Educational program for self-care in heart failure: PEAC-IC: randomized control trial

BACKGROUND: Worldwide, approximately 64 million people live with signs and symptoms of heart failure(HF), considered one of the leading causes of morbidity and mortality, hospitalizations and worsening of quality of life. Self-care is a nonpharmacological approach to control the progression of HF, which involves behaviors to maintain health and monitor and manage symptoms. However, self-care still insufficient among this population in Brazil and worldwide. The Educational Program for Self-Care in Heart Failure (PEAC-CI) is an acceptable and feasible intervention that needs to be evaluated for its effectiveness. OBJECTIVE: To evaluate the effectiveness of the PEAC-IC in improving self-care behaviors (primary outcome), knowledge, quality of life, the number of hospitalizations, and access to emergency services in patients with HF (secondary outcome). METHODS: A parallel randomized clinical trial with HF patients recruited in a clinical cardiology ward and outpatient settings of the Dante Pazzanese Institute of Cardiology in São Paulo/Brazil. Participants were randomized to the intervention group (IG), receiving the PEAC-CI intervention, and the control group (CG), receiving standard care. The intervention consisted of a face-to-face session followed by five structured telephone contacts every week during six weeks. Standard care consisted of general guidance during hospital discharge and outpatient follow-ups with medical and nursing consultations when indicated. The outcomes were assessed in seventh week or after the six sessions of the implementation of PEAC-IC, and then third and sixth month after the first assessment in both groups. The primary outcome was measured with the Self-Care of HF Index v.6.2, which measures selfcare maintenance, management, and confidence; scores of these three scales range between 0-100, with higher scores meaning better self-care. RESULTS: We enrolled 80 patients, and 56 completed the entire intervention. These patients were mostly males (52.5%), with a mean age of 61.8 years (SD= 12,6) 44.9% white, with a diagnosis of HF from an average of 174.9 (SD=158,3), 50% in New York Heart Association functional class III. At baseline, self-care maintenance, management, and confidence scores were 51.6, 56.2, and 54.1, respectively. At the seven-week follow-up, the IG scored 72.3 on self-care maintenance, while the CG scored 61. The difference between the two groups, assessed with the linear mixed model, was clinically and statistically significant (p0.05). CONCLUSION: The PEAC-CI has effectively improved self-care maintenance in patients with HF. Even though the improvement in the secondary outcomes was not statistically significant, we observed a trend towards statistically significance. Key-words: nursing; heart failure; self-care; randomized controled trial.

Raciocínio diagnóstico de enfermeiros especialistas em cardiologia / Diagnostic reasoning of nurses experts in cardiology

O objetivo deste estudo foi compreender a experiência do raciocínio diagnóstico de enfermeiros especialistas em cardiologia. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada em Dados (Grounded Theory). Em entrevistas, 11 enfermeiros especialistas em cardiologia foram solicitados a relatar a experiência de identificar necessidades de cuidados em uma situação clínica que haviam vivenciado. A análise comparativa dos dados conduziu o delineamento de um modelo sobre a experiência do raciocínio clínico do enfermeiro especialista. O raciocínio diagnóstico apresentou-se associado ao raciocínio terapêutico e o modelo de raciocínio diagnóstico foi definido por três construtos. O construto encontrando-se no desafio de cuidar representa os processos pelos quais o enfermeiro vivencia o desafio do raciocínio clínico. A partir da vivência do desafio, emerge o segundo constructo, cuidando, que se refere ao processo central do raciocínio clínico caracterizado como um processo analítico, sistematizado e dinâmico, composto de uma sequência de pensamentos no sentido de tomar decisões sobre suas ações. Esses dois construtos integrados são permeados por um terceiro, atribuindo valor ao cuidar, que os modula e dá especificidade a cada situação vivenciada. Dar continuidade ao estudo do modelo derivado nesta pesquisa possibilitará propor hipóteses que permitam testá-lo e aprofundar a compreensão do raciocínio clínico.