Knowledge and practice about self-care among patients with chronic heart failure at Hop Luc general hospital, Thanh Hoa in 2020

Nội dung text: Knowledge and practice about self-care among patients with chronic heart failure at Hop Luc general hospital, Thanh Hoa in 2020

1. RESEARCH ARTICLE KNOWLEDGE AND PRACTICE ABOUT SELF-CARE AMONG PATIENTS WITH CHRONIC HEART FAILURE AT HOP LUC GENERAL HOSPITAL, THANH HOA IN 2020 Le Thi Lieu1, Vu Van Thanh2, Nguyen Thi Dung2, Mai Thi Yen2 1Hop Luc Medical and Pharmaceutical College, 2Namdinh University of Nursing ABSTRACT Objective: To describe the knowledge was 35.1 ± 17.5 (highest score was 100), and practice about self-care among the mean of practice “care management” patients with chronic heart failure at Hop was 47.2 ± 14.63 (highest score was 100), Luc General Hospital, Thanh Hoa in 2020. the mean of Practice “Confidence in self- Method: A descriptive study was conducted care” was 41.3 ± 15.39 (highest score to collect data by using self-determination was 100). Conclusion: Knowledge and questionnaires from 86 patients with practice about self-care among patients chronic heart failure at Hop Luc General with chronic heart failure in the study is still Hospital,Thanh Hoa from January to May limited. Therefore, health education should 2020. Results: Knowledge and practice be implemented regularly to improve about self-care among patients with chronic knowledge and practice for patients with heart failure at Hop Luc General Hospital chronic heart failure. were still limited, the mean of knowledge Keywords: knowledge, practice, self- was 10.0 ± 2.89 (highest score was 22); care, patients with chronic heart failure. The mean of practice “maintaining care” 1. INTRODUCTION Heart failure is one of the leading causes rate of heart failure in Europe (0.4% - 2%), of hospitalization, and high morbidity it is estimated that Viet Nam has between and mortality rates in many countries [1]. 320,000 and 1.6 million people suffering According to literaturview, around 26 million from heart faiure [4]. The rate of people with people worldwide have heart failure and it heart failure is continue to increase as the is predicted that the incidence will increase population aging [5]. to 25% by 2030 [2]. In the US, the number Heart failure has become a health of people with heart failure has increased problem for all human with rate of re- from 5.7 million, accounting for 2.2% of hospitalization in 30 days after discharge is the population (2012) to 6.5 million people about 25% [6] and a 5-year death rate of (2014), and each year there are about around 50% [3]. Chronic heart failure with a 650,000 new cases [3]. In Viet Nam, there bad prognosis and deterioration is not always are no exactly statistics, but based on the preventable. In fact, more than a half of hospitalized chronic heart failure cases are due to serious illness and are a direct result of poor self-care [7]. Poor self-care such as lack of adherence to medication therapy, Cor. author: Le Thi Lieu failure to comply with salt-restricted diets, Email: lieu.hopluc@gmail.com Received: Nov 15, 2020 fluid restriction, failure to self-monitor daily Revised: Nov 22, 2020 weight, delaying the time of hospitalization Accepted: Mar 05, 2021 in the presence of symptoms of the disease 32 Journal of Nursing Science - Vol. 04 - No. 01
2. RESEARCH ARTICLE will increase. worsen the disease status, 2.4. Sample size and sampling method increase hospitalization rate and increase Sample size: Including 86 patients with the risk of death in patients with chronic chronic heart failure heart failure [8]. Many people with chronic heart failure have poor self-care behavior. Sampling method: Collected all patients In Viet Nam, the elderly with low self-care that met the criteria using the convenient behavior accounting for 50.9% - 83.6% sampling method from January to May 2020 [9], [10]. Self-care is very important in the 2.5. Data collection treatment and prevention of complications caused by chronic heart failure. The All data were collected by using European Heart Association emphasizes questionnaire to interview patients with the importance of self-care as part of chronic heart failure. successful treatment and enhances self- 2.6. Research instruments care for patients by providing educational The research instruments were used in programs that can alleviate symptoms, this study which modified from Atlanta Heart worsening of the disease, reducing the risk