Parallel paths to improve heart failure outcomes: evidence matters.
Parallel paths to improve heart failure outcomes: evidence matters.
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改善心力衰竭结果的并行途径：证据很重要。
DOI：
10.4037/ajcc2013212
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
N. Albert
中科院分区：
文献类型：
--
作者：
N. Albert
护士在心力衰竭教育方面的差距和差异以及晚期心力衰竭患者在完成自我保健行为方面的表现可能是临床失代偿和计划外医疗保健消费的因素。出院前是否有效地提供了护士主导的教育？护士长必须了解护士与自我护理原则相关的知识库的实力以及最佳实践的重要障碍。护士可能不愿意向患者传授干体重、膳食计划、心力衰竭药物或渐进式活动和锻炼步骤。此外，临床护士可能没有时间在出院前向患者提供深入的教育。同样重要的是，需要进行研究来了解增强患者对心力衰竭自我护理行为依从性的因素，因为遵守国家循证心力衰竭指南的建议可以改善临床结果。因此，护士和患者在为改善晚期心力衰竭患者的自我护理依从性奠定基础方面处于平行的道路上。通过研究，我们发现护士作为心力衰竭教育者没有做好充分准备，患者也不相信他们能够控制心力衰竭。在两项旨在帮助患者了解他们可以控制液体管理并遵循严格的每日液体限制的教育干预研究中，患者的临床结果得到了改善。因此，对心力衰竭的误解可以通过干预措施来克服，而不仅仅是传达建议的“什么”自我护理行为。研究结果表明证据很重要！需要系统和流程来支持护士在出院前提供自我护理教育的知识、舒适度和频率，提高患者控制心力衰竭信念的准确性，并增强患者遵守指南推荐的心力衰竭自我护理行为的愿望。本文描述了护士和患者研究项目并行路径的发展，并探讨了将研究结果转化为实践和临床转化研究的发展。
Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before hospital discharge? Nurse leaders must understand the strength of nurses' knowledge base related to self-care principles and important barriers to best practice. Nurses may not be comfortable teaching patients about dry weight, meal planning, heart failure medications, or progressive steps of activity and exercise. Further, clinical nurses may not have time to provide in-depth education to patients before discharge. Equally important, research is needed to learn about factors that enhance patients' adherence to heart failure self-care behaviors, because adherence to recommendations of national, evidence-based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators and that patients did not believe they were able to control heart failure. In 2 educational intervention studies that aimed to help patients understand that they could control fluid management and follow a strict daily fluid limit, patients had improved clinical outcomes. Thus, misperceptions about heart failure can be overcome with interventions that move beyond communicating "what" self-care behaviors are recommended. Research results reflect that evidence matters! Systems and processes are needed to support nurses' knowledge, comfort, and frequency in delivering self-care education before discharge, increase the accuracy of patients' beliefs about controlling heart failure, and enhance patients' desire to adhere to guideline-recommended heart failure self-care behaviors. This article describes the development of the parallel paths of nurse and patient programs of research and explores translation of findings into practice and development of clinical translational research.