1. Seskevich, Jon BSN, BA, RN, CHTP
  2. Gabert, Helen MPH, RN, CS
  3. Charles, Ann BFA, ARRT, MR
  4. Cuffe, Michael S. MD

Article Content

Tech patients skills they can use at home.


Heart failure (HF) is the number one reason elderly Americans are hospitalized. Research has shown that psychosocial factors, especially anxiety and emotional stress, are significant


prognostic indicators. By using mind-body and behavioral techniques to reduce stress, you can help your patients relax and cope with this condition better.



Use these suggestions to help teach your patient how to deal with stress.


* Slow down. Pull up a chair, sit down, and let patients know you have time for them. Avoid talking about how busy you are.


* Listen supportively. Let your patients know you're really hearing them by making eye contact, nodding when appropriate, and restating or paraphrasing their words. If they're stable, ask open-ended questions to find out what's on their minds. Then try weaving silences into your discussion-even for 15 or 30 seconds-to give them more time to collect their thoughts and share their deeper concerns.


* Teach them this three-step relaxation technique. First, ask patients to try diaphragmatic breathing. Have them lie down in semi-Fowler's position with a pillow under their heads and their knees bent. Tell them to put one hand on their chest and the other on their abdomen, just below their rib cage.Then instruct them to breathe in and out slowly using their abdominal muscles. They should see the hand on their abdomen rise as they inhale and fall as they exhale; their other hand shouldn't move. Have them repeat this exercise three or four times to slow down their breathing and relax their body.Second, ask them to concentrate on feeling the bed support their weight; tell them to be aware of how their muscles soften and get warm and heavy.Third, ask them to focus silently on a calming phrase or word. Tell them that their mind may wander; when it does, they should return their focus to the relaxation phrase or picture.


* Use nonverbal communication. Lightly touching patients' shoulders and smiling at them communicate compassion and interest in what they are saying. So does moving to the same physical level, rather than standing over them, which connotes authority.


* Teach them to pace themselves. Many patients with chronic HF have periods of stability and relative wellness punctuated by discouraging exacerbations of disease symptoms. Teach your patients to manage fatigue and avoid other chronic symptoms by alternating periods of activity and rest. For practical purposes, encourage them to view activity as time when their feet are on the floor, and rest as time when their feet are off the floor. This perspective can help them balance appropriate activity and exercise with frequent breaks for rest. Days of illness in the hospital simply require longer periods of rest balanced by many smaller activity periods.



The take-home message? Listen to your patients with HF, validate their concerns, and teach them how to manage their stress and fatigue. By teaching them skills they can use to maintain their health and well-being at home, you'll help them avoid serious HF exacerbations and improve their quality of life.