Bakgrund: I Sverige är det cirka 250 000 som lever med hjärtsvikt och sjukdomen fortsätter att öka i hela världen. Hjärtsvikt är ett kroniskt sjukdomstillstånd som idag inte går att bota och är förenad med morbiditet samt en för tidig död. Men genom god följsamhet till egenvård kan sjukdomen bli mer hanterbar. Syfte: Beskriva hjärtsviktspatienters upplevelser av sin egenvård.   Metod: Kvalitativ metod med deduktiv ansats har använts till litteratur-översikten. Totalt 10 stycken vetenskapliga artiklar granskats och analyserats enligt Fribergs femstegsmodell. Alla artiklar har kvalitetsgranskats.      Resultat: Två huvudteman tillsammans med tre subteman utformades. Huvudteman var resurser och stöd samt förstå information. Subteman blev socialt stöd och professionellt stöd samt patientutbildning. I resultatet beskrivs vikten av att patienter får individanpassad information som kan ges både muntligt och skriftligt om sin hjärtsvikt samt hur patienter upplever sin egenvård. Slutsats:  Information är en viktig källa till motivation och delaktighet i patienters egenvård. Patientutbildning från sjuksköterska samt stöd från familj och närstående ökar motivation till följsamhet till egenvård hos hjärtsviktspatienter. Kunskap och förståelse om patientens inre känslor för sin sjukdom är betydelsefull att ha när denna patientgrupp möts i samhället. Informationen bör ges individanpassat och gärna med stöd från närstående. / Background: In Sweden, there are approximately 250,000 living with heart failure and the disease continues to increase worldwide. Heart failure is a chronic disease condition that today cannot be cured and is associated with morbidity and premature death. But through good adherence to self-care, the disease can become more manageable. Aim: The purpose was to describe the experiences of heart failure patient’s self-care. Method: A qualitative method with a deductive approach has been used for the literature review. A total of 10 scientific articles were reviewed according to Friberg's five-step model. All articles have been quality checked.      Results: Two main themes together with three subthemes were designed. Main themes were resources and support as well as understanding information. Sub-themes became social support and professional support as well as patient education. The result describes the importance of patients receiving personalized information that can be given both orally and in writing about their heart failure as well as how patients experience their self-care. Conclusion: Information is an important source of motivation and participation in patients' self-care. Patient education from the nurse as well as support from family and close relatives increases motivation for adherence to self-care in heart failure patients. Knowledge and understanding of the patient's inner feelings for their illness are important to have when this patient group meets in the community. The information should be provided individually and preferably with the support of close relatives.

Numerous scholars have examined multiprocessors and techniques to decrease the heart failure readmission rate and to improve heart failure patient self-management. This project examined a new teaching method to create the experts' awareness of possible solutions to improve heart failure education in a small community hospital. The purpose of this project was the assessment of a new iPad heart failure patient pre-discharge education program video HFPDEV). Pender's health care model (PHM) served as a framework for this project. Five local nursing educator experts (master prepared) were asked to view a new iPad HFPDEV. After reviewing the 15-minute iPad HFPDEV, the local experts were asked to evaluate the video by completing a Likert-type survey, which evaluated the content, process, design, time, and functionality of the iPad HFPDEV along with a section for comments and recommendations. Descriptive analysis was used to analyze the survey results. Four of the experts defined the content, process, design, and functionality of the iPad HFPDEV as 'excellent.' One defined the content, process, design, and functionality of the iPad HFPDEV as 'adequate.' All experts expressed recommendations to improve the IPad HFPDEV by doubling the iPad size with an enlargement of print for easy reading and erecting all teaching iPads on mobile stands. A future pilot project will evaluate the relationship of HF readmission rate to the iPad HFPDEV. Social change will occur when the organization provides HF patients with iPad HFPDEV that will increase HF self-management skills and decrease HF readmissions.

Congestive heart failure (CHF) is a progressive medical condition affecting more than 7 million people in the United States (US) with 700,000 new cases reported annually. More than half of those treated for CHF are readmitted at least once a year. The problem addressed by this quality improvement initiative was lack of adherence to low sodium diet (LSD) among CHF patients, knowledge and skill deficit, and excessive 30-day CHF readmissions. The health belief model and the self-care deficit theory guide nurses in acquiring the skills needed to teach LSD. Twelve months of data were selected from 93 CHF readmissions from a target population of 499 CHF admissions. Measures of central tendency were used to extract meaningful summaries between variables for patterns related to 30-day readmissions and to plan educational interventions to improve patient outcomes. The educational intervention focused on educating nurses to teach adult patients with CHF to adopt a LSD. Discharge teaching materials developed were standardized, customizable, evidence-based, and included opportunities for evaluation of patient understanding and reteaching as necessary. Analysis of variance was conducted to evaluate the difference between days to readmission and compliance with the patient education process, and no significant difference (p < .05) was found (F(3,89) = .314, p = .815). The implications of this project for social change include preparing nurses to teach patients to adopt a LSD, empowering CHF patients to improve health outcomes, and improving the financial outcomes related to CHF.

Cognitive impairment is commonly seen in the elderly population. It is unclear if cognitive deficit in heart failure (HF) patients is a primary factor for higher hospital readmission rates in this population. The Centers for Medicare and Medicaid Services have established strict guidelines for reimbursement on readmissions that occur within 30 days. It is imperative that organizations identify and rectify issues that impact readmissions. The aim of this project was to determine if there is a reduction in HF readmission after patients are screened for cognitive impairment. Orem's self-care model guided the project by providing a framework of inquiry regarding the impact of cognitive impairment on self-care deficits and the need for support for persons with heart failure. The project examined the hospital's 30-day readmission rate for the HF patients who received cognitive screening using a chi-square test; this analysis excluded HF patients who were not screened for cognitive impairment. Readmission rates for all patients during a 6-month period were examined. Two hundred sixty-eight patient records were reviewed; 48 patients were readmitted, and of those, 28 patients had completed the cognitive assessment, meeting the criteria for the project. The change in readmission rates was not significant (p = 0.196), suggesting that cognitive screening of patients is not associated with reduced readmission rates. Further research should examine the role of cognitive screening in addition to other resources on the 30-day readmission rate of HF patients. Social change will be improved as a result of the improved quality of life for HF patients and the reduced per-capita cost of health care in the United States.

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to a SNF. This project evaluated the effectiveness of this intervention using the Donabedian quality framework. The Donabedian quality framework consists of 3 concepts: structure, process, and outcome. Sources of evidence were obtained through the electronic medical record systems at both facilities. Total of 1,009 patients were seen by the cardiac APN from 2012 to 2016. Results showed a steady decline in readmissions from 47% to 6%. This supported the conclusion that collaboration between hospitals and SNFs post hospital discharge is essential to improve the management and readmissions of HF. Specialized APNs, such as the cardiac APN in this study, may be more effective in the management and coordination of care for a specific patient population. Implications of this successful collaboration include better working relationships between nonaffiliated health care facilities, improved patient care outcomes, decreased readmissions for HF patients, and an improved community health care system.

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this project. The research question explored whether a transition-of-care guideline would reduce hospital readmission for the HF population. The methodology used to develop the clinical practice guideline was derived from a synthesis of scholarly literature and evidence-based transitional care quality initiatives. Seven interdisciplinary experts involved in HF transition of care used the Appraisal of Guidelines Research and Evaluation II instrument (AGREE II) to assess the development of the practice guideline. The scores of 6 AGREE II domains were summed and scaled to obtain a percentage of the maximum possible score for each domain. Scores showed that the clinical practice guideline was rigorous, high quality, effective in improving transition of care, and has the potential to reduce HF readmission. Positive social changes resulting from this practice guideline include an improvement in patient outcomes, a reduction in readmission rates, and a reduction in the associated financial burden to the hospital.

Transitions of care is a model designed to ensure that patients have resources needed to assist them to care for themselves at home after hospital discharge, which helps to decrease preventable adverse events. For people with heart failure (HF) to transition home from the hospital successfully, specific education is needed that is individualized to the disease process, but most patients' educational needs after discharge are unmet. The purpose of this qualitative study, guided by the Meleis middle range theory of transition, was to explore the perspectives of people with HF about their educational needs in order to gather data that could inform better care practices for them once they are discharged from the hospital. Twelve participants with HF were interviewed post hospital discharge about their education experience at discharge and what they felt was needed for them to be successful in caring for themselves after discharge. Data were analyzed, and three themes emerged: discharge preparation, lifestyle changes, and transitions of care. Participants indicated that they had a positive experience with the education provided, that they had to make changes to their daily routines, and that the transition of care program was beneficial in helping them successfully care for themselves after discharge. Further studies should interview people of different ethnicities with HF, should include multiple sites in the study, and should extend the research to people with other illnesses to gain their perception of discharge education. Results contribute to positive social change because individuals with HF who know how to care for themselves at home will be able to improve their quality of life as they can effectively transition to home from the hospital setting.

Background: Chronic heart failure is caused by several cardiac conditions. Heart failure can consist of forward failure and/or backward failure, which can affect the right ventricle as well as the left. The main symptoms are fatigue, dyspnea, and oedema. Modern medical treatment has improved the prognosis. Physical activity increases muscle strength, enhances quality of life, and reduces the risk of hospitalisation. Nurses need to be perceptive towards the persons’ experiences to support their health and well-being. Aim: The aim of this study was to describe older persons’ experiences of living with chronic heart failure. Method: A qualitative literature-based study was used in which 13 qualitative articles were analysed. The results were interpreted to obtain new themes. Results: Three main themes were discovered: “To not recognize your own body”, “To find hope and meaning” and “To maintain self-care ability”. The first main theme consisted of two subthemes: “Fatigue leads to physical limitations” and “To feel despair and fear”. The second main theme consisted of three subthemes: “To continue living”, “Motivation to self-care” and “Desire for normality”. Two subthemes emerged from the third main theme: “To need support from family” and “The importance of information and a person-centered care”. Conclusion: Chronic heart failure affected the persons’ lives mentally, physically, and socially.They felt alienated in terms of themselves and their bodies. Support from family and friends,and person-centered information provided by the nurse, had an important role concerning selfcare.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18191号 / 社医博第52号 / 新制||社医||8(附属図書館) / 31049 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 佐藤 俊哉, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19606号 / 医博第4113号 / 新制||医||1015(附属図書館) / 32642 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 YOUSSEFIAN Shohab, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM