Mary Boyde

Educational interventions for patients with heart failure :a systematic review of randomized controlled trials

Background:Patient education is an important intervention for the management of heart failure; however, in practice patient education varies considerably. Aim:To systematically review educational interventions that have been implemented for heart failure patients and assess their effectiveness. Methods:Randomized controlled trials from 1998 to 2008 in CINAHL, MEDLINE, PsychInfo, EMBASE, and Cochrane were reviewed using the following search terms: patient education, education, educational intervention, self-care in combination with heart failure. There were 1515 abstracts reviewed independently by 2 reviewers. Results:A total of 2686 patients were included in the 19 studies that met the inclusion criteria. Commonly, the initial educational intervention was a one-on-one didactic session conducted by nurses supplemented by written materials and multimedia approaches. Seven studies referred to a theoretical model as a framework for their educational intervention. Studies used a variety of outcome measures to evaluate their effectiveness. Of the studies reviewed, 15 demonstrated a significant effect from their intervention in at least one of their outcome measures. Conclusion:All we hope from patient education has not yet been realized. Despite improvements in knowledge, we have variable results in outcomes, and this is very likely related to the heterogeneity of the studies included in this review. It was difficult to establish the most effective educational strategy as the educational interventions varied considerably in delivery methods and duration as well as the outcome measures that were used for the evaluation. A patient-centered approach to education based on educational theory and evaluated appropriately may assist to develop an evidence base for patient education.

Pilot testing of a self-care education intervention for patients with heart failure

Background: A key component of the structured approach to the management of chronic heart failure (CHF) is effective patient education. Patient education is a precursor to performing appropriate health-related behaviours that can decrease rehospitalizations. Aim: To pilot test an educational intervention and to determine the efficacy of a self-care manual combined with a DVD for patients with CHF. Outcomes of interest included heart failure-related knowledge and self-care behaviours. Methods: This pilot study enrolled a sample of 38 patients with CHF. A pre-test/post-test design was conducted to assess changes in knowledge and self-care abilities. Knowledge was assessed with the Dutch Heart Failure Knowledge Scale and self-care behaviours were assessed using the Self-Care of Heart Failure Index. Results: Of the 38 participants 71% were male, 50% were aged between 65 and 74 years, and 31.6% had not completed Year 10 education. There was a statistically significantly difference in the pre- and post-test scores for knowledge (p < 0.0001). Self-care showed positive improvement between pre- and post-test scores; maintenance (p = 0.027), management (p < 0.0001) and confidence (p = 0.051). Conclusion: This pilot study has indicated that a patient-centred self-care manual combined with a DVD is beneficial and is associated with an improvement in patients’ knowledge and self-care abilities. Practice implications: Healthcare professionals should utilize multimedia educational resources specifically designed to meet the learning needs of patients with CHF.

What have our patients learnt after being hospitalised for an acute myocardial infarction

BACKGROUND Education for hospitalised patients is an important aspect of care for people who have an acute cardiovascular event. OBJECTIVE To investigate the cardiovascular risk factor behaviours of patients together with their acute coronary syndrome (ACS) knowledge, attitudes and beliefs following admission to hospital for an acute myocardial infarction. METHODS Patients diagnosed with an acute myocardial infarction participated in an observational study. Patients completed a questionnaire consisting of cardiovascular risk factor behaviour questions and the ACS Response Index prior to discharge and at follow-up 10 weeks later. RESULTS Of the 135 participants enrolled, 114 (84%) completed follow-up, 70% were males; mean age was 63 (± 11.6) years. The median length of hospital stay was 3 days (IQR 1) and the time to follow-up after discharge was 10 weeks. Self-reported risk factor behaviours improved significantly for diet (p < 0.001) and smoking cessation (p = 0.023) following discharge. At discharge 39% of patients had inadequate knowledge of ACS symptoms. The ACS Response Index improved significantly after discharge for attitudes (p = 0.004) and beliefs (p = 0.008). Despite 85% of patients indicating they would attend cardiac rehabilitation only 30% had commenced a programme at follow-up. CONCLUSION Patients reported implementing a number of healthy lifestyle changes following discharge including smoking cessation and healthy eating. Attitudes and beliefs regarding ACS showed a significant improvement following discharge. More than one third of patients had inadequate knowledge at discharge, suggesting current education practices may not be meeting the needs of patients with a myocardial infarction.

