Supportive Educative Nursing Program Effectively Increasing Self Care for Heart Failure Patients

Heart failure patients generally experience activity intolerance resulting in functional limitations and decreased self-care abilities. One of the systems identified Orem in patients with self-care fulfillment barriers is the supportive educational system, which is an effort to assist patients who need educational support in the hope that patients will need independent care. This study aimed to determine the effect of the supportive educative nursing program on self-care for heart failure patients. This research method was a quasi-experimental research with a pre-post-test control group design approach. A sample of 28 respondents was divided into treatment groups that received a supportive educative nursing program and a control group given education according to discharge planning procedures at Mangusada Regional Hospital. The questionnaire used was the Self Care Heart Failure Index (SCHFI). Data were analyzed using an independent T-test. The result of this study showed that there were significant differences between self-care in the intervention and control group with a p-value (0.017), where p < (0.05), which means that statistically providing supportive educative nursing program was more effective compared to ordinary education. Providing supportive educative nursing programs can be used as nursing interventions to improve patients' independent care with heart failure.


INTRODUCTION
Heart failure is a progressive health problem with high mortality and morbidity rates in developed and developing countries. An estimated 5 million people in the United States have heart failure, predominantly elderly, with nearly 80% of cases occurring in patients over the age of 65 with a mortality rate of around 45-50% (O'Connor et al., 2009). In Indonesia, heart failure patients are relatively younger than Europe and America, accompanied by a more severe clinical appearance (PERKI, 2015).
According to the Ministry of Health's basic health research (2013), heart failure prevalence based on interviews with diagnosed doctors in Indonesia is 0.13% or an estimated 229,696 people (Kemenkes, 2013).
In general, heart failure is caused by myocardial problems (coronary heart disease, cardiomyopathy, myocarditis), and mechanical disorders of the myocardium (hypertension, aortic stenosis, aortic coarctation) (Kabo, 2012). Impaired ventricular ability to store or eject blood causes breathlessness and fatigue, limiting activity tolerance (Pereira et al., 2016).
Generally, patients with heart failure will experience activity intolerance resulting in functional limitations. Functional limitations will affect the ability of heart failure patients to perform self-care. According to Dorothea Orem, self-care is an action in optimizing a person's ability to care for himself independently so that the ability to maintain his health and well-being is achieved (Alligood, 2014). A person can take care of himself, which is called a selfcare agency. Self-care agency for heart disease sufferers has decreased due to prolonged illness (Indiarti, 2014).  found that most heart failure patients had not carried out proper self-care as taught, such as a low salt diet, regular physical activity, fluid restriction, and daily weight monitoring. The inability to carry out self-care can be a factor affecting the rehospitalization of heart failure patients.
One of the systems identified by Orem for patients with barriers to fulfilling self-care is a supportive-educative system, which is an effort to assist patients who need educational support in the hope that patients will be able to require independent care.
This system is carried out to perform nursing actions after learning (Alligood, 2014). According to Etemadifar et al. (2014), the supportive-educative system is an effective intervention given by nurses to families and heart failure patients. This intervention is simple, inexpensive, and practical to provide. Heart failure patients will perform self-care if there is an understanding of different aspects of therapeutic self-care behavior so that the most appropriate intervention is to provide appropriate supportive-educative care (Zamanzadeh et al., 2013).
Data on heart failure patients at the   (anxiety), social support, the patient's role in the family, and socioeconomic conditions (Laksmi, Suprapta and Surinten, 2020).  Table 4 shows that in the control group The analysis results in both groups showed that the education given to both the intervention group and the control group was the same sign to improve self-care for patients with heart failure. Therefore, an

RESULTS AND DISCUSSION
Independent T-Test was conducted between the two groups to analyze the supportive educative nursing program's effectiveness in the following table 5.

CONCLUSION
Supportive educative nursing programs are more effective in increasing self-care for heart failure than regular education according to discharge planning procedures.
Educational programs given to patients should be accompanied by nurses and equipped with attractive educational media so that the information conveyed is understood and implemented by the patient.

ACKNOWLEDGMENT
The authors thank any parties supporting this study, especially to Ristekdikti, to provide opportunities and support in this research. The authors also thank STIKES Bina Usada Bali and Mangusada Regional Hospital for the facilities and all their assistance in completing this research.