Patient's education by nurse: what we really do achieve?

To evaluate what is really achieved with nurse education in an outpatient heart failure population.

The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment.

Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35-86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year (p<0.001). Only 28% initially understood the disease; 55% at follow-up (p<0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% (p<0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% (p<0.001), of the action of these pills from 24% to 44% (p<0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% (p<0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively (p<0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% (p<0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly (p=0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found.

Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.