Abstract
The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.
Highlights
About 80% of elderly patients with dementia who are in the acute exacerbation phase of heart failure are likely to develop behavioral psychological symptoms of dementia (BPSD) such as restlessness, agitation, and hyperactivity as they hardly understand the necessity of disease management and feel stressed against invasive treatments [1]-[6]
In the year of 2016, a revision of the medical payment system was made in Japan, in a way that the number of points added is reduced by 40% per day if they performed physical restraint to the elderly patients with dementia who have symptoms categorized to the ADL criteria level III or above [7]
We considered that we need to develop a nursing protocol from perspectives of nurses specialized in chronic heart failure and dementia care, who are the specialists for nursing care in chronic heart failure and dementia, in order to prevent discontinuation of treatments for acute exacerbation phase of heart failure in patients with impaired cognitive function using a method other than physical strain
Summary
About 80% of elderly patients with dementia who are in the acute exacerbation phase of heart failure are likely to develop behavioral psychological symptoms of dementia (BPSD) such as restlessness, agitation, and hyperactivity as they hardly understand the necessity of disease management and feel stressed against invasive treatments [1]-[6]. In the year of 2016, a revision of the medical payment system was made in Japan, in a way that the number of points added is reduced by 40% per day if they performed physical restraint to the elderly patients with dementia who have symptoms categorized to the ADL criteria level III (which interfere with activities of daily living, showing difficulty in activities and communications and requiring nursing care) or above [7]. It is required for medical institutions to develop nursing care other than physical restraint with which they can continue treatments for acute exacerbation of physical disorders in elderly people with dementia
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