Managing of Heart Failure Is Complex as

¶ … managing of heart failure is complex as it encompasses a treatment regimen that has to follow a lot of norms. One of the key elements in heart failure care is self-care behaviors that are essentially required to be learnt for patients through self-participation.

According to Britz and Dunn, (2010), there are certain self-efficacy norms that need to be followed by heart failure patient rat include regimens like weighing themselves or a regular basis, adhering to the a diet with low sodium, monitoring symptoms for worsening of the hearth conditions, adhering to a regimen that entails restricted fluid consumption and participating in physical activity either alone or in groups (Britz & Dunn, 2010). Moreover the patients with heart failure need to follow a strict regimen of medicines.

This complicated pharmacologic regimen is often very critical in continued care for heart patients. Medicines need to be taken at regular intervals and within the time that is specified by doctors and physicians. Any irregularity in the intake of medicine can result in deterioration of the health conditions of the patients.

Additionally patients with heart failure also has to make symptom management decisions according to their assessment of the symptoms and the medical prescriptions like the decreasing or increasing of the sodium intake or deciding when it would be an appropriate time for calling of the health care staff. The need for assessment of one's medical condition and the adjustments of the treatment regimen also is a cause for the increasing complexity of the heart failure care management.

This is often due to the fact that patients needing changes in treatment according to the changing health conditions may often find it hard to assess the need for change. Heart failure patients may find it difficult to detect gradual and small changes in their health status and therefore be unable to correctly assess the time for alerting the health care providers.

According to Friedman and Quinn, (2008), argued on the above mentioned points and claimed that this increases the need and makes it very critical for the heart failure patients to engage in educative measures of self-efficacy (Friedman & Quinn, 2008). Improvement of the self-care behavior is the primary aim of and the focus of education of patients with heart failures. Such education of patients in heart failure management and self-efficacy include topics like medications, exercise, symptoms, exercise, diet, fluid restriction and importance of activities like the daily weighing of the patient.

But experts like J. Mattera, (2011) often claim that adherence to self-care behaviors related to heart failure patients is not always successful through education (Mattera, 2011). Thus experts often describe self-efficacy as the belief in one's ability to achieve a desired result and changes only happen when the education of self-efficacy is able to influence the health choices and behaviors of the patients with heart failure (Bandura, 1977). Outcome and efficacy expectations are differentiated in Bandura's theory.

The expectations from outcomes related to the belief of an individual that a particular activity would lead to a particular outcome. On the other hand while talking about the expectations of efficacy or the perception of self-efficacy is the belief of an individual on the self-ability to be able to conduct or perform a particular behavior (Bandura, 1977).

Self-ability to have control of the health practices and the belief on the level of self-efficacy and its related impact on the goals and faithfulness for an individual is the perceived self-efficacy in health care (Bandura, 2004). The responses to the challenges and set-backs in health care and the individual's expectation about the result of embarking on a behavior change are influenced by self-efficacy (Bandura, 2004). One of the key areas in the management of heart failures is the monitoring of the weight of the individual.

Some type of adjustments need to be done for patients of heart failure when there is any gain or increase in weight and this adjustment needs to be initiated by the individual patient. In cases of patients with heart failure, the adjustments that needs to be undertaken in case of weight gain needs to flow from the knowledge or the belief that the an increase in the diuretic would help the patient in reducing weight.

The heart failure oatie3nt also needs to have the confidence that the corrective action that the individual would undertake to reduce weight is the correct way to address the problem. While the knowledge and belief is called efficacy expectation, the confidence of the patient about the corrective measure is referred to as efficacy expectation. Therefore education in self-efficacy according to Bandura's theory does not only involve the gaining of knowledge but the belief that the knowledge would be helpful in achieving a certain result (Bandura, 2004).

Experts claim that primary outcomes can be influenced by self-efficacy. Research has suggested that self-care ability improves when there is an increase in self-efficacy among individuals. Glasgow et al., (1997) in their work claim that studies have indicated that the individualization of the patients' experience with the intervention based on self-efficacy was the focus of a dietary behavioral intervention in patients with diabetes apart from the need for educating the patients (Glasgow et al., 1997)).

