The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: A quasi-experimental study

doi:10.1016/j.ijnurstu.2012.04.013

International Journal of Nursing Studies

Volume 49, Issue 10, October 2012, Pages 1230-1242

https://doi.org/10.1016/j.ijnurstu.2012.04.013 Get rights and content

Abstract

Background

Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home.

Objective

To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only.

Design

This is a quasi-experimental study design.

Methods

Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients’ health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group × time interaction were analysed using Mixed Model in SPSS (17.0).

Results

Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function—Relationships between family and subsystems and Relationships between family and society were improved in the experimental group compared to the comparison group, but Relationships between family and family members was not different.

Conclusions

The results provide evidence that telehealth care combined with discharge planning could reduce family caregiver burden, improve stress mastery, and improve family function during the first 30 days at home after heart failure patients are discharged from the hospital. Telenursing specialists cared caregivers with the concepts of providing transitional care to help them successful cross the critical transition stage.

Section snippets

Background

Heart failure is a life-threatening and progressive condition associated with multiple chronic diseases. This progressive condition causes patients to require repeated hospitalisations, results in poor life expectancy and impaired quality of life, and represents a heavy burden to family and society (AHA, 2008, Hunt et al., 2005). Patients with heart failure need advanced disease management and appropriate nursing care to help the patients and family caregivers to successfully transition from

Design

A two-group pretest–posttest design was used. Patients with heart failure have a critical situational and illness transition, as patients with the diagnoses of heart failure and acute myocardial infarction have the highest readmission rates within 30 days among recorded by health insurance companies (Armola and Topp, 2001). Follow-up plans are suggested to decrease readmission rates within 30 days (Armola and Topp, 2001). Therefore, data were collected at the first contact with patients and

Participants’ characteristics

The characteristics of the 60 family caregivers revealed no significant differences between the experimental and comparison groups in terms of gender, age, educational background, employment status, marital status, or religion (Table 1). Most family caregivers were over 40 years old (80.0% vs. 86.7%) and the majority had a bachelor's degree (53.4% vs. 53.3%). Most participants had worked before becoming a family caregiver.

Caregivers in the two groups also did not differ significantly in terms

Discussion

The results of this study show that nurse-led transitional care combining telehealth care and discharge planning significantly reduced family caregiver burden, improved mastery of stress related to the caregiver role, and improved family function. This facilitated successful transition for family caregivers of heart failure patient compared to the comparison group. Previous primary and systematic reviews focused on evaluating the patient's health, self-care behaviours, and medication compliance

Conclusion

Based on Meleis's transitional theory, nursing-led transitional care combining telehealth care and discharge planning could help family caregiver's successful transition in three outcome indicators—decreased family caregiver burden, increased stress mastery and improved family function in family caregivers of patients with heart failure one month after discharge compared to those receiving traditional discharge planning only. However, caregivers’ acceptance of the patient's critical condition,

Implications for practice and policy

Integrated telehealth care combining with discharge planning provides better nurse-led intervention for family caregivers and better care of the family as a unit. Chronic disease is not only a personal event; it is a critical family event. Providing discharge planning to heart failure patients and their families might improve patient self-care and reduce readmission rates. Telemedical monitoring in chronic heart failure might reduce total mortality as well as the number and duration of hospital

Acknowledgements

This is supported the Tele-Health Center in National Taiwan University Hospital. This study has some supported by grants from the National Science Council (no. NSC97-2314-B-039-034-MY3).

References (66)

S.D. Anker et al.
Telemedicine and remote management of patients with heart failure
The Lancet
(2011)
S.I. Chaudhry et al.
Telemonitoring for patient with chronic heart failure: a systematic review
Journal of Cardiac Failure
(2007)
S. Finkel et al.
E-care: a telecommunications technology intervention for family caregivers of dementia patients
American Journal of Geriatric Psychiatry
(2007)
N. Hagan et al.
Living with heart failure: partner perspectives
Australian Critical
(2007)
K.I. Harkness et al.
Measurement of the caregiving experience in caregivers of persons living with heart failure: a review of current instrument
Journal of Cardiac Failure
(2007)
Y.L. Ho et al.
Improved cost-effectiveness for management of chronic heart failure by combined home-based intervention with clinical nursing specialists
Journal of Formosa Medicine
(2007)
C. Klersy et al.
A meta-analysis of remote monitoring of heart failure patients
Journal of the American College of Cardiology
(2009)
A. Natanzon et al.
Pericardial and pleural effusions in congestive heart failure—anatomical, pathophysiologic, and clinical considerations
American Journal of Medical Science
(2009)
S. Winkler et al.
A meta-analysis of remote monitoring of heart failure patients
Journal of the American College of Cardiology
(2010)
ACC/AHA
Guidelines for the evaluation and management of chronic heart failure in the adult: executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Circulation
(2001)

ACC/AHA

AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)

Journal of American Colleague of Cardiology

(2005)

R.R. Armola et al.

