The Effectiveness of a Patient Education Program on Promoting Self-Care in Patients with Heart Failure

Sunday, 27 July 2014: 1:55 PM

Hsing-Mei Chen, PhD, RN
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Shyh-Jong Wu, PhD
Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
Liang-Miin Tsai, MD
Department of Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan
Chee-Siong Lee, MD
Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Hsueh-Wei Yen, MD
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan


Self-care is fundamental to effective management of heart failure. However, patients with heart failure (HF) report poor self-care behaviors. Patient education is the best way to promote self-care. However, healthcare providers do not provide sufficient self-care information to the patients due to heavy working routines and poor quality of teaching materials. In considering many patients with HF are elderly or have vision or cognition impairments, a HF home self-care brochure with 8 topics was developed. The purpose of this study was to examine the effectiveness of a nurse-led self-care intervention on self-care behaviors, health-related quality of life, depression, sleep disturbances, and readmission in patients with HF from hospitalization to one month after discharge from hospital. 


A quasi research design with a non-probability sampling was used. Participants were recruited from two medical centers located in southern Taiwan. Inclusion criteria were as follows: 1) a diagnosis of HF with NYHA functional class II and above; 2) age 20 or older; 3) able to communicate either by speaking or writing Mandarin; and 4) willing to participate in this study. Instruments included demographic questionnaire, heart failure characteristics questionnaire, Patient Outcome Questionnaire-9, Pittsburgher Sleep Quality Index, Kansas Cardiomyopathy City Questionnaire, and revised HF Self-Care Behavior Scale. After completing the questionnaires at baseline, participants in the experimental group were asked to receive a pre-discharge education session and a telephone follow-up or an outpatient follow-up. Control group received usual hospital discharge teaching. The posttest was done in one month after their discharges. T-tests were used to examine the differences between two groups.


The results showed that 34 participants were assigned in the experimental group and 32 were in the control group. no statistical differences were found in demographic data, HF characteristics, sleep quality, depression, self-care, and quality of life between the experimental and control groups at the baseline. Among the three self-care variables, self-care maintenance was the lowest and the only one had score lower than the cut-off point of 70 in both groups (57.13 for experimental group vs. 64.84 for control group, p= .080). At the posttest, the experimental group had significantly higher score in self-care maintenance (76.64 vs 66.09, p= .003). However, there were no differences in the other major variables between the two groups. For the readmission, there was one readmission for the experimental group and three readmissions for the control group.


The study supports the effectiveness of the patient education program on promoting self-care maintenance in patients with HF one month after discharge from hospital. The study findings can be served as a reference for healthcare providers and researchers to promote self-care and conduct research studies in people with heart failure.