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Abstract
Purpose
This study was conducted to examine the effects of tailored supportive education on physical, psychological status and quality of life in the patients with congestive heart failure (CHF) who had not participated previously in cardiac rehabilitation program.
Methods
This study was used a non-equivalent control pre-post design, conducted on 64 CHF patients under medical treatment in a hospital. The experimental group (n=31) received the tailored supportive educational program (once 1~2 days before discharge and 6 times after discharge through outpatient visits or telephone contact: once every week for the first 4 weeks after discharge and once every 2 weeks for the remaining 4 weeks). The control group (n=33) received a traditional discharge education. Data were analyzed using descriptive statistics, x2-test, Fisher's exact test, t-test and repeated measure ANOVA using the SPSS/ WIN 18.0 program.
Results
Participants in the experimental group showed the significantly increased scores of the quality of life (F=16.01, p <.001), and the significantly decreased scores of physical function (F=7.27, p =.009), depression (F=8.25, p =.006) and anxiety (F=4.11, p =.047), when compared to those of the control group.
REFERENCES
Austin J.., Williams R.., Ross L.., Moseley L.., Hutchison S.2005. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. The European Journal of Heart Failure. 7:411–417.
Delaney C.., Apostolidis B.2010. Pilot testing of a multicomponent home care intervention for older adults with heart failure: An academic clinical partnership. Journal of Cardiovascular Nursing. 25(5):27–40. http://dx.doi.org/10.1097/JCN.0b013e3181da2f79.
Faul F.., Erdfelder E.., Lang A. G.., Buchner A.2007. G∗ Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 39:175–191.
Gary R. A.., Dunbar S. B.., Higgins M. K.., Musselman D. L.., Smith A. L.2010. Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure. Journal of Psychosomatics Research. 69:119–131. http://dx.doi.org/10.1016/j.jpsychores.2010.01.013.
Heart Failure Society of America. 2006. Educational modules on heart failure. Retrieved February 15, 2002, from HFSA Web site:. http://www.hfsa.org/heart_failure_education_modules.asp.
Jessup M.., Abraham W. T.., Casey D. E.., Feldman A. M.., Francis G. S.., Ganiats T. G., et al. 2009. Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults. Circulation. 119:1977–2016. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064. Epub 2009 Mar 26.
Juenger J.., Schellberg D.., Kraemer S.., Haunstetter A.., Zugck C.., Herzog W., et al. 2002. Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart. 87:235–241.
Kim C. J.., Kim G Y.., Noh Y. S.., Song E. K.., Kang S. M.., Yoo M. S., et al. 2006. Relationship between psychosocial factors and symptom experience in patients with cardiovascular disease: Over a six-month follow-up period. The Korean Journal of Fundamentals of Nursing. 13(1):76–85.
Kim Y. S.2007. A path analysis model of health-related quality of life in patients with heart failure. Korean Journal of Adult Nursing. 19:547–555.
Koelling T. M.., Johnson M. L.., Cody R. J.., Aaronson K. D.2005. Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation. 111:179–185.
Kulcu D. G.., Kurtais Y.., Tur B. S.., Gülec S.., Seckin B.2007. The effect of cardiac rehabilitation on quality of life, anxiety and depression in patients with congestive heart failure: A randomized controlled trial, short-term results. Europa Me-dicophysica. 43:489–497.
Lee L. Y.., Lee D. T.., Woo J.2009. Tai chi and health-related quality of life in nursing home residents. Journal of Nursing Scholarship. 41(1):35–43.
Lee S. H.., Ahn S. H.2005. Self care compliance, family support, and depression in patients with congestive heart failure. The Korean Journal of Fundamentals of Nursing. 12:186–194.
Lenz E. R.., Pugh L. C.., Milligan R. A.., Gift A.., Suppe F.1997. The middle-range theory of unpleasant symptoms: An update. Advanced Nursing Science. 19(3):14–27.
Lewis S. M.., Heitkemper M. M.., Dirksen S. R.., O'brien P. G.., Giddens J. F.., Bucher L.2004. Medical-surgical nursing: Assessment and management of clinical problems. 6th ed.St. Louis, Missouri: Mosby.
