Nurse's Knowledge about Modifiable and Non-Modifiable Risk Factors of Heart Failure Patient in Erbil Teaching Hospitals

: Background : The changes in cardiac function are associated with heart failure which result in a decrease of cardiac output. This results form a decline in stroke volume that is due to systolic dysfunction, diastolic dysfunction or a combination of the two. Nurses can play a role in prevention of heart failure disease by being knowledgeable of the risk factors associated with disease and also, the nurse may be a teacher-motivator for the patient. The aim of the study is to find out the association between nurse's knowledge about modifiable and non-modifiable risk factors of heart failure. Methods: A non probability purposive sample was 20 of February, 2014 to 20 of April 2014, 64 subjects, were selected in medical wards and coronary care units in both Hawler and Rizgary Teaching Hospitals. The study instrument contained of two parts. Part one included socio-demographic characteristics and part two was observational check list which contained 21 items for nurse's knowledge about modifiable and non-modifiable risk factors of heart failure patient. Data was analysis by the statistical package for science service (SPSS version 17) was used for data entering and analysis such as S= significant (<0.05), very highly significant (<0.000) and non-significant (>0.05), Percentage, frequency and Chi-square test were used to interpretation. Results: According to the results, that majority of the sample (67.2%) were within age group 23-32 years old. Male were more than female, the majority 83.8% of them were married and 75% of them graduates from nursing institute. Most of them had 1-7 years of experiences. The study shows very highly significance association of gender and highly significances association of marital status, levels of education and years of experiences in medical ward and coronary care unit. Conclusion: According to the results, the majority of the samples were within young age group, male more than female, the majority of them were graduated from nursing institution. Concerning statistical association between age group and nurse's knowledge about heart failure risks shows non-significant, while shows very highly significant within gender and highly significant between nurse's knowledge with their marital status, levels of education and years of experiences in medical ward and coronary care unit. Recommendation : Training session, continuous education and work shop by world health organization should be conduct for nurses at coronary care unit and medical ward to provide best nursing care for heart failure patient. Further study should be done to find out the gap between nursing practices and theory topics


INTRODUCTION:
Heart failure is a condition in which the heart has lost of the ability to pump enough blood to the body's tissues, with too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly 1&2 .Heart failure is a common, costly, disabling and often fatal disorder that affects approximately 5.8 million Americans, despite of improvements in medical care and advances in treatment, hospital discharges for heart failure have increased 155% over the past two decades 3 .Patient with heart failure may be asymptomatic or mildly symptomatic due to compensatory mechanisms 4 .The heart fails when, owing to intrinsic disease or a structural defect, it can't handle a normal blood volume or in the absence of disease, it can't tolerate a sudden expansion in blood volume 5 .Types of heart failure are acute and chronic, acute is a sudden changes in the heart ability to contract and can cause life threatening symptoms and pulmonary edema.Chronic heart failure occurs when the heart's ability to pump effectively is gradually compromised and its impaired contractility remains prolonged 6 .Common causes of heart failure are hypertension, coronary artery disease, cardiomyopathy, valvular disease, congenital disease, and cardiac infection 7 .Risk factors for heart failure patient may be divided into two classifications; modifiable and non-modifiable risk factors.Modifiable risk factors are those that an individual can change, including elevated serum cholesterol level, a diet high in saturated fat, obesity, physical inactive, hypertension, cigarette smoking, and alcohol consumption.And non-modifiable risk factors are those that an individual can't change, such as age, gender, ethnicity and heredity 8 .Right sided heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen.Left side heart failure occurs if the heart can't pump enough oxygen-rich blood to rest of the body 9 .The most causes of heart failure are coronary artery disease, cardiomyopathy, hypertension, heart valve disease, congenital heart disease and alcohol consumption 4 .The most symptoms are shortness of breathing, frequent cough, swollen extremities, abdominal selling, fatigue, dizziness and sudden deth 10 .Heart failure is usually treated with lifestyle changes and medicines.Dietary changes to maintain proper weight and reduce salt intake may be needed, reducing salt intake helps to lessen swelling in the legs, feet, and abdomen, appropriate exercise also may be recommended and other lifestyle changes that may reduce the symptoms of heart failure including stopping smoking, reducing alcohol consumption and not using harmful drugs.Some drugs may be described such as diuretics, digitals, vasodilators, betablockers, angiotensin converting enzyme inhibitors and calcium channel blocker 11 .Nurses play a key role in the evaluation of heart failure disease, monitoring the hemodynamic function and disease management.Nursing interventions have been shown to reduce patient stress.The nurse provided care management programs using an integrated or multifactor approach have been shown to be highly effective in reducing morbidity and mortality 12 .Nurse's skills make a different in care, such as monitoring oxygen, pulse oximetry, cardiac monitor, assess cardiac status, assess neurological status, observe dyspnea, blood pressure, neck vein, peripheral edema, lethargy, check pulse rate, heart sound, weight, and etc 5&12 .The nurse should keep abreast of the latest research finding so as to affect community-based health education programs, positive motivation strategies, effects of lowering cholesterol and triglycerides, gender differences, and nutritional studies 13 .
Objective Of The Study:Is to find out the association between nurse's knowledge about modifiable and non-modifiable risk factors of heart failure.

