Educación para la salud: la efectividad de las intervenciones en pacientes con insuficiencia cardíaca

Oliveira, Ana Paula Dias de; Cavalcante, Agueda Maria Ruiz Zimmer; Carneiro, Camila de Souza; Santos, Vinicius Batista; Moorhead, Sue; Lopes, Juliana de Lima; Barros, Alba Lucia Bottura Leite de

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (2) • 2020 • https://doi.org/10.1590/0034-7167-2018-0782 copiar

Educación para la salud: la efectividad de las intervenciones en pacientes con insuficiencia cardíaca

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

Evaluar la efectividad de las intervenciones NIC “Enseñanza: Proceso de Enfermedad”, “Educación para la Salud” y “Cuidados Cardíacos” en la mejora de resultados NOC en individuos con insuficiencia cardíaca (IC) y el diagnóstico de enfermería (DE) “Control Ineficaz de la Salud”.

Métodos:

Ccohorte retrospectivo conducido en un ambulatorio de enfermería de educación para la Salud. Se incluyeron 14 pacientes con IC acompañados durante un año, en seis consultas presenciales bimestrales. La efectividad de las intervenciones fue verificada por medio del cambio de los escores de los resultados, con uso de las Pruebas no paramétricas de Friedman y Análisis de Variancia no Paramétrica para medidas repetidas. El nivel de significancia adoptado fue del 5%.

Resultados:

Llas intervenciones fueron implementadas en las consultas con variación de las actividades. Se observó una mejoría significativa de los resultados obtenidos hasta la cuarta consulta (p <0,001).

Conclusiones:

Llas intervenciones fueron efectivas en la mejora de los resultados en pacientes con IC y Control Ineficaz de la Salud.

Descriptores:
Educación para la Salud; Educación en Enfermería; Efectividad; Insuficiencia Cardíaca; Diagnóstico de Enfermería

Consultation	Steps Held	Interventions	Nursing actions	Evaluation	Duration
Consultation 1	1. Interview/Patients' anamnesis and physical examination; 2. Confirmation of Ineffective Health Control ND, CD and FR; 3. Documentation on specific instruments.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To offer guidance about the disease, non-pharmacological and pharmacological treatment; 2. To present the website developed by the outpatient clinic group of researchers; 3. To provide informative material^* * All printed informative material was developed by the study and research group, and was used during the consultations and given to patients and their companions. (individual guidelines regarding medications prescribed by the doctor, appointments and purposes of each; adequate diet, fluid restriction, water content of the main foods ingested by the Brazilian population);	Evaluation of NOC results indicators: Self-control of Heart Disease, Compliance Behavior.	2 h
Telephone consultation	1. Identification of the patient's health condition; 2. Identification of emerging needs and compliance with treatment.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To check the difficulties with the therapeutic regimen; 2. To check the degree of knowledge about the disease and treatment acquired in the previous consultation; 3. To verify patient compliance with the guidelines received.	1. Presence of signs and symptoms described by the patient and suggestive of clinical decompensation.	15 min
Other Consultations	1. Physical Examination; 2. CD and FR re-evaluation; 3. Clarification of current doubts and difficulties reported by patients; 3. Pointing solutions or improvements; 4. Verification of knowledge of the disease and treatment, and knowledge gaps.	Implementation of intervention activities: - Education: Disease Process - Heart Care - Health Education.	1. To reorientate on the disease, non-pharmacological and pharmacological treatment (identification of knowledge gaps for reinforcement); 2. To check patient compliance with given instructions; 3. To verify the difficulties regarding the therapeutic regime and to establish strategies to overcome difficulties; 4. To assess and identify signs of decompensation.	Evaluation of NOC results indicators: Self-control of Heart Disease, Adhesion Behavior.	1 h 30 min

Nursing results	Clinical indicators assessed
Self-control of Heart Disease	1. Limits sodium intake 2. Follows the recommendation regarding fluid restriction 3. Monitors body weight 4. Maintains an ideal weight 5. Uses medication as prescribed 6. Is vaccinated against influenza (flu) 7. Is vaccinated against pneumonia
Compliance Behavior	1. Asks questions about health 2. Weighs risks/benefits regarding health behavior 3. Uses strategies to eliminate unhealthy behavior 4. Justifies deviating from a health diet 5. Performs self-monitoring of health condition

