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Item type Presentation

Format Text-based Document

Title Feasibility Study of a Nurse-Led Heart FailureStandardized Education Program to Reduce 30-DayReadmission

Authors Awoke, Martha Sissay; Baptiste, Diana Lyn

Downloaded 19-Jul-2018 10:24:55

Link to item http://hdl.handle.net/10755/622740

www.nursing.jhu.edu

Feasibility study of a nurse-led heart failure standardized

education program to reduce 30-day readmission

Martha Awoke DNP, RNDiana Baptiste, DNP, RN

Cheryl Dennison Himmelfarb RN, PhD, FAANAllen Roberts II, M.D., M.Div., FCCP, FACP

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Disclosure

The authors declare no conflict of interest. The authors received no financial support or commercial sponsorship for this study.

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Objectives

By the end of this session the learner will be able to: 1. Recognize three concepts of self-care behaviors related to

heart failure2. Describe three key concepts related to knowledge of heart

failure3. Identify two evidence-based instruments that can be used to

quantify self-care and knowledge of heart failure4. Recognize three factors that contribute to readmission

3

Background

• Globally-23 Million people live with heart failure (HF)

• National-5.8 Million people live with HF• Annually >550,000 people are diagnosed• 50% of patients with HF die within 5 year from

initial diagnosis• Annually-$32 billion is spent to treat HF-related

conditions

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Literature Review• 30-days post-hospitalization- most vulnerable period for HF

patients

• Patient’s knowledge level and recognition of HF symptoms influences self-care behavior

• Knowledge deficit and poor self care contributes to readmissions

• Nurses knowledge and comfort level with educating patients affects the quality of patient education

Albert et al. (2012); Dharmarjan et al.(2012); Paul & Hice (2014); Yancy et al. (2013)

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Purpose

To implement a standardized heart failure patient education program and evaluate its impact on knowledge, self-care and all cause 30-day readmission for individuals with heart failure.

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Aims

1. To improve patients’ knowledge of heart failure

2. To improve self-care behaviors among patients with heart failure

3. To reduce all-cause 30-day re-admission4. To evaluate nurses confidence in using Teach-

back method during patient education

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Methods

• Design: Quasi-experimental • Setting: Two inpatient cardiovascular units at a

large urban academic medical center• Sample: A convenient sample of patients

primary and secondary diagnosis of HF

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Intervention

•Teach-back Method instruction provided to nurses prior to implementing patient education

•Nurse-led education as recommended by the AHA and ACC encompassing:

medication adherencedaily weight monitoringdiet and fluid restrictionSymptom monitoring/management

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Measurement

Dutch Heart Failure Knowledge Scale (DHFKS)

Quantitative instrument 15-item questionnaire Score: 0-15, (0 = no knowledge, 15=

optimum knowledge) Reliability and construct validity reported by

scale author

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Van der Wal et al. (2005)

MeasurementSelf-Care Heart Failure Index (SCHFI)

22- item questionnaire Self-care maintenance (α .553) Self-care management (α .597) Self-care confidence (α .827) Subscale scores, standardized from 0-100 Reliability and construct validity reported by

scale author

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Barbaranelli, C., Lee, C. S., Vellone, E., & Riegel, B. (2014)

MeasurementConviction and Confidence Scale

• 4 questions measuring nurses’ confidence, conviction, and ease of using teach-back method

• Score: 0-10 (0=low, 10= high)

12Agency for Healthcare Research and Quality (2015)

Study Flow Chart

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Results

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SD= Standard Deviation; NYHA= New York Heart Association

Results: Aim 1

To improve patients knowledge level about heart failure

P value <.05 is considered statistically significant. ** Statistically significant. Paired t-test used to calculate significance.

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Results: Aim 2To improve self-care among patients with heart failure

P value <.05 is considered statistically significant. ** Statistically significant. Paired t-test used to calculate significance.

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To reduce all cause 30-day re-admission

Chi-Square used to calculate significance. P<.05 indicates significance

Results: Aim 3

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Results: Aim 4

SD= Standard deviation. Scale 0-10, 0= not convinced, not confident. 10= very convinced, very confident.

How often do you ask patient to explain back in their own wordsN=23 Response (%)

I do not do it now, but plan to do this in the next month 21.7

I have been doing this for less than 6 months 30.4

I have been doing this for 6 months or more 39.1

Table 5. Percent (%) of nurses who use teach-back method during patient education.

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N=23 Mean SDHow convinced are you that it is important to use teach-back method

9.39 0.89

How confident are you in your ability to use teach-back

7.52 1.78

To evaluate nurses confidence with Teach-Back

Limitations

• Small, non-random sample• Quasi-experimental design with no

randomized control group• High attrition rate• Single site study• Short term study• Study not generalizable

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DiscussionSimilar to previous studies, this study highlights:

• Standardized nurse-led heart failure education had a positive outcome.

• Education focused on knowledge & self-care improves knowledge and self-care behaviors

• Nurses play a key role in patient education

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Conclusions

• HF is a common condition with high symptom burden

• HF education should be standardized following by AHA/ACC guidelines

• Further investigation is necessary to identify gaps in practice that may contribute to all-cause readmissions

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26; quiz 227-8. doi:10.1097/NCM.0b013e318257347d [doi] 3. Albert, N. M., Cohen, B., Liu, X., Best, C. H., Aspinwall, L., & Pratt, L. (2015). Hospital nurses’ comfort in and frequency of delivering heart failure self-

care education. European Journal of Cardiovascular Nursing, 14(5), 431-440 10p. doi:10.1177/14745151145407564. Barbaranelli, C., Lee, C. S., Vellone, E., & Riegel, B. (2014). Dimensionality and reliability of the self-care of heart failure index scales: Further evidence

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12. Kommuri, N. V., Johnson, M. L., & Koelling, T. M. (2012). Relationship between improvements in heart failure patient disease specific knowledge and clinical events as part of a randomized controlled trial. Patient Education and Counseling, 86(2), 233-238. doi:10.1016/j.pec.2011.05.019 [doi]

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