An integrative review of interventions promoting self-care of patients with heart failure.

AIM AND OBJECTIVE To examine the interventions used to improve self-care of heart failure patients. The specific objectives were to examine the efficacy of interventions to improve heart failure self-care (self-maintenance and self-management behaviours) and patient-related factors such as knowledge about heart failure, self-efficacy for heart failure self-care (confidence) and beliefs regarding heart failure self-care. BACKGROUND Despite the significant advances in the treatment and management of heart failure, there continues to be poor patient outcomes associated with this clinical syndrome. DESIGN An integrative review. METHOD A search of MEDLINE, PsychINFO, Cochrane data base of clinical trials and the cumulative index of nursing and allied health literature (CINAHL) databases was conducted using 14 search terms for a period from 2000-2010. Hand searching of reference lists and author lists was also conducted. Nineteen eligible self-care intervention studies were included in this review. RESULTS Cognitive-behavioural intervention mechanisms were most frequently used to improve patient's heart failure self-care. In the majority of the studies, the interventions demonstrated efficacy by improving heart failure patients' self-care maintenance and management behaviours. Intervention group subjects, in the majority of studies, had significantly higher levels of knowledge pertaining to heart failure and heart failure related self-care. RELEVANCE TO CLINICAL PRACTICE Based on these findings, there are improved patient outcomes when standard patient education for heart failure is augmented using cognitive-behavioural strategies that include additional evidence-based education and counselling.