Health education: the effectiveness of interventions in patients with heart failure

Oliveira, Ana Paula Dias de; Cavalcante, Agueda Maria Ruiz Zimmer; Carneiro, Camila de Souza; Santos, Vinicius Batista; Moorhead, Sue; Lopes, Juliana de Lima; Barros, Alba Lucia Bottura Leite de

doi:10.1590/0034-7167-2018-0782

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (2) • 2020 • https://doi.org/10.1590/0034-7167-2018-0782 linkcopy

Health education: the effectiveness of interventions in patients with heart failure

Educación para la salud: la efectividad de las intervenciones en pacientes con insuficiencia cardíaca

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: To evaluate the effectiveness of NIC interventions “Teaching: Disease Process”, “Health Education” and “Cardiac Care” in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) “Ineffective Health Control”.

Methods: Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman’s Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%.

Results: The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001).

Conclusions: The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

Descriptors: Health Education; Nursing Education; Effectiveness; Cardiac Insufficiency; Nursing Diagnosis

Consultation	Steps Held	Interventions	Nursing actions	Evaluation	Duration
Consultation 1	1. Interview/Patients' anamnesis and physical examination; 2. Confirmation of Ineffective Health Control ND, CD and FR; 3. Documentation on specific instruments.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To offer guidance about the disease, non-pharmacological and pharmacological treatment; 2. To present the website developed by the outpatient clinic group of researchers; 3. To provide informative material^* * All printed informative material was developed by the study and research group, and was used during the consultations and given to patients and their companions. (individual guidelines regarding medications prescribed by the doctor, appointments and purposes of each; adequate diet, fluid restriction, water content of the main foods ingested by the Brazilian population);	Evaluation of NOC results indicators: Self-control of Heart Disease, Compliance Behavior.	2 h
Telephone consultation	1. Identification of the patient's health condition; 2. Identification of emerging needs and compliance with treatment.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To check the difficulties with the therapeutic regimen; 2. To check the degree of knowledge about the disease and treatment acquired in the previous consultation; 3. To verify patient compliance with the guidelines received.	1. Presence of signs and symptoms described by the patient and suggestive of clinical decompensation.	15 min
Other Consultations	1. Physical Examination; 2. CD and FR re-evaluation; 3. Clarification of current doubts and difficulties reported by patients; 3. Pointing solutions or improvements; 4. Verification of knowledge of the disease and treatment, and knowledge gaps.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To reorientate on the disease, non-pharmacological and pharmacological treatment (identification of knowledge gaps for reinforcement); 2. To check patient compliance with given instructions; 3. To verify the difficulties regarding the therapeutic regime and to establish strategies to overcome difficulties; 4. To assess and identify signs of decompensation.	Evaluation of NOC results indicators: Self-control of Heart Disease, Adhesion Behavior.	1 h 30 min

Nursing results	Clinical indicators assessed
Self-control of Heart Disease	1. Limits sodium intake 2. Follows the recommendation regarding fluid restriction 3. Monitors body weight 4. Maintains an ideal weight 5. Uses medication as prescribed 6. Is vaccinated against influenza (flu) 7. Is vaccinated against pneumonia
Compliance Behavior	1. Asks questions about health 2. Weighs risks/benefits regarding health behavior 3. Uses strategies to eliminate unhealthy behavior 4. Justifies deviating from a health diet 5. Performs self-monitoring of health condition

		Consultation 1	Consultation 2	Consultation 3	Consultation 4	Consultation 5	Consultation 6	p value^* * Teste de Friedman.
		n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	p value^* * Teste de Friedman.
Limits sodium intake	Never demonstrated	2 (14.2)	1 (7.1)	0	0	1 (7.1)	0	<0.001
	Rarely demonstrated	3 (21.4)	1 (7.1)	1 (7.10	0	0	2 (14.2)
	Sometimes demonstrated	6 (42.8)	6 (42.8)	1 (7.1)	3 (21.4)	3 (21.4)	2 (14.2)
	Often demonstrated	2 (14.2)	3 (21.4)	5 (35.7)	3 (21.4)	4 (28.5)	4 (28.5)
	Consistently demonstrated	1 (7.1)	3 (21.4)	7 (50.0)	8 (57.1)	6 (42.8)	6 (42.8)
Complies with the recommendation regarding fluid restriction	Never demonstrated	0	0	1 (7.1)	2 (14.2)	2 (14.2)	0	0.050
	Rarely demonstrated	4 (28.5)	2 (14.2)	0	1 (7.1)	2 (14.2)	2 (14.2)
	Sometimes demonstrated	6 (42.8)	8 (57.1)	6 (42.8)	1 (7.1)	1 (7.1)	3 (21.4)
	Often demonstrated	4 (28.5)	2 (14.2)	1 (7.1)	1 (7.1)	2 (14.2)	4 (28.5)
	Consistently demonstrated	0	2 (14.2)	6 (42.8)	9 (64.2)	7 (50.0)	5 (35.7)
Monitors body weight	Never demonstrated	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	0	0	0.059
	Rarely demonstrated	5 (35.7)	2 (14.2)	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)
	Sometimes demonstrated	3 (21.4)	3 (21.4)	4 (28.5)	2 (14.2)	2 (14.2)	0
	Often demonstrated	4 (28.5)	3 (21.4)	3 (21.4)	2 (14.2)	5 (35.7)	5 (35.7)
	Consistently demonstrated	1 (7.1)	4 (28.5)	5 (35.7)	7 (50.0)	6 (42.8)	8 (57.1)
Maintains an ideal weight	Never demonstrated	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	1 (7.1)	0	0.012
	Rarely demonstrated	2 (14.2)	2 (14.2)	2 (14.2)	1 (7.1)	2 (14.2)	1 (7.1)
	Sometimes demonstrated	2 (14.2)	2 (14.2)	0	2 (14.2)	0	1 (7.1)
	Often demonstrated	5 (35.7)	4 (28.5)	6 (42.8)	5 (35.7)	4 (28.5)	3 (21.4)
	Consistently demonstrated	4 (28.5)	4 (28.5)	5 (35.7)	5 (35.7)	7 (50.0)	9 (64.2)
Uses medication as prescribed	Never demonstrated	1 (7.1)	0	0	0	0	0	0.014
	Rarely demonstrated	1 (7.1)	1 (7.1)	1 (7.1)	1 (7.1)	1 (7.1)	0
	Sometimes demonstrated	4 (28.5)	2 (14.2)	3 (21.4)	1 (7.1)	1 (7.1)	0
	Often demonstrated	5 (35.7)	7 (50.0)	3 (21.4)	4 (28.5)	2 (14.2)	2 (14.2)
	Consistently demonstrated	3 (21.4)	4 (28.5)	7 (50.0)	8 (57.1)	10 (71.4)	12 (85.7)
Is vaccinated against influenza (flu)	Never demonstrated	4 (28.5)	2 (14.2)	3 (21.4)	2 (14.2)	1 (7.1)	1 (7.1)	0.001
	Rarely demonstrated	0	0	0	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	1 (7.1)	0	0	0
	Often demonstrated	3 (21.4)	0	0	1 (7.1)	0	0
	Consistently demonstrated	4 (28.5)	11 (78.5)	10 (71.4)	11 (78.5)	13 (92.8)	13 (92.8)
Is vaccinated against pneumonia	Never demonstrated	7 (50.0)	2 (14.2)	2 (14.2)	2 (14.2)	1 (7.1)	0	0.001
	Rarely demonstrated	0	0	0	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	1 (7.1)	0	0	0
	Often demonstrated	3 (21.4)	0	0	0	0	0
	Consistently demonstrated	1 (7.1)	11 (78.5)	11	12	13 (92.8)	14 (100.0)

