Does nurse-led interventions improve self-care behaviors among patients with heart failure? Results of a systematic review and meta-analysis

Background\r\nHeart failure is the most common cause of hospitalization for\r\nadults over the age of 65 years. The World Health Organization\r\nReport on therapeutic patient education recognizes the\r\nimportance of patient centered education in the effective\r\nmanagement of chronic diseases. It has been recognized that\r\nadoption of self-management skills by persons with chronic\r\ndiseases is necessary to enable them to manage their condition.\r\nThis meta-analysis evaluates the effectiveness of the nurse-led\r\nself-management interventions to improve self-care behaviors\r\namong patients.\r\nMethods\r\nRelevant major electronic databases were searched from\r\ninception to February 2014. All randomized controlled trials\r\n(RCTs) that compared nurse led self-management education\r\nwith routine treatment were included in the systematic review.\r\nFor meta-analyses of continuous data, standardized mean\r\ndifference (SMD), along with 95% confidence interval (CI),\r\nwas calculated because the same underlying concept was\r\nmeasured using different outcome measurements.\r\nResults\r\nSeven studies were included in the meta-analysis for a total of\r\n942 participants, 493 (52.3%) of which were in the intervention\r\ngroup. Four studies involving 406 participants assessed\r\nthe self-care abilities at 3 months (short term). The SMD was\r\n0.64 (95%CI 0.19–1.10) in favor of the self-management\r\neducation intervention. Four studies with a total of 707\r\nparticipants reported on self-care abilities at 6-9 months\r\n(intermediate term) while the long-term effect of the\r\neducational intervention was assessed by two studies, with\r\nnot statistically significant results in both cases (SMD 0.45;\r\n95%CI -0.12–1.02 and SMD 0.06; 95%CI -0.15–0.26,\r\nrespectively).\r\nConclusions\r\nSupportive nursing educational interventions improve the selfcare\r\nbehavior in patients with heart failure but only in the\r\nshort period. Educational interventions should be reconsidered\r\nin a perspective of continuity of care. For this reason an\r\neffective discharge planning is crucial to guarantee continuity\r\nin an intermediate care framework.\r\nKey message\r\n Promoting self-care in chronic patients is necessary to\r\nenable them to manage their condition.