		Consultation 1	Consultation 2	Consultation 3	Consultation 4	Consultation 5	Consultation 6	p value^* * Teste de Friedman.
		n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	p value^* * Teste de Friedman.
Limits sodium intake	Never demonstrated	2 (14.2)	1 (7.1)	0	0	1 (7.1)	0	<0.001
	Rarely demonstrated	3 (21.4)	1 (7.1)	1 (7.10	0	0	2 (14.2)
	Sometimes demonstrated	6 (42.8)	6 (42.8)	1 (7.1)	3 (21.4)	3 (21.4)	2 (14.2)
	Often demonstrated	2 (14.2)	3 (21.4)	5 (35.7)	3 (21.4)	4 (28.5)	4 (28.5)
	Consistently demonstrated	1 (7.1)	3 (21.4)	7 (50.0)	8 (57.1)	6 (42.8)	6 (42.8)
Complies with the recommendation regarding fluid restriction	Never demonstrated	0	0	1 (7.1)	2 (14.2)	2 (14.2)	0	0.050
	Rarely demonstrated	4 (28.5)	2 (14.2)	0	1 (7.1)	2 (14.2)	2 (14.2)
	Sometimes demonstrated	6 (42.8)	8 (57.1)	6 (42.8)	1 (7.1)	1 (7.1)	3 (21.4)
	Often demonstrated	4 (28.5)	2 (14.2)	1 (7.1)	1 (7.1)	2 (14.2)	4 (28.5)
	Consistently demonstrated	0	2 (14.2)	6 (42.8)	9 (64.2)	7 (50.0)	5 (35.7)
Monitors body weight	Never demonstrated	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	0	0	0.059
	Rarely demonstrated	5 (35.7)	2 (14.2)	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)
	Sometimes demonstrated	3 (21.4)	3 (21.4)	4 (28.5)	2 (14.2)	2 (14.2)	0
	Often demonstrated	4 (28.5)	3 (21.4)	3 (21.4)	2 (14.2)	5 (35.7)	5 (35.7)
	Consistently demonstrated	1 (7.1)	4 (28.5)	5 (35.7)	7 (50.0)	6 (42.8)	8 (57.1)
Maintains an ideal weight	Never demonstrated	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	1 (7.1)	0	0.012
	Rarely demonstrated	2 (14.2)	2 (14.2)	2 (14.2)	1 (7.1)	2 (14.2)	1 (7.1)
	Sometimes demonstrated	2 (14.2)	2 (14.2)	0	2 (14.2)	0	1 (7.1)
	Often demonstrated	5 (35.7)	4 (28.5)	6 (42.8)	5 (35.7)	4 (28.5)	3 (21.4)
	Consistently demonstrated	4 (28.5)	4 (28.5)	5 (35.7)	5 (35.7)	7 (50.0)	9 (64.2)
Uses medication as prescribed	Never demonstrated	1 (7.1)	0	0	0	0	0	0.014
	Rarely demonstrated	1 (7.1)	1 (7.1)	1 (7.1)	1 (7.1)	1 (7.1)	0
	Sometimes demonstrated	4 (28.5)	2 (14.2)	3 (21.4)	1 (7.1)	1 (7.1)	0
	Often demonstrated	5 (35.7)	7 (50.0)	3 (21.4)	4 (28.5)	2 (14.2)	2 (14.2)
	Consistently demonstrated	3 (21.4)	4 (28.5)	7 (50.0)	8 (57.1)	10 (71.4)	12 (85.7)
Is vaccinated against influenza (flu)	Never demonstrated	4 (28.5)	2 (14.2)	3 (21.4)	2 (14.2)	1 (7.1)	1 (7.1)	0.001
	Rarely demonstrated	0	0	0	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	1 (7.1)	0	0	0
	Often demonstrated	3 (21.4)	0	0	1 (7.1)	0	0
	Consistently demonstrated	4 (28.5)	11 (78.5)	10 (71.4)	11 (78.5)	13 (92.8)	13 (92.8)
Is vaccinated against pneumonia	Never demonstrated	7 (50.0)	2 (14.2)	2 (14.2)	2 (14.2)	1 (7.1)	0	0.001
	Rarely demonstrated	0	0	0	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	1 (7.1)	0	0	0
	Often demonstrated	3 (21.4)	0	0	0	0	0
	Consistently demonstrated	1 (7.1)	11 (78.5)	11	12	13 (92.8)	14 (100.0)

