Providing clinically meaningful education and training in family nursing through programs such as the ETI program for practicing nurses at a university hospital is essential in supporting nurses applying new knowledge, when providing evidence-based health care services, to individuals and their family members. Such training can facilitate integration of new and needed information in clinical practice.

The findings illustrate complex effects of the cardiac arrest on the survivor's life. Support after hospital discharge needs to be organized in a more structured fashion. The need for security and support was fundamental and should be addressed with continuity and vigilance in health care.

AimsThere are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio‐economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio‐economic factors were associated with patient‐reported outcome measures (PROMs).Methods and resultsIn this cross‐sectional survey, PROMs were measured with seven validated instruments, as follows: self‐care (the 12‐item European Heart Failure Self‐Care Behaviour scale), HF‐related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care—‘Patients' evaluation’), health status (EQ‐5D visual analogue scale), health‐related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status.The patients' (n = 124, mean age 73 ± 14.9, 69% male) self‐care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF‐specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1–6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ‐5D) on average at 65.5 (scale 0–100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care‐related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out‐of‐pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out‐of‐pocket expenses after the crisis, income, or whether patients lived alone or with others.ConclusionsThis Icelandic patient population reported similar health‐related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

Aims and objectives This study aimed to (1) describe the development of integrated services between hospital‐based heart failure nursing services and municipally located home care nurses’ services and (2) identify the benefits of this collaboration for the development of home care nursing services. Background Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved. Design A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure. Methods Data were field notes from observations at meetings of the steering group designing the services, visits to patients’ homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist. Results In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients’ homes. A clinical pathway was developed to assure effective assessment of patients’ condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition. Conclusions The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services. Relevance to clinical practice The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.

Aims: To describe and compare family functioning, family health, and perceived social support from nurses and to identify the variables that are associated with family functioning in patients with heart failure (HF) and their family members in Denmark,

Background Heart failure (HF) affects over 26 million people worldwide. Multidisciplinary management strategies that include symptom monitoring and patient self-care support reduce HF hospitalization and mortality rates. Ideally, HF follow-up and self-care support includes lifestyle-change recommendations and remote monitoring of weight and HF symptoms. Providing these via a digital solution may be ideal for improving HF disease outcomes and reducing the burden on providers and healthcare systems. This study’s main objective was to assess the feasibility of a digital solution including remote monitoring, lifestyle-change, and self-care support for HF outpatients in Iceland. Methods Twenty HF patients (mean age 57.5 years, 80% males) participated in an 8-week study. They were provided with a digital solution (SK-141), including lifestyle-change and disease self-care support, a remote symptom monitoring system, and a secure messaging platform between healthcare providers and patients. This feasibility study aimed to assess patient acceptability of this new intervention, retention rate, and to evaluate trends in clinical outcomes. To assess the acceptability of SK-141, participants completed a questionnaire about their experience after the 8-week study. Participants performed daily assigned activities (missions), including self-reporting symptoms. Clinical outcomes were assessed with the Hospital Anxiety and Depression Scale and the Kansas City Cardiomyopathy Questionnaire at the study's beginning and end with an online survey. Results Of the 24 patients invited, 20 were elected to participate. The retention rate of participants throughout the 8-week period was high (80%). At the end of the 8 weeks, thirteen participants completed a questionnaire about their experience and acceptability of the SK-141. They rated their experience positively including on questions whether they would recommend the solution to others (6.8 on a scale of 1–7), whether the solution had improved their life and well-being (5.7 on a scale of 1–7), and whether it was user friendly (5.5 on a scale of 1–7). Many of the clinical parameters studied exhibited a promising trend towards improvement over the 8-week period. Conclusion The digital solution, SK-141, was very acceptable to patients and also showed promising clinical results in this small feasibility study. These results encourage us to conduct a longer, more extensive, adequately powered, randomized-controlled study to assess whether this digital solution can improve the quality of life and clinical outcomes among HF patients.

Background: Heart failure (HF) affects over 26 million people worldwide. Multidisciplinary management strategies that include symptom monitoring and patient self-care support reduce HF hospitalization and mortality rates. Ideally, HF follow-up and self-care support includes lifestyle-change recommendations and remote monitoring of weight and HF symptoms. Providing these via a digital solution may be ideal for improving HF disease outcomes and reducing the burden on providers and healthcare systems. This study's main objective was to assess the feasibility of a digital solution including remote monitoring, lifestyle-change, and self-care support for HF outpatients in Iceland. Methods: Twenty HF patients (mean age 57.5 years, 80% males) participated in an 8-week study. They were provided with a digital solution (SK-141), including lifestyle-change and disease self-care support, a remote symptom monitoring system, and a secure messaging platform between healthcare providers and patients. This feasibility study aimed to assess patient acceptability of this new intervention, recruitment potential among patients in the HF clinic, retention rate, and to evaluate trends in clinical outcomes. To assess the acceptability of SK-141, participants completed a questionnaire about their experience after the 8-week study. Participants performed daily assigned activities (missions), including self-reporting symptoms. Clinical outcomes were assessed with the Hospital Anxiety and Depression Scale and the Kansas City Cardiomyopathy Questionnaire at the study's beginning and end with an online survey. Results: The retention rate of participants was high (80%) and participants rated the digital solution very highly with, e.g., a score of 6.8 out of 7 on their likelihood to recommend it to others. There was a trend towards improvement in all-but-one health-related variables logged in the digital solution from week 1 until week 8. Clinical outcomes revealed a positive trend for six out of seven variables, including for key heart failure variables such as shortness of breath, leg swelling, and fatigue. Conclusion: The digital solution, SK-141, was acceptable to patients and had promising results in this small feasibility study. These results encourage us to conduct a longer, more extensive, adequately powered, randomized-controlled study to assess whether this digital solution can improve quality of life and clinical outcomes among HF patients.

Background Promoting patients' sense of security is among the goals of nursing care within heart failure management. Objective The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. Methods Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0–100), their sense of security (Sense of Security in Care–Patients' Evaluation; possible scores, 1–100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0–100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. Results The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status (P < .01) and sense of security (P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. Conclusions Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.