After being discharged, patients with heart failure, are exposed to the problems of disease management in the family and community, and follow-up interventions after discharging can play a significant supportive role in promoting a sense of worth in them. The purpose of this study was to investigate the effect of post-discharge telephone follow-up on the inherent dignity of patients with heart failure.

 

The present study was a randomized clinical trial with a parallel design that was registered with the code IRCT20100114003064N14 in the Iranian clinical trial system. After library studies and obtaining the necessary permission from the Vice Chancellor for Research and the Research Ethics Committee of Shahroud University of Medical Sciences, 70 patients with heart failure were assigned into two intervention and control groups using the block randomization with block size of 4 based on inclusion and exclusion criteria from among patients who referred to Post-CCU / CCU wards and The heart ward of Imam Hossein Hospital in Shahroud in 2019.
Inclusion criteria were: at least one month has passed since the diagnosis of heart failure, discharge fraction of 40% or less (21), age over forty years and ability to speak Persian; and exclusion criteria were: the use of psychotropic drugs such as ascites and ecstasy or mental illness such as depression and anxiety that was diagnosed by a specialist doctor. According to the study of Farazmand et al. (2017) (19) who estimated the difference between the two means to be twelve points, the significance level was 0.05 and the test power was 0.80. The number of samples required to compare the two means was estimated 27 in each group. According to the type of study and the probability of shedding, the sample size increased to 35 people in each group.
 

The intervention group was followed up by telephone for one month once a week with regard to drug use, symptoms, daily activities, and type of nutrition. The patients' inherent dignity was assessed using the Inherent Dignity Questionnaire (IDQ) before and after one month of the intervention. Data were analysed using descriptive statistics (frequency, frequency percentage, mean and standard deviation) and inferential statistics (independent Chi-square and t-test using SPSS software version 16 (SPSS Inc., Chicago, Ill., USA)) and the significance level was considered 0.05.

 

Results

Discussion

The aim of this study was to determine the effect of telephone follow-up after discharge on the inherent dignity of patients with heart failure. Based on searches in various information sources, no study has been conducted on the effect of post-discharge telephone follow-up on patients' inherent dignity, and the present study was conducted for the first time in the country and abroad. Therefore, the results of this study were compared with the results of studies on the effect of post-discharge telephone follow-up on other variables similar and close to the concept of patients' intrinsic dignity. The results of this study showed that telephone follow-up in the intervention group compared with the control group within one month after discharge increased the mean score of intrinsic dignity. In this regard, Oscalices et al. (2019) in their study concluded that the experimental group was more committed to drug use and telephone follow-up was effective and improved treatment and led to reduction of readmission and death rate in patients with heart failure (24). Najafi et al. (2016) achieved similar results in their research (25). In addition, other studies have shown that performing various interventions, including communication with the patient and following the patient's condition in different ways and providing the patient with the necessary training, are effective in increasing patients' life expectancy and quality of life (14, 19). Therefore, the use of anxiety reduction strategies in patients with heart failure was considered beneficial in order to improve their status (26).
Other studies have pointed to the positive effects of educational interventions and telephone follow-up after discharge of caregivers on various aspects of the life of heart failure patients. In 2015, Yu et al. conducted a study to determine the effect of using an educational guide and telephone follow-up on patient adherence to medication and quality of life in patients with heart failure. The findings of this study showed the effectiveness of health education interventions and telephone follow-ups. It was also concluded that telephone follow-up can effectively improve patients' treatment outcomes and help maintain a degree of physical, psychological and social well-being in these patients (18). The results of this study are consistent with the results of the present study. Also in 2013, McMillan et al. performed a five-week study to determine the effect of a model-based problem-solving process in caregivers of heart failure patients on patients' quality of life, knowledge, self-care, and mood. The results of this study showed that there was no statistically significant difference between the score of depression and anxiety and quality of life of patients with the knowledge of patient caregivers in the two studied groups. In other words, the use of problem-solving interventions in caregivers of patients with heart failure is not effective on depression, anxiety, quality of life, patients' self-care behaviours, and caregivers' knowledge. The findings of this study were not consistent with the results of the present study (27). Perhaps the reason for the difference can be seen in the fact that in the study of McMillan et al. (2013) the process was performed on patient caregivers and the effect of intervention on caregivers on quality of life and self-care knowledge and moods of patients was measured; but in the present study, the intervention was performed on patients.
In the present study, the effect of telephone follow-up after discharge on different dimensions of intrinsic dignity was investigated and the comparison of score differences before and after the intervention in the dimension of intrinsic dignity in the family showed a positive effect. This matter showed that when the patient is faced with the support of medical staff and his needs are followed, the patient feels safe and valuable in the family and can be effective in promoting the patient's position in the family and play an important role in improving family attention to the patient. In this regard, Piamjariyakul et al. (2013) in their study showed that family attention to the care of heart failure patients was effective on some clinical outcomes of these patients and increased self-confidence, an important component of intrinsic dignity (11).
One of the important points in the concept of intrinsic dignity is the feeling of value in society that the present study showed a positive and significant effect of telephone follow-up after discharge on the dimension of intrinsic dignity of the patient in society. Consistent with this result, Philipp et al. (2016) in their research emphasized the role of patient support and the need for their independence and security in society in maintaining patients' self-esteem and dignity and stated that lack of self-esteem and dignity in patients is an important problem. And it is due to ignoring the patients' need for independence and security in society. It should be noted that providing support and meeting the needs of patients in this area helps maintain their self-esteem (28).
In the present study, the results of the effect of post-discharge telephone follow-up on the dimension of inherent dignity in the treatment environment were also evaluated as significant. In this regard, Cajanding et al. (2016) in their study examined the effectiveness of nurse cognitive-behavioural interventions on quality of life and self-esteem and behavioural status of patients with heart failure in the Philippines and found that nurse cognitive-behavioural interventions are effective strategies to improve quality of life and trust and mood of patients with heart disease (20). Also, Tauber ‐ Gilmore et al. (2018) in their research, emphasized the importance and necessity of training for staff in order to properly implement patient dignity care programs and stated that clinical nurses play a major role in ensuring the dignity of patients in the hospital (29).

 

Conclusion

 According to the results of the present study, which showed that post-discharge telephone follow-up improves the inherent dignity of patients, therefore, to maintain and promote the inherent dignity of patients with heart failure in the community, planned and systematic post-discharge follow-ups are recommended.

 

Acknowledgments

This study was conducted as a part of a dissertation in the master's degree in intensive care nursing approved by the Graduate Council of Shahroud University of Medical Sciences with ethics code IR.SHMU.REC.1397.177 from the committee of the university. The authors of the article consider it obligatory to appreciate the financial support of Shahroud University of Medical Sciences in the implementation of this research project with the number 97134 and also all the staff of the research departments and the subjects of the present research; Because the results obtained in the present study are the result of their sincere cooperation.

 

Conflicts of Interest

The authors declared no connflict of interest.