Decimal numbers and safe interpretation of clinical pathology results

Objective To determine the understanding of decimal numbers by medical laboratory scientists, doctors and nurses. Methods A Decimal Comparison Test determined the comprehension of decimals numbers. Additional questions sought the participants’ understanding of concentrations and reference ranges, and their preferences for the presentation of clinical pathology results. Results Of the 108 participants, 40% exhibited poor comprehension of decimal numbers. One-third of the medical laboratory scientists, a quarter of doctors, and half the nurses were characterised as lacking numeracy skills. The majority of participants (60%) thought it would be safer for results to be presented as whole numbers rather than as decimals with leading zeros. Conclusions The number of laboratory and clinical staff who show numeracy issues that could lead to misinterpretation of clinical pathology results and contribute to medical error strongly supports recommendations that pathology results should be presented as whole numbers.

Education Material for Heart Failure Patients: What Works and What Does Not?

Patient education is an important element of care, but evidence with regard to education material is not always apparent, as it is intertwined with educational strategies as components of heart failure management programs. Difficulties have arisen in determining the effectiveness of particular education strategies, as multiple strategies are commonly bundled together and packaged within research protocols. To further complicate this issue, the bundles are diverse, lack precision in describing their components, and report different outcomes. Despite these difficulties, clinicians can utilise a number of proven commonalities to deliver effective education: assessment of learning needs and style, verbal interaction with a healthcare professional, and a selection of multimedia patient education materials.

In-Hospital Cardiac Arrests: Effect of Amended Australian Resuscitation Council 2006 Guidelines

OBJECTIVE To evaluate cardiac arrest outcomes following the introduction of the Australian Resuscitation Council (ARC) 2006 amended guidelines for basic and advanced life support. METHODS A retrospective study of all consecutive cardiac arrests during a 3-year phase pre-implementation (2004-06) and a 3-year phase post-implementation (2007-09) of the ARC 2006 guidelines was conducted at a tertiary referral hospital in Brisbane, Australia. RESULTS Over the 6-year study phase 690 cardiac arrests were reported. Resuscitation was attempted in 248 patients pre-implementation and 271 patients post-implementation of the ARC 2006 guidelines. After adjusting for significant prognostic factors we found no significant change in return of spontaneous circulation (ROSC) (odds ratio 1.21, 95% confidence interval 0.80-1.85, P=0.37) or survival to discharge (odds ratio 1.49, 95% confidence interval 0.94-2.37, P=0.09) after the implementation of the ARC 2006 guidelines. Factors that remained significant in the final model for both outcomes included having an initial shockable rhythm, a shorter length of time from collapse to arrival of cardiac arrest team, location of the patient in a critical-care area, shorter length of resuscitation and a day-time arrest (0700-2259 hours). In addition the arrest being witnessed was significant for ROSC and younger age was significant for survival to discharge. CONCLUSIONS There are multiple factors that influence clinical outcomes following an in-hospital cardiac arrest and further research to refine these significant variables will assist in the future management of cardiac arrests. WHAT IS KNOWN ABOUT THIS TOPIC? The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. WHAT DOES THIS PAPER ADD? This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines, which included a refocus on providing quality cardiopulmonary resuscitation with minimal interruptions. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding cardiopulmonary resuscitation is essential to improve outcomes.