Failure Knowledge Test [12] and Self-Care of re-hospitalization, improving quality of of Heart Failure Index [11]. The instruments life and reducing mortality [11]. was translated into VietNamese and used by The study was conducted with the aim: Pham Thi Hong Nhung at Nam Dinh General To describe the knowledge and practice Hospital [13]. The instruments were used about self-care among patients with chronic to do pilot with 30 patients (not in research heart failure at Hop Luc General Hospital, sample) and to verify the reliability before Thanh Hoa in 2020. using, the knowledge coefficient cronbach alpha = 0.89; maintenance practice with 2. RESEARCH METHOD cronbach coefficient alpha = 0.75; Care 2.1. Research subjects management has cronbach alpha coefficient - Patients with chronic heart failure at = 0.88 and confidence in self-care has Hop Luc General Hospital, Thanh Hoa . cronbach alpha coefficient = 0.91. - Inclusion criteria: Patients from 18 Evaluation criteria years old and above. The patient has the Knowledge: Patients participating in the ability to receive and answer interview study answered 22 questions, each correct questions. The patient agrees to participate answer got 1 point, incorrect answer or in the study. no answer got 0 point. The correct and - Exclusion criteria: Patients with incorrect knowledge of the patient is based acute and emergency medical conditions on available knowledge of heart failure receiving intensive treatment. pathology, drug use, weight monitoring, diet and exercise of chronic heart failure 2.2. Setting and research period patients. - Research period: from December 2019 Practice: The score for each behavior to August 2020. depends on the patient’s choice with - Setting: Hop Luc General Hospital, the highest score of 4. Each area of ​​self- Thanh Hoa. care practice (maintenaning care, care management and confidence in self-care) 2.3. Research design is calculated separately from the score Study design: Cross section description. spectrum from 0 - 100 points. Journal of Nursing Science - Vol. 04 - No. 01 33
3. RESEARCH ARTICLE 2.7. Data analysis confidential, and their identity will not be revealed, only use for research purposes. The data were synthesized by using SPSS 20.0 software. Descriptive statistical 3. RESULTS including mean, percentage, standard 3.1. General characteristics of deviation were used to describe knowledge research subjects and practice about self-care among patients with chronic heart failure The majority of participants in the study are the elderly, the age group> 60 years old 2.8. Ethical consideration accounts for 65.1%, the 18-40 age group The research proposal was approved accounts for the lowest percentage (5.8%), by the Ethical Review Board of Nam Dinh female were more than male. Most of the University of Nursing. An informed consent subjects had a certificate from secondary was obtained to ensure that the subjects school (37.2%). The patients lived in rural voluntarily participated in this study. areas (53.5%), in urban areas (46.5%). The Participants have the right to withdraw from patients were (41.9%), farmers (30.2%), the study at any time and public employees (2.3%). Most of patients lived with their families (76.7%) The responses would be kept strictly 3.2. Knowledge and practice about self-care among patients with chronic heart failure at Hop Luc General Hospital. 3.2.1. Knowledge about self-care among patients with chronic heart failure Table 1. Patient’s knowledge about heart failure and drug use (n=86) Correct Incorrect Contents Number % Number % Heart failure Heart failure is a medical condition 36 41.9 50 58.1 The ability to control heart failure 26 30.2 60 69.8 Vaccinations and regular checkups 32 37.2 54 62.8 Drug use The effect of diuretics 34 39.5 52 60.5 When using diuretics must supplement Kali 35 40.7 51 59.3 Patients with heart failure forget to take medicine, need to take them as soon as they 35 40.7 51 59.3 remember Heart failure patients had limited knowledge of heart failure and drug use. More than a half of patients have incorrect knowledge about heart failure and drug use: Heart failure is a medical condition (58.1%); The ability to control heart failure (69.8%); Vaccinations and regular checkups (62.8%); The effect of diuretics (60.5%); When using diuretics must supplement Kali (59.3%); Patients with heart failure forget to take medicine, need to take them as soon as they remember (59.3%). 34 Journal of Nursing Science - Vol. 04 - No. 01