Variables that discriminate length of stay and readmission within 30 days among heart failure patients

Lippincott's Case Management

(2001)

American Heart Association

Heart Disease and Stroke Statistics: 2008 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

(2008)

American Nurses Association

Telehealth: a tool for nursing practice

Nursing Trends & Issues, ANA Policy Series

(1997)

T. Bakas et al.

Family caregiving in heart failure

Nursing Research

(2006)

R.W. Brislin et al.

Cross-cultural Research Methods

(1973)

M. Clarke et al.

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis

Journal of Telemedicine and Telecare

(2011)

J. Carelock et al.

Heart failure: pathophysiologic mechanisms

American Journal of Nursing

(2001)

M.S. Caserta et al.

Exploring the Caregiver Burden Inventory (CBI): further evidence for a multidimensional view of burden

International Journal of Aging Human Development

(1996)

N. Chick et al.

Transitions: a nursing concern

Y.H. Chan

Biostatistics 301A: repeated measurement analysis (Mixed Models)

Singapore Medical Journal

(2004)

K.R. Chou et al.

The reliability and validity of the Chinese version of the Caregiver Burden Inventory

Nursing Research

(2002)

J.G. Cleland et al.

Prevalence and incidence of arrhythmias and sudden death in heart failure

Heart Failure Review

(2002)

J. Cohen

A power primer

Psychological Bulletin

(1992)

L.G. Collins et al.

Caregiver care

American Family Physician

(2011)

P.M. Davidson et al.

Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure

Journal of Cardiovascular Nursing

(2007)

V.P. Dias et al.

Telenursing in primary health care: report of experience in southern Brazil

Studies in Health Technology and Informatics

(2009)

E.R.M. Duvall et al.

Marriage and Family Development

(1985)

A.T. Hoglund et al.

‘It's easier to talk to a woman’. Aspects of gender in Swedish telenursing

Journal of Clinical Nursing

(2008)

N. Hohashi et al.

Validity and reliability of the Chinese version of the Feetham Family Functioning Survey (FFFS)

Journal of Family Nursing

(2008)

C.R. Huang et al.

Telecare and Telehealth care network in Taiwan

S.L. Hughes et al.

Effectiveness of team-managed home-based primary care: a randomized multicenter trial

The Journal of the American Medical Association

(2000)

G. Hu et al.

Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure

Circulation

(2010)

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The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: A quasi-experimental study

Abstract

Background

Objective

Design

Methods

Results

Conclusions

Section snippets

Background

Design

Participants’ characteristics

Discussion

Conclusion

Implications for practice and policy

Acknowledgements

The Lancet

Journal of Cardiac Failure

American Journal of Geriatric Psychiatry

Australian Critical

Journal of Cardiac Failure

Journal of Formosa Medicine

Journal of the American College of Cardiology

American Journal of Medical Science

Journal of the American College of Cardiology

Guidelines for the evaluation and management of chronic heart failure in the adult: executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Circulation

Journal of American Colleague of Cardiology

Variables that discriminate length of stay and readmission within 30 days among heart failure patients

Lippincott's Case Management

Heart Disease and Stroke Statistics: 2008 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Telehealth: a tool for nursing practice

Nursing Trends & Issues, ANA Policy Series

Family caregiving in heart failure

Nursing Research

Cross-cultural Research Methods

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis

Journal of Telemedicine and Telecare

Heart failure: pathophysiologic mechanisms

American Journal of Nursing

Exploring the Caregiver Burden Inventory (CBI): further evidence for a multidimensional view of burden

International Journal of Aging Human Development

Transitions: a nursing concern

Biostatistics 301A: repeated measurement analysis (Mixed Models)

Singapore Medical Journal

The reliability and validity of the Chinese version of the Caregiver Burden Inventory

Nursing Research

Prevalence and incidence of arrhythmias and sudden death in heart failure

Heart Failure Review

A power primer

Psychological Bulletin

Caregiver care

American Family Physician

Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure

Journal of Cardiovascular Nursing

Telenursing in primary health care: report of experience in southern Brazil

Studies in Health Technology and Informatics

Marriage and Family Development

‘It's easier to talk to a woman’. Aspects of gender in Swedish telenursing

Journal of Clinical Nursing

Validity and reliability of the Chinese version of the Feetham Family Functioning Survey (FFFS)

Journal of Family Nursing

Telecare and Telehealth care network in Taiwan

Effectiveness of team-managed home-based primary care: a randomized multicenter trial

The Journal of the American Medical Association

Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure

Circulation