Navigating the Patient with Heart Failure through the Health-care System – The Perspective of Hospital Nurses

Tamara Štemberger-Kolnik; Bojana Filej; Silva Nemeš; Andreja Ljubič

doi:10.3889/oamjms.2024.11882

Authors

Tamara Štemberger-Kolnik Research Institute, Faculty of Health Sciences in Celje, Celje, Slovenia https://orcid.org/0000-0002-8241-0550
Bojana Filej Research Institute, Faculty of Health Sciences in Celje, Celje, Slovenia https://orcid.org/0000-0001-7194-7259
Silva Nemeš Prevention and Promotion Programmes Management Centre, National Institute of Public Health, Ljubljana, Slovenia https://orcid.org/0009-0000-4148-437X
Andreja Ljubič Research Institute, Faculty of Health Sciences in Celje, Celje, Slovenia; Department of Public Health, Ministry of Health, Ljubljana, Slovenia https://orcid.org/0000-0003-1310-8793

DOI:

https://doi.org/10.3889/oamjms.2024.11882

Keywords:

healthcare systems, heart failure, health literacy, navigation, patient journey

Abstract

BACKGROUND: Navigating the complex health-care system requires the patients to have comprehensive knowledge, active participation, and self-efficacy in health management to effectively engage in planned activities that include diagnosis, treatment, and rehabilitation, to ensure a high quality of life and successfully prevent disease-related complications.

AIM: This study aims to investigate which activities nurses in hospital settings perform to support patients with heart failure to increase health literacy and navigate effectively through the health-care system.

METHODS: Based on qualitative research, the data were collected through semi-structured interviews with 11 nurses from hospitals where patients with heart failure are treated. After reviewing and analyzing the transcribed interviews, a qualitative content analysis of the text followed.

RESULTS: Based on an inductive approach, we first identified coding units, which were grouped into 10 subcategories, and these into five categories: General health literacy, digital literacy, communication health literacy, interprofessional collaboration, and navigation through the health-care system. We found that the treatment of patients with heart failure varies in Slovenian hospitals.

CONCLUSION: Inequality in the treatment of patients between different hospitals highlights the need for a coordinated approach in the Slovenian health-care system. It is crucial to establish uniform national guidelines that would define treatment standards, ensure evidence-based patient care, and thus reduce the disparity in the quality of treatment between different medical institutions.

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References

Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors influencing the implementation of patient navigation programs for adults with complex needs: A scoping review of the literature. Health Serv Insights. 2021;14:1-17. https://doi.org/10.1177/11786329211033267 PMid:34349519 DOI: https://doi.org/10.1177/11786329211033267

Budde H, Williams GA, Scarpetti G, Kroezen M, Maier CB. What are patient navigators and how can they improve integration of care? In: Policy Brief. European Observatory on Health Systems and Policies; 2022. p. 44. Available from: https://www.ncbi.nlm.nih.gov/books/NBK577643/#Ch-sec1 [Last accessed on 2023 Sep 23].

Van der Gaag M, Van der Heide I, Spreeuwenberg PM, Brabers AE, Rademakers JJ. Health literacy and primary health care use of ethnic minorities in the Netherlands. BMC Health Serv Res. 2017;17(1):350. https://doi.org/10.1186/s12913-017-2276-2 PMid:28506230 DOI: https://doi.org/10.1186/s12913-017-2276-2

Loignon C, Dupéré S, Fortin M, Ramsden VR, Truchon K. Health literacy-engaging the community in the co-creation of meaningful health navigation services: A study protocol. BMC Health Serv Res. 2018;18:505. https://doi.org/10.1186/s12913-018-3315-3 DOI: https://doi.org/10.1186/s12913-018-3315-3

Griese L, Berens EM, Nowak P, Pelikan JM, Schaeffer D. Challenges in navigating the health care system: Development of an instrument measuring navigation health literacy. Int J Environ Res Public Health. 2020;17(16):5731. https://doi.org/10.3390/ijerph17165731 PMid:32784395 DOI: https://doi.org/10.3390/ijerph17165731

Dadaczynski K, Krah V, Frank D, Zügel-Hintz E, Pöhlmann F. Promoting navigation health literacy at the intersection of schools and communities. Development of the game-based intervention nebolus. Front Public Health. 2021;9:752183. https://doi.org/10.3389/fpubh.2021.752183 DOI: https://doi.org/10.3389/fpubh.2021.752183

World Health Organization. WHO Global Strategy on People- Centred and Integrated Health Services. Intern Report. Geneva: WHO Document Production Services; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/155002/ who_his_sds_2015.6_eng.pdf?sequence=1&isallowed=y [Last accessed on 2023 Sep 13].

Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: Illuminating the design and development process of the European health literacy survey questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948. https://doi.org/10.1186/1471-2458-13-948 PMid:24112855 DOI: https://doi.org/10.1186/1471-2458-13-948

Perez L, Morales KH, Klusaritz H, Han X, Huang J, Rogers M, et al. A health care navigation tool assesses asthma self-management and health literacy. J Allergy Clin Immunol. 2016;138(6):1593-9. e3. https://doi.org/10.1016/j.jaci.2016.08.043 PMid:27744030 DOI: https://doi.org/10.1016/j.jaci.2016.08.043

Fields B, Rodakowski J, James AE, Beach S. Caregiver health literacy predicting healthcare communication and system navigation difficulty. Fam Syst Health. 2018;36(4):482-92. https://doi.org/10.1037/fsh0000368 PMid:30148377 DOI: https://doi.org/10.1037/fsh0000368

Dadaczynski K, Okan O, Messer M, Leung AY, Rosário R, Darlington E, et al. Digital health literacy and web-based information-seeking behaviors of university students in Germany during the COVID-19 pandemic: Cross-sectional survey study. J Med Internet Res. 2021;23(1):e24097. https://doi.org/10.2196/24097 PMid:33395396 DOI: https://doi.org/10.2196/24097

Davis DA, Angeles G, McNaughton-Reyes L, Matthews DD, Muessig KE, Northbrook S, et al. Examining how health navigation affects mental health among gay, bisexual, and other men who have sex with men living with human immunodeficiency virus in Guatemala. AIDS Patient Care STDS. 2021;35(4):126-33. https://doi.org/10.1089/apc.2021.0008 DOI: https://doi.org/10.1089/apc.2021.0008

Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva: World Health Organization; 2020. Available from: https://www.who.int/data/ gho/data/themes/mortality-and-global-health-estimates/ghe- leading-causes-of-death [Last accessed on 2023 Sep 23].

Palmer K, Bowles KA, Morphet J. The heartache of living with failure: The experience of people with chronic heart failure. Collegian. 2022;30(2)286-92. https://doi.org/10.1016/j.colegn.2022.09.010 DOI: https://doi.org/10.1016/j.colegn.2022.09.010

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-726. https://doi.org/10.1093/eurheartj/ehab368 PMid:34447992 DOI: https://doi.org/10.1093/eurheartj/ehab368

Jiang Y, Wang W. Health promotion and self-management among patients with chronic heart failure. In: Haugan VG, Eriksson M, editor. Health Promotion in Health Care-Vital Theories and Research. Cham, CH: Springer International Publishing; 2021. p. 269-85. https://doi.org/10.1007/978-3-030-63135-2_19 DOI: https://doi.org/10.1007/978-3-030-63135-2_19

Jeon YH, Kraus SG, Jowsey T, Glasgow NJ. The experience of living with chronic heart failure: A narrative review of qualitative studies. BMC Health Serv Res. 2010;10:77. https://doi.org/10.1186/1472-6963-10-77 PMid:20331904 DOI: https://doi.org/10.1186/1472-6963-10-77

Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, et al. Health literacy and cardiovascular disease: Fundamental relevance to primary and secondary prevention: A scientific statement from the American heart association. Circulation. 2018;138(2):e48-74. https://doi.org/10.1161/CIR.0000000000000579 PMid: 29866648 DOI: https://doi.org/10.1161/CIR.0000000000000579

Matsuoka S, Tsuchihashi-Makaya M, Kayane T, Yamada M, Wakabayashi R, Kato NP, et al. Health literacy is independently lf-care behavior in patients with heart failure. Patient Educ Couns. 2016;99(6):1026-32. https://doi.org/10.1016/j.pec.2016.01.003 PMid:26830514 DOI: https://doi.org/10.1016/j.pec.2016.01.003

Cui X, Zhou X, Ma L, Sun TW, Bishop L, Gardiner F, et al. A nurse-led structured education program improves self- management skills and reduces hospital readmissions in patients with chronic heart failure: A randomized and controlled trial in China. Rural Remote Health. 2019;19(2):5270. https://doi.org/10.22605/RRH5270 PMid:31113205 DOI: https://doi.org/10.22605/RRH5270

Fleg JL. Healthy Lifestyle and Risk of Heart Failure: An Ounce of PreventionWellWorth the Effort. Circ Heart Fail. 2016;9(4):e003155. https://doi.org/10.1161/circheartfailure.116.003155 PMid:27072862 DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.116.003155

Del Gobbo LC, Kalantarian S, Imamura F, Lemaitre R, Siscovick DS, Psaty BM, et al. Contribution of major lifestyle risk factors for incident heart failure in older adults. The cardiovascular health study. JACC Heart Fail. 2015;3(7):520-8. https://doi.org/10.1016/j.jchf.2015.02.009 PMid:26160366 DOI: https://doi.org/10.1016/j.jchf.2015.02.009

Marques CR, De Menezes AF, Ferrari YA, Oliveira AS, Tavares AC, Barreto AS, et al. Educational nursing intervention in reducing hospital readmission and the mortality of patients with heart failure: A systematic review and meta-analysis. J Cardiovasc Dev Dis. 2022;9(12):420. https://doi.org/10.3390/jcdd9120420 PMid:36547417 DOI: https://doi.org/10.3390/jcdd9120420

Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, et al. Healthy lifestyle and decreasing risk of heart failure in women: The Women’s health initiative observational study. J Am Coll Cardiol. 2014;64(17):1777-85. https://doi.org/10.1016/j.jacc.2014.07.981 PMid:25443698 DOI: https://doi.org/10.1016/j.jacc.2014.07.981

Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: Prospective cohort study. BMJ. 2020;368:l6669. https://doi.org/10.1136/bmj.l6669 PMid:31915124 DOI: https://doi.org/10.1136/bmj.l6669

Jaarsma T, Hill L, Bayes-Genis A, La Rocca HB, Castiello T, Čelutkienė J, et al. Self-care of heart failure patients: Practical management recommendations from the heart failure association of the European society of cardiology. Eur J Heart Fail. 2021;23(1):157-74. https://doi.org/10.1002/ejhf.2008 PMid:32945600 DOI: https://doi.org/10.1002/ejhf.2008

Malik A, Brito D, Vaqar S, Chhabra L, Doerr C. Congestive heart failure (nursing). In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/ books/NBK574497/[Last accessed on 2003 Sep 23].

Frankenstein L, Fröhlich H, Cleland JG. Multidisciplinary approach for patients hospitalized with heart failure. Rev Esp Cardiol (Engl Ed). 2015;68(10):885-91. https://doi.org/10.1016/j.rec.2015.05.008 PMid:26409892 DOI: https://doi.org/10.1016/j.rec.2015.05.008

Griese L, Schaeffer D, Berens EM. Navigational health literacy amongpeoplewithchronicillness.ChronicIlln.2023;19(1):172-83. https://doi.org/10.1177/17423953211073368 DOI: https://doi.org/10.1177/17423953211073368

Tran TP, Robinson LM, Keebler JR, Walker RA, Wadman MC. Health Literacy among Parents of Pediatric Patients. West J Emerg Med. 2008;9(3):130-4. PMid:19561727

Oscalices MI, Okuno MF, Lopes MC, Batista RE, Campanharo CR. Health literacy and adherence to treatment of patients with heart failure. Rev Esc Enferm USP. 2019;53:e03447. https://doi.org/10.1590/S1980-220X2017039803447 PMid:31314864 DOI: https://doi.org/10.1590/s1980-220x2017039803447

Ezekowitz JA, O’Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, et al. 2017 comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure. Can J Cardiol. 2017;33(11):1342-433. https://doi.org/10.1016/j.cjca.2017.08.022 DOI: https://doi.org/10.1016/j.cjca.2017.08.022

Lainscak M, Blue L, Clark AL, Dahlström U, Dickstein K, Ekman I, et al. Self‐care management of heart failure: Practical recommendations from the patient care committee of the heart failure association of the European society of cardiology. Eur J Heart Fail. 2011;13(2):115-26. https://doi.org/10.1093/eurjhf/ hfq219 DOI: https://doi.org/10.1093/eurjhf/hfq219

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coat AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200. https://doi.org/10.1093/eurheartj/ehw128 DOI: https://doi.org/10.1093/eurheartj/ehw128

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation. 2017;136:e137-61. https://doi.org/10.1161/CIR.0000000000000509 DOI: https://doi.org/10.1161/CIR.0000000000000509

Boyde M, Peters R, New N, Hwang R, Ha T, Korczyk, D. Self- care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial. Eur J Cardiovasc Nurs. 2018;17:178-85. https://doi.org/10.1177/1474515117727740 PMid:28832179 DOI: https://doi.org/10.1177/1474515117727740

Van der Wal MH, Jaarsma T, Moser DK, Veeger NJ, Van Gilst WH, Van Veldhuisen DJ. Compliance in heart failure patients: The importance of knowledge and beliefs. Eur Heart J. 2006;27(4):434-40. https://doi.org/10.1093/eurheartj/ehi603 PMid:16230302 DOI: https://doi.org/10.1093/eurheartj/ehi603

Huesken A, Hoffmann R, Ayed S. Persistent effect of nurse- led education on self-care behavior and disease knowledge in heart failure patients. Int J Nurs Sci. 2021;8(2):161-7. https://doi.org/10.1016/j.ijnss.2021.03.002 PMid:33997129 DOI: https://doi.org/10.1016/j.ijnss.2021.03.002

Róin T, Á Lakjuni K, Kyhl K, Thomsen J, Veyhe AS, Róin Á, et al. Knowledge about heart failure and self-care persists following outpatient programme-a prospective cohort study from the Faroe Islands. Int J Circumpolar Health. 2019;78:1653139. https://doi.org/10.1080/22423982.2019.1653139 PMid:31429677 DOI: https://doi.org/10.1080/22423982.2019.1653139

Riegel B, Lee S, Hill J, Daus M, Baah FO, Wald JW, et al. Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure. Heart Lung. 2019;48(3):179-85. http://doi.org/10.1016/j.hrtlng.2018.12.008 PMid:30638609 DOI: https://doi.org/10.1016/j.hrtlng.2018.12.008