Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale.

BACKGROUND: To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose. METHODS: The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale. RESULTS: The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items. CONCLUSIONS: This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.

Nursing capacity building in health coaching with hospitalised chronic heart failure patients: a quasi-experimental study.

BACKGROUND: Difficulty in adherence to treatment and self-care behaviours is a leading cause of preventable readmission in people with chronic heart failure (CHF). Although there is evidence of benefits of health coaching for the management of this situation, few interventions have been tested in the hospital setting. AIM: To evaluate a coaching programme (H-Coaching) designed to develop nursing capacity in health coaching for chronic heart failure inpatients. METHODS: A quasi-experimental pre-post study including all nurses in a single centre cardiology ward (N = 19). The intervention consisted of two training packages: (1) five theoretical-practical sessions on health-coaching competencies, emotional intelligence, communication and support of chronic heart failure patients in their illness in the hospital setting; and (2) training sessions seven months after the first training package to reinforce the theoretical and practical knowledge. On four occasions, the Competence Instrument of Health Education for the Nursing professional was used to measure nurses' knowledge, skills and attitudes in health coaching for chronic heart failure patients. RESULTS: The difference between the preintervention and postintervention scores were statistically significant for knowledge [mean difference = 1.00 (95% CI -1.45 to -0.51; p = 0.000)], skills in general [mean difference = 0.50 (95% CI -1.41 to -0.21; p = 0.015)] and personal/social skills [mean difference = 1.00 (95% CI -1.10 to -0.01; p = 0.048)]. While attitudinal and affective domains did not differ, there were differences in knowledge and skills. CONCLUSION: The H-Coaching programme proved to be effective for building nursing capacity in health coaching CHF inpatients. Similar programmes designed to improve knowledge in verbal and nonverbal communication techniques, and skills for coaching interventions adapted to meet the needs of individual patients, should be tested in future interventional experimental studies. CLINICAL TRIAL REGISTRATION NUMBER: NCT05300880. IMPACT STATEMENT: To our knowledge, this is the first nursing training intervention in health coaching for chronic heart failure the inpatient setting. This study has demonstrate improvements in both the knowledge and personal and social skills of cardiology nurses with regard to the development of health coaching in a hospital setting. Given the study design, further research is warranted. PLAIN LANGUAGE SUMMARY: Many patients with chronic heart failure have problems in adhering to the treatment and self-care behaviours and this is one of the main causes of preventable readmission. To promote self-care, patients need to be empowered to integrate these habits into their daily lives and we should implement innovative strategies to achieve this. Health coaching is an ideal alternative to this but very few nurses in the hospital cardiology setting are experienced in health coaching. Our study has shown preliminary results demonstrating that a structured theoretical and practical training programme for nurses can improve nurses' knowledge and skills in health coaching for inpatient patients with chronic heart failure. This study provides an opportunity for future research to demonstrate whether nurses with this training have a positive impact on the health outcomes of chronic heart failure patients and, more specifically, on their levels of self-care and empowerment.

Interventions on the social dimension of people with chronic heart failure: a systematic review of randomized controlled trials.

AIMS: The symptom burden of patients with chronic heart failure (CHF), together with social determinants and psychosocial factors, results in limitations to maintain adequate social life and roles, participate in social events and maintain relationships. This situation's impact on health outcomes makes it of utmost importance to develop meaningful social networks for these patients. The primary objective aimed to identify randomized controlled trials that impact the social dimension of people with CHF. The secondary objectives were to analyze the methodological quality of these interventions, establish their components, and synthesize their results. METHODS AND RESULTS: A systematic review following PRISMA guidelines was conducted in Pubmed, Scopus, Cochrane CENTRAL, PsychINFO, and CINAHL databases between 2010 and February 2022. The Revised Cochrane risk-of-bias tool for randomized trials was used. The protocol was registered in PROSPERO. Eight randomized controlled trials were identified, among which two were at 'high risk of bias.' Interventions were synthesized according to the following categories: delivery format, providers and recipients, and the intervention content domains. Half of the studies showed statistical superiority in improving the intervention group's social support in people with CHF. CONCLUSION: This review has highlighted the scarcity of interventions targeting the social dimension of people with CHF. Interventions have been heterogeneous, which limits the statistical combination of studies. Based on narrative review and vote counting, such interventions could potentially improve social support and self-care, which are important patient reported outcomes, thus warrant further research. Future studies should be co-created with patients and families to be adequately targeted. REGISTRATION: PROSPERO CRD42021256199.

Causes, experiences and consequences of the impact of chronic heart failure on the person´s social dimension: A scoping review.

Chronic heart failure (CHF) is a progressive and disabling condition that significantly impacts patients' daily lives. One of its effects is decreased opportunities to participate in social life, leading to reduced social interaction, loneliness, social isolation and lack of social support to continue with their daily life activities. This study aimed to explore the causes, experiences, and consequences of the impact of CHF on the social dimension of the person. According to the Arksey & O'Malley method, a scoping review of the literature was conducted to examine existing knowledge in the area, summarise existing evidence and identify gaps in the literature. The search was conducted in the PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. Twenty-six articles were identified. The reasons why CHF influences the social dimension of the person were multifactorial and related to physical aspects, sociodemographics, lifestyle changes and the feelings experienced by these patients. Social relationships play a key role, and the benefits of good social relationships and the impact of poor or inadequate social support were identified. Furthermore, the influence of alterations in the social dimension on the CHF patient's clinical outcomes was described. This approach will help to detect and better understand the bidirectional influence that exists in each person between social isolation, relationships, and support life experiences, self-care activities, and morbi-mortality rates. These findings have shown the importance of detecting higher-risk groups and systematically assessing factors related to the social dimension in all patients with CHF.

Experiencing the possibility of near death on a daily basis: A phenomenological study of patients with chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a syndrome that greatly impacts people's lives. Due to the poor prognosis of CHF, together with the frequent exacerbations of symptoms, death is a topic that is very present in the lives of patients with CHF. OBJECTIVE: To explore thoughts about death experienced by patients with chronic heart failure in their daily lives. METHODS: A hermeneutic phenomenological study was carried out. Conversational interviews were conducted with 20 outpatients with chronic heart failure. Analysis of the responses was based on the method proposed by van Manen. RESULTS: From the analysis, four main themes emerged: (1) Feeling afraid of the possibility of dying; (2) Acceptance of the possibility of death; (3) Desiring death for relief from suffering; and (4) Striving to continue living to enjoy family. CONCLUSIONS: This study presents, as a novel finding, that people with CHF experience the possibility of near death on a daily basis. This experience, which they must encounter on their own, makes them afraid. In addition, some of them, in view of the discomfort they are living, wish to die, with some even considering committing suicide.

Nursing students' experience of providing frontline COVID-19 support: A qualitative study.

Understanding the unique experience of nursing students providing frontline support in COVID-19 hospital wards is crucial for the design of strategies to improve crisis management and mitigate future pandemic outbreaks. Limited research concerning this phenomenon has been published. This qualitative study aimed to understand the experience of providing support from COVID-19 frontline nursing students' perspective. Online interviews were conducted with nine nursing students from April to May 2020; interview data were analyzed by content analysis using Burnard's method. Six main categories emerged from the data analysis: "experiencing a rapid transition from student to professional," "fear and uncertainty of the unknown," "resilience throughout the crisis," "sense of belonging to a team," "shared responsibility," and "importance of the profession." Based on these findings, multicomponent strategies that function in parallel with practical contexts should be developed to enable students to diligently adapt their abilities to their new role and cope with health crises.

Family Narratives About Providing End-of-Life Care at Home.

Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.

Interventions to empower cardiorenal patients: A systematic review.

AIMS: To identify the most effective interventions to empower cardiorenal patients. DESIGN: A systematic review of the literature has been carried out. DATA SOURCES: The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020. REVIEW METHODS: Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected. RESULTS: The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life. CONCLUSION: A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment. IMPACT: There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.

Unexplored Aspects of the Meaning of Living with Chronic Heart Failure: A Phenomenological Study within the Framework of the Model of Interpersonal Relationship between the Nurse and the Person/Family Cared for.

The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient's perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.

Redefining a 'new normality': A hermeneutic phenomenological study of the experiences of patients with chronic heart failure.

AIM: To explore the perception of normality in life experienced by patients with chronic heart failure. DESIGN: A hermeneutic phenomenological study was conducted. METHODS: Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis. RESULTS: From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others. CONCLUSIONS: The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process. IMPACT: Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.

The personal experience of living with chronic heart failure: a qualitative meta-synthesis of the literature.

AIMS AND OBJECTIVES: To determine, from a systematic literature review, the experience of living with heart failure and to propose some practice guidelines and research questions. BACKGROUND: Chronic heart failure has been one of the fastest growing illnesses in recent decades, with almost 23 million people affected worldwide. This complex syndrome has multiple causes and appears when underlying heart disease is advanced. Currently, heart failure has no cure and leads to a significant deterioration in patients' quality of life. DESIGN: Qualitative meta-synthesis. METHODS: A qualitative meta-synthesis was conducted to extract and analyse qualitative research from the Cochrane, PubMed, CINAHL, PsycINFO, Web of Science and Cuiden databases. Snowball sampling and a manual search were performed to identify other relevant studies. RESULTS: Twenty-five qualitative studies were selected. The findings indicate that there are three main themes that describe the phenomenon. The first theme refers to the experiences related to the beginning of the process. The second theme is connected with the effects on the person: physical, emotional, social and spiritual changes. The third theme is linked with how to live with heart failure despite the illness, including the adjustment and coping process and how external resources can help them to manage. CONCLUSIONS: Heart failure has a major impact on the entire person, but some areas have not been addressed. By creating new tools to understand and evaluate the impact of this illness and interventions that prevent or improve some situations, we can promote the well-being and the quality of life of this population. RELEVANCE TO CLINICAL PRACTICE: Nurses must have a personal knowledge of the experiences and needs of the patients. To do this, nurses should create care environments that promote an exchange of experiences and knowledge between the nurse and the patient and family.

[Coping strategies used by the family of a patient with acute fulminant hepatitis]. / Paciente con hepatitis aguda fulminante.

In the holistic care to the patient, the family should be an important part because its members are also affected by the situation. Therefore, nursing work should be directed to both the individual and his environment, being of great help to identify family's needs in order to meet their specific needs accurately. Also in the process of recovery the family goes through several stages of coping, each of them have its own characteristics and nurses' interventions should be adapted to them. The aim of this paper is to evidence the importance of caring for the family, identifying the stages of coping, recognizing their needs and identifying relevant care. For this, a clinical case of a family with a relative hospitalised in an intensive care unit because of an acute fulminant hepatitis was developed. The instruments used to carry out the analysis of the case are: family's needs described by Leske et al., coping stages identified by Kubler-Ross, and ways of coping scale developed by Lazarus and Folkman. Nurses have a relevant role due to their close contact with people, this helps to become a factor which facilitates the interaction of patient and family within the hospital environment. A holistic approach of nursing care involves assessing the needs of families to develop strategies for effective interventions.

[Patients' view of nursing care: a literature review]. / Visión de los pacientes sobre el cuidado de enfermería. Una revisión de la literatura.

AIM: To know patients'vision about nursing care, to explore what the patient perceives and expresses on the care of nursing and to identify which are the potential areas for improvement. METHODOLOGY: A narrative review was conducted in which a synthesis of the information, a codification and a thematic analysis of primary studies were carried out in order to categorize the emerging themes of the reviewed literature. For this purpose, a search was conducted in the databases CINAHL, CUIDEN, MEDLINE and Cochrane Library, from 1990 to 2011. RESULTS: Seven principal categories were identified: personal qualities of the nurse, individualized care, affective Implication, communication skills, "I am in good hands", knowledge and technical skills and the role of the nurse. DISCUSSION: From the patients' statements, positive aspects could be extracted about nursing care but also different ideas were identified that should be modified. It is important to include regularly in practice patients' views of the care that they receive, since they can better evaluate the reality of the nurse role. CONCLUSIONS: To provide a holistic and individualized care to the person, it is necessary to include her vision about the received care. This is the way to evaluate the quality of the care and to verify whether health care assistance corresponds with users' demands.

Paciente con hepatitis aguda fulminante / Clinical case: coping strategies used by the family of a patient with acute fulminant hepatitis

Dentro del cuidado integral al paciente, la familia debe ocupar una parte indispensable puesto que también se ve afectada por la situación. Por ello, la labor de enfermería debe ir dirigida tanto al individuo como a su entorno, siendo de gran ayuda identificar sus necesidades para cubrirlas adecuadamente. Además, dentro del proceso de convalecencia, la familia atraviesa varias fases de afrontamiento y cada una de ellas tiene unas características propias que hacen que las intervenciones de enfermería deban adecuarse. El objetivo de este artículo es evidenciar la importancia de la atención a la familia, identificando las fases de afrontamiento, reconociendo sus necesidades y detectando los cuidados pertinentes. Para ello, se desarrolla un caso clínico que aborda la situación de una familia con un miembro ingresado en una unidad de cuidados intensivos por una hepatitis aguda fulminante. Los instrumentos utilizados para llevar a cabo el análisis del caso son: las necesidades de la familia descritas por Leske y otros autores, las fases de afrontamiento identificadas por Kubler-Ross y la escala de modos de afrontamiento desarrollada por Lazarus y Folkman. Las enfermeras tienen un rol privilegiado por su contacto cercano con las personas; esto contribuye a ser un agente facilitador en la interacción del paciente y su familia con el ambiente hospitalario. Un enfoque holístico requiere evaluar las necesidades de las familias para posteriormente desarrollar estrategias de intervención efectivas(AU)

In the holistic care to the patient, the family should be an important part because its members are also affected by the situation. Therefore, nursing work should be directed to both the individual and his environment, being of great help to identify family’s needs in order to meet their specific needs accurately. Also in the process of recovery, the family goes through several stages of coping, each of them have its own characteristics and nurses' interventions should be adapted to them. The aim of this paper is to evidence the importance of caring for the family, identifying the stages of coping, recognizing their needs and identifying relevant care. For this, a clinical case of a family with a relative hospitalised in an Intensive Care Unit because of an acute fulminant hepatitis was developed. The instruments used to carry out the analysis of the case are: family's needs described by Leske et al., coping stages identified by Kubler-Ross, and ways of coping scale developed by Lazarus and Folkman. Nurses have a relevant role due to their close contact with people; this helps to become a factor which facilitates the interaction of patient and family within the hospital environment. A holistic approach of nursing care involves assessing the needs of families to develop strategies for effective interventions(AU)

Visión de los pacientes sobre el cuidado de enfermería: una revisión de la literatura / Patients’ view of nursing care: a literature review

Objetivo. Conocer la visión de los pacientes acerca del cuidado enfermero, explorar lo que el paciente percibe y expresa sobre el cuidado que recibe e identificar cuáles son las áreas susceptibles de mejora en la atención. Metodología. Se realizó una revisión narrativa en la que a través de una síntesis de los datos, la codificación y el análisis temático de los estudios primarios, se categorizaron los temas emergentes de la literatura revisada. Para ello, se desarrolló una búsqueda bibliográfica en las bases de datos CINAHL, CUIDEN, MEDLINE y The Cochrane Library entre los años 1990 y 2011. Resultados. Se identificaron siete categorías principales: Cualidades personales de la enfermera, Atención individualizada, Implicación afectiva, Habilidades de comunicación, «Me siento en buenas manos», Conocimientos y habilidades técnicas y El rol de la enfermera. Discusión. De los relatos de los pacientes se pueden extraer aspectos positivos sobre el cuidado recibido, pero también se señalan ideas que se tendrían que corregir. Se deberían tomar medidas que incluyesen regularmente en la práctica las opiniones de los pacientes sobre el cuidado que reciben, ya que son ellos los que mejor pueden evaluar la realidad de la labor enfermera. Conclusiones. Para proporcionar un cuidado holístico e individualizado a la persona, es necesario incluir su visión sobre la atención que recibe. Así se podrá evaluar la calidad de los cuidados prestados y comprobar si la asistencia proporcionada se corresponde con las demandas de los usuarios (AU)

Aim. To know patients’ vision about nursing care, to explore what the patient perceives and expresses on the care of nursing and to identify which are the potential areas for improvement. Methodology. A narrative review was conducted in which a synthesis of the information, a codification and a thematic analysis of primary studies were carried out in order to categorize the emerging themes of the reviewed literature. For this purpose, a search was conducted in the databases CINAHL, CUIDEN, MEDLINE and Cochrane Library, from 1990 to 2011. Results. Seven principal categories were identified: personal qualities of the nurse, individualized care, affective Implication, communication skills, «I am in good hands», knowledge and technical skills and the role of the nurse. Discussion. From the patients’ statements, positive aspects could be extracted about nursing care but also different ideas were identified that should be modified. It is important to include regularly in practice patients’ views of the care that they receive, since they can better evaluate the reality of the nurse role. Conclusions. To provide a holistic and individualized care to the person, it is necessary to include her vision about the received care. This is the way to evaluate the quality of the care and to verify whether health care assistance corresponds with users’ demands (AU)