Subjects And Methods:
The study was conducted at both Hawler and Rizgary Teaching Hospitals-Medical ward and coronary care units in Erbil City.The study was carried out from the period of February 2014 to April 2014.The population of the study was the nurses who worked in both medical wards and coronary care units in Rizgary and Hawler Teaching Hospitals.A was tool prepared by the researcher as a check list questionnaire.A purposive sample of nurses was selected through a data collection in the three shifts and both genders.The total number of nurses in both areas was 64 nurses.Each of the nurses was assessed by observation individually face to face and the researcher spent 20 to 25 minutes with each nurse during the period of observation.For measuring and assessing the knowledge of nurses, it was considered to be as know=1 and don't know=2.The statistical package for science service (SPSS version 17) was used for data entering and analysis such as S= significant (<0.05), very highly significant (<0.000) and non-significant (>0.05),Percentage, frequency and Chi-square test were used to interpretation.As shown in table 1, more than half of the nurses (67.2%) were within age group 23-32 years, around (73.4%) were male and high percentages of the study sample (82.8) were married while no one of them was divorced and widowed.75% of them were graduated from nursing institute and (70.3%) of them had 1-7 years of experiences in medical and coronary care unit.3, show significant association in item sedentary lifestyle is worsening heart failure, between gender and nurse's knowledge, while show highly significant association in items stress has been worse condition of heart failure patient, males more than females expose to heart failure, there are categories of modifiable risk factors of heart failure, there are categories of nonmodifiable risk factors of heart failure, the most dangerous of modifiable risk factors of heart failure, the most dangerous of non-modifiable risk factors of heart failure, one of the most modifiable risk factors that affects heart failure patient, one of the most non-modifiable risk factors that affects heart failure patient and sleep apnea has been linked to the development of heart failure patient and the rest items show non-significant association.N(%) N(%) N(%) N(%) 1.Salty diet is worse heart failure 7(10.9)0(0.0) 46(71.9)2(3.1) 9(14.1)0(0.0) 0.709 2.Hypercholestero is worse heart failure 7(10.9)0(0.0) 43(67.2) 5(7.8) 9(14.1)0(0.0) 0.405 3.Sedentary lifestyle is worsening heart failure 4(6.3) 3(4.7) 24(37.5)24(37.5)8(12.5)1(1.6) 0.  The results of the study in table 4 show significant association between levels of education and nurse's knowledge in items stress has been worse condition of heart failure patient, hyperglycemia causes heart failure, aging has a role to increase the risk of heart failure patient, there are categories of modifiable risk factors of heart failure, there are categories of nonmodifiable risk factors of heart failure, the most dangerous of modifiable risk factors of heart failure, the most dangerous of non-modifiable risk factors of heart failure and one of the most modifiable risk factors that affects heart failure patient, while the table show highly significant association in item males more than females expose to heart failure only, but the rest items show non-significant association.*significant **highly significant Table 5, show significant association between years of experience in medical ward and coronary care unit and nurse's knowledge in items family history is a risk of exposing patient to heart failure, there are types of risk factors of heart failure, there are categories of modifiable risk factors of heart failure, the most dangerous of modifiable risk factors of heart failure, the most dangerous of non-modifiable risk factors of heart failure and one of the most non-modifiable risk factors that affects heart failure patient, while the result shows highly significant association in items sedentary lifestyle is worsening heart failure, there are categories of non-modifiable risk factors of heart failure , but the rest items show non-significant association.