		Consultation 1	Consultation 2	Consultation 3	Consultation 4	Consultation 5	Consultation 6	p value^* * Testes de Friedman.
		n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	p value^* * Testes de Friedman.
Asks questions about health	Never demonstrated	0	0	0	0	0	0	<0.001
	Rarely demonstrated	3 (21.4)	3 (21.4)	1 (7.1)	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	0
	Often demonstrated	3 (21.4)	5 (35.7)	4 (28.5)	4 (28.5)	2 (14.2)	1 (7.1)
	Consistently demonstrated	5 (35.7)	5 (35.7)	7 (50.0)	9 (64.2)	11 (78.5)	13 (92.8)
Weighs risks/benefits regarding health behavior	Never demonstrated	0	0	0	0	0	0	0.003
	Rarely demonstrated	5 (35.7)	2 (14.2)	0	0	2 (14.2)	0
	Sometimes demonstrated	2 (14.2)	5 (35.7)	4 (28.5)	2 (14.2)	0	2 (14.2)
	Often demonstrated	4 (28.5)	3 (21.4)	5 (35.7)	6 (42.8)	5 (35.7)	5 (35.7)
	Consistently demonstrated	3 (21.4)	4 (28.5)	5 (35.7)	6 (42.8)	7 (50.0)	7 (50.0)
Uses strategies to eliminate unhealthy behavior	Never demonstrated	0	0	0	1 (7.1)	0	0	0.128
	Rarely demonstrated	4 (28.5)	1 (7.1)	1 (7.14)	0	3 (21.4)	2 (14.2)
	Sometimes demonstrated	6 (42.8)	7 (50.0)	5 (35.7)	3 (21.4)	2 (14.2)	2 (14.2)
	Often demonstrated	1 (7.1)	4 (28.5)	4 (28.5)	3 (21.4)	1 (7.14)	4 (28.5)
	Consistently demonstrated	3 (21.4)	2 (14.2)	4 (28.5)	7 (50.0)	8 (57.1)	6 (42.8)
Justifies deviating from a health diet	Never demonstrated	2 (14.2)	2 (14.2)	1 (7.1)	1 (7.1)	2 (14.2)	2 (14.2)	0.013
	Rarely demonstrated	7 (50.0)	3 (21.4)	0	2 (14.2)	2 (14.2)	1 (7.1)
	Sometimes demonstrated	3 (21.4)	5 (35.7)	7 (50.0)	2 (14.2)	3 (21.4)	4 (28.5)
	Often demonstrated	1 (7.1)	3 (21.4)	2 (14.2)	5 (35.7)	2 (14.2)	2 (14.2)
	Consistently demonstrated	1 (7.1)	1 (7.1)	4 (28.5)	4 (28.5)	5 (35.7)	5 (35.7)
Performs self-monitoring of health condition	Never demonstrated	0	1 (7.1)	0	0	0	0	<0.001
	Rarely demonstrated	5 (35.7)	1 (7.1)	1 (7.1)	1 (7.1)	0	0
	Sometimes demonstrated	4 (28.5)	6 (42.8)	4 (28.5)	3 (21.4)	5 (35.7)	1 (7.1)
	Often demonstrated	1 (7.1)	3 (21.4)	4 (28.5)	2 (14.2)	1 (7.1)	5 (35.7)
	Consistently demonstrated	4 (28.5)	3 (21.4)	5 (35.7)	8 (57.1)	8 (57.1)	8 (57.1)

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All printed informative material was developed by the study and research group, and was used during the consultations and given to patients and their companions.