Mrs Akiko Sakamoto
1Chiba Prefectural University of Health Sciences, Japan
Biography:
She is an Assistant Professor in the Department of Nursing at Chiba Prefectural University of Health Sciences, with extensive experience in cardiovascular and palliative care nursing. Her research focuses on nursing care for patients with chronic cardiovascular diseases, particularly end-of-life care for heart failure patients. She has published extensively in leading Japanese nursing journals, including the Journal of the Japan Academy of Nursing Science and the Journal of Cardiovascular Nursing. She has received multiple research grants from the Japan Society for the Promotion of Science. This presentation reflects her commitment to evidence-based practice development and making visible expert nursing knowledge.
Abstract:
Background:
End-stage heart failure patients experience multidimensional suffering comparable to cancer patients. Previous studies identified that nurses implement symptom assessments and non-pharmacological interventions such as positioning, massage, and environmental modifications. However, expert nurses observe patients’ subtle changes moment by moment and adjust their care accordingly, drawing on accumulated clinical wisdom. This practice knowledge remains tacit and undocumented, hindering care standardization and nursing education.
Aim:
To identify and describe the specific content and detailed practices of nursing interventions for symptom management in end-stage heart failure patients through interviews with expert nurses.
Methods:
Qualitative descriptive study with five registered nurses having 6-25 years cardiovascular nursing experience. Semi-structured interviews explored symptom characteristics, specific nursing interventions, clinical judgments, and multidisciplinary collaboration. Qualitative inductive analysis generated codes, subcategories, and categories. Ethics approval obtained.
Results:
Six categories of nursing interventions emerged: (1) Multifaceted Approaches to Dyspnea—integrating morphine with cooling-ventilation techniques using ice packs and fans; coordinating multidisciplinary care for ventilator-related distress; (2) Comprehensive Care for Fatigue—recognizing fatigue as often overlooked, providing anticipatory care before patients request help, frequent repositioning; (3) Relief Through Touching—therapeutically utilizing nurses’ hand warmth with gentle pressure, prolonged back rubbing; (4) Psychological Support—making explicit promises to stay with patients, building relationships through patients’ interests, facilitating family connections; (5) Supporting Hope—interpreting non-verbal cues to understand wishes, providing flexibility within treatment restrictions; (6) Advocacy and Coordination—reporting using patients’ own words to physicians, documenting care plans to ensure continuity, coordinating multidisciplinary teams around patient values.
Conclusion:
This study revealed specific nursing techniques previously undocumented in literature: ice pack-ventilation combinations for dyspnea, therapeutic use of hand warmth, verbal promises for existential support, and patient-centered advocacy methods. These findings address the identified knowledge gap regarding detailed nursing practices, contributing to care standardization, nursing education, and quality improvement in heart failure palliative care.