Impaired knowledge in individuals with heart failure: a middle range nursing theory

Silva, Cláudia Gabrielle da; Araújo, Suelayne Santana de; Morais, Sheila Coelho Ramalho Vasconcelos; Frazão, Cecília Maria Farias de Queiroz

doi:10.1590/0034-7167-2020-0855

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (02) • 2022 • https://doi.org/10.1590/0034-7167-2020-0855 copy

Impaired knowledge in individuals with heart failure: a middle range nursing theory

Conocimiento deficiente en individuos con insuficiencia cardíaca: una teoría de enfermería de mediano alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To develop a middle range nursing theory of impaired knowledge in individuals with heart failure.

Methods:

Descriptive study of the cross type developed through the theoretical-causal validity method, which used six steps for theory building: Definition of the construction approach; Definition of theoretical-conceptual models; Definition of main concepts; Development of a pictorial scheme; Construction of propositions; and Establishment of causal relations and evidence for practice.

Results:

Twenty-four articles were found, which identified two attributes, eight antecedents, and seven consequences, which gave rise to the pictogram, which schematized the concepts by relating them to cardiac physiology. Finally, 11 propositions and four causal relationships were created.

Conclusion:

The constructed theory enables a targeted driving of nurses’ clinical judgment regarding impaired knowledge in individuals with heart failure, culminating in individualized interventions to improve quality of life.

Descriptors:
Knowledge; Nursing Care; Heart Failure; Nursing Diagnosis; Nursing Theory

Attributes
Inadequate information
Vague answers to questions
Consequences
Increased hospital readmissions
Inaccurate statements about the disease and/or therapy
Deficit in self-care performance
Inadequate performance in the management of complications
Impaired social interaction
Decreased quality of life
Inadequate instructional follow-up
Antecedents
Anxiety
Low education of the individual and/or caregiver
Mild cognitive impairment
Depression
Elderly
Non-participation of the patient in health care planning
Inadequate orientation offered by health professionals
Weakened relationship between professional and individual

Propositions for the antecedents
From the moment the individual is not invited to elaborate his/her care plan together with the team, he/she becomes a passive agent, so that his/her understanding may be compromised and become a focal stimulus for the appearance of a deficient knowledge related to heart failure.
Inadequate guidance offered by health professionals is a stimulus that directly affects the heart failure patient, perpetuating the adaptive problem "decrease in cognitive process".
Vague responses to questioning and/or inadequate information regarding heart failure are found among patients who have a weakened relationship with health care professionals.
Sociodemographic (age and low education) and clinical factors (anxiety, depression, and mild cognitive impairment) are triggers that are present in patients who have vague answers to questions and/or inadequate information regarding heart failure.
Propositions for consequences
One of the factors leading to increased hospital readmissions among patients with heart failure is impaired knowledge about their disease and therapy.
The individual with heart failure will have a self-care deficit behavior that will be greater the less knowledge he/she has about the disease.
Decreased cognitive process interferes with decision making in the face of an intercurrence.
Impaired knowledge about heart failure leads to patient behaviors: for example, impaired social interaction.
The worsening in the quality of life of patients with heart failure who also have the adaptive problem "decreased cognitive process" is noticeable.
Inadequate follow-up instruction is a behavior present in patients who reported vague answers to questions and/or inadequate information regarding heart failure.
Inaccurate statements about disease and/or therapy are issued by patients with heart failure when they have the adaptive problem "decreased cognitive process".

Causal relations of impaired knowledge
Focal Stimuli
Inadequate orientation offered by health professionals can lead to impaired knowledge for the adequate performance in the management of intercurrences.
A weakened relationship between professional and individual may contribute to the appearance of inaccurate statements about the disease and/or therapy due to impaired knowledge.
Impaired knowledge can be associated with patients' non-participation in their health care planning, evidencing an increase in hospital readmissions.
The patient's non-participation in his or her health care planning can generate anxiety and result in deficits in self-care performance.
Contextual stimuli
Anxiety is a condition that can arise in response to inadequate guidance offered by health professionals, perpetuating a deficit in self-care performance.
Residual stimuli
Mild cognitive impairment and low education of the individual and/or caregiver may be responsible for inaccurate statements about the disease and/or therapy, evidencing impaired knowledge.
Depression may start after a new clinical condition and be responsible for inadequate instructional follow-up and self-care deficits, demonstrating impaired knowledge.

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[1] Corresponding author: Cláudia Gabrielle da Silva E-mail: cgsgabrielle@gmail.com