4. RESEARCH ARTICLE Table 2. Knowledge about weight, diet and physical activity of the patients (n=86) Correct Incorrect Contents Number % Number % Weight Knowledge of weight gain in 1-2 days 40 46.5 46 53.5 Self-monitoring daily weight 38 44.2 48 56.8 The best time to weigh is in the morning 42 48.8 44 51.2 The patient should see a doctor or call the health-care worker when gaining weight, edema, 20 23.3 66 76.7 and dyspnea Diet Foods that contain a lot of salt 28 32.6 58 67.4 The foods that contain the least amount of salt 54 62.8 32 37.2 Classification of liquids 33 38.4 53 61.6 Measures to reduce thirst 18 20.9 68 79.1 Physical activity Effects of exercise 17 19.8 69 80.2 When patients with heart failure need to stop 44 51.2 42 48.8 exercising Patients who have correct knowledge of weight, diet and physical activity to improve heart failure are still low, many people do not understand the role of weight monitoring, salt reduction diet, and reduced intake. water in and the effect of physical activity. Table 2 showed some of the main results of knowledge with the lowest percentage of correct knowledge was effects of exercise (19.8%). 3.2.2. Practice about self-care among patients with chronic heart failure Table 3. Practice “Maintaining care” of the patient (n=86) Pass Not pass Contents Number % Number % Keep track of your weight 32 37.2 54 62.8 Watch for leg edema 28 32.5 58 67.5 Prevention of disease 24 27.9 62 72.1 Physical activity 37 43.0 49 57.0 Periodic examination 42 48.9 44 51.1 Salt-reduced diet 28 32.5 58 67.5 Exercise for 30 minutes 20 23.3 66 76.7 Forget to take 1 medicine in the daily 37 33.7 47 66.3 prescription Note to reduce salt when eating at restaurants 16 18.6 70 81.4 There is a reminder to take medicine 24 27.9 62 72.1 Journal of Nursing Science - Vol. 04 - No. 01 35
5. RESEARCH ARTICLE Table 3 showed that the percentage of patients who achieve maintenance practice is very low. The patient has not done well to monitor the signs of disease such as weight gain, Watch for leg edema, very few of the patients follow the diet to reduce salt (35.5%), exercise for 30 minutes (23.3%). and disease prevention (27.9%). 70% 66.3 60% 50% 43 39.5 40% 37.2 31.4 29.1 30% 20% 10% 0% Quickly Practice of Practice of Take an extra See a doctor Certainly recognize reducing salt in reducing the diuretic pill or call a methods help symptoms the diet amount of medical staff improve drinking water dyspnea Figure 1. Practical “Care management” among patients with chronic heart failure (n=86) The percentage of patients who have achieved “care management” were not high. Practicing to reduce salt in the diet, reduce the amount of water, and taking an extra diuretic pill only account for 29.1% to 43.0%. However, the percentage of patients who had achieved practice in terms of seeing a doctor or call a medical staff was higher, accounting for 66.3%. 60% 52.3 50% 41.9 40% 27.9 30% 24.4 18.6 20% 17.4 10% 0% Self-preservation Confident Confident self- Confidently Confident Confidently not to be prescription assess recognize applying assess the manifestations of treatment, symptoms of changes in measures have effectiveness of the disease compliance with heart failure health been instructed measures worsening treatment advice to improve and applied to treat reduce heart failure Figure 2. Practice “Confidence in self-care” among patients with chronic heart failure (n = 86) 36 Journal of Nursing Science - Vol. 04 - No. 01
6. RESEARCH ARTICLE The level of confidence in self-care of heart failure patients was low, only 18.6% of the patients confidently maintain Self-preservation not to be manifestations of the disease worsening; 27.9% of patients confidently self-assess symptoms of heart failure and only 17.4% of patients confidently assess the effectiveness of measures applied to treat. The percentage of patients Confident prescription treatment, compliance with treatment advice (52.3%) and confidently recognize changes in health (41.9%). 3.2.3. Mean of knowledge and practice among patients with chronic heart failure Table 4. Mean of knowledge and practice among patients with chronic heart failure (n=86) Pass score Contents Mean Min Max ( X ± SD) Knowledge 2 17 10.0 ± 2.89 Practice “Maintaining care” 7 83 35.1 ± 17.5 Practice “Management care” 22 84 47.2 ± 14.63 Practice “Confidence in self-care” 11 84 41.3 ± 15.39 The mean of knowledge of patients with chronic heart failure was 10.0 ± 2.89 points out of 22 points. The mean of Practice “maintaining care” was 35.1 ± 17.5 points out of 100, the lowest score was 7, the highest score was 83; The mean of Practice “Management care” was 47.2 ± 14.63 points out of 100, the lowest score was 22, the highest score was 84; The mean of practice “Confidence in self-care” was 41.3 ± 15.39 points out of the total score of 100, the lowest score was 11, the highest score was 84. 