Lee & Dickson , 2011 ). Self-care skills can be defined as patients being able to make the right decisions when their symptoms worsen ( selfcare management ) and being able to maintain a healthy lifestyle and adhere to treatment ( selfcare maintenance ) ( Riegel et al ., 2009 ).
Evangelista et al ( 2015 ) conducted a prospective , quasi-experimental study to measure the outcome of Remote Monitoring Systems ( RMS ) on self-care , activation , and quality of life in elderly CHF patients for three months . As a result of non-randomisation in this type of study , their findings are considerably weaker than RCTs due to threats to the study ’ s internal validity ( Sutherland , 2017 ). Forty-two patients were included in this study by using convenience sampling : twenty-one patients in the RMS group and twenty-one patients in the comparison group .
Evangelista et al ( 2015 ) report that patients in both groups experienced an increase in their self-care management levels . However , in the RMS group , there is a significant increase in patients ’ self-care management levels ( p value < 0.001 ). Significant p-values are p < 0.05 , p < 0.01 and p < 0.001 ( Moule , 2018 ). In the RMS group , there is an increase in their selfcare maintenance levels , but in the comparison group , a decrease occurs ( Evangelista et al ., 2015 ). It is observed that there is a significant positive correlation between self-care management and self-care maintenance ( r = 0.594 , p < 0.001 ). This means that as patients ’ self-care management level increases , their selfcare maintenance level also increases , and vice versa ( Evangelista et al ., 2015 ).
Jaana et al ( 2019 ) state that overall , telemonitoring did not lead to an improvement in patients ’ self-care maintenance levels . There is an overall increase in patients ’ self-care management levels except on some measures . The measures are the ability for patients to recognise early that breathlessness and ankle swelling are HF symptoms , to take an extra diuretic or call doctors and nurses for advice , and lack of confidence to whether the use of remedies would be helpful ( Jaana et al ., 2019 ). All these imply that there is a need for patient education to be focused on self-care in HF patients that are using telemonitoring ( Jaana et al ., 2019 ).
After six months of using telemonitoring , most of the patients can identify when a significant change has occurred in their vital signs , and they can communicate this to the telemonitoring nurse for support and guidance ( Riley et al ., 2013 ). However , these patients are not able to make their own decisions based on the changes in their vital signs . Patients are provided with basic education on heart failure ( Riley et al ., 2013 ), and this could be the reason why patients are unable to develop their self-care skills effectively . It is evident from the findings that these patients would need to be educated more specifically on self-care when using telemonitoring . After the 12th month of the trial , patients in the telemonitoring group experience a significant increase ( p < 0.001 ) in their selfcare skills , and patients in the usual care group did not experience an increase in their self-care skills ( Boyne et al ., 2014 ).
Fairbrother et al ( 2014 ) report that patients are unable to self-manage their condition even with prompts from healthcare professionals , as they relied on healthcare professionals in the management of their condition . The healthcare professionals perceived that this could be because of the telemonitoring system ’ s daily patient questions , as it was more controlling by telling patients what to do at a specific time instead of prompting them ( Fairbrother et al ., 2014 ). This suggest that telemonitoring technologies and systems need to be developed in a way that promotes self-care in patients . The healthcare professionals state that there is a need for patients and healthcare professionals using telemonitoring in patient care to be educated and trained on self-management , but this did not occur in this study ( Fairbrother et al ., 2014 ). de Oliveira et al ( 2017 ) found that in the intervention group , there is a significant increase in HF patients ’ self-care skills in the second and fourth month ( p = 0.001 ). However , a significant increase did not occur in the control group regarding their self-care skills .
In conclusion , patients find the telemonitoring technology user-friendly ( Fairbrother et al ., 2014 ; Jaana et al ., 2019 ; Riley et al ., 2013 ).
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