The Journal of cardiovascular nursing
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Randomized Controlled Trial
The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients.
: Heart failure (HF) patients experience frequent episodes of decompensation. While medication and behavior change play a major role in maintaining physiological stability, patient adherence to self-care recommendations is not optimal. The Theory of Heart Failure Self-care helped to understand the concepts of self-care and chose a model of intervention. Conviction and confidence are central factors in facilitating self-care. Motivational interviewing (MI), which aims to strengthen conviction and confidence, has been shown to improve self-care. In addition, the Transtheoretical Model, based on patients' readiness to change, also has proven efficacy. The MI based on the stages of change (MISC), a combination of MI and Transtheoretical Model, offers promise for improving self-care. The goal of this pilot study was to evaluate the preliminary effect of an MISC intervention on HF patients' self-care behaviors. ⋯ : Significant results were obtained regarding the confidence in performing self-care behaviors specific to HF (P =.005). Although the results of the other hypotheses were not statistically significant, for the majority, trends were in the expected direction in favor of the EG. The study suggests that an MISC intervention is useful to increase patients' confidence in HF self-care and has potential to improve self-care. Further research is needed.
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Randomized Controlled Trial
Motivating people to learn cardiopulmonary resuscitation and use of automated external defibrillators.
The purpose of this study was to test the effect of a motivational message on the intention of laypersons to learn cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. A pretest-posttest, double-blind, randomized design was used with 220 community-dwelling adults. Participants were randomly assigned to the treatment group reading the CPR and AED pamphlet emphasizing learning CPR and AED use to save someone they love and the 3-minute window for response time; or to the comparison group reading the identical pamphlet without the 2 motivational statements. ⋯ Significantly more treatment participants than comparison participants planned to routinely look for AEDs in public areas after reading the pamphlet, however. Teaching critical facts such as the low survival rate for out-of-hospital cardiac arrest might encourage laypersons to learn CPR and AED use. Routinely teaching family members of people at risk for a cardiac arrest about the short window of time in which CPR and AED use must begin and encouraging them to learn about CPR and AEDs to save someone they love may encourage family members to identify the location of AEDs in public places.
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Review
Psychological distress in patients diagnosed with atrial fibrillation: the state of the science.
Atrial fibrillation (AF) is a life-complicating illness adversely affecting morbidity, health-related quality of life (HRQOL), and healthcare use. Studies using HRQOL instruments suggest that patients diagnosed with AF experience more psychological distress than do healthy controls. Psychological distress in forms of anxiety and depression in patients with heart failure or coronary artery disease is related to increased mortality, morbidity, and consumption of healthcare. ⋯ Lack of conceptual clarity and diversity of study purposes, designs, participants, and instruments limit the ability to draw coherent conclusions from findings. Nevertheless, findings suggest that psychological distress is present in a substantial portion of patients diagnosed with AF and its presence is related to adverse outcomes. Further study to identify the prevalence, characteristics, and consequences of psychological distress in patients diagnosed with AF is required to extend our knowledge and provide a foundation for development of interventions to address psychological distress in this rapidly increasing population.
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Review Comparative Study
Measuring self-care in chronic heart failure: a review of the psychometric properties of clinical instruments.
Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care. ⋯ Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.
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Multicenter Study
Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients.
Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. ⋯ Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.