4. DISCUSSION Most of the subjects had a certificate from secondary school (37.2%). This study 4.1. General characteristics of research subjects result is similar to the research of Tran Thi Ngoc Anh [1], the study of Nguyen Ngoc The study collected data from 86 patients Huyen in 2013 [3] and the study of Pham with chronic heart failure at Hop Luc General Thi Hong Nhung in 2018 [2]. Patients Hospital. The majority of subjects was the with low education often lack knowledge elderly group (> 60 years old), accounting about prevention of diseases including for 65.1% . The finding is similar to the study cardiovascular disease and do not have the of Tran Thi Ngoc Anh at the Viet Nam Heart economic conditions to check their health Institute in 2016 [1], Pham Thi Hong Nhung regularly, so they cannot detect symptoms at the Department of Cardiology - Nam Dinh of heart failure early. General Hospital in 2018 [2] and a study of 89 patients with heart failure hospitalized in 4.2. Knowledge about self-care the Department of Cardiology - Hue Central among people with chronic heart failure Hospital in 2017 [2]. The elderly are faced with aging and impaired function including Research shows that the status of self- the cardiovascular system, which is also a care knowledge of patients with chronic risk factor for cardiovascular diseases. heart failure treated at Hop Luc General Journal of Nursing Science - Vol. 04 - No. 01 37
7. RESEARCH ARTICLE Hospital was limited. The mean of general is in the morning. However, patient had knowledge was only 10.0 ± 2.89 out of the correct knowledge about diet and exercise total score of 22. This result is equivalent to was lower than Tran Thi Ngoc Anh’s study the research of Tran Thi Ngoc Anh [1] with [1] with 52.5% of correct knowledge of foods the general knowledge score of patients containing high salt and liquid classification, with heart failure of 11.9 ± 2.8 and Pham Thi 88.5% and 87% of patients know which Hong Nhung [4] with average knowledge foods contain low salt and have correct score of 10.41 ± 3.54 points out of a total knowledge about stopping exercise if there score of 22. are signs of difficulty breathing, chest pain, and dizziness. The results difference Their knowledge of heart failure disease between these two studies may be due and drug use remains low: The percentage to different sample sizes, different study of patients with correct knowledge setting and the educational level of patients was only from 23.3% to 41.9%. This in ​​the two different studies. result is similar to Tran Thi Ngoc Anh’s study [1] with 43% of subjects correctly Patients in other countries had much understanding the concept of heart failure, better knowledge, according to Wal MH 32.5% of subjects correctly understanding et al. [4], 84% of the subjects understand controllable heart failure and Pham Thi the effects of diuretics, 80% of the subjects Hong Nhung’s study in 2018 [2] only 41.1% perception the importance of daily exercise of the respondents correctly understood and 99% of subjects knew when to stop the concept of heart failure, 31.1% of the exercising. respondents correctly understood that 4.3. Practice about self-care among heart failure can be controlled, and 37.8% people with chronic heart failure of the respondents correctly understood the concept of controllable heart failure, 20% Practice about self-care among people of respondents correctly understand that with chronic heart failure at Hop Luc when using diuretics, they must add more General Hospital is limited in 3 areas: kali and 30% of them understand correctly mean of maintenaning care was 35.1 ± when forgetting to take the drug, they 17.5 points out of 100; The mean of care should take it as soon as they remember. management was 47.2 ± 14.63 points; The It have been explained that the patient mean of Confidence in self-care was 41.3 has not actively searched for information ± 15.39 points out of the total score of 100. from many information sources, but mainly This result is supported from the research received information