Main Article Content
The aims of descriptive study was to evaluate elements of the health care service, self-care behavior, and opinions of persons with heart failure (HF) receiving care at the HF clinics, Ramathibodi Hospital. Donabedian’s quality of care model was use to guide the conceptual framework. Purposive sampling was used to recruit 31 persons with HF. Data were collected from July to October 2017, using a personal data questionnaire, a health status data questionnaire, the structured interviews about self-care behaviors and the opinions of persons with HF receiving care from the heart failure clinics. Descriptive statistics was used for data analysis. Results showed that the majority of the subjects was males (58.1%) and ages ranged between 26 to 83 years with a mean of 56.8 years. Most of the subjects had stage C HF (83.9%) and 93% of subjects have been entered in the HF clinic more than 6 months. The baseline health status data indicated that most of the subjects had six- minute walk test (6 MWT) of less than 300 meters (51.6%), 90.3 percent of the subjects had left ventricular ejection fraction (LVEF) <40% and unable to work. All of the subjects had been hospitalized or visited an emergency room due to HF. After enrolling in HF clinic, about 71% of the subjects had 6 MWT more than 300 meters and of those LVEF of 25 persons had increased (80.65%). Only 3 persons with HF had been re-hospitalized and had never been visited emergency room. Regarding to self-care behaviors in relation to volume overload management, it was found that 100% of the subjects were able to limit the amount of salty food, monitoring of fluid overload (100%), assessing edema (96.8%), weight measurement (96.7%), adjusting diuretic medications (61.3%), and measuring fluid intake and output (83.9%). Most of the subjects (80.7%) exercised daily or at least 3-5 days per week. Most of the subjects had no sleeping disorders (61.3%); took medications regularly (77.4%). All of them had prior knowledge of factors that aggravate heart failure (100%). Almost all of them neither drank alcoholic beverages (90.3%), nor smoked (96.8%). Furthermore, all the subjects said that the HF clinic was beneficial as it assisted them with the adjustment of self-care behaviors, the services could be easily to access, and the consultation could be made via multiple communication channels. All of these multiple helping methods would be facilitated the favor clinical outcomes. The findings of the study will assist health care providers to get a better understanding of the multidisciplinary approach taken at the HF clinic, in which nurse professional is considered as a key person in the HF clinic.
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในรามาธิบดีพยาบาลสาร ถือเป็นลิขสิทธิ์ของวารสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่หรือเพื่อกระทำการใด ใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากรามาธิบดีพยาบาลสารก่อนเท่านั้น
Drazner MH, et al. 2013 ACCF/AHA Guideline for the
management of heart failure: Executive summary. JACC.
2. Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald’s
heart disease: a textbook of cardiovascular medicine. 9th
ed. Philadelphia: Elsevier Saunders; 2012.
3. Heart Failure Society of America. Executive summary:
HFSA 2010 Comprehensive heart failure practice
guideline. J Card Fail. 2010;16(6):e1-2.
4. Jaarsma T, Stromberg A, Gal TB, Cameron J, Driscoll A,
Duengen H, et al. Comparison of self-care behaviors of
heart failure patients in 15 countries worldwide. Patient
Educ Couns. 2013;92:114-20.
5. Kanjanavanit R, Phrommintikul A. Comprehensive heart
failure management program. Bangkok: Concept Medical;
2014. (in Thai)
6. Riegel B, Lee CS, Dickson VV, Carlson B. An update on
the self-care of heart failure index. J Cardiovasc Nurs.
7. Woda A, Haglund K, Belknap RA, Sebern M. Self-care
behaviors of African Americans living with heart failure.
J Community Health Nurs. 2015;32:173–86.
8. The Heart Association of Thailand under the Royal
Patronage of H.M. the King, Heart Failure Society of
Thailand. Guidelines for diagnosis and treatment of heart
failure, 2014. Bangkok: A-Plus Printing; 2014. (in Thai)
9. European Society of Cardiology. 2016 ESC Guidelines
for the diagnosis and treatment of acute and chronic heart
failure. Eur J Heart Fail. 2016;37(27):1-85.
10. Kanjanavanit R. Comprehensive heart failure management
program. 2nd ed. Bangkok: Concept medical; 2015. (in
11. Glogowska M, Simmonds R, McLachlan S, Cramer H,
Sanders T, Johnson R, et al. Managing patients with heart
failure: A qualitative study of multidisciplinary teams with
specialist heart failure nurses. Ann Fam Med.
