High Risk for Ineffective Management of Therapeutic Regimen: A Protocol Study

Abstract

In this article, the authors present a protocol study developed to evaluate the usefulness of the nursing diagnosis "high risk for ineffective management of therapeutic regimen" among patients with congestive heart failure (CHF). Nursing interventions for increasing the CHF patient's abilities to perform therapeutic self-care for the promotion and maintenance of a prescribed medication regimen were evaluated based on predicted outcomes. Orem's self-care deficit theory of nursing provided the theoretical framework used in the protocol. Orem's supportive-educative nursing system was the approach used. Knowledge deficit was noted to be a major obstacle to maintaining the prescribed medication regimen among CHF patients. Comprehensive teaching of the patient, supported by a therapeutic nurse-patient relationship, was found to be the most important factor in the promotion and maintenance of a prescribed medication regimen among patients with CHF.

Male patients with congestive heart failure and their conception of the life situation

“…This insecurity creates an incapacity for self-help and the feeling of helplessness which they experience contributes to more stress and anxiety. It is necessary that these patients are aware that self-care behaviour requfres adaptation before they can commit to making changes in lifestyle (Fujita & Dungan 1994). This adaptation to CHF requires that the patients leam to understand and interpret their body, modify thefr lifestyle and test the limits of thefr CHF (Rideout 1992).…”

Assessment of hypertensive patients' self-care agency after counseling training of nurses

“…The supportive-educative system requires teaching and supporting the patients in decision making and management in order to achieve a healthy lifestyle. Some research has used this approach in different contexts regarding medication for congestive heart failure after discharge from hospital (Fujita & Dungan, 1994); the work of nurse practitioners in primary care settings (Geden, Isaramalai, & Taylor, 2001) and the categorization of the barriers that patients with heart failure experience in self-care behavior (Jaarsma, Abu-Saad, Dracup, & Halfens, 2000) but has not been found to be used in hypertension care before. When using this supportive-educative system for nursing actions, a greater effect is seen in patients' lifestyle changes when nurses are patient centered in their counseling (Britt, Hudson, & Blampied, 2004), and this is the aim of the motivational interviewing (MI) used in our intervention (Rollnick, Mason, & Butler, 2002).…”

The Relationship of Medication Regimen to Hospital Readmissions for Older Adults With Heart Failure

“…Activation of the RAAS also leads directly to increased systemic vascular resistance to preserve the perfusion of vital organs 7 . Patients with HF have systolic and/or diastolic dysfunction characterized by low cardiac output, increased filling pressures, and decreased exercise capacity 8 . Although patients with low cardiac output may be asymptomatic, 7 those with preserved left ventricular systolic function may exhibit clinical symptoms such as fatigue, shortness of breath, and peripheral edema.…”

“…Treatment for HF consists of an exercise and activity regimen, dietary modifications, and a specific medication plan. Therefore, the ultimate goal of therapy is to: 1) minimize or eliminate the underlying cause of HF; 2) decrease volume in the ventricles at end diastole and decrease the resistance the ventricle pumps against to reduce the heart's workload; and 3) increase contractility 8 …”