Aims Home‐based interventions for heart failure (HF) patients might be particularly effective in middle‐income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment. Methods and results HELEN‐II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse‐based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN‐II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow‐up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤24 h), a hospital readmission (>24 h), or all‐cause death, assessed during the first 6 months of follow‐up. Most enrolled subjects were middle‐aged (62 ± 13 years) males (63%) in NYHA functional class II–III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54–0.99; P = 0.049). At the end of follow‐up, the rate of use of the standard‐of‐care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self‐care were significantly increased in the interventional group. Conclusions A post‐discharge, nurse‐led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle‐income country. Trial registration NCT01213875

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Objective: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. Methods: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. Results: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001). Conclusion: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862 Visita domiciliar mejora conocimiento, auto cuidado, adhesión en la insuficiencia cardíaca: Ensayo Clínico Aleatorizado HELEN -IObjetivo: Verificar el efecto de una intervención educativa de enfermería combinada de visita domiciliaria y contacto telefónico en pacientes con internación reciente por insuficiencia cardiaca descompensada, en el conocimiento de la enfermedad, las habilidades para el autocuidado y la adhesión al tratamiento comparado con el acompañamiento convencional de pacientes en el período de seis meses. Métodos: Ensayo Clínico Aleatorizado en pacientes que fueron ingresados recientemente por insuficiencia cardiaca descompensada. El grupo intervención recibió cuatro visitas domiciliarias y cuatro contactos telefónicos para reforzar las orientaciones en seis meses de acompañamiento; el grupo control recibió acompañamiento convencional sin visitas y sin contactos telefónicos. Resultados: Fueron aleatorizados doscientos pacientes (101: intervención y 99: control). Tras seis meses, se observó una mejoría significativa en el conocimiento y el autocuidado para el grupo intervención (P=0,001 y P<0,001), respectivamente; la adhesión al tratamiento, comparada al final entre los grupos, fue significativamente mayor en el grupo intervención (P<0,001). Conclusión: La estrategia de visita domiciliaria para pacientes internados recientemente por insuficiencia cardiaca descompensada fue efectiva en la mejora de los desenlaces evaluados y su implementación merece ser considerada en Brasil con objeto de evitar internaciones no planificadas. NCT- 01213862Descriptores: Aprendizage; Autocuidado; Cooperación del Paciente; Enfermagem; Visita Domiciliaria.

Objective: to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care. Method: an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017. Results: 29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years. Conclusion: variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.