DISCUSSION:
The study revealed that most of the nurse's age were within age group 23-32 years and male, while the majority of them were married third of fourth of the study sample were graduated from nursing institute, also the majority of them were had experience in medical ward and CCU in the period of 1-7 years.Regarding association between age group and nurse's knowledge about heart failure, the study shows significance association in item, hypertension is worsening heart failure.A study found that hypertension had relationship to aggravate heart failure 12 .While the rest items show non-significant association.Concerning association between gender and nurse's knowledge about heart failure, shows significant association in item sedentary lifestyle is worsening heart failure, a study revealed that inactive or sedentary lifestyle may be worse heart failure disease 13 , and highly significant association in items, stress has been worse condition of heart failure, male more than female expose to heart failure, another study examined 2.1 million samples found that heart failure more prevalence from male 9.7/1000 than female 8.2/1000 14 , one of the most modifiable risk factors that affects heart failure, study identified that hypertension and smoking were the major risk factors among heart failure 15 and sleep apnea has been linked to development of heart failure.Also very highly significant in items,There are categories of modifiable risk factors of heart failure,There are categories of non-modifiable risk factors of heart failure, The most dangerous of modifiable risk factors of heart failure, study said that hypertension, diabetes mellitus, obesity, cigarette smoking, and hypercholesterol have been aggravated risk factors of heart failure 16 .The most dangerous of non-modifiable risk factors of heart failure andone of the most non-modifiable risk factors that affect heart failure patient.A study indicated that aging and family history were the risk of heart failure 17 .While the rest items, were non-significant association.The study determined the association between levels of education and nurse's knowledge about heart failure, significant association in items, stress has been worse condition of heart failure, hyperglycemia is the cause of heart failure, aging has a role to increase the risk of heart failure, there are categories of modifiable risk factors of heart failure, there are categories of non-modifiable risk factors of heart failure, the most dangerous of modifiable risk factors of heart failure, the most dangerous of non-modifiable risk factors of heart failure, one of the most modifiable risk factors that affects heart failure A study revealed that prevalence of modifiable of risk factors such as hypertension, hypercholesterol, obesity, cigarette smoking and sedentary lifestyle were the more dangerous risk of heart failure 18 , and highly significant association in item male more than female expose to heart failure.While showing nonsignificant association in the rest items, regarding years of experience in medical ward and CCU, and nurse's knowledge about heart failure are shows significant association in items family history is a risk of heart failure, there are types of risk factors of heart failure, there are categories of modifiable risk factors of heart failure, the most dangerous of modifiable risk factors of heart failure, A study estimated that the incidence for the association between modifiable risk factors such as cigarette smoking, diabetes mellitus, hypercholesterol, hypertension and obesity and heart failure disease 19 .The most dangerous non-modifiable risk factors of heart failure, one of the most non-modifiable risk factors that affects heart failure, A study found that non-modifiable risk factors such as aging, gender and family history were risk factors for heart failure 20 , another study said that family history played a significant role in the developing of heart failure 21 , and showed highly significant association in items, sedentary lifestyle is worsening heart failure and there are categories of non-modifiable risk factors of heart failure.While showing non-significant association in the other items.

CONCLUSION:
The majority of the samples were within young age group, male more than female; the majority of them were graduated from nursing institution.Concerning statistical association between age group and nurse's knowledge about heart failure risks shows non-significant, while shows very highly significant within gender and highly significant between nurse's knowledge with their marital status, levels of education and years of experiences in medical ward and coronary care unit

RECOMMENDATION:
Training session, continuous education and work shop by world health organization should be conduct for nurses at coronary care unit and medical ward to provide best nursing care for heart failure patient.Further study should be done to find out the gap between nursing practices and theory topics.

Table 2 ,
shows non-significant association between age group and nurses knowledge in all items except the first item, do you know that salty diet is worse heart failure it was significant.