Moser D. K.., Watkins J. F.2008. Conceptualizing self-care in heart failure: A life course model of patient characteristics. Journal of Cardiovascular Nursing. 23:205–218. http://dx.doi.org/10.1097/01.JCN.0000305097.09710.a5.
O'Connor C. M.., Whellan D. J.., Lee K. L.., Keteyian S. J.., Cooper L. S.., Ellis S. J., et al. 2009. Efficacy and safety of exercise training in patients with chronic heart failure. Journal of American Medical Association. 301:1439–1450. http://dx.doi.org/10.1001/jama.2009.454.
Oh S. M.., Min K. J.., Park D. B.1999. A study on the standardization of the hospital anxiety and depressed scale for Koreans. Journal of the Korean Neuropsychiatric Association. 38:289–296.
Palmer N. D.., Appleton B.., Rodregues E. A.2003. Specialist nurse-led intervention in outpatients with congestive heart failure: Impact on clinical and economic outcomes. Disease Management & Health Outcomes. 11:693–698.
Park K. S.2007. A study on the difference in perception on educational needs in patients with heart failure and nurses. Unpublished master's thesis, Hanyang University, Seoul.
Rector T. S.., Kubo S. H.., Cohn J. N.1987. Patient's self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure, the minnesota living with heart failure questionnaire. Heart Failure. 3:198–207.
Riegel B.., Carlson B.., Glaser D.2000. Development and testing of a clinical tool measuring self-management of heart failure. Heart & Lung. 29(1):4–15.
Song E. K.2005. Effect of a telephone monitoring on self- management & symptom experiences in patients with heart failure. Korean Journal of Adult Nursing. 17(1):56–67.
Song E. K.., Kim C. J.., Yoo I. Y.., Kim G. Y.., Kim J. H.., Ha J. W.2006. Factors influencing functional status in patients with heart failure. Journal of Korean Academy Nursing. 36:853–862.
Statistics Korea. 2010. Cause of death statistics table. Retrieved July 15, 2012, from Web site:. http://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.board?bmode=read&bSeq=&aSeq=250282&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=.
Sung J. D.., On Y. K.., Kim H. S.., Chae I. H.., Sohn D. W.., Oh B. H., et al. 2000. Development of Korean activity scale/index (KASI). Korean Circulation Journal. 30:1004–1009.
Tahylor-Piliae R. E.., Haskell W. L.., Waters C. M.., Froelicher E. S.2006. Change in perceived psychosocial status following a 12-week tai chi exercise programme. Journal of Advanced Nursing. 54:313–329.
Yeh G. Y.., Wayne P. M.., Phillips R. S.2008. Tai chi exercise in patients with chronic heart failure. Medical Sport Science, Basel, Karger. 52:195–208. http://dx.doi.org/10.1159/000134300.
Yu D. S.., Lee D. T.., Woo J.2010. Improving health-related quality of life patients with chronic heart failure: Effects of relaxation therapy. Journal of Advanced Nursing. 66:392–403. http://dx.doi.org/10.1111/j.1365-2648.2009.05198.x.
Zigmond A. S.., Snaith R. P.1983. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 67:361–370.
Table 1.
