Iran Journal of Nursing

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Zahed Nakhjiri L, Darvishpour A, Pourghane P, Gholami Chaboki B. Assessing the Self-care Status in Older Adults Diagnosed with Heart Failure and Hospitalized in the Cardiovascular Intensive Care Units of the Public Hospitals in the East of Guilan, Iran (2020). IJN 2021; 34 (129) :67-81
URL: http://ijn.iums.ac.ir/article-1-3389-en.html

Background & Aims: One of the most common diseases during old age is cardiovascular disease. Heart failure is the leading cause of death, disease, hospitalization, and poor quality of life. There are different approaches for controlling heart failure, including self-care, and adherence to self-care behaviors in patients suffering from this disease is very important. People with effective self-care have a better quality of life, and mortality and readmission rates are lower among these people than those with poor self-care. Medication adherence, diet adherence, rest, improving sleep quality and life quality, knowing how to control emotions, and self-care could help control the complications and problems associated with this disease. Meanwhile, knowing how to perform self-care is very important. Despite the importance of self-care in positive health outcomes, many patients with heart failure have inadequate self-care behaviors. Considering the role of nurses in health promotion and instruction of self-care behaviors, they can plan interventions to promote the patients' self-care behaviors and consequently the quality of life in patients diagnosed with heart failure. The present study aimed to determine self-care status in older adults diagnosed with heart failure.
Materials & Methods: This article reports part of the results of a larger cross-sectional study. The study population consisted of the elderly with heart failure hospitalized in the cardiovascular intensive care units of East Guilan public hospitals in 2020. A sample of 125 patients was selected from the population via convenience sampling. The sample of the study met the inclusion and exclusion criteria. Inclusion criteria were: age 60 years and older, heart failure based on clinical signs, electrocardiography (ECG) and echocardiography showing an ejection fraction of less than 40%, functional class II to IV based on the patient medical file and the approval of a cardiologist, the ability to communicate, and informed consent to participate in the study. Patients with severe mental or cognitive impairments, history of neurological problems, cerebrovascular accidents, transient ischemic attack, short-term memory impairment or dementia, mental instability (according to medical records), inability to speak, auditory and visual impairments, and Charlson comorbidity index of 1-2 were not included in the study, and the exclusion criteria included incomplete completion of the questionnaire and unwillingness to continue collaborating in the study. The research instruments included demographic characteristics questionnaire and the self-care of heart failure index (SCHFI) questionnaire. Cronbach’s alpha was used to check the reliability of the SCHFI in the present study which was 0.82. Sampling lasted from late May to December 2020. Having obtained permission from the ethics committee of Guilan University of Medical Sciences and relevant officials, the researcher referred to the mentioned medical centers, selected the research units, introduced himself, provided sufficient explanations about the purpose of the research, obtained their written consent, and distributed the questionnaires to be completed during the interview. Data were analyzed using descriptive statistics (frequency, mean, and standard deviation) in SPSS 16.
Results: The analysis of the questionnaires revealed that most patients (55.2%) were male, aged 75-90 (54.4%), married (57.6%), with average monthly income (60%), and illiterate (72%). The findings showed that the patients of the study obtained 67.16 ± 10.96 for self-care items, 28.94 ± 4.39 for self-care maintenance, 17.98 ± 3.96 for self-care management, and 20.49 ± 4.05 for self-care confidence. The scores of most participants were satisfactory in terms of total self-care (75.2%) and its subscales including self-care maintenance (59.2%), self-care management (69.6%), and self-care confidence (82.4%). The optimal self-care status was considered satisfactory in terms of adherence to self-care behaviors, self-care management, and self-care maintenance, respectively. The optimal self-care status belonged to self-care confidence, self-care management, and self-care maintenance, respectively. Regarding the items on the self-care maintenance subscale, the best self-care behaviors were self-protection measures to prevent illnesses, a low-salt diet, and regular visits to a physician or a health center to assess heart condition, respectively, and the most inappropriate self-care behaviors were related to exercise and daily weight.
Conclusion: The findings showed that the self-care status of patients with heart failure is generally satisfactory. Despite the study findings, it is essential to pay more attention to nursing care and treatments that promote self-care behaviors in older adults especially in self-care behaviors related to exercise and daily weighing. It is suggested that hospitals offer educational classes to improve the knowledge, attitude, and self-care practices in patients with heart failure.