The Upbeat programme: embedding nursing values in the systematic development of a theory-driven, evidence-based, self-care intervention for people living with heart failure

Abstract Introduction Improving self-care is a major focus of multidisciplinary heart failure (HF) management programmes worldwide and such programmes are linked with better quality of life, lower mortality and lower readmission rates. HF models of self-care are described as one of three processes that comprise the construct of HF self-care: maintenance, symptom perception, and management, Modern healthcare is shifting from a disease-centric model to a more patient-centric model, recognising the importance of patient engagement and subsequent empowerment in developing group education programmes. Concomitant cognitive impairment has a prevalence of 40% in heart failure cohorts and requires consideration in constructing and tailoring key self-care messages. Core nursing values of care, compassion and commitment underpin nursing practice in Ireland and are embedded in the development of the Upbeat programme. Aim to delineate the influence of nursing values in the development of the Upbeat programme. Methods The development of the theory-driven, evidence-based, patient-centric rather than disease-centric self-care intervention is examined via the lens of nursing values. Commitment: Intervention development was underpinned by a rigorous literature review to identify the existing evidence base and to identify a theoretical model (Middle range theory of self-care of chronic illness) to underpin the intervention. This literature review also formed the basis of team brainstorming sessions to identify key education messages, processes and outcomes. Care: Relatable heart failure educational content that was also cognisant of the multi-morbid context of heart failure was developed into a four-week group education programme. Behaviour change techniques and principles were used in constructing educational messages (consciousness raising, salience of consequences, comparison, repetition, decisional balance, pros and cons, goal setting). Motivational interviewing principles were utilised in the delivery of the messages. Reiteration of key information to affirm self-efficacy and repetition as a learning technique was utilised to minimise cognitive load. Compassion: Cognitive impairment is frequently an exclusion criteria of group education interventions. The Upbeat programme was designed for patient/family dyads and tailored to cognitive impairment using a two -tier messaging system; simpler, clear messages designed to minimise cognitive load combined with more in-dept messaging designed for carers. Heart failure education was extended to broader healthy aging messages. The use of a falls prevention bingo session delivering twenty-four pieces of information in a more easily assimilated manner than traditional didactic formats. Conclusion To date the Upbeat Programme is innovative, has been well-received by participants and evaluations have been promising.