ABSTRACT

Purpose: Chronic heart failure patients are often rehospitalized because they fail to seek appropriate, timely care. However, both patients and nurses experience difficulties in detecting signs of heart failure exacerbation. We aimed to qualitatively investigate how visiting nurses detect symptoms of disease progression in chronic heart failure patients in their homes.

Methods: Participants were three experienced home-visit chronic heart failure nurses who completed one-to-one interviews. Data were analysed using the qualitative synthesis method (KJ method).

Results: Six themes were identified that reflected detection of disease exacerbation and nursing support to prevent disease progression: difficulty of judging deterioration in patients with comorbidities; ascertaining conditions needing immediate intervention; detection of illness progression from changes in the patient’s appearance; inferring instability in physical condition from patients’ concerns and questions; arranging to ensure continued management of the patient post discharge; and instructing patients to ensure they never return to their old habits.

Conclusions: The findings indicate that nurses experience challenges in detecting illness progression and judging when outpatient or hospital care is needed. However, nurses use a range of signs and symptoms to determine deterioration. Home-visit nurses thus play a crucial role in the post-hospital care of chronic heart failure patients.

摘要

目的：慢性心力衰竭患者经常因无法寻求适当，及时的护理而重新住院。但是，患者和护士在检测心力衰竭加重迹象时都遇到困难。我们旨在定性调查来访护士如何在家中检测慢性心力衰竭患者的疾病进展症状。

方法：参加者为三位经验丰富的家庭访问慢性心力衰竭护士，他们完成了一对一的访谈。使用定性合成方法（KJ方法）分析数据。

结果：确定了六个主题，这些主题反映了疾病恶化的检测和预防疾病进展的护理支持：难以判断合并症患者的病情恶化；确定需要立即干预的条件；从患者外貌变化中检测疾病进展；从患者的担忧和疑问中推断出身体状况的不稳定性；安排确保出院后对患者进行持续管理；并指导患者确保他们永远不会恢复以前的习惯。

结论：研究结果表明，护士在发现疾病进展和判断何时需要门诊或医院护理方面遇到挑战。但是，护士会使用各种体征和症状来确定病情恶化。因此，家庭看护护士在慢性心力衰竭患者的院后护理中起着至关重要的作用。