Academic journal article Nursing Praxis in New Zealand

Nurses and Heart Failure Education in Medical Wards

Academic journal article Nursing Praxis in New Zealand

Nurses and Heart Failure Education in Medical Wards

Article excerpt

Introduction

Heart failure is a common chronic and debilitating disease with significant hospitalisation rates. Heart failure is defined as a "syndrome of symptoms and signs that suggest impairment of the heart as a pump supporting physiological circulation. It is caused by structural or functional abnormalities of the heart" (National Clinical Guideline Centre, 2010, p.19). Hospitalised patients with acute symptoms of heart failure present with wide ranging symptoms and signs including fluid retention, fatigue, shortness of breath and the inability to tolerate exercise (Arroll, Doughty, & Anderson, 2010). In New Zealand the median length of hospital admission for heart failure patients in 2008 was 5 days (Wasywich, Gamble, Whalley, & Doughty, 2010); 6% of acute medical admissions in 2007 were for heart failure (Tester et al., 2009). Heart failure has a high mortality rate, in an English study of 6162 heart failure patients the mortality rate was 9% per year (Hobbs et al., 2010). There are also significant heart failure ethnic disparities. Maori male and female heart failure mortality rates for those 65 years old and over are significantly higher as compared to nonMäori (males RR 2.80, females RR 1.70) along with Maori hospitalisation rates (males RR 4.73, females RR 4.85) (Ministry of Health, 2011). Pacific people also have higher rates of morbidity being twice as likely to have a hospital discharge diagnosis of heart failure as compared to the total New Zealand population (Sopoaga, Buckingham, & Paul 2010).

The symptoms of heart failure can be managed with interventions that improve function and reduce hospitalisations and mortality. The American Heart Failure Practice Guideline recommends that during an acute hospital stay essential education is provided with respect to understanding heart failure and treatment goals, along with medication and follow up arrangements (Heart Failure Society of America, 2010). The New Zealand guidelines (National Heart Foundation of New Zealand, 2010a) suggest that education should be delivered in a structured manner and ideally by heart failure trained professionals. Nurses working in medical wards also contribute to heart failure education, particularly as specialist heart failure nurses are not available across all District Health Boards (Tester et al., 2009). Nurses have the opportunity to rectify patient knowledge gaps during hospitalisations for symptom management. The study reported in this paper aimed to describe medical ward nurses' educational activities with heart failure patients, thus providing baseline data about topic areas addressed by medical nurses, along with their use of heart failure information in patient education.

Background

Heart failure is a complex disease with multiple symptoms which can impact on quality of life. A study of the last 6 months of life identified 21 symptoms from 80 medical records, the most common being breathlessness, pain and fatigue (Nordgren &Sörensen, 2003). Anxiety, physical activity limitations, nausea, ankle swelling, constipation and loss of appetite also featured strongly. Similarly, another study of heart failure patients (n = 66) found dyspnoea, angina and tiredness were the most troublesome symptoms reported (Anderson et al., 2001). Sleep disorders are also prevalent with sleep difficulty being ranked as the most burdensome symptom in a study by Zambroski, Moser, Bhat and Ziegler (2005). Managing these symptoms on an every-day basis requires considerable expertise to maximise quality of life. Education about heart failure management includes weight monitoring and action in response to changing signs and symptoms, medication knowledge, dietary and fluid precautions and an appropriate exercise programme (National Heart Foundation of New Zealand, 2010a). The development of a plan of action to ensure a timely response to deterioration in condition is also important (Arroll, Doughty & Anderson, 2010). …

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