The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Int J Nurs Stud. 2022 Aug;132:104255. doi: 10.1016/j.ijnurstu.2022.104255. Epub 2022 Apr 20.
Insufficient self-care behaviors, low self-efficacy, depression, and poor illness perceptions are obstacles to the management of people with heart failure, leading to adverse patient outcomes. Self-care interventions are strategies used to support individuals in self-care. Currently, evidence on the effects of nurse-led self-care interventions on self-care behaviors and the correlates (self-efficacy, depression, and illness perceptions) in people with heart failure is scarce.
This review aims to systematically synthesize current evidence to determine the effectiveness of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure and identify the optimal characteristics of effective nurse-led heart failure self-care programs.
MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and PsycINFO were electrically searched for relevant articles from the inception to December 2021. Randomized controlled trials examining the effects of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure published in the English language were included. The quality appraisal of included studies was performed using the revised Cochrane tool for assessment of the risk of bias in randomized controlled trials (RoB 2.0). The meta-analysis was conducted using statistical software R. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Twenty-four trials with 2488 participants were identified in this review. The results of our study revealed that nurse-led self-care interventions improved self-care maintenance (mean difference [MD]: 9.58, 95% confidence interval [CI]: 5.96 to 13.20, moderate certainty of evidence), self-care management (MD: 12.08, 95% CI: 8.05 to 16.11, high certainty of evidence), self-efficacy (standardized mean difference [SMD]: 0.98, 95% CI: 0.42 to 1.54, moderate certainty of evidence), and depression (SMD: 0.55, 95% CI: 0.34 to 0.77, high certainty of evidence) among people with heart failure. Moreover, subgroup analyses indicated that the ideal intervention duration to enhance self-care behaviors and self-efficacy was 1 to 3 months and to reduce depression was within 1 month.
This review revealed the beneficial effects of the nurse-led self-care interventions on self-care behaviors, self-efficacy, and depression among people with heart failure. The duration of the intervention is one of the factors that may affect the intervention effects. Further well-designed randomized controlled trials are recommended to strengthen the current evidence.
(PROSPERO): CRD42022299754.
自我护理行为不足、自我效能感低、抑郁和疾病认知不良是心力衰竭患者管理的障碍，导致患者预后不良。自我护理干预是支持个体自我护理的策略。目前，关于护士主导的自我护理干预对心力衰竭患者自我护理行为及相关因素（自我效能感、抑郁和疾病认知）影响的证据很少。
本综述旨在系统综合现有证据，确定护士主导的自我护理干预对心力衰竭患者自我护理行为、自我效能感、抑郁和疾病认知的有效性，并确定有效的护士主导的心力衰竭自我护理计划的最佳特征。
从建库至 2021 年 12 月，对 MEDLINE、Embase、Web of Science、CENTRAL、CINAHL 和 PsycINFO 进行电子检索，以获取有关心力衰竭患者中护士主导的自我护理干预对自我护理行为、自我效能感、抑郁和疾病认知影响的相关文章。纳入了以英语发表的评估护士主导的自我护理干预对心力衰竭患者自我护理行为、自我效能感、抑郁和疾病认知影响的随机对照试验。使用修订后的 Cochrane 工具（RoB 2.0）评估纳入研究的偏倚风险。使用统计软件 R 进行荟萃分析。使用推荐评估、制定与评价（GRADE）方法对证据的确定性进行评级。
本综述共纳入 24 项试验，共 2488 名参与者。我们的研究结果表明，护士主导的自我护理干预可改善自我护理维持（均数差 [MD]：9.58，95%置信区间 [CI]：5.96 至 13.20，中等确定性证据）、自我护理管理（MD：12.08，95%CI：8.05 至 16.11，高确定性证据）、自我效能感（标准化均数差 [SMD]：0.98，95%CI：0.42 至 1.54，中等确定性证据）和抑郁（SMD：0.55，95%CI：0.34 至 0.77，高确定性证据）。此外，亚组分析表明，增强自我护理行为和自我效能感的理想干预持续时间为 1 至 3 个月，降低抑郁的理想干预持续时间为 1 个月内。
本综述揭示了护士主导的自我护理干预对心力衰竭患者自我护理行为、自我效能感和抑郁的有益影响。干预持续时间是可能影响干预效果的因素之一。建议进一步开展设计良好的随机对照试验，以加强现有证据。
（PROSPERO）：CRD42022299754。
