Key result
Specialized nurses provide comprehensive care across heart failure stages, emphasizing early advance care planning.
Why the study?
The context of end-of-life care for older heart failure patients with a complex clinical course provided by GCNSs and CNCHFs was unclear.
Specialized nurses provide comprehensive end-of-life care for older heart failure patients by integrating acute and palliative care, psychological support, and early multidisciplinary advance care planning.
Answers are grounded in this paper and cite their sources.
Supports specialized nursing roles in heart failure; leaves open whether early advance care planning improves outcomes.
BACKGROUND: The context of end-of-life care for older heart failure patients with a complex clinical course provided by certified nurse specialists in gerontology (GCNSs) and Certified nurses in chronic heart failure (CNCHFs) is unclear; therefore, this study aims to describe comprehensive nursing practice for older patients with heart failure at their end of life. METHODS: This study adopts a qualitative descriptive design using content analysis. Five GCNSs, and five CNCHFs were interviewed using a web app from January to March 2022. RESULTS: Thirteen categories of nursing practices for older patients with heart failure were generated: (1) Provide thorough acute care by a multidisciplinary team to alleviate dyspnea, (2) Assess psychiatric symptoms and use a suitable environment to perform treatment, (3) Explain the progression of heart failure with the doctor, (4) Build a trusting relationship with the patient and family and implement advance care planning (ACP) early during the patient's recovery, (5) Involve multiple professions to help patients to achieve their desired life, (6) Perform ACP always in collaboration with multiple professionals, (7) Provide lifestyle guidance according to patients' feelings so that they can continue living at home after discharge from the hospital, (8) Provide palliative and acute care in parallel with multiple professions, (9) Achieve end-of-life care at home through multidisciplinary cooperation, (10) Provide basic nursing care to the patient and family until the moment of death, (11) Provide concurrent acute and palliative care as well as psychological support to alleviate physical and mental symptoms, (12) Share the patient's prognosis and future wishes with multiple professionals, and (13) Engage in ACP from early stages, through several conversations with patients and their families. CONCLUSIONS: Specialized nurses provide acute care, palliative care, and psychological support to alleviate physical and mental symptoms throughout the different stages of chronic heart failure. In addition to nursing care by specialized nurses at each stage shown in this study, it is important to initiate ACP early in the end-of-life stage and to provide care for patients with multiple professionals.
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Doi et al. (2023) studied End-of-life care for older patients with heart failure (n=10). End-of-life care practices by specialized nurses was evaluated on Categories of nursing practices for older patients with heart failure at the end of life. Specialized nurses provide acute care, palliative care, and psychological support throughout the stages of chronic heart failure, highlighting the importance of early advance care planning.
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