The Development of Nursing Care Network Based on Self–Management for Patients with Heart Failure in Sakon Nakhon Province

Abstract

This research and development research aimed to develop the nursing care network based on self–management for patients with heart failure in Sakon Nakhon province and study the outcomes after development. The target groups were purposively selected according to the specified qualifications consisted of the network development group, 36 nursing administrators and 21 specialists in nursing care for heart failure patients. The outcome evaluation group consisted of 18 nurse administrators, 36 professional nurses, and 180 heart failure patients which were divided into the experimental group, 90 patients received a self–management program, and the control group, 90 patients received usual care. The research was conducted in 6 steps from March, 2023 to November, 2023. The research tools were the self–management program for patients with heart failure, nurse’s competency development in self–management, supervision guideline for nursing network. The data collection tools were the focus–group discussions form, data collecting form, competency assessment form, clinical supervision form, quality of life assessment form and satisfaction assessment form. Data were analyzed by statistics, number, percentage, mean, standard deviation, independent t–test and Wilcoxon signed–ranks test. The results found that 1) the nursing care network based on self–management for patients with heart failure, Sakon Nakhon province composed of 3 components; professional nurses with nursing competency for patients with heart failure, self–management program, network and clinical supervision and 2) the outcomes before and after network development as measured by the 6–minute walks test, the quality of life and the number of hospital admission were statistically significant difference (p < 0.008, p < 0.001 and p < 0.001, respectively).