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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
1
Disclosure
The authors declare no conflict of interest. The authors received no financial support or commercial sponsorship for this study.
2
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
2
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)
5
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
7
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
9
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
10
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
11
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)
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.
15
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.
16
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
20
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
20
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
21
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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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6. Centers for Disease Control and Prevention. (2013) Heart failure fact sheet. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
7. Dennison, R. C., McEntee, L. M.,Samuel, L., Johnson J. B., Rotman S., Kielty A,, Russell D. S. (2011). Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients.26(5), 359-367. doi:doi: 10.1097/JCN.0b013e3181f16f88
8. Dharmarajan, K., Hsieh, F. -., Lin, Z., Ross, J. S., Kim, N., Barreto-Filho, J., . . . Krumholz, H. M. (2012). The timing of 30-day readmissions after hospitalization for heart failure and acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 5(3)
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10. Dunlap, C. L., & Upper, T. M. (2012). INSPIRING CHANGE. increasing patient education for heart failure. Nursing, 42(2), 12-13 2p. doi:10.1097/01.NURSE.0000410322.84475.df
11. Hart, P. L., Spiva, L., & Kimble, L. P. (2011). Nurses' knowledge of heart failure education principles survey: A psychometric study. Journal of Clinical Nursing, 20(21), 3020-3028 9p. doi:10.1111/j.1365-2702.2011.03717.xii]
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]
13. Liou, H. L., Chen, H. I., Hsu, S. C., Lee, S. C., Chang, C. J., & Wu, M. J. (2015). The effects of a self-care program on patients with heart failure. Journal of the Chinese Medical Association : JCMA, doi:S172-4901(15)00149-5 [pii]
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References
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15. Paul, S., & Hice, A. (2014). Role of the acute care nurse in managing patients with heart failure using evidence-based care. Critical Care Nursing Quarterly, 37(4), 357-376.
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