Abstract
Background
The ESC guidelines on management of patients with heart failure support a multidisciplinary management program including intensive patient teaching and follow-up care. However, adequate information of patients with heart failure on their disease by the treating physician is often limited due to time restrictions.
Aim
This study evaluated the short and long-term impact of a structured education program by a qualified heart failure nurse on the patient's understanding of his disease and adherence to therapy.
Methods
95 consecutive patients (67 male, mean age 66±11 years) hospitalized for heart failure symptoms were included in a structured education program. Each patient underwent an individual one hour teaching program by a qualified heart failure nurse who used structed teaching material. Patients were requested to respond to a questionnaire consisting of 15 questions 1 day before and 1 day after the teaching course as well as at a 6 months follow-up. The questionnaire included the nine questions of the European Heart Failure Self-Care Behaviour Scale (EHFSCB9-Scale) as well as 6 questions on the patient's knowledge about his disease. For each question the patient had to respond to a scale ranging from 1 point (complete disagreement) to 5 points (complete agreement). 6 months follow-up data were obtained by physicians providing the outpatients care and implemented into a password protected software offering all patient data within the local network consisting of the hospital and 4 regional outpatient cardiologists.
Results
Total self-care behavior and disease knowledge score improved from 48.3±10.1 points before teaching to 64.0±9.9 points after teaching (p<0.001). Before teaching there were significant differences in the scores of individual questions ranging from 2.40±1.36 points on understanding of the own disease to 4.71±0.80 points on complete adherence to the medication protocol. After teaching there was a more homogenous score levels. Greatest gains on individual question scores could be obtained on “the patients understanding of the causes of his disease” (1.52±1.38 points), “the feeling of being completely informed about the disease” (1.44±1.23 points) and “daily weight control” (1.73±1.58 points). At 6-months follow-up total self-care behavior and disease knowledge score was 59.2±13.2 points (p=0.231 to immediately after teaching) in the 67% of patients with complete follow-up. In a logistic regression analyses no parameter could be defined which predicted a low knowledge score before teaching or an insufficient teaching effect.
Conclusions
A qualified nurse education program significantly improves self-care behavior and disease knowledge. The effect persists at 6 months follow-up. Improvements can be obtained in particular with regards to patients understanding of his disease causes and daily weight control. There are no patient characteristics which obviate the need for teaching or predict a low teaching effect.
Acknowledgement/Funding
Deutsche Stiftung für chronisch Kranke
Development of a self-care simulation education program for older patients with heart failure