Scientific evidence reinforces the influence of supportive family relationships and correlates family support with positive patient outcomes. Alternatively, chronic disease is not only a stressor for the patient, but also for the family. This fact requires that nursing provide interventions to the family as well as the patient to ensure positive health and well being. The purpose of this paper is to discuss the nursing interventions of education, support and acting as an integrator to promote the health of a patient and family dealing with congestive heart failure.
Congestive heart failure is a chronic illness that affects nearly . 7 million Americans (Piamjariyakul, Smith, Werkowitch, & Elyachar, 2012). Nearly 700,000 new cases are diagnosed each year resulting in approximately one million hospitalizations costing $39. 2 billion annually (Piamjariyakul et al. , 2012). One of the greatest contributors to hospital admissions amongst this population is noncompliance, either with diet or medication (Piamjariyakul et al. , 2012).
A major aspect of congestive heart failure care is dietary restrictions, most which occurs within the family context (Dunbar et al. , 2013). To maximize positive outcomes and promote health, it is imperative to address family nvolvement in the management of congestive heart failure. The Developmental Model of Family Health aims to increase the ability of individual and families to practice health promotion daily (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). In applying this model, the role of the nurse is evolving but remains focused on the goal of empowerment.
To achieve empowerment, the three interventions that are critical are education, support and acting as an integrator (Kaakinen et al. , 2015). This model, used in conjunction with family empowerment strategies, encourages families to work together y focusing on strength and resources (Kaakinen et al. , 2015). Because two of the main aspects of self management of congestive heart failure, diet and medication compliance, occur in the family context, family involvement is key to success. Lack of family support often leads to poor self management and adverse health behaviors (Dunbar et al. 2013).
In providing education the nurse is assisting not only the family but the patient to self efficacy. When providing comprehensive education in chronic illness management, it is important for the nurse to stress that health promotion behaviors are not pisodic, but rather long term and should be considered and implemented as lifestyle changes. Lofvenmark, Saboonchi, Edner, Billing, and Mattiasson (2013) illustrated that efforts to increase knowledge lead to a greater sense of emotional well being and also contribute to the quality of life of family members.
Additionally, disease related knowledge allows a sense of control and is a determinant of psychological well being (Lofvenmark, Saboonchi, Edner, Billing, & Mattiasson, 2013). My first approach in educating a patient and family member in comprehensive congestive heart failure care would be to first nderstand what their knowledge base is. In assessing baseline knowledge, I can better target my education while clarifying any misinformation (Bastable, 2014). My next step would be to explain the physiology of the disease.
This provides a foundation for me to education on the function of the medication. People are more likely to be compliant when they understand the “why’s” and “how’s” of a concept such as prescribed medical regiments (Bastable, 2014). By providing comprehensive disease education, patients and families are able to better manage the condition and prevent decompensation necessitating hospital admission (Villarruel, 013). Not only is education necessary for health promotion but it is also required in order for facilities to meet federal standards and guidelines of care.
At the conclusion of education, I would review and ask the patient if there were any questions or concepts that I could clarify. Then I would ask questions that require thought and processing by the patient to verify the comprehension (Bastable, 2014). In providing support to the patient and family, education on disease management is primary to patient outcomes. However, because providing care for an ill family member creates stress for family members, upport should also be directed towards caregivers (Lofvenmark et al. , 2013).
While the daily life of congestive heart failure is affected by physical and emotional limitations, family members are tasked with increased responsibility and role changes (Lofvenmark et al. , 2013). In mitigating the stress with these factors, the nurse must include the caregiver and family members in her assessments. One study in particular demonstrates that information regarding care of the congestive heart failure patient targeted towards the caregiver are considered to be of great importance and contribute to a sense f preparedness and increase feelings of relief (Lofvenmark et al. 2013).
Social support of caregivers is suggested to promote a sense of security and involvement that protects caregivers from the effects of stressors (Lofvenmark et al. , 2013). Information would be provided to the caregiver regarding burn out and the importance of self care. In addition to providing education, resources such as respite care and community resources and support groups would also be provided. In the role of integrator, the nurse behaves in such a way to raise awareness and guides the patient and the caregiver with nalysis of a situation (Kaakinen et al. 2015).
In guiding the patient, rather than simply dictating the answer, the nurse assists the patient in identifying a solution through support of the patient’s strengths (Kaakinen et al. , 2015). In doing so, the nurse is able to assist the patient in identifying possible solutions, making decisions and identifying additional resources (Kaakinen et al. , 2015). Essentially, there is active involvement by the family to develop strategies in dealing with the disease and its management while relying on the family’s strengths to achieve goals (Kaakinen et al. 2015).
By initially providing education to the patient and family, meaningful participation is achieved in future management strategies. The element of education also allows the patient and family to take responsibility of self care and develop methods of coping and care that are specifically tailored. By providing support and resources to the caregiver, family functioning has shown improvement (Lofvenmark et al. , 2013). Therefore, the strategies of education, support and acting as an integrator are effective methods to influence health outcomes and encourage health promotion.
