A CSM-Based Volume Management Program for Chronic Heart Failure

This is a prospective, single‐center, randomized controlled trial. A total of 88 CHFpatients will be enrolled and randomly allocated in a 1:1 ratio to either theintervention group or the control group.‐Intervention Group: Participants receive a 5‐phase, nurse‐led intervention fromadmission to 3 months post‐discharge.Phase 1 (Health Threat Stimuli, Days 1‐2): Bedside interviews to activate patients'illness experiences by recalling prior acute decompensation episodes, combined withstructured lectures on volume overload pathophysiology.Phase 2 (Cognitive Representation, Days 1‐2): BIPQ assessment to identify misconceptions,followed by targeted one‐on‐one cognitive reframing sessions addressing specificcognitive distortions.Phase 3 (Emotional Representation, Days 1‐2): GAD‐7/PHQ‐9 assessment with one‐on‐oneemotional counseling and brief emotion regulation techniques (deep breathing,mindfulness).Phase 4 (Coping Strategy Development, Days 3‐4 before discharge): Comprehensive skillstraining covering: (a) recognition of 6 early signs of volume overload; (b) daily weightmonitoring using the "four fixed" method (fixed time, clothing, scale, and recording);(c) 24‐hour intake/output recording; (d) sodium restriction (<3g/d stable, <2g/d acute)with low‐salt cooking skills; (e) fluid management (1500‐2000mL/d euvolemic,1000‐1500mL/d overloaded); (f) diuretic self‐management with weight‐based adjustmentguidelines; (g) 4‐step problem‐solving skills training through scenario simulation.Self‐efficacy is enhanced through four pathways: enactive mastery (hands‐on practice),vicarious experiences (peer success stories), verbal persuasion (nurse reinforcement),and emotional arousal (stress management). An individualized home volume management planand structured discharge follow‐up schedule are developed collaboratively with eachpatient.‐Control Group: Participants receive standard in‐hospital care including admissionguidance, routine medication and dietary education, fluid management, weight monitoring,and psychological support. Before discharge, participants receive enhanced education, ahealth handbook, and are invited to a heart failure WeChat group for online consultation.Follow‐up Protocol: The intervention group receives telephone follow‐ups weekly duringmonth 1, biweekly during month 2, and an outpatient visit at month 3 with systematicreview of weight trends, symptom control, and behavioral goal attainment. The controlgroup receives telephone follow‐ups at month 1 and month 3 assessing symptoms, medicationadherence, and adverse events.Data Collection Schedule: Assessments are conducted at three time points: baseline(pre‐discharge), 1‐month post‐discharge, and 3‐month post‐discharge. Clinical indicators(LVEF, BNP, heart rate, NYHA class) are measured at baseline and 3 months only.