Illness Representation and Self-care Behaviors in Patients with Heart Failure: Effects of a Nurse led Educational Intervention Based on the Commonsense Model

• Main Authors: Wan-TzuChang, 張婉慈
• Other Authors: Hsing-Mei Chen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/p3zr4y

碩士 === 國立成功大學 === 護理學系 === 106 === Purpose: The purpose of this study was to examine the effect of a nursing led patient education based on commonsense model on self-care behaviors in patients with heart failure three months after discharge. Method: This was an experimental design and a convenience sampling study. The study recruited participants at a cardiology ward of a medical center in southern Taiwan. The participants were randomly assigned to 2 groups, and completed questionnaires at baseline, 1 month, and 3 months after discharge. The inclusion criteria: heart failure diagnosed (NYHA class II to III) by physicians, aged above 20 years, able to communicate with Mandarin or Taiwanese, performing activities of daily living independently. There were 107 participants (n=58 in intervention group vs. n=49 in usual care group), and there were 62 participaents finished 3-month follow-up (n=30 vs. n=32). Both groups received usual care and heart failure brochure. The researcher provided a 20-60 minutes of patient education to the participants in the intervention group based on their baseline illness representation score. Two groups completed the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index with telephone follow-ups between the data collection time periods. Data were analyzed using independent t-tests and liner mixed effect model, and the missing data were performed by using direct maximum likelihood estimation. Results: Results showed that the mean age for the total participants was 62 yeas old (64 years old of the intervention group vs. 60 years old of the usual care group). There were no statistically significant differences in demographic data between the 2 groups. There were 78.5% of patients held misperceptions of the cause of heart failure, but the majority of illness representation single-item scores tended to be consistent with the healthcare providers. There were no sidnificant differences between 2 groups in the illness representation total score, identity, timeline, control and consequences on effect of time, group and the interaction between time and group. The self-care confidence mean scores were 59 in the intervention group and 53 in the usual care group at baseline. There were significant differences on the effect of groups (p〈.001) and the interaction between time and groups (p〈.05) in self-care confidence in the liner mixed effect model. The post hoc tests showed that there were significant differences between 2 groups at the 1st month (p〈.05), 3rd month (p〈.001) and the gain between 3rd month and baseline (p〈.01). The self-care maintenance mean scores were 54 in the intervention group and 56 in the usual care group at baseline. There was a significant difference between 2 groups in self-care maintenance on the effect of time (p〈.001), but no significant differences on the effect of groups and interaction between time and groups. Conclusion: The study showed that the two groups had consistent illness representation with the healthcare providers but poor self-care behaviors. There were no significant improvements of self-care in the intervention group after receiving the illness representation education based on commonsense model and 3-month telephone follow-up. Despite the poor self-care confidence, the education could maintain the patients’ confidence.