ABSTRACT
BACKGROUND: Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe. OBJECTIVE: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur). METHODS: Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis. RESULTS: Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic). CONCLUSIONS: Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.
Subject(s)
Caregivers , Heart Failure/therapy , Self Care , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
. Mixed methods designs: an innovative methodological approach for nursing research. The mixed method research designs (MM) combine qualitative and quantitative approaches in the research process, in a single study or series of studies. Their use can provide a wider understanding of multifaceted phenomena. This article presents a general overview of the structure and design of MM to spread this approach in the Italian nursing research community. The MM designs most commonly used in the nursing field are the convergent parallel design, the sequential explanatory design, the exploratory sequential design and the embedded design. For each method a research example is presented. The use of MM can be an added value to improve clinical practices as, through the integration of qualitative and quantitative methods, researchers can better assess complex phenomena typical of nursing.
Subject(s)
Nursing Research/methods , Research Design , Qualitative ResearchABSTRACT
BACKGROUND: Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care. OBJECTIVE: The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. DESIGN: A secondary analysis of data from a cross-sectional study. SETTING: Outpatient heart failure clinics in 28 Italian provinces. PARTICIPANTS: 628 Italian heart failure patients. METHODS: We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data. RESULTS: Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management. CONCLUSION: Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.
Subject(s)
Cognition , Heart Failure/psychology , Self Care/psychology , Aged , Cognition Disorders , Cross-Sectional Studies , Female , Humans , MaleABSTRACT
Delivering prescription drugs directly to patients at the moment of discharge from the hospital is a useful tool for ensuring continuity in patient drug use, improving prescriptive appropriateness, limiting pharmaceutical expenditure and analyzing pharmacoepidemiological data. A project was therefore conducted from April 2005 to January 2007, at the G. Rumino hospital in Benevento (Italy), to encourage the direct delivery of drugs to patients upon discharge. The project consisted of various phases. Firstly, the medical records of all patients discharged from the hospital during April 2005 were analysed, mainly to collect information regarding discharge prescriptions, verify whether copies of the discharge form and prescription records were present in the chart, the type of drugs prescribed and whether these were available in the hospital pharmacy list of available drugs and had been dispensed to the patient. The percentage of drugs not available and of patients who did not pick up the prescribed drugs was calculated, critical aspects of the prescription process were analysed, and corrective measures implemented. A second evaluation of medical records was then performed for patients discharged in January 2007, to evaluate the effectiveness of the corrective measures applied. Results show that most discharged patients continue not to take advantage of the direct distribution of drugs in hospital and more information and communication to physicians and patients regarding this opportunity is required.
