Self-Efficacy and Educational Interventions in Heart Failure: A review of the Literature

Purpose: The purpose of this study was to conduct a systematic review of the literature to better understand how to structure educational interventions for heart failure patients to improve their self-efficacy for self-care behaviors. Methods: A computer search of the literature from 1966 through May 2009 was conducted, yielding 84 manuscripts. All manuscripts were reviewed in relation to the search criteria, resulting in 12 articles that were evaluated. Results: Each of the reviewed studies utilized an intervention plus education to improve self-efficacy. Self-efficacy was a primary outcome for seven of the studies, and a secondary outcome for five on the studies in this literature search. Both short and long-term interventions can improve self-efficacy demonstrating that the duration of the intervention can vary and still be successful. Conclusion: Existing evidence suggests that it is not the amount of education (number of sessions/length of sessions) that improves self-efficacy, but some other factor or factors that remain unknown at present. Education delivery costs, flexibility, and the ability to more easily integrate new discoveries need to be explored. Interventions that include components specifically geared toward increasing self-efficacy for self-care in patients with heart failure are needed. Learning activities need to be incorporated into patient education programs in order to provide practice time that may result in behavior changes. The opportunity to practice self-care behaviors within the context of the education provided to those with heart failure, along with ongoing support, needs to be explored in future studies

Heart Failure in Hispanic Americans: Improving Cultural Awareness

Hispanic Americans are the largest and fastest growing ethnic group in the United States. Hispanic Americans have high rates of heart failure (HF) risk factors, such as hypertension, diabetes mellitus, obesity, obstructive sleep disorders, and dyslipidemia. Certain unique HF risk factors prominent among Hispanic Americans are uncommon in the general population, such as younger onset of valvular disease and Chagas disease. Advanced practice nurses providing care to Hispanic Americans have an ethical obligation to provide culturally competent care and assist these patients in overcoming barriers to health care so that they can effectively manage their HF

Hypoplastic Left Heart Syndrome: Parent Support for Early Decision Making

Hypoplastic Left Heart Syndrome is a life threatening congenital cardiac anomaly. After a child has been diagnosed with hypoplastic left heart syndrome, parents must make life or death decisions within days of birth. Healthcare providers must provide appropriate education so that parents are able to make informed, timely decisions. Information regarding the diagnosis, treatment options, and parental decision making process for initial decision making for hypoplastic left heart syndrome are provided to guide nurses who work with these families. The challenging decision making process which parents must go through after diagnosis of hypoplastic left heart syndrome will be described. Rachel and Evan, a young couple expecting their first child, received unexpected and devastating news at the completion of a routine screening ultrasound at 20 weeks. The ultrasound revealed that their unborn son had a congenital heart defect. After further testing, the diagnosis of hypoplastic left heart syndrome (HLHS) was confirmed. Rachel and Evan received information about HLHS from several physicians, made an appointment with a pediatric cardiothoracic surgeon to discuss surgical options, and found information from pediatric hospitals and HLHS online support groups. Ultimately, Rachel and Evan had decisions to make. Four options were presented by the healthcare team, including (1) terminating the pregnancy immediately, (2) continuing with the pregnancy and proceeding with staged palliative surgical intervention in the first week of their son’s life, (3) continuing with the pregnancy with the hopes of a heart transplant in the first week of their son’s life, or (4) choosing comfort care after delivery, and allowing death to occur naturally, likely in the first week of life. The time frame for option one was urgent because of abortion laws in their state and the gestational age of the fetus. After several sleepless nights of reviewing information, statistics, options, and prognosis, they elected to continue with the pregnancy and give their son a chance at life

Impact of an Aging Simulation Game on Pharmacy Students’ Empathy for Older Adults

Objective. To evaluate changes in empathy and perceptions as well as game experiences among student pharmacists participating in an aging simulation game. Methods. First-year student pharmacists participated in an aging simulation game. Changes were measured pre/post-activity using the Kiersma-Chen Empathy Scale (KCES) and Jefferson Scale of Empathy – Health Professions Scale (JSE-HPS) for empathy and the Aging Simulation Experience Survey (ASES) for perceptions of older adults’ experiences and game experiences. Wilcoxon signed rank tests were used to determine changes. Results. One hundred fifty-six student pharmacists completed the instruments. Empathy using the KCES and JSE-HPS improved significantly. Of the 13 items in the ASES, 9 significantly improved. Conclusion. Simulation games may help students overcome challenges demonstrating empathy and positive attitudes toward elderly patients. Read More: http://www.ajpe.org/doi/abs/10.5688/ajpe7956

Psychometric Testing of the Self-Care of Hypertension Inventory

Background: Hypertension (HTN) is a global public health issue. Self-care is an essential component of HTN treatment, but no instruments are available with which to measure self-care of HTN. Objectives: The purpose of this study is to test the psychometric properties of the Self-care of Hypertension Inventory (SC-HI). Methods: Using the Self-care of Chronic Illness theory, we developed a 24-item measure of maintenance, monitoring, and management appropriate for persons with chronic HTN, tested it for content validity, and then tested it in a convenience sample of 193 adults. Exploratory factor analysis was used to identify measure structure. Cronbach\u27s α and factor determinacy scores and were used to assess reliability. Validity was tested with the Medical Outcomes Study General Adherence Scale and the Decision Making Competency Inventory. Results: Seventy percent of the sample was female; mean age was 56.4 ± 13 years; mean duration of HTN was 11 ± 9 years. Removal of 1 item on alcohol consumption resulted in a unidimensional self-care maintenance factor with acceptable structure and internal consistency (α = .83). A multidimensional self-care management factor included “consultative” and “autonomous” factors (factor determinacy score = 0.75). A unidimensional confidence factor captured confidence in and persistence with each aspect of self-care (α = .83). All the self-care dimensions in the final 23-item instrument were associated with treatment adherence and several with decision making. Conclusion: These findings support the conceptual basis of self-care in patients with HTN as a process of maintenance, monitoring, and management. The SC-HI confidence scale is promising as a measure of self-efficacy in self-care

A Qualitative Analysis of Coronary Heart Disease Patients’ Views of Dietary Adherence and of Web-Based and Mobile-Based Nutrition Tools

Purpose: Dietary adherence can be challenging for patients with coronary heart disease (CHD), as they may require multiple dietary changes. Choosing appropriate food items may be difficult or take extensive amounts of time without the aid of technology. The objective of this project was to (1) examine the dietary challenges faced by patients with CHD, (2) examine methods of coping with dietary challenges, (3) explore the feasibility of a web-based food decision support system, and (4) explore the feasibility of a mobile-based food decision support system. Methods: Food for the Heart (FFH), a website-based food decision support system, and Mobile Magic Lens (MML), a mobile-based system, were developed to aid in daily dietary choices. Three CHD patient focus groups were conducted and focused on CHD-associated dietary changes as well as the FFH and MML prototypes. A total of 20 CHD patients and 7 informal caregivers participated. Qualitative, content analysis was performed to find themes grounded in the responses. Results: Five predominant themes emerged: 1) decreasing carbohydrate intake and portion control are common dietary challenges, 2) clinician and social support makes dietary adherence easier, 3) FFH could make meal-planning and dietary adherence less complicated, 4) MML could save time and assist with healthy choices, and 5) additional features need to be added to make both tools more comprehensive. Conclusions: FFH and MML may be tools that CHD patients would value in making food choices and adhering to dietary recommendations, especially if additional features are added to assist patients with changes

The Integration of an Online Module on Student Learning

Heart failure is a prevalent and costly condition. Patients with better self-management are less likely to be rehospitalized. An online interactive heart failure module was developed and integrated into a medical-surgical nursing course to assist students in learning how to care for patients with heart failure. The purpose of this study was to examine whether the integration of an online heart failure module improved baccalaureate nursing students\u27 heart failure self-management knowledge. A pretest/posttest design was used to examine the effects of student knowledge of heart failure self-management following implementation of an online module. Among 235 students, significant improvement of heart failure self-management knowledge was observed (P \u3c .05). The mean posttest scores ranged from 13.82 to 15.93. Students had problems mastering knowledge of weight monitoring, use of nonsteroidal anti-inflammatory drugs, symptoms to report to physicians, and potassium-based salt substitutes. These findings were similar to four studies examining nurses\u27 knowledge of heart failure. Students and nurses have difficulty mastering similar heart failure education concepts. An additional strategy, such as simulated or case scenarios, needs to be developed to help nurses and nursing students master all key concepts of heart failure self-management

Relationship between standardized glycemic protocols and healthcare cost

Rising healthcare costs and the management of diabetes are financially straining to healthcare organizations. The study purpose was to examine whether a direct relationship existed between the cost of hospitalization, length of stay, excess admission days, and discharge blood glucose (DC-BG) levels and utilizing a standardized glycemic protocol. A retrospective cohort analysis was conducted of adult diabetes mellitus type 2 (DM-2) patients\u27 pre-diabetic protocol (January 1, 2011-December 31, 2011) and post-diabetic protocol (August 1, 2012-October 31, 2012). The sample included DM-2 inpatients aged ≥ 18 years admitted without complications and/or with abnormal fasting blood glucose. Pre-protocol sample comprised n = 346 subjects and post-protocol sample comprised n = 149 subjects. Patients who received the diabetic protocol in 2012 experienced a decrease in the DC-BG (p \u3c .05) and decrease in excess admission days (p \u3c .05). Evidence supports that utilizing a standardized glycemic protocol improves glycemic control and reduces healthcare cost

Assessment of the Impact of the Geriatric Medication Game© on Pharmacy Students’ Attitudes Toward Older Adults

Objective: To examine the impact of participation in the Geriatric Medication Game on pharmacy students’ (1) perceptions of and attitudes toward older adults and (2) familiarity with common disabilities and the process of seeking healthcare. Design: In the Game, first professional year students “became” older adults during a three hour pharmacy practice laboratory. They were given aging-related challenges (e.g., impaired vision or mobility) and participated as patients in simulated healthcare scenarios, such as a physician’s office and pharmacy. Assessment: After the Game, students completed a five question reflection about their experiences and attitudes towards older adults. Content analysis was performed to identify themes from four years of student (n=625) reflections. Predominant themes included: improved attitudes toward older adults, better understanding of patient experiences, and increased willingness to provide assistance. Conclusions: Incorporating The Geriatric Medication Game into the pharmacy curriculum may facilitate students’ understanding of the challenges older adults face and improve future interactions

Impact of the Geriatric Medication Game® on Nursing Students\u27 Empathy and Attitudes Toward Older Adults

BACKGROUND: Nurses should be well-prepared to improve and address health-related needs of older adults, but students may have difficulty understanding and empathizing, as they may not yet have personally experienced aging-related challenges. Simulation games can be used to help students understand the experiences of others, but limited information is available on the impact of simulation experiences on student empathy. OBJECTIVE: The objective of this study was to examine the impact of participation in an aging simulation game on nursing students\u27 empathy and attitudes toward older adults as well as their understanding of patients\u27 experiences in the healthcare system. DESIGN: This study used a quasi-experimental, pretest-posttest design. SETTING: A school of nursing in the Midwestern United States. PARTICIPANTS: The convenience sample included 58 sophomore-level baccalaureate nursing students. METHODS: Students played the role of an older adult during a 3-hour laboratory aging simulation game, the Geriatric Medication Game® (GMG). Students completed the (1) Kiersma-Chen Empathy Scale (KCES, 15 items, 7-point Likert-type), (2) Jefferson Scale of Empathy-Health Professions Students (JSE-HPS, 20 items, 7-point Likert-type), and (3) Aging Simulation Experience Survey (13 items, 7-point Likert-type) pre- and post-game to assess study objectives. Descriptive statistics and paired t-tests were performed in SPSS v.21.0, as the data were normally distributed. RESULTS: Students\u27 empathy (N=58) toward older adults significantly improved overall (KCES p=0.015, JSE-HPS p CONCLUSIONS: Students may not be aware of older adults\u27 feelings and experiences prior to experiencing aging-related changes themselves. Simulation activities, such as the GMG, can be a useful mechanism for addressing empathy and caring during student education