Running head: EVIDENCE BASED CHF FAMILY CARE 1

Evidence Based CHF Family Care

Abigail OBrien
Ferris State University










EVIDENCE BASED CHF FAMILY CARE 2

Healthcare implications
Physicians, nurses, unlicensed assistive personal and other members of the
interdisciplinary care team within the acute and long term care settings are faced with an
epidemic. The prevalence of congestive heart failure and detriment to the health care system that
CHF patients pose to the formal caregiver is different than the psychosocial effects the patient
places on the familial or non-formal caregiver after discharge. Heart failure is a chronic
condition marked by the hearts inability to pump blood to the tissues for adequate oxygenation
(Bare, Cheever,Hinkle, Smeltzer 2005, p. 825).
Complications of CHF provide for difficulty completing activities of daily living due to
shortness of breath, loss of stamina and overall decreased ability to function independently.
Johnston, Molloy, and Witham (2005), suggest in their systemic review article titled, Family
caregiving and congestive heart failure. Review and analysis; that CHF patients and their
familial care givers do not receive enough support to keep up with the demands of the disease.
The article implies that patients need more education at the time of discharge from the hospital
and that caregivers need continued social support to stave off depression and burn out that comes
with the demands of caring for a relative with CHF. The study tries to find strengths and
weaknesses within healthcare that can prevent exacerbations for both patient and caregiver.
Study Conduction
The research article by Johnston, et al. (2005) is a meta synthesis of three qualitative
studies and a review of 13 quantitative studies. The literature review consisted of three
databases: PsychINFO, Medline and Web of Science. The search criterion was reviewed over the
course of ten years (1993-2003). Key words the researchers used were: heart failure, cardiac
failure, carer, caregiver, partner, spouse and family. To substantiate their hypothesis that there is
EVIDENCE BASED CHF FAMILY CARE 3

a disservice to patients and their families with CHF the researchers compare and contrast the
volume of studies conducted on patients with other chronic illnesses, such as cancer and stroke
and the outcomes it placed on caregivers for those types of patients. The qualitative studies
suggest that the higher acuity of care required by the CHF patient the higher stress and demand
on the caregiver, but mentions further research (randomized control trial at the time of discharge)
with these patients is needed. The downfalls of the quantitative studies are the small sample sizes
that are not representative of all the populations that experience increased stress when caring for
CHF family members.
Results/Limitations/Comparison
The comprehensive analysis of the outcomes for CHF patients is summed up in the fact
that two thirds of hospitalizations are preventable with proper tertiary prevention and education
(Johnston et al, 2005). Patients families that were involved in discharge planning and education
felt better prepared to care for their family member. The strengths in this analysis is that it offers
solutions, such as conducting more studies to ascertain outcomes of patients and family members
and suggests education and community responsibility in caring for chronic CHF patients and
results of clinical trials to determine caregiver strain. The article suggests that less severe cases
of CHF affect caregiver stress more than the severe cases due to noncompliance. This article
shares an opinion of the authors that caregivers face more stress than those people that face
Alzheimers disease, which is a disease that affects cognition and has physical manifestations.
The comparison of these two distinct diseases and lobbying that one is more of a hardship on a
family, as opposed to another is unfounded by research because , as the article suggests there is
little evidence to support the effects of caregiver strain. Rather than comparing two separate
EVIDENCE BASED CHF FAMILY CARE 4

disease processes it may beneficial to form an individualized plan of care for each family and
how they cope with illness and stress.
Plan of Care
To provide individuals and their families with holistic care and support that prevents
unnecessary hospitalizations nurses need to be at the forefront of discharge planning. To
accommodate the care of a CHF patient education is necessary. Medication and activity
compliance is essential to achieve optimal outcomes. One of the most important things that
nurses can do is empower their patients. Patients need to recognize that they are not helpless
and that they can influence the direction of their lives and the outcomes of treatment, (Bare, et
al, 2010, p. 837). Patients are shown to respond to treatment and comply with medication
regimes if they are given choices and autonomy. Caregivers will feel less pressure to give total
care if a patient is encouraged to perform self-care. The Joint Commission has standards of care
for patients with heart failure that are basic. These standards should be implemented into nursing
practice for all patients and family members. (Bare et al , 2005, p.836) Some topics for nurses to
discuss are: nutrition, especially low sodium diet, reducing anxiety and using stress relieving
mechanisms such as guided imagery, monitoring weight daily and keeping scheduled
appointments with cardiologist and general practitioner.
Relevance of study to nursing practice
Heart failure is the most common reason for hospitalization of people older than 65
years of age. There are 5 million people in the United States with chronic heart failure (Bare et
al, 2005, p.825). As nurses there is the capacity to be advocates for patients and family members
in times of stress and improve quality of life for those with chronic disease and the people that
support them. The authors of this study have brought about valid points, that, in healthcare the
EVIDENCE BASED CHF FAMILY CARE 5

focus in current research appears to be on acute onset of conditions such as Alzheimers disease
and stroke and the psychosocial implications it places on caregivers, but there is little evidence
supporting those with chronic conditions, such as congestive heart failure and those that are a
part of their care.















EVIDENCE BASED CHF FAMILY CARE 6

References
Bare,B.G., Cheever,K.H., Hinkle, J.L., & Smeltzer,S.C. (2010). Brunner & Suddarths Textbook
of Medical Surgical Nursing.Philedelphia:Wolters-Kluwer, Lippincott,Williams &
Wilkins.
Johnston, D.W., Molloy, G.J., & Witham, M.D. (2005). Family caregiving and congestive heart
failure. Review and analysis. The European Journal of Heart Failure, 7, 592-603. doi:
10.1016/j.ejheart.2004.07.008