Résumé:
1Petra Schäfer-Keller, PhD RN; 1Gabrielle Santos, MScN; 1Josepha Pasche, MScN; 1Marie-Elise Verga MScN; 2Denis Graf MD; 3Prof. Anna Strömberg, PhD RN; 4Prof. David A. Richards, PhD RN
1School of health sciences Fribourg Heds-FR - University of applied sciences and arts western Switzerland HES-SO
2Cardiology, cantonal hospital Fribourg, Switzerland
3Department of medical and health sciences, Linköping University, Sweden
4University of Exeter medical school, United Kingdom;
Introduction: Heart failure (HF) self-care is vital for improving quality of live and reducing morbidity and mortality. Although the Medical Research Council (MRC) provides guidance for the development of complex interventions, little has been reported on the development of self-care support interventions.
Purpose: Following MRC recommendations, we aimed to design a feasibility- and pilot-testable prototype intervention to support HF self-care for nurse-facilitated multidisciplinary structured follow-up.
Method: Three sub-studies were conducted to define the problem and determine the needs within our context. Firstly, via focus group discussions (16 nurses, 3 physicians; median professional experience: 19 years (Q1-Q3: 11-27 years)), we explored health care professionals’ perceived barriers to HF care. Secondly, in 310 patients with HF (female: 37.4%; mean age: 76.8y; NYHA III: 55%), we examined patients’ self-care levels, vulnerability profiles, and symptom experience, as well as these variables’ associations with past hospitalizations. Thirdly, we surveyed and assessed HF nurses’ (N=59) patient self-care education practices. To design and operationalize the intervention, we considered our needs assessment results, the evidence-based self-care support literature and the European Society of Cardiology guidelines for HF patient self-care education.
Results: In Study 1, physicians and nurses reported important barriers to patient-centred care but felt a strong need to provide it; in Study 2, patients reported a high prevalence of inadequate self-care on virtually all relevant items, with the majority showing important vulnerability characteristics and symptom burden. Finally, Study 3 indicated that nurse-provided patient education rarely addressed individuals’ self-care levels or symptom experience. The intervention’s operationalization allowed formulation of a self-care support algorithm that uses patients’ vulnerability factors and self-care maintenance, management and confidence data to help set self-care support priorities. Relevance to the prognosis (e.g., adherence, physical activity support), as well as each patient’s preferences, confidence levels and/or self-care capabilities, guided prioritization of self-care maintenance activities. Self-care management levels determine the support required to ensure appropriate countermeasures if symptoms are experienced.
Conclusion: We developed an evidence-informed prototype intervention for patients with HF that considers our local context to operationalize self-care support. In a guideline-type format, it uses an algorithm structure similar to treatment guidelines to evaluate each patient’s assessment data and any vulnerability characteristics relevant to self-care and allows the provision of tailored support. Feasibility and piloting will finalize this intervention for a definitive trial to test its effects on quality of life, morbidity and mortality in individuals with HF.
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