Research conducted concerning chronic and non-communicable diseases suggests that “the public (and public officials) need to be not just informed” about diseases such as congestive heart failure but also be active in reforming healthcare and resources to research chronic, life-threatening conditions such as CHF (Wagner, 2008, para. 9). Educating everyone about conditions such as CHF will aid in preventing these diseases and decrease the mortality rate from these diseases. When a diagnosis of congestive heart failure is made, nurses and caregivers should thoroughly educate the patient and the family about the disease process, signs and symptoms to watch for, and how to take care of themselves at home to decrease or prevent hospitalizations related to exacerbation of symptoms. The patient needs to understand how important it is to closely follow his or her prescribed treatment regimen. The patient also needs to stop smoking if he or she smokes. The patient’s family education should also include measures to support the patient in the drastic lifestyle change that he or she will have to make. The patient’s family will be a support network and may keep the patient from becoming isolated and depressed due to the diagnosis and living with congestive heart failure.
When caring for patients who have congestive heart failure, cultural competence is of the utmost importance in regard to the patient and family preferences, religious practices and daily lifestyle that is important to the patient. The patient and family need intervention and education from several disciplines within the medical care team. The patient and family need education regarding CHF. The patient and family members need to be aware of signs and symptoms of exacerbation. The patient should also be taught about self-care techniques to employ after being discharged from the hospital, which includes weighing daily first thing in the morning to detect weight gain due to fluid retention. The patient should understand and be encouraged to adhere to any recommendations and treatment modalities prescribed by his or her doctor. This would include eating a low sodium diet to discourage fluid retention, edema, lower blood pressure, and facilitate weight loss. Recent studies have suggested that “obesity (assessed according to body mass index (BMI)) may be an under recognized risk factor for CHF” (Nicklas, et al, 2006, p. 1). Taking all medications exactly as they are prescribed and not taking any medications that are not prescribed by his or her physician or taking over-the-counter medications should be avoided. Patients with congestive heart failure are particularly at risk for increased potassium levels due to “coexisting comorbidities and use of multiple medications that impair potassium (K) excretion such as angiotensin converting enzyme (ACE) inhibitors” (Ramadan, et al, 2005, p. 1). Research has also shown that “recent use of nonsteroidal anti-inflammatory drugs (NSAIDs) by older persons increases the risk of hospitalization for congestive heart failure (CHF)” (NSAIDS raise risk of hospitalization for CHF, 2000, para. 1). Other research studies have revealed “a potentially increased risk of cardiovascular (CV) events associated with the use of thiazolidinediones (TZDs)” in older patients being treated with oral hypoglycemic agents, particularly rosiglitazone (Avandia), which is used to treat type II diabetes (Treatment of type II diabetes with rosiglitazone associated with increased risk of cardiovascular events among older adults, 2008, para. 1). Patients diagnosed with congestive heart failure need to be educated on performing all home treatments and using home medical equipment as prescribed, such as a nebulizer, c-pap, or bi-pap, and encourage physical activity balanced with adequate rest. The prescribed treatments will only improve the patient’s condition and make him or her feel better. Physical activity is important and advisable within limits set by the physician and will facilitate weight loss. Physical activity also encourages participation in social activities, which will help the patient to avoid depression and social isolation. People living with congestive heart failure are usually depressed and have a feeling of hopelessness. Caregivers and nursing staff that care for patients diagnosed with CHF should refrain from being biased and having the attitude that the patient “did it to themselves”. This attitude is often the case due to the nature of congestive heart failure. CHF could be prevented many times with lifestyle modifications that most people choose to ignore until symptoms begin to interfere with daily activities and quality of life. Healthcare professionals tend to be biased and insensitive to the needs of patients with congestive heart failure by feeling no compassion due to formed opinions and attitudes. However, no one involved in the care of any patient should form a biased opinion or attitude until he or she has experienced what the patient has experienced. When treating the patient with congestive heart failure, several healthcare providers specializing in different areas are usually involved his or her care. The patient and family require education, reinforcement, support, and encouragement to comply with all recommendations by physicians, pharmacists, dieticians, nurses, psychiatrists, counselors, pastoral services, and any other specialty provider that may be caring for and supporting the patient. Clear and timely communication of recommendations and patient outcomes should take place between all care providers on a regular basis to ensure continuity of care. Many patients who suffer with CHF require community and government resources to assist in the cost of medical care. The hospital social services workers can refer the patient to the correct agencies and assist the patient in obtaining needed medical equipment, home health services, medical coverage, transportation, and local support groups. Patients diagnosed with congestive heart failure require all these valuable services nearly all the time. The social worker also can help ensure continuity of care in this aspect by ensuring that the patient gets the needed services and equipment required for independent living and self-care at home.
Cultural Competence and CHF Educate patient and family Encourage compliance with treatment regimen Encourage social activities Avoid caregiver biases Ensure continuity of care Consult hospital social services
References Nicklas, B., Cesari, M., Penninx, B., Kritchevsky, S., Ding, J., Newman, A., et al. (2006, March). Abdominal Obesity Is an Independent Risk Factor for Chronic Heart Failure in Older People. Journal of the American Geriatrics Society, 54(3), 413-420. Retrieved March 14, 2009, doi:10.1111/j.1532-5415.2005.00624.x Ramadan, F., Masoodi, N., & El-Solh, A. (2005, June). Clinical factors associated with hyperkalemiain patients with congestive heart failure. Journal of Clinical Pharmacy & Therapeutics, 30(3), 233-239. Retrieved March 14, 2009, doi:10.1111/j.1365- 2710.2005.00638.x NSAIDs raise risk of hospitalization for CHF. (2000, June). Formulary, Retrieved March 14, 2009, from MasterFILE Premier database. Treatment of type 2 diabetes with rosiglitazone associated with increased risk of cardiovascular events among older adults. (2008, February). Formulary, Retrieved March 14, 2009, from MasterFILE Premier database. Wagner, C. (2008, March). Fighting Noncommunicable Diseases. Futurist, 42(2), 9-9. Retrieved March 15, 2009, from Professional Development Collection database.