Homogeneity Test on Demographic and Clinical Characteristics of Subjects (N=64)
| Variables | Categories | Exp. (n=31) | Cont. (n=33) | x2 or t | p |
|---|---|---|---|---|---|
| n (%) or M±SD | n (%) or M±SD | ||||
| Gender | Male | 13 (41.9) | 18 (54.5) | 1.02 | .313 |
| Female | 18 (58.1) | 15 (45.5) | |||
| Age (year) | 65.4±14.5 | 63.1±12.2 | 0.68 | .501 | |
| ≥70 | 15 (48.3) | 13 (39.4) | |||
| ＜70 | 16 (51.7) | 20 (60.6) | |||
| Marital status | Married | 25 (80.6) | 31 (93.9) | - | .142† |
| Single | 6 (19.4) | 2 (6.1) | |||
| Education level | ≤Middle school | 22 (70.9) | 22 (66.7) | 0.14 | .711 |
| ≥High school | 9 (29.1) | 11 (33.3) | |||
| Occupation | Employed | 17 (54.8) | 16 (48.5) | 0.26 | .611 |
| Unemployed | 14 (45.2) | 17 (51.5) | |||
| Household income (10,000 won) | ＞100 | 8 (25.8) | 5 (15.2) | 1.12 | .290 |
| ≤100 | 23 (74.2) | 28 (84.8) | |||
| BMI (kg/m2) | 23.4±3.5 | 24.1±3.6 | 0.01 | .942 | |
| ＞25 | 11 (35.5) | 12 (36.4) | |||
| ≤25 | 20 (64.5) | 21 (63.6) | |||
| Comorbidity‡ | DM (yes) | 10 (32.3) | 8 (24.2) | 0.78 | .437 |
| Hypertension (yes) | 16 (51.6) | 13 (39.4) | |||
| NYHA class | II | 20 (64.5) | 24 (72.7) | 0.50 | .479 |
| III | 11 (35.5) | 9 (27.3) | |||
| LVEF (%) | ＜40 | 16 (51.6) | 13 (39.4) | 0.96 | .326 |
| ≥40 | 15 (48.4) | 20 (60.6) | |||
| Pulmonary edema | Yes | 20 (64.5) | 25 (75.8) | 0.97 | .325 |
| No | 11 (35.5) | 8 (24.2) |
Table 2.
Homogeneity Test on Dependent Variables (N=64)
Table 3.
Effect of Intervention on Physical, Emotional Status and Quality of Life of the Study Subjects (N=64)
| Variables | Categories | Groups | Pretest | Posttest 1 (after 4 week) | Posttest 2 (after 8 week) | Source | F† | p |
|---|---|---|---|---|---|---|---|---|
| M±SD | M±SD | M±SD | ||||||
| Physical status | Physical symptoms | Exp. (n=31) | 16.55±3.15 | 13.42±3.45 | 13.29±3.06 | Group | 0.15 | .701 |
| Cont. (n=33) | 15.55±3.73 | 14.33±3.59 | 14.24±3.54 | Time | 3.84 | .027 | ||
| t (p) | 1.16 (.251) | -1.04 (.303) | -1.15 (.255) | Group×Time | 4.78 | .033 | ||
| Physical function | Exp. (n=31) | 26.34±17.18 | 31.22±17.48 | 39.05±16.47 | Group | 0.01 | .943 | |
| Cont. (n=33) | 31.85±18.61 | 33.50±14.81 | 30.52±17.46 | Time | 3.96 | .024 | ||
| t (p) | -1.23 (.224) | -0.57 (.574) | 2.01 (.049) | Group×Time | 7.27 | .009 | ||
| Emotional status | l Depression | Exp. (n=31) | 12.32±1.97 | 11.87±1.96 | 10.61±1.82 | Group | 0.01 | .939 |
| Cont. (n=33) | 11.42±3.02 | 11.73±2.49 | 11.76±2.14 | Time | 5.03 | .010 | ||
| t (p) | 1.40 (.167) | 0.26 (.799) | -2.30 (.025) | Group×Time | 8.15 | .006 | ||
| Anxiety | Exp. (n=31) | 6.39±3.39 | 5.06±3.47 | 4.03±2.44 | Group | 0.80 | .376 | |
| Cont. (n=33) | 5.76±3.49 | 5.55±3.54 | 6.00±3.64 | Time | 3.98 | .024 | ||
| t (p) | 0.73 (.468) | -0.55 (.585) | -2.55 (.013) | Group×Time | 6.52 | .013 | ||
| Quality of life | Exp. (n=31) | 38.74±10.16 | 35.74±10.29 | 34.90±8.89 | Group | 1.57 | .215 | |
| Cont. (n=33) | 38.21±12.90 | 38.52±12.09 | 42.73±13.37 | Time | 7.99 | .001 | ||
| t (p) | 1.82 (.856) | -0.99 (.328) | -2.77 (.008) | Group×Time | 16.01 | ＜.001 |
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