

出版信息

J Cardiovasc Nurs. 2018 Mar/Apr;33(2):E1-E6. doi: 10.1097/JCN.0000000000000416.

DOI:10.1097/JCN.0000000000000416

PMID:28481827

Abstract

BACKGROUND

In contrast to recommendations in recent guidelines, prognosis is not optimally discussed with patients with heart failure (HF). Reasons for not doing so can be related to both patient and provider characteristics.

PURPOSE

The purpose of the study was to explore which patient- and nurse-related variables influence discussing prognosis with patients at an HF clinic.

METHOD

Data from a previous survey on attitudes and clinical practice of HF nurses on discussing prognosis that was conducted in Sweden and the Netherlands were combined with data from a registration on topics that nurses discussed with their patients during a prespecified week at the HF clinic. Multivariable logistic regression analysis was performed to assess which variables are related to discussing prognosis.

RESULTS

A total of 275 HF nurses (mean age, 49 years) and data of 1633 patients with HF (mean age, 71 years) were included in the study. Prognosis was discussed with 42% of all patients during the visit at the HF clinic. Patients with whom prognosis was discussed were more often in New York Heart Association classes III to IV (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.44-2.26). Nurses discussing prognosis reported more knowledge on the topic (OR, 1.71; 95% CI, 1.36-2.16) and discussed more topics with the patient (OR, 1.27; 95% CI, 1.21-1.32). Dutch HF nurses were more likely to discuss prognosis compared with their Swedish colleagues (OR, 1.83; 95% CI, 1.43-2.33).

CONCLUSIONS

Discussing prognosis with patients with HF by nurses at the HF clinic is related to the characteristics of patients and HF nurses. Future interventions to improve communications about prognosis therefore should have a broad approach.

摘要

背景

与近期指南中的建议相反，心力衰竭（HF）患者并未得到关于预后的最佳讨论。不这样做的原因可能与患者和医护人员的特征都有关。

目的

本研究的目的是探讨哪些与患者和护士相关的变量会影响在HF诊所与患者讨论预后。

方法

将先前在瑞典和荷兰进行的一项关于HF护士对讨论预后的态度和临床实践的调查数据，与护士在HF诊所预先指定的一周内与患者讨论的主题登记数据相结合。进行多变量逻辑回归分析以评估哪些变量与讨论预后相关。

结果

该研究共纳入了275名HF护士（平均年龄49岁）和1633名HF患者的数据（平均年龄71岁）。在HF诊所就诊期间，42%的患者接受了预后讨论。接受预后讨论的患者更常处于纽约心脏协会III至IV级（优势比[OR]，1.81；95%置信区间[CI]，1.44 - 2.26）。讨论预后的护士报告对该主题有更多了解（OR，1.71；95%CI，1.36 - 2.16），并且与患者讨论的主题更多（OR，1.27；95%CI，1.21 - 1.32）。与瑞典同事相比，荷兰的HF护士更有可能讨论预后（OR，1.83；95%CI，1.43 - 2.33）。