A better quality in the relationship between patients with heart failure and nurses reduces hospital admissions and adverse clinical events

Abstract

Background An estimated 64.3 million people live with heart failure (HF) worldwide and most are older adults. HF patients often use emergency services, and unplanned hospitalizations represent 20-25% of all hospital admissions in those over 65 years of age. During these frequent hospitalizations, patients with HF may experience adverse clinical events, such as falls, pressure ulcers, and infections. Furthermore, during these hospitalizations, patients with HF can develop a good mutuality(i.e., good quality in the relationship)with nurses, characterized by empathy, trust, reciprocity, equality, shared goals, shared decision making, and sharing of care. It is unknown whether mutuality is associated with hospital admissions, and adverse clinical events. Purpose The aim of this study was to investigate whether nurse-patient mutuality is associated with reduced hospital admission(i.e., use of emergency services and unplanned hospitalizations) and adverse clinical events(i.e., falls, pressure ulcers, and infections). Method A multicenter cross-sectional study was conducted in Italy. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness Scale, which includes three dimensions: "Developing and going beyond"(score ranges 3-15),"Being a point of reference"(score ranges 8-40)and "Deciding and sharing care"(score ranges 9-45). Higher scores mean better mutuality. Adverse clinical events were obtained from medical records. Data were analyzed with descriptive statistics and logistic regression. Covariates in the tested models were age, sex, education, living conditions, number of diseases, and number of medications. Results A sample of 167 patients with HF participated in the study (mean age 66.6, SD ±13.9; 58.1 % male). The mutuality average scores were 12.8(±2.4), 35.4(±5.0) and 32.0(±8.7) for "Developing and going beyond", "Being a pointof reference" and "Deciding and sharing care",respectively. Logistic regression showed that higher "Developing and going beyond" scores were associated with lower odds of pressure ulcers(OR=.49, 95%CI[.27-.87])and infections(OR=.75, 95%CI[.59-.96]); higher "Being a point of reference" scores were associated with lower odds of pressure ulcers(OR=.56, 95%CI[.37-.84]); higher "Deciding and sharing care" scores were associated with lower odds of infections(OR=.86, 95%CI[.80-.92]), of uses of emergency services(OR=.92, 95%CI[.87-.97]), of unplanned hospitalizations(OR=.94, 95%CI[.89-.99]),and of falls(OR=.90, 95%CI[.84-.97]). Among the covariates, patients living alone were 3.01(95%CI [1.06-.8.54])times as likely to have emergency access than those living with a family. Conclusions Our study showed that nurse-patient mutuality has an important role in predicting either hospital admissions or adverse clinical events. These results, if supported by further studies, may be useful to guide future interventions for patients with HF in order to reduce their hospitalizations and improve their clinical outcomes.