Improvements in abilities to take care of oneself was improved after educational intervention among the diabetic patients about their eating habits such as consumption of fewer calories and fat. The intervention yielded desirable primary results for the patients which was lower serum cholesterol. Certain references in literature suggest that often assessment of the primary outcomes that were relevant to the chronic illness were not studied when researchers and investigators made assessment of self-efficacy.

Adherence to specific health behaviors that have the potential to influence primary positive health outcomes for patients leads to improvement of self-efficacy and hence self-efficacy is also often considered to be an intermediate measure. Therefore patients with heart failure would probably not be properly prepared and thus would not be able to perform all recommended self-care behaviors in case there is a failure to increase self-efficacy in health care education intervention programs.

Poor or non-adherence to self-care practices as prescribed to patients with heart failure have been seen, in certain studies, as the primary result of low levels of self-efficacy (Ni et al., 1999). Hence it has been suggested by many researchers that educational intervention programs that are intended to increase self-efficacy needs to address the aspect of how interventions affect self-efficacy and this understanding should be used to decide the approach that needs to be taken by health care practitioners for the designing of health care interventions (Young, Barnason & Do, 2015).

Period of Educational Interventions It is therefore also critical to understand the components that make up a structured educational intervention that aim to improve the self-efficacy in order to enhance and positively enhance the self-care behaviors in heart failure patients (STAMP, 2012).

In this context what is most important as the elements of educational intervention that aims to influence and enhance self-efficacy in heart failure patients is the number of educational intervention sessions organized for an individual, the length of the individual sessions for patients and the type of contact that is made for the intervention program which include options like face-to-face interventions, interventions through telephonic conversation and instructions and the internet.

There are several studies that point out at varying lengths of time that should be used to measure the amount education by numbers of minutes per educational session. For example according to Flynn et al. (2005) provided, a good health education program efficacy needs to be conducted for ninety minutes of educational sessions for over twelve months (Flynn et al., 2005). On the other hand experts like Gary, (2006) suggested that the best timing for the length and duration of such intervention programs would be at least weekly education over twelve weeks (Gary, 2006).

Others like Riegel and Carlson's educational interventions were organized on a weekly basis for the first thirty days and then once a month for the next 90 days (Riegel & Carlson, 2004). There were a number of other experts who recommended various other timings for the health educational interventions. Dunagan et al. (2005) suggests that heart failure patients should be educated at least weekly over two weeks (Dunagan et al., 2005) and Yehle et al.

(2009) claimed that two education interventions sessions over a period of sixteen weeks at eight-week's interval was enough (Yehle et al., 2009). Other experts like Schreurs et al. (2003) was of the view that administering health educational intervention programs for heart failure patients should be conducted on a bi-weekly for four times which should be followed by a one-time session after a period of one month (Schreurs et al., 2003.

The educational intervention sessions of Kline, Scott, and Britton's occurred weekly for a total period of eight weeks (KLINE, SCOTT & BRITTON, 2007) and Maddison, Prapavessis and Armstrong believed that a onetime ten-minute education intervention sessions was enough (Maddison et al., 2008). Researchers however while agreeing to the varied needs about periods and number of sessions of educational interventions of patients with heart failure, claimed that there were statistically significant improvement in self-efficacy among the patients who had taken part in both long and short education sessions.

But the statistics were not able to establish any trend with regards to time among the statistical data. Guidelines for self-efficacy Researchers over the years have been able to come to a conclusion about the matters that need to be included in educational interventions for self-efficacy related to heart failure patients. These have resulted in the forming of the framework for the content of the various educational intervention programs for the heart failure patients. These have also helped standardize the content of the educational programs.

One of the more informational and information rich program is one that is suggested by the European Society of Cardiology. The guidelines suggested by the organization is more or less the accepted standards for the recommendations that need to be given to the heart failure patients regarding their self-care methods and techniques and the manner that needs to be given so the patients feel confident about suing the techniques and methods.