from medical staff, of Pham Thi Hong Nhung [1] with the mean while the hospital was often overcrowded, of practice (41.52 ± 20.51), maintenaning the number of patients coming for medical care (35.56 ± 15.21), care management examination and treatment was too high. It (35.56 ± 15.21), Confidence in self-care was so big that the medical staff could not (50.45 ± 16.11). This finding is higher explain the disease to the patient. than study in Iran in 2013 [2] with mean of maintenaning care (18.5 ± 12); the mean Patients with correct knowledge of of care management (11.9 ± 11.19) points; weight gain in 1-2 days, self-monitoring Mean of confidence in self-care (10.6 ± daily weight, the best time to weigh in the 13.3). morning is consistent with research of Tran Thi Ngoc Anh [1] with 46% of patients had For maintaining care, the number of the right knowledge of the best time to weigh people achieving practice is still very low: 38 Journal of Nursing Science - Vol. 04 - No. 01
8. RESEARCH ARTICLE The percentage of patients who achieve acquire knowledge about heart failure and practice was only from 18.6% to 37.2%. self-care in heart failure. When patients have This result is simiar to the study of Pham better knowledge, they adhere to better Thi Hong Nhung [1] that 22.2% of patients treatment and can implement effective regularly monitor their weight, 36.9% of self-care behaviors. Many studies had also the patients reduce salt daily. This result is shown that the knowledge of heart failure is lower than in Tran Thi Ngoc Anh’s study [3] a factor influencing self-care behavior [6], with patients who regularly eat and reduce [3], [4]. Therefore, to improve knowledge salt by 77% and Nguyen Thi Hong Hai’s and practice about self-care for patients study [4] with 54% of patients monitoring with chronic heart failure, it is necessary to leg edema, , 43% of the patients agree that implement health education interventions. “I eat bland”. 5. CONCLUSION For care management, patients had limited practice. The results in this study Patients with chronic heart failure had is higher than study of Pham Thi Hong limited knowledge and practice about Nhung [1] with 24.7% of the patients quickly self-care. The mean of knowledge among recognized the symptoms and reduced patients with chronic heart failure only salt intake; Only 16% of patients reduce reached 10.0 ± 2.89 out of 22 points; Self- the amount of water they drink; 17.3% of care knowledge helps to control the disease the respondents will definitely implement and reduces the worsening symptoms of the above measures to help improve the heart failure such as salt restriction, reduced swelling, difficulty breathing. water intake, kali supplementation when taking diuretics, and low physical activity. For confidence in self-care, only 18.6% Practice of “Maintaining care” only reached of the patients confidently maintain Self- 35.1 ± 17.5 points out of the total score preservation not to be manifestations of of 100; Practice of “Care management” the disease worsening; 27.9% of patients reached 47.2 ± 14.63 points out of the total confidently self-assess symptoms of score of 100; Practice of “Confident in self- heart failure and only 17.4% of patients care” reached 41.3 ± 15.39 points out of the confidently assess the effectiveness of total score of 100. measures applied to treat. The percentage of patients Confident prescription treatment, Therefore, in order to enhance compliance with treatment advice (52.3%) knowledge and practice of self-care for and confidently recognize changes in health patients with chronic heart failure at Hop (41.9%). The results is similar to the study Luc General Hospital, it is necessary to of Pham Thi Hong Nhung [5], patients who implement health education intervention. confidently maintained themselves in order REFERENCES not to suffer from worsening manifestations of heart failure (50.6%); Confidence in 1. World Health Organization (2010), prescription treatment (55.6%); confident in Global status report on noncommunicable recognizing health changes (37.0%). diseases, Available at: who.int/iris/bitstream/10665/44579/ Orem (2001) demonstrated that 1/9789240686458_eng.pdf, Accessed: knowledge is essential for improving self- 9/10/2017. care behavior. Health education for patients with chronic heart failure helps them to 2. Ponikowski P, Anker S. D, AlHabib Journal of Nursing Science - Vol. 04 - No. 01 39
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