Perceived social support and self-care in patients hospitalized with heart failure.

BACKGROUND: Rehospitalization of heart failure patients is often considered the result of inadequate self-care yet only one study documents superior outcomes with better self-care. AIMS: If inadequate self-care is related to hospitalizations, then hospitalized heart failure patients should have lower self-care skills than non-hospitalized patients. The purpose of this study was to evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure. The self-care of heart failure index (SCHFI) and medical outcomes study of social support (MOS-SS) were the key instruments used in the research. METHODS AND RESULTS: This descriptive study used t tests and multiple regression to analyze the data. Results were compared with non-hospitalized heart failure patients in another study. Perceived social support ( t=-4.007, df=211, P<0.001) and self-care maintenance ( t=-3.343, df=220, P<0.002) scores were lower in the hospitalized participants than the comparison group. Self-care confidence was the only variable significantly related to perceived social support ( ß=0.210, t=2.210, P<0.30). CONCLUSIONS: This study supports the premise that heart failure rehospitalizations are related to inadequate self-care.

Timing is everything: results to an observational study of mealtime insulin practices.

PURPOSE: The purpose of this study was to evaluate the timing and practices of blood glucose testing and rapid-acting insulin administration around mealtimes. DESIGN: This study used an observational, descriptive design to assess the time between blood glucose testing and insulin administration and the time between first bite of the meal and insulin administration. SETTING: The setting was 4 cardiology units in 2 hospitals within a large community healthcare system. SAMPLE: Sixty-four mealtime practice events at breakfast, lunch, and supper were observed. METHODS: Investigators directly observed the timing of rapid-acting insulin administration at 3 mealtime periods an assessed timing of blood glucose testing, food intake, and method of glucose reporting. RESULTS: Overall, 14% (n = 64) of the patients received blood glucose testing within 1 hour prior to insulin administration and insulin administration within 15 minutes of the meal. As separate elements, blood glucose testing was done within the defined ideal range 35% (n = 63) of the time, and insulin was administered within range 40% (n = 58) of the time. CONCLUSIONS: Timing for meals, blood glucose testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various patient caregivers with low achievement of ideal practices. IMPLICATIONS: Results to this study revealed opportunities for better coordination of mealtime insulin practices. Lack of coordination can lead to medication errors and adverse drug events. Further study should include effect of mealtime coordination on glycemic control outcomes and testing the effect of interventions on timing of mealtime insulin practices.

Assessment of an educational intervention on nurses' knowledge and retention of heart failure self-care principles and the Teach Back method.

BACKGROUND: Nurses must have optimum knowledge of heart failure self-care principles to adequately prepare patients for self-care at home. However, study findings demonstrate that nurses have knowledge deficits in self-care concepts for heart failure. METHODS: A quasi-experimental, repeated measures design was used to assess nurses' knowledge of heart failure self-care before, immediately after, and 3-months following an educational intervention, which also included the Teach Back method. Follow-up reinforcement was provided after the educational intervention. RESULTS: One hundred fifty nurses participated in the study. Significant differences were found between pre-test (65.1%) and post-test (80.6%) scores (p < 0.001). Teach Back proficiency was achieved by 98.3%. Only 61 participants completed the 3-month assessment of knowledge. In this group, mean knowledge scores increased significantly across all three measurements (p < 0.001): 66.5% (pre-test); 82.1% (post-test); 89.5% (follow up post-test). CONCLUSIONS: Participation in a comprehensive educational program resulted in increased nurses' knowledge of heart failure self-care principles and the knowledge was sustained and increased over time.

Clinical nurse specialist assessment of nurses' knowledge of heart failure.

PURPOSE/OBJECTIVE: Patients' self-management of heart failure (HF) is associated with improved adherence and reduced readmissions. Nurses' knowledge about self-management of HF may influence their ability to adequately perform discharge education. Inadequate nurse knowledge may lead to insufficient patient education, and insufficient education may decrease patients' ability to perform self-management. Prior to developing interventions to improve patient education, clinical nurse specialists should assess nurses' knowledge of HF. The purpose of this study was to determine nurses' knowledge of HF self-management principles. DESIGN: This was a prospective, exploratory, and descriptive online test. SETTINGS: There were 3 patient care settings: tertiary care teaching hospital, community hospital, and home healthcare division. SAMPLE: The sample was composed of 90 registered nurses who worked directly with patients with HF. METHODS: Nurses completed an online test of knowledge using the Nurses' Knowledge of Heart Failure Education Principles instrument. FINDINGS: Registered nurses (n = 90) completed the knowledge test instrument; their average score was 71% (SD, 10.8%) (range, 20%-90%). The percentage of correct items on each subscale ranged from 63.9% (SD, 30.0) for medications to 83.3% (SD, 25.0) for exercise. Only 8.9% of respondents achieved a passing score of greater than 85%, and a passing score was not associated with any demographic characteristics. CONCLUSIONS: Overall, nursing knowledge of HF self-management principles was low. Scores from our nurses were similar to those found in other studies. IMPLICATIONS: There is a need to develop interventions to improve nursing knowledge of HF self-management principles. Clinical nurse specialists can be instrumental in developing knowledge interventions for nurses.

Hyponatremia caused by polydipsia.

Hyponatremia (serum sodium <135 mEq/L) is the most common electrolyte disorder. The severity of symptoms is related to how rapidly the condition develops and the degree of cerebral edema that results from the low serum level of sodium. Hypertonic saline and the new vasopressin receptor antagonists are highly effective treatments for severe symptomatic hyponatremia, yet they can result in severe neurological complications if sodium levels are restored too quickly. Hyponatremia is classified as hypovolemic, euvolemic, and hypervolemic. Treatments include administration of high-risk medications and fluid restriction to restore fluid and electrolyte balance and relieve cerebral effects. Nursing care to ensure safe outcomes involves multidisciplinary collaboration, close monitoring of serum sodium levels and intake and output, and assessment for neurological changes.