		Consultation 1	Consultation 2	Consultation 3	Consultation 4	Consultation 5	Consultation 6	p value^* * Testes de Friedman.
		n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	p value^* * Testes de Friedman.
Asks questions about health	Never demonstrated	0	0	0	0	0	0	<0.001
	Rarely demonstrated	3 (21.4)	3 (21.4)	1 (7.1)	0	0	0
	Sometimes demonstrated	3 (21.4)	1 (7.1)	2 (14.2)	1 (7.1)	1 (7.1)	0
	Often demonstrated	3 (21.4)	5 (35.7)	4 (28.5)	4 (28.5)	2 (14.2)	1 (7.1)
	Consistently demonstrated	5 (35.7)	5 (35.7)	7 (50.0)	9 (64.2)	11 (78.5)	13 (92.8)
Weighs risks/benefits regarding health behavior	Never demonstrated	0	0	0	0	0	0	0.003
	Rarely demonstrated	5 (35.7)	2 (14.2)	0	0	2 (14.2)	0
	Sometimes demonstrated	2 (14.2)	5 (35.7)	4 (28.5)	2 (14.2)	0	2 (14.2)
	Often demonstrated	4 (28.5)	3 (21.4)	5 (35.7)	6 (42.8)	5 (35.7)	5 (35.7)
	Consistently demonstrated	3 (21.4)	4 (28.5)	5 (35.7)	6 (42.8)	7 (50.0)	7 (50.0)
Uses strategies to eliminate unhealthy behavior	Never demonstrated	0	0	0	1 (7.1)	0	0	0.128
	Rarely demonstrated	4 (28.5)	1 (7.1)	1 (7.14)	0	3 (21.4)	2 (14.2)
	Sometimes demonstrated	6 (42.8)	7 (50.0)	5 (35.7)	3 (21.4)	2 (14.2)	2 (14.2)
	Often demonstrated	1 (7.1)	4 (28.5)	4 (28.5)	3 (21.4)	1 (7.14)	4 (28.5)
	Consistently demonstrated	3 (21.4)	2 (14.2)	4 (28.5)	7 (50.0)	8 (57.1)	6 (42.8)
Justifies deviating from a health diet	Never demonstrated	2 (14.2)	2 (14.2)	1 (7.1)	1 (7.1)	2 (14.2)	2 (14.2)	0.013
	Rarely demonstrated	7 (50.0)	3 (21.4)	0	2 (14.2)	2 (14.2)	1 (7.1)
	Sometimes demonstrated	3 (21.4)	5 (35.7)	7 (50.0)	2 (14.2)	3 (21.4)	4 (28.5)
	Often demonstrated	1 (7.1)	3 (21.4)	2 (14.2)	5 (35.7)	2 (14.2)	2 (14.2)
	Consistently demonstrated	1 (7.1)	1 (7.1)	4 (28.5)	4 (28.5)	5 (35.7)	5 (35.7)
Performs self-monitoring of health condition	Never demonstrated	0	1 (7.1)	0	0	0	0	<0.001
	Rarely demonstrated	5 (35.7)	1 (7.1)	1 (7.1)	1 (7.1)	0	0
	Sometimes demonstrated	4 (28.5)	6 (42.8)	4 (28.5)	3 (21.4)	5 (35.7)	1 (7.1)
	Often demonstrated	1 (7.1)	3 (21.4)	4 (28.5)	2 (14.2)	1 (7.1)	5 (35.7)
	Consistently demonstrated	4 (28.5)	3 (21.4)	5 (35.7)	8 (57.1)	8 (57.1)	8 (57.1)

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[1] Corresponding Author: Ana Paula Dias de Oliveira E-mail: anapaulahsp@hotmail.com