The heart failure nurse visits Sheila at home. She re-assesses Sheila using the PHQ-9 and Sheila’s score is unchanged.
The heart failure nurse has training in Motivational Interviewing and she uses this approach when chatting with Sheila about her depression.
You have been introduced to the concept of motivational interviewing in the previous case study (Angus) but, if you are interested in learning more, a number of online learning modules are available:
- Royal College of Psychiatrists: Introduction to Motivational Interviewing
- NHS Education for Scotland e-Learning Zone (NHS Scotland staff, login required to access content)
Medication
One of Sheila’s expressed problems is that she has difficulty remembering to take her medication. It is important to be aware of potential cognitive changes which may impact on self-management and medication / therapy adherence as there is some evidence that there may be an increased risk of experiencing cognitive changes with cardiac disease.The nurse used a validated tool, The General Practitioner Assessment of Cognition (GPCOG) to assess Sheila’s level of cognition. The tool indicates that Sheila does not have significant cognitive impairment, apart from her inability to manage her medication effectively. (There are a number of validated tools that can be used in this situation – please see below.)
The heart failure nurse contacts the pharmacist and arranges for Sheila’s medications to be prescribed in dosette boxes. Dosette boxes are individualised boxes containing medications organised into compartments by day and time. These are especially useful in patients with polypharmacy, such as Sheila. Sheila finds these much easier to use and no longer worries that she has forgotten to take her tablets.
Pulse point
Cognition
It is important that Sheila continues to be monitored for cognitive deficits, as there is a possibility that her mood might improve with treatment but her memory impairment will continue. Problems with memory, confusion, language, thinking or judgement may be due to Sheila’s depression or may be indicative of something else, for, example hypoxic brain injury. Cognitive Impairment can cause poor self-management and adherence to medication, and is associated with a worse prognosis. It also includes an increased risk of mortality in heart failure.
The following resource contains information on assessment of cognitive abilities:
Pulse point
Loneliness
have shown that perceived loneliness in heart failure patients can lead to increased visits to hospital and hospitalisation. (As with cognitive impairment, there are a number of validated tools which can be used to measure loneliness – please see Supporting Information below.) Singing in her choir had provided Sheila with social contacts and community involvement. The heart failure nurse contacts a local third sector organisation, who arrange for a volunteer driver to take Sheila to choir practices and collect her once she has had coffee with her friends. They also organise for a befriender to sit with her husband and keep him company while Sheila is out.
A number of tools for measuring loneliness can be found at the following link:
Page last reviewed: 25 Sep 2020