The Self-care Educational Intervention for Patients With Heart Failure: A Study Protocol

Background: A variety of educational interventions have been implemented to assist patients with heart failure (HF) to maintain their own health, develop self-care behaviors, and decrease readmissions. The most effective approach to education has yet to be established. Objective: The aim of this study is to determine the effectiveness of a multimedia educational intervention for patients with HF in reducing hospital readmissions. Secondary outcomes include changes in knowledge and self-care behaviors. Methods: A randomized controlled trial in a large tertiary referral hospital in Australia has recruited 200 patients and will follow them for 12 months. Patients diagnosed with HF have been randomly allocated 1:1 to either usual education or a multimedia educational intervention. Framed by the principles of adult learning, this individualized intervention was delivered face to face by a specialized HF nurse, with a targeted educational assessment and subsequent development of an educational plan. The multimedia approach combined viewing a DVD and verbal discussion supported by a written manual. The teach-back strategy at the conclusion of the intervention evaluated the patient’s learning through 5 key questions about self-management of HF. Readmissions are assessed at 28 days, 3 months, and 12 months. Knowledge and self-care behavior are assessed at baseline, 3 months, and 12 months. Conclusions: This study evaluates the effectiveness of a targeted multimedia educational intervention. Study results may inform the design of in-hospital education for HF patients.

Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial

Background: A variety of educational interventions have been implemented to assist patients with heart failure to maintain their own health, develop self-care behaviours and decrease readmissions. Aims: The purpose of this study was to determine the effectiveness of a multimedia educational intervention for patients with heart failure in reducing unplanned hospital readmissions. Methods: The study, a randomised controlled trial in a large tertiary referral hospital in Australia, recruited 200 patients. Patients diagnosed with heart failure were randomly allocated 1:1 to usual education or a multimedia educational intervention. The multimedia approach began with an individual needs assessment to develop an educational plan. The educational intervention included viewing a DVD, and verbal discussion supported by a written manual with a teach-back evaluation strategy. The primary outcome was all-cause unplanned hospital readmission at 28 days, three months and 12 months post-recruitment. The secondary outcomes were changes in knowledge and self-care behaviours at three months and 12 months post-recruitment. Results: At 12 months, data on 171 participants were analysed. There were 24 participants who had an unplanned hospital readmission in the intervention group compared to 44 participants in the control group (p=0.005). The self-care educational intervention reduced the risk of readmission at 12 months by 30% (relative risk: 0.703; 95% confidence interval: 0.548–0.903). Conclusion: A targeted multimedia educational intervention can be effective in reducing all-cause unplanned readmissions for people with heart failure.

A systematic review of the impact of nurse-initiated medications in the emergency department

BACKGROUND Nurse-initiated medications are one of the most important strategies used to facilitate timely care for people who present to Emergency Departments (EDs). The purpose of this paper was to systematically review the evidence of nurse-initiated medications to guide future practice and research. METHODS A systematic review of the literature was conducted to locate published studies and Grey literature. All studies were assessed independently by two independent reviewers for relevance using titles and abstracts, eligibility dictated by the inclusion criteria, and methodological quality. RESULTS Five experimental studies were included in this review: one randomised controlled trial and four quasi-experimental studies conducted in paediatric and adult EDs. The nurse-initiated medications were salbutamol for respiratory conditions and analgesia for painful conditions, which enabled patients to receive the medications quicker by half-an-hour compared to those who did not have nurse-initiated medications. The intervention had no effect on adverse events, doctor wait time and length of stay. Nurse-initiated analgesia was associated with increased likelihood of receiving analgesia, achieving clinically-relevant pain reduction, and better patient satisfaction. CONCLUSION Nurse-initiated medications are safe and beneficial for ED patients. However, randomised controlled studies are required to strengthen the validity of results.

The need to address poor numeracy skills in the emergency department environment

Substantial evidence exists for lack of numerical skills among many health professionals. Although poor numeracy has long been recognised as a contributor to medication error, other activities for which numerical literacy are required, such as interpretation of diagnostic results, have been largely ignored. Poor self‐awareness of lack of numerical literacy increases the risk, especially in the busy and hurried emergency environment. System changes, such as standardising units and improving number presentation, reduce the potential for misinterpretation; however system changes do not address the underlying deficiencies in mathematical skills. The training of doctors in numeracy has been largely ignored. In contrast, education for nurses frequently occurs during both pre‐ and post‐registration programmes. Interventions have had mixed success, although additional emphasis in increasing conceptual understanding of numbers is encouraging. The consequences of poor numerical literacy should be addressed in all clinical staff, not only by practice change to remove the potential for errors to be made, but also complemented by self‐awareness and education.