This also provides the guidelines that are necessary for the patients to make self-assessment of their condition and to know when to approach or alert the health care provider for specialized action and remedial measures. The recommendations for heart failure patients that need to be included in the educational intervention sessions should relate to: Physical Activity In the matter of exercise and the discharge patients of heart failure should be advised on individual basis while keeping in mind the clinical characteristics lifestyle, attitudes, culture and environment of the patient.

Moderate intensity activity of at least 30 minutes on most days of the week should be recommended to patients who generally lead a sedentary life. Begin at low intensities and gradually increasing intensity over period of over several weeks is recommended with patients with coronary heart diseases. For such patients the periods of the exercise need to be of short durations (http://www.health.govt.nz, 2015). Nutrition Management The adoption of a cardio protective dietary pattern is absolutely critical for all patients with cardiovascular disease and heart failure.

In this food and nutrition pattern there can be large servings of fruit, vegetables and whole grains, low fat dairy products, small servings of unsalted nuts and seeds regularly and fish or legumes. The consumption of fatty meat and full fat dairy products needs to be avoided to the maximum extent possible. However lean meat is allowed in small portions.

A heart patient needs to be made aware about the need for a long-term adherence to the diet prescribed and the possible suggestions of a dietician for further consultations on the diet regimen. There also needs to be regular follow ups of the diet charts according to the conditions of the patient from time to time (MAYOU, WELSTAND & TYNDEL, 2005). The patient also needs to be recommended for the adoption and maintenance of this dietary pattern in a strict manner.

The role and the importance of adoption of strict diet regiment needs to be included in the education programs and the benefits of adherence and the possible ill effects of non-adherence also needs to be mentioned clearly. Contrary to beliefs in case of heart failure patients, it needs to be recommended that alcohol consumption is allowed in small portions and in fact can be beneficial for the patients (MAYOU, WELSTAND & TYNDEL, 2005).

Weight Management The management of weight needs to be included as one of the important aspects of management of self-efficacy for heart failure patients. Educational intervention programs should highlight the combination of a reduced-energy diet and increased physical activity as absolutely necessary for overweight and obese patients with heart failure. This reduction or management of weight should be recommended through regular exercise and it should be borne in mind that the exercise should be in accordance to the physical condition of the patient.

The intervention program should also identify the weight management targets in relation to the general heart condition of the patient and the capability of the patient to take on exercise. Also the patients should be taught about the relation between weight management and the food habits, especially the intake of carbohydrates and energy rich foods such as sugar, confectionery, cakes, biscuits, soft drinks and chocolate. Smoking Smoking is a vital part of the life style intervention that should be highlighted for the patients with heart failure.

The intervention program should seek to establish the ill effects of the habit on the heart condition of the patient and the need to give up the habit. Quitting smoking should be one of the primary objectives in the education intervention. Group counseling, nicotine replacement therapy and some anti-depressant medications can be included as replacements for the smoking habit for long-term smoker with heart failure cases.

Psychosocial Aspects The educational intervention programs post discharge of the heart failure patients should include issues that are related to the psychological interventions like patient education, counseling and cognitive behavioral techniques. Among the psychological rehabilitation aspects are the issues that are related to the availability of social support to the patient and the aspects of the illness perception of the patient, the coping skills and ability of the patient and the external support system available to the patient.

The role of the spouses and the peers should also be included in the program. In case of heart failure patient who exhibit a high level of anxiety or depression, the suggestion for help from a trained practitioner for assessment and treatment of their anxiety and depression should be included and recommended in the post discharge education intervention program. Moreover the aspect of sexual activity also needs to be included in the program sessions.

Pharmacotherapy A detailed discussion about the need for pharmacotherapy with the inclusion of the regular medicines and the importance of timings and regular intake is an integral part of the post discharge educational program. Case Management The education l program needs to be individualized and specific and comprehensive for each patient with respect to cardiac rehabilitation. Physiology vs.

Psychology in Education Intervention In a study on self-efficacy and health status in patients with coronary heart disease by Sarkar, Ali and Whooley, (2009), the researchers looked into the aspect of improvement of the patient-reported health status which included the functional status and quality of life. The discharge educational program for heart failure patients, the researchers claimed that focus of such programs is now equally shared between the physiological needs to and the health status outcomes and the well-being of patients.