Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments

Abstract

Background The Self-Management and Care of Heart Failure through Group Clinics Trial (SMAC-HF) evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high risk heart failure (HF) patients. Objective The purpose of this article is to: (1) describe key SMAC-HF group clinic interactive learning strategies; (2) describe resources and materials used in the group clinic appointment; and (3) present results supporting this patient-centered group intervention. Methods This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients’: (1) group clinic session evaluations; (2) HF Self-Care Behaviors Skills; (3) HF related discouragement and quality of life scores and (4) HF related reshopitalizations during the 12 month follow-up. Also the costs of delivery of the group clinical appointments were tabulated. Results Overall, patients rated group appointments as 4.8 out of 5 on the “helpfulness” in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio (IRR) = 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ2(1) = 3.9, p = 0.04). The total cost for implementing five group appointments was $243.58 per patient. Conclusion The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF related hospitalizations.

The effect of nurse-led group discussions by race on depressive symptoms in patients with heart failure

“…The detailed intervention materials and the guided discussion topics in each session were published. 26…”

“…27 This standard HF home care information was delivered by trained HF nurses on the day of hospital discharge in an individual patient session and during one post-hospital telephone call to reinforce HF self-management. 26 This same information was provided throughout the intervention discussions.…”

“…The detailed intervention objectives, discussion topics, and tables of strategies used by professionals in these group discussions have been published. 26 All patients enrolled in the trial had been recently hospitalized for an exacerbation of HF and all had received standard HF hospital care. Standard care included discharge teaching on HF self-care management, medication prescriptions, and scheduling the patients’ first post-hospital physician appointment.…”

Habilidades empáticas na consulta de enfermagem ao cliente com doença cardiovascular: uma revisão integrativa

“…Em sua Teoria de Enfermagem, Travelbee segmentou em fases distintas o processo de relacionamento enfermeiropaciente, com algumas características da divisão realizada por Larsen e Neighbour para consulta, tendo como principal diferença a parte compartilhada entre o cliente e o profissional que tem como foco o autocuidado e o cuidado de si 25 25 . Reforçando a importância da consulta de enfermagem, estudos demonstram que pessoas com doenças cardiovasculares atendidas continuamente por enfermeiros apresentam um menor número de reinternações por complicações relativas à sua doença de base 19,26,27 , causando um benefício individual e também coletivo (devido ao alto custo de internações, licenças médicas e perda de produtividade).…”

“…Em pesquisa com clientes com Insuficiência Cardíaca (IC), a maioria dos participantes escreveu comentários, indicando que "falar sobre" e "compartilhar opiniões com os outros" eram as melhores maneiras de aprender a lidar e gerenciar sua IC 27 , o que mostra a importância do diálogo para manejo da doença.…”