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PONTIFICIA UNIVERSIDAD JAVERIANA NURSING FACULTY COLOMBIA CLAUDIA CAMARGO DIANA CÓRDOBA

MOTIVATIONAL INTERVIWEING AS A NURSING INTERVENTION TO PROMOTE SELF-CARE IN PATIENTS WITH HEART FAILURE IN A FOURTH LEVEL INSTITUTION IN BOGOTÁ. PONTIFICIA UNIVERSIDAD JAVERIANA NURSING FACULTY COLOMBIA CLAUDIA CAMARGO DIANA CÓRDOBA ANGELA GUÍO. CONTENT. 2. Problem statement.

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PONTIFICIA UNIVERSIDAD JAVERIANA NURSING FACULTY COLOMBIA CLAUDIA CAMARGO DIANA CÓRDOBA

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  1. MOTIVATIONAL INTERVIWEING AS A NURSING INTERVENTION TO PROMOTE SELF-CARE IN PATIENTS WITH HEART FAILURE IN A FOURTH LEVEL INSTITUTION IN BOGOTÁ PONTIFICIA UNIVERSIDAD JAVERIANA NURSING FACULTY COLOMBIA CLAUDIA CAMARGO DIANA CÓRDOBA ANGELA GUÍO

  2. CONTENT 2. Problem statement 3. Justification 1. Problem description 4. Objetives 7. Conclusions and recommendations 6. Results 5. Methodology

  3. PROBLEM STATEMENT Millions of people are affected in Europe and United States. Cause of death in these countries and some Latin American countries. In Colombia… Ministry of Social Protection, causes “6% of hospitalizations in adults, 7% of emergency department visits”. - Rate of 9.3 x 100,000 habitants. RODRÍGUEZ, Leonor. Et. Al. Capítulo 24, “Cuidado al paciente con Falla Cardíaca”, Enfermería Cardiovascular, Editorial Distribuna, Comité Editorial, Capítulo de Enfermería, Sociedad Colombiana de Cardiología, Bogotá, Colombia, 2008. Pg. 469-471. ISBN: 978-958-8379-00-5. Consultado: Marzo 20 de 2011.

  4. Patients have between low and intermediate self-care. The don’t carry out all actions and indications given by health professionals. “Daily practices and decisions on them, made by a person, family or group to take care of their own health”. SELF-CARE RIEGEL, Barbara. Et. al. “A motivational Counseling approach to improving Heart Failure Self-Care”, Journal of Cardiovascular Nursing, Vol. 21, No. 3, pg. 232 – 241, 2007, Estados Unidos. Consultado: Octubre 10 de 2011. PARADIS, Veronique. Et. al. “The Efficacy of a Motivational Nursing Intervention Based on the stages of change on Self-Care in Heart Failure patients”, Journal of Cardiovascular Nursing, Vol. 25, No. 2, pg. 130 – 141, Estados Unidos, 2010. Consultado: Octubre 29 de 2011. TOBON, Ofelia. “El auto cuidado una habilidad para vivir”. Departamento de enfermería. Universidad del Caldas. Disponible en línea: http://promocionsalud .ucaldas.edu.co/downloads/Revista%208_5.pdf Consultado: 28 Octubre 2011.

  5. PROBLEM DESCRIPTION SELF-CARE The professional nurse should encourage the patient to make changes and adjustments in his lifestyle, for better control of the disease. Motivation: “the probability that a person begins and continue adhering to a determined strategy and therefore to the treatment”. PORTILLO, Mónica. “Intervención terapéutica desde la entrevista motivacional”. La entrevista motivacional en las mujeres consumidoras de cannabis. III jornadas nacionales de patología dual y género. Clínica-UCA Hospital Universitario de la Ribera, Madrid, España, Diciembre 2007. Disponible en línea: http://www.patologiadual.es/genero09/cdrom/html/docs/ponencias/m_portillo.pdf Consultada: 23 mayo 2011. autocuidado medio, es decir, que no lleva a cabo todas las indicaciones y acciones dadas por el profesional de salud., RIEGEL, Barbara. Et. al. “A motivational Counseling approach to improving Heart Failure Self-Care”, Journal of Cardiovascular Nursing, Vol. 21, No. 3, pg. 232 – 241, 2007, EstadosUnidos. Consultado: Octubre 10 de 2011.

  6. MOTIVATIONAL INTERVIEWING “(…) Aclient-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” FLÓREZ-ALARCÓN, Luis. Et Al. Entrevista motivacional como herramienta para el fomento de cambios en el estilo de vida de personas con enfermedad crónicas no trasmisibles. Avances en psicología latinoamericana. Julio-Diciembre. Volumen 25. Universidad del Rosario. Bogotá, Colombia. 2007. Referencia a Casals. MILLER, William. ROLLNICK, Stephen. ¿Qué es la entrevista motivacional?. En: Revista de toxicomanías, Reino Unido, 1996. no. 6. Disponible en línea: http://www.cat-barcelona.com/pdfret/RET06-1.pdf. Consultado el 18 de Octubre de 2011.

  7. PROBLEM STATEMENT ¿What is the effectiveness of Motivational Interviewing as nursing intervention to promote self-care in patients with Heart Failure at a fourth level institution in Bogotá between January and May of 2012?

  8. Patient • Empowerment, decision making and generation of new changes. • Decrease hospitalizations rate and/or complications. • Professional nurse • New intervention: MI • Improve quality of nursing care. • Fourth level institution • - Added – Value (plus) • - Future JUSTIFICATION

  9. OBJECTIVES General Determine whether motivational interviewing,as a nursing intervention,is effective to promote self-care in patients with heart failure at a fourth level institution in Bogota between January and May of 2012.

  10. OBJECTIVES Specific • Determine socio-demographic characteristics of the patients with HF in a fourth level institution during the period between January to May of 2012. • Determine seeking help to respond rising or exacerbation of symptoms of HF before and after implementation of MI, at a fourth level institution during the period between January to May of 2012.

  11. OBJECTIVES Specifics • Determine adaptation activities and behavior to limitations imposed by the disease before and after implementation of MI, in patients with HF at a fourth level institution during the period between January to May of 2012. • Determine compliance to treatment regimen before and after implementation of MI in patients with HF at a fourth level institution between the period between January to May of 2012. • Compare levels of self-care before and after implementation of MI in patients with HF at a fourth level institution during the period between January to May of 2012.

  12. METHODOLOGY • Design • Quasi-experimental with a unique group. • Independent variable: Motivational Interviewing • Dependent variable: Self-care • Population • For this study population corresponded to 48 hospitalized patients at a fourth level institution in Bogota with HF diagnosis during the period between February and March of 2012.   • Sample size • Statistical power 80% and risk of error 0.05 = 25 patients • 4 process not culminated = 21 patients • Sampling • Probabilistic simple random sampling.

  13. INCLUSION CRITERIA EXCLUSION CRITERIA • Men and woman with HF diagnosis functional class I, II and III hospitalized in a fourth level institution in Bogota. • People capable of understanding, adequate mindset and alphabetized. • People residing in Bogotá and had telephone service. • Men and woman with HF diagnosis functional class IV, or whom can not achieve their self-care. • People incapable to respond and participate in the study.

  14. Nohelia Hewitt Dean School of Psychology TRAINING Claudia Camargo Victoria V. Dickson, PhD, CRNPBrookdale Leadership in Aging FellowNew York University

  15. PROCEDURE 1 2 M.I.

  16. INSTRUMENT • European Heart Failure Self-Care Behavior Scale (EHFScBS) • 6 item: therapeutic regimen compliance • 4 item: seeking help to respond rising or exacerbation of symptoms • 2 item: adaptation activities and behavior to limitations imposed by the disease • Validated in 442 patients • Cronbach Alpha of 0,81. • GONZALEZ, Beatriz. Et Al. Aplicación de la escala europea de autocuidado en insuficiencia cardíaca (EHFScBS) en una unidad de insuficiencia cardíaca en España. Revista Española de Cardiología. 2006. Vol. 59, N° 2. Pags: 166-170. • YU, Doris; et. Al. “Psychometricproperties of theChineseversion of theEuropeanHeartFailureSelf-careBehaviourScale”, International Jpurnal of Nursing, Studies 48, 2011. Disponible en línea: http://www.ncbi.nlm.nih.gov/pubmed/20970800. Consultado: Octubre 7 de 2011. Pg. 458 - 467.

  17. ANALYSIS AND RESULTS

  18. RESULTS Figure 1. Socio-demographic characteristics of patients with Heart Failure featured by age Figure 2. Socio-demographic characteristics of patients with Heart Failure featured by gender. Fuente: Test de información de características sociodemográficas en pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  19. RESULTS Figure 3. Socio-demographic characteristics of patients with Heart Failure featured by marital status Figure 4. Socio-demographic characteristics of patients with Heart Failure featured by socioeconomic stratum Fuente: Test de información de características sociodemográficas en pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  20. RESULTS Figure 5. Socio-demographic characteristics of patients with Heart Failure featured by support network Figure 6. Socio-demographic characteristics of patients with Heart Failure featured by level of education Fuente: Test de información de características sociodemográficas en pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  21. RESULTS Figure 7. Socio-demographic characteristics of patients with Heart Failure featured by education received prior to the intervention Fuente: Test de información de características sociodemográficas en pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  22. RESULTS Table 1. Therapeutic regimen compliance results in patients with Heart Failure Never Never Every once in a while Every once in a while Rarely Rarely Sometimes Sometimes Always Always Fuente: Resultados Escala Europea de Autocuidado aplicada a pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  23. RESULTS Table 2. Ability to adjust to sickness in patients with HF. Never Every once in a while Rarely Never Every once in a while Rarely Sometimes Sometimes Always Always Fuente: Resultados Escala Europea de Autocuidado aplicada a pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  24. RESULTS Table 3. Seeking help to respond rising or exacerbation of symptomsin patients with HF Every once in a while Never Never Rarely Every once in a while Rarely Sometimes Sometimes Always Always Fuente: Resultados Escala Europea de Autocuidado aplicada a pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  25. INFERENCIAL RESULTS Table 5. Compared self-care levels results before and after implementation of Motivational Interviewing Fuente: Resultados Escala Europea de Autocuidado aplicada a pacientes con insuficiencia cardíaca en una institución de cuarto nivel en Bogotá, 2012.

  26. CONCLUSIONS • Stating that 0.0207 < 0.05 is possible to reject the null hypothesis and conclude that Motivational Interviewing as a nursing intervention to promote self-care in patients with Heart Failure in a fourth level hospital, in Bogotá, is effective. • The support network was considered as a protective factor when promoting self-care in patients with Heart Failure, as well as the family support to help strengthen practices.

  27. CONCLUSIONS RECOMENDATION • Professional nurses can use MI to promote self-care in patients with this disease, because, while intrinsic motivation occurs, the person is able to generate changes in behaviors unfavorable for his/her health. • Further research on MI implementation in a longer time tracking to assess the effectiveness on the intervention over time.

  28. THANKS…

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