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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