The Essay On Psychological Interventions And Physical Exercise In Chronic Heart Failure Patients.

You are provided with a case study. You are asked to select 3 articles that best provide evidence-based guidance for the patient in the case study.

There are three parts to this task:

Part 1: Annotated Bibliography

Part 2: Justification for your choice of articles

Part 3: Recommendations for patient/clinical practice

William, a 75-year old overweight man, has arrived at the general practice clinic where you are currently working as a Registered Nurse. William is breathless, has visible peripheral oedema and tachycardia. In 2017, William was diagnosed with chronic heart failure as a result of ischaemic cardiomyopathy and hypertension. He states that in the past few days he has experienced distressing shortness of breath and is becoming increasingly unwell.

Select each article that you believe best provides evidence-based guidance on how William can better manage his condition.

Overview of the Research Studies

The systematic review of the randomised control trial, conducted by Jiang, Shorey, Seah, Chan, Tam and Wang (2018) aimed towards examining the overall impact of the psychological interventions in increase the provision of self-care, psychological health and overall health outcomes of the patients who have encountered chronic heart failure (CHF). The authors reviewed 29 randomised control trial (RCT) articles that are published with the last 10 years. While the selection of the articles within the last 10 years helped the author to provide the current approach of the evidence based practice, but a total of 29 articles showed a reduced sample size that might lead to biased results (Parahoo, 2014). The analysis of the RCT studies showed that psychological interventions are effective in improving the overall skills of self-care among the CHF patients. However, the significance is only positively associated with the patients who are free from cognitive problems and clinical depression. The study also revealed that implementation of the psychological interventions help to improve the comprehensive health and well-being by improving health-related quality of life of the patients. However, authors failed to highlight any significant correlation with the psychological interventions and anxiety management. Moreover, the review of the articles also failed to provide the underlying approach of how psychological interventions are helping to improve the quality of life of post CHR patients.

The study conducted by Molloy et al. (2012) attempted to provide an evidence-based practice in improving the overall medication adherence of the people suffering from cardiovascular problems. The main study approaches selected by the authors include systematic review of the randomized control trials. This is can be regarded as one of the important strength of the study in the domain of the study design as systematic review of the RCT falls under the level 1 of the evidence. The RCT studies that conducted a comparative analysis with the intervention group and the placebo group were selected for the review. The main population of interests were adults (people who are 18 years old or above). The final analysis of the 16 articles revealed that non-pharmacological intervention, which is successful in increasing the patient’s adherence of the medication include increased provision for the patient education. The review of the RCT studies however failed to highlight any valid justification behind the simplification of the drug regime in improving therapy adherence of the patient. In order to increase the level of patient engagement by education, patient centered educational plan based on the behavioral needs of the patient is found to be effective. One of the limitations of the study is poor sample size (Parahoo, 2014). This might be a reason why the review failed to provide the detail perceptive of the therapy adherence in relation of simplification of the drug regime.

Impact of Psychological Interventions on Self-care, Psychological Health, and Overall Health Outcomes

Sagar et al. (2015) conducted a systematic review and meta-analysis in order to update the Cochrane systematic review about the importance of the exercise-based cardiac rehabilitation (CR) program for heart failure. A total of 33 trials were included in the review consisting of 4740 participants. The papers were selected in such a way that it had a follow-up period of 1 year. The selection of the study of a standard sample size can be considered as one of its strength. However, having a long follow-up period is regarded as one of the limitations as candidate dropouts occurs during the follow-up leading to decrease in the overall sample size of the participants (Parahoo, 2014). The analysis of the results highlighted that regular practice of mild to moderate physical activity under in CR program helps to reduce the overall risk of the re-hospitalization of the heart failure patients. Meta-regression analysis showed that overall benefits were independent in relation to the dosage and type of exercise in the CR program along with the duration of the total follow-up of the trial. The results also showed decrease rate in the overall hospitalization of the post-stroke patients for further cardiac complications. However, the authors recommend an individual participant data meta-analysis in order to provide a confirmatory evidence for the importance of the subgroup of the patients and program level characteristics (duration and intensity of exercise) over the outcome.

The review conducted by Jiang, Shorey, Seah, Chan, Tam and Wang (2018) was selected for this paper because it helps to get an idea regarding the importance of the psychological interventions for improving the overall quality of life. In relation to this, Steptoe, Deaton and Stone (2015) stated that mental health and well-being is a significant influence over the physical well-being of the individuals with complex cardiovascular problems. A person who is happy and free from unwanted tension or depression is more likely to follow health lifestyle regime and self-care in order to improve the physical well-being. William had a past history of hypertension, ischaemic cardiomyopathy and has been experiencing shortness of breath for the past few days. However, he went for medical help only when the conditions went more severe for example, visible signs of peripheral oedema. This highlights that William lack self-awareness and skills of self-care. Thus implementation of the psychological interventions will help to induce self-care and self-management skills in William. In relation of the psychological interventions, Ward, White and Druss (2015) are of the opinion that proper implementation of the psychological interventions helps to improve the mental well-being of the people and thereby helping them to take active initiatives in favour of their physiological health like abiding by healthy lifestyle regime and periodic mentoring of vital signs and visit to doctor when needed. This helps to avoid chances of encountering medical emergencies.

Effectiveness of Physical Exercise in Reducing the Risk of Re-hospitalization and Improving Health-related Quality of Life

The systematic review of Molloy et al. (2012) was selected in order to highlight the importance of the patient education   in generation of the disease awareness and increase in the tendency of the therapy adherence. The study conducted by de Melo Ghisi, Grace, Thomas and Oh (2015) stated that proper education of the patients with chronic heart failure in the domain disease prognosis helps to promote the therapy adherence and at the same time helps to decrease the chance of the rehospitalisation resulting from further cardiac complications. Case study reveals that in spite of having the previous reported cases of the chronic heart failure, Mr. William is over-weight. Thus it shows that he is not abiding the therapy like for example promoting of physical activity to lose weight. The case study also reveals that William was experiencing distressing symptoms for the past few days but showed zero initiatives to contact doctors at that time and this lead to delayed reporting. Powers et al. (2018) stated that proper education of the patient about disease prognosis helps in identification of the early signs and symptoms of cardiovascular complications and thereby helping to prevent the negative prognosis of the disease. Stanhope and Lancaster (2015) argued that patient education given under the community health approach and in a culturally competent manner is found to fetch positive results in the domain of effective self-management of the disease.

The study of Sagar et al. (2015) was selected because it provides significant evidence in the domain of importance of the physical exercise under the cardiac rehabilitation program for improving the health-related quality of life of the cardiac patients. The analysis of the case study reveals that William is over-weight. Owen et al. (2015) stated that older adults who are over-weight patients are more vulnerable in developing cardio-vascular complications, as they are more prone to develop atherosclerosis. Owen et al. (2015) further reported that weight people who have previous history of cardio-vascular problems and are over-weight are prone to disease reoccurrence. William, a 75-year old man was over-weight and has past history of CHF. Thus promotion of physical activity practice through CR program will help to reduce body weight of William and thereby helping to reduce body mass index (BMI). Decrease in the BMI will help to reduce the breathing problems and hyper-tension and thereby helping to decrease the severity of the cardiovascular disease.

The recommendation for the clinical practice includes recruitment of the home-based physical exercise trainer for Mr. William and an occupational therapist in order to aid William with person-centred physical exercise training regime. Practice of person-centred approach of for devising of the physical activity regime helps to fetch improved outcome (Sagar et al., 2015). The promotion of weight loss and maintenance of the healthy lifestyle habits can be further facilitated by designing of the person centred health education program. The education program will include dietary regime that will be helpful for William to overcome his body weight. Since William is 75 years old it is recommended to avail a home cooking help for William in order to abide by the diet regime. Commonwealth Home Support Programme of Australian Government might be proved to be helpful for William (Australian Government Department of Health, 2019). The psychological interventions of William must be framed under the active supervision of the mental health professionals. Moreover, informal caregivers must also be educated about the disease prognosis in order to take active action at the time of emergency through identification of the early signs and symptoms (Piette et al., 2015).

References

Australian Government Department of Health. (2019).  Aeging and Aged Care Service. Access date: 27^th March 2019. Retrieved from: https://agedcare.health.gov.au/older-people-their-families-and-carers/staying-at-home/help-to-stay-at-home

de Melo Ghisi, G. L., Grace, S. L., Thomas, S., & Oh, P. (2015). Behavior determinants among cardiac rehabilitation patients receiving educational interventions: An application of the health action process approach. Patient education and counseling, 98(5), 612-621. https://doi.org/10.1016/j.pec.2015.01.006

Jiang, Y., Shorey, S., Seah, B., Chan, W. X., Tam, W. W. S., & Wang, W. (2018).The effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure—A systematic review and meta-analysis.International Journal of Nursing Studies, 78, 16-25. doi:10.1016/j.ijnurstu.2017.08.006

Molloy, G. J., O'Carroll, R. E., Witham, M. D.,&McMurdo, M.E. T. (2012). Interventions to enhance adherence to medications in patients with heart failure: A systematic review. Circulation Heart Failure, 5, 126-133.https://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569

Owen, C. G., Kapetanakis, V. V., Rudnicka, A. R., Wathern, A. K., Lennon, L., Papacosta, O., ... & Whincup, P. H. (2015). Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study. BMJ open, 5(9), e008105. https://dx.doi.org/10.1136/bmjopen-2015-008105

Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.

Piette, J. D., Striplin, D., Marinec, N., Chen, J., & Aikens, J. E. (2015). A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes. Medical care, 53(8), 692.

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., ... & Jauch, E. C. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46-e99. https://doi.org/10.1161/STR.0000000000000158

Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H. M., Lough, F., ... & Taylor, R. S. (2015). Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open heart, 2(1), e000163. https://dx.doi.org/10.1136/openhrt-2014-000163

Stanhope, M., & Lancaster, J. (2015). Public health nursing: Population-centered health care in the community. Elsevier Health Sciences.

Steptoe, A., Deaton, A., & Stone, A. A. (2015). Subjective wellbeing, health, and ageing. The Lancet, 385(9968), 640-648. https://doi.org/10.1016/S0140-6736(13)61489-0

Ward, M. C., White, D. T., & Druss, B. G. (2015). A meta-review of lifestyle interventions for cardiovascular risk factors in the general medical population: Lessons for individuals with serious mental illness. The Journal of clinical psychiatry. https://dx.doi.org/10.4088/JCP.13r08657