وضعیت خودمراقبتی در سالمندان مبتلا به نارسایی قلبی بستری در بخش‌های مراقبت ویژه قلبی بیمارستان‌های دولتی شرق گیلان در سال 1399

زمینه و هدف: نارسایی قلبی دلیل اصلی مرگ، بیماری، بستری شدن در بیمارستان و کیفیت پایین زندگی است. گزینه‌های زیادی برای کنترل نارسایی قلبی وجود دارد که خود‌مراقبتی یکی از آنها است. با وجود اهمیت خودمراقبتی در نتایج مثبت سلامتی، بسیاری از بیماران مبتلا به نارسایی قلبی رفتارهای خودمراقبتی ناکافی دارند. هدف از پژوهش حاضر تعیین وضعیت خود‌مراقبتی در سالمندان مبتلا به نارسایی قلبی بوده است. روش بررسی: این مقاله بخشی از نتایج یک مطالعه مقطعی بزرگتر را گزارش می‌نماید. جامعه پژوهش شامل سالمندان مبتلا به نارسایی قلبی بستری در بخش‌های مراقبت ویژه قلبی بیمارستان‌های دولتی شرق گیلان در سال 1399 بود. از این جامعه، 125نفر نمونه به صورت در دسترس انتخاب شد. ابزارهای پژوهش شامل مشخصات جمعیت شناختی و پرسشنامه خودمراقبتی بیماران مبتلا به نارسایی قلبی (schfi) بود. داده‌ها توسط نرم افزار spss نسخه 16 و با استفاده از آمار توصیفی (جداول توزیع فراوانی، میانگین و انحراف معیار) تحلیل شد.یافته‌ها: نتایج در خصوص میانگین نمرات خودمراقبتی بیماران شرکت کننده در مطالعه، نشان داد که میانگین نمره کل خودمراقبتی 10.96 ± 67.16، استمرار خودمراقبتی 4.39 ± 28.94، مدیریت خودمراقبتی 3.96 ± 17.98و اطمینان به انجام خودمراقبتی 4.05 ± 20.49 بوده است. بیشتر نمونه‌های پژوهش از نظر خودمراقبتی کل (75.2%) و زیرمقیاس‌های آن شامل استمرار خودمراقبتی (59.2%)، مدیریت خودمراقبتی (69.6%) و اطمینان به انجام خودمراقبتی (82.4%) دارای وضعیت مطلوب بودند. بهترین وضعیت خودمراقبتی مطلوب به ترتیب در ابعاد اطمینان به انجام خودمراقبتی، مدیریت خودمراقبتی و استمرار خودمراقبتی بودند. نتیجه‌گیری کلی: یافته‌ها نشان داد وضعیت خودمراقبتی بیماران مبتلا به نارسایی قلبی بطور کلی در وضعیت مطلوبی است. با وجود این نتایج، توجه بیشتر در مراقبت‌های پرستاری و درمانی جهت ارتقاء و بهبود وضعیت خودمراقبتی در سالمندان خصوصاّ در رفتارهای خود‌مراقبتی مربوط به انجام ورزش و توزین روزانه ضروری به نظر می‌رسد.

Assessing the Self-care Status in Older Adults Diagnosed with Heart Failure and Hospitalized in the Cardiovascular Intensive Care Units of the Public Hospitals in the East of Guilan, Iran (2020)

Background Aims: One of the most common diseases during old age is cardiovascular disease. Heart failure is the leading cause of death, disease, hospitalization, and poor quality of life. There are different approaches for controlling heart failure, including selfcare, and adherence to selfcare behaviors in patients suffering from this disease is very important. People with effective selfcare have a better quality of life, and mortality and readmission rates are lower among these people than those with poor selfcare. Medication adherence, diet adherence, rest, improving sleep quality and life quality, knowing how to control emotions, and selfcare could help control the complications and problems associated with this disease. Meanwhile, knowing how to perform selfcare is very important. Despite the importance of selfcare in positive health outcomes, many patients with heart failure have inadequate selfcare behaviors. Considering the role of nurses in health promotion and instruction of selfcare behaviors, they can plan interventions to promote the patients #39; selfcare behaviors and consequently the quality of life in patients diagnosed with heart failure. The present study aimed to determine selfcare status in older adults diagnosed with heart failure. Materials Methods: This article reports part of the results of a larger crosssectional study. The study population consisted of the elderly with heart failure hospitalized in the cardiovascular intensive care units of East Guilan public hospitals in 2020. A sample of 125 patients was selected from the population via convenience sampling. The sample of the study met the inclusion and exclusion criteria. Inclusion criteria were: age 60 years and older, heart failure based on clinical signs, electrocardiography (ECG) and echocardiography showing an ejection fraction of less than 40%, functional class II to IV based on the patient medical file and the approval of a cardiologist, the ability to communicate, and informed consent to participate in the study. Patients with severe mental or cognitive impairments, history of neurological problems, cerebrovascular accidents, transient ischemic attack, shortterm memory impairment or dementia, mental instability (according to medical records), inability to speak, auditory and visual impairments, and Charlson comorbidity index of 12 were not included in the study, and the exclusion criteria included incomplete completion of the questionnaire and unwillingness to continue collaborating in the study. The research instruments included demographic characteristics questionnaire and the selfcare of heart failure index (SCHFI) questionnaire. Cronbach rsquo;s alpha was used to check the reliability of the SCHFI in the present study which was 0.82. Sampling lasted from late May to December 2020. Having obtained permission from the ethics committee of Guilan University of Medical Sciences and relevant officials, the researcher referred to the mentioned medical centers, selected the research units, introduced himself, provided sufficient explanations about the purpose of the research, obtained their written consent, and distributed the questionnaires to be completed during the interview. Data were analyzed using descriptive statistics (frequency, mean, and standard deviation) in SPSS 16.Results: The analysis of the questionnaires revealed that most patients (55.2%) were male, aged 7590 (54.4%), married (57.6%), with average monthly income (60%), and illiterate (72%). The findings showed that the patients of the study obtained 67.16 ± 10.96 for selfcare items, 28.94 ± 4.39 for selfcare maintenance, 17.98 ± 3.96 for selfcare management, and 20.49 ± 4.05 for selfcare confidence. The scores of most participants were satisfactory in terms of total selfcare (75.2%) and its subscales including selfcare maintenance (59.2%), selfcare management (69.6%), and selfcare confidence (82.4%). The optimal selfcare status was considered satisfactory in terms of adherence to selfcare behaviors, selfcare management, and selfcare maintenance, respectively. The optimal selfcare status belonged to selfcare confidence, selfcare management, and selfcare maintenance, respectively. Regarding the items on the selfcare maintenance subscale, the best selfcare behaviors were selfprotection measures to prevent illnesses, a lowsalt diet, and regular visits to a physician or a health center to assess heart condition, respectively, and the most inappropriate selfcare behaviors were related to exercise and daily weight.Conclusion: The findings showed that the selfcare status of patients with heart failure is generally satisfactory. Despite the study findings, it is essential to pay more attention to nursing care and treatments that promote selfcare behaviors in older adults especially in selfcare behaviors related to exercise and daily weighing. It is suggested that hospitals offer educational classes to improve the knowledge, attitude, and selfcare practices in patients with heart failure.