| 1. |
|
|
| 2. |
|
|
| 3. |
- Jaarsma, Tiny, et al.
(författare)
-
Developing a supportive-educative program for patients with advanced heart failure within Orem's general theory of nursing
- 1998
-
Ingår i: Nursing Science Quarterly. - : SAGE Publications. - 0894-3184 .- 1552-7409. ; 11:2, s. 79-85
-
Tidskriftsartikel (refereegranskat)abstract
- Recovery from heart failure and coping with the effects of this serious condition has a major impact on the self-care demand of patients with heart failure. To prevent potential self-care deficits, education and support are important issues in nursing care. The purpose of this article is to describe the development of a supportive-educative program that is designed to enhance self-care abilities of patients with heart failure. To structure nursing care for these patients and their families in a consistent systematized way, Orem's general theory of nursing is used as a frame of reference.
|
|
| 4. |
- Jaarsma, Tiny, et al.
(författare)
-
Effects of education and support on self-care and resource utilization in patients with heart failure
- 1999
-
Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 20:9, s. 673-682
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure. METHODS: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'. The supportive educative intervention consisted of intensive, systematic and planned education by a study nurse about the consequences of heart failure in daily life, using a standard nursing care plan developed by the researchers for older patients with heart failure. Education and support took place during the hospital stay and at a home visit within a week of discharge. Data were collected on self-care abilities, self-care behaviour, readmissions, visits to the emergency heart centre and use of other health care resources. RESULTS: Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure. Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge, but the increase in the intervention group was significantly more after 1 month. Although self-care behaviour in both groups decreased during the following 8 months, the increase from baseline remained statistically significant in the intervention group, but not in the control group. No significant effects on resource utilization were found. CONCLUSIONS: Intensive, systematic, tailored and planned education and support by a nurse results in an increase in patients' self-care behaviour. No significant effects were found on use of health care resources. Additional organisational changes, such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support.
|
|
| 5. |
- Jaarsma, Tiny, et al.
(författare)
-
'Maintaining the balance'--nursing care of patients with chronic heart failure
- 1997
-
Ingår i: International Journal of Nursing Studies. - 0020-7489 .- 1873-491X. ; 34:3, s. 213-221
-
Tidskriftsartikel (refereegranskat)abstract
- Nurses in different settings are involved in caring for patients with heart failure. In the clinic, hospital, nursing home or patients' home, the nurse has a role in detecting, identifying and treating heart failure. In order to provide optimal care, literature on possible and effective interventions should be available to nurses. This study gives an overview of nursing care for patients with heart failure as described in practice, literature and standard nursing care plans. Based on interviews of 45 nurses, a review of all pertinent literature published between 1983 and 1993 and a review of standard nursing care plans used in the Netherlands to care for patients with heart failure, four composite themes emerged; namely, basic nursing care, assessment and observation, symptom-relieving interventions, and patient education. Caring for patients with heart failure is very complex and is often aimed at keeping a very delicate balance between, e.g. rest and activity, fluid intake and elimination, and therapeutic cost and benefit. Treatment strategies for optimizing care for these patients are described.
|
|
| 6. |
- Jaarsma, Tiny, et al.
(författare)
-
Quality of life in older patients with systolic and diastolic heart failure
- 1999
-
Ingår i: European Journal of Heart Failure. - 1388-9842 .- 1879-0844. ; 1:2, s. 151-160
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: To get insight into the quality of life of a clinical practice sample of patients with heart failure that are admitted to the hospital. Secondly to determine differences between patients with systolic and diastolic dysfunction and finally to describe factors relating to quality of life. METHODS: Three dimensions of quality of life (functional capabilities, symptoms and psychosocial adjustment to illness) were assessed during interviews of 186 patients with chronic heart failure. In addition, data on demographic, clinical and self-care characteristics were collected and patients completed a 6-min walk. RESULTS: On average patients walked 172 m in 6 min and reported functioning in daily life at a mean level of 4.5 MET. Patients experienced four different symptoms of heart failure. Most of them described dyspnea, fatigue, sleep disturbance and ankle oedema. Problems with psychosocial adaptation occurred mostly in social and vocational domains. Overall well-being of patients was rated as 6.4 on a 10-point scale. In regard to quality of life, the only differences between patients with systolic and diastolic heart failure was the occurrence of ankle oedema and health-care orientation. The variance in components of quality of life were partly explained by demographics and clinical characteristics. All three dimensions of quality of life were related to ability for self-care. CONCLUSION: Patients with heart failure seen in clinical practice are often not comparable to patients described in major clinical trials or patients that are admitted for transplant evaluation. Their functional capabilities are more compromised, but they may have fewer problems with psychosocial adjustment. Patients with normal systolic dysfunction also report a low quality of life. It could be important to enhance self-care abilities of patients to improve psychosocial adaptation to illness.
|
|
| 7. |
- Jaarsma, Tiny, et al.
(författare)
-
Self-care and quality of life in patients with advanced heart failure : the effect of a supportive educational intervention
- 2000
-
Ingår i: Heart & Lung. - : Elsevier BV. - 0147-9563 .- 1527-3288. ; 29:5, s. 319-330
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The goal of this study was to determine the effects of a supportive educational nursing intervention on self-care abilities, self-care behavior, and quality of life of patients with advanced heart failure. DESIGN: The study design was an experimental, random assignment. SETTING: The study was located at the University Hospital in Maastricht, The Netherlands. PATIENTS: The study included 179 patients (mean age 73 years, 58% men, New York Heart Association classification III and IV) admitted to a university hospital with symptoms of heart failure. OUTCOME MEASURES: Outcome measures included self-care abilities (Appraisal of Self-care Agency Scale), self-care behavior (Heart Failure Self-care Behavior Scale), 3 dimensions of quality of life (functional capabilities, symptoms, and psychosocial adjustment to illness), and overall well-being (Cantril's ladder of life). INTERVENTION: The intervention patients received systematic education and support by a nurse in the hospital and at home. Control patients received routine care. RESULTS: Self-care abilities did not change as a result of the intervention, but the self-care behavior in the intervention group was higher than the self-care behavior in the control group during follow-up. The effect of the supportive educational intervention on quality of life was limited. The 3 dimensions of quality of life improved after hospitalization in both groups, with no differences between intervention and control group as measured at each follow-up measurement. However, there was a trend indicating differences between the 2 groups in decrease in symptom frequency and symptom distress during the 9 months of follow-up. CONCLUSION: A supportive educational nursing intervention is effective in improving self-care behavior in patients with advanced (New York Heart Association class III-IV) heart failure; however, a more intensive intervention is needed to show effectiveness in improving quality of life.
|
|
| 8. |
- Jaarsma, Tiny, et al.
(författare)
-
Self-care behaviour of patients with heart failure
- 2000
-
Ingår i: Scandinavian Journal of Caring Sciences. - 0283-9318 .- 1471-6712. ; 14:2, s. 112-119
-
Tidskriftsartikel (refereegranskat)abstract
- Heart failure-related self-care behaviour is important to optimize outcomes for patients with heart failure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heart failure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heart failure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heart failure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heart failure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits).
|
|
| 9. |
- Jaarsma, Tiny, et al.
(författare)
-
Sexual function in patients with advanced heart failure
- 1996
-
Ingår i: Heart & Lung. - 0147-9563 .- 1527-3288. ; 25:4, s. 262-270
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the effect of low ejection fraction on sexual function and the relation between alterations in sexual function and pertinent clinical, demographic, and psychosocial variables in patients with advanced heart failure. DESIGN: This study was descriptive and correlational in design. SETTING: The setting was an outpatient clinic of a university-affiliated hospital. SUBJECTS: Sixty-two male (82%) and female (18%) patients with advanced heart failure (New York Heart Association [NYHA] class III or IV) were studied. MEASURES: Exercise tolerance and symptom severity were assessed by the 6-minute walk and NYHA classification. Ejection fraction was measured by echocardiography. Alterations in the patients' emotional, social, and sexual function were assessed with the self-report version of the Psychosocial Adjustment to Illness Scale. RESULTS: Approximately three quarters of the patients reported a marked decrease in sexual interest and in the frequency of sexual relations caused by illness, with one quarter having ceased all sexual activity. Half the patients described having experienced marked reductions, after heart failure developed, in the pleasure or satisfaction they normally experienced from sex. Few patients had arguments with their spouses about sex or reported significant marital problems as a result of their illness. A significant relation was documented between patients' sexual function and the results of the 6-minute walk (r = 0.32, p < 0.005), as well as between sexual function and NYHA functional class (r = 0.21, p < 0.05). Sexual function was also related to the patient's social environment (r = 0.59, p < 0.001), psychologic distress (r = 0.38, p < 0.001), and domestic environment (r = 0.29, p < 0.05). No significant differences in sexual function were noted when patients were compared on the basis of differences in ejection fraction, medications, gender, or age. CONCLUSION: Advanced heart failure results in marked changes in libido and in the ability to perform sexually. These changes do not affect the marital relationship negatively, at least in the view of the patient. As patients' symptoms of heart failure become increasingly more severe, physicians and nurses need to counsel patients and their spouses about the changes they may experience in their sexual relationships. Attention needs to focus on ways to cope with the decreasing physical status that accompanies advanced heart failure to minimize negative changes in sexual functioning.
|
|
| 10. |
|
|