12. Amaritakomol A. Nursing role of heart failure clinic. In:
Kanjanavanit R, editor. Comprehensive heart failure
management program. 2nd ed. Bangkok: Concept medical;
2015. p.77-91. (in Thai)
13. Jaarsma T. Inter-professional team approach to patients
with heart failure. Heart. 2005;91(6):832–38.
14. Hsiao I, Chien C, Chen C, Lin C, Koo M. Predictors of
lack of improvement in the left ventricular ejection fraction
in patients with congestive heart failure 18 months after
commencement of a disease management program: a
prospective observational study. Tzu Chi Medical Journal.
15. Wongwantanee S, Kiatjaroensin s, Dowmanee P,
Jaratpatanawong C, Kumti T. Effectiveness of heart failure
clinic care in Rayong hospital. The Journal of Prapokklao
Hospital Clinical Medical Education Center.
2010;27(4):222-33. (in Thai)
16. Medical Statistics. Statistics for heart failure patients.
Ramathibodi Hospital; 2560. (in Thai)
17. Joynt KE, Jha AK. A path forward on medicare
readmissions. N Engl J Med. 2013;368(13):1175-77.
18. Donabedian A. The quality of care. JAMA.
19. Krumholz HM, Baker DW, Ashton CM, Dunbar SB,
Friesinger GC, Havranek EP, et al. Evaluating quality of
care for patients with heart failure. Circulation.
20. Malathum P, Intarasombat, P. Evaluation of nursing care
quality: outcome indicators. Rama Nurs J. 2006;12(1):
25-36. (in Thai)
21. Pfeiffer E. A short portable mental status questionnaire for
the assessment of organic brain deficit in elderly patients.
J Am Geriatr Soc. 1975;23(10):433-41.
22. Intarasombat P. Assessment of health status among the
elderly. Rama Nurs J. 1996;2(3):44-57. (in Thai)
23. Suwanno J, Petsirasan R, Prasearttha P, Chanpradi A,
Saisu W. Self-care among patients with chronic heart
failure. Thai Journal of Nursing Council. 2008;
23(1):35-47. (in Thai)
24. Intarasak N, Chinnawong T, Kritpracha C. The effect of
self-management support program on health behaviors
and clinical status among patients with congestive heart
failure. Songklanagarind J Nurs. 2015;35:131-42. (in
25. WHO expert consultation. Appropriate body-mass index
for Asian populations and its implications for policy and
intervention strategies. Lancet. 2004;363:157-63.
26. Lehnbom EC, Bergkvist AC, Gransbo K. Heart failure
exacerbation leading to hospital admission: a crosssectional
study. Pharm World Sci. 2009;31(5):572–79.
27. Rerkluenrit J. Effectiveness of a literacy and counseling
program on self-are abilities among persons with heart
failure. Journal of Nursing and Health Care.
2015;33(2):61-70. (in Thai)
28. Suwanno J, Petsirasan R, Prasearttha P, Chanpradi A,
Saisu W. Age and heart failure self-care: a comparison of
self-care maintenance between elderly and adults.
Songklanagarind Medical Journal. 2009;27(4):335-46.
29. Tung HH, Chen SC, Yin WH, Chen CH, Wang T.J, Wu
SF. Self care behavior in patients with heart failure in
Taiwan. Eur J Cardiovasc Nurs. 2012;11(2):175-82.
30. Pollentier B, Iron SL, Benedetto CM, Dibenedetto AM,
Loton D, Seyle RD, et al. Examination of the six minute
walk test to determine functional capacity in people with
chronic heart failure: a systematic review. Cardiopulm
Phys Ther J. 2010;21(1):13-21.
31. Arslan S, Erol, MK, Gundogdu F, Sevimli S, Aksakal E,
Senocak H, et al. Prognostic value of 6-minute walk test
in stable outpatients with heart failure. Tex Heart Inst J.
32. Seto E, Leonard KJ, Cafazzo JA, Masino C, Barnsley J,
Ross HJ. Self-care and quality of life of heart failure
patients at a multidisciplinary heart function clinic. J
Cardiovasc Nurs. 2011;26(5):377-85.