A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Despite effective treatment, it is characterized by frequent recurrences. Optimal therapeutic management of AF requires active participation and self-management from patients. Two major components of self-management are self-monitoring and sign-and-symptom management. Pulse self-palpation (PSP) is a method of self-monitoring; however, not all AF patients are capable of successfully performing PSP. Due to a lack of interventions on this topic, a nurse-led intervention for patients with AF (PSPAF intervention) was developed to foster self-monitoring and to enhance self-management through PSP. The purpose of this pilot study was to test the acceptability, feasibility, and potential effects of this intervention on the capability of patients' PSP and sign-and-symptom management. Moreover, we aimed at gathering data on the feasibility of applied research methods to aid in the design of future studies.; The pilot trial involved 20 adult patients with AF, randomized to an intervention or usual care group. At baseline and during a home visit 3-5 weeks later, we collected data using questionnaires, checklists, field notes, a mobile ECG device, and a diary. Acceptability and feasibility measures were validated through predefined cut-off points. Effect size estimates were expressed as relative risks (RR) and the number needed to treat (NNT).; The PSPAF intervention seemed feasible, but only partly acceptable. There were limitations in terms of potential effectiveness, suitability, addressing participants' willingness to implement its content in daily life, and adherence. Estimations of effect sizes suggest a large effect of the intervention on patients' PSP capability (RR = 6.0; 95% CI = [0.83, 43.3]; NNT = 2.4), but almost no effect on sign-and-symptom management (RR = 1.5; 95% CI = [0.7, 3.1]; NNT = 4.0). The feasibility of applied research methods showed minor limitations on recruitment and participant burden.; Despite some limitations, the intervention seemed to be applicable and promising. Taking into account the suggestions and amendments we have made, we recommend conducting a full-scale trial to examine the efficacy of the PSPAF intervention.; This pilot study was registered in the German Clinical Trials Register at September 4, 2017 (Main ID: DRKS00012808)

Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients

Family witnessed resuscitation - experience and attitudes of German intensive care nurses.

To explore German intensive care nurses' experiences and attitudes toward family witnessed resuscitation (FWR). The subject of FWR has fuelled much controversy among health professionals. Typically studies involving European critical and cardiac nurses' under-represent the perspective of individual countries. Arguably research exploring the experiences and attitudes of nurses by country may expand understanding and embrace cultural values. Descriptive survey. Three hundred and ninety-four German intensive care nurses attending a conference were invited to complete a 36-item questionnaire on their experiences and attitudes towards FWR. Participants were also invited to share, in writing, other thoughts relevant to the study. Data was analysed using descriptive statistics. A total of 166 (42.1%) questionnaires were returned completed. Seventy participants had experiences with family members being present and for 46 (65.7%) these were negative. Participants (68%) did not agree that family members should have the option to be with loved ones during resuscitation. Over half (56.0%) were concerned that family presence may adversely influence staff performance during resuscitation procedures. There was a lack of certainty about the outcomes of the practice, although 61% agreed that family presence could facilitate better understanding among relatives. Qualitative responses where characterized by four broad themes relating to individualized decision-making, supporting families, threats of violence and family involvement. German intensive care nurses have guarded attitudes towards FWR because of their experiences and concerns for the well-being of relatives and staff. Introducing this topic within nursing curricula, as part of resuscitation training and by wider professional debate will help challenge and resolve practitioner concerns and objections. Health professionals have anxieties about possible consequences of FWR, strategies involving education and simulation training may improve attitudes

A study to investigate the impact of an education and counselling program on self-care and care dependency in patients with heart failure

Eine mangelnde Selbstpflege bei Patienten mit chronischer Herzinsuffizienz (CHI) kann zu Pflegeabhängigkeit und Rehospitalisierung führen. Patientenschulungen zur Förderung der Selbstpflege sind in der Lage, die Selbstpflege zu fördern, krankheitsspezifische Symptome zu reduzieren und die Lebensqualität zu steigern. Für Deutschland liegen Untersuchungen hinsichtlich der Auswirkungen von Patientenschulung auf zahlreichen Outcomeparameter vor, jedoch wurde noch nicht untersucht, welche Auswirkung eine im akutstationären Bereich durchgeführt Patientenschulung auf krankheitsspezifische Selbstpflege und Pflegeabhängigkeit hat. Ziel der Arbeit war, folgende Fragestellung zu beantworten: (1) Wie reliabel und valide ist die deutsche Version der 9-Item European Heart Failure Self-care Behaviour Scale (G9-EHFScBS)? (2) Wie pflegeabhängig sind hospitalisierte Patienten mit CHI? (3) Welche Auswirkung hat eine Patientenschulung zur Förderung der Selbstpflege bei CHI Patienten auf Selbstpflege, Pflegeabhängigkeit und Lebensqualität? Methodik: (Ad 1) Querschnittsstudie mit 109 Patienten. Daten zur Selbstpflege wurden mittels G9-EHFScBS erhoben und analysiert. Überprüft wurden Strukturvalidität (exploratorische Faktorenanalyse, diskriminante und konkurrente Validität mittels „known goups“-Ansatz), interne Konsistenz und Test-Retest Reliabilität. (Ad 2) Sekundärdatenanalyse von fünf Querschnittsstudien zur Erfassung von pflegesensitiven Outcomeparametern. Der Grad der Pflegeabhängigkeit von Patienten mit CHI wurde deskriptiv ausgewertet. (Ad 3) Randomisiert-kontrollierte Studie mit 110 Patienten. Patienten in der Interventionsgruppe erhielten eine einstündige Schulung zur Förderung der Selbstpflege, Patienten in der Kontrollgruppe erhielten keine Intervention. Outcomeparameter waren Selbstpflege, Pflegeabhängigkeit und Lebensqualität. Effekt der Schulung wurde mittels Varianzanalyse mit Messwiederholung ermittelt. Ergebnisse: (Ad 1) Es ergeben sich erste Hinweise auf vorhandene Validität und Reliabilität der G9-EHFScBS. Items laden auf 3 Faktoren. Interne Konsistenz ist mit einem Alpha von 0,71 ausreichend. Das Instrument ist in der Lage zwischen geschulten und nicht-geschulten Patienten zu unterscheiden und misst ein anderes Konstrukt als krankheitsspezifische Lebensqualität. (Ad 2) Hospitalisierte Patienten mit CHI können überwiegend als pflegeunabhängig betrachtet werden. Items, bei denen der höchste Grad der Einschränkung gemessen wurde, waren Mobilität, Körperpflege, An- und Auskleiden, Kontinenz, Gefahren vermeiden und Alltagsaktivitäten. (Ad 3) Es zeigt sich ein signifikanter Zeit-Intervention-Effekt auf Selbstpflege (F(1/108)=4,174; p=0,043; η2=0,037), allerdings nicht auf die Pflegeabhängigkeit (F(1/106)=.175; p=0,676; η2=.002) und Lebensqualität (F(1/108)=1.638; p=0,203; η2=.0015). Schlussfolgerung: Die Ergebnisse geben Hinweise, dass mit der G9-EHFScBS ein valides und reliables Instrument zur Messung der Selbstpflege vorliegt. Eine einstündige Schulung zur Förderung der Selbstpflege bei Patienten mit CHI ist in der Lage ist, die krankheitsspezifische Selbstpflege, jedoch nicht den Grad der Pflegeabhängigkeit und die Lebensqualität positiv zu beeinflussen. Unklar bleibt, inwieweit Veränderungen der krankheitsspezifischen Selbstpflege Auswirkungen auf den Grad der Pflegeabhängigkeit und die Lebensqualität haben.Patients with chronic heart failure (CHF) with a lack of self-care behaviors risk care dependency and re-hospitalization. Patient education sessions improve self-care behaviors, reduce CHF symptoms and increase quality of life (QoL). Research in Germany has demonstrated the effect of patient education on different outcome parameters. However, the effect of patient education on disease-related self-care behaviors and care dependency in acute care settings has not been evaluated yet. This work aimed to address the following questions: (1) How reliable and valid is the German version of the 9-item European Heart Failure Self-care Behavior Scale (G9-EHFScBS)? (2) What is the degree of care dependency in hospitalized CHF patients? (3) What is the effect of self-care education in CHF patients on self-care, care dependency and QoL? Method: (Ad 1) Cross-sectional study of 109 patients. Self-care was measured using the G9-EHFScBS. Structural validity using exploratory factor analysis, discriminant validity and concurrent validity with “known groups”, internal consistency and test-retest reliability were assessed. (Ad 2) Secondary data analysis of five cross-sectional studies assessing nursing sensitive outcomes. Descriptive statistics evaluated the degree of care dependency in CHF patients. (Ad 3) Randomized-controlled trial of 110 patients. Patients in the intervention group participated in a one-hour disease-related self-care education session. Patients in the control group had no intervention. Outcome variables included self-care behavior, degree of care dependency and QoL. The education session’s effects were assessed using variance analysis with repeated measurement. Results: (Ad 1) Data reveal preliminary evidence on validity and reliability of the G9-EHFScBS. Items are loading on three factors. Internal consistency is fair (Cronbach´s alpha = 0,71). The instrument can discriminate patients with and without heart failure self-care specific education. The G9-EHFScBS does not correlate with an instrument measuring QoL. (Ad 2) Most hospitalized CHF patients are care-independent. Items showing the highest level of care dependency are mobility, hygiene, dressing, continence, avoidance of danger and daily activities. (Ad 3) There is a significant time-intervention-effect on self-care (F(1/108)=4,174; p=0,043; η2=0,037), but not on care dependency (F(1/106)=.175; p=0,676; η2=.002) and QoL (F(1/108)=1.638; p=0,203; η2=.0015). Conclusions: Results of the studies demonstrate the G9-EHFScBS to be a valid and reliable instrument assessing self-care behaviors in CHF patients. Also, a one-hour education session on disease-related self-care behaviors in CHF patients significantly effects self-care behaviors. However, no effect on care dependency and QoL was found. The extent to which disease-related self-care influences care dependency and QoL remains unclear

Methodological quality of studies assessing validity and reliability of the European Heart Failure Self-care Behaviour Scale : a systematic review using the COSMIN methodology

Aims The European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology. Methods and results To identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality. Conclusion Although the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS

Additional file 1: of Health care professionals’ attitudes regarding palliative care for patients with chronic heart failure: an interview study

Title of data: Interview Guide PaCa-HF Study. Description of data: Interview guide developed for the study and used as basis for each interview of the study. (DOCX 39 kb

Additional file 2: of Health care professionals’ attitudes regarding palliative care for patients with chronic heart failure: an interview study

Title of data: Coding scheme. Description of data: Coding scheme derived from the interviews according to Mayrings’ Qualitative Data Analysis